Objective To investigate the efficacy of treatment on malignant intracranial gliomas with the chemotherapy of intracerebral implantation of 5-Fu biodegradable polymers combined with radiotherapy of interstitial implantation of 125Ⅰ after microsurgery resection. Methods Sixty-five patients with malignant intracranial gliomas who had underwent craniotomy microsurgical resection were intraoperatively implanted in the tumor bed around with 5-Fu biodegradable polymers and 125Ⅰ seeds. After first implantation (3 months to 1 year), stereotactic guided implantation was carried out 1 or 2 times again. The patients were followed up for 6-36 months to observe the efficacy, edema and adverse reactions, compared with follow-up of 40 patients with malignant intracranial gliomas treated by conventional radiotherapy and chemotherapy after microsurgical total resection. Results Within 1 week after the implantation the patients had headache significantly, WBC of cerebrospinal fluid was increased to some degrees, and edema was obvious compared with surgery alone. All patients were treated and discharged. Forty-four patients were completely followed-up and the survival period was significantly longer. Within 6 months, 1 year, 2 years and 3 years, there were 4 cases (9.1 %) of recurrence and no case of death, 14 cases (31.8 %) of recurrence and no case of death, 20 cases (45.5 %) of recurrence and 12 cases (27.6 %) of death and 29 cases (65.9 %) of recurrence and 20 cases(45.5 %) of death, respectively. No obviously adverse reactions were found and the quality of life was significantly improved. Conclusion Microsurgical total resection is the key of the treatment. It is an alternative treatment of human malignant gliomas in the safe and effective way that the local chemotherapy of intracerebral implantation of 5-Fu biodegradable polymers combined with local sensitivity radiotherapy of interstitial implantation of 125Ⅰ after microsurgical resection.

Objective To investigate the CT and MRI features and morphology classification of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B).Methods A total of 18 patients with IPMN-B proved by pathology were retrospectively analyzed.Out of 18 patients,16 patients underwent enhanced and non-enhanced CT,13 underwent contrast enhanced MR,and 11 out of 13 underwent both CT and MRI.IPMN-B was classified into 4 types:typical IPMN-B,cystic-forming IPMN-B,non-tumor IPMN-B and invasive IPMN-B,according to imaging findings and gross pathological findings.Results Typical IPMN-B (9 cases):tumors were distributed along the bile ducts,both upstream and downstream bile ducts were obviously dilated.Cystic-forming IPMN-B (5 cases):single or multiple tumors were found in aneurysmal dilatation of bile ducts.Non-tumor 1PMN-B (2 cases):no mass was found in the widely dilated bile ducts with smooth bile duct wall.Invasive IPMN-B (2 cases):tumors protruded into the dilated bile ducts causing jagged wall of bile duct,with accompanied abnormal density or signal intensity outside the bile ducts.Bile duct dilatations were shown in all 18 cases,and tumors were shown in 16 cases.In 2 cases no mass was displayed in widely dilated bile ducts.CT density of the tumor was lower than that of liver parenchyma,and higher than that of the bile and intraductal mucin.Signal intensity of the tumor was higher than that of stones,and lower than that of bile and intraductal mucin at MR T2WI.All tumors showed high intensity on DWI.Tumors showed mild to moderate enhancement after injection of contrast agent,CT density or signal intensity of the tumors were lower than that of the liver parenchyma during all three phases of contrast-enhanced CT or MRI.Conclusion IPMN-B has some specific CT and MR imaging features,which are helpful for the diagnosis and classification of IPMN-B.

