Objective To investigate the diagnosis and treatment of multiple spinal intradural extramedullary tumors.Methods Totally 15 patients(11 men and 4 women) with multiple spinal intradural extramedullary tumors were enrolled in this study.The patients aged from 16 to 81 years with a mean of(51.0?21.2) years.The mean course of the disease was(11.0?7.6) months(range:2-27 months).In the patients,no skin neurofibroma or coffee spots were detected;brain MR showed no abnormalities.Enhanced MR revealed totally 46 spinal intradural extramedullary tumors,35 of which ≥0.5 cm in diameter,involving the cervical segment in 1 case,the thoracic segment in 5,and lumbar and sacrum segments in 12.All the patients received tumorectomy via the posterior midline approach.If the tumor was less than 1 cm,hemilaminectomy was performed under a microscope;the tumor was removed completely,while crucial nerves supplying the tumor were conserved as much as possible.When it is difficult to separate the nerves,we freed the roots of the nerves at our best ability,so that to carry out anastomosis of the roots after removing the tumor.Antibiotics and hormone therapy were administered after the operation,and the patients were required to wear neck/waist support brace for 2 months,and practice the back and waist muscles at the meantime.Results Among the 15 cases,total resection of the spinal tumors was performed on 12 patients(33 tumors were removed),of which one patient received anastomosis of the nerve roots.In the other three patients,two were diagnosed as having scattered multiple small neurofibroma or Schwannoma(

Objective The purpose of this study was to evaluate the outcome of surgical treatment for spinal cord tumors. Methods We retrospectively analyzed a series of 660 patients with 676 intra-spinal tumors who were treated surgically from February 1993 to December 2007. The tumors located at the cervical level in 231 patients,thoracic in 202,lumbar in 159,sacral in 9,cervico-thoracic in 16,thoracico-lumbar in 42,and lumbar-sacral in 17. Totally 699 operations were performed,including posterior bilateral laminectomy approach in 599,unilateral laminotomy in 71 and laminoplasty in 6 cases.Besides,23 additional operations via lateral or ventral-lateral were performed for resection of extra-spinal component of dumbbell shaped tumors. Results In this series,Schwannomas and meningiomas were the most common extramedullary tumors accounting for 76.5% of the cases [517/676,rate of total resection: 92.3% (477/517)]. The intra-medullary tumors accounted for 23.5% (159/676),in which astrocytomas and ependymomas were the most often observed [rate of total resection: 67.3% (107/159)]. The peri-operative mortality was 1.7% (11/660). The motor and sensory functions were found to be improved after operation in 77.8% (357/459) and 79.2% (397/501) respectively. The sphincter function was improved in 72.4% (215/297). The rate of pain relief was 93.3% (361/387). The follow-up periods ranged from 0.5 to 15.1 years in 582 patients with an average of 5.9 years;during the period,87.8% (499/568) of the patients had an ASIA impairment scale E neurological function. Conclusions Intra-spinal tumors locate mostly in the subdural-extramedullary space,with a majority are Schwannomas and meningiomas. The widespread application and availability of MRI investigation provide the physician with accurate localization of the lesion thereafter ensure a minimally invasive surgical treatment strategy keeping the stability of the spine while removing the tumors with an satisfactory outcome.

