Objective:To study the diagnosis of magnetic resonance imaging(MRI)and the effect of microsurgical treatment for Arnold-Chiari malformation.Methods:Retrospective analysis of clinical data of 35 patients with Arnold-Chiari malformation.Results:Thirty-five cases were diagnosed by MRI.Posterior fossa decompression and plastic operation of cistern magna was performed in 35 cases.30 in all cases were followed up from 3 months to 7 years.Postoperative MRI revealed the size of the syrinx cavity decreased in all cases,disappeared in 5 cases.Conclusion:MRI is the best diagnostic method for Arnold-Chiari malformation.The effect of post fossa decompression and plastic operation of cistern magna for Arnold-Chiari malformation is satisfactory.

Objective To summarize the radiographic characteristic and endovascular interventional technique in patients with intracranial vertibrobasil dissectimng aneurysm.Methods Totally 30 patients of intracranial vertibrobasil dissectimng aneurysm were embolized by endovascular therapy,4 with stent implantation technique,26 with stent assisted coiling technique.Results Patency of parent artery was restored in 25 cases(83.3%),and except 1 case(3.3%) of postoperative intracerebral hemorrhage,no other complications occurred.All patients were followed up from 5 months to 34 months(average 11.2).All cases recovered well.No case died in the cohort.Conclusion Intracranial vertibrobasil dissectimng aneurysm has following angiographic features: string sign,pearl and string sign,and double lumen sign.Therapeutic strategies depend on clinical symptoms,the location,configuration of the dissection,and the relationship of vital branches around.The results suggested that embolization of intracranial vertibrobasil dissectimng aneurysm with coils is minimally invasive,safe,effective and reliable.

Objective To study and assess the therapeutic efficacy of Gamma knife on pituitary adenoma. Methods An analysis of 145 cases with pituitary adenoma treated by Gamma knife in our department in the past 4 years was performed. Adenoma diameter varied from 2.8 to 46.9 mm, averaging 15.6mm. In all cases, 4 mm and 8 mm isocenters were targeted at pituitary adenoma located by MRI and ? plan network. The target margin dose varied from 8 to 36 Gy, averaging 22.7 Gy (nonfunctioning adenomas, 18.5 Gy; functioning adenomas, 24.1 Gy). Results The follow up of 124 cases after radiosurgery varied from 6 to 56 months. Pituitary adenoma of 24 patients(19.4%) disappeared, 95 (76.6%) decreased, and 1 (76.6%) increased. Endocrinological normalization rate was 13 cases (13.3%), and a significant decrease of excessive hormone production was found in 71 patients (72.4%). Amelioration of clinical symptom was found in 114 patients (91.9%), deterioration in 4 patients (3.2%). Postradiosurgical complications were found in 2.4%. Neither optical lesion nor death was found in all cases. Conclusions Gamma knife radiosurgery is a minimally invasive technique to treat pituitary adenoma with satisfactory therapeutic efficacy. It is associated with a low risk of complication. Grasping adaptive sign strictly and planning precisely are needed to decrease complication.

Objective To investigate protein kinase A (PKA) signal regulatory mechanism of corticotropin-releasing hormone (CRH) mRNA expression, after CRH stimulated neuron of hypothalamic slices in rats in vitro. Methods After CRH stimulated corticotropin-releasing hormone type 1 receptor (CRH1R) of hypothalamic slices in rats in vitro, the changes of activity of PKA signal pathway and their relationship with CRH mRNA expression were observed by reverse transcription-polymerase chain reaction (RT-PCR), Western blotting. Results CRH may cause the remarkable increase in phosphorylated PKA (P-PKA), phosphorylated cyclic adenosine monophosphate response element-binding protein (P-CREB) and CRH mRNA content in hypothalamic slices in rats. However, CP-l54526 or H89 could have significant inhibition effects on the synthesis of P-PKA, P-CREB and CRH. Conclusion PKA signal pathway in ultrashort positive feedback control of CRH secretion in hypothalamus in the stress due to severe traumas.

Objective To investigate the signal regulatory mechanism of expression of corticotropin releasing hormone (CRH) stimulated neurons of hypothalamic slices in rats in vitro . Methods Model of hypothalamic slices of rats was established. After CRH stimulatation of corticotropin releasing hormone type 1 receptor (CRH1R) of hypothalamic slices in rats in vitro , the changes of activity of protein kinase A (PKA) signal passway were observed by immunocytochemical method and Western blotting. The relationship between the changes and CRH mRNA expression was also observed. Results CRH could cause the remarkable increase in phosphorylated PKA, phosphorylated CREB, and CRH content in hypothalamic slices in rats. However, CPl54526 or H89 could have significant inhibitory effect on the synthesis of P PKA, P CREB, and CRH. Conclusion PKA signal passway can regulate the ultrashort positive feedback of CRH secretion in the rat hypothalamus in stress due to severe trauma.

