Volume 93  ·   Issue 03  ·  2013

To investigate the clinical features,risky factors and outcome of the trigemino-cardiac reflex (TCR) during surgery for skull base tumors.

Two hundred and sixty-two neurosurgical patients with skull base tumors underwent general anesthesia and open surgery from October 2009 to December 2011 in department of neurosurgery of Beijing Tiantan Hospital.The occurrence of TCR and the type of tumor,the surgical approach as well as the postoperative complication relative to TCR was evaluated retrospectively.

Seventeen patients occurred TCR events intraoperatively (6.5%).There were 8 men and 9 women with an average age of 40.5 years.Eleven of them (64.7%) underwent schwannoma surgery.Regarding with the surgical procedure,the suboccipital retrosigmoidal approach and the middle fossa transtentorial approach were most commonly associated with TCR in this series (88.2%).The heart rate and blood pressure returned to the patient′s normal baseline level after cessation of the surgical manipulation.There was no TCR-relative complication in cardiovascular system.The postoperative course is uneventful in all 17 patients.

TCR may occur during surgery for skull base tumor,especially when performing schwannoma surgery and suboccipital retrosigmoidal or middle fossa transtentorial approach.Accurate recognition and management of TCR during skull base surgery often carry on favorable outcome.

To explore the methods and applications of intraoperative magnetic resonance imaging (iMRI) -guided functional neuronavigation plus intraoperative neurophysiological monitoring (IONM) for microsurgical resection of lesions involving hand motor area.

A total of 16 patients with brain lesions adjacent to hand motor area were recruited from January 2011 to April 2012.All of them underwent neuronavigator-assisted microsurgery.Also IONM was conducted to further map hand motor area and epileptogenic focus.High-field iMRI was employed to update the anatomical and functional imaging date and verify the extent of lesion resection.

Brain shifting during the functional neuronavigation was corrected by iMRI in 5 patients.Finally,total lesion resection was achieved in 13 cases and subtotal resection in 3 cases.At Months 3-12 post-operation,hand motor function improved (n=10) or remained unchanged (n=6).None of them had persistent neurological deficit.The postoperative seizure improvement achieved EngeⅡ level or above in 9 cases of brain lesions complicated with secondary epilepsy.

Intraoperative MRI,functional neuronavigation and neurophysiological monitoring technique are complementary in microsurgery of brain lesions involving hand motor area.Combined use of these techniques can obtain precise location of lesions and hand motor functional structures and allow a maximum resection of lesion and minimization of postoperative neurological deficits.

To evaluate the efficacy and adverse effects of half-dose depot long-acting triptorelin in the therapy of endometriosis.

The efficacy and adverse effects of routine-dose or half-dose triporelin in postoperative endometriosis patients were prospectively observed.A total of 186 postoperative patients with moderate or severe endometriosis received an intramuscular injection of triporelin every 28 days for 6 times.They were randomly divided into 3 groups,i.e.half-dose group (n=99): 1.875 mg each time;"draw-back"group (n=52):3.75 mg first time,then 1.875 mg each time;and routine-dose group (n=35): 3.75 mg each time.

Amenorrhea was effectively induced in all patients after the second injection.There was no significant difference in the rate of serum E2 level at Day 28 of every injection below the upper limit of"estrogen threshold (110-146 pmol/L) "not stimulating ectopic endometrium proliferation among half-dose group,"draw-back"group and routine-dose group (99% vs 100% and 99.0%,P>0.05),the percentage of E2<37 pmol/L in E2<110 pmol/L in half-dose group was significantly lower than that in"draw-back"and routine-dose groups after 2-5^th injection (69% vs 79% and 85%,P<0.01),but there was no significant difference after first half-dose and routine-dose injection (71% vs 73%,P>0.05).No significant difference existed in the rate of pelvic pain relief during the first returning menstruation and the recurrence rate of endometriosis within 1 year postoperation among three groups (both P>0.05).However,the incidences of menopausal syndrome and severe menopausal syndrome in half-dose group were significantly lower than those in"draw-back"and routine-dose groups (both P<0.01).And the incompletion rate of six-time drug for severe menopause syndrome was also significantly lower (P<0.05) while the completion rate of six-time drug use in half-dose group was significantly higher (P<0.05).

As a postoperarive adjuvant,half-dose depot triptorelin therapy is efficacious for endometriosis.It reduces menopausal syndrome and treatment cost and enhances patient compliance.

To obtain the three dimensional visualization model with normal measurements of fetal brain in the second trimester and analyze the developmental changes with gestational age (GA),sexual dimorphisms and cerebral asymmetries.

