Volume 87  ·   Issue 05  ·  2007

Up to now, the treatment of meningioma is still mainly surgery. With the progress of microsurgery, the treatment effect has been obviously improved, but the recurrence rate after operation can still reach 7% ~32%. The surgery of some special parts and grade 2 and 3 meningioma is still very challenging for neurosurgeons, and how to improve the curative effect of meningioma surgery is still an important task for neurosurgeons. Some problems of meningioma surgery are briefly described below.

Objective to investigate the clinical characteristics and endoscopic treatment of suprasellar cistern cyst. Methods 42 patients with suprasellar cistern cyst treated by endoscopy were retrospectively analyzed. Among them, 22 males and 20 females, aged from 6 months to 53 years, with an average age of 10.4 years, the main clinical manifestations were intracranial hypertension, walking instability and visual field impairment. All patients underwent CT and MRI examination before operation, and they were accompanied by hydrocephalus. Among 42 cases, 39 cases underwent endoscopic cyst-ventriculostomy, and 3 cases underwent cyst-cistern fistula simultaneously. The average follow-up period was 20.8 months. Results There were no deaths in this group, 2 patients (4.8%) had postoperative complications. 25 patients (59.5%) had complete relief of symptoms, 14 patients (33.3%) had improved symptoms, and 3 cases underwent ventriculo-peritoneal shunt due to recurrent hydrocephalus. Postoperative CT and/or MR examination showed that the cyst volume was reduced to varying degrees, and the cerebrospinal fluid flow at the stoma and aqueduct was smooth. Conclusion Endoscopic cyst-ventriculostomy and cistern fistula is a safe and effective method for the treatment of suprasellar cistern cyst.

Objective to investigate the diagnosis and treatment of spinal hemangioblastoma. Methods the imaging characteristics and surgical methods of 42 patients with spinal hemangioblastoma were summarized, and 38 patients were followed up for an average of 4.2 years. Results the majority of spinal hemangioblastoma showed substantial occupation with clear boundary, and the enhancement was obviously uniform.Spinal angiography can confirm the diagnosis for the cases with difficulty in differentiation.All 42 cases in this group obtained total resection, and the postoperative symptoms were improved in 27 cases, 6 cases had no obvious changes, and 5 cases were aggravated.Conclusion Spinal MRI and angiography can make the localization and qualitative diagnosis of spinal hemangioblastoma, and the surgical effect is reliable.Total resection of tumor can cure the disease, and early diagnosis and treatment can protect the spinal cord function to the maximum extent.

Objective to summarize the clinical experience in the treatment of ethmoid sinus malignant tumors by cranionasal orbital approach.Methods the clinical data of 39 cases of ethmoid sinus malignant tumors invading anterior cranial fossa and orbit by cranionasal orbital approach.Among 39 cases, 29 males and 10 females were aged 20-65 years, with an average age of 42 years; The tumor types included 10 cases of olfactory blastoma, 8 cases of adenocarcinoma, 7 cases of squamous cell carcinoma, 6 cases of papilloma, 4 cases of sarcoma, 3 cases of undifferentiated carcinoma and 1 case of basal cell carcinoma. 38 cases of tumor invaded the anterior cranial fossa, 31 cases invaded the orbit, 5 cases invaded the pterygopalatine fossa, 3 cases invaded the middle cranial fossa and cavernous sinus, and the clinical manifestations included nasal congestion, rhinorrhea, epistaxis, nasal mass, exophthalmos, visual decrease, facial numbness and disturbance of consciousness, etc. Results 32 cases of tumor were totally resected (including 9 cases of complete removal), 7 cases of near total resection, 5 cases of transient cerebrospinal fluid rhinorrhea after operation, without intracranial or incisional infection. 27 cases (77.1%) were followed up with a follow-up time of 3 months to 7 years, with an average of 3 years and 6 months. 8 cases of tumor recurred locally, 1 case of pulmonary metastasis, and 4 cases died from 1 month to 6 years after operation.

