Objective To explore the management of gliomas in pregnant women.Methods We retrospectively analyzed the clinical data in 11 pregnant women with gliomas treated at Xuanwu Hospital of Capital Medical University between January 1989 and December 2012.Results All the patients were first diagnosed with gliomas during pregnancy,including two cases during early pregnancy,four cases during midpregnancy,and five cases during late pregnancy.The main clinical manifestations were dizziness,headache,nausea and vomiting due to intracranial hypertension,accompanied by epilepsy and blurred vision,hearing and speech disorder and other neurological dysfunctions.Among the 11 patients,one received no obstetric treatment,five underwent cesarean section,three had metaphase induced labor,one had induced abortion,and one had spontaneous abortion.Five neonates appeared normal without malformation:four survived,and one with severe asphyxia died.Ten patients underwent neurosurgery,four of them were diagnosed with low-grade gliomas and six were diagnosed with high-grade glioma by pathology.Seven patients received craniotomy after termination of pregnancy,two underwent craniotomy before termination of pregnancy,and one received emergency craniotomy immediately after admission without obstetric treatment because of her critical conditions.Of the ten patients treated with craniotomy,one died after a coma for 50 days,one was lost to follow-up,six received radiotherapy plus chemotherapy,one received chemotherapy alone,and one received neither radiotherapy nor chemotherapy.Among the 11 patients,one patient who underwent cesarean section without craniotomy was lost to follow-up,one patient with low-grade glioma died 50 days after operation,one treated with craniotomy was lost to follow-up,and eight were followed up for four months to three years,among which four survived and four with high-grade glioma died within one year after operation.Conclusion The overall prognosis of glioma patients during pregnancy is poor.It is important to take into account the tumor status of the pregnant women,gestational age,fetal maturity and patient's desire for tocolysis,and weigh the pros and cons,and timely terminate pregnancy and perform neurosurgery.

Objective To explore the diagnosis value of dual energy CT in severity analysis of acute pancreatitis.Methods Pancreas CT perfusion images of 60 patients were formatted using the method of Siemens dual energy CT.According to the severity of the acute pancreatitis,60 patients were divided into 3 groups:normal control (NC)group,mild acute pancreatitis (MAP)group and severe acute pancreatitis (SAP)group.Every group had 20 patients.Blood flow(BF),blood volume(BV),permeability of capillary surface (PS)and mean transit time(MTT)were calculated by Siemens MMWP workstation post process software.The meaning of these CT perfusion parameters for severity of acute pancreatitis was analyzed.Results Compared to the NC group,BF and BV in MAP,SAP group were reduced significantly (P <0.01).BF and BV in MAP group were higher than those in SAP group (P <0.01).PS in MAP,SAP group were higher than that in NC.MTT had no difference in three groups(P >0.05).We also found in ≥45 years old patients,MTT in both MAP and SAP groups were higher than NC group(P <0.05).Conclusion (1)BF and BV are useful in diagnosis of acute pancreatitis and analysis of severity of it.(2)PS is useful in diagnosis of acute pancreatitis.(3)MTT is useful in diagnosis of acute pancreatitis in elderly patients (≥45 years old).

