Volume 93  ·   Issue 05  ·  2013

Hospital-acquired infection (HAI) is a common complication of neurosurgical patients, which not only affects the prognosis and outcome of patients, but also increases the medical expenses, prolongs the hospital stay, and brings a huge economic burden to patients and society^[1]。 In order to standardize the diagnosis and treatment of nosocomial infections in neurosurgical patients, the Neurosurgery Branch of Chinese Medical Association, the Critical Care Physician Branch of Chinese Medical Association and the Critical Care Medicine Professional Committee of Chinese Pathophysiological Society jointly organized 35 domestic experts and scholars in related fields, and set up a writing secretary group composed of 5 experts. In recent years, the latest literature on epidemiology, etiology, drug resistance, clinical diagnosis and treatment of nosocomial infections in neurosurgery was analyzed, and finally the Expert Consensus on the Application of Antibacterial Drugs in Neurosurgery Hospital Infections (2012) (hereinafter referred to as the Consensus) was formed for the reference of clinical medical staff.

To study the features of chordoid glioma of the third ventricle.

The MRI findings of five cases of chordoid glioma of the third ventricle pathologically proved were reviewed and correlated with operative and pathologic reports.

The patients were 3 women and 2 men, 30-50 years old in age.The main symptoms were progressive headache, and usually erratic irregular menstruation in women.Five cases of chordoid glioma were located in the third ventricles.Grossly, the 5 tumors size range were 2-4 cm in diameter, and were well-circumscribed mass with rouded or irregular morphological features on standard MRI.They were isointense to slightly hypointense relative to normal white matter in T₁WI, slightly hyperintense in T₂WI and hypointense in DWI on MR.The significant contrast enhancement of this tumour on postcontrast T₁WI result from a breakdown of the blood-brain barrier and extavasation of contrast medium, as confirmed by the absence of vascular proliferation on histological examination.4 tumors were enhanced equivalently and 1 tumor had central nonenhancing components representing small cysts, because of its large size (4 cm in diameter).

Chordoid glioma of the third ventricle is rare and the MR appearances possess unique features which are very helpful in diagnosis of chordoid glioma, but to make a definite diagnosis is based on clinical and histopathological features and immunohistochemical staining.

To explore the clinical efficacies of scleral tunnel sutureless trabeculectomy plus phacoemulsification and intraocular lens implantation in the treatment of glaucoma and cataract.

A total of 49 cataract patients with glaucoma (52 eyes) from our hospital during the period of February 2009 to June 2012.Their visual acuities were<0.3 and intraocular pressure was not desirable or in need of various ocular hypotensive drugs.A phaco tunnel knife was employed to prepare a 4 mm×4 mm scleral tunnel flap with 1/2-2/3 whole layer of sclera depth.Phacoemulsification instrument was used to emulsify cataracts.Foldable intraocular lens was implanted.A trabecular cut of 2 mm×1.5 mm was made under the scleral tunnel.Tile scleral flap was not sutured and conjunctival flap tightly closed.

After a 12-month follow-up, >0.5 in 42 eyes (80.8%).The intraocular pressure was 11.32-17.63 mm Hg (1 mm Hg=0.133 kPa) and the mean intraocular pressure (13.59±4.26) mm Hg.There was a mean pressure reduction of 11.2 mm Hg from (24.53±5.71) mm Hg pre-operation.Statistical significance existed (t′=11.073,P<0.01).The filtering blebs of type Ⅰ-Ⅱ was 43 eyes (82.6%) and the mean central anterior chamber 3.28 mm±0.42 mm.There was statistical difference (t′=20.486, P<0.01) with (1.79±0.31) mm at pre-operation.On 52 eyes, the mean postoperative astigmatism was (1.01±0.62) D versus (1.13±0.74) D at pre-operation.There was no statistical significance (F=2.0673,P>0.05).No severe complication occurred in all cases.

Compared with traditional trabeculectomy and triple procedure, this improved and updated procedure lowers intraocular pressure, improves visual acuity and decreases the occurrences of complications.It is a safe, reasonable, quick and effective treatment for cataract patients with glaucoma.