Objective to establish an in vitro isolation and culture system of tumor stem cells from human neuroepithelial brain tumors, observe their differentiation phenomenon, identify their specific markers, and lay a foundation for further research on brain tumor stem cells. Methods 26 cases of brain tumor were inoculated in serum-free medium containing growth factor at a density of 2×105/ml to proliferate the brain tumor stem cells, and monoclonal formation experiment and bromodeoxyuridine incorporation experiment were carried out; Then, the proliferated brain tumor stem cell globules are inoculated in serum-containing medium without growth factors to induce differentiation; The expression of CD133 and nestin in brain tumor stem cells was detected by immunofluorescence and immunohistochemistry. Results Only a few tumor cells could survive in serum-free medium and grow in suspension, and proliferate to form clonal brain tumor stem cell spheres. Adherent differentiation of brain tumor stem cells in serum-containing medium; The brain tumor stem cells in vitro express CD133 and nestin, which are specific markers of neural stem cells, and the positive expression rate of CD133 cells in tumor tissue sections is (21.0±6.2) % ~ (38.0±7.0) %. Conclusion A small number of brain tumor stem cells with self-renewal and proliferation ability and expressing CD133 and nestin can be isolated, cultured and induced to differentiate in vitro; Brain tumor stem cells may become a new platform for basic research of brain tumor and important target cells for clinical treatment.

Objective to investigate the methylation and mRNA expression of tumor suppressor genes SLC5A8 and TMS1/ASC in the promoter region of glioma, and to investigate the relationship between them and clinical situation.Methods the DNA methylation of SLC5A8 and TMS1/ASC in 88 glioma tissues, 10 normal brain tissues and glioma cell lines U251 and SHG-44 was detected by methylation polymerase chain reaction (MSP); The mRNA expressions of SLC5A8 and TMS1/ASC were detected by traditional reverse transcription polymerase chain reaction (RT-PCR) and real-time quantitative PCR; The effects of 5-Aza-CdR on DNA methylation and mRNA expression were detected. Results The methylation rate of SLC5A8 promoter was 70.45% (62/88) in 88 gliomas, and the methylation rate increased with the increase of malignancy. The methylation rate of TMS1/ASC promoter was 51/88 (57.95%), and the methylation rate decreased with the increase of malignancy of glioma. The methylation of SLC5A8 and TMS1/ASC gene was not detected in 10 normal brain tissues, and the expression of SLC5A8 and TMS1/ASC mRNA was down-regulated in all grades of glioma compared with normal brain tissues, and the differences were statistically significant (P<0.05). The methylation of SLC5A8 and TMS1/ASC gene was detected in U251 and SHG-44 glioma cell lines, and the expression of SLC5A8 and TMS1/ASC gene was reactivated by 5-Aza-CdR demethylation reagent. Conclusion The methylation of SLC5A8 and TMS1/ASC gene in the promoter region of glioma leads to the down-regulation of mRNA expression, and the incidence of methylation and mRNA expression are closely related to the malignancy of glioma.

Objective to investigate the role of optimized thiazole blue (MTT) colorimetric assay in predicting natural drug resistance of liver carcinoma. Methods the modified MTT colorimetric assay was used to detect the drug sensitivity of 30 liver carcinoma samples without chemotherapy, and the tissue microarray was constructed from the corresponding paraffin samples of cancer tissues. The expressions of P-gp, MRP3, LRP, GST-π, p16INK4a and p21WAF1 were detected by immunohistochemistry. Results Among 30 liver carcinoma cases, 16 (53.3%) were drug resistant and 14 (46.7%) were sensitive. The strong positive expression rate of P-gp in drug resistant group (56.3%) was significantly higher than that in sensitive group (14.3%, P<0.05). Conclusion the optimized MTT method is more scientific. The natural drug resistance of liver carcinoma is common, and P-gp can be used as a predictive index of natural drug resistance of liver carcinoma.

