Purpose To evaluate the application value of volume CT perfusion (CTP) protocol with 128-slice CT scanner in patients with unilateral middle cerebral artery (MCA) stenosis or occlusion.Materials and Methods Thirty-five patients with severe unilateral MCA stenosis or occlusion who underwent cerebral volume CTP examination in Wuhan No.1 Hospital between July 2013 and December 2014 were evaluated.The volume CTP parameter maps of cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT) and time to peak (TTP) were analyzed.Meanwhile,the dynamic CT angiography (4D-CTA) images were obtained.Results In three patients,CBF,CBV and MTT were observed normal but TTP was delayed.In the other thirty-two patients,CBF in the affected side was lower than that in the contralateral side (but difference without significance:P＞0.05).The increased CBV,prolonged TTP and MTT were also detected in the affected side compared with the contralateral side (difference with significance:P＜0.05).McNemar test showed 4D-CTA and DSA diagnosis of middle cerebral artery occlusion were not significantly different (P＞0.05),and they had better consistency (Kappa=0.861,P＜0.05).Conclusion Brain volume CTP protocol with 128-slice CT scanner provides valuable information about cerebral artery abnormalities and hemodynamic changes in patients with severe stenosis or occlusion of MCA.It has great value for clinical application.

Objective To investigate the efficacy of spectral entropy measurement in reflection of depth of anesthesia and noxious stimulation. Methods Forty-five patients of ASAⅠorⅡ were randomly divided into three groups(n=15).Group A,B and C received fentanyl 1,3 and 5 ?g/kg,respectively,3 min before target controlled infusion(TCI) of propofol.Intubation was performed when the effect-site concentration(CE)reached 3.5 ?g/mL,which was maintained until 5 min after incision.Response entropy(RE),State entropy(SE) as well as heart rate(HR),mean arterial pressure(MAP) were measured at the time points of before fentanyl and 2,3 min after fentanyl,every CE of propofol steps,before intubation,immediately and 1,3,5 min after intubation,before skin incision,and 0.5,1,3,5 min after skin incision,respectively. Results Three minutes after receiving fentanyl,the values of RE and SE in the three groups decreased significantly in a dose-dependent manner,and increased obviously at the same degree during intubation and after skin incision.The values recovered to the level before stress stimulation 1 min after intubation and 5 min after skin incision.There were no differences in the fluctuation of RE and SE among the three groups when the CE of propofol reached 1.0 ?g/mL.Conclusion Spectral entropy may effectively reflect the depth of anesthesia,but not analgesia during anesthesia.

In this study, we designed and synthesized 12 novel aloperine derivatives with different core structures. Among them, compound 3 with a ten-membered ring core was obtained through a special ring expansion reaction after γ-H Huffman elimination of quaternary ammonium salt, and the structure was verified by X-single crystal diffraction. Furthermore, their antiviral activity against human β-coronavirus HCoV-OC43 was evaluated by CCK-8 assay. Quaternary ammonium salt 2a and 3 had a good inhibitory effect against HCoV-OC43, and 2a had the highest anti-HCoV-OC43 activity with an EC₅₀ values of 3.77 μmol·L^-1 and a SI value of over 53.1. Schrӧdinger molecular docking results showed that both 2a and 3 might display their anti-HCoV-OC43 activity by directly acting on host TMPRSS2 and SR-B1. The results expanded the structural types of endocyclic aloperine and the function against coronavirus, and provided useful scientific data for the development of pharmaceutical applications of these compounds.

BACKGROUND: Although previous studies have indicated that transplantation of marrow stromal cells (MSCs) has enhanced axonal regeneration and improved motor dysfunction induced by spinal cord injury. However, it is still unclear how transplanted MSCs promoted axonal regeneration and the relationship of transplanted cells and regenerated axons.OBJECTIVE: By immunofluorescence and immunoelectron microscopy, this study sought to elucidate the mechanism of promoting axonal sprouting following transplantation of MSCs into a completely transected spinal cord.DESIGN, TIME AND SETTING: The in vivo cytology randomized controlled animal experiment was performed at the Department of Anatomy of National University of Singapore from March 2006 to June 2007.MATERIALS: MSCs were isolated and purified from a Wistar neonatal rat. Model of completely transected spinal cord injury was established by transection at T_(10) segment with asepsis technique using 36 clean adult female Wistar rats.METHODS: MSCs were subcultured and purified. Thirty-six adult female Wistar rats were randomly divided into transplanted and control groups, with 18 animals in each group. Following 9 days of completely transected spinal cord injury, rats in the transplanted group were injected with MSCs (1×10~(11)/L), 5 μL in the defect region and 2.5 μL in 1 mm upper and lower the defect region. Rats in the control group were infused with an equal volume of DMEM, at the speed of 1 μL/min.MAIN OUTCOME MESSURES: Survival and differentiation of transplanted MSCs; Regeneration of axon and survival of host-derived nestin-, NF200-, GFAP-, and CNP-positive cells in control and transplanted groups; Relationship of regenerated axon and CNP-positive cells RESULTS: Two weeks after transplantation, a large number of CFDA-SE labeled MSCs were detected in the lesion site. Survival transplanted cell number was decreased over time. Abundant 0×42-positive phagocytes/activated microglia and cavity might affect the survival of transplanted cells. The number of MSCs was decreased, but MSC transplantation could promote axonal regeneration in the lesion site, and enhance the survival of host-derived nestin-, NF200-, GFAP-, and CNP-positive cells in lesion site, and host-derived CNP-positive cells and Schwann cells provided structural support to regenerated axons and promote their remyelination in spinal cord injury.CONCLUSION: Transplantation of MSCs enhances survival of host-derived CNP- positive cells and Schwann cells, and which may provide structural support to regenerated axons and promote their remyelination in spinal cord injury.

