Objective To study the surgical skills for parasagittal meningioma at the central cortex. Methods A total of 32 patients with parasagittal meningiomas at the central cortex were treated with microsurgery. Through the arachnoid interfaces between the tumor and the brain tissue, the tumor was removed piece by piece. The vein of central sulcus, other draining veins, and normal brain tissues were protected, and the involved sagittal sinus was appropriately treated. Results Simpson Ⅰ, Ⅱ, and Ⅲ grades resection was achieved in 17 (53.1%), 11(34.4%), and 4 (12.5%) of the 32 patients respectively. None of the patients died. Two patients developed cerebral edema and infarction and were cured by surgical decompression. Hemiparalysis was deteriorated in 10 patients, 8 of them recovered spontaneously in 1 to 6 weeks, and the other 2 developed hemiparesis. Among the patients, 21 patients were followed up for 3 months to 5 years. 4 patients had recurrent meningioma in 1 to 3 years after the operation (Ⅱ grade resection in 2 and Ⅲ grade resection in 2). Conclusions For parasagittal meningiomas at the central cortex, preoperation imaging evaluation and microsurgical techniques are key factors for complete resection and surgical outcomes. The vein of central sulcus, other draining veins, and normal brain tissues should be protected during the procedure.

Objective To summarize the clinical features,treatment and prognosis of bullous systemic lupus erythematosus (BSLE).Methods Clinical data were collected from 6 cases of BSLE between May 2009 and September 2015,and were analyzed retrospectively.Results Among the 6 patients,2 were male and 4 were female.The mean age of onset was 34 years.All the 6 patients presented with tense blisters and bullae arising on an erythematous base or normal skin,which were arranged in an annular pattern in 3 patients.The SLE Disease Activity Index (SLEDAI) score was ＞ 4 in all the 6 patients.Histopathological examination showed subepidermal blisters or fissures in all the patients.Direct immunofluorescence (DIF) revealed continuous linear deposition of immunoglobulin G (IgG),IgM and IgA in all the patients,linear deposition of C3 in 4 patients,and linear deposition of Clq in 2 patients at the basement membrane zone (BMZ).All the 6 patients were treated with oral glucocorticoids and hydroxychloroquine,and 2 patients were additionally treated with cyclophosphamide.During the follow-up period,adverse reactions to different extents were observed in the 6 patients.Conclusions BSLE mainly occurs in young and middle-aged people.Histopathologically,subepidermal blisters or fissures can be observed with linear deposition of IgG,IgM,IgA,or C3 along the basement membrane zone on DIF.

Objective To investigate the association between HLA-DRB1 alleles and pemphigus vulgaris (PV) in a Han population in Sichuan.Methods Polymerase chain reaction with sequencespecific primer (PCR-SSP) method was used for low-resolution and high-resolution typing of HLA-DRB1 alleles in 19 patients of Han nationality with PV and 25 healthy controls in Sichuan.Allele frequencies were calculated,and differences in the allele frequency between the above two groups were compared by using chisquare test.Results Totally,9 kinds of DRB 1 low-resolution alleles and 19 kinds of DRB 1 high-resolution alleles were identified in the PV patients and healthy controls.Frequencies of the DRB1* 14 allele (39.47％[15/38] vs.8.00％[4/50],x2 =17.43,P ＜ 0.05) and DRB1*1405 allele (15.79％[6/38] vs.2.00％[1/50],x2 =4.25,P ＜ 0.05) were significantly higher in the PV patients than in the healthy controls.Conclusion The HLA-DRB1*14 allele may be a common susceptibility gene for PV in the Han population in Sichuan,and the HLA-DRB1* 1405 allele may be most closely associated with PV.

