OBJECTIVE: Aneurysmal subarachnoid hemorrhage is mainly due to intracranial aneurysm rupture. Modern techniques enable most survivors to make a good functional recovery Nevertheless,it has been suggested that such patients suffer from a persistent disturbance of cognitive function,which affects their life quality. Therefore,cognitive assessment following aneurysmal subarachnoid hemorrhage has been gradually drawing increasing attention in recent years.DATA SOURCES: Related literature was searched through the computer in PUBMED with key terms of "aneurysmal subarachnoid hemorrhage" and"cognitive deficit" and the language was limited to English. Meanwhile literature between 2001 an.d 2004 was also searched with key terms of"subarachnoid hemorrhage" and "cognitive function" in the Chinese or English language,respectively.STUDY SELECTION: Literature with cognitive assessment as its main index determined by standardized measurement was enrolled in this study.DATA EXTRACTION: A total of 101 related articles were collected,including 15 ones closely related to the present study,while those with cognitive assessment as part of their content and cognitive function determined with new methods were excluded.DATA SYNTHESIS: Cognitive assessment was analyzed in respect of its content,measurement,results and risk factors. Effect of aneurysmal subarachnoid hemorrhage itself and its complications,as well as therapeutic methods on the onset and development of cognitive disturbance were also explored.CONCLUSION: Patients with aneurysmal subarachnoid hemorrhage suffer from cognitive impairment,which also results from operation,anesthesia and drugs.

Objective: To determine the frepuency and severity of cognitive impairments associated with aneurysmal subarachnoid hemorrhage. Methods: A series of 37 patients with aneurysmal subarachnoid hemorrhage were examined by means of a battery of cognitive tests before surgical treatment. Results: In 70.3% of the patients, one or more cognitive functions were impaired. Compared with normative data, 2.7% of patients showed impairment on arithmetic, digit symbal and picture complement respectively, 5.4% on digit span, 48.6% on Visual Reproduction , 27%(food) and 18.9% (ordinary tools) on verbal fluency test, 18.9%(part A) and 21.6% (part B) on trail-making test,?18.9% on MMSE (mini mental state examination). Conclusion: The patients have impressive cognitive deficits after aneurysmal subarachnoid hemorrhage. SAH patients were especially impaired in functions that are related to short-term memory, concentration capacity, and frontocortical functions.

BACKGROUND: Neuroprotective role of hypothermia on cerebral ischemic-reperfusional impairment has been long acknowledged. Since general hypothermia is complicated and unfit for observing postoperative consciousness and neurological function, it is of important significance to explore novel methods of focal cerebral hypothermia.OBJECTIVE: To study the neuroprotective effect of lateral ventricle infusion of low-temperature fluid on ischemic neurons of middle cerebral artery (MAC) occlusion models established on New Zealand rabbits.DESIGN: A randomized case-control study based on experimental animal models.SETTING: Neurosurgical department and pathological department of a general military hospital of Chinese PLA.MATERIALS: This study was carried out at Neurosurgical Laboratory of Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA. Altogether 18 healthy New Zealand male rabbits, weighing from 2. 8 to 3.2 kg, were selected 4 - 6 months after birth, and randomly divided into occlusion group, hypothermia group and control group.INTERVENTIONS: Cerebral focal ischemic-reperfusional model was established on the New Zealand rabbits through MCA occlusion for 2 hours followed by reperfusion for 24 hours.MAIN OUTCOME MEASURES: Scores for neurological function, water content in the left and right brain, pathological changes of nerve cells in the left MCA supplying region.pothermia group, significantly higher than that in occlusion group(7.58 ± 0.58 )( P ＜ 0.01 ), but no significant difference could be observed in contrast with brain was(81.64 ± 0.82)% and (79.26 ± 1.30)% in occlusion and hypothermia groups with significant difference between them( P ＜ 0.05), and it was significantly different between the left side [ (81.64 ± 0. 82 )% ] and opyknosis and deep staining could be observed in nerve ganglion cells in occlusion group under optical microscope, but no obvious pathological changes were observed in MCA supplying brain regions in hypothermia group.CONCLUSION: Permanent infusion of low-temperature fluid into the lateral ventricle plays an important neuroprotective role by attenuating cerebral ischemic-reperfusional impairment and improving post-ischemic neurological functions.

