Objective To sum up clinical experiences of intractable temporal lobe epilepsy by microsurgery. Methods A retrospective review was conducted in 50 cases with epilepsy,and temporal lobe was resected by microsurgery from June 1996 to Oct. 2003. Results Follow-up patients from six months to five years.The follow up showed healing outcome in 25 cases,good results in 13 cases,unsatisfactory outcome in 9 cases,no improvement in 3 cases.Slight paresis 6 cases,divagation 8 cases,psychosis 5 cases and no death case. Conclusions Application of microsurgery can obvously improve the clinical result of patients with temporal lobe epilepsy and decrease the complication after operation.

In recent years, researchers have become more interested in fish scrap collagen collection .Fish collagen, thanks to its low antigenic and hypoallergenic properties , is superior to that of higher animals .Meanwhile , fish collagen derives from a wealth of sources and has a moderate price .Based on recent fish collagen extraction and modification , this article summarizeds extraction technologies , such as hot-water, chemistry, bio-enzyme, compound extraction and such modification methods as physical and chemical processes to improve the thermal stability .

Clinical teaching is an important link in cultivating clinician,Heuristic teaching can stimulate students'activeness of learning,enlighten their thoughts,arouse their positivity and creativity,find out their inner potential,and increase teaching effect.Intractable case discussion is an important method of heuristic clinical teaching,which can help strengthening theory knowledge,exercising correct clinical thinking,creating scrupulous scientism and satisfactory medical ethics.

Objective To investigate the expressions of aquaporin 4 (AQP4) in the bacterial meningitis in rats and to explore the molecular mechanism for brain edema caused by bacterial meningitis.Methods Totally 40 of 3-week-old-Sprague-Dawley healthy rats,body weight 60-80 g,male or female,were divided into a normal control group(n =10),and infection groups:24 hours after injection(n =10),48 hours after injection(n =10),and 5 days after injection(n =10).The expressions of AQP4 in the brain were detected by immunohistochemistry and Western blot methods respectively after 24 hours,48 hours,5 days of inoculation.Results Mortality rate:no rats in the control group and the infection group after 24 hours were dead.Two rats in the infection group after 48 hours and 4 rats in the infection group after 5 days were dead because of serious sickness,with the mortality rates 20％ and 40％,respectively.AQP4 expression was slightly positive under light microscope,and the positive cells mainly surrounded glial cells and blood vessels,while neurons were not dyed.Immunohistochemical staining showed that AQP4 expression in the model group increased with the severity of edema;compared with the control group,the AQP4 expression in the brain tissues increased in different periods after rats were infected,and the differences between groups were statistically significant (F--91.84,P ＜ 0.01).Western blot analysis showed that after the brain received streptococcus pneumoniae injection,expression of AQP4 began to increase in 24 hours after streptococcal injection,and reached to the peak in 48 hours,but decreased in 5 days,but the expression still remained higher than that of the normal control group.Each group had statistically significant difference(F =14.23,P ＜ 0.01).Conclusions Expression of AQP4 in the models with bacterial meningitis may increase initially and decrease later.It suggests that AQP4 plays a protective role during the development of infectious brain edema.

Objective: To develop ~(99)Tc~m labeled dopamine transporter(DAT) imaging agent ~(99)Tc~m-(2?-[N,N~(,)-bis(2-mercaptoethyl)ethylenediamino]methyl,3?-(4-chlorophenyl)tropane(TRODAT-1) for evaluating changes of DAT in patients with Parkinson disease(PD). Methods: The SD rats were divided into control group(n=5),PD models group(n=22)and generalized cerebral infarction models group(n=5).~() Unilateral smashing and injecting autothrombo into carotid artery of SD rats were used.~(99)Tc~m-TRODAT-1 distributing in normal rat striatum was observed.The uptakes in sound side and smashed side of PD rats striatum and in two sides of multiple infarction rats striatum were compared. Results:~(99)Tc~m-TRODAT-1 distribution in normal rats striatum exhibited a obvious uptake in striatum.And PD rats results exhibited that the uptake was less in normal striatum than in smashed striatum obviously.The result of multiple infarction rats is same as normals rats. Conclusion: ~(99)Tc~m-TRODAT-1 might betaked specificly.Its imaging can provide a beneficial evidence for PD disease early diagnose.

