Objective To investigate the effect of endovascular cooling on perioperative brain injury in patients undergoing intracranial aneurysm resection.Methods Sixteen Hunt-Hess Ⅱ -Ⅳ patients of both sexes aged 18-64 yr undergoing intracranial aneurysm resection were randomly divided into 2 groups(n = 8 each): mild hypothermia group(group MHT)and nonnothermia group(group NT).A CL-2295AE catheter was placed in the femoral vein after anesthesia induction to perform endovascular cooling.Bladder temperature was reduced to 34 ℃ and maintained for 24 h.The hemodynamic parameters were recorded during and after operation.Coagulantion function and electrolyte levels were determined at 24 h before operation and at 12 and 24 h after operation.The serum neuron-specific enolase(NSE)and S100B concentrations were determined at 1 d before operation and at 1,3and 7 d after operation by ELISA.Neurological function was assessed with GOS grade at 1 and 3 months after operation.Results There was no significant difference in hemodynamic parameters,electrolyte levels(Na+ ,K+ ,Ca2+)and coagulantion function(PT,APTT,Plt)between the two groups(P ＞ 0.05).The GOS grade was significantly higher,while serum NSE and S100B concentrations were significantly lower after operation in group MHT than in group NT(P ＜ 0.05).Conclusion Endovascular cooling(34℃,24 h)can reduce the brain injury safely and effectively during the perioperative period in patients undergoing intracranial aneurysm resection and improve the prognosis.

Objective To analyze the correlation between the position and the removal extent of the tumor and the postoperative sodium metabolic disturbance in patients with craniopharyngiomas. Methods Retrospective analysis of the postoperative sodium metabolic disturbance in craniopharyngioma patients admitted from Feb.2006 to Oct. 2010 was performed. Results In the 30 casese,10 cases occurred hypernatremia,9 with hyponatremia and, 2 with fluctuating hyponatremia and hypematremia. One cases died in the population. No sodium metabolic disturbance occurred in patients with craniopharyngiomas located in the interasellar region, whereas 8 occurred in the inter and suprasellar region(61.5% ,8/13) , and 3 occurred post and beside assellar region(60.0% ,3/5) , 10 occurred in the third and lateral cerebral ventricle (100.0%, 10/10). Sodium metabolic disturbance occurred in 15 cases(62. 5% ) among 24 cases underwent total resection,in all 4 cases underwent sub-total resection (100.0% ) ,and all 2 cases underwent paritical resection ( 100. 0% ). The degree of resection was not correlated with Sodium metabolic disturbance(x2 = 3.21 ,P>0.05). Conclusion Sodium metabolic disturbance after craniopharyngioma surgery may be correlated with the position of tumor, but not correlated with the removal extent.

Objective To evaluate the effects of long-term intraperitoneal flurbiprofen axetil on the gastric mucosa and liver function in rats with bone cancer pain (BCP).Methods Thirty-six healthy female Sprague Drawley rats,weighing 200-250 g,were randomly divided into 6 groups (n =6 each):BCP + normal saline group (group BCP),BCP + flurbiprofen axetil 10 mg·kg-1 ·d-1 group (group BF10),BCP + flurbiprofen axetil 25 mg· kg-1 · d-1 group (group BF25),BCP + flurbiprofen axetil 50 mg· kg-1 · d-1 group (group BF50),flurbiprofen axetil 50 mg·kg-1 ·d-1 group (group F50),and sham operation + normal saline group (group S).BCP was induced by injecting Walker 256 mammary gland cancer cells into the bone marrow of the left tibia.In BCP and S groups,paw withdrawal threshold to mechanical stimulation (MWT) was measured at 1 day before inoculation of cancer cells (T0) and 3,5,7,10,14,17 and 21 days after inoculation (T1-7).The corresponding doses of flurbiprofen axetil or normal saline were administered intraperitoneally twice a day at 12 h intervals starting from T7 for 7 consecutive days.Blood samples were obtained from the abdominal aorta to determine the levels of alanine transaminase (ALT),aspartate transaminase (AST),total protein (TP),and albumin (ALB) in serum.The rats were then sacrificed and stomach and livers were removed for microscopic examination of pathological changes.The ulcer index (UI) was calculated.Results Compared with group S,MWT was significantly decreased at T2-7,no significant changes were found in the other parameters mentioned above in BCP group,the serum levels of TP and ALB were decreased in BF50 and F50 groups,and UI was increased in BF25,BF50 and F50 groups.Compared with BCP group,the serum levels of TP and ALB were decreased in BF50 and F50 groups,and UI was increased in BF25,BF50 and F50 groups.No significant changes were found in each parameter between BF50 and F50 groups.Microscopic examination showed that the epithelium of gastric mucous membrane became defect in partial region of the stomach and showed damage to gastric glands in the deep part and massive inflammatory cell infiltration in BF50 and F50 groups.Microscopic examination showed mild damage to the integrity and continuity of gastric mucosa and did not show any abnormality in livers in BF25 group.Conclusion Long-term intraperitoneal flurbiprofen axetil can cause damage to the gastric mucosa dose-dependently and has no effect on liver function in rats with BCP.

