Objective To investigate the effects of tetanic stimulation of peripheral nerve on intracranial direct electrical stimulation motor-evoked potentials (MEP) in patients undergoing cerebral functional area operation. Methods Eight patients undergoing elective brain tumor resection under propofol-fentanyl anesthesia with partial neuromuscular blockade were enrolled in the study. Both conventional MEP (C-MEP) monitoring and posttetanic MEP (P-MEP) monitoring were performed throughout the operation for each patient, and the two groups of data were recorded. For one group, direct electrical stimulation with a train of five pulses was delivered to motor cortex and pyramidal tract, C-MEP was unilaterally recorded from the abductor pollicis brevis, and P-MEP was obtained 1 s after tetanic stimulation (frequency 50 Hz, intensity 50 mA, duration 5 s) to the ipsilateral tibial nerve.For the other group, direct electrical stimulation with a train of five pulses was delivered to motor cortex and pyramidal tract, C-MEP was unilaterally recorded from the tibialis anterior, and P-MEP was obtained 1 s after tetanic stimulation (frequency 50 Hz, intensity 50 mA and duration 5 s) to the contralateral tibial nerve. Randomized crossover method was used for C-MEP and P-MEP recording in each group, with an interval of 120 s. The adverse effects were observed. Results Amplitudes of P-MEP from the abductor pollicis brevis and tibialis anterior were significantly higher than those of C-MEP. Three patients had body movement during intraoperative cortex stimulation, while there was no awareness during operation and other electrical stimulation-related nervous system impairment and complications. Conclusion The application of tetanic stimulation of peripheral nerve before direct electrical stimulation can augnent the amplitudes of MEP from the abductor pollicis brevis and tibialis anterior in patients undergoing cerebral functional area operation.

Objective To investigate the clinicopathological characteristics and postoperative prognosis analysis of intra-thoracic localized Castleman disease (LCD).Methods The clinical data of 9 patients with intra-thoracic LCD who accepted surgical treatment were retrospectively analyzed.There were 5 males and 4 females,with age of (32.8 ± 10.9) years.Two patients complained of chest pain,1 patient suffered from paraneoplastic pemphigus,and the rest were diagnosed by physical examination.Four cases were diagnosed with LCD by preoperative CT examination.Results All patients underwent surgical resection.Four patients were performed open surgery and 5 patients had video assisted thoracic surgery.All patients accepted radical surgery.But 2 of these patients had postoperative complications.One patient was the injury of phrenic nerve and another was pericardial effusion.Patho-histological showed hyaline vascular type of Catleman disease in all patients.All patients survived without recurrence during the follow-up for 2-53 months.Conclusions Intra-thoracic is rare and liable to misdiagnosed.For increasing the preoperative diagnosis rate of LCD,the combined application of imaging tests is important,and clinicians and radiologists should also enhance the awareness of this disease.Complete surgical resection of the tumor is the best therapeutic alternative for intra-thoracic LCD.

Objective To evaluate the effect of video- assisted thoracoscopic pulmonary segmentectomy in patients with isolated pulmonary arteriovenous fistula (PAVF). Methods A retrospective analysis was performed on 10 patients with PAVF in the department of thoracic surgery of the first affiliated hospital of Nanjing Medical University between January 2010 and December 2016. Computed tomography angiography (CTA) and three-dimensional reconstruction were performed before operation, and all patients accepted video-assisted thoracoscopic pulmonary segmentectomy. Results The diagnosis of PAVF was identified by CTA, with maximum diameter of tumor of 3.0- 5.0 cm. No perioperative mortality or postoperative complications were observed including bleeding, hemoptysis, serious air leakage, and bronchopleural fistula. The lesions were completely removed in all 10 patients, and no patients converted to open surgery intraoperatively. Blood gas analysis showed that oxygen partial pressure before operation, in the first day after operation and the third month after operation was (62.5 ± 6.7), (70.2 ± 4.8) and (75.4 ± 4.8) mmHg (1 mmHg = 0.133kPa) respectively; which was significantly increased successively (P<0.05). After a follow-up time of 3-30 months, no recurrences were observed. Conclusions Video- assisted thoracoscopic pulmonary segmentectomy guided by preoperative CTA and three-dimensional reconstruction is a very effective method for the treatment of isolated PAVF.

