Objective:To investigate the emergency surgical effect of ruptured intracranial dural arteriovenous fistula (DAVF).Methods:Patients with ruptured intracranial DAVF underwent microsurgery in the Department of Neurosurgery, Nanping First Hospital Affiliated to Fujian Medical University from May 2013 to July 2022 were retrospectively included. The clinical, imaging and follow-up data were collected, and the clinical characteristics, selection of surgical methods and treatment effects of patients were summarized.Results:A total of 8 patients with DAVF were enrolled. Their age ranged from 11 to 60 years (average, 48 years). There were 7 males and 1 female. All 8 patients suffered from intracranial hemorrhage, manifested as headache and vomiting in 2 cases, simple conscious disturbance in 2 cases, conscious disturbance with cerebral hernia in 3 cases, and conscious disturbance with limb paralysis in 1 case. The fistula was located in the anterior fossa in 4 cases (including 2 cases with aneurysms), the middle fossa in 2 cases (including 1 case with moyamoya disease), the transverse sinus in 1 case, and the anterior 1/3 area of the sagittal sinus in 1 case. Cognard classification: 7 patients were type Ⅲ and 1 was type Ⅳ. After admission, all patients underwent emergency craniotomy and microsurgery to remove hematoma. Among them, 4 patients underwent decompressive craniectomy at the same time, 1 patient with moyamoya disease underwent dural turnover and temporalis muscle application at the same time, and 2 patients with aneurysms at the same location were clipped at the same time. Postoperative re-examination of head CT showed that the hematoma was cleared satisfactorily and the midline was no shift in all 8 patients. CT angiography (CTA) showed that the fistula disappeared within 2 weeks. Seven patients were followed up within 1-12 months after operation. CTA or digital subtraction angiography showed no recurrence of DAVF. Two patients with aneurysms did not have residual or recurrent aneurysms. All patients had no new neurological symptoms, and the Glasgow Outcome Scale score in 2 patients increased by 1 compared with that at discharge.Conclusion:Emergency microsurgery is an effective method for the treatment of ruptured intracranial DAVF, especially for patients with special parts or complicated hematoma, cerebral hernia, and other vascular diseases.

Objective:To establish an air-pouch bladder cancer (APBCa) model and investigate whether it could be a new animal model to evaluate the efficacy of intravesical therapy through chemotherapeutics and BCG instillation.Methods:Filtered sterile air was injected subcutaneously into the backs of BALB/c Nude mice to create a 2.5 cm×3.5 cm air pouch. After 24 hours, human bladder cancer cells EJ were seeded on the inner face of the pouch wall to establish APBCa of human cancer (H-APBCa). Gemcitabine instillation was used to investigate whether chemotherapy could inhibit tumor growth in the H-APBCa model, and Tunel staining was used to verify the apoptosis of tumor cells 20-day treatment. Filtered sterile air was injected subcutaneously into the backs of C57BL/6 mice to create a 2.5 cm×3.5 cm air pouch. After 24 hours, mice bladder cancer cells MB49 were seeded on the inner face of the pouch wall to establish APBCa with intact immunity (I-APBCa). BCG instillation was used to investigate whether BCG could inhibit tumor growth in the APBCa model. Immunofluorescence was used to verify the infiltration of immune cells after 20-day treatment.Results:H-APBCa and I-APBCa mice models could be established by immune deficiency and intact mice. At day 20, chemotherapeutic instillation therapy could inhibit tumor growth (781.02±241.02 vs. 1213.88±214.02 mm 3, P<0.05) by inducing tumor cell apoptosis with statistically significant differences (77.33±4.63 vs. 14.67±2.60, P<0.05). BCG instillation was able to inhibit tumor growth (645.02±156.63 vs. 948.84±221.76, P<0.05) by increasing CD80 + macrophage (49.67±7.57 vs. 16.33±5.69, P<0.05) and T cells in the tumor with statistically significant differences (18.00±3.46 vs. 4.67±1.45, P<0.05). Conclusions:APBCa model could evaluate the efficacy of drug instillation and was expected to be a new animal model for studying drug for intravesical therapy.