Objective To study intraoperative neural electrophysiological monitoring applied in lumbosacral spinal cord tumor resection.Methods We retrospectively reviewed the clinical data of 212 patients undergoing lumbosacral spinal cord tumor resection with or without intraoperative neural electrophysiological monitoring in our hospital.The patients were divided into two groups:124 patients in the monitored group received intraoperative neural electrophysiological monitoring while 88 ones in the control group did not.The monitoring was performed by recording the cortical somatosensory evoked potential (CSEP),dermatomal somatosensory evoked potential (DSEP) and electromyography (EMG).The patients were followed up for 3-6 months and their postoperative outcome was analyzed.Results There were significant differences in the outcome (P <0.05),but no difference was found in the incidence of complications between the monitored group and the control group.The sensitivity of CSEP +DSEP+EMG was 100%,and the specificity was 55.9% in the former group.Conclusion Combined monitoring with CSEP,DSEP and EMG during lumbosacral spinal cord tumor resection is valuable in protecting the spinal nerve roots and ensuring better operation safety.

Objective Through comparision of HER2/neu status detected by immunohistoehemistry (IHC),fluorescence insitu hybridization(FISH)and chromogenic insitu hybridization(CISH),to explore the clinical significance of FISH and CISH on detecting gene status of HER2.Methods Sixty-four paraffinembedded breast samples whose pathological types were infiltrating ductal carcinomas were tested by IHC for HER2 protein overexpression and CISH,FISH for HER2 gene status.The rate of chromosome 17 polysomy was also analyzed.Results Among the cases of HER2 protein overexpression(+++)group,the concordant ratios of IHC and CISH.FISH detecting HER2/neu status were 100%.Among the cases of HER2 protein overexpression(++)group,the concordant ratios were 95.83%and 91.67%.Among the cases of HER2 protein overexpression(+/-)group,the concordant ratios were also 100%.One case in which FISH and CISH were performed yielded the different results.so the general coincident rate was 98.41%.The incidence of chromosome 17 polysomy Was 45.16%,45.83%and 11.11%in three IHC(+++,++,+/-)groups,and the total incidence was 40.62%.ConclusionIHC is a preliminary screening method;HER2 gene status detected by CISH and FISH have high concordant ratio,CISH is a more convenience and viable method to detect HER2/neu status,when doubling interference of fichromosome 17 polysomy,we need to select FISH further.

Objective:To investigate the influence of clinical outcomes and the risk factors of poor prognosis for preoperative nutritional risk in gastric cancer patients.Methods:A prospective study was performed in 140 patients with gastric cancer and the nutritional risk screening 2002 (NRS 2002) was done.The influence of preoperative nutritional risk on postoperative complications,hospital stay,ICU stay,hospital expenses,60 days readmission and mortality was analyzed,and the risk factors of perioperative complication were identified by univariate and multivariate analysis.Results:The significant difference (NRS 2002 ≥ 3 group vs.NRS 2002 ＜ 3 group) was observed in the rates of overall postoperative complications,pulmonary infection,overall hospital stay and postoperative hospital stay (P ＜ 0.05).The rates of anastomotic fistula,pleural effusion,60 days readmission,60 days mortality and hospitalization expenses in NRS 2002 ≥ 3 group were higher than that of NRS 2002 ＜ 3 group,but there were no differences between the two groups (P ＞ 0.05).By univariate and multivariate analysis,preoperative high cholesterol levels and preoperative nutritional risk are the risk factors of poor prognosis and postoperative complications.Conclusion:Preoperative high cholesterol levels and preoperative nutritional risk are independent risk factors of postoperative complications.

Animals ; Evoked Potentials, Motor ; physiology ; Male ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; Spinal Cord ; physiology

