Brain metastasis is among the most common complications of non-small celllung cancer (NSCLC) and may obviously influence the survival and quality of life in the NSCLC patients. Recently, the development in traditional treatments, the widely-used micro-molecular targeted drugs, and the combined treatment have improved the overall survival and the quality of life of these patients. In addition, the exploration of new therapeutic targets and cognitive function protective methods for current treatments also deserves at-tention. This review emphasizes the relevant clinical and basic problems and the therapeutic strategies in NSCLC with brain metastases.

Objective To discuss the clinical feature, diagnostic main points and treatment of diffuse axonal injury(DAI). Methods The clinical materials and imaging findings and treatment and prognosis of 48 cases with DM were analyzed retrospectively. Results 18 cases showed a good outcome, while 12 were moderately disabled, 10 severely disabled or survived in a permanent vegetative state and 8 cases died. Conclusion To preserve the fluent respiratory tract, to control intracranial pressure, to treat with hyperbaric oxygenation and high-dose naloxone in early time were crucial in clinical practice to DAI.

Aged ; Female ; Glossopharyngeal Nerve Diseases ; surgery ; Humans ; Light Coagulation ; Lingual Nerve ; surgery ; Male ; Microwaves ; therapeutic use ; Middle Aged

Objective To investigate the effect of DHA on proliferation and killing activity of γδT cells against SW1990 cells in vitro.Methods γδT cells were generated in vitro by stimulating peripheral blood mononuclear cells of healthy donors in RPMI 1640 completed medium containing IPP and IL-2 for 8 d,and then co-cultured with different concentrations of DHA for 48 h.Proliferation rates of γδT cells for each group were detected by MTT method.The perforin,granzyme B and CD107a expression in γδT cells were verified by flow cytometer.The cytotoxic activity of γδT cells against SW1990 cells were analyzed by CCK-8 kit.Results The purity of γδT cells in each group reached 75.46％ ±5.32％ after 8 d of culture.Compared with the control group,the proliferative capability of γδT cells were enhanced significantly after treated with 50-100 μmol/ml DHA for 48 h,moreover,cytotoxicity against SW1990 cells and perforin,granzyme B and CD107a expression of the γδT cells treated with DHA were higher than the control group.Conclusion DHA could enhance the antitumor activity of γδT cells,which may be associated with the upregulation of perforin and granzyme B expression in γδT cells.

Objective To evaluate the clinical value of endovascular embolization in the treatment of intracranial aneurysm.Methods 41 patients with 46 intracranial aneurysms were treated by endovascular embolization with different treatment protocols and the clinical data were analyzed.Results Intracranial aneurysms were embolized with detachable coil in 33 patients with 38 aneurysms,rupture of aneurysm occurred during the operation in 1 patient.Seven patients with 7 aneurysms were treated with intraeranial covered stentand,no nerve dysfunction occurred.One patient with 1 aneurysm was embolized by parent artery,no occlusion nerve dysfunction occurred.Conclusion Endovascular treatment is a minimally invasive,safe and effective technique for treating intracranial aneurysms.

ObjectiveTo review the experience with surgical removal of meningiomas in the falx cerebri and sagittal sinuses.MethodsThirteen patients with meningiomas in the falx cerebri and sagittal sinuses were retrospectively analyzed.ResultsTumors in eleven patients were totally removed( Simpson Grade Ⅰ and Ⅱ ),while in two patients they were subtotally resected( Simpson Grade Ⅲ and Ⅳ ).After operations,no patient died.ConclusionAdequate surgical exposure,efficient management of operative bleeding,protection and replacement of the sagittalsinus,and avoidence of damage to the brain tissues were the key factors to improve operative effect.

Objective To classify patients with pelvic pain and to improve the understanding of etiology and to guide treatment by using a clinical phenotype system (UPOINT) and to examine the relationship between UPOINT and symptoms in patients with interstitial cystitis/painful bladder syndrome. Methods From November 2009 to October 2011,54 IC/PBS patients including 42 female and 12 male patients were treated.The mean age was 41.0 ± 12.4 yrs (range from 21 to 76 yrs).Median symptom duration was 63.0 ± 59.2 months ( range from 6 to 240 months).54 patients with interstitial cystitis/painful bladder syndrome were classified in each domain of UPOINT,that was urinary,psychosocial,organ specific,infection,neurological/systemic and tenderness.Symptoms were assessed using the Interstitial Cystitis Symptom Index,Pain/Urgency/Frequency score and visual analogue scale for pain/urgency/frequency.Clinically relevant associations were calculated. Results In the 54 IC/PBS patients,median ICSI score was 15.0 ± 1.84 points ( range from 9 to 19 points) ; Median PUF was 20.0 ± 2.3 points ( range from 14 to 25 points) ; Median pain associated with bladder score of VAS was 7.0 ± 1.0 points (range from 5 to 10 points).The percent positive for each domain was urinary 100％,psychosocial 44％,organ specific 96％,infection 33％,neurological/systemic 24％ and tenderness 28％,respectively.All patients were included in at least 2 domains,with 2 domains of 11％,3 domains of 38％,4 domains of 36％,5 domains of 13％ and 6 domains of 2％.The number of domains was associated with greater symptom duration ( Spearman r =0.76,P ＜0.01 ) but not age.The number of domains was also associated with poorer general interstitial cystitis and pain symptoms ( Spearman r =0.89,P ＜ 0.01 ) but not with frequency or urgency.The psychosocial domain was associated with increased pain,urgency and frequency,while tenderness was associated with increased ICSI score,PUF score and urgency.The neurological/systemic domain was associated with increased ICSI score while the infection domain was not associated with any increased symptoms. Conclusions The UPOINT phenotyping system can classify patients with interstitial cystitis according to clinically relevant domains.The UPO1NT system can act as the guiding theoretical basis for directing multimodal therapy,it deserves clinical promotion.