Objective To investigate the protective effect of melatonin and its possible mechanism for repairing in the immature white matter damage due to brain hypoxia-ischemia (HI).Methods Forty-eight three-day SD rats after birth were randomly divided into 3 groups:sham-operated(SHAM) group,HI group and melatonin treatment(MT) group.Periventricular white matter damage (PWMD) to animal models were estabished according to Rice modeling.MT group was treated with melatonin pre-operatively,immediately postoperation,1 hour postoperation and 24 hours postoperation via intraperitoneal injection,and the other groups were injected with the same volume of dissolvent.The rats were executed by decollation after 2 days and 14 days.The histological changes in periventricular white matter were observed by HE staining and immunohistochemistry.Results For the 3 groups,the structure in ope-ration side of the white matter in the peripheral ventricles of the brain 2 days postoperation were significant different (P ＜0.05).The O4 positive cells decreased one by one/greatest in the SHAM group[(75.548 ± 7.333)/hpf] followed by MT group [(59.971 ± 3.635)/hpf],and HI group [(40.511 ± 2.848)/hpf] (P ＜ 0.05).The expression of Casepase-3 increased in the SHAM group (107.724 ± 10.266),MT group (132.289 ± 8.537),and HI group (202.168 ± 14.367),and the difference was statically significant (P ＜ 0.05).Ventricular index was greater in operation side of the white matter in the peripheral ventricles of the 14-day-brain in the SHAM group(0.928 ±0.063),MT group (1.813 ± 0.110),HI group (2.752 ± 0.201),increasingly,while absorbance value of myelin basic protein decreased one by one in sequence(39.504 ± 1.673,21.729 ± 1.614,11.344 ± 1.118).Conclusions MT plays a role in protecting the periventricular white matter via inhibiting the apoptosis of oligodendrocyte progenitor cell,and thus benefits the PWMD.

Objective To investigate the expressions of Occludin in brain after bacterial meningitis and to discuss possible molecular mechanism of bacterial meningitis when brain edema occurs. Methods The models of bacterial meningitis and normal control were constructed via inoculating intracisternally with strain Ⅲ streptococcus pneumoniae and the same volume of normal saline solution, respectively. The expression of Occludin in brain was detected by immunohistochemistry and Western blot methods respectively and 24 h, 48 h and 5 days after inoculation. Results (1) Loeffler neurologic deficit score (NDS) in 24 h, 48 h and 5 d decreased significantly when compared with that of control group (P < 0.05). (2) After the brain received streptococcus pneumoniae injection, expression of Occludin began to decrease at 24 h and touch the bottom at 48 h,then increase at the 5th day, but still remained lower than that in control group, which indicated statistical difference (P < 0.05). Conclusions Expression of Occludin in the models of bacterial meningitis decreased firstly and then increased regularly. It suggests that Occludin plays a protective role during the development of infectious brain edema.