Objective to investigate the characteristics of automatic processing of auditory information in patients with panic disorder. Methods the mismatched negative wave (MMN), a component of event-related potential (ERP), was used to evaluate the automatic processing of auditory information in 15 patients with panic disorder and 15 normal controls objectively. Results the MMN amplitude of patients with panic disorder was significantly higher than that of normal controls in the incubation period window of 60~210 ms (60~110 ms:F1,28=11.413, P =0.02; 110~160 ms:F1,28=6.639, P =0.016; 160~210 ms:F1,28=5.758, P =0.023), and it showed an early (60~160 ms) left brain region dominance effect. Conclusion There is excessive automatic processing of auditory information changes in patients with panic disorder, which provides new objective evidence for studying the pathogenesis of PD.

Objective to analyze the relationship between the expression of survivin in nucleus and cytoplasm and the clinicopathological parameters and prognosis of patients with glioma. Methods the expression of survivin protein in nucleus and cytoplasm of 94 patients with glioma was detected by tissue microarray technique combined with immunohistochemistry, and the clinical follow-up data were analyzed. Results of 94 patients with glioma, 21 cases (22.3%) had positive expression of survivin in nucleus and 82 cases (87.2%) had positive expression of survivin in cytoplasm. The positive expression rates of survivin in pathological grade Ⅰ ~ Ⅱ and Ⅲ ~ Ⅳ were 7.3% and 34.0%, respectively (P<0.01); The positive nuclear expression rates of survivin in recurrent and non-recurrent gliomas were 29.8% and 10.8%, respectively (P<0.05). The 5-year overall survival rates of positive and negative survivin nuclear expression groups were 0% and 39.50%, respectively (P<0.01), and the 3-year progression-free survival rates were 0% and 27.52%, respectively (P<0.05). The 5-year overall survival rates were 43.60% and 13.85% (P>0.05), respectively, and the 3-year progression-free survival rates were 23.88% and 0% (P>0.05). Multivariate analysis showed that the nuclear expression of survivin was an independent prognostic factor for the overall survival rate. Conclusion The nuclear expression of survivin was negatively correlated with the degree of glioma differentiation, which was an adverse factor for the prognosis of the overall survival rate and the progression-free survival rate of glioma patients. The cytoplasmic expression of survivin was not associated with the prognosis of glioma.

Objective to establish a method for detecting contact heat pain evoked potential (CHEP), estimate the peripheral nerve conduction velocity of this evoked potential, and explore its application in carpal tunnel syndrome.Methods Contact heat pain evoked potential stimulator was applied with adjustable pulses at two intensity levels, and the stimulation sites were thenar muscle, back of hand and palmar side of forearm. The relationship between stimulation intensity and pain grading, main components of evoked potential and peripheral nerve conduction velocity were measured by net instrument. Results The relationship between stimulation intensity and pain grading was as follows: the pain grading was 3.2 ± 0.3 and 4.4 ± 0.5 at 49.5℃ and 54.5℃, respectively, and the pain grading was 6.3 ± 0.8 and 7.2 ± 0.5 at 54.5℃, respectively. Three main components were recorded: Cz/N550, Cz/P750 and Pz/P1000. The incubation period of each wave was related to arm length. The peripheral nerve conduction velocity of this evoked potential was 12.9 m/s ± 7.5 m/s and 1.70 m/s ± 0.40 m/s, respectively, which corresponded to the conduction velocity of A δ fiber and C fiber, respectively. The conduction velocity of A δ fiber and C fiber in patients with carpal tunnel syndrome was 12.0 m/s ± 5.6 m/s and 0.60 m/s ± 0.10 m/s, respectively. Conclusion Contact heat pain evoked potential can be stably and reliably extracted; The peripheral nerves of this evoked potential are A δ fiber and C fiber. The conduction velocity of C fiber is slowed in patients with carpal tunnel syndrome.

