Objective To evaluate the safety and validity of an early steroid withdrawal protocol including cyclosporine (CsA) and mycophenolate mofetil (MMF) in middle aged and elderly renal transplant patients. Methods Between September 2000 and April 2008, the prospective, randomized study design was used in 80 middle aged and elderly renal transplant patients. Steroid withdrawal group (n=39) with primary cadaveric kidney transplants received a protocol consisting of CsA 4～6 mg·kg~(-1)·d~(-1) beginning at postoperative day 3, MMF 0. 75 g twice a day from the next postoperative day, and methylprednisolone (MP) 500 mg daily from day 0 to 3. Then prednisone (Pred) 20 mg daily was gradually tapered and withdrawn after postoperative day 30. Conventional steroid treatment group (control group, n=41) received a regimen consisting of CsA, MMF and MP, and Pred 20 mg daily. Pred was tapered to 5 mg daily over a period of 6 months, then maintained thereafter. Outcome parameters were patient and graft survival rates, renal function, acute rejection ( AR), arterial hypertension, hyperlipidemia or diabetes mellitus, weight gain and infection. Results The incidence of AR in the steroid withdrawal group was similar to the control group (23. 1% vs. 19. 5%, χ~2=0. 15,P>0. 05). Patient survival rates at 12, 24, 36 months were 97. 4%, 94. 8% and 88.0% in the steroid withdrawal group and were 97.6%, 97.6 and 87.8% in the control group, respectively (χ~2=0. 17, P>0. 05). And graft survival rates were 94. 9%, 88. 6% and 83. 7% in the steroid withdrawal group and were 95. 1%, 91. 5% and 79. 5% in control group, respectively (χ~2 = 0.07, P>0. 05). Conclusions In middle aged and elderly renal transplant patients, early steroid withdrawal is feasible and may not significantly increase the risk of acute rejection episodes.

Objective To discuss the clinical application of noninvasive positive pressure ventila-tion for patients with acute respiratory distress syndrome (ARDS) as a result of cytomegalovirus (CMV) interstitial pneumonia after renaltransplantation. Methods There were 371 renal transplan-tation from March 2003 to October 2006, 27 patients were diagnosed as CMV pneumonia postopera-tion. Ten patients were treated with noninvasive positive pressure ventilation within the 11 patients who aggravated to ARDS. The clinical data of before and after mechanical ventilation were reviewed. Results Among patients received noninvasive positive pressure ventilation, 1 died of complication. Seven patients were cured by noninvasive positive pressure ventilation. Significant difference of the physiological index presented between the 7 patients cured with noninvasive positive pressure ventila-tion before and after the use of ventilation(P<0.05), and significant difference of the renal function also existed(P<0.05). Conclusion The major value of noninvasive positive pressure ventilation is to correct the hypoxemia.

Objective To study the expression and significance of survivin,an apoptotic suppressor gene,in craniopharyngioma. Methods Fifty specimens were collected from patients with craniopharyngioma admitted in West China Hospital of Sichuan University from 2000 to 2005. By using immunohistocbemistry (S-P) method, the expression of survivin in craniopharyngioma was detected. The results were analyzed quantitatively by using digital image analysis. Results Survivin positive expression was observed in craniopharyngioma but not in normal brain tis-sue. There was more expression of survivin in adamantinomatous craniopharyngiomas than in squamous papillary types( P = 0.036 ) , in male than in female (P = 0.002 ), in children ≤ 16 years than in adults > 16 years, and in re-current group than in non-recurrent group( P = 0.011 ). There was no significant difference among different properties of craniopharyngioma ( P = 0. 057 ), and different courses of disease ( P = 0. 083 ). Conclusions Survivin may be considered as a significant index for assessment of tumor recurrence.