Objective To discuss the surgical strategy of parasagittal and falcial meningiomas in the middle 1/3 cortex area and raise resective rates of tumors and surgical effects.Methods The clinical,imaging and operative data of 74 cases of parasagittal and falcial meningiomas in the middle cortex area which underwent operation were reviewed and followed up.Results Of 74 tunors,67 were resected with Simpson Ⅱ grade,7 with Simpson Ⅲ,none of them with Simpson Ⅰ.Superior sagittal sinus and the vein of central suleus and feeders of cortex were reserved well.Severe brain injury was not occurred in 66 cases with tumors debulking(Simpson Ⅱ 61 cases,Simpson Ⅲ 5 cases),the neuro-functions of patients were normal or transient slight weakness of contralateral lower extremities postoperatively.Tumors of 8 cases were "turned over" and resected by piecemeal (Simpson Ⅱ 6 cases,Simpson Ⅲ 2 cases),weakness and paralysis of contralateral lower extremities occurred in 7 cases and 1 cases respectively after surgery.Followed-up ranged from 6 months to 4 years and 2 months,4 cases were lost to follow-up.Neuro-function of all cases with weakness of contralateral lower extremities recovered after one month.Muscle strength of the cases with paralysis of contralateral extremity recovered to grade Ⅳ 6 months later,no recurrence and death.Conclusion The measures,including piecemeal tumor reseeted mierosugically,good protection of the vein of central sulcus,excellent management of superior sagittal sinus,and avoiding damage to functional cerebral cortex during operations,are best ways for raising the tumor resection rate and nearo-function reserved.

Objective To explore the potential association of HLA-A alleles and genetic susceptibility with systemic lupus erythematosus (SLE). Methods Polymerase chain reaction-sequence specific primer (PCR-SSP) was used to analyze the distribution of HLA-A alleles among 106 patients with systemic lupus erythematosus and 122 healthy persons. Results Nineteen out of twenty-four kinds of HLA-A alleles were found from the specimens, including 18 kinds in SLE specimens, and 15 kinds in control specimens. Among them, HLA-A*11 allele was positively associated with SLE (RR = 2.4380, EF = 0.1502, ?2 = 12.2440, P = 0.0005, Pc = 0.0095). For A*01 and A*24, although the P values were less than 0.05, the Pc values were more than 0.05 (0.9462 or 0.2356, respectively). Conclusions The results indicate that HLA-A*11 may be the susceptible allele or may be closely linked with the susceptible genes in Chinese SLE patients.

Objective: To explore and evaluate the biomechanic relationships between different depth of pedicle screw penetration with the sagittal plane reconstruction in thoracolumbar fracture. Methods:Six fresh cadaveric specimens of lumbar spine from L_1 to L_3 were used to make the model of thoracolumbar fracture. The system of universal spine system( USS )pedicle screw was adopted with the 6 mm diameter of screw. Each of two Schanz screws was implanted into the pedicles of L_1 and L_3 A canulated screw was fixed into the former of vertebral body in L_1 and L_3, and the distance of the two canulated screws was taken as the normal height. The axial loads were given while the pedicle screws were implanted at the depth of D1, D2 and D3, and the distance of the two canulated screw was measured as well as the distance was reduced to the normal height by axial load. The index measured included of the depth of pedicle screw penetration, the height of fractured vertebral body and afterload. Results: Along with the increasing of afterload, the height of injured vertebral body was increased accordingly, but the extent was different at three depth of pedicle screw penetration (D1, D2, and D3). While the injured vertebral body was reduced totally (reduced distance 0.00 mm), there was (2 630±13) g of afterload needed in Dl depth, and (2 339±61) g and(2 221± 164) g of afterload in D2 and D3 depth respectively. There was significant difference in distance between D1, D2 and D3 (P< 0.01), however, no significant difference between D2 and D3 (P> 0.05). Conclusion: There is a relationship in the depth of pedicle screw penetration, the capacity of reduction and sagittal plane reconstruction. The depth of pedicle screw had a significant effect on the capacity of reduction for the injured vertebral body, which would be the best option in biomechanics when the pedicle screw was implanted more than 1/2 pedicle or all of it.