Objective:To explore a simple and effective method of local hypothermia, and to testify its neuroprotective effects . Methods:This experiment adopts twelve adult and healthy New Zealand rabbits as experimental animals. These rabbits were randomly assigned to two groups : ① MCAO (n=6),② MCAO and hypothermia (n=6). The middle cerebral artery (MCA) was exposed through the left orbital approach, and was clipped 2 hours by a 3 mm straight aneurysm clip to establish the MCAO model. We assign 2 cavities ventricle tube to puncture the frontal angle of the lateral ventricle, then 22℃ physiological brine was dropped into the lateral ventricle to reduce the brain temperature in MCAO and hypothermia group. Temperature thermister probes were inserted for measuring the brain and rectal temperatures. The neurological deficits and histological changes of brain tissue were evaluated in all experimental animals.Results: Brain temperature below cortex was descend to 35℃within 20 minutes after hypothermia in MCAO and hypothermia group while rectal temperature has maintained normal. The neurological deficits and histological changes of brain tissue of MCAO and hypothermia group were better than those in MCAO group. Conclusion: The local intra-ventricle hypothermia model is a reliable, cooling rapidly and useful method for selective brain cooling.

Objective: To explore the effects of continuous trickle of low temperature liquids through the lateral ventricle on neural cell apoptosis after rabbit local cerebral ischemia/reperfusion. Methods:The middle cerebral artery (MCA) of New Zealand rabbit was clipped by micro aneurysm clip for 2 hours and reperfused for 24 hours. Immediately after clipping the MCA, we trickled the left lateral ventricle continuously with low temperature liquids(22℃) to decrease the brain temperature to mild hypothermia (33℃-35℃)and maintained for 2 hours. After reperfusion for 24 hours , we assessed TUNEL method to determine the apoptotic cell rate in the sham-operated group, the control group and the mild hypothermia group respectively. Results:The apoptotic cell rate of the cortex tissues accommodated by MCA in the mild hypothermia group was obviously lower than that in the control group(P0.05). Conclusion:Trickling ventricle with low temperature liquids could decrease the apoptotic cell rate and alleviate cerebral ischemia/reperfusion injury.

Objectives:To explore the protective effects of continuous trickle of low temperature liquids through the lateral ventricle on neurons after rabbit local cerebral ischemia reperfusion. Methods: The middle cerebral artery (MCA) of New Zealand rabbit was clipped with micro aneurysm clip for 2 hours and reperfused for 24 hours. Immediately after clipping the MCA, we trickled the left lateral ventricle continuously with low temperature liquids to decrease the brain temperature to mild hypothermia(32-35℃) and maintained for 2 hours. After reperfusion for 24 hours, we assessed the animal's neural deficits, observe the pathology of the ischemic brain tissues dyed by HE and determined the dry wet ratio for brain edema in the sham operated group, the control group and the mild hypothermia group respectively.Results:①The grades of neural deficits in mild hypothermia group were obviously lower than that in the clipping group( P 0.05 );②The dry wet ratios were obviously different in the mild hypothermia group and clipping group;③ Pyknosis and dense dying by HE were observed in the neural nuclei of ischemic cortex tissues of the clipping group, but no obvious changes were observed in the mild hypothermia group. Conclusions:Trickling ventricle with low temperature liquids could alleviate cerebral ischemia reperfusion injury, ameliorated neural deficit after ischemia reperfusion and were protective on the brain.

Objective:To study the relationship between the recurrence of benign meningiomas and cell proliferation, and to find some parameters that can predict the recurrence of benign meningiomas. Methods:49 samples from 15 recurrent benign meningiomas and 22 non recurrent benign meningimas were immunohistochemically stained with PCNA antibody and Ki 67 antibody.The ratios of positive tumor cells were calculated,then PCNA LI and Ki 67 LI of different groups were compared. Results:PCNA LI or Ki 67 LI in recurrent benign meningiomas was significantly higher than non recurent benign meningiomas individually( P 0.05). Conclusion:The proliferative potential of recurrent benign meningiomas was higher than that of non recurrent benign meningiomas.When the PCNA LI was greater than 2.0%,the recurrent risk was high.The proliferative potential did not increase when benign meningiomas recurred.