To ascertain the metabolic changes in patients of severe acute respiratory syndrome (SARS) and SARS-related post-traumatic stress disorder (PTSD) and elucidate the relationship between PTSD, SARS and brain metabolism.

A total of 58 convalescent SARS patients were evaluated by the scores of impact of event scale (IES), self-rating anxiety scale (SAS) and self-rating depression scale (SDS), etc.And 44 of them participated in ¹H-MRS study.There were 18 patients (M∶F=6∶12) with SARS-related PTSD and 26 convalescent SARS patients without PTSD.And the procedures were repeated in 18 age, gender and education-matched normal control subjects.In all patients and controls, the regions of interest on magnetic resonance spectroscopy (MRS) were anterior cingulate gyrus (ACG), posterior cingulate gyrus (PCG), left anterior periventricular white matter (LAPWM) and left posterior periventricular white matter (LPPWM).And the correlations between MRS findings and the scores of SAS, SDS and IES were evaluated.

In comparisons with the control subjects (n=18) and convalescent SARS patients without PTSD (n=26), the SARS-related PTSD group (n=18) had significantly lower N-acetylaspartate/creatine (NAA/Cr) in 4 regions of interest while the NAA/Cr of the convalescent SARS patients was significantly lower than controls in 3 regions of interest (ACG, PCG and LAPWM).The ratios of NAA/Cr showed no close correlation with the scores of IES, SAS and SDS in convalescent SARS patients.

The changes of brain metabolism in PTSD are caused by SARS.But their exact relationship awaits further explorations.SARS may also lead to the changes of brain metabolism.

To compare the clinical efficacies of two different procedures in the treatment of degenerative lumbar scoliosis.

From August 2008 to August 2011, 28 patients of lumbar degenerative scoliosis were divided into one group (n=14) undergoing modified transforaminal lumbar interbody fusion (TLIF) instrumented surgery and another group (n=14) undergoing posterolateral fusion (PLF) instrumented surgery.There were 12 males and 16 females with a mean age of 66.2 years (range:54- 79).The operative durations and bleeding volumes of two groups were recorded.The post-operative efficacy was evaluated with VAS (visual analogue scale) for low back pain, ODI (Oswestry disability index), Cobb′angle and lumbar lordosis angle on plain film.

The mean follow-up period was 25.9 months.The operative duration was 192.0±44.7 min in modified TLIF group versus 163.0±39.0 min in PLF group.The bleeding volume was 718.0±197.2 ml in modified TLIF group versus 546.0±226.6 ml in PLF group.All operated lumbar intervertebrae achieved bony fusion in modified TLIF group by the last follow-up.Two cases had no bony fusion and there was one case of pseudarthrosis in PLF group.Significant differences existed between two groups in pre-operative and post-operative values of VAS, ODI, Cobb′s angle and lumbar lordosis angle (P<0.05).There were significant differences between two groups in the values of pre-operative and post-operative VAS and lumbar lordosis angle (P<0.05) but not in the values of pre-operative and post-operative ODI and Cobb′s angle (P>0.05).

As an alternative, safe and effective procedure, modified TLIF instrumented is superior to PLFinstrumented in the treatment of lumbar degenerative scoliosis.

To determine the respiratory indices capable of improving predictive accuracy of extubation success through serial measurements of during spontaneous breathing trial (SBT) in automatic tube compensation (ATC) pattern of mechanical ventilation.

For this prospective observational study, patients ventilated over 48 hours were enrolled according to the weaning criterion and underwent a 60 minutes spontaneous breathing trial (SBT) in ATC pattern (ATC=100%, FiO₂=0.4, PEEP=0 cm H₂O, PS=0 cm H₂O).During SBT,heart rate (HR) and mean artery pressure (MAP) were monitored continuously and minute volume (VE), respiratory rate (RR), tidal volume of spontaneous breath (VT), rapid shallow breathing index (RSBI), change and rate of change (ΔRSBI60_1 andΔRSBI60_1/RSBI1, etc.) were recorded or calculated at the first, 30^thand 60^thminute of SBT.Patients tolerating the trial were extubated immediately.Clinical data and respiratory indices during SBT were compared between patients in extubation success group and those in extubation failure group.Predictive accuracy of extubation success was assessed by area under the receiver operating characteristic (ROC) curve (AUC) for each index.

