In order to investigate the pathophysiologic mechanisms responsible for trauma-induced hearing disturbances due to auditory nerve degeneration, we established for the first time a rat experimental model in which auditory nerve degeneration due to compression injury of the cerebellopontine (CP) angle portion of the auditory nerve can be quantitatively evaluated. In this paper, Ⅰ demonstrate our clinical experience in CP angle surgery and some of the results of our experiments performed onthis rat experimental model. Trauma-induced hearing loss in CP angle operations has long been regarded as a sort of unavoidable "natural course"and therefore hopeless.I believe that this pessimistic view should be challenged and changed through new approaches in scientific research.

Objective To analyze retrospectively the clinical characteristics, pathogeny and therapy of traumatic interhemispheric subdural hematoma (ISH). Methods 31 ISH cases admitted since 1996 were reviewed and analyzed retrospectively concerning the clinical characteristics and therapies. Typically,ISH manifested itself with hemiplegia or monoplegia in the contralateral lower limb, called the falx syndrome, and unconsciousness was infrequent at the initial stage of the head injury. The pathogeny of ISH involved cracks of the bridging vein, hematomas in the interhemispheric small arteries and veins and probably coagulation dysfunction or anticoagulant therapy. Results In all 31 patients, 29 were cured and 2 died ofmultisystem organ failure (MSOF) and cerebral hernia respectively. The follow-up revealed that 6 cured patients developed interhemispheric subdural effusion. Conclusion CT scanning showing the interhemispheric hematoma exceeds 20 mL, or the interhemispheric hematoma is thicker than 1 cm can be referential to the diagnosis of ISH. For the ISH treatment, surgery and conservative management are suggested based on the functional disturbance or the stability of the disease. Patients with progressive neurologic deterioration should be operated without delay.

Amyloid β-peptide (Aβ) stimulating inducible nitric oxide synthase (iNOS) induces neuron death or apoptosis through the transcription factor NFκB (nuclear factor κB) signal pathway mechanism. Aβ functiones together with microglia and astrocyte to stimulate the inflammatory responsecorrelative with expression ofiNOS, the activation of the NFκB signal pathway and the expression ofiNOS,which results in significant peroxynitrite damage to neurons and the neurodegeneration in Alzheimer's disease (AD). Activation of CD36 signaling in microgila by Aβ fibrils initiates the association of the Src-family kinase Lyn with CD36. Together with another Src kinase, Fyn, Lyn activates a MAPK signaling response and results in the activation of inflammatory programs such as the production of MCP-1 and ROS.In parallel, Syk-family kinase activity specifically regulates increased cytokine production in response to Aβstimulation. After the stimulation, NFκB works independent of Src and Syk activation. Aβ-stimulated microglial secretes TNF-α and O2-, resulting in iNOS overexpression and excessive peroxynitrite and neuronal apoptosis.

Objective To evaluate the effect ofendovascular embolization on intracranial aneurysms with detachable coil and detachable balloon and to emphasize the mainpoint of embolization technique.Methods 1328 patients underwent complete cerebral angiography using microcatheter under DSA imaging. 85 cases with 90 aneurysms were embolized by MDS, 825 cases with 847 aneurysms were embolized by GDC, 418 cases with 433 aneurysms were embolized by EDC. 37 of 67 giant aneurysms were embolized by detachable balloon, 18 aneurysms by GDC, 11 aneurysms by EDC, 1 by MDS. Results 1328 patients with 1370 aneurysms were cured successfully; 1 322 cases recovered clinically, 6 patients died. 1 281 aneurysms achieved 100 % occlusion, 65with 95 % occlusion, 20 with 90 % occlusion, and 4with 80 % embolization. 9 aneurysms reputured during the embolization, 5 patients had cerebral infarction, 1 patient died of intractable cerebral vasospasm for microcoil escape. 2 recurrent cases were cured by second GDC embolization. Conclusion The method of endovascular embolization to treat intracranial aneurysm is safe, reliable and effective. Those cases with giant aneurysms will have high recurrence. Patients who suffer from SAH repeatedly may have great possibility of aneurysm rupture during embolization.

Objective To explore the expression and its implication of angiogenesis and invasiveness related factor in primary and recurrent glioma. Methods Expressions of vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP-2) and MMP-9 were detected by immunohistochemical technique. The morphological characteristics of ultrastructure of glioma were observed by transmission electron microscope (TEM). Results The expressions of VEGF, MMP-2 and MMP-9 varied in different grades of primary glioma. With the elevation of the malignant degree of the primary glioma, positive staining rates of VEGF, MMP-2 and MMP-9 increased significantly. The expression of VEGF correlated with both MMP-2 and MMP-9 expression. Compared with the primary glioma, the immunoreactivities of VEGF, MMP-2 and MMP-9 in recurrent glioma increased, especially in those with more severe malignancy. Under transmission electron microscope, endothelial cells markedly proliferated and protruded from the deficiency of basemembrane, concomitantly with edema of the extracapillary gap, plasma extravasation as well as some small worm-eaten caverns in the basemembrane.Conclusion VEGF, MMP-2 and MMP-9 play important roles in glioma angiogenesis and invasiveness.Inhibition of their expressions may be a useful therapy to glioma.