Objective To assess the efficacy and side effects of intravesical instillation of BCG after transurethral resection of the bladder tumor (TURBT) in non-muscle invasive bladder cancer (NMIBC) patients.Methods The clinical data of patients treated with BCG 120 mg per course induced perfusion or more after TURBT from December 2013 to October 2016 in 18 hospitals of northeast China region,were analyzed retrospectively.The first part,data of 106 patients with moderate,high-risk NMIBC were collected.A total of 83 patients were male,while the other 23 patients were female.The average age was 66.7 years old.The clinical staging were T1 in 86(81.1％) cases,Ta in 20(18.9％) cases and carcinoma in situ in 6 (5.7％) patients.Intravesical instillation of BCG was executed after transurethral resection of the bladder tumor.The incidence rate of recurrence and progression during more than 6 months' follow-up time were observed.Multivariate analyses were done by using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method.The second part,treatment compliance of 276 patients with bladder cancer,including moderate/high-risk NMIBC in 263 cases,moderate/high-risk NMIBC followed with renal pelvis/ureteral carcinoma in 8 cases were and moderate/high-risk NMIBC with renal pelvis/ureteral carcinoma in 5 cases who treated with BCG after the surgeries,were observed.Patients consisted of 211 males and 65 females with average age of 68.3 years.Results With a median follow-up of 12 months,9 (8.5％) patients experienced tumor recurrence and 2 (1.9％) patients were found progression in the first part.The one-year cancer free recurrence rate of the patients was 91.5％.Statistically significant prognostic factors for recurrence identified by multivariable analyses were prior recurrence of the tumors (OR =3.214,95％CI0.804-12.845,P =0.099).In the second port,an incidence rate of adverse effects was 64.1％ (177/276).The Ⅲ/Ⅳ degree complications were occurred in 11 patients and satisfactory outcomes achieved with active treatment.A total of 36 patients withdrawal with the major causes were recurrence and progression of bladder tumor in 12 cases (4.4 ％),9 cases (3.3 ％) with economic reasons and 11 cases (4.0％) with serious complications.Conclusions NMIBC patients treated with intravesical BCG therapy have approving cancer free recurrence rates and acceptable adverse effects.Prior recurrence may be prognostic factor of recurrence after intravesical BCG therapy.

Objective To evaluate the application values of diffusion tensor tractography (DTT) combined with neuronavigation in microsurgery of insular gliomas. Methods The clinical data of 27 patients with insular gliomas, admitted to our hospital from March 2013 to October 2017, were analyzed retrospectively. All DTT images were transferred to the neuronavigation system, and the three-dimensional location of tumors and pyramidal tracts were re-constructed. Surgical approaches were designed and excision scopes were defined before the surgery. Techniques on how to distinguish and protect the key blood vessels and pyramidal tracts were discussed. The treatment efficacies were analyzed. Results Total lesion resection was achieved in 22 patients (81.5％), subtotal resection in 4 (14.8％ ), and partial resection in one (3.7％ ). Postoperative pathology indicated 7 were oligodendrogliomas, and 20 were astrocytomas, including WHO grade I in one, grade II in 18, and grade III in one. One patient had transient aphasia (recovery after two weeks), 2 experienced worsened hemiplegia on opposite side of their bodies (normal after one month), and the left 24 patients remained intact function after operation. Conclusions The combination of DTT and neuronavigation is safe and effective in surgical treatment for insular gliomas, which can protect the brain function at greatest degree and maximize lesion resection, and improve the postoperative quality of life.

Objective To compare the safety and effect of the holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate(TURP) for benign prostatic hyperplasia(BPH).Methods Three hundred and forty-nine cases with benign prostatic hyperplasia were divided into HoLEP group (172 cases) and TURP group(177 cases).All patients were assessed preoperatively,then we recorded hemorrhage volume,operation time,catheter indwelling time and complication rate.Follow-up 3 months,postvoid residual(PVR),maximal urinary flow rate(Qmax),international prostate symptom score(IPSS),quality of life score(QOL) were analyzed.Results Hemorrhage volume,operation time,catheter indwelling time in HoLEP group were significant less than TURP group(P ＜ 0.05),complication rate of HoLEP group was lower than that of TURP group(P ＜ 0.05).After 3 months follow-up,IPSS,Qmax,PVR,QOL were obviously improved in both groups compared with preoperation (P ＜ 0.05).Conclusions HoLEP is safer than TURP on the base of same effectiveness,it is an promising surgical method for BPH patients.

BACKGROUNDAmplatz dilation and balloon dilation are different methods in creating the accesses during percutaneous nephrolithotomy (PCNL). The aim of this study was to review the surgical experiences of managing staghorn calculi by Amplatz dilation and balloon dilation for 3 years.

METHODSWe retrospectively analyzed clinical data from 125 patients (129 kidneys) with staghorn kidney stones who underwent PCNL from January 2010 to December 2012, of whom 60 patients underwent Amplatz dilation (AD group) and 65 underwent balloon dilation (BD group) during PCNL.