Objective To study the liver histological changes in chronic hepaitits B (CHB) patients with normal serum alanine aminotransferase (ALT) levels and the related factors. Methods Six hundred and thirty-two CHB patients with normal ALT levels had undergone ultrasound guided percutaneous liver biopsies. All specimen were examined by HE staining, collagen fiber Masson staining and immunohistochemical staining for hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg). The Knodell inflammation score and Ishak fibrosis score were both calculated and the relationship with age, serum levels of ALT and hepatitis B virus (HBV) DNA, hepatic expressions of HBsAg and HBcAg were analyzed. The means between two groups were compared by t test and those among groups were compared by one-factor analysis of variance and q test. Enumeration data were analyzed by x2 test. Results Among 632 CHB patients with normal ALT levels, 167 (26.4%) showed moderate necrotic inflammation in liver tissues and 26 (4.1%) showed severe necrotic inflammation; 217 (34. 3 % ) showed moderate fibrosis and 52 (8. 2 % ) showed severe fibrosis (cirrhosis). The Knodell inflammation score and Ishak fibrosis score in high ALT group were higher than low ALT group, those in female high ALT group were higher than male high ALT group and those in patients ＞ 40 years old were higher than ≤20 years old (q= 19.63, P＜0. 05). The liver injuries in patients with active HBV replication were more severe than those with undetectable HBV DNA levels (Knodell score, q=3.87, 2.87, 6.34; Ishak score, q=2.64,2. 64,5.54, all P＜0. 05),while there was no significant difference between patients with high levels and low levels of HBV DNA (F= 1.35, P＞0. 05). There was no significant difference between expressions of HBsAg (F= 1.65,0. 73,respectively; both P＞0. 05) and HBcAg in liver tissues and Knodell inflammation score and Ishak fibrosis score (F=0. 17, 1.29, respectively; both P＞0. 05). Conclusions Liver biopsies should be considered in CHB patients with normal ALT levels and detectable HBV DNA levels, especially those ＞ 40 years old and with ALT of (0.75-1.00) × upper limits of normal (ULN).

BACKGROUND: Adequate preparation of donors and recipients prior to living-related donor renal transplantation, short warm and cold ischemia time for donor kidney, good histocompatibility of human leukocyte antigen match, and low postoperative rejection incidence provide feasibility for use of low-dose immunosuppressive agents after living-related donor renal transplantation. OBJECTIVE: To investigate the safety and effectiveness of low-dose calcineurin inhibitors (CNI), an immunosuppressive agent, in living-related donor renal transplantation. METHODS: A total of 38 recipients who underwent living-related donor renal transplantation at the Center of Renal Transplantation of the First Affiliated Hospital of Nanjing Medical University from January 2006 to June 2008 were randomized for treatment with mycophenolate mofetil (750 mg twice a day), prednisone, and either standard-dose CNI (n=18) or low-dose CNI (n=20) during 12 months post-transplantation. Ciclosporin A was given orally (starting dose, 6 and 4 mg/kg per day, respectively) in two divided doses to achieve the 12-hour whole blood concentration as measured by fluorescence polarization immunoassay. The starting dose of tacrolimus was 0.12 and 0.08 mg/kg per day respectively, and its whole blood concentration was measured by enzyme-multiplied immunoassay technique. After transplantation, patients were followed up. Renal function, pulmonary infection, liver dysfunction, and CNI nephrotoxicity at different time periods were compared between different regimens. RESULTS AND CONCLUSION: During 12 months post-transplantation, patient death occurred in one of 18 patients (5.6%) in the CNI standard-dose group and none of 20 patients (0%) in the CNI low-dose group. There was no significant difference in renal function and acute rejection between CNI standard-dose and CNI low-dose groups (P > 0.05). The incidence of liver dysfunction and CNI nephrotoxicity was significantly lower in the CNI low-dose group than in the CNI standard-dose group (P < 0.05). In addition, a low-dose CNI regimen helped recipients to lessen the economic burdens. These findings indicate that it is effective, safe and economical to use a low-dose CNI regimen in living-related donor renal transplantation.