Objective:To discussed the diagnostic value of magnetic resonance cholangiopancreatography (MRCP), and the use of laparoscopic surgery in management of patients with choledochal cyst with extrahepatic bile duct anomaly.Methods:Of 330 consecutive patients who underwent laparoscopic choledochectomy at Guangzhou Women and Children's Medical Center from January 2010 to September 2018, there were 23 patients with extrahepatic bile duct anomaly. The data of these patients were retrospectively analyzed. There were 4 males and 19 females, with an average age of 3.2 (range 0.3~9.0) years. According to whether the extrahepatic bile duct anomaly was diagnosed by preoperative MRCP, these patients were divided into the preoperative MRCP diagnosis group and the preoperative MRCP undiagnosed group. The impact of MRCP in diagnosing bile duct anomaly to prevent bile duct injury, on operation time, hospital stay and the types of extrahepatic bile duct anomaly on outcomes of laparoscopic treatment were analyzed.Results:All the 23 patients with choledochal cysts complicated by extrahepatic bile duct anomaly were confirmed at surgery. The incidence of extrahepatic bile duct anomaly was 6.97% (23/330). There were 47.8% of type II AHD (11/23); 36.8% of type III AHD (7/23); 4.3% of type IV AHD (1/23); 17.4% (4/23) of the type with communication with accessory bile duct (CABD). The preoperative MRCP diagnosis group consisted of 14 patients, while the preoperative MRCP non-diagnosis group consisted of 9 patients, including 2 patients without MRCP. The diagnostic rate of MRCP in preoperative diagnosis of extrahepatic bile duct anomaly was 66.7%(14/21). The preoperative MRCP undiagnosed group, when compared with the preoperatives MRCP undiagnosed group, had a significantly higher bile duct injury rate [preoperative MRCP diagnosis group 7.1%(1/14), preoperative MRCP non-diagnosis group 55.6%(5/9)], and a significantly longer operation time [preoperative MRCP diagnosis group(232.6±10.0) min, preoperative MRCP undiagnosed group (278.9±22.45)min], (all P<0.05). Laparoscopic surgery was completed in 22 of 23 patients. One patient was converted to open surgery. AHD reconstruction was needed in 11 patients with type II AHD and 1 patient with type IV AHD. Seven patients with type III AHD did not require any surgical intervention for the anomaly. The 4 patients with CABD underwent simple ligation. Postoperative chyloperitoneum developed in 1 patient, who successfully responded to conservative treatment. Postoperative recovery was uneventful in the remaining patients. At a median follow-up of 2 years (range 1 to 5 years), no further complications, including intrahepatic bile duct dilatation and hepatic atrophy were detected. Conclusions:MRCP was effective in preoperative diagnosis of choledochal cysts with extrahepatic bile duct anomaly. It helped to decrease intraoperation injuries to bile duct anomalies. MRCP was also useful in classifying patients with extrahepatic bile duct anomaly to better preoperatively planning of surgical treatment strategies. Laparoscopic surgery could be completed in the majority of these patients with good postoperative results.

[ ABSTRACT] AIM:To investigate the effects of pathological products, urinary proteins and advanced glycosyla-tion end products ( AGE) produced in the progression of chronic kidney disease ( CKD) , on the structure and function of lysosomes in renal tubular epithelial cells ( TECs ) , and try to find a novel approach for preventing or delaying CKD. METHODS:The renal specimens of the untreated patients with minimal change nephrotic syndrome (MCNS), diabetic nephropathy (DN) or normal kidney were collected.The expression of lysosomal-associated membrane protein 1 (LAMP1) and cathepsin B ( CB) was studied in TECs by indirect immunofluorescent staining.Human renal tubular epithelial cell line HK-2 was incubated with 8 g/L urinary proteins or 100 mg/L AGE.The expression of LAMP1 and CB was investigated by indirect immunofluorescence and the activity of CB and cathepsin L ( CL) was measured by biochemical and enzymatic as-says.The degradation of DQ-ovalbumin was also determined.RESULTS: The lysosomal membrane permeabilization oc-curred in the TECs of MCNS and DN patients.After treatment with urinary proteins or AGE-BSA, the lysosomal membrane permeabilization of the HK-2 cells was increased.The activity of CB and CL and degradation of DQ-ovalbumin were de-creased as compared with normal control group.CONCLUSION:The digestive function of lysosome was decreased and ly-sosomal membrane permeabilization occurred in the TECs exposed to urinary proteins and AGE, which might be a key factor to induce the tubulointerstitial fibrosis.

