Objective To explore the clinical features of meningeal carcinomatosis (MC). Methods The clinical data of 3 male patients with MC, administered to the authors' hospital within one-year period, were retrospectively analyzed. The pathological mechanism, clinical manifestations, diagnosis, treatment and the prognosis were summarized and relevant literature was reviewed. Results All the three patients presented neurological symptoms at the onset. Case 1, 52-year-old having a history of radical resection for gastric cancer 3 years ago, suffered from headache for 2 months without apparent digestive symptoms. Case 2, 71-year-old, presented diplopia for 2 months. Case 3, 46-year-old, complained diplopia for 3 months, followed by left hip pain and urinary retentions. For case 1, examinations after admission suggested no signs of local recurrence or systemic metastasi. For case 2 and 3, lung tumors were detected and then pulmonary carcinoma was diagnosed. Cerebrospinal fluid (CSF) of the three patients showed similar changes, including mild increase of protein, decrease of glucose and chlorides. Carcinous cells (heterocyst, signet-ring cell and large round heterocyst) were found and cells with positive tumor markers were found in the CSF of all the three patients. MRI also showed specific enhancement on meninges. All these patients, died on day 7, 47 and 24 respectively, after the diagnosis was established. Conclusions Neurological symptoms might be the earliest or the exclusive clinical features of meningeal carcinoma metastasis. A detailed neurological and oncological examination is necessary for the patients with progressive neurological lesions without obvious precipitating cause.

BACKGROUND:The levels of interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) are increased during infectious brain edema, and are positively relevant to the degree of brain damage. However, whether TNF-α can enhance blood brain barrier (BBB) permeability remains unclear, especially in vitro.OBJECTIVE: To understand the changes and possible mechanism of the BBB permeability induced by TNF-α in vitro.DESIGN: Randomized controlled cell model study in vitro.SETTING:Department of Pediatrics, Xiangya Hospital, Central South University; Department of Biochemistry, Xiangya Medical College, Central South University.MATERIALS: Twenty 7-day-old healthy Sprague-Dawley rats, of clean grade and either gender, were provided by the Animal Center, Xiangya Hospital, Central South University. TNF-α was purchased from sigma Company; DMEM fluid medium and fetal bovine serum were purchased from Hyclone Company; Y-27632 was purchased from Alexis Company,and rabbit anti-human factor Ⅷ -related antigen was purchased from Zymed Company; Mouse anti-rat glial fibrillary acidic protein (GFAP) was purchased from Neomarkers. Other biochemical reagents were imported (Sigma Company).METHODS: This experiment was carried out in the Xiangya Hospital, Central South University between March 2004 and April 2005. Brain microvascular endothelial cells and astrocytes were co-cultured 10 days to set up rat models of BBB in vitro. Then, the cells were divided into 4 groups: model group(BBB models were prepared), TNF-α group ( BBB model incubated with 0.01 g/L TNF-α for 5 hours), Y-27632 pretreated group ( BBB model incubated with 30 μmol/L Y-27632 for 1 hour before 0.01g/L TNF-α challenge ) and Y-27632 control group (BBB models only incubated with Y-27632 as those in the Y-27632 pretreated group). The effect of TNF-α on BBB permeability was observed by detecting the 125 I -BSA, which passed through the inserts at each time point (30,60,120 and 240 minutes) using .γradioimmunoassay counter.MAIN OUTCOME MEASURES: The 125 I -BSA, which passed through the inserts in rat models of BBB at different time points after intervention.RESULTS: The 125 I -BSA, which passed through the inserts in rat models of BBB, was all significantly higher in the TNF-α group than in the other groups at 30, 60, 120 and 240 minutes after intervention, respectively (P ＜ 0.01), and reached the peak at 240 minutes; The 125 I -BSA, which passed through the inserts, was lower in the Y-27632 pre-treated group than in the TNF-α group at 30 and 60 minutes after intervention (P＜ 0.01). There was also significant difference in 125 I -BSA permeation between Y-27632 pretreated group and Y-27632 control group after 120 minutes (P ＜ 0.05).CONCLUSION: TNF-α can increase BBB permeability, and Y-27632 pretreatment can early reverse the effect of TNF-α on BBB permeability.

