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BACKGROUND: Cerebral vascular spasm is the main complication of intracranial aneurysm during perioperative period. Anesthesia of clamp operation of intracranial aneurysm not only meet the basic requirement of anesthesia, but also prevent cerebral vascular spasm and protect cerebral function possibly.OBJECTIVE: To observe the changes of angiotensin Ⅱ and endothelins of paitents with intracranial aneurysm under the anesthesia of desflurane during the clamp operation so as to discuss the effect of desflurane on cerebral protection.DESIGN: Case analysis.SETTING: Department of Neurosurgery and Department of Anesthesiology of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences.PARTICIPANTS: Totally 64 patients, 30 males and 34 females, who were prepared for clamp operation of intracranial aneurysm, were selected from Department of Neurosurgery of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences between October 2002 and June 2004.METHODS: After anesthesia induction, tracheal cannula was used to control respiration and desflurane was used to maintain the anesthesia. Totally 4 mL arterial blood were collected at the four time points: before anesthesia induction, cutting dura mater, clamp aneurysm and 30 minutes after clamp aneurysm. Levels of angiotensin Ⅱ and endothelins in plasma were assayed with radioimmunoassay.MAIN OUTCOME MEASURES: Levels of angiotensin Ⅱ and endothelins at the four time points: before anesthesia induction, cutting dura mater,clamp aneurysm and 30 minutes after clamp aneurysm.RESULTS: Aneurysm of two patients was disrupted during the operation of angiotensin Ⅱ was ranged normally before operation, and that at the other three time points during the anesthesia of desflurane did not changed endothelins: Level of endothelins at the three time points of cutting dura mater, clamp aneurysm and 30-minutes after clamp aneurysm was lower than that at the time point of pre-an esthesia induction [(40.4±10.3),(40.0±9.6), (40.7±12.3), (49.3±12.7) ng/L, (P=0.002, 0.001, 0.009)].CONCLUSION: Levels of angiotensin Ⅱ and endothelins which anesthetizes by desflurane are not increased during the whole clamp operation of intracranial aneurysm. However, level of endothelins is obviously lower than that at the time point of pre-anesthesia induction, and there is not significantly different from that at various time points of the operation. This suggests that anesthesia of desflurane can avoid the onset of acute cerebral vascular spasm induced by the increasing liberation of angiotensin Ⅱ and endothelins and decrease the onset of secondary cerebral ischemic injury so as to protect brain.

BACKGROUND: Cerebral ischemia and reperfusion affects not only cellular necrosis at acute stage, but also delayed neuronal apoptosis in central neural system.OBJECTIVE: To observe apoptosis rate, necrosis rate and expression of Bcl-2 and Bax apoptpsis-regulating proteins in hippocampal neurons at various reperfusion stages of complete cerebral ischemia in rats so as to probe into the regulation of injury induced by complete cerebral ischemia and reperfusion.DESIGN: Randomized control experiment.SETTING: Department of Neurosurgery and Department of Anesthesiology in Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences.MATERIALS: The experiment was performed in Beijing Institute of Neurosurgery Affiliated to Capital University of Medical Sciences from January 2003 to January 2004. Totally 33 healthy adult male Wistar rats of clean grade were employed, randomized in 5 groups, named ischemia +reperfusion 24 hours group (24 hours group) (7 rats), ischemia + reperfusion 48 hours group (48 hours group) (7 rats), ischemia + reperfusion 72hours group (72 hours group) (7 rats), ischemia + reperfusion 7 days group (7 days group) (7 rats) and sham-operation control (control) (5 rats).INTERVENTIONS: Model of complete cerebral ischemia and reperfusion was prepared in rat. Cerebral hippocampal tissues were collected in 24, 48,72 hours and 7 days after reperfusion successively. The flow cytometer was used to determine cellular apoptosis rate and necrosis rate and expression of Bcl-2 and Bax proteins in cerebral hippocampal neurons in rats.percentages of Bcl-2 and Bax proteins.hippocampal neurons in 7 days group was the highest [(24.59±0.97) %].The peak value of necrosis rate presented in 24 hours group [(16.67±1.04)%], which was remarkably higher than the control [(1.28±0.50)%,low [(1.07±0.27)%], but high expression of Bax presented [(46.09±5.37)%].and reperfusion [(14.41±0.67)%] and the peak value of Bax protein presented in 72 hours after ischemia and reperfusion [(77.38±1.52)%].CONCLUSION: Hippocampal neuronal apoptosis rate is increased gradually and expression of Bcl-2 and Bax apoptosis-regulating genes was increased abnormally after injury induced by complete cerebral ischemia and reperfusion, which suggests that Bcl-1 and Bax proteins are involved in apoptosis regulation in the injury induced by complete cerebral ischemia and reperfusion.