Objective The aim of this study was to evaluate the optimal time for decompression in a 24-hour lasting porcine model.Methods After baseline data were recorded,24 pigs were randomly allocated into three groups as follows:one SAP-alone group,and two SAP + ACS groups (decompression at 6 and 12 hours,respectively).We used a N2 pneumoperitoneum to increase the intra-abdominal pressure to 25 mmHg and retrograde intra-ductal infusion of sodium taurocholate to induce severe acute pancreatitis (SAP).Systemic hemodynamic profiles,urine output,systemic oxygenation,and serum biochemical parameters of the animals were obtained.Results After induction of ACS,the hemodynamics and oxygenation of the study animals deteriorated significantly.The survival time of the 12-hour group was significantly shortened (P =0.008 vs.6 hours).Early decompression (6 h) restored systemic hemodynamics,oxygenation,organ function,and inflammatory intensity to a level comparable to that of the SAP-alone group.In contrast,animals in 12-hour group developed more severe hemodynamic suppression,oxygenation and organ dysfunction and inflammatory process.For instance,the cardiac output levels in the three groups were 2.70 ±0.50 for the SAP group,2.75 ±0.48 for the 6 hour-group and 2.19 ±0.43 for the 12 hour-group.Conclusion Early decompression could significantly reduce the mortality in a porcine model of SAP incorporating ACS,and also improve systemic hemodynamics,organ function and inflammatory intensity.

Objective To study the effect of hydrogen sulfide (H2S) on acute cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) and explore its mechanism.Methods (1) A total of 48 adult male SD rats were randomly allocated into a normal group,a SAH group,a low dose NaHS group and a high dose NaHS group (n=12).Rat models of SAH were induced by injecting autologous blood into the prechiasmatic cistern.Rats in the later two groups were given 0.7 mg/kg and 2.8 mg/kg NaHS,respectively,0.5 h after modeling.Neurological scale scores were assessed 24 h after modeling;HE staining,TUNEL and immunohistochemical double-staining were employed to detect the morphology of approximated A2 blood vessel of anterior cerebral artery (ACA),tube wall thickness and endothelial cell apoptosis,respectively.(2) Brain microvascular endothelial cells (BMECs) were chosen and divided into blank control group,100 μmol/L OxyHb prevention group,25 μmol/L NaHS pretreatment group and 100 μmol/L NaHS pretreatment group.The cells were collected and observed 24 h after treatment,and then,the number of endotheliocytes was counted,and the Caspase-3 protein expression was detected by Western blotting.Results (1) The neurological scale scores (8.5±2.4) were significantly lower,the vessel wall ([43.5±6.2] μm) was significantly thickened,the lumen area ([30 488±938) μm2) was obviously reduced,and the number of TUNEL positive cells ([36.51±11.45]％) was remarkably increased in the SAH group as compared with those in the normal group (16.1 ±1.7,[25.8±3.5] μm,[51707± 1422] μm2 and [2.86±0.75]％ in turn,P＜0.05).The neurological scale scores (11.6±1.9 and 15.4±2.3) were significantly higher,the vessel wall ([34.7±3.7] and [31.7±4.6] μm) was significantly thinned,the lumen area ([41 463±1104] and [45 244±1217] μm2) was obviously increased,and the number of TUNEL positive cells ([17.14±5.36] and [8.10±4.62] ％) was remarkably reduced in the low dose NaHS group and high dose NaHS group as compared with those in the SAH group (P＜0.05).The neurological scale scores in high dose NaHS group were significantly higher than those in the low dose group and the number of TUNEL positive cells was signficantly smaller than that in the low dose group (P＜0.05).(2) The number of apoptotic endothelial cells ([40.56±9.85] ％) and the expression of Caspase-3 (0.395±0.122) in OxyHb prevention group were significantly larger/higher than those in the blank control group (P＜0.05).The number of apoptotic endothelial cells and the expression of Caspase-3 in the low dose group ([16.65± 6.35]％ and [0.223±0.083]) and high dose group([14.12±6.65] ％ and [0.208±0.104]) were obviously reduced as compared with those in the OxyHb prevention group,with significant differences (P＜0.05).Conclusion H2S can effectively expand cerebral vasospasm,and its vasoprotective mechanism may be through inhibiting vascular endothelial cell apoptosis.