The duration of mechanical ventilation was longer in patients of extubation failure group than that of extubation success group (10.75±2.73: 7.47±5.11, P=0.035) and extubation failure rate was 17.14%.During SBT, RSBI increased initially and then decreased in patients of extubation success group, but increased continuously in patients of extubation failure group.There were significant difference ofΔRSBI60_1 andΔRSBI60_1/RSBI1 in patients between extubation success and failure groups (-11.5±16.6:12.1±38.9, P=0.001 and -17±26:13±39, P=0.028).AUCs of RSBI60,ΔRSBI60_1 andΔRSBI60_1/RSBI1 were 0.75, 0.73 and 0.72 and the sensitivity, specificity and diagnostic accuracy 81.0%, 66.7% and 78.5% respectively.

It is important to observe change of various respiratory indices dynamically during SBT in patients ventilated in ATC pattern.ΔRSBI60_1 andΔRSBI60_1/RSBI1 have greater predictive value for extubation success.Stable or decreased RSBI60 means higher extubation success rate.

To explore the clinical characteristics and early effective treatment for pulmonary infection after acute cervical spinal cord injury.

A total of 215 inpatients with acute cervical spinal cord injury were retrospectively analyzed.Their chest radiological films and blood profiles at discharge were analyzed.The fourth generation cephalosporin was used to treat pulmonary infection as soon as admission and the antibiotics switched according to the results of sputum culture and drug sensitive test.Incision of trachea was performed and breath supported by breath machine according to respiratory condition and blood gas analysis.All patients were turned over and slapped on the back in order to excrete phlegm in time.Sometimes bronchial lavage was used to excrete phlegm.The chest radiological examinations and sputum culture were performed twice one week.Once fungal infection was definite, specific antibiotic was used to treat infection.Three-liter bas and nasal feeding were used to improve the nutrition condition.Incision of trachea was closed as soon as possible.

Pulmonary infection of 214 patients was finally cured.Among them, 43 suffered from pulmonary closure.One patient died from severe infection of Klebsiella pneumoniae.Pulmonary infection appeared upon admission and was mostly accompanied with hyperpyrexia.The result of sputum culture revealed baumanii and the pathogen of hemoculture was Pseudomonas aeruginosa.At 3- 4 weeks later, mycotic infection appeared.And 17 patients suffered from Klebsiella pneumoniae and one died.

Pulmonary infection after acute cervical spinal cord injury is severe and occurs early.Effective antibiotics according to the result of sputum culture, turnover& back-slapping for excreting phlegm in time, expectoration training and strengthening overall nutrition are effective therapeutic measures.

To explore different risk factors between anterior and posterior circulation affecting onset and prognosis in the North Chinese young ischemic stroke patients.

This study included 446 cases of young ischemic stroke patients in northern China.All patients were recruited from our department from 2001 to 2010, Among them, the lesion sites were anterior circulation infarction (n=353), posterior circulation infarction (n=56) and both anterior and posterior circulation infarction (n=37).Non-conditional Logistic regression analysis was used to determine the risk factors of predicting the onset of either anterior or posterior or mixed stroke and their short-term prognosis.

Advanced age and a higher white blood cell count (WBC) increased the risk of non-anterior circulation lesions (OR 0.951,P=0.030;OR 0.876, P=0.014).Patients with a history of alcohol drinking had an increased risk for simple posterior circulation lesions (OR 1.856, P=0.047); Both high National Institute of Health stroke scale (NIHSS score) and high total cholesterol (TC) predicted a poor short-term prognosis for simple anterior circulation lesions (OR 1.884, P=0.000; OR 1.792, P=0.008).

Age, WBC count, alcohol intake, NIHSS score and TC are closely correlated with different lesions of northern Chinese young patients with ischemic stroke and their poor short-term prognosis.