OBJECTIVETo investigate the direct effects of the Flt3 ligand (FL) on hematopoiesis, such as the stimulation of the formation of hematopoietic colonies and the proliferation of dendritic cells, as well as the indirect stimulation of hematopoiesis, especially via the proliferation of endothelial cells.

METHODSMononuclear cells from human cord blood were plated in methylcellulose medium containing different cytokines to induce hematopoietic colony formation. Dendritic cells (DCs) were induced from the mononuclear cells with a cytokine cocktail with or without recombinant human soluble FL (rhFL; 100 ng/ml). The Flt3 receptors on the surface of a human microvascular endothelial cell line (ECV) were analyzed by flow cytometry. The proliferation of ECV stimulated by rhFL was measured with the microculture tetrazolium assay. The levels of FL, IL-6, IL-8, G-CSF and GM-CSF in the supernatant of ECV cultures were measured by enzyme linked immunoabsorbent assay (ELISA).

RESULTSrhFL stimulates colony formation from cord blood when used as a sole stimulant. FL in combination with other cytokines increased colony formation significantly. The number of DCs was approximately 2.5 times higher when rhFL was used. rhFL stimulates the proliferation of ECV on which Flt3 receptors are expressed. Furthermore, ECV secretes FL, IL-6, IL-8, G-CSF and GM-CSF, which were augmented by tumor necrosis factor-alpha and rhFL.

CONCLUSIONSrhFL enhances hematopoietic colony formation and DC proliferation from human cord blood cells. FL not only stimulates the proliferation of ECV, but is also secreted by ECV. FL may exert direct and indirect effects on hematopoiesis.

Cell Division ; drug effects ; Cell Line ; Dendritic Cells ; cytology ; drug effects ; immunology ; Dexamethasone ; pharmacology ; Dose-Response Relationship, Drug ; Endothelium, Vascular ; cytology ; drug effects ; metabolism ; Fetal Blood ; cytology ; drug effects ; Hematopoiesis ; drug effects ; Hematopoietic Stem Cells ; cytology ; drug effects ; Humans ; Immunophenotyping ; Membrane Proteins ; pharmacology ; Recombinant Proteins ; pharmacology ; Tumor Necrosis Factor-alpha ; pharmacology

Objective:To investigate the efficacy and safety of fractionated stereotactic radiotherapy (FSRT) based on linear accelerator for small volume brain metastases.Methods:A total of 21 patients with small volume brain metastases who received FSRT from August 2020 to June 2022 were enrolled as subjects, including 45 lesions. Small-volume brain metastases were defined as ≤3 cm in diameter and ≤6 cm 3 in volume, and the dose/fractionation scheme was 27-30 Gy/3 F or 30-40 Gy/5 F. Three months after radiotherpy, the efficacy of FSRT in small brain metastases and the incidence of radiation brain injury were evaluated, and the incidence of radiation brain injury in subgroup analysis was performed according to the diameter, volume, dose/fractionation scheme, biological effective dose (BED) 10, and location of lesions. Results:Twenty-four lesions (53.33%, 24/45) were evaluated as complete response, another 13 lesions (28.89%, 13/45) were evaluated as partial response, and in the remaining 8 lesions (17.78%, 8/45) were evaluated as stable disease. The local control rate was 100% (45/45), the objective remission rate was 82.22% (37/45), and the intracranial distant progression rate was 23.81% (5/21). During the treatment and follow-up, there were 7 lesions (15.56%, 7/45) of radiation-induced brain injury, and the incidence of symptomatic radiation-induced brain injury was 11.11% (5/45). Subgroup analysis showed that the incidence of radiation brain injury in the group with a lesion diameter of 2-3 cm was higher than that with a lesion diameter of <2 cm group, with a statistically significant difference [80.00% (4/5) vs. 7.50% (3/40), χ2=12.69, P<0.001]; the incidence rate of radiation brain injury in the group with lesion volume of 4-6 cm 3 was higher than that with lesion volume of <4 cm 3 group, with a statistically significant difference [57.14% (4/7) vs. 7.89% (3/38), χ2=7.49, P=0.006]. There was no significant difference in the incidence of radiation brain injury between the dose/fractionation scheme of lesions 27-30 Gy/3 F and 30-40 Gy/5 F [9.52% (2/21) vs. 20.83% (5/24), χ2=0.40, P=0.527]. There was no significant difference in the incidence of radiation brain injury between the BED 10<60 Gy and ≥60 Gy [28.57% (2/7) vs. 13.16% (5/38), χ2=0.22, P=0.641]. There was no significant difference in the incidence of radiation brain injury between the lesions in the same lobe and the single or multiple lesions in different lobes [28.57% (4/14) vs. 9.68% (3/31), χ2=1.38, P=0.240) . Conclusion:FSRT based on linear accelerator is effective for small volume brain metastases. Brain metastases with the diameter <2 cm or volume <4 cm 3 are associated with a lower incidence of radiation brain injury than that of lesions with the diameter of 2-3 cm or volume of 4-6 cm 3.