Objective To compare the clinical effect of the small bone flap craniotomy and traditional craniotomy in the treatment of elderly patients with hypertensive striatocapsular hemorrhage .Methods According to the digital table ,80 patients with hypertensive striatocapsular hemorrhage were randomly divided into control group and treatment group ,40 cases in each group .The treatment group was treated with small bone flap craniotomy ,and the control group was treated with traditional craniotomy .The operative incision length ,intraoperative blood loss ,operation time,hematoma clearance rate,rebleeding rate,GCS score,postoperative pulmonary infection rate and GOS score in the 1 month after treatment were compared between the two groups .Results The operative incision length , intraoperative blood loss, operative time, GCS score after 1 week, pulmonary infection of the treatment group were (7.0 ±1.5)cm,(100 ±35)mL,(1.5 ±0.6)h,(12.5 ±1.4),25.0％,respectively,which of the control group were (18.0 ±4.5)cm,(500 ±85) mL,(2.2 ±0.8) h,(10.5 ±1.1),47.5％,respectively,the differences between the two groups were statistically significant (t=303.791,P=0.000;t=244.467,P=0.000;t=24.366,P=0.003;t=3.294,P=0.031;χ2 =4.381,P=0.036).The hematoma clearance rate,rebleeding rate of the treatment group were 90.0％,7.5％,respectively,which of the control group were 85.0％,10.0％,respectively,there were no statistically significant differences between the two groups (χ2 =0.457,P=0.499;χ2 =0.157,P=1.692).The prognosis of the patients in the treatment group was significantly better than those in the control group (Z=-2.022,P=0.043). Conclusion The small bone flap craniotomy in the treatment of hypertensive striatocapsular hemorrhage has the advantages of less trauma , shorter operative time , less intraoperative bleeding , high hematoma clearance rate , low rebleeding rate,low complication rate and good prognosis .

According to the locations of main hematomas,60 patients with hypertensive basal ganglia hemorrhage were surgically treated through different approaches from June 2014 to September 2017.Thirty six cases with anterior hematoma near the Sylvian point were treated through transsylvian-transinsular approach,24 cases with the posterior hematoma far from the Sylvian point were treated through translower-rolandic-point (transLRP) transinsular approach (n =11) or transsuperior-temporal-sulcus (transSTS) transinsular approach (n =13),respectively.All patients were followed up for at least 6 months and evaluated by Glasgow Outcome Scale.Fourteen patients showed good recovery,25 patients showed moderate disability,18 patients showed severe disability,one patients showed vegetative survival and two patients died.

Objective To investigate clinical application of lateral supraorbital approach in microsurgery for tuberculum sellae meningioma.Methods A retrospective analysis was performed of the 46 patients with tuberculum sellae meningioma who had received microsurgery at Department of Neurosurgery,The First Affiliated Hospital to Soochow University from January 2010 to September 2017.Of the 46 patients,the lateral supraorbital approach was applied in 18 and the pterional approach in 28.The excision of tumor,operation time,hospital stay and visual improvement were compared between the 2 operative approaches.Results There was no significant difference in tumor excision rate between the patients using the lateral supraorbital approach and those using the pterional approach (P＞0.05).The operation time and hospital stay for the patients using the lateral supraorbital approach were significantly less than for those using the pterional approach (P＜0.05).Of the 12 cases with preoperative visual deterioration in the former patients,5 obtained no obvious visual change but 7 visual improvement;of the 23 cases with preoperative visual deterioration in the latter patients,9 obtained no obvious change,12 visual improvement and 2 further visual deterioration.Conclusion Neuro-microsurgery via the lateral supraorbital approach is a safe and mini-invasive treatment for tuberculum sellae meningioma.