To explore the electromyography (EMG) and nerve conduction (NC) features of patients with myotonic dystrophy type 1 (DM1).

Routine PCR and triplet primed-PCR (TP-PCR) were performed for 33 clinically diagnosed DM1 cases at our clinic from June 2009 to June 2012.The EMG and NC results of 30 patients with a genetic diagnosis of DM1 were collected and analyzed.

Myotonic discharges were found in all patients and EMG revealed myogenic changes in 29 patients.Among all 123 muscles examined, the incidence of myotonic discharges was, a little higher than that of myogenic changes (91.87% vs 90.24%).The rate of myotonic discharges in distal muscles was higher than that of myotonic discharges in proximal muscles (100% vs 83.61%).And the difference was statistically significant.No difference existed in myogenic changes between distal and proximal muscles (87.10% vs 93.44%) Nerve conduction was all normal.

Myotonic discharges and myogenic changes are important EMG features in DM1.In early stage of DM1, myotonic discharges may be the isolated EMG abnormality.Myotonic discharges are predominantly detected in distal muscles.The involved regions detected by EMG are wider than those of clinical findings.EMG is an important screening tool for subclinical or early atypical DM1 patients.

To explore the prognostic significance of serum vascular endothelial growth factor receptor-2 (VEGFR-2) in patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).

A total of 69 HCC patients undergoing TACE from October 2008 to April 2012 were recruited and examined.Their serum level of VEGFR-2 level was measured by enzyme-linked immunosorbent assay (ELISA).The relationship between VEGFR-2 and their clinicopathologic features were observed.Prognostic significance of VEGFR-2 was assessed for their survival.

Significant differences existed when the serum level of VEGFR-2 was categorized by tumor number and liver cirrhosis (P=0.021, P=0.049).The post-treatment serum level of VEGFR-2 was significant higher than that at pre-treatment (P=0.045).When the mean pre-treatment serum level of VEGFR-2 (8709 ng/L) was used as a cut-off point, the patients with a low serum level of VEGFR-2 had better overall and progression-free survival than those with a high serum level of VEGF (17 vs.28 months, P=0.001 and 10 vs.15 months P=0.031 respectively).As revealed by multivariate Cox analysis, the pre-treatment serum level of VEGFR-2 was an independent and significant prognostic factor of survival for HCC patients at post-TACE.

The pre-treatment serum level of VEGFR-2 may predict the post-TACE prognosis in HCC patients.

To observe the expression variations and influencing factors of programmed death one (PD-1) and DNA demethylation of PD-1 promoter on peripheral blood mononuclear cells (PBMCs) in chronic hepatitis B (CHB) patients and further investigate the relationship between the demethylation pattern of PD-1 gene in promoter region and the PD-1 expression on PBMC in CHB patients.

A total of 162 subjects, including 144 CHB patients and 18 healthy blood donors, were enrolled.The expression of PD-1 on PBMCs was detected by flow cytometry.And the serum HBV markers, HBV DNA load and liver function were also measured.DNA of PBMCs was treated with sodium bisulfite; the PD-1 promoter fragments were amplified by polymerase chain reaction (PCR) and then transformed into Escherichia coli.Positive clones were selected for sequencing and the methylation status of fragments of PD-1 promoter was examined.

With the PD-1 expression in normal controls (10.8%±4.4%) as a baseline level, the expression of PD-1 in CHB patients significantly increased.In CHB patients, the serum expression of PD-1in PBMCs from patients with positive HBeAg (27.1%±18.4%) was much higher than that from those with negative HBeAg (19.6%±15.6%).And the expression level of PD-1 was not correlated with serum HBV DNA load and serum level of alanine aminotransferase.The results of bisulfite genomic sequencing showed that demethylation probability of some CG points in PD-1 promoter region (-601,-553,-538,-483,-463,-317 bp) were significantly correlated with PD-1 expression level (P<0.05).

The demethylation pattern of PD-1 gene in promoter region is associated with the PD-1 expression on PBMC in CHB patients.