Objective to explore the mechanism of verbal auditory hallucinations by using event-related functional magnetic resonance imaging (efMRI) in vivo. Methods Twenty-six paranoid schizophrenic patients (13 auditory hallucinations and 13 non-auditory hallucinations) and 13 normal controls were all subjected to MRI scanning. Functional imaging took familiarity of sound as the task, and functional images were collected based on the principle of blood oxygen level-dependent effect.The experimental results of subjects with a correct judgment rate of more than 70% were selected and entered into statistical analysis.Results Intra-group analysis: Compared with unfamiliar sounds, the left superior temporal gyrus, right frontal lobe and limbic system were significantly activated in auditory hallucinations (P<0.01, pixel value>10). Intergroup analysis: Compared with normal controls, patients with auditory hallucinations activated the left precuneus lobe and the right frontal lobe respectively when distinguishing familiar or unfamiliar sounds (P<0.01, pixel value>10); Compared with non-auditory hallucination patients, the left temporal lobe and right frontal lobe were significantly activated in auditory hallucination patients when distinguishing familiar sounds (P<0.01, pixel value>10). Conclusion There may be changes in neurocognitive pattern of familiar sound in schizophrenia patients with auditory hallucination; The results of the inter-group analysis support the hypothesis of endogenous speech disorder, that is, the activation of endogenous speech in the brain of patients with auditory hallucinations inhibits the activation of relevant brain regions by foreign sounds.

Objective to investigate the upstream signaling pathway of mucin (MUC) 5AC high expression induced by neutrophil elastase (NE) through epidermal growth factor receptor (EGFR). Methods Human airway BEAS-2B epithelial cells were cultured and stimulated by NE. TNF-1 inhibitor (TAPI-1) and reactive oxygen species (ROS) scavenger (DMTU) were used as intervention factors. Enzyme-linked immunosorbent assay (ELISA) was used to detect the contents of MUC5AC and soluble transforming growth factor (TGF) -α protein in culture supernatant. The levels of phosphorylated epidermal growth factor receptor (p-EGFR) protein were analyzed by Western blot. Results the levels of MUC5AC gene transcription and protein expression after NE stimulation were significantly higher than those in the control group without NE stimulation (P<0.01), and the levels of soluble TGF-α and p-EGFR protein were also increased, and the differences were statistically significant compared with those in the control group (all P<0.01); The expression levels of the above indexes were significantly downregulated by adding TAPI-1 at a concentration of 20 μ mol/L (all P<0.01), and DMTU also reduced the gene transcription and product level of MUC5AC and the relative content of soluble TGF-α protein. The differences were statistically significant compared with those of NE-stimulated group (P<0.01), but there was no significant effect on the increase of MUC5AC gene transcription and protein synthesis caused by exogenous TGF-α stimulated group (all P>0.05). Conclusion NE can stimulate the production of ROS in cells, and reactivate tumor necrosis factor converting enzyme (TACE) to increase the production of mucin, which constitutes the main signaling molecule upstream of EGFR pathway. Therefore, the transduction pathway of ROS/TACE/TGF-α precursor/EGFR is an important mechanism of NE-induced hypersecretion of airway mucus.

Objective to investigate the effect of somatostatin on serum inflammatory mediators in rats with endotoxin-induced septic shock.Methods Twenty-four healthy Wistar male rats were randomly divided into control group and somatostatin intervention group.The vital signs and levels of interleukin-6 (IL-6) and tumor necrosis factor (TNF-α) were observed at 4 time points at 0, 30, 90 and 360 min.Results Somatostatin effectively inhibited the decrease of blood pressure in rats with septic shock, (34±48) mm Hg vs (86±20) mm Hg (1 mm Hg =0.133 kPa) at 360 min, P<0.05; the decrease of IL-6 levels, (230±92) mg/L vs (217±26) mg/L (P<0.05) and TNF-α levels at 360 min: (474±219) mg/L vs (440±49) mg/L (P<0.05); In the control group, 2 rats died between 30 and 90 minutes, and 4 rats died between 90 and 360 minutes. In the intervention group, all rats survived, P =0.0054. Conclusion Somatostatin can improve the prognosis and reduce the mortality rate by inhibiting the inflammatory response of rats with septic shock.