Objective To choose the appropriate operation for patients with Sylvian fissure arachnoid cysts.Methods The data of 87 patients with intracranial arachnoid cysts(67 male,20 female,mean age 13.4 years),admitted to out hospital from March 2003 to August 2008,were retrospectively analyzed.Forty of them accepted simple endoscopic neurosurgery;19 of them accepted endoscope-controlled neurosurgery;22 of them accepted microsurgery.The efficacy and complications of these 3 methods were analyzed and compared.Results No significant differences on age,the size of the cysts,postoperative complications,the decreased size of the cysts and the improvement were found among these 3 methods(P>0.05).The operation time and bleeding volume of the simple endoscopic neurosurgery group were 97±26.8 min and 15±4.8 mL;the endoscope-controlled neurosurgery group were 87±27.6 min and 18±5.7 mL;the microsurgery group were 143±36.0 min and 160±39.6 mL.As compared with those in the first 2 groups,the operation time was statistically longer and the bleeding volume was obviously increased in the later group(P<0.05);while no significant difference of those was found between the first 2 groups(P>0.05).Conclusion Endoscopic neurosurgery is an effective method with shorter operation time and less bleeding than craniotomy in treating the Sylvian fissure arachnoid cysts.

OBJECTIVETo discuss a new technique about reconstruction of medial collateral ligament (MCL) with double bundle allograft and to evaluate the short-term clinical efficacy.

METHODSAll 53 patients who suffered from valgus instability of the knee were selected. All cases were diagnosed of MCL injury because the medial gap of the knee widened more than 5 mm compared with collateral knee by the stress X-ray, MRI displayed discontinuity of MCL and valgus stress test was positive. All patients were accepted arthroscopic evaluation through inferomedial and inferolateral arthroscopy portal incisions to ascertain whether there were intra-articular injuries. An 8 cm incision was made from 1 cm superior adductor tubercle to 5 cm proximal medial tibia joint line in a longitudinal fashion. The anterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 45 mm under the medial tibia joint line. The posterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 20 mm under the medial tibia joint line. We used 5 mm or 6 mm reamer to drill the tibia tunnel along with guide pin, and then drill the femur tunnel with 6 mm or 7 mm drill in the top of the adductor tubercle about 25 mm or 30 mm length. The allograft was pulled into the tunnel from tibia to the femur and fixed with absorbable interference screw. Patients carried out active rehabilitation program after operation. One year after the operation, IKDC score, Lysholm score were used to evaluate the clinical effect.

RESULTSThe IKDC score (A or B, 86.78% vs. 0), Lysholm scores (89.7 ± 3.4 vs. 51.8 ± 4.9, t = -79.724, P < 0.05) were significantly improved compared with preoperative in all patients. Medial joint widened gap decreased from (10.4 ± 2.4) mm preoperative to (2.8 ± 1.5) mm postoperative from X ray and the differences were significant (t = 41.727, P < 0.05). Among these patients, the medial joint widened gap of 46 cases were less than 3 mm, 7 cases were from 3 mm to 5 mm. The range of motion was 135.4° ± 2.5° preoperative and 132.7° ± 3.7° postoperative. The 9 patients still had medial tenderness 1 year after operation.

CONCLUSIONApplication double bundle allograft technique to reconstruct MCL can significantly improve the stability of the knee and the short-term clinical efficacy was sure.

Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Medial Collateral Ligament, Knee ; injuries ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Transplantation, Homologous ; Treatment Outcome ; Young Adult

OBJECTIVETo report a case of rectal non-Hodgkin lymphoma with concomitant rectal adenocarcinoma.

METHODSClinical records of a 71 years old male patient with rectal non-Hodgkin lymphoma with concomitant rectal adenocarcinoma admitted on May 19, 2010 to the First Affiliated Hospital of Sun Yet-sen University were retrospectively reviewed. Clinical manifestations, diagnosis, and treatment as well as postoperative pathology were summarized.