Objective To evaluate the curative effects and complications of synthetic dural substitute (Neuro-Patch) in the surgical treatment of Chiari type I malformation (CMI) complicated with syringomyelia (SM). Methods .Forty patients suffered from CMI with SM were given foramen magnum decompression and duraplasty between June 2002 and June 2004. The duraplasty was performed using either synthetic dural substitute (Neuro-Patch Group, n=20) or autologous fascia lata (Autologous Group, n= 20). Results .Symptoms were improved in 17 patients in both of groups (85.0%) at 6 months postoperatively, and no deterioration of symptoms was seen. Postoperative pyrexia occurred in 12 patients in the Neuro-Patch Group (60.0%) and 9 patients in the Autologous Group (45.0%), without significant differences (?2=0.902,P=0.342). No statistically significant differences were observed between the Neuro-Patch Group and the Autologous Group in the operating time (3.6?0.7 h vs. 3.4?0.4 h; t=1.109,P=0.274), the time to the onset of postoperative pyrexia (7.3?3.4 d vs. 9.4?2.5 d;t=-1.560,P=0.135), the length of duration of postoperative pyrexia (range, 1~19 d vs. 1~8 d, median, 4.5 d vs. 2 d;z=-1.643,P=0.100), the drainage time (1.3?0.5 d vs. 1.2?0.4 d; t=0.230, P=0.820), the drainage volume (range, 15~300 ml vs. 20~250 ml, median, 80 ml vs. 37.5 ml; z=-1.359,P=0.174), the duration of antibiotic administration (15.8?4.8 d vs. 13.7?1.5 d;t=1.260,P=0.223), and the assessment outcomes of curative effects. The length of duration of hormone requirement was longer in the Neuro-Patch Group (12.8?4.1 d) than in the Autologous Group (7.8?3.1 d) (t=3.055, P=0.007). On MRI examinations at 6 postoperative months, no posterior cranial fossa effusion was detected in both of groups. Follow-up checkups for 9 months ~ 2 years in the 40 patients showed delayed infectious granuloma on the wound in 1 patient in the Autologous Group, which was cured by debridement. Conclusions .The Neuro-Patch is a reliable dural substitute for repairing of dural defects in the treatment of CMI associated with syringomyelia.

Objective To discuss the diagnosis and treatment of brain abscesses. Methods A total of 20 patients with brain abscesses from January 1996 to June 2004 were studied.All the patients received a CT scanning,and 8 patients were given an MRI examination(two of them underwent a magnetic resonance spectroscopy).An administration of ceftriaxone in combination with metronidazole was given for 1~9 weeks(mean,3.7 weeks).Surgery was conducted in 8 patients under the guidance of CT scanning or B-ultrasonography,including 3 cases of abscess resection and 5 cases of aspiration and drainage. Results One patient died of ventricle involvement,16 patients were cured without after-effects,and 3 patients were improved but the hemiplegia was left behind.No surgery-related deaths were encountered in the 8 surgical cases.Among 8 patients who complicated with diabetes mellitus,tuberculosis,HIV infection,or kidney transplantation,4 patients were cured;all the remaining 12 patients without co-morbidities were cured.Among 9 patients with lesions closely near the ventricle,5 were cured,while the rest of 11 patients with superficial abscesses were all cured.All the 5 patients with multiple abscesses were cured,and 11 out of 15 patients with solitary lesion were cured. Conclusions Most brain abscesses can be cured by early diagnosis and early drug administration.The magnetic resonance is an important means for early diagnosis,and the stereotactic operation is a favorable surgical treatment.

Objective To evaluate the effect of surgical treatment of hypertensive intracerebral hemorrhage (HICH) through a straight incision and keyhole minimally invasive craniotomy. Methods According to the location of the hematoma revealed by preoperative CT scans, a straight skin incision was made 4～5 cm in length, and then a keyhole craniotomy 2 cm in diameter was performed. The underlying cortex was incised the hematoma was exposed and removed under microscope. Results The hematomas were thoroughly cleared in 17 cases. The clearance rate was 90% in 18 cases and 80% in 4 cases. Re-hemorrhage occurred in 2 cases after operation. A total of 35 cases was followed for 0.5～3 years (mean, 2.1 years). The quality of life was assessed by activity of daily living (ADL) classification, which revealed 9 cases of grade 1, 12 cases of grade 2, 9 cases of grade 3, 4 cases of grade 4, and 1 case of grade 5 at the 6th postoperative month. The mortality of this series was 10.3% (4/39). Conclusions Straight incision keyhole minimally invasive craniotomy is a rapid, effective, and safe technique for the removal of hypertensive cerebral hemorrhage. The method herein provides an effective decompression of hematoma, with low recurrence rate and good prognosis compared with conventional surgery.

