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.

BACKGROUND: It is of significance to imitate facial nerve paralysis of temporal trauma, establish the model of facial nerve paralysis, and study the histopathologic changes of facial muscle after denervation and the effect on rehabilitation of facial muscle function.OBJECTIVE: To investigate the relationship between rehabilitation of facial muscle function and the structural changes of mitochondria and succinate dehydrogenase (SDH) of oris muscles after denervation.DESIGN: A randomized controlled trail based on experimental animals.SETTING: Department of otolaryngology in a hospital of a university.MATERIALS: The experiments were conducted in the Center of Animal Experiment, the Department of Histoembryology, and the Second Electron Microscope(EM) Center, China Medical University. Sixty white guinea pigs provided by the Center of Animal Experiment, China Medical University [certification No: SCXK (liao) 2003-0009 ], were randomly divided into three groups, 5 s squeezed group( n = 15, 10 tested for the function of facial muscle, 5 for EM specimen 15 days after operation), 15 s squeezed group( n =20, 10 tested, 5 for EM specimen 15 days and 30 days after operation), and 30 s squeezed group( n = 25, 10 tested, 5 for EM specimen 15 days after operation and 10 for EM specimen 30 days after operation).INTERVENTIONS: Models of facial paralysis were established. The threshold of facial nerve was detected with electroneurogram(ENoG) before and after squeezed, and the duration of the functional recovery of facial muscle was observed with blink reflex. Orbicularis oris was taken for SDH cytochemical staining, and the ultrastructural changes of SDH positive reaction granules,mitochondria and muscle fibers were observed under transmission electroscope.MAIN OUTCOME MEASURES: ENoG threshold value, tine for recovery of facial muscle function, SDH positive reaction granules and ultrastructural changes of mitochondria and muscle fibers.RESULTS: In 5 s squeezed group, the average inhibition time of nerve excitement conduction was(35.2 ± 16.8) minutes, the structure of mitochondria and the positive reaction granules of SDH remained normal, and the muscle fiber had no pathologic changes. In 15 s squeezed group, it took an average of(47 ± 15) days for blink reflect to recover. In 15 s squeezed group of 15 days, the mitochondria showed slight bubble degeneration and the SDH granules decreased and the muscle fiber had slight pathologic changes, but recovered after 30 days. The mitochondria changed severely and SDH granules decreased significantly in 30 s squeezed group of 15 days and 30 days; no case of blink reflect recovered within' half a year.CONCLUSION: The longer the facial nerve is injured, the nore severely the function of facial muscles is damaged, and the more difficultly it will recover. Therefore, facial nerve decompression should be performed as early as possible.

Objective To investigate the medical cost of 72 patients with panic disorder and efficacy of paroxetine(SSRIs)in the treatment.Methods The course,medical cost,types and times of main examination of all 72 patients were reviewed and analyzed.The effect of paroxetine on the patients was studied in terms of anxiety and depression scale.Results The 72 patients had long course,high medical cost and received many unnecessary medical examinations.Paroxerine was effective on patients with panic disorder in light of anxiety and depression scale.Con- clusion Patients with panic disorder had long course and spent much unnecessany money before final diagnosis. Paroxetine was useful and safe in the treatment of panic disorder.