RESULTSThe preoperative diagnosis of the patient was severe atypical adenomatous hyperplasia with focal carcinogenesis, and the preoperative staging was T2N0-1M0. The patient underwent a Parks procedure (rectal resection and colo-anal anastomosis) and subtotal resection of left lateral liver. The operation was successful, postoperative recovery uneventful. Postoperative pathology showed moderately differentiated tubular adenocarcinoma with deep muscular invasion, and non-Hodgkin lymphoma with marginal zone cell. Both the distal and proximal resection margins were negative and no vascular and neural invasion were seen. Immunohistochemical staining indicated L26(+), Bcl-2(+), Bcl-6(+), CD3(-), CD23(-), CK epithelial cells(+), and M-CEA luminal border(+). The pathological and immunohistochemistry results of liver specimens showed hepatic mucosa-associated marginal zone lymphoma.

CONCLUSIONSRectal adenocarcinoma and lymphoma occurring at the same site simultaneously is extremely rare with unique pathologic features.

Adenocarcinoma ; complications ; pathology ; Aged ; Humans ; Lymphoma, Non-Hodgkin ; complications ; pathology ; Male ; Rectal Neoplasms ; complications ; pathology

BACKGROUNDMany factors interfering with a listener attempting to grasp speech in noisy environments. The spatial hearing by which speech and noise can be spatially separated may play a crucial role in speech recognition in the presence of competing noise. This study aimed to assess whether, and to what degree, spatial hearing benefit speech recognition in young normal-hearing participants in both quiet and noisy environments.

METHODSTwenty-eight young participants were tested by Mandarin Hearing In Noise Test (MHINT) in quiet and noisy environments. The assessment method used was characterized by modifications of speech and noise configurations, as well as by changes of speech presentation mode. The benefit of spatial hearing was measured by speech recognition threshold (SRT) variation between speech condition 1 (SC1) and speech condition 2 (SC2).

RESULTSThere was no significant difference found in the SRT between SC1 and SC2 in quiet. SRT in SC1 was about 4.2 dB lower than that in SC2, both in speech-shaped and four-babble noise conditions. SRTs measured in both SC1 and SC2 were lower in the speech-shaped noise condition than in the four-babble noise condition.

CONCLUSIONSpatial hearing in young normal-hearing participants contribute to speech recognition in noisy environments, but provide no benefit to speech recognition in quiet environments, which may be due to the offset of auditory extrinsic redundancy against the lack of spatial hearing.

Adolescent ; Adult ; Auditory Threshold ; physiology ; Female ; Hearing ; physiology ; Humans ; Male ; Noise ; Speech Perception ; physiology ; Speech Reception Threshold Test ; Young Adult

Pituitary carcinoma is extremely rare. We report two cases of non-functioning pituitary carcinoma treated in our hospital. The two female patients, aged 39 and 40 years, were diagnosed by CT and MRI and postoperative pathological examination. The tumor was surgically resected followed by stereotactic radiotherapy. Despite of the treatments, both of the patients showed tumor recurrence and died at 1 and 2 months after discharge. The diagnosis of this disease relies on a combined evaluation of the clinical, radiological, cytological, immunohistochemical features. Due to the highly malignant nature and poor prognosis of this disease, early surgical intervention and systemic evaluation of the patients' condition are imperative. Currently more effective therapeutic approaches are needed to control the tumor progression.
Adult ; Female ; Humans ; Pituitary Neoplasms

OBJECTIVETo analyze the clinical risk factors for deep vein thrombosis (DVT) after total hip and knee arthroplasty in Chinese patients who received prophylactic treatment for DVT.

METHODSWe evaluated 128 total hip arthroplasty (THA) and total knee arthroplasty (TKA) in 95 patients performed at our center from April 2004 to August 2004, which included 48 THAs in 43 patients and 80 TKAs in 52 patients. There were 27 men and 68 women with a mean age of 59.77 years (range, 23-78 years). All patients had been given low-molecular-weight heparin before operation and for 7-10 days post-operation to prevent DVT. Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all patients before operation and at 7-10 days after operation. Nineteen clinical factors were examined preoperation and 7-10 days post-operation in order to analyze their influences on DVT formation after surgery.

RESULTSThere were 45 patients who developed DVT after operation. The incidence of DVT in all patients was 47.4% (45/95) and the incidence of proximal DVT was 3.2%. There were more asymptomatic DVT (57.8%, 26/45) than symptomatic ones, and some patients without DVT (14%, 7/50) presented some of the DVT symptoms. Logistic regression analysis demonstrated a definite association of female, obesity (representative by BMI), cement usage and diagnosed RA with DVT with odds ratio of 10.008, 3.094, 8.887, and 0.194 respectively. Other clinical factors had no statistically significant association with DVT.

CONCLUSIONSFemale, obesity, and cement usage were the risk factors for DVT after THA and TKA, and diagnosed RA was the protecting factors for DVT after THA and TKA. Other clinical factors such as age, OA, type of implant, monolateral or bilateral operation, duration of anesthesia, surgery and bandage usage for blood control, time for immobilization et al were not the risk factors for DVT.

Adult ; Aged ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Hip ; adverse effects ; Arthroplasty, Replacement, Knee ; adverse effects ; Bone Cements ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Obesity ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Risk Factors ; Sex Factors ; Thrombophlebitis ; etiology ; prevention & control