Objective To investigate the clinical characteristics,diagnosis and treatment of senile primary central nervous system lymphoma.Methods The patients were divided into two groups,one group of the patients underwent chemotherapy and radiotherapy treatment following surgical resection,the other received a combined treatment of chemotherapy and radiotherapy only.The survival were analyzed with log-rank test.Results All of the lesions showed the iso-to slightly high density in the CT scan,and the boundary was unclear,surrounded by edema.Contrast enhancement was found in all of the patients.MRI showed iso-to low T1 and iso-to slightly high T2 signal intensity to the adjacent gray matter.The lesions were surrounded by the edema belt.Contrast enhancement such as rim enhancement or homogeneous enhancement was found in all.The pathological diagnosis was B cell lymphoma(n=32)and T cell lymphoma(n=4).In addition,all of the patients were excluded out of HIV infection and their immune function was normal.The median survival time of the group receiving surgery combination treatment and the group receiving just chemotherapy and radiotherapy were 19 months and 14 months,respectively.There was no significant statistics between the survival time of the two groups.Conclusion It is necessary to differentiate primary central nervous system lymphoma from glioma,metastatic tumor,meningoma,and so on.The surgical resection seems no help for those senile central nervous system lymphoma patients with multi-focus.The diagnosis should be suspected after MRI and obtained by stereotactic biopsy in order to avoid an unnecessary extend of surgery in primary central nervous system lymphoma(PCNSL).

Objective To evaluate the curative effect of salvage liver transplantation and repeated hepatectomy for recurrent hepatocel-lular carcinoma.Methods The data of 72 patients with recurrent hepatocellular carcinoma fulfilling Child-Pugh A and the Milan criteria from September 2004 to August 2010 were retrospectively studied.According to different treatments,53 patients were divided into repeated hepatec-tomy group,and 19 patients were divided into salvage liver transplantation group.The overall survival rates and disease-free survival rates after operation were evaluated by Kaplan-Meier method.COX proportional hazard was used for univariate analysis and multivariate analysis to eval-uate the risk factors for prognosis.Results The 1-year,3-year and 5-year survival rates were 86.79%,62.26% and 45.28% in repeated hepatectomy group,and 89.47%,68.42%and 57.89% in the salvage liver transplantation group respectively.There was no significant differ-ence in the overall survival rates between the two groups (χ2 =2.530,P =0.112).The 1-year,3-year and 5-year disease-free survival rates were 67.92%,47.17% and 35.85%in the repeated hepatectomy group,94.74%,68.42% and 52.63% in the salvage liver transplantation group respectively.There was a significant difference in the disease-free survival rates between the two groups(χ2 =4.395,P =0.036).The univariate analysis and multivariate analysis indicated that microvascular invasion,satellite lesion and multiple tumors were the independent risk factors to influence the survival.Conclusion The salvage liver transplantation obtains a better effect for the patients fulfilling Child-Pugh A and the Milan criteria,which is an effective method in the treatment of hepatocellular carcinoma.

Objective To explore the neurovascular distribution around multifidus muscles in the low back and its clinical significance via regional dissection.Methods Five cadavers were dissected in the low back.The anatomical relationships between the longissimus thoracis,iliocostalis and the start-stop,direction and position of multifidus muscles were observed.Branches,distribution and the characteristics of the erector spinae muscle,the lateral branches of spinal nerves and blood vessels were examined.Then measured the distances from the emerging point of the lateral cutaneous branches of spinal nerves to the spinous processes.Results After removed the deep fascia,the longissimus thoracis was found medially and the iliocostalis was found laterally.The muhifidus muscles located deeply to the longissimus and the iliocostalis muscles.The lateral branches of the posterior rami of the spinal nerves and the dorsal branches of lumbar blood vessels run in the multifidus muscle gaps.Conclusion The multifidus muscle gaps contain plenty of neurovascular bundles.Surgery involving the low back often takes the advantage of the gaps between multifidus muscles.Therefore,surgeons should take caution to avoid damaging the lateral branches of the posterior rami of the spinal nerves and the dorsal branches of lumbar vessels during low back surgery.