Objective To analyze the patients with convexity meningioma with respect to pathological factors leading to recurrence, surgical technique, and complication. Methods The data of 120 surgical cases of convexity meningioma were retrospectively reviewed. Statistical analysis were performed by SPSS 17.0 with method of Kaplan-Meier survival analysis. Results The 30-day mortality was 0. The pathology of the tumors was benign in 105 cases (87.5%), atypical meningioma in 12 cases (10.0%), and anaplastic/malignant meningioma in 3 cases (2.5%). In 8 cases designated benign, there were borderline atypical features. Two cases of benign tumor recurred whose pathology involved tumors with borderline atypia.Conclusions Patients with convexity meningioma should be actively operated, and Simpson Ⅰ resection must be performed to the best of ability whether the tumors are benign or malignant. Further postoperative adjuvant treatment will be implemented or not according to the histopathological types of the tumors. Although there are many factors of recurrence for convexity meningioma. The range of surgical resection and pathological types are still the important causes for recrudescence.

Objective To investigate the clinical effects of communicating tumors on anterior skull base with neuroendoscope-assisted surgery. Methods Nineteen eases of crani-nosel and crani-orbital nosel communicating tumors underwent the combined craniofacial approach. The defect of anterior skull base was repaired with the compound flap with pedicel frontal galea muscle and temporalis myofascial flap.Results All 19 patients were successfully treated without CSF leak and cranial infection. The tumor total re-section rate was 78.9%, subtotal resection rate was 15.8% ,partial resection rate was 5.3%. Four patients of benign tumor were survival,15 patients of malignant tumor 2- year survival was 11, 3-year survival was 8,above 5- year survival was 6. Conclusion The neuroendoscope-assisted combined craniofacial approach can provide a relatively safe and effective resection for communicating tumors on anterior skull base,and has better clinicall value.

Objective By conducting a Meta-analysis on morphometric and functional imaging studies in drug-free patients,to examine the degree of overlap between anatomical and functional brain changes in schizophrenia.Methods A systematic search was conducted using PubMed,Embase,Web of Science and The Cochrane Library to identify relevant previous publications.A multimodal analysis was conducted using "Seed-based d Mapping"software.Results Fourteen structural MRI studies comprising 446 drug-free patients and 461 healthy controls,and 15 functional MRI and PET studies with 360 drug-free patients and 396 controls were enrolled in the present study. Multimodal analysis revealed considerable overlap between anatomical and functional changes,mainly in fronto-temporal regions,bilateral medial posterior cingulate/paracingulate gyrus,bilateral insula,basal ganglia,and left cerebellum.Conclusion The overlapping anatomical and functional brain abnormalities mainly in the default-mode network (DMN)and the auditory network (AN)in drug-free schizophrenia patients. The pattern of changes differed in these networks.Decreased gray matter was associated with decreased activation within the DMN, while decreased gray matter was associated with increased activation within the AN.These discrete patterns suggest different pathophysiological changes impacting structure/function relationships within different neural networks in schizophrenia.

Objective To evaluate the effectiveness of absolute alcohol in hemostasis in surgical resection of giant meningiomas with rich blood supply. Methods Twelve patients with giant meningiomas with rich blood supply were injected with absolute alcohol (8.5-27 mL, mean 11.2 mL) in the operations, and the tumors were resected under microscope. Results The tissues in the injection areas turned white and the tumors became hardened after the injection. The bleeding of the tumor surface and section was obviously decreased or even stopped. The quantities of bleeding were 48-154 mL in the operations, with an average of 67 mL. Total tumor resection was achieved in 11 patients (91.6%) and partial resection in 1 patient. No complications associated with the surgery were found in these cases. Conclusion Injection of absolute alcohol for hemostasis in surgical removal of giant meningiomas with rich blood supply is convenient and effective and can be widely applied in clinical practice.