RESULTSThe AD and BD groups were similar in age, male-female ratio, stone burden, stone type, hydronephrosis, and proportion of patients who had undergone extracorporeal lithotripsy. However, these two groups showed significant differences in terms of duration of percutaneous access (15.1 ± 3.6) minutes vs. (10.0 ± 3.3) minutes, one-attempt success rate of dilation via a single access 88.9% (72/81) vs. 97.8% (91/93), hemoglobin drop after surgery (3.5 ± 0.9) g/dl vs. (1.7 ± 0.9) g/dl, number of cases requiring intraoperative and postoperative blood transfusion 27.9% (n = 17) vs. 13.2% (n = 9), changes of central venous pressure before and after surgery (2.3 ± 1.2) cmH2O vs. (1.2 ± 0.7) cmH2O, number of patients who experienced postoperative fever >37.5°C 21 (34.4%) vs. 13 (19.1%) (all P < 0.05). No injury of adjacent organs, including pleura, liver, spleen, or bowel, was noted in patients.

CONCLUSIONSDuring ultrasound-guided PCNL for staghorn stones, balloon dilation and Amplatz dilation are all effective and safe. Compared with Amplatz dilation, balloon dilation is a better choice, as it has a higher access creation success rate, shorter access creation time less blood loss, and lower proportions of circulatory overload and postoperative fever.

Adult ; Aged ; Female ; Humans ; Kidney Calculi ; surgery ; Male ; Middle Aged ; Nephrostomy, Percutaneous ; methods ; Retrospective Studies ; Young Adult

Objective To investigate the prevalence of toxoplasma gondii (Tox),rubella virus (RV),cytomegalovirus (CMV) and herpes simplex virus (HSV) infections (TORCH infections) among childbearing-age population in Henan province.Methods Enzyme-linked immunosorbent assay (ELISA) was applied to detect plasma TORCH IgM and IgG among 3084 childbearing-age men and women from theFirst Affiliated Hospital of Zhengzhou University during July and September,2011.The positive rates of anti-TORCH antibodies were compared among the various age and gender groups by x2 test.Results The total positive rate of anti-TORCH IgM was 5.5％ (170/3084),in which the positive rate of anti-RV IgM was the highest (2.9％),followed by anti-HSV IgM (1.0％).Within positive rate of anti-TORCH IgG,anti-HSV IgG was the highest (90.4％),followed by anti-CMV IgG (89.7％),RV IgG (48.1％) and Tox IgG (0.7％).The positive rate of anti-TORCH IgM was the lowest in individuals aged ＞ 30-40 year old.With the age increasing,the positive rates of anti-Tox IgG,anti-CMV IgG and anti-HSV IgG increased,but the positive rate of anti-RV IgG decreased.Women had higher positive rates of anti-CMV IgG and antiHSV IgG than men (x2 =83.470 and 7.026,P ＜ 0.O1).Conclusions Current infection of TORCH exists in childbearing-age population of Henan province,and the positive rate of anti-RV IgG is low.It is recommended to screen for TORCH infection in childbearing-age men and women.

Objective To investigate the effects of rosiglitazone,an agonist of proliferators activated receptor?(PPAR?),on expression of nuclear factor-kappa B(NF-?B)in peripheral blood mononuclear cells(PBMC)of multiple organ dysfunction syndrome(MODS) rats.Methods Forty male SD rats were randomly divided into four groups(n = 6 per group): vehicle control group,endotoxin(LPS) group,rosiglitazone(ROSI) pretreatment group,and PPAR-?antagonist GW9662 pretreatment group.Blood was taken 4 hours after operation,and mononuclear cells were separated.The expression of NF-?B p65in PBMC was detected by immunocytochemical method and image analysis was carried out.Results The expression of NF-?B p65 was low in vehicle control group.In LPS group,the expression of NF-?B p65 was significantly higher than that in vehicle control group(P0.05).Conclusion Rosiglitazone protected the MODS rats by inhibiting NF-?B activation.

ObjectiveTo observe the effect of monosialo gangliosides-1 (GM-1) and Radix salviae miltiorrhizae (RSM) on neonatal hyposemic ischemic encephalopathy (HIE).Methods62 cases of HIE were randomly divided into treatment group and control group, and both groups received conventional therapy. Injection of RSM and GM-1 were added into the treatment group in 7～10 days therapy. ResultsHigh curative effect, average curative effect and total curative effect in the treatment group of 31 cases were 80.6%, 16.1% and 96.8%, while that in control group of 31 cases were 32.3%, 51.6% and 83.9% respectively. There was significant difference in the high curative effect and total effect between the two groups (P<0.05). ConclusionThe treatment combined with RSM and GM-1 can enhance the curative effect on HIE without any side effect.

Objective To explore the key factors which affect maintenance cost of large-scale medical equipment. Methods The basic factors which affect maintenance cost of medical imagining equipment were summarized. The relationships of them are analyzed and then an interpretative structure mode of each factor was set. Additionally, the multiple relationship and controllability between each factor were also analyzed and the judging standard of key factors was set. Results The maintenance policy and mode were the key factors which affect maintenance cost of medical imagining equipment. Conclusion High quality maintenance for equipment condition and scientific optimization of the maintenance policy are necessary to fundamentally reduce the maintenance cost of large-scale medical equipment.