The brains of 69 fetal specimens of 12-22 weeks GA were scanned by 7.0T magnetic resonance imaging (MRI).The developing structures were analyzed and a three dimensional visualization model was rebuilt with Amira 4.1 software.

Most sulci,except for postcentral and intraparietal sulcus,were present until 22 weeks GA.And none developed secondary branches.Laminar organization,described as early as 12 weeks GA,was delineated as layers with different signal intensities and became typical after 16 weeks GA.Basal nuclei was distinctly visible.Brains had different growth rates linearly increasing with GA.But neither sexual dimorphisms nor cerebral asymmetries was detected.

The initial developmental stage of fetal brain occurs at 12-22 weeks GA.The developing structures may be distinctly visualized on 7.0T post-mortem MRI.And the three dimensional visualization model aids greatly in the precise cognition of immature brain.

To explore the causes of pseudarthrosis and evaluate the clinical neurological function and neck subaxial symptoms after anterior cervical fusion.

A total of 412 patients were followed up with an average of 5.4 years.The bone mineral density,bone graft trimming and placement,management of endplate,smoking and neck support fixation time were observed.Japanese Orthopedic Association (JOA) score was used to evaluate the changes of neurological functions and clinical outcomes.Visual analog scale (VAS) score was used to evaluate the neck subaxial symptoms.And pseudarthrosis was examined by flexion-extension radiography.SPSS statistical software 13.0 was used to evaluate the differences of JOA and VAS scores between pseudarthrosis and control groups.

Among them,37 cases of pseudarthrosis were observed.There were osteoporosis (n=30 vs n=119),cartilage end-plate punctuate hemorrhage (n=18 vs n=340),25 and 43 cases with ineffective cervical external fixation (n=25 vs n=43) and smoking (n=26 vs n=87) in pseudarthrosis and fusion groups respectively.Significant differences existed in the above-mentioned indices between two groups.However,no significant difference existed in bone graft shape between two groups.There were significant differences in JOA and VAS scores between two groups.

The causes of pseudarthrosis included decreased bone density,osteoporosis,over-curette of endplate,shortness of neck support fixation time and smoking.And pseudarthrosis may influence the long-term recovery of neurological functions or it is correlated significantly with neck symptoms.

To evaluate whether or not brachial artery peak velocity (Vpeak-BA) induced by passive leg raising (PLR) may predict volume responsiveness.

We prospectively studied 29 patients enrolled into our intensive care unit (ICU) with spontaneous breathing during mechanical ventilation.Through echocardiography we compared the changes of brachial artery peak velocity induced by passive leg raising (ΔVBA-PLR) and the changes of left ventricle outflow tract velocity-time integral after volume expansion (ΔVTI-VE).Also the sensitivity and specificity of ΔVpeak-BA were determined in predicting volume responsiveness.

Among them,15 responded to volume expansion and the rest 14 did not.ΔVBA-PLR and ΔVTI-VE were mutually correlated (R²=0.378,P=0.011).The sensitivity and specificity of ΔVpeak-BA≥16% to predict volume responsiveness were 73% and 87% respectively.

Brachial artery peak velocity induced by passive leg raising is a reliable indicator of predicting volume responsiveness in patients with spontaneous breathing.

To explore the changes and regulations in T-scores of hip and lumbar vertebrae in different aged people through retrospective data analyses of dual energy X-ray absorptiometry (DXA) and improve their reference values.

With the aid of DXA,the bone densities of hip (femoral neck) and lumbar (L1-L4) bones were measured in 3662 malesand females over 45 years old.There were9 female and 9 males groups based upon the stratifications of gender and 5-year age intervals (>85-year-olds combined as one group).After ruling out the"single-part test"data,the T-score averages were calculated and their differences analyzed by t-test.

In females,T-scores of hip and lumbar bone mineral density were basically the same before 50 years old.Significant differences existed between 51 and 75 years old females.The lumbar T-scores were lower than their hip counterparts.In some age groups,T-scores of lumbar vertebrae showed decreased bone mass while those of hip remained normal.However,T-scores of lumbar vertebrae might be diagnosed by osteoporosis but decreased bone mass of hip was absent in the other age groups.After 75 years,no obvious differences existed between hip and lumbar bone T-scores;in all male groups,hip T-scores were lower than lumbar counterparts.There were small changes in T-scores of lumbar vertebrae with aging while the hip ones decreased gradually;each group had a single measurement rate of skeletal site.In females,the minimal and maximal values of single site measurement rate were 12.50% and 63.98% versus 16.68% and 44.50% in males.

Differences of lumbar and hip T-scores exist in some age groups.Thus some normal T-scores of one skeletal site may be abnormal at another site.While evaluating one particular site,one should consider these differences to avoid an incorrect diagnosis.