Objective To observe the short-term curative effect and safety of recombinant human erythropoietin(rHu-EPO)on patients with primary brain stem injury. Methods Sixty patients with primary brain stem injury were recruited at Liaocheng People' Hospital from July 2010 to July 2013. All cases were randomly divided into EPO group and control group. The patients in EPO group were injected subcutaneous with rHu-EPO five times at dose of 6 000 U,while patients in the control group were treated with placebo in 2 weeks. All other conventional treatments were the same. NIHSS score and GOS score were evaluated in two weeks and three months respectively. Moreover,blood pressure and hemoglobin were also measured. Results NIHSS score in EPO group was 11. 37 ± 7. 78,significant higher than that of control group after two weeks(19. 41 ± 8. 26,P = 0. 019). GOS score in EPO group was also significant differences in two groups after three months (Z = - 2. 367,P = 0. 009 ). However,no significant difference was observed in the followed-up blood tests. Conclusion Recombinant human erythropoietin could be the exact nerve protective effect,and might be an effective therapy for patients with primary brain stem injury.

Objective To observe the curative effect and safety of operation combined with recombinant human erythropoietin on patients with severe intracerebral hemorrhage. Methods Seventy-six surgery patients with severe intracerebral hemorrhage were divided into rHu-EPO group (40 cases) and control group (36 cases) by random digits table method. The rHu-EPO group was injected subcutaneously with rHu-EPO, and the control group was treated with placebo. Neurologic impairment (National Institute of Health Stroke Scale, NIHSS score) and activities of daily living (Barthel index) were evaluated 1 month and 3 months after treatment respectively. Moreover, blood pressure, hemoglobin, and adverse reaction were also observed. Results The scores of NIHSS and Barthel index in two groups before treatment had no significant differences (P>0.05). One month and 3 months after treatment, the scores of NIHSS and Barthel index in rHu-EPO group were significantly better: (12.27±5.26) scores vs. (15.36±4.34) scores and (8.17±2.40) scores vs. (13.90±2.54) scores, (54.36±21.87) scores vs. (43.47±20.29) scores and (69.71±23.08) scores vs. (52.56±21.32) scores, there were statistical differences(P<0.05). There were no statistical differences in systemic blood pressure, diastolic blood pressure and hemoglobin between 2 groups (P>0.05). There were no apparente adverse reactions such as fever, erythra, itching and deep venous thrombosis in rHu-EPO group. Conclusions Operation combined with recombinant human erythropoietin has nerve protective effect, and might be an effective and safe therapy target in severe intracerebral hemorrhage.

ObjectiveTo explore the short-term curative effect and safety of autologous bone marrow mesenchymal stem cells transplantation in patients with primary brain stem injury.MethodsFifty-four cases with primary brain stem injury were hospitalized during Jul.2007 to Jul.2010 at Liaocheng Brain Hospital,Shandong Province.All cases were randomized into transplantation group( n =30)or control group( n =24 ).The transplantation group was treated with autologous bone marrow mesenchymal stem cell transplantation by subarachnoid space injection (n =30).The control group were selected from primary brain stem injury patients without stem cell transplantation who were hospitalized at the same period with patients from the transplantation group.Respectively,National Institutes of Health Stroke Scale (NIHSS) score was employed to evaluate the condition of patients in the two groups one month after treatment,and Glasgow Outcome Scale (GOS) score was used to evaluate curative effects of the two groups at sixth months after treatment.Meanwhile,some other parameters were observed,including blood routine,clotting mechanisms,biochemicalitemsand tumor markers.ResultsThere was significant difference between the transplantation group and the control group in N IHSS score at one month after treatment [ ( 10.86 ± 7.48) vs.( 18.26 ± 8.74),t =2.681,P ＜ 0.05 ].GOS score was significantly different( Z =2.306,P ＜ 0.05 ) between the transplantation group and the control group at sixth month after transplantation.There was no significant difference between the two groups in the blood examination results during the followed-up period.Conclusion Autologous bone marrow mesenchymal stem cells transplantation is confirmed to be an effective and safe therapy in patients with primary brain stem injury in the short-term.Further evaluation still needs for its long-term efficacy on primary brain stem injury