To observe the pro-apoptotic effects of Curcumin associated with CIK cells against SKOV3 cells of ovarian carcinoma and discusses the possible molecular mechanisms.

CIK cells were induced from umbilicus cord blood.The apoptotic morphology of SKOV3 cells was observed under electron microscope after treated with Cur, CIK cells and Cur associated with CIK cells.The levels of Fas protein on surface of ovarian cancer cells and FasL protein on surface of CIK cells after Curcumin treatment were determined by Western blot.The inhibition rates on proliferation of CIK cells and Cur associated with CIK cells after addition of Fas L monoclonal antibody were detected by (thiazolyl blue tetrazolium bromide) MTT.

The changes of apoptotic morphology in the group of Cur associated with CIK cells were most obvious compared with that in the group of Cur or CIK cells alone.Cur could promote the expression of Fas on surface of SKOV3 cells and FasL on membranes of CIK cells.The inhibition rates on proliferation in the group of CIK cells and Cur associated with CIK cells could be restrained obviously after an addition of anti-Fasm Ab.

The pro-apoptotic effects of SKOV3 cells increase with the combined use of Cur and CIK cells.The mechanism may be that Cur can promote the expression of Fas protein on cell surface of SKOV3 cells and Fas L protein on cell membrane of CIK cells so as to up-regulate the expression of Fas protein in SKOV3 cells and lead ultimately to the a higher expression of Caspase3.

To evaluate the application of computational fluid dynamics (CFD) on a patient-specific hemodynamic model of aortic arch.

The original Dicom format image data of a patient were acquired by computed tomographic angiography (CTA).A 3-dimensional (3D) model based on CFD was constructed through the right amount of boundary conditions and hemodynamic parameters related with flow velocity,shear force and wall stress on lumen were analyzed accordingly.

The 3D model based on CFD could reflect the characteristic of flow velocity, shear force and wall stress on lumen in vitro. (1) The distributions of hemodynamic variables during cardiac cycle were spatiotemporally different.The unidirectional high-speed systolic current was replaced by diastolic eddy current and reversed flow.The distribution of flow velocity and shear stress gradually increased from outer wall of aortic artery to inner wall under the influences of such anatomical factors as vascular branching and distortions of descending aorta| (2) the magnitude and volatility of wall stress in ascending aorta were greater than those of aortic arch and descending aorta, but the least results were at the lateral wall of descending aorta area.In addition, the wall stress of external wall was higher than the lateral wall in the same section.

The hemodynamic research of aortic arch based on CFD may actually simulate the characteristics of blood flow and wall stress so as to become a new reliable and convenient application tool in etiological diagnosis and surgical planning.

To explore the values of magnetic resonance spectrum (MRS) in early diagnosis, quantization analysis and staging of hepatic fibrosis.

A rat model of hepatic fibrosis was established by the method of carbon tetracarbon (CCl₄). A total of 47 SD rats were divided into model (n=40) and control (n=7) groups. ¹H-MRS was performed.The model rats of hepatic fibrosis were grouped according to their pathological stages.The ratio of peak height and peak area of metabolites and lipid (Cho/Lip, Glx/Lip, Lac/Lip and Cr/Lip) were calculated and compared respectively.

The ratios of peak height of metabolites and lipid were as follows: ratio of Cho and Lip:significant differences existed between control and grades 3 and 4 model groups (P<0.05); ratio of Glx and Lip: significant differences existed between control and grades 2, 3 and 4 model groups (P<0.05); ratio of Cr and Lip:significant differences existed between control and grade 3 model groups (P<0.05).The peak area ratio of main metabolites and lipid of liver were as follows:ratio of Cho and Lip:significant differences existed between control and grade 4 model groups (P<0.05); ratio of Glx and Lip:significant differences existed between control and other groups (P<0.05); ratio of Cr and Lip:significant differences existed between control and grade 4 model groups (P<0.05); ratio of Lac and Lip: no significant differences existed between these groups (P>0.05).

The ratios of peak height and peak area of Cho/Lip, Glx/Lip and Cr/Lip are important for the staging of hepatic fibrosis.