BACKGROUND: Quiet a number of researches has reported the morphological changes of global ischemic reperfusion model. However, there are few reports on the ultrastructural changes of cortex in early reperfusion, especially the change of blood brain barrier.OBJECTIVE: To explore the changes of brain cortex neurons, glial cells and blood brain barrier in order to provide reliable evidence for clinical treatment.DESIGN: A randomized and controlled trial.SETTING: Department of Neurosurgery, Departnent of Anesthesia and Electron Microscope Room of Beijing Tiantan Hospital.MATERIALS: The experiment was conducted to 6 Wistar rats in Beijing Neurological Surgery Research Institute of Capital University of Medical Sciences during February 2003 to February 2004. The rats were randomly divided into two groups with one of ischemia-reperfusion group and sham operation group with 3 rats in each group.INTERVENTIONS: To prepare global ischemic reperfusion model of rats. Brain was removed from ischemic group in one hour of reperfusion and from sham operation group one hour after the operation. Electronic microscope technique was used to observe the ultrastructural changes of cortex.MAIN OUTCOME MEASURES: Ultrastructural changes of cortex.RESULTS: The neurons of cortex shrank to certain degree in the early stage of ischemic reperfusion(1 hour) . The glial cells were swollen with dissolved chromosome in nucleus and unclear nuclear membrane. The foot protrusions around blood vessel slightly swelled and separated from basement membrane. Mircro-tubes were partially dissolved.CONCLUSION: In early stage of reperfusion injury, the cortex neurons, glial cells, cellular framework and blood brain barrier already changed which suggested that the protective treatment such as reducing brain edema, protecting blood brain barrier should start as early as possible.

Objective To investigate the effect of radiofrequency on trigeminal neuralgia as the chief complaint of intracranial benign tumor. Methods 18 patients with intracranial benign tumor mainly presenting with trigeminal neuralgia were treated with radiofrequency thermocoagulation guided by CT scanning. The numeric rating scales (NRS) of pain and the complication were observed. Results The scores of NRS decreased significantly after treatment (P<0.01). The common complications included facial numbness and masticatory movement obstacle. One patient recurred 13 months and another patient recurred 24 months after operation. Both were treated with radiofrequency once again, and the pain ceased. Conclusion Radiofrequency is effective on secondary trigeminal neuralgia after intracranial benign tumor.

Objective To analyse the therapeutic effect and safety of radiofrequency thermocoagulation on refractory neuralgia after craniotomy.MethodsFourteen patients with refractory neuralgia after craniotomy were treated by radiofrequency thermocoagulation. The pain degree (Numeric Rating Scales, NRS) and the complication were observed.ResultsNRS decreased significantly after treatment(P<0.01). No serious complication was observed after radiofrequency thermocoagulation except numbness. No patients recurred after one year follow-up.ConclusionRadiofrequency thermocoagulation is effective on refractory neuralgia after craniotomy.

Objective:To observe the clinical efficacy of warm needling therapy for chronic lumbar strain.Methods:A total of 60 patients with chronic lumbar strain who met the inclusion criteria were randomized into a treatment group and a control group by the random number table,with 30 cases in each group.The treatment group was treated with warm needling therapy,while the control group was treated with ordinary acupuncture treatment.The treatments were both performed once every other day,and 7 times constituted a course of treatment.Visual analog scale (VAS) score was used to assess the degree of pain and the clinical efficacy was compared between the two groups.Results:The total effective rate of the treatment group was higher than that of the control group (P＜0.05).There was no significant difference in VAS score between the two groups before treatment (P＞0.05).After treatment,the VAS scores of both groups decreased significantly,and the intra-group differences were statistically significant (both P＜0.05).The VAS score of the treatment group after treatment was statistically different from that in the control group (P＜0.05).Conclusion:Warm needling therapy has a better curative effect than ordinary acupuncture in the treatment of chronic lumbar strain.