ObjectiveTo compare the short-term efficacy and safety of autologous bone marrow mesenchymal stem cells transplantation on patients with early spinal cord injury by subarachnoid injection and by intravenous injection.MethodsNinety-six patients with early spinal cord injury were hospitalized and treated from November 2006 to March 2010.Thirty-eight cases (subarachnoid transplantation group) got transplantation by subarachnoid injection,32 cases (intravenous transplantation group) got transplantation by intravenous injection,26 cases (control group) were hospitalized in the same period but not transplanted.The motor and sensory functions of all three groups were evaluated according to the score standard developed by American Spinal Injury Association(ASIA) before treatment and at the first,the third,the sixth month after treatment.Meanwhile,routine blood test,coagulation,biochemical items and tumor markers were also examined in follow-up.ResultsThe motor and sensory function of three groups had different degree of recovery at the first month after treatment,and sensory function recovered muchsignificantly,but the comparison among three groups had no statistical significance.The scores of motor function increased in three groups at the third month after treatment,but still had no statistical significance (P＞ 0.05).The scores of sensory function of subarachnoid transplantation group[(130.9 ±41.6) scores] and intravenous transplantation group [ (131.2±22.7 ) scores ] increased obviously,and had significant difference compared with control group [ (109.3±36.4) scores] (P ＜ 0.05),but there were nosignificant difference between subarachnoid transplantation group and intravenous transplantation group (P ＞ 0.05).The scores of sensory and motor function of control group didn't increase obviously at the sixth month after treatment,while the scores of subarachnoid transplantation group and intravenous transplantation group gradually improved and had statistical significance compared with control group(P ＜ 0.05).The scores of sensory function was higher in subarachnoid transplantation group[ (151.6±46.9) scores ] than that in intravenous ransplantation group [(134.6 ±40.7) scores] (P ＜0.05).There were no obvious abnormality in the results of followed-up examination.Conclusions The safety and short-term efficacy of autologous bone marrow mesenchymal stem cells transplantation in treating early spinal cord injury by subarachnoid injection and intravenous injection is certified.The subarachnoid injection is better than intravenous injection,but the long-term efficacy need furter study.

Objective To study the management of vascular injury.Methods Retrospective analysis was made on the clinical data of 59 cases of vascular injury,including 55 cases of vascular injury in neck and(extremity) and 4 cases of portal vein and vena cava injury.Among them,21 cases had femoral artery injury with infection and 4 cases had vascular injury due to intervention therapy.All patients with vascular wound of extremity or neck had undergone hemostasis by compression and antishock treament before hospital admission.All cases of femoral artery injury with infection underwent hemostasis by arterial ligation and incision and(drainage) of abscess.Vascular anastomosis was performed in 11 cases,vascular grafting in 12 cases,and(vascular) repair in 14 cases.Results There were 2 deaths.5 cases had amputation(including a case of(femoral) embolism due to intervention trerapy).Postoperative intermittent claudication,decreased skin(temperature) and other signs of ischemia occurred in 21 cases of femoral artery injury with infection,but none developed limb gangrene. The other cases were discharged in good health.Conclusions In the treatment of vascular injury,wound hemostasis and antishock treatment should be done first to save the patient′s life and the management of the vascular injury depends on the situation,with the aim to try by all means to save the extremity.Vascular reconstruction is the main method for treatment of vassular injury.Vascular ligation can be done in cases of femoral artery injury with infection.

Objective To summarize the experience in the diagnosis and treatment of hepatic trauma. Methods The clinical data of 260 patients with hepatic trauma admitted from January 1988 to December 2007 were retrospectively reviewed with regard to degree of trauma, treatment methods, therapeutical effects, complications and SO on. Results One hundred and fifty-three eases were treated by operative management,1 07 cases by nonoperative management.236 cases were cured,24 cases died,and the case fatality rate was 10.2%.There were no death among 139 patients with hepatic trauma grades Ⅰ～Ⅱ,22 death among 119 grades Ⅲ～Ⅴ patients, all death of 2 in grade VI, which demonstrated the correlation between death and hepatic trauma grade was statistically significant. Complications appeared in 82 eases, mainly including Secondary hemorrhage, abdominal infection and so on. Conclusions Nonoperative management is suitable for hepatic trauma with stable hemodynamics. Operative management is rapidly selected when the hemodynamics aren't stable. The cooperation of many specialities can enlarge the application of nonoperative management and decrease complications.