Objective Toexploretherelationshipbetweenthemicrostructuralintegrityofwhitematter(WM)andperipheralinterleukin10 (IL-10)inschizophrenia.Methods Diffusion MRIdataandvenousbloodsampleswereacquiredfrom47schizophreniapatients(SZ) and49healthycontrols (HC).Tract-basedspatialstatisticswasconductedtoexaminethedifferencesinFAandradialdiffusivity (RD)betweentwogroups.QuantitativechemiluminescenceassaywasperformedtomeasureperipheralIL-10levels.Regressionanalysiswas conductedtoinvestigatetherelationshipbetweenperipheralIL-10levelsanddiffusion measures (FAandRD).Results Compared withHC,therewerewidespreadreductionsinFAandincreaseinRDinSZ.Additionally,comparedwith HC,peripheralIL-10levels werehigherinSZ.PeripheralIL-10wasnegativelycorrelatedwithFAintherightposteriorthalamicradiationandleftinferiorfronto-occipitalfasciculusamongthepatients(β=-0.51,P=0.01andβ=-0.47,P=0.02,respectively)butnotcontrols(β=-0.01,P=0.95 andβ=-00.03,P=09.8,respectively).Andthecorrelationcoefficientsofthetwogroupsweredifferent(z=25.0,P=00.1andz=23.7,P=00.2, respectively).Conclusion TheperipheralIL-10maycontributetothedisruptionsofmicrostructuralWMintegrityinschizophrenia, supportingthenotionforanimportantroleofinflammationinthepathogenesisofschizophrenia.

OBJECTIVETo investigate the correlation between arterial partial pressure of CO2 (PaCO2) and end expiratory tidal partial pressure of CO2 (Pet-CO2) in morbidly obese patients during anesthesia for laparoscopic gastric bypass surgery.

METHODSForty morbidly obese patients with a body mass index (BMI) between 35 and 50 kg/m(2) underwent laparoscopic gastric bypass surgery under general anesthesia. PaCO2 and Pet-CO2 were measured after intubation and before induction of pneumoperitoneum (T0), at 30 min (T1), 60 min (T2), and 120 min (T3) during pneumoperitoneum, and at 30 min (T4) and 60 min (T5) after deflation.

RESULTSAt each time point of measurement, Pet-CO2 was lower than PaCO2 in all the patients. PaCO2 and Pet-CO2 were positively correlated before, during, and after pneumoperitoneum (P<0.05). At a moderate pressure of CO2 pneumoperitoneum (16 mmHg), the level of correlation between PaCO2 and Pet-CO2 at T1, T2, and T3 differed from that before and after post-pneumoperitoneum.

CONCLUSIONSPaCO2 and Pet-CO2 are closely correlated during a moderate CO2 pneumoperitoneum in morbidly obese patients undergoing laparoscopic gastric bypass surgery.

Adult ; Anesthesia ; Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; blood ; Female ; Gastric Bypass ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity, Morbid ; blood ; surgery ; Pneumoperitoneum, Artificial

Objective To investigate the effect of long-term high-fat diet on cognitive function and hippocampus neurons ultrastructure in obese rats.Methods Forty SD rats were randomly assigned to a high fat diet (HFD) group and a common diet (CD) group.Meanwhile,HFD-induced obese rat model were established.The spatial learning and memory were measured by the Morris water maze,and the neurons ultrastructural changes in rat hippocampus CA1 region at the corresponding period were observed by transmission electron microscopy.Results The average weight of rats was 25％,28％,and 22％ higher in the HFD group than in the CD group at the 12,16,and 20 weeks,respectively;the Lee's indexes were 6％,4％,and 8％ higher;the average swimming latency were 52％,44％,and 40％ longer;the average swimming distance were 85％,45％,and 51％ longer;the average swimming speed were 57％,34％,and 18％ higher;the duration of staying in the target quadrant were 32％,54％,and 63％ shorter;and the average times of crossing the plate form were 30％,34％,and 34％ shorter,respectively (all P ＜0.001).In comparison of ultrastructure in hippocampus CA1 region of rats at corresponding time points,the amounts of degenerated and necrosis neurons,of the deformed and vacuolar mitochondria,and of the less rough endoplasmic reticulum were significantly more at 12,16,and 20 weeks in the HFD group than in the CD group.Conclusions Long-term HFD-induced obesity damages the structure of neurons in the hippocampus,impairs spatial learning and memory function,and accelerates cognitive aging in rats.