Objective To analyze the causes of under-staging in first transurethral resection of bladder tumor (TURBt) and find out solutions. Methods We retrospectively analyzed 118 cases (93 males and 25 females) of non-muscle invasive bladder cancer and compared the grade and stage between the first TURBt with the second transurethral resection (TUR) or partial cystectomy (PC) or radical cystectomy (RC) from January 2006 to March 2011.The mean patient age was 63.0 ±8.6 yrs.The tumors located in lateral,dome and posterior wall were 71,23,24 respectively; 75 of them were with single and 43 were with multifocal lesions; the sizes of tumor ranged from 0.5 -4.0 cm and 39 of them were ≥3.0 cm; The procedures performed by senior and junior urologist were 53 and 65 cases,respectively.In the study,we used the 2004 WHO/ISUP and 2002 TNM classification system for grading and staging.The data were analyzed with x2 and the logistic regression test to find out the causes of under-staging in first TURBt. Results There were 13 and 105 cases with high-grade Ta and T1 (low-grade T1 44 cases,high-grade T1 61 cases) in first TURBt,respectively.The finial stages were low-grade Ta(2),high-grade Ta(6),low-grade T1 (36),highgrade T1 ( 38 ),T2 (36) and 39 cases (33.1 ％ ) were under staged ( P ＜ 0.01 ).There were 17 and 22 under-staged cases compared with the second-TUR group (60 cases) and PC/RC groups (58 cases),respectively.The reasons of under-staging were related to tissue morphology changes (63 cases) and the absence of the detrusor muscle (56 cases) in specimens collected during the first TURBt.Multivariate analyses revealed that large tumors ( ≥3 cm),and lateral/dome/anterior wall tumors were independent risk factors to the absence of the detrusor muscle in the resected specimens with OR (95％ CI):3.766 ( 1.263 -11.225 ),and OR (95 ％ CI):5.951 (2.186 - 16.203 ),respectively.While surgery performed by senior surgeons was the protective factor to the presence of detrusor muscle,OR (95％ CI):0.274 (0.127 -0.593). Conclusions It is difficult for the first TURBt to completely avoid under-staging.The causes were related to tissues morphology changes and the absence of underlying detrusor muscle in specimens collected during the first TURBT procedure.Tissues morphology changes and the absence of detrusor muscle are related to the tumors location and size.A senior urologist and second-TUR can improve the under-staging.

Objective To investigate the relationship between the expression of the survivin gene and CpC methylation in exon 1 of the survivin gene in CA tissue, and to study the expression of survivin protein in CA tissue and its modulation mechanism. Methods Tissue samples were obtained from the CA lesions of 30 patients, normal cervix of 10 female controls, and normal foreskin of 10 male controls. Immunohistochemistry was carried out to detect the expression of survivin protein in these specimens, RT-PCR to measure the mRNA expression of survivin, and methylation specific PCR (MSP) to analyze the methylation status of CpG island in the survivin gene exon 1. Results The positivity rate of survivin protein and mRNA was 90% (27/30) and 93.3% (28/30) in CA tissue specimens, respectively, 5% (1/20) and 5% (1/20) in control tissue specimens, respectively; there was a significant difference between the two groups of specimens in both the parameters (x2 = 35.187, 38.437, both P < 0.01). The demethylation of CpG island in the survivin gene exon 1 was observed in 86.7% (26/30) of the CA tissue specimens and in 15% (3/20) of the control tissue specimens (x2 = 10.865, P < 0.01). There was a positive correlation between the demethylation status of CpG island in exon 1 and the mRNA expression of survivin gene (x2 = 13.929, P = 0.014). Conclusions The expression of survivin protein in CA tissues might be associated with the demethylation of CpG island in exon 1 of the survivin gene, and may play a certain role in the development of CA.

Objective To explore the significance, indicatinos and complications of emergency tracheotomy for patients with severe craniocerbral trauma. Methods The clinical data of 42 patients with severe craniocerbral trauma were retrospectively analyzed. Results Of them, 20 were basically cured (48%), 12 had improvement (29%) ,3 were released from the hospital(7 % ), 1 survived(2 % ) in a vegetative state,and 6 died(14%). Conclu- sion Emergent tracheotomy should be performed on patients with severe craniocerbral trauma to resolve respiratory tract obstruction, improve air current, prevent cerebral anoxia, prevent and treat pulmonary infection, increase the therapeutic efficacy.