BACKGROUND: Brain injury often causes secondary cerebral ischemia and hypoxia, which aggravate the brain damages. Cerebral surgery can induce the increase of oxygen free radical in plasma, which may aggravate brain damage. As a new drug to induce and maintain anesthesia, the role of propofol in brain protection is more conspicuous.OBJECTIVE: To observe the effect of propofol on the serum concentration of S100B in patients undergoing neurosurgery, analyze its relation with the score of mini-mental state examination (MMSE) after 6 months, and evaluate the brain protective effects of propofol.DESIGN: A randomized and concurrent controlled trail.SETTINGS: Department of Anesthesiology, Department of Neurosurgery,Central Laboratory, Wuhan General Hospital of Chinese PLA; Staff Room of Anesthesiology, Zhongnan Hospital of Wuhan University.PARTICIPANTS: Thirty patients with acute craniocerebral injury, who were randomly selected from the Department of Neurosurgery, Wuhan General Hospital of Chinese PLA from January to June 2004, were divided into propofol group (n=15) and isoflurane group (n=15) according to the method of random number table.METHODS: The patients accepted the removal of intracranial hematoma and/or focal cerebral contusion and laceration by craniotomy under general anesthesia. In the propofol group, the patients were pumped with propofol (4-8 mg/kg per hour) perioperatively, and the anesthesia was maintained with intravenous injections of fentanvl (1-2 μg/kg per hour) and vecuronium (0.02-0.03 mg/kg per hour). In the isoflurane group, the patients inhaled isoflurane (0.8-1.2 MAC) perioperatively, and the anesthesia was maintained with intravenous injections of fentanvl (1-2 μg/kg per hour)and vecuronium (0.02-0.03 mg/kg per hour). The serum concentration of S100B was detected with enzyme-linked immunoabsorbent assay (ELISA)before operation, at 2 hours after the beginning of the operation and at the end of the operation respectively. After 6 months, 23 patients were evaluated by the indexes of localization, recordance, calculation and attention,memory, speech and spatial sense in MMSE, and the scores were recorded.The total score of MMSE was 30 points, the higher the scores, the better their intelligence.MAIN OUTCOME MEASURES: The changes of the brain injury marker of S100B at each time point perioperatively, MMSE scores at 6 months postoperatively, and the correlation between them were mainly observed in both groups. RESULTS: The blood samples of the 30 patients were all involved. For the follow-up after 6 months, 3 and 4 cases died in the propofol group and isoflurane group respectively, and totally 23 patients were followed up and evaluated by MMSE. ① The serum S100B at 2 hours perioperatively and that at the end of the operation were increased as compared with the preoperative one in both groups; At the end of the operation, it was significantly lower in the propofol group than in the isoflurane group (P ＜ 0.05).The S100B showed an ascending process before the operation, at 2 hours after the beginning of the operation and at the end of the operation. ② The MMSE score in the propofol group was not significantly higher than that in the isoflurane group [(22.33±5.96), (19.91±6.13), t=0.9603, P ＞ 0.05). ③ The S100B content at the end of the operation had a significant negative correlation with the MMSE score after 6 month (r=-0.487, P ＜ 0.05).CONCLUSION: The clinical anesthetic dose of propofol can reduce the increase of the serum concentration of S100B perioperatively, ameliorate the cognitive ability of the patients at 6 months postoperatively, and attenuate the occurrence of dysnoesia.

ObjectiveTo discuss the relationships among spastic paralysis and motor function, balance function and other clinical variables after stroke.MethodsAssessed the clinical spastic index of hemiplegic lower limbs with CSI scale, motor function with Fugl-Meyer Assessment, and balance function with Berg Equilibrium Scale, respectively. And then analyzed the relationship between clinical spasm index with motor function, balance function of the hemiplegic lower limbs with Pearson correlation analysis. Finally, ascertained which was the most important factor affecting the clinical spasm index of spastic lower limbs with stepwise regression analysis.ResultsThere is negative correlation between clinical spasm index with motor function and balance function, respectively. Tendon reflex, muscular tension and clonus are the deciding factors to motor function(P<0.05) and balance function(P<0.05) of the hemiplegic lower limbs.ConclusionThe clinical spasm index of hemiplegic limbs can affect the recovery of motor function and balance function significantly. So, assessing and improving the clinical spasm index of paralytic lower limbs can optimize the rehabilitation program to stroke patients.