Objective to investigate the role of ultrastructural characteristics of budding moss fiber (MF) synapses in the pathogenesis of hippocampus in temporal lobe epilepsy (TLE) and the relationship between the expression of axonal inducing factor netrin-1 and MF synapse remodeling.Methods TLE was induced by lithium-pilocarpine, and Timm histochemical staining was used to label the ends of budding MF synapses in rats.The ultrastructural characteristics of neonatal synapses were observed under electron microscope.The expression of netrin-1 in hippocampus was detected by in situ hybridization.Results the budding MF synapses were mainly axospinal asymmetric synapses, and occasionally the budding axons and excitatory granulosa cell bodies formed synaptic connection.7 days after epilepsy (SE), the expression of netrin-1 mRNA was up-regulated in the granulosa cell layer of dentate gyrus of hippocampus, and lasted until 28 days after SE. The spatial and temporal sequence of its expression was consistent with hippocampal MF budding and synaptic recombination.Conclusion The ultrastructural characteristics of budding MF synapses support the formation of repeated excitatory circuits in recombined synapses; The neural axon inducing factor netrin-1 may play an important role in the targeted growth and synaptic recombination of budding MF.

Objective to investigate the effects of V97L and A136G mutations of presenilin-1 (PS1) gene on neuroblastoma SH-SY5Y cells and the protective mechanism of insulin-like growth factor-1 (IGF-1) in two families of Chinese familial Alzheimer's disease (FAD). Methods SH-SY5Y cell models stably expressing wild-type and mutant PS1 genes were established, and serum deprivation or serum deprivation plus IGF-1 were given to compare the susceptibility to apoptosis and the protective effect of IGF-1 in each transfected cell line; RESULTS the sensitivity of V97L and A136G mutant cell lines to serum deprivation was increased, and the apoptosis rate was significantly higher than that of wild type cell lines and empty vector transfected cells (MOCK) (P<0.01). IGF-1 can effectively improve the effect of serum deprivation on SH-SY5Y cells, and reduce apoptotic cells. There is no significant difference in the glucose incorporation rate of each group, but after adding IGF-1, the glucose incorporation rate of each group increased by 25% on average, and the translocation expression of GLUT1 in cell membrane increased by 15% ~20%. Conclusion The increased susceptibility of SH-SY5Y cells to nutrition deprivation by PS1 V97L and A136G mutations may be one of the reasons for the degeneration and loss of FAD neurons; IGF-1 can promote glucose transport, enhance cell activity and play a protective role.

A 50-year-old male was admitted to hospital due to diplopia for 3 days with left gingival pain. The patient developed diplopia without obvious inducement 3 days ago, and felt difficulty in lifting the right upper eyelid, no light in the morning and severe in the evening, no headache, dizziness, no fever and aversion to cold, no nausea and vomiting. At the same time, he felt pain in the left lower gingival area, which spread to the left cheek. The symptoms improved after taking ibuprofen.

The basic purpose of surface treatment of artificial joint prosthesis bone contact interface is to improve the biological and mechanical state of prosthesis-bone interface as much as possible, so as to achieve good fixation effect.

Stroke is a common disease that affects the cognitive function of the elderly.The cognitive changes and final prognosis of stroke survivors vary widely.About 10% ~30% of stroke survivors develop dementia.It is reported in literature that the incidence of dementia within 5 years after stroke is three times that of the age-matched general population.However, 10% ~50% of stroke patients can show delayed cognitive function improvement within 3~15 months after onset of the disease.Therefore, how to detect high risk factors early and predict whether the cognitive function of patients can be improved is very important for secondary prevention.

A 16-year-old male went to Weihai Wendeng Central Hospital in November 2005 because of cough, fever and chest pain. The patient was in the fetal period, and the mother had severe pregnancy reaction and little diet. After 6 months of birth, the patient had frequent cold and fever, lung infection and perennial weakness. He was diagnosed as congenital heart disease due to heart murmur, but was later excluded. Physical examination: height 180 cm, weight 65 kg, normal development, black around eyelids. Chest X-ray showed atrophy of thymus and large area of lung shadow compared with young people of the same age.