Objective To study the relationship between the change in serum levels of vascular endothelial growth factor(VEGF) and endostatin (ES) after trascatheter arterial chemoembolization (TACE) and the prognosis of patients with liver carcinoma. Methods Serum VEGF and endostatin levels were measured by enzyme-linked immunoassay in 120 patients with hepatocellular carcinoma before and a week after TACE.Results Among patients with large (diameter ≥5 cm) tumors , the serum levels of ES and VEGF before and after TACE are 43.35 ( ±9.80),48.35 ( ± 10.89), 310.23 (±64.31) ,and 369.10 ( ±60. 11) ng/ml respectively. Among patients with portal vein tumor thrombus, the corresponding figures are 54.28 (±8.78 ),50.28 (±7.51), 331.26 (±63.38) and 400.29 (±60.98) ng/ml. The levels of VEGF and ES were significantly related to the presence of portal vein tumor thrombus, the clinicopathological grade and size of the tumor(P ＜0.05 ). Patients with a higher grade tumor were more likely to have elevated levels of VEGF and ES.So are patients with more advanced stage tumors. In addition, higher levels of VEGF and ES in serum are associated with worse survival. Conclusion Elevated serum VEGF and endostatin levels in patients with hepatocellular carcinoma are closely correlated with the grade and size of the tumor, and the presence of portal vein tumor thrombus. Serum VEGF and ES level may be used for predicting the biological behavior, invasion, metastasis and prognosis of hepatocellular carcinoma.

OBJECTIVETo discuss the mechanism of cerebral vessel spasm caused by concussion and the effect of Nimodipine on concussion.

METHODSA total of 224 patients who were treated from March 1995 to October 1999 were divided into two groups randomly, ie, Nimodipine group (113 cases) and control group (111 cases). Middle cerebral artery (MCA), basilar artery (BA) and the average peak forward velocity of cerebral blood flow were observed by color three-dimensional transcranial Doppler (3D-TCD) within 24 hours after admission and at the end of 3-6 days of treatment. Cerebral blood flow changes, characteristics and treatment effect were analyzed and determined by clinical main symptom disappearance rate.

RESULTSIn concussion, cerebral blood flow was divided into 3 phases: cerebral blood flow low infusion dilation phase, cerebral blood vessel spasm phase and cerebral blood flow recovery phase. In the Nimodipine group, clinical main symptom disappearance rate was higher than that in the control group in the cerebral spasm and recovery phases with a significant difference (P < 0.01).

CONCLUSIONSCerebral vessel spasm, hypoxia and ischemia lesion are the main pathological changes. Whether cerebral dysfunction is reversible or not is mainly determined by spasm time of cerebral blood vessel. Nimodipine has a good effect on releasing spasm and diminishing the cerebral blood flow velocity. It not only improves curative effect on concussion, but also reduces and prevents concussion sequelae. Hence, concussion patients who have cerebral spasm confirmed by 3D-TCD should be given Nimodipine routinely and early.

Adolescent ; Adult ; Aged ; Blood Flow Velocity ; Brain Concussion ; complications ; diagnostic imaging ; Cerebral Arteries ; diagnostic imaging ; drug effects ; Cerebrovascular Circulation ; drug effects ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Injury Severity Score ; Male ; Mannitol ; administration & dosage ; Middle Aged ; Nimodipine ; administration & dosage ; Reference Values ; Treatment Outcome ; Ultrasonography, Doppler, Transcranial ; Vasospasm, Intracranial ; drug therapy ; etiology ; physiopathology

Objective To study changes and significance of endothelin(ET) in rat cerebral concussion.Methods 80 Wistar male rats were used for animal model of cerebral concussion,which were sacrificed on 1,3,7,14 and 30 days after injury and the brain tissue were taken off. The expression of ET was studied in the course of cerebral concussion by means of immunohistochemistry.Results Typical clinical manifestation was observed in the 100 g group in which the pathological changes included cerebral vascular constriction and dilatation,congestion and edema of cerebral tissue,neuronal degeneration,necrosis,and obviously decreased even disappeared Nissl bodies.Increased expression of ET was observed on the first day,the positive area was seen in the plasma of endothelial cells in cerebral cortex,hippocampus,cerebellum and thalamus.ET expression peak occurred on the 7th day,the positive area was also found in the plasma of Purkinje cells in the cerebellum.Decreased ET expression was found on 14th day and returned to normal level on the 30th day.Conclusion The main pathological changes of cerebral concussion contained blood circulation disorder,and degeneration and necrosis of substantial cells.ET was involved in the brain tissue injury during the pathological process of cerebral concussion and might be related to regulation of cerebral vascular reaction,and neuron degeneration and necrosis.

Objective To enrich the clinical meanings of common pulse manifestations,and to explore mechanisms of those pulses by analyzing the correlation between pattern elements of disease nature and common pulse manifestations in patients with viral hepatitis or cirrhosis based on the combination of pat-tern and diseases.Methods A national multicenter cross-sectional epidemiological survey was conduc-ted to collect TCM symptoms,tongue manifestations and pulse conditions(including depth,frequency, width,length,hardness,and frequency of pulse)of patients with viral hepatitis or cirrhosis.The survey questionnaire used the Information Collection form of Vital Hepatitis Cirrhosis drafted by the research group.Standard ofHepatitis Cirrhosis Pattern Elements Differentiation was made to identify patterns and pattern elements.Descriptive statistics such as frequency and rate,Chi-square test,and correlation analy-sis were used.Results Pulses of 801 patients were collected.Pulses with occurrence rate above 20％was defined as common pulse manifestations,in which wiry pulse accounted for 75.2％ (n =602);thready pulse,29.0 ％ (n =279);deep pulse 29％ (n =232);and slippery pulse,23.1％ (n =185). There was positive correlation between wiry pulse and blood stasis and qi stagnation (correlation coefficient was 0.141 and 0.166 respectively,P <0.05).There was positive correlation between slippery pulse and yin deficiency and damp heat (correlation coefficient were 0.093 and 0.131 respectively,P <0.05).There was positive correlation between deep pulse and qi deficiency and yang deficiency(correlation coefficient was 0.099 and 0.111 respectively,P <0.05).There was positive correlation between thready pulse pulse and yin deficiency,qi deficiency,yang deficiency and water retention(correlation coefficient was 0.089,0.109, 0.105 and 0.075 respectively,P <0.05).Conclusion There is a certain correlation between pattern ele-ments and common pulse manifestations in viral hepatitis cirrhosis patients.