To compare ultrasound guidance versus nerve stimulator guidance supraclavicular brachial plexus block for regional hemodynamic changes of upper extremity.

Sixty ASAⅠ-Ⅱpatients scheduled for upper extremity operation were randomly assigned to receive a supraclavicular brachial plexus block guided by either ultrasound (U group,n=30) or nerve stimulation (N group,n=30).20 ml mixture of equal volumes of 2% lidocaine and 0.75% ropivacaine was injected in both groups.Regional hemodynamic parameters were measured in the ipsilateral ulnar artery and radial artery,using pulsed-wave Doppler ultrasound,before and 30 minutes after the block.Regional hemodynamic parameters included peak systolic velocity (PSV),end-diastolic velocity (EDV),time averaged maximum velocity (TAMAX),resistance index (RI),pulsatility index (PI),cross-sectional area (Area) and Blood flow (Q).The intensity of sensory block was measured at 30 minutes after the block.

There was no significant difference in the hemodynamic parameters of ulnar artery and radial artery before the block between two groups.Compared with N group,EDV,TAMAX and Q of ulnar artery were higher in U group (1.88-fold,1.71-fold and 1.84-fold)(P<0.01 or P<0.05),PI and RI of ulnar artery were lower in U group (P<0.01) at 30 minutes after the block,EDV of redial artery was higher in U group (1.47-fold)(P<0.01),PI and RI of redial artery were lower in U group (P<0.05) at 30 minutes after the block.Comparing the hemodynamic parameters of ulnar artery and radial artery with complete block between two groups at 30 minutes after the block,EDV,TAMAX and Q of ulnar artery in U group were higher than that in N group (1.68-fold,1.55-fold and 1.62-fold)(P<0.01 or P<0.05),PI of ulnar artery in U group was lower than that in N group (P<0.01),EDV and TAMAX of redial artery in U group was higher than that in N group (1.54-fold and 1.26-fold)(P<0.01 or P<0.05),PIand RIof redial artery in U group was lower than that in N group (P<0.05).The rate of complete block in U group was higher than that in N group (28/30 vs 22/30,P<0.05).

Ultrasound-guided supraclavicular brachial plexus block enhance the degree of sympathetic block of upper extremity,especially of ulnar artery and increase the blood flow of ulnar artery compared with nerve stimulator.

To investigate the correlation between the ApoE genotype and age at onset in a cohort of hospital-based AD patients of Han population in China.

All cases were consecutive probable AD patients from the Memory and Cognitive Impairment Clinic of Peking Union Medical Collge Hospital from 1999 to 2010.They were all Han ethnicity.They were divided into two groups according to age at onset (AAO) :early onset AD (EOAD,AAO<65 years) and late onset AD (LOAD,AAO≥65 years).DNA was extracted and ApoE was genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis.The linkage between ApoE polymorphism and AAO of AD were analyzed by one-way ANOVA.

AAO of all cases (n=495) was (69±10) years,of EOAD (n=149) was (58±5) years and of LOAD (n=346) was (74±6) years.ApoE ε4 (+) genotypes were not associated with AAO of EOAD[ε4-/-: (57±5) years,n=90;ε4+/-: (59±5) years,n=50;ε4+/+: (59±5) years,n=9;F=0.99,P=0.38],while they were significantly associated with AAO of LOAD[ε4-/-: (75±6) years,n=189;ε4+/-: (73±6) years,n=138;ε4+/+: (71±5) years,n=19;F=6.51,P=0.002].As for all ApoE genotypes,A AO of LOAD reduced gradually in a way as follows:ε2/3>ε3/3>ε3/4>ε2/4>ε4/4.There was great correlation between AAO and ApoE polymorphism in LOAD without dementia family history,whereas no correlation in LOAD with dementia family history.

ApoE genotypes carrying at least oneε4 allele maybe significantly lower AAO of LOAD in a dose-dependent manner whereas no such correlation in LOAD with dementia family history.

To explore the role of leukoaraiosis (LA) on the cognitive function in patients with Parkinson disease (PD).

The cohort for this study included 63 patients with PD,whom were divided into 3 groups according to cognitive status:with intact cognition (PD-IC,n=23),with mild cognitive impairment (PD-MCI,n=23) and with dementia (PDD,n=17).All the patients were recruited from the Department of Neurology,First Affiliated Hospital,Anhui Medical University between September 2011 and July 2012.The cognitive functions were evaluated by mini-metal state examination (MMSE),the Cambridge cognitive examination-Chinese version (CAMCOG-C),clinical dementia rating (CDR),clock drawing task (CDT) and verbal fluency test,etc.Depression symptoms were assessed by the geriatric depression scale (GDS) while motor symptoms by the Unified Parkinson′s Disease Rating Scale-motor (UPDRS-motor) and the Hoehn and Yahr scale (HY).All the patients underwent magnetic resonance imaging (MRI) with a 3.0-T system.LA was rated using the semiquantitative visual rating system proposed by scheltens et al.