Objective To observe changes in relative pituitary hormones after severe traumatic brain injury (STBI) in children and to investigate the short-and long-term effects of mild hypothermia on pituitary function.Methods Included for this study were 81 children who had been admitted to the Brain Hospital of Liaocheng People's Hospital from June 2011 to January 2015 for STBI and abnormal secretion of pituitary-related hormones.They were divided by the wishes of patients and their families into 2 groups,subjected to mild hypothermia treatment (n=42) or conventional treatment (n=41).The levels were examined of growth hormone (GH),prolactin (PRL),adrenocorticotropic hormone (ACTH),free triiodothyronine (FT3),free thyroxine (FT4) and thyroid stimulating hormone (TSH) for both groups unpon admission and in the moming of 1,3,5,7 and 14 days after injury.At 6 months after injury the patients were followed up for Glasgow Outcome Score (GOS) and levels of pituitary-related hormones.Results Of the 83 patients,disturbance of one single hormone was found in 31 (30.10％) and disturbance of 2 or more hormones in 52 (50.48％).The top 3 hormones disturbed were PRL,ACTH and GH.On days 3,5 and 7 after injury,the levels of PRL and ACTH in the mild hypothermia treatment group were significantly lower than in the conventional treatment group (P＜0.05).On day 3 after injury,the level of FT3 in the mild hypothermia treatment group was significantly lower than in the conventional treatment group (P＜0.05).At 6 months after injury,the GOS score for the conventional treatment group was 3.04±0.38,significantly lower than that for the mild hypothermia treatment group (4.56±0.62) (P＜0.05).The incidence of hypopituitarism in the hypothermia treatment group (16.67％) was significantly lower than in the conventional treatment group (46.88％) (P＜0.05).Conclusions Incidence of pituitary dysfunction is high in children following severe traumatic brain injury.Mild hypothermia treatment can effectively alleviate early-stage parasecretion of pituitary hormones,and decrease the incidence of later pituitary dysfunction.

Objective:To explore the efficacy and safety of mechanical thrombectomy (MT) in patients with minor stroke with large vessel occlusion (LVO).Methods:Twenty-three patients with minor stroke with LVO, admitted to our hospital from January 2017 to July 2019, were consecutively collected in our study; patients with contraindications of intravenous thrombolysis should be treated with direct thrombectomy, and the left were given bridging therapy (intravenous thrombolysis combined with MT). NIHSS scores were used to assess the degrees of neurological impairment at admission, and 12 h and 7 d after treatment. Vascular recanalization was assessed by modified cerebral infarction thrombolysis (mTICI) grading, with grading 2B-3 defined as successful recanalization. The prognoses 90 d after treatment were assessed by modified Rankin scale (mRS), and mRS scores≤2 was classified as having good prognosis. Safety indicators included symptomatic intracranial hemorrhage, incidence of complications, and mortality 90 d after treatment.Results:Twenty-two patients had successfully recanalization; 19 patients had mTICI grading 3 and 3 patients had grading 2B. The NIHSS scores were 3 (2, 5) at admission, 2 (2, 3) 12 h after treatment, and 2 (1, 2) 7 d after treatment, with significant difference ( χ2=14.028, P=0.001); NIHSS scores 12 h and 7 d after treatment were significantly lower than those at admission ( P<0.05). Sixteen patients (69.6%) enjoyed good prognosis and 7 patients (30.4%) had poor prognosis. In terms of safety, two patients had symptomatic intracranial hemorrhage,10 had systemic complications, and one died during 90-d of follow-up. Conclusion:MT is effective and safe in minor stroke patients with LVO.