Objective: To observe the effect of Ruxiankang (RXK) Capsule (Radix Bupleuri, Poria, Rhizoma Atractylodis macrocephalae, Radix Angelicae Sinensis, Radix Paeoniae Alba, Rhizoma Cyperi, etc.) on mammary gland and sex hormone of rat with mastoplasia. Methods: After benzoate estradiol and progestogen were injected into rats for 30 days the mastoplasia model was made, the model rats were treated with tamoxifen and RXK Capsule for 30days, and injected estradiol at the same time. Results: RXK Capsule and tamoxifen could significantly inhibit HMG rat's mammary gland swell, reduce quantity of lobule alveolus in mammary glands and secretion ( P

Objective To investigate the role ot adhesion molecule CD44 in respiratory syncytial virus (RSV) infection induced bronchiolitis.Methods Thirty-six children with RSV infection induced bronchiolitis (infection A group),34 children with only RSV infection (infection B group) and 40 healthy children (control group) were selected.The proportion of peripheral blood CD44+ cell was determined by flow cytometry.The levels of peripheral blood interferon (IFN)-γ,interleukin (IL)-4,IL-10 and IL-12 were determined by enzyme-linked immunosorbent assay.Results The expression of CD44 and the level of IL-4 in peripheral blood in infection A group were significantly higher than those in infection B group and control group,there were statistical differences (P ＜ 0.05).The level of IFN-γ in peripheral blood in infection A group was significantly lower than that in infection B group and control group,there were statistical differences (P ＜0.05).The levels of IL-12 in peripheral blood in infection A group and infection B group were significantly lower than that in control group,there were statistical differences (P ＜ 0.05).There were no statistical differences in the level of IL-10 in peripheral blood among the 3 groups (P ＞ 0.05).In the children with RSV infection,the expression of CD44 in peripheral blood was positively correlated with the level of IL-4 (r =0.798,P ＜ 0.05),the level of IL-12 was negatively correlated with the level of IL-4 (r =-0.186,P ＜0.05).Conclusion The expression of adhesion molecule CD44 may play a role in the RSV infection induced bronchiolitis,and the high expression of CD44 in children with RSV infection may increase the susceptibility to bronchiolitis.

Background and purpose:Increased glucose metabolism is a characteristic of malignant tumors.This characteristic might be related to a facilitative glucose transporter(Glut-1) and the proliferating activities of tumors.This study was aimed to assess the relationship among the over-expression of facilitative glucose transporter(Glut-1) and proliferating cell nuclear antigen(PCNA) as well as the fluorine-18 fluorodeoxyglucose(18F-FDG) uptake of tumors in patients with nasopharyngeal carcinoma.Methods:Between March 2005 and August 2006,40 patients with nasopharyngeal carcinoma were imaged with 18F-FDG positron emission tomography(PET).Their maximum standard uptake values(SUVmax) were measured.The expression of Glut-1 and the proliferating cell nuclear antigen(PCNA) in the 40 cases were studied in paraffin sections by SP immunohistochemistry.Results:The 18F-FDG uptake of tumors of the 40 patients with nasopharyngeal carcinoma was 9.4?1.9(SUVmax).All 40 tumors tested Glut-1 positive and PCNA positive.The Glut-1 positive cells consisted of 45.18% of the tumor cell area,whereas the PCNA positive cells consisted of 36.18% of the tumor cell area.There were correlations between Glut-1 expression levels(r=0.369,P=0.019) and the tumors' 18F-FDG uptake but no correlations were found between PCNA expression level and the tumors' 18F-FDG uptake(r=0.135,P=0.407).Conclusion:Glut-1 over-expression correlates with 18F-FDG uptake whereas PCNA over-expression does not correlate with 18F-FDG uptake in patients with nasopharyngeal carcinoma.

Objective To determine the most appropriate combination of target effect-site concentrations (Ce) of propofol and remifentanil administered by TCI for fiberoptic bmnchoscopy in terms of depth of anesthesia and safety.Methods One hundred and eighty ASA Ⅰ or Ⅱ patients of both sexes aged 18-60 yr with body mass index ranging from 20-25 kg/m2 undergoing elective fiberoptic bronchoscopy under general anesthesia were randomized into 6 groups based on Ce of propofol (5.0,5.5,6.0 μg/ml) and remifentanil(2.5,3.0 ng/ml)(n=30 each):P5.0 R2.5,P5.5 R2.5,P6.0 R2.5,P530 R3.0,P5.5 R3.0 and P6.0 R3.0.Anesthesia was induced and maintained with TCI of propofol and remifentanil.MAP,HR,and SpO2 were continuously monitored.The examination was started when the target Ce was reached.When continuous coughing or bronchospasm occurred,2% lidocaine was given for topical anesthesia.When MAP decreased by more than 30% of the baseline value and/ or HR<55 boats per min,ephedrine was injected iv.When MAP increased by more than 30% of the baseline value and/or HR>120 beats per min,remifentanil was injected iv.TCI was stopped when the examination was over.The amount of propofol and remifentanil consumed,induction time,emergence time,duration of bronchoscopy and the number of the patients in whom ephedrine and intermittent iv boluses of remifentanil were given were recorded and compared among the 6 groups.The efficacy ofanesthesia was evaluated and the doctors' satisfaction recorded.Results The induction time and emergence time were significantly longer in P6.0 R3.0 and P6.0 R2.5 groups than in the other 4 groups ( P < 0.05). The efficacy of anesthesia was better in group P5.5 R3.0 and P6.0 R3.0 than in group P5.0 P2.5, P5.5 R2.5 and P5.0 R3.0 ( P < 0.05). Anesthesia was more satisfactory as evaluated by the doctor in group P5.5 R3.0.The number of patients who received iv bolus of remifentanil and ephedrine during bronchoscopy was smallest in group P5.5 R3.0 ( P < 0.05 ). Conclusion TCI of propofol at Ce of 5.5 μg/ml combined with remifentanil TCI at Ce of 3.0 ng/ml provides satisfactory anesthesia for flberoptic bronchoscopy.