Cytokine-induced killer cells (CIK) is the fourth largest cancer treatment after surgery,chemotherapy and radiotherapy,and it is the development direction of cancer treatment.It is a new type of immune cell,and it is named after natural killer cell samples T lymphocytes as it express CD3 and CD56.Currently,CIK treatment has a broader range of clinical applications,and it has achieved the better clinical efficacy in the blood system cancer and solid tumors,The CIK adoptive immunotherapy is considered to be a new hope for the anticancer treatment.

Objective To explore the clinical characteristics of epidural hematoma in children. Methods A total of 120 children with epidural hematomas within recent three years were reviewed. Results The main cause of injury in infants and preschool children was falling or sliping, but traffic accident was the predominant cause in children over seven years old. About 65.8% children were complicated by skull fractures, with average Glasgow Coma Scale (GCS) score of 13.6. Except for acute hematoma treated with emergency surgical operation, the other hematoma was rechecked with CT scan at days 1 and 3 or so after it was found for the first time. Patients receiving operation accounted for 57.5% and those with hematoma due to diploe bleeding for 43.9%. Conclusions The primary cerebral injury is not severe relatively in children with epidural hematoma, in which the incidence of skull fracture is lower than that in adults. The main cause for hematoma formation is diploe bleeding. Sound prognosis can be obtained through recheck of CT scan and suitable therapy.

Objective To observe the changes of arm equilibrium pressure (Parm) in different occlusion time,the reference range of Parm in hemodynamic stable patients,and to explore the relationship between Parm and systemic hemodynamic parameters.Methods Mechanically ventilated postoperative abdominal surgery patients who admitted to ICU with stable hemodynamic status were enrolled.After hemodynamic data were recorded,arm stop-flow maneuvers were performed to measure Parm.At 10,20,30,40,50,60 seconds after occlusion,arterial pressure were measured twice within 5 minutes and recorded as the average value.Results Thirty patients were included.The Parm decreased gradually with the prolongation of the occlusion time.The value was not stable within 60 s,but the reducing extent was not obvious after 40s.The 95％ reference range of Parm 30 S was 23-44 mmHg(1 mmHg =0.133 kPa) and Parm 60 S was 19--35 mmHg.Parm at 30 s and 60 s were positively correlated with systolic arterial pressure,diastolic arterial pressure,mean arterial pressure,central venous pressure (all P ＜ 0.001),but not heart rate and pulse pressure.Linear regression analysis showed that Parm at 10 s,20 s,30 s only had linear correlation with diastolic arterial pressure (10 s,β =0.504,P =0.001;20 s,β =0.297,P =0.005;30 s,β =0.231,P =0.015),and Parm at 40 s,50 s,60 s were linear correlation with diastolic arterial pressure (40 s,β =0.220,P =0.004;50 s,β =0.210,P =0.004;60 s,β =0.213,P =0.004) and central venous pressure (40 s,β =0.516,P =0.018;50 s,β =0.513,P =0.01;60 s,β =0.472,P =0.023).Conclusion In mechanically ventilated postoperative abdominal surgery patients with stable hemodynamic status,Parm decreases when occlusion time is prolonged,which is not stable within 60 s occlusion.Arterial blood pressure and central venous pressure are positively correlated with Parm.