The damage degree of neurons in perilesion at different time points was observed in order to explore the optimal operation occasion. Piglet lobar hematomas were produced by pressure-controlled infusions of 2.5 mL autonomous blood into the right frontal hemispheric white matter over 15 min, and the metabolic changes were ambulatorily detected with MRS at 3rd, 12th, 24th and 48th h after hematoma induction. Brain tissues of perihematoma were also obtained at different time points. The transcription level of Bax gene was detected by in situ hybridization and apoptosis by TUNEL technique, and the pathologic change of neurons was observed under an electron microscope. The results showed that the number of Bax positive cells reached the peak at 24 h (79.00 +/- 4.243/5 fields). There was no significant difference in A values between 3 h and 6 h, 12 h (P > 0.05), but there significant difference between 24 h and 3 h, 6 h, 12 h (P < 0.05). The number of apoptotic cells reached the peak at 24 h (P < 0.001), and there was no significant difference between 3 h and 6 h (P = 0.999). The area of the apoptotic cells showed no significant difference between 3 h and 6 h or among 3 h, 6 h and 6 h (P > 0.05). Lac peak mainly occurred at 24 h and 48 h, while on the healthy side, no Lac peak was detectable. The ratio of NAA/Cr presented a descent tendency, but there was no significant difference among the groups before 12 h (P > 0.05), there was very significant difference between 3, 6 and 24, 48 h (P < 0.01). Under electronic microscopy, the neuronal damage surrounding hematoma in 3 to 6 h was milder than in 24 h to 48 h. It was concluded that the secondary apoptosis, damage and metabolic disturbance of the neurons surrounding hematoma was milder in 3-6 h in acute intracerebral hemorrhage, while obviously aggravated in 24-48 h. An effective intervention is needed to reduce secondary damage as soon as possible.
Brain/*pathology ; Cerebral Hemorrhage/*pathology ; Hematoma/*pathology ; Magnetic Resonance Imaging ; Neurons/pathology ; Random Allocation ; Swine ; Swine, Miniature ; Time Factors

Objective To examine the distribution characteristics the medial branch of the posterior branch of the spinal nerves around the lumbar facet joints, so as to explore the localization and targeting of the medial branch of the posterior branch in neurectomy.MethodsFive corpses were dissected, and the anatomical relationships between the medial branches of the posterior branch of the spinal nerves and the facet joints were examined.Measured the distances from the lateral port of the bone fiber tube,the articular process of the facet joint and the superior articular process to the spinous processes.Results The medial branch of the posterior branch of the spinal nerve was close to the root of the articular process and the transverse process,which was not easy to be explored and dissected.Meanwhile, it was easily traced after the medial branch of the posterior branch of the spinal nerve ran through the fibrous tube.Conclusion It may improve the safety and effective when the techniques of medial branch block is performed after the medial branch ran through the fibrous tube.

Objective To investigate the perihematomal changes of hyperacute parenchymal hematomas and the clinical value by MRI. Methods Multi-sequence MRI was performed on 4 hematomas in vitro and on 15 pigs with lobar intracerebral hemorrhage (ICH) for about 30～60 min and 3 h respectively. The integrity of blood-brain barrier (BBB) in ICH pigs was assessed by electron microscopy and Evan's blue dye technique. MR scanning was performed on 2 ICH patients proved by CT for 4 and 9 h after onsets. Results FLAIR and T 2-weighted images showed hyperintensity signal around the hematomas in vitro and in pigs with ICH within 1 h, and more obviously at 3 h. When the gelose cavity was cut, plasma was seen around the clot. The perihematomal ADC values of the pigs increased both within 1 and at 3 h after ICH. However, the BBB was intact at 3 h, which was proved by electron microscopy and Evan's blue dye technique. Water-like intensity signal was observed around the hematomas in two patients with acute ICH. Conclusion The perihematomal changes of hyperacute ICH observed on MRI are resulted from the blood clot contraction and the serum formation and extravasation, but not real cerebral edema.