Objective To construct recombinant Mycobacterium smegmatis vaccine expressing Cysticercus cellulosae cC1 anti-gen. Methods The recombinant pET28a-cC1 plasmid was extracted and double digested by Xho I and BamH I restriction en-zymes,and shuttle plasmid pMV261 was extracted and double digested by Hind III and BamH I restriction enzymes. Both frag-ments were modified by Klenow fragment to form blunt end,then the large fragments of cC1 and pMV261 plasmid were purified and ligated by T4 ligase enzyme. The recombinant pMV261-cC1 plasmid was constructed and sequenced. Then the pMV261-cC1 plasmid was transformed into Mycobacterium smegmatis by the electrotransformation method. The recombinant cC1-Mycobacterium smegmatis was induced by heat and identified by the Western blotting method with the sera of cysticercosis patients. In addition, the growth states of the Mycobacterium smegmatis and the recombinant cC1-Mycobacterium smegmatis were compared and the growth curves were drawn. Results The restriction enzyme and sequencing results showed that the recombinant pMV261-cC1 plasmid was successfully constructed. After heat induction,a 40 kD band was showed by PAGE analysis of cC1-Mycobacterium smegmatis. The Western blotting results showed that the sera of cysticercosis patients could recognize the 40 kDa band,which sug-gested that cC1 protein was expressed in Mycobacterium smegmatis. Compared with the Mycobacterium smegmatis,the recombi-nant cC1-Mycobacterium smegmatis showed no significant difference in proliferation characteristics. Conclusion The recombi-nant cC1-Mycobacterium smegmatis vaccine has been successfully constructed.

BACKGROUND:In early experiments, we prepared hydroxyapatite-coated mechanical heart valve embedded with col agen using impulse laser sediment method.
OBJECTIVE:To further analyze the histocompatibility and toxicity of hydroxyapatite-coated mechanical heart valve embedded with col agen.
METHODS:After passage, canine vascular endothelial cellsuspension was inoculated onto the hydroxyapatite-coated mechanical heart valve embedded with col agen. One group was inoculated in 5%CO2, 37 ℃ incubator for 3 weeks static culture, and the other group was inoculated in 5%CO 2 , 37 ℃ incubator for 3 weeks spinner culture. Scanning electron microscope was used to observe cellattachment on the material. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to the proliferative capacity of vascular endothelial cells cultured with the hydroxyapatite-coated mechanical heart valve embedded with col agen.
RESULTS AND CONCLUSION:During the spinner culture, adherent cells were found on the surface of mechanical heart valve, and the cells distributed evenly and confluent at 21 days to cover the surface of the material. The number of adherent cells in the spinner culture was higher than that in the static culture. The cells during the static culture were aggregated and distributed irregularly. The mechanical heart valve exhibited no effects on the proliferation of canine vascular endothelial cells which grew wel . These findings indicate that the hydroxyapatite-coated mechanical heart valve embedded with col agen exert no effect on proliferation of vascular endothelial cells, has no toxicity and has good biocompatibility.

Alemtuzumab (Campath) was successfully injected in 21 kidney transplant patients,7 islet transplant patients and 1 simultaneous kidney and islet transplant patient for either prevention or treatment of graft rejection.Prophylactic administration was successfully completed in all patients without discontinuation.Adverse events were not observed in 11 patients (38%),but hypertension in 18 patients (62%),shivering in 3 patients (10.3%),high fever in 3 patients (10.3%),and bronchospasm in 1 patient (3%),respectively.All complications alleviated after proper therapy.During the prophylactic administration of alemtuzumab,strict,timely and proper ward-management was needed.Care for lung,perineum,skin,diet and psychological nursing were necessary.Neither graft acute rejection nor graft chronic rejection episode occurred in all patients during 6 months to 2 years follow-up.Therefore,long term effects of Alamtuzumab and consequences of lymphocytopenia need further observation.