Objective By making models of premature animal,explores the effects of dexamethasone on the brain development of premature rats and its mechanisms.Methods Eighteen SD rats were randomly divided into high-dexamethasone(H-Dex) group,low-dexamethasone (L-Dex) group and normal saline(NS) control group,with 6 rats in each group.The pregnant rats in L-Dex group were injected with dexamethasone [0.1 mg/(kg·d)] from 16 to 18 days of pregnancy,while the pregnant rats in H-Dex group were injected with dexamethasone [0.5 mg/(kg· d)] ; the pregnant rats in NS control group were injected with 0.9％ NaCl of the same volume.All of the fetal rats were received after administrating caesarean operation on the day 19 of pregnancy.Rats were sacrificed at the directed time and brain tissue was prepared.Histological feature and the water content of the brains were observed.Level of apoptosis was measured by flow cytometry.The expressions of myelin basic protein (MBP) and interleukin(IL)-1β in brain tissue homogenate were detected by ELISA.Results (1) The brain water contents of rats in H-Dex group,L-Dex group and NS control group were (85.94 ± 0.54) ％,(86.08 ± 1.01) ％,(86.94 ± 0.82) ％.Compared with NS control group,the water contents of Dex group were lower (P ＜ 0.05).(2) Glial cells of brain cortex in L-Dex group and H-Dex group were more mature than in NS control group,and the changes in H-Dex group was more significant.(3) The expressions of MBP in brain tissue of H-Dex group,L-Dex group and NS control group were (5.73 ± 1.06) μg/mg,(5.46 ±0.77) μg/mg and (2.42 ±0.52) μg/mg.Compared with NS control group,Dex group was higher(P ＜0.05).While the expressions of IL-1β in brain tissue of H-Dex group,L-Dex group and NS control group were (249.05 ± 11.29) pg/g,(257.47 ± 9.33) and (292.66 ± 21.51) pg/g.Compared with NS control group,Dex group was lower(P ＜ 0.05).There was no significant difference between H-Dex group and L-Dex group(P ＞ 0.05).(4) The level of apoptosis in H-Dex group,L-Dex group and NS control group were (18.07 ± 1.63) ％,(6.88 ± 0.47) ％ and (2.00 ± 0.32) ％.Compared with NS control group,the level of apoptosis in Dex group was higher(P ＜0.05),and H-Dex group was higher than that in L-Dex group.Conclusion (1) Using dexamethasone prophylactic could promote the development of glial cells,reduce the water content,increase the expressions of MBP,and decrease the expressions of IL-1β in brain tissues.It indicates that dexamethasone may play a major role in maturation of fetal brain.(2) Using dexamethasone prophylactic could increase the amounts of the apoptosis cells,and this effect is dose-dependent.It indicates that dexamethasone may have a negative effect on the fetal brain and suggestes that using dexamethasone in premature infant should be cautious,and if it has to,using a lower dose.

There has been no specific therapeutic measures for acute lung injury /acute respiratory distress syndrome ( ALI/ARDS) , a disease of high fatality rate.Besides having good curative effects for the cardiovascular system diseases, cancer, obesity and preventing aging, traditional Chinese herbal medicines also have obvious therapeutic effects on ALI/ARDS.In this paper, we summari-zes the protection and the underlying mechanisms of traditional Chinese herbal medicines on ALI/ARDS.

Objective To summarize the value of early mechanical ventilation plus continuous vacuum suction in treatment of serious pulmonary contusion.Methods Forty-eight cases of severe pulmonary contusion were assigned to mechanical ventilation plus continuous vacuum suction (observation group,n =20) and mechanical ventilation plus discontinuous vacuum suction (control group,n =28)according to the random number table.Modes of mechanical ventilation were synchronized intermittent mandatory ventilation (SIMV),pressure support ventilation (PSV),and positive and expiratory pressure (PEEP).Changes in blood gas analysis,mechanical ventilation time,and associated complications were compared between groups.Results At ventilation time of 6 and 24 hours,PaO2 in observation group was (100.36 ± 5.90) mmHg and (105.34 ± 7.40) mmHg respectively,with significant differences from (75.36 ± 8.95) mmHg and (76.36 ± 8.35) mmHg in control group (P ＜ 0.01).At ventilation time of 24 hours,PaO2/FiO2 was (283.50 ± 15.20) mmHg in observation group and (201.50 ± 10.20) mmHg in control group (P ＜0.01).Mechanical ventilation time and PEEP at ventilation time of 48 hours in observation group was (3.2 ± 1.1) days and (4.5 ± 2.3) cmH2 O,with significant differences from (6.5 ± 2.8) days and (8.5 ± 2.5) cmH2O in control group (P ＜ 0.01).Associated complications of the two groups revealed no significant difference (P ＞ 0.05).Conclusion Early mechanical ventilation with sustained vacuum suction is effective to keep airway clear,improve oxygenation index,decrease PEEP level,and control the duration of mechanical ventilation,but may not lower the risks of ventilator-associated pneumonia and pulmonary atelectasis.