OBJECTIVE: To provide anatomic data for cochlear implantation, and to find the method of locating lamina spiralis (LS) on the surface of promontory. METHOD: Microanatomical study was carried out on 30 sides of human temporal bones by observing and measuring lamina spiralis below promontory, including its location, course and adjacent structures. RESULT: (1) The basal turn of lamina spiralis below promontory can be divided into three segments: the hook segment (1.52 +/- 0.16) mm, the anteroinferior round window segment (3.83 +/- 0.37) mm and the forwarding segment (2.70 +/- 0.36) mm by two hinge points of which one was located at anterior of the junction of superior margin and anterior border of RW, and the other was located at anteroinferior of the round window; (2) The plane of round window anteroinferior segment of LS lay (51.00 +/- 5.97) degrees anteroinferior to horizontal segment of the facial nerve and comparative permanently meet posterior margin of'stapes head. Made posterior margin of stapes head as a fixation point and draw a line on promontory lay (51.00 +/- 45.97) degrees anteroinferior to horizontal segment of the facial nerve. This line can be thought as the projection of anteroinferior round window segment of LS on promontory; (3) The width of scala tympani at cochleostomy site on promontory: width of scala tympani at midpoint of superior margin of round window was (0.36 +/- 0.06) mm; width of scala tympani at midpoint of anterior border of round window was (0.97 +/- 0.14) mm; width of scala tympani at 3 mm point of anteroinferior round window segment was (1.24 +/- 0.21) mm. CONCLUSION (1) The basal turn lamina spiralis below promontory can be divided into three segments (the hook segment, the anteroinferior round window segment and the forwarding segment) by two hinge points; (2) The projection of anteroinferior round window segment of LS and the features exhibited in its course provide reference for locating the basal turn scala tympani and offer reliable anatomical basis for minimal invasive intervention during cochlear implantation.
Adult ; Cochlear Implantation ; methods ; Facial Nerve ; anatomy & histology ; surgery ; Humans ; Round Window, Ear ; anatomy & histology ; surgery ; Scala Tympani ; anatomy & histology ; surgery ; Temporal Bone ; anatomy & histology ; surgery

In order to investigate the protective effects of the overexpression of bcl-xl gene on local cerebral infarction in the transgenic mice subject to permanent occlusion of middle cerebral artery, the models of bcl-xl transgenic mice were established and subjected to cerebral infarction by intralu- minal occlusion of the middle cerebral artery. The infarct volume and the neurological scores were observed and comparison between the wild type mice and the transgenic mice was made. It was found that the infarct volume and the neurological scores in the transgenic mice were significantly decreased as compared with those in the wild type mice. It was suggested that the overexpression of bcl-xl gene in transgenic mice could reduce the infarct volume and improve the neurological function of the mice.

The damage degree of neurons in perilesion at different time points was observed in order to explore the optimal operation occasion. Piglet lobar hematomas were produced by pressure-controlled infusions of 2.5 mL autonomous blood into the right frontal hemispheric white matter over 15 min, and the metabolic changes were ambulatorily detected with MRS at 3rd, 12th, 24th and 48th h after hematoma induction. Brain tissues of perihematoma were also obtained at different time points. The transcription level of Bax gene was detected by in situ hybridization and apoptosis by TUNEL technique, and the pathologic change of neurons was observed under an electron microscope. The results showed that the number of Bax positive cells reached the peak at 24 h (79.00±4. 243/5 fields). There was no significant difference in A values between 3 h and 6 h, 12 h (P＞0.05), but there significant difference between 24 h and 3 h, 6 h, 12 h (P＜0.05). The number of apoptotic cells reached the peak at 24 h (P＜0. 001), and there was no significant difference betw een 3 h and 6 h (P=0. 999). The area of the apoptotic cells showed no significant difference between 3 h and 6 h or among 3 h, 6 h and 6 h (P＞0.05). Lac peak mainly occurred at 24 h and 48 h, while on the healthy side, no Lac peak was detectable. The ratio of NAA/Cr presented a descent tendency, but there was no significant difference among the groups before 12 h (P＞0.05), there was very significant difference between 3, 6 and 24, 48 h (P＜0.01). Under electronic microscopy, the neuronal damage surrounding hematoma in 3 to 6 h was milder than in 24 h to 48 h. It was concluded that the secondary apoptosis, damage and metabolic disturbance of the neurons surround ing hematoma was milder in 3-6 h in acute intracerebral hemorrhage, while obviously aggravated in 24-48 h. An effective intervention is needed to reduce secondary damage as soon as possible.

OBJECTIVETo explore the relationship between the distributions of posterior ramus of spinal nerve (PRSN) and locations of acupoint in low back through anatomical observation.

METHODSThe regional anatomy was performed at five corpses to observe the distribution of erector spinae muscle and PRSN in areas ofpoints and back-points in low back.

RESULTSThe T, L, L, Land LPRSN distributed on both sides of the spine; the medial branches of PRSN travelled between spinalis thoracis muscle and longissimus thoracis muscle, while the lateral branches of PRSN travelled between longissimus thoracis muscle and iliocostalis lumborum muscle.

CONCLUSIONS points and back-points in low back are closely associated with PRSN, particularly T, L, L, Land L.