Objective There are differences in the diagnosis and treatment of primary melanocytoma in central nervous sys -tem.The article was to investigate the experience of its diagnosis and treatment . Methods Retrospective analysis were made on the clinical data of 14 cases with primary melanocytoma in central nervous system ( CNS) from January 1999 to December 2012, among which were 5 males and 9 females.The incidence ages were 14-52, average 32.7.The course of disease ranged from half a month to 19 years, geometric average 7.9 months.5 cases recurred and 9 cases occurred first.10 cases were intracranial and 4 were intraspinal. Results 14 patients underwent surgery and had pathologic diagnosis of melanocytoma .Total resection was performed in 7 patients, subtotal resection in 3, and partial resection in 1.Immunohistochemical study showed , in all cases, S-100 and HMB-45 were positive, GFAP and EMA were negative .Vimentin was positive in 8 cases and MelanA positive in 5 cases.12 cases recovered well and dis-charged except for paraplegia and facial paralysis in 1 case each. Conclusion Primary melanocytoma in CNS is very rare .Diagnosis is based on intraoperative findings , surgical pathology and immunohistochemistry results .Surgery is the primary therapy and early total resection is advocated .Adjuvant radiotherapy can reduce the recurrence rate .

Objective To analyze and explore the value of 3 T high resolution magnetic resonance vessel wall imaging for identifying the activity of Takayasu arteritis. Methods Twenty-six consecutive patients with Takayasu arteritis underwent 3.0 T high resolution MR vessel wall imaging on supraortic vessels (according to the classification of Lupi-Herrea , type Ⅰ and Ⅲ were included). Sixteen patients were in active phase and 10 in inactive phase based on the Kerr criteria. The MR vessel wall imaging appearances of Takayasu arteritis were compared between the active phase and inactive phase cases. Results Wall thickening was demonstrated in all involved arteries. There were statistically significant differences between active phase and inactive phase cases in MR appearances including multi-ring thickening of vessel wall (75/80 and 18/50), arterial inner wail enhancement (50/80 and 19/50), obscurity of perivascular fat (55/80 and 18/50,X<'2>=50.39,7.41,13.40,P<0.01). There was also a statistically significant difference in the thickness of carotid artery wall between the two groups [ (3.8±0.2) mm vs (2.5±0.8) mm]. Conclusion 3 T high resolution MR vessel wall imaging is valuable for identifying the activity of Takayasu arteritis.

Objective To analyze risk factors for the perioperative complications and death following hip fracture in the elderly. Methods The present study included 1352 elderly patients (≥65 years) who had received hip fracture surgery from January 2010 to June 2015 in Huadong hospital affiliated to Fudan University. Their clinical data were analyzed to determine risk factors for perioperative complications and death. Results Factors significantly affecting the perioperative complications included gender, preoperative serum albumin, ASA grade (≥Ⅲ), cardiac functional grade (≥Ⅲ), respiratory system disease and blood transfusion. Factors significantly affecting the death included preoperative serum albumin, ASA grade (≥Ⅲ), cardiac functional grade (≥Ⅲ) and blood transfusion. Multivariate Logistic regression analysis revealed that the independent risk factors for perioperative complications included gender (B=-0.686, P=0.019), preoperative serum albumin (B=-0.808, P=0.006), cardiac functional grade (≥Ⅲ, B=1.181, P=0.004), blood transfusion (B=0.890, P=0.004) and respiratory system disease (B=3.118, P=0.000);while the independent risk factors for death included preoperative serum albumin (B=-2.516, P=0.000) and blood transfusion (B=1.396, P=0.010). Conclusions In elderly patients undergoing hip fracture surgery, the independent risk factors for perioperative complications included gender, preoperative serum albumin, cardiac functional grade, blood transfusion and respiratory system disease, while the independent risk factors for death included preoperative serum albumin and blood transfusion. Perioperative risk assessment and prevention are the keys of better prognosis.