Objective To understand the effects of mRNA assay for enterovirus in cerebrospinal fluid (CSF) of patients by using reverse transcription polymerase chain reaction (RT-PCR) on clinical diagnosis and therapy of viral encephalitis. Methods RT-PCR with one pair of picornaviridae-specific primer (PSP) against the conserved 5'noncoding region of enterovirus (EV) was employed to investigate enterovirus RNA in CSF of 43 patients who were diagnosed as viral encephalitis by their clinical features.The patients' symptoms, abnormal signs and laboratory evaluation including routine examinations of CSF,CSF biochemistry, antibodies to other virus in CSF, cranial computed tomography (CT), cranial magnetic resonance imaging (MRI) and electroencephalogram (EEG) were observed and statistically analyzed by Student's tests. Results By the CSF EV RT-PCR, 18 out of 43 patients, most of them male, were tested to be EV positive (41.9%), and their symptoms and signs were not significantly different from that of EV negative. The albumen and cell content in CSF of the patients of EV positive was higher than patients of negative. Sometimes antibodies to other virus could be found in serum of EV positive patients.Conclusion Viral encephalitis owing to enterovirus has higher morbidity and sometimes goes with other virus infection. The results of EV RT-PCR are not always consistent with that of serum assay. The result of EV RT-PCR could be used to guide clinical diagnosis and treatment.

Objective To investigate the photodynamic effect mediated with 5-aminolevulinic acid (5-ALA) on U251 human glioma cells. Methods Fluorescence microscope and confocal laser scanning microscope were used to detect the localization of Pp Ⅸ in U251 human glioma cells. The cells with/without 5-ALA were irradiated at the wavelength of 635 nm. MTT assay was used to measure the cell survival after laser irradiation. Results 5-ALA cocultured with U251 cells successfully produced endogenous Pp Ⅸthat was observed distributively in the cytoplasm, but not in nuclear region. The overall survival rates of the U251 glioma cells photodamaged by ALA-PDT decreased as the incubation time went by or the 5-ALA concentration increased, while peaked at the incubation time of 6 h and the 5-ALA concentration of 2.0mmol/L. Without one of 5-ALA and light irradiation, the survival rate of the cells had no significant difference compared with that of cells of the control group. Conclusion The 5-ALA-induced PDT appears to be a promising therapy for human glioma. The optimal incubation time may be 6 h and the optimal 5-ALA concentration be 2.0 mmol/L.

Objective To discuss the etiological relationship between brain trauma and glioma.Methods A case of post-traumatic glioblastoma was reported with regard to his clinical manifestations,imaging features and pathological characteristics, and the related literatures were present. Results This case is consistent with the criteria on the glioblastoma mutiforme following cerebral trauma in literatures.Conclusion The development of a brain tumour following a cortical injury is possible, although rare. The presupposition for the development of a glioma following brain trauma is a predisposing genetic alteration of brain cells.

Objective This study aimed to better examine the relationship between hyperglycemia and outcome after traumatic diffuse axonal injury (TDAI). Methods We prospectively studied 118patients with moderate or severe TDAI [Glasgow Coma Scale scores (GCS), 3～12] who were treated conservatively in the surgical intensive care unit of zhuhai hospital between January 2000 and December 2004. Serum glucose, GCS and Glasgow Outcome Scale (GOS) of all the patients were measured: serum glucose, GCS score was recorded on admission, on days 3, 7 and 2 weeks; Outcome was determined by GOS score at discharge and after 3 months , respectively and the data were analyzed statistically to determine the relationship between serum glucose levels, severity of injury, and neurological outcome.Results Patients who died had significantly higher admission serum glucose values than those patients who survived (230 mg/dL vs 130 mg/dL, P＜0.005). Admission serum glucose ≥210 mg/dL was uniformly associated with a worse outcome. Conclusion Early hyperglycemia is a significant indicator of its severity, and a reliable predictor of outcome to TDAI.

Objective To explore the feasibility of recently developed nucleofection method in delivering plamid DNA directly into the nucleus for the introduction of a plasmid encoding enhanced green fluorescent protein (EGFP) into primary bone marrow stromal cells (BMSCs) of rabbit. Methods Rabbit BMSCs were harvested by means of density gradient centrifugation following a thighbone puncture. The primary BMSCs were cultured and either transfected with pEGFP-C2 by nucleofector technology (as EGFP group) or uninfected (as control) in vitro. Compared with the control, the cellular viability, adhesive rates and the growth curves of the labeled cells were respectively analyzed. Transfection efficiencies were evaluated through the detection of EGFP expression. Results EGFP were successfully expressed 24 h after nucleofection. Similar morphological development, adhesive rates and growth curves were found in the 2 groups. The positive EGFP expression was enhanced gradually alone with the prolonged culture time, and showed the strongest 6 d after marked, with about 47.8% of EGFP-positive cells in the total BMSCs. The EGFP did not attenuate even 1 month after the marking. Conclusion Neuclofection of pEGFP-C2 shows no significant effect on the proliferation of rabbit BMSCs. EGFP plays an important role in stable gene marking of rabbit BMSCs. Nucleofection is an efficient nonviral gene transfer method for the introduction of genes into primary rabbit BMSCs.