Objective To study the effect of electroencephalograph (EEG) bionic electrical stimulation at Wangu (GB12), Tianzhu (BL10), Neiguan (PC6) on cerebral blood flow and metabolism in patients with persistent vegetative state (PVS). Methods 60 patients with PVS were divided into observation group (n=30) and control group (n=30) according to the random number table. The control group received routine treatment, including basic management, hyperbaric oxygen therapy, awaking medicine, sensory stimulation, and so on; while the observation group received EEG bionic electrical stimulation at bilateral Tianzhu, Wangu (cheif electrodes) and Neiguan (auxiliary electrodes) in addition. They were treated for 30 days. They were assessed with the PVS score, and observed with transcranial Doppler ultrasound (TCD) and magnetic resonance spectroscopy (MRS) one day before and one day after treatment. Results The incidence of improvement was 86.67% in the observation group, more than 60.00% in the control group (P<0.05). The difference of blood flow velocity before and after treatment (ΔVm) of anterior-middle cerebral artery was more in the observation group than in the control group respectively (P< 0.001), as well as those of posterior cerebral-vertebral-basilar artery (P<0.01). The N-acetyl aspartic acid/creatine (NAA/Cr) increased more in the observation group than in the control group respectively (P<0.01), and the choline/creatine (Cho/Cr) decreased more (P<0.01), after treatment. Conclusion EEG bionic electrical stimulation can improve the cerebral circulation and metabolism in patients with PVS, which may associate with the wake promoting.

Objective To observe the effects of repeated Botulinum toxin type A (BTX-A) injection on lower limb spasticity after stroke.Methods 180 cases with lower limb spasticity after stroke were divided into the treatment group (n=90) and the control group (n=90). The treatment group was treated with BTX-A injection twice in the spastic muscles at interval of 3~6 months, while both the treatment group and the control group accepted the rehabilitation based on the neurodevelopmental therapy. They were assessed with modified Ashworth Scale (MAS), Fugl-Meyer Lower Limb Assessment (FMAL), Berg Balance Scale (BBS), modified Barthel Index (MBI) before each injection, and 3 d, 7 d, 1 month, 3 months after each injection or the same time for the controls. Results There was significant difference in scores of MAS, FMAL, BBS, MBI for the treatment group among before and 3 d, 7 d, 1 month after each injection (P<0.05), but not significant between 2 injections (P<0.05). There was significant difference in scores of all the assessment between the treatment and control group at the same time (P<0.01). Conclusion Repeated intramuscular injection of BTX-A can reduce the spasticity of lower limb after stroke.

BACKGROUNDTo study the expression of MMP-2, MMP-9, TIMP-1 proteins and mRNA in NSCLC and to analyse their relations with prognosis.

METHODSImmunohistochemistry (IHC) and in situ hybridization (ISH) were used to detect the expression of MMP-2, MMP-9, TIMP-1 proteins and mRNA in pa-raffin-embedded NSCLC specimens.

RESULTSThere were no significant differences among the MMP-2, MMP-9, TIMP-1 expression and age, sex, histological type and differentiation. There was statistical relationship between expression of MMP-2, MMP-9, TIMP-1 and lymph node metastasis. Multivariate Cox model analysis suggested that the survival time was significantly related to lymph node metastasis, expression of MMP-2 and MMP-9. The results of IHC and ISH suggested that the concordant rates of MMP-2, MMP-9, TIMP-1 proteins and mRNA were of statistical significance (P < 0.01,P < 0.005,P < 0.025).

CONCLUSIONSMMP-2 and MMP-9 are independent factors that affect prognosis, TIMP-1 is an useful parameter to the prognosis of NSCLC.