Objective To compare the efficacy and toxicities between preoperative concomitant boost intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal RT (3-DCRT) for locally advanced rectal cancer.Methods A prospective study from May 2010 to May 2015.A total of 130 patients with histologically confirmed,newly diagnosed,locally advanced rectal adenocarcinoma (cT3-T4 and/or cN +) located within 10 cm from the anal verge were included in this study.The patients were divided into IMRT and 3D-CRT groups by random number table method.Sixty-six patients were treated with IMRT,and the other sixty-four patients were treated with 3-DCRT.In the IMRT group,the prescription dose was 1.8 Gy/fraction to 45 Gy to the pelvis and 2.2 Gy/fraction to 55 Gy to the gross tumor volume simultaneously.The 3D-CRT prescription was 45 Gy in 25 fractions to the pelvis.Capecitabine (1 650 mg· m 2 · d-1) was given twice daily from days 1 to 14 and days 22 to 35 during RT in both arms.Total mesorectal excision (TME) was scheduled 6-8 weeks after the completion of chemoradiation.Results There were no significant differences in age,gender,tumor location,pathological differentiation degree and clinical stage between the two groups.Two patients withdrew from the study:one for grade 3 radiation dermatitis in IMRT group and the other for grade 3 fatigue in 3D-CRT.There was no significant difference in hematologic or nonhematologic toxicities between the two groups.No grade 4 or 5 toxicity was observed in either group.Compared with conformal radiotherapy,IMRT did not increase the difficulty of surgery.No significant difference was found in type of surgery or postoperative complications between the two groups.The rate of tumor regression grade (TRG) 4 (pathologic complete response,pCR) was 22.7％ for IMRT and 15.6％ for 3D-CRT,respectively(P ＞ 0.05).The rate of both TRG4 and 3 was 42.4％ for IMRT and 25.0％ for 3D-CRT,respectively (x2 =4.406,P=0.036).Conclusions Neoadjuvant concomitant boost IMRT is feasible and has a higher histopathological regression for patients with locally advanced rectal cancer.Trial registration Chinese clinical trial registry,ChiCTR-IN R-16008004.

Objective To compare the efficacy of adrenocorticotrophic hormone (ACTH) and methylprednisolone on the rat models of infantile spasms (IS).Methods The SD rats on postnatal 10 day (P10) were divided into blank group (n =18),control group (n =18) and model group (n =110) according to the random number table method.The rats of model group were prepared by adopting prenatal stress exposure and N-methyl-D aspartate (NMDA) injection.In the model group,after inducing epileptic seizures,the rats were divided into different groups (18 rats in each group) according to the random number table method as following:model group Ⅰ (subcutaneous injection ofACTH,50 IU/kg,at P10:14:00,21:00;P11,P12:7:00,14:00,21:00;P13:7:00),model group Ⅱ (subcutaneous injection of 9 g/L saline),model group Ⅲ (intraperitoneal injection of methylprednisolone,60 mg/kg,at P11,P12,P13:9:00,once per day),model group Ⅳ (intraperitoneal injection of 9 g/L saline) and model group Ⅴ (positive control group,with no drug or saline injection).Three days later,epilepsy was induced again,and the rats of model group were intraperitoneally injected with NMDA (12 mg/kg) at P13 (10:00).The rats of control group were injected intraperitoneally with same volume of 9 g/L saline,but the rats of blank group were not treated.Behaviors of rats with epilepsy seizures were observed and epilepsy scores were given.The expression of corticotropin-releasing hormone (CRH) in the hypothalamus of each group was detected by using immunohistochemistry and fluorescence quantitative polymerase chain reaction.The learning and memorizing capacity of the rats were measured by Y-maze experiment.Results There was no death in the model group after the onset of seizure.In the model group Ⅰ,13 cases were attacked(72.22％),and 14 cases were attacked in the model group Ⅲ (78.78％).The level of attack was decreased.The buckling state was not observed in model group and Ⅲ,but the latency period of epilepsy was prolonged and the epilepsy scores were significantly decreased.There were no significant differences of onset latency [(2 369.38 ± 628.70) s vs.(1 922.93 ± 462.36) s] and epilepsy score [(2.15 ± 1.14) scores vs.(2.07 ± 0.83) scores] between the 2 groups (all P ＞ 0.005).The rats of model group Ⅱ,Ⅳ,Ⅴ were all attacked completely and presented buckling state.There was no onset or death in blank group and control group.The number of CRH positive cells and CRH mRNA relative expression of each model group were higher than those in the blank group and control group.The number of CRH positive cells and CRH mRNA expression of model group Ⅰ and Ⅲ were lower than those in model group Ⅱ,Ⅳand Ⅴ,and the differences were significant (all P ＜ 0.002 4).There was no significant difference in the number of CRH-positive cells(39.12 ± 5.98 vs.41.48 ± 7.61) and CRH mRNA relative expression (1.92 ± 0.16 vs.2.06 ± 0.39) between model group Ⅰ and Ⅲ (all P ＞ 0.002 4).No significant difference was found between blank group and control group,or among model group Ⅱ,Ⅳ and Ⅴ (all P ＞ 0.002 4).There were no significant differences in the learning capacity among all groups (F =2.196,P ＞ 0.002 4).The correct response rate after 24 hours of the model group was lower than the blank group and control group,and ACTH and methylprednisolone pretreatment did not influence the memorizing capacity (P ＞ 0.002 4).Conclusion The effect of pretreatment of ACTH is similar to that of methylprednisolone in the rat model of IS.