Background The penetration of bacterial agents into the vitreous cavity is difficult because of the existence of blood-retina barrier.So conventional drug therapy is not enough effective on endophthalmitis.Drug delivery systems can decrease drug dose and reduce the drug toxicity.To construct nano controlled-release system of anti-bacterial agents is very important for the treatment of intraocular infectious diseases.Objective This study was to investigate the toxicology and intraocular pharmacoklnetics of intravitreal PNIPAAm-PEO loaded norvancomycin nanoparticles (NV-PNIPAAm-PEO) in normal rabbit eyes.Methods NV-PNIPAAm-PEO was constructed with the drug-loading rate about 22％,and then the drug gelatin solution (20 g/L) was prepared using normal saline solution.Forty-one New Zealand albino rabbits were randomized divided into experimental group and control group.20 g/L drug gelatin solution 0.1 ml was monocularly injected into the vitreous cavity in the experimental group,and the equal volume of sterilized normal saline solution was used in the control group.In 1 day,2,3,7,14,21 and 28 days after injection,ocular anterior and posterior segments were examined by slit lamp microscope and Bsonography,and electroretinogram (ERG) was recorded and the histopathological examination was performed to evaluate the biotoxicity of the drug.Norvancomycin contents in the cornea homogenate,aqueous humor,vitreous,retinochoroid homogenate were detected by high performance liquid chromatography (HPLC) system.Results The anterior and posterior segments were normal by the slit lamp microscope and B-sonography 1-28 days after injection of NV-PNIPAAm-PEO.In 7,14,21 and 28 days after injection,there were no statistically significant difference in the a-wave latency and amplitude of max-ERG between the two groups,as well as the b-wave amplitude(P＞0.05).The histopathological examination showed that the retinal structure was normal in both groups.HPLC assay showed that the norvancomycin level was gradually declined in different eye tissues from 1 day through 28 days after injection.Norvancomycin was undetectable in the cornea during the observing duration.The maximal norvancomycin content in the blood plasma was (0.34 ± 0.11) mg/L in the second day,and norvancomycin content ranged (0.08 ± 0.04)-(2.16±0.07) mg/L in the aqueous humor,(0.11 ±0.22)-(2.54 ±0.38) μg/g in the chorioretina,respectively.The drug concentration was (5.65 ± 1.14)-(406.69 ± 21.05) mg/L in the vitreous,which was higher than the minimal inhibitory concentration (MIC) to the most gram-positive bacteria.Conclusions The intravitreal injection of 22％ NV-PNIPAAm-PEO maintains the therapeutic drug concentration till 21 days in vitreous without the toxic effect on eye tissues,suggesting a great treating potential for intraocular infecting diseases.

Objective To evaluate the therapeutic efficacy of gamma knife for the treatment of idiopathic trigeminal neuralgia Methods An analysis of 87 cases with idiopathic trigeminal neuralgia treated by gamma knife in our department in the past 5 years was performed In all cases, 4 mm isocenter was targeted at the proximal nerve at the root entry zone located by MRI The target dose varied from 70-90 Gy Results After a follow up of 6-67 months, complete relief of pain occurred in 66 patients (75 9%), 50%-90% relief in 18(20 7%), relief less than 50% in 2(2 3%) but no relief in 1(1 1%) Repeated radiosurgery was performed in 2 patients (2 3%) with recurrent pain After the second radiosurgical procedure, complete relief of pain was found in the 2 patients Two patients(2 3%) experienced facial numbness after radiosurgical procedure Conclusion Gamma knife radiosurgery is a minimally invasive technique for the treatment of trigeminal neuralgia with few complications Repeated radiosurgical procedure may result in relief of pain, but the long term outcome of gamma knife surgery for trigeminal neuralgia needs to be further studied

Objective: To investigate the effect of continuous iliac fascia space block on the placement of body position and postoperative analgesia in patients with femoral fractures. Methods: 60 patients with senile selective unilateral femoral fracture, aged 68-87 years old, weight 49-70kg, ASA grade II-III were selected, and they were randomly divided into iliac fascia block group (A group) and intravenous analgesia group (B group) according to the digital, 30 cases in each group.The two groups underwent lumbar epidural anesthesia, A group received continuous fascia iliaca compartment block 15 min before the the body position.B group was routinely given combination of lumbar and hard anesthesia.After operation, A group was connected with the automatic infusion pump continuous infusion of 0.2% ropivacaine 0.1mL·kg^-1·h^-1.B group received controlled intravenous analgesia, postoperative given loading dose of dezocine intravenous infusion of 5mg with automatic injection pump for dezocine 0.01mg·kg^-1·h^-1.When the patients entered the room (T0) and just after the placement of the body position (T1), the heart rate, diastolic blood pressure and systolic blood pressure were measured and recorded.At postoperative 2, 4, 6, 12, 24 and 48h, the VAS scores and pethidine usage during surgery, the adverse reaction were recorded. Results: The heart rate, diastolic pressure and systolic pressure at T1 in A group had no significant change compared with T0 (all P>0.05). The heart rate, diastolic pressure and systolic pressure in the control group (B group) at T1 were significantly higher than at T0(t=5.302, 7.369, 5.629, all P<0.05). At T1, T2, T4, T6, T12, T24 and T48, the pain VAS scores in A group were lower than those in B group (t₁=66.401, t₂=7.719, t₄=25.260, t₆=13.170, t₁₂=3.837, t₂₄=3.081, t₄₈=6.202.all P<0.05). The study group had no complications such as puncture hematoma, intoxication of local anesthetic and other complications. Conclusion Continuous iliofascial block can provide continuous analgesia for elderly patients with femoral fractures.It is safe and effective, and is easy to perform.It provides favorable conditions for later operative treatment.