Both the PD-IC (2.43±2.79) and PD-MCI (4.48±4.33) groups showed significantly lower deep hyperintensities (DHs) scores than the PDD group (7.88±6.69,P=0.004 and 0.040,respectively),especially in frontal (1.09±1.31;1.83±1.90;3.24±2.64,P<0.05) and parietal areas (0.09±0.29;0.65±1.03;1.53±2.32,P<0.05).There were no significant differences in periventricular (1.57±1.75;2.52±2.37;3.24±2.64,P>0.05),basal ganglia (0.09±0.42;0.30±0.77;0.53±1.33,P>0.05) and infratentorial white matter hyperintensities scores (--;0.13±0.63;0.18±0.73,P>0.05) among three groups.The DHs showed a significant correlation with age (P=0.003),MMSE (P=0.009),verbal fluency test (P=0.009),orientation (P=0.047) and executive function (P=0.027) in CAMCOG-C.The multiple regression analysis showed that the MMSE scores were associated significantly with education (P<0.001,β=0.600),DHs (P=0.001,β=-0.678) and HY (P=0.035,β=-0.480).DHs were the most significantly associated with MMSE scores.

There was a significant correlation between D Hs and multiple domain cognitive impairment in PD,especially in executive function.DHs,which were the most significantly variable associated with MMSE scores,may contribute to cognitive impairment in PD.

To investigate the mechanism(s) that prostaglandin E1 (PGE1) promotes human umbilical vein endothelial cell (HUVEC) proliferation and migration.

Western blot,enzyme linked immunosorbent assay,cell proliferation and cell migration tests,and tube formation were used for analyzing the roles and mechanisms of PGE1 on HUVEC;Western blot was used for analyzing the effects of PGE1 on the expression of vascular endothelial growth factor (VEGF) in rat aortic vascular smooth muscle cells (VSMC).

PGE1 significantly increased VEGF expression of HUVEC in time and a dose dependent manner with concomitantly increased HUVEC proliferation;treatment of HUVEC with Bevacizumab apparently suppressed PGE1-stimulated VEGF expression,which led to decreased tube formation,reduced cell proliferation and migration by 41% and 38%,respectively,compared with PGE1 treatment alone;PGE1 time-dependently induced both phosphorylation of ERK and p38 in HUVEC,whereas ERK inhibitor,PD98059,or p38 inhibitor,SB203580,blocked PGE1-induced VEGF expression of HUVEC,resulting in dramatically suppression of HUVEC proliferation and migration compared with PGE1 treatment alone (60% and 55% by PD98059,62% and 51% by SB203580,respectively);in addition,cAMP-dependent protein kinase A inhibitor,H89 or Rp-cAMP blocked PGE1-induced VEGF expression in VSMC.

PGE1 promotion of proliferation,migration and tube formation of HUVEC via VEGF further provides a novel theoretical support in efficacy of PGE1 treatment of critical limb ischemia and other related diseases.

To explore the effects of blueberry on the expressions of peroxisome proliferator-activated receptor γ (PPARγ) and platelet-derived growth factor B (PDGF-B) in rat hepatic fibrosis.

A total of 45 male Sprague-Dawley rats were randomly divided into control group,CCl₄-induced hepatic fibrosis (model group),blueberry prevention (BBgroup),DSHX prevention (DSHX group) and blueberry+DSHX prevention (BB+DSHX group) (n=9 each).Fibrous liver models of rats were induced by subcutaneous injection of CCl₄ and high-lipid/low-protein diet for 8 weeks except for control group.Then the expressions of collagenⅠ (ColⅠ),PPARγ and PDGF-B were determined by real-time polymerase chain reaction (RT-PCR),immunohistochemistry and Western blot respectively.

Compared with the control group,the expression of PPARγ decreased and those of ColⅠ and PDGF-B were elevated in model group (P<0.05).The expression of PPARγ increased and ColⅠ and PDGF-B decreased in BB,DSHX and BB+DSHX groups as compared to model group (P<0.05).

The inhibitory effects of blueberry in CCl₄-induced liver fibrosis may be correlated with the activation of PPARγ,the inhibited expression of PDGF-B and the reduced synthesis of extracellular matrix.