Objective: To investigate the changes and clinical significance of vascular endothelial (VE)-cadherin and procalcitonin (PCT) in serum and cerebrospinal fluid (CSF) of children with viral encephalitis or bacterial meningitis(BM). Methods: A total of 42 cases of children with viral encephalitis(viral encephalitis group), 36 cases of children with BM(BM group), and 20 cases of children with non-nervous system injury(control group) were selected from September 2016 to June 2018 at the Third Hospital of Zhengzhou University.The serum and CSF levels of VE-cadherin and PCT levels of the 3 groups were detected by using enzyme-linked immunosorbent assay. Results: The levels of VE-cadherin in the serum of viral encephalitis group, BM group and control group at the acute phase were (5.60±1.17) mg/L, (7.08±1.01) mg/L and (2.52±0.68) mg/L respectively, and the levels of VE-cadherin in CSF of viral encephalitis group, BM group and control group were (6.00±1.09) mg/L, (6.97±1.11) mg/L and(1.93±0.88) mg/L, respectively.The levels of PCT in the serum of viral encephalitis group, BM group and control group at the acute phase were (0.26±0.11) μg/L, (0.82±0.17) μg/L and (0.27±0.13) μg/L, respectively, and the levels of PCT in the CSF of viral encephalitis group, BM group and control group were (0.25±0.11) μg/L, (0.72±0.14) μg/L, (0.28±0.17) μg/L, respectively.As a result, the levels of VE-cadherin and PCT in the serum and CSF of BM group showed significant increase, compared with viral encephalitis group and control group in the acute phase(F=124.94, 163.21, 151.62, 127.37, all P<0.01). The levels of VE-cadherin in the serum and CSF of viral encephalitis group were also significantly higher than that of control group (all P<0.01), but there was no difference between viral encephalitis group and control group about the levels of PCT in the serum and CSF (all P>0.05). The levels of VE-cadherin in the serum of viral encephalitis group and BM group after treatment were (2.34±0.81) mg/L and (2.67±1.29) mg/L, and were(2.55±0.92) mg/L and(2.39±0.74) mg/L in the CSF.The levels of PCT in the serum of viral encephalitis group and BM group after treatment were (0.25±0.11) μg/L, (0.30±0.17) μg/L, and the levels of PCT in the CSF of viral encephalitis group and BM group were(0.22±0.10) μg/L and (0.27±0.12) μg/L.After effective treatment, the levels of VE-cadherin, PCT in serum and CSF of BM group and viral encephalitis group were almost equal, and the difference was not statistically significant(F=1.83, 0.76, 2.72, 3.89, all P>0.05). In the receiver operating characteristic (ROC) curve, the area under the ROC curve of VE-cadherin in serum and CSF was 0.896 and 0.912, and was 0.670 and 0.668 of PCT respectively. Conclusions VE-cadherin may be involved in the early stage of intracranial infection, and it may be helpful in differentiation of virus or bacterial infection with PCT.VE-cadherin has a good diagnostic value for intracranial infection.