Objective:To evaluate the effect of the occlusal surface height of a mandibular posterior implant-supported single crown on stress in bone tissues.Methods:Three-dimensional finite element models of the implant-supported single crown replacing the missing right lower second premolar,mesial and distal natural teeth,periodontal membrane,alveolar bone,loaded rigid body and analog food of almond were established.Using the Federation Dentaire International (FDI)system,the first premolar, the second premolar and the first molar were represented with 44,45,46.Three occlusal surface heights of the crown were studied:(1 )normal height;(2)1 5 μm reduction in height;(3)30 μm reduction in height.The models were loaded by independent loading with maximal occlusal force(44 by 280 N,45 by 360 N,and 46 by 480 N)and average occlusal force(44 by 1 40 N,45 by 1 80 N,and 46 by 240 N)on the single crown;combined loading (maximal occlusal force transformed into uniform load of 3 .7 MPa on top of rigid body,in contact with points on the occlusal surface),and analog almond-like food loading (average occlusal force transformed into uniform load of 1 .67 MPa in simulated food chewing,in contact with points on the occlusal surface).Results:For maximal biting force under independent loading,Von Mises stress peak values in bone tissues around 44,45,and 46 were 82.57 MPa,45.26 MPa and 27.79 MPa;For average biting force,peak values were 41 .28 MPa,22.63 MPa and 1 3.89 MPa.Under com-bined loading,compared with the normal occlusal surface height group,Von Mises stress peak values de-creased 4.6 MPa,by 0.84%;increased 7.52 MPa,by 20.04%,and decreased 1 .8 MPa,by 5.84%, for 45,46,and 44 in the 30 μm infra-occlusion group,respectively.Under food loading,Von Mises stress peak values decreased 0.34 MPa,by 1 .62%;increased 1 .1 1 MPa,by 2.66%;and increased 0.06 MPa,by 0.54%,and for 45,46,and 44 in the 30 μm infra-occlusion group,respectively.Con-clusion:Within the limitation of this study,within 30 μm reduction of the occlusal surface height of im-plant-supported single crown,no significant difference of the peak values was observed.

Objective To assess the clinical diagnosis value and treatment effect of anti-Müllerian hormone(AMH)and inhibin B(INHB)in polycystic ovary syndrome(PCOS)patients.Methods Total of 300 cases of PCOS patients were enrolled in this study from January 2014 to January 2016 in the First Affiliated Hospital,Hunan University of Chinese Medicine,and those patients were randomly divided into group A,group B and group C.There were 100 patients in every group.The patients in group A were interfered by traditional Chinese medicine.The patients in group B were treated with Western medicine and those in group C were treated with traditional Chinese medicine combined with western medicine.Total of 264 cases health volunteers were enrolled as the control group.The effect was evaluated.The level of AMH and INHB in serum of PCOS patients were detected by chemiluminescent assay before treatment and three months after treatment.Results The cutoffs of AMH and INHB were 6.98 ng/ml and 150 pg/ml,respectively.The AUC of AMH combined with INHB was significantly larger than that of AMH or INHB(0.945 vs.0.859,0.945 vs.0.784).In the PCOS group,the positive PCOS rate of AMH combined with INHB was significantly larger than that of AMH or INHB[87.00％(261/300)vs.83.33％(250/300)vs.93.67％(281/300),x2=15.593,P=0.000].The sensitivity[93.67％(281/300)],specificity[92.42％(244/264)],positive predictive value[93.36％(281/288)],negative predictive value[92.78％(244/264)]and Jordanian index(0.659)of AMH combined with INHB was significantly larger than that of AMH[87.00％(261/300),87.88％(232/264),89.08％(261/293),85.61％(232/271)and 0.612]or INHB[83.33％(250/300),90.15％(238/264),90.58％(250/276),82.64％(238/301)and 0.571].After treatment,AMH[(9.06±2.13)ng/ml vs.(6.34±1.12)ng/ml,t=10.595,P=0.000;(9.08±2.08)ng/ml vs.(6.02±1.02)ng/ml,t=13.209,P=0.000;(9.13±2.31)ng/ml vs.(3.53±0.83)ng/ml,t=22.814,P=0.000]and INHB[(173.13±14.22)pg/ml vs.(145.26±13.05)pg/ml,t=14.440,P=0.000;(174.28±13.82)pg/ml vs.(145.39±12.98)pg/ml,t=15.238,P=0.000;(174.98±13.77)pg/ml vs.(133.15±12.04)pg/ml,t=22.869,P=0.000]in 3 groups had decreased.After treatment,the AMH of group C [(3.53±0.83)ng/ml] was significantly lower than that of group A and B[(6.34±1.12)ng/ml and(6.02±1.02)ng/ml,F=237.936,P=0.000],and the level of AMH in group C [(133.15±12.04)pg/ml] was significantly lower than that in both group A and group B[(145.26±13.05)pg/ml and(145.39±12.98)pg/ml,F=30.645,P=0.000].Conclusions AMH combined with INHB can be used to diagnose PCOS.AMH and INHB can be used to evaluate PCOS efficacy.