Objective: To explore the value of GALAD model, including gender, age, AFP, AFP-L3 and DCP in diagnosis of primary hepatocellular carcinoma and prediction of microvascular invasion (MVI). Methods: Using retrospective study method, 5 919 patients with primary hepatocellular carcinoma (HCC) who received radical operation from January 2015 to December 2018 in Eastern Hepatobiliary Surgery Hospital were enrolled into study group. At the same time, 1 745 patients with benign liver diseases (BLDs) were enrolled into control group. The concentration of DCP was detected by Lumipulse G1200 automatic immune analyzer, and the concentration of AFP was detected by Cobas e601 automatic immune analyzer. AFP-L3 was detected by affinity adsorption centrifugation. The non-parametric Mann Whitney test was used to compare the difference between two groups. The chi square test was used to compare the rates. The diagnostic value of single serological marker and GALAD model for primary hepatocellular carcinoma was analyzed. The predictive effect of GALAD model on MVI of primary hepatocellular carcinoma was evaluated. Results: Compared with single serum marker, the diagnostic value of GALAD model is higher. When the cutoff value is -0.33, the diagnostic sensitivity, specificity and accuracy reach to 91.9% (5 440/5 919), 86.8% (1 515/1 745) and 90.7% (6 955/7 664), respectively. The area under the curve can reach 0.960 [95%CI (0.955-0.964)]. Compared with no MVI (M_O) group, the value of GALAD model in MVI low-risk group (M₁), MVI high-risk group (M₂) and MVI (M₁₊₂) were significantly higher (Z values were-12.517, -22.883, -21.655, P<0.05), Galad model predicts MVI (M2) in high risk group,AUC was 0.717 [95%CI (0.701-0.733)] (M₀ ratio M₂). Conclusion GALAD model has better diagnostic performance in primary hepatocellular carcinoma and has certain predictive value for microvascular invasion.

Endogenously eliminating the hematoma is a favorable strategy in addressing intracerebral hemorrhage (ICH). This study sought to determine the role of retinoid X receptor-α (RXR-α) in the context of hematoma absorption after ICH. Our results showed that pharmacologically activating RXR-α with bexarotene significantly accelerated hematoma clearance and alleviated neurological dysfunction after ICH. RXR-α was expressed in microglia/macrophages, neurons, and astrocytes. Mechanistically, bexarotene promoted the nuclear translocation of RXR-α and PPAR-γ, as well as reducing neuroinflammation by modulating microglia/macrophage reprograming from the M1 into the M2 phenotype. Furthermore, all the beneficial effects of RXR-α in ICH were reversed by the PPAR-γ inhibitor GW9662. In conclusion, the pharmacological activation of RXR-α confers robust neuroprotection against ICH by accelerating hematoma clearance and repolarizing microglia/macrophages towards the M2 phenotype through PPAR-γ-related mechanisms. Our data support the notion that RXR-α might be a promising therapeutic target for ICH.

Endogenously eliminating the hematoma is a favorable strategy in addressing intracerebral hemorrhage (ICH). This study sought to determine the role of retinoid X receptor-α (RXR-α) in the context of hematoma absorption after ICH. Our results showed that pharmacologically activating RXR-α with bexarotene significantly accelerated hematoma clearance and alleviated neurological dysfunction after ICH. RXR-α was expressed in microglia/macrophages, neurons, and astrocytes. Mechanistically, bexarotene promoted the nuclear translocation of RXR-α and PPAR-γ, as well as reducing neuroinflammation by modulating microglia/macrophage reprograming from the M1 into the M2 phenotype. Furthermore, all the beneficial effects of RXR-α in ICH were reversed by the PPAR-γ inhibitor GW9662. In conclusion, the pharmacological activation of RXR-α confers robust neuroprotection against ICH by accelerating hematoma clearance and repolarizing microglia/macrophages towards the M2 phenotype through PPAR-γ-related mechanisms. Our data support the notion that RXR-α might be a promising therapeutic target for ICH.
Anilides/pharmacology* ; Cerebral Hemorrhage/drug therapy* ; Hematoma/drug therapy* ; Humans ; Macrophages ; Microglia ; Neuroprotection ; PPAR gamma ; Retinoid X Receptor alpha