Objective Both flee triiodothyronine (FT3) level and Glasgow Coma scale (GCS) scores have been separately described as prognostic predictors for mortality in hypertensive intracerebral hemorrhage (HICH).This study is conducted to investigate the relationship and prognostic impact of low-T3 syndrome and GCS in HICH patients.Methods Two hundred and thirty patients with HICH,admitted to our hospital from January 2015 to January 2016,were chosen and performed thyroid hormone levels examination (FT3,FT4 and thyroid stimulating hormone [TSH] 3).According to the thyroid hormone results,these patients were divided into low T3 group I (FT3＜3.1 pmol/L,normal TSH level) and normal thyroid function group (normal FT3,FT4 and TSH levels).According to best cut-off levels defined by receiver operating characteristic (ROC) curve,these patients were divided into low GCS scores group (GCS＜7.5) and high GCS scores group (GCS＞7.5),and low T3 group Ⅱ (FT3＜2.85 pmol/L) and high T3 group (FT3＞2.85 pmol/L).Telephone follow-up was performed every 6 months,and using death or re-bleeding during follow-up period as end point of the event,prognostic values of FT3 level and GCS scores defined by ROC curve in mortality and re-bleeding rote were recorded;survival rate of these patients were analyzed by Kaplan-Meier curves and compared between each two groups;multivariate Cox regression was used to analyze the relations of FT3 level and GCS scores with mortality and re-bleeding rate.Results As compared with normal thyroid function group,low T3 group Ⅰ had significantly higher re-bleeding rate,percentage of patients with blood loss＞30 mL,and rate of breaking into the ventricles,and statistically lower GCS scores at admission and FT3 level (P＜0.05);the mean age in patients of low T3 group Ⅰ was significantly elder than that in patients of normal thyroid function group (P＜0.05).ROC results indicated that the sensitivity and specificity of GCS scores in predicting mortality and re-bleeding rate were 63％ and 73％,and those of FT3 level were 45％ and 73％.Kaplan-Meier curves showed that both low GCS group and low T3 group Ⅱ had significantly increased mortality and re-bleeding rate as compared with high GCS group and high T3 group (P＜0.05).Unified prediction results indicated that patients from low T3 and low GCS group had significantly higher mortality and re-bleeding rate as compared with patients from low T3 and high GCS group,high T3 and low GCS group,and high T3 and high GCS group (P＜0.05).Conclusion Low T3 syndrome is common in patients with HICH;FT3 level and GCS scores appear to be important predictors for mortality and recurrence in patients with HICH.