Purpose: The poor retention and ambiguous differentiation of stem cells (SCs) within corpus cavernosum (CC) limit the cell application in erectile dysfunction (ED). Herein, the effects and mechanism of microRNA-145 (miR-145) gene modification on modulating the traits and fate of bone marrow-derived mesenchymal stem cells (BMSCs) were investigated. Materials and Methods: The effects of miR-145 on cell apoptosis, proliferation, migration, and differentiation were determined by flow cytometry, cell counting kit-8, transwell assays and myogenic induction. Then, the age-related ED rats were recruited to four groups including phosphate buffer saline, BMSC, vector-BMSC, overexpressed-miR-145-BMSC groups. After cell transplantation, the CC were harvested and prepared to demonstrate the retention and differentiation of BMSCs by immunofluorescent staining. Then, the target of miR-145 was verified by quantitative real-time polymerase chain reaction and immunohistochemical. After that, APTO-253, as an inducer of Krüppel-like factor 4 (KLF4), was introduced for rescue experiments in corpus cavernosum smooth muscle cells (CCSMCs) under the co-culture system. Results: In vitro, miR-145 inhibited the migration and apoptosis of BMSCs and promoted the differentiation of BMSCs into smooth muscle-like cells with stronger contractility. In vivo, the amount of 5-ethynyl-2′-deoxyuridine (EdU)+cells within CC was significantly enhanced and maintained in the miR-145 gene modified BMSC group. The EdU/CD31 co-staning was detected, however, no co-staining of EdU/α-actin was observed. Furthermore, miR-145, which secreted from the gene modified BMSCs, dampened the expression of KLF4. However, the effects of miR-145 on CCSMCs could be rescued by APTO-253. Conclusions Overall, miR-145 modification prolongs the retention of the transplanted BMSCs within the CC, and this effect might be attributed to the modulation of the miR-145/KLF4 axis. Consequently, our findings offer a promising and innovative strategy to enhance the local stem cell-based treatments.

ObjectiveTo investigate the correlation between systemic immune-inflammation index (SII) and prognosis in patients with hepatic alveolar echinococcosis. MethodsA retrospective analysis was performed for the clinical data of 242 patients who were admitted to Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, from January 2015 to December 2018 and underwent surgery for hepatic alveolar echinococcosis, and SII was calculated. The chi-square test was used for comparison of categorical data between two groups, and a Spearman correlation analysis was performed. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of SII; the Kaplan-Meier method was used to plot survival curves and analyze overall survival time in the two groups, and the log-rank test was used for comparison of survival rates between the two groups; univariate and multivariate Cox regression analyses were used to identify the influencing factors for the prognosis of patients with hepatic alveolar echinococcosis. ResultsThe Spearman correlation analysis showed that SII was positively correlated with the postoperative fatality rate of patients with hepatic alveolar echinococcosis (r=0.267, P＜0.001). The ROC curve showed that the optimal cut-off value of SII before surgery was 758.92, and based on this, 242 patients with hepatic alveolar echinococcosis were divided into low SII (SII ≤758.92) group with 126 patients and high SII (SII ＞758.92) group with 116 patients. The low SII group had 1-, 3-, and 5-year survival rates of 98.20%, 88.47%, and 6610%, respectively, and the high SII group had 1-, 3-, and 5-year survival rates of 90.80%, 53.05%, and 27.40%, respectively. The low SII group had a cumulative survival rate of ＞50% and a mean survival time of 55.584 months (95% confidence interval［CI］: 53550-57.617), while the high SII group had a cumulative survival rate of ＜50%, a mean survival time of 39.384 months (95% CI: 35.070-43.698), and a median survival time of 43 months (95% CI: 34.694-51.306). The low SII group had a significantly better survival rate than the high SII group, and there was a significant difference in overall survival rate between the two groups (χ2=46.979, P＜005). The univariate analysis showed that SII ＞758.92 (hazard ratio ［HR］=5.907, 95% CI: 3.386-10.306, P=0.001) was an influencing factor for the overall survival time of patients with hepatic alveolar echinococcosis, and the multivariate Cox regression analysis showed that preoperative peripheral blood SII (HR=3.507, 95% CI: 1.911-6.435, P=0.001) was an independent risk factor for the overall survival rate of patients with hepatic alveolar echinococcosis. ConclusionPreoperative SII level is clearly correlated with the prognosis of patients with hepatic alveolar echinococcosis and can thus be used as a clinical indicator to evaluate the prognosis of patients. The higher the peripheral blood SII before surgery, the worse the prognosis of patients.