Objective To investigate the predictive factors of short-term poor outcome in patients with cerebral venous sinus thrombosis (CVST).Methods The clinical data of 42 consecutive inpatients with CVST were analyzed retrospectively.The clinical outcomes were assessed with the modified Rankin scale (mRS) at discharge.The patients were divided into either a good outcome group (mRS 0 to 2) or a poor outcome group (mRS 3 to 6).The related factors,such as demographic,etiology,and clinical features were compared between the two groups,Multivariate logistic regression analysis was used to determine the independent predictive factors for short-term poor outcome in patients with CVST.Results A total of 42 patients with CVST were enrolled,29 of them (69.05％) had good outcome and 13 (30.95％) had poor outcome.The proportions of central nervous system infections (20.69％ vs.61.54％ ; x2 =6.740,P =0.009),cancer (6.90％ vs.38.46％ ;x2 =6.439,P =0.011),pregnancy,postpartum,oral contraceptives or hormone replacement therapy (6.90％ vs.38.46％ ; x2 =6.439,P =0.011),and high homocysteine hyperlipidemia (27.59％ vs.76.92％ ;x2 =8.922,P =0.003),as well as the baseline D-dimer levels (730 ± 240 ng/ml vs.1 060 ± 250 ng/ml; t =4.485,P =0.000) in patients of the good outcome group were significantly lower than those of the poor outcome group.There was significant difference in treatment modalities (x2 =11.274,P =0.004) with the poor outcome group.The proportions of patients in anticoagulants,thrombolysis and anticoagulants + thrombolysis were 13.79％,24.14％,and 62.07％,respectively,in the good outcome group,while those were 61.54％,23.08％,and 15.39％,respectively,in the poor outcome group.Multivariate logistic regression analysis showed that the baseline D-dimer level ＞990 ng/mL was an independent predictive factor for short-term poor outcome in patients with CVST (odds ratio [OR] 1.006,95％ confidence interval [CI] 1.002-1.011; P=0.005).Anticoagulants + thrombolytic therapy was an independent protective factor for short-term poor outcome in patients with CVST (OR 0.027,95％ CI 0.002-0.447; P=0.033).The ROC curve analysis showed that when the cutoff value of the baseline D-dimer was 990 ng/ml,the sensitivity and specificity of predicting short-term poor outcome of CVST were 76.9％ and 86.2％ respectively.Conclusions The level of baseline D-dimer ＞990 ng/ml is an independent predictive factor for short-term poor outcomes in patients with CVST.The effect of anticoagulants in combination with thrombolytic therapy is best in patients with CVST.

ObjectiveTo explore the best treatment method of cerebral artery dissection.Methods This study included eight patients who were definitely diagnosed as cerebral artery dissection by the cerebral angiography in our department of neurology during Oct.2009 and Nov.2011.They were all treated by the anticoagulation or anti-platelet methods.Some patients received the stent therapy.All patients' were followed for at least three months. The treatment effect was assessed by NIHSS,mRS and by the cerebral angiography.ResultsSix patients had carotid artery dissection,2 had vertebral artery dissection.Four patients were given anticoagulant therapy and the other 4 were given anti-platelet therapy. The reexamination by angiography 10-14 days after admission showed that in 3 patients,the stenosis was aggravated or the infarction occurred.They were diagnosed as having repeated transient ischemic attack (TIA) during pharmacotherapy and received stents for treatment.There was no TIA and cerebral infarction in the follow-up period after individualized therapy.Mean NIHSS scores of 8 patients between pre and post treatment were 5.9,1.6 respectively. Mean mRS scores pre and post treatment were 2.5,0.9respectively.Conclusion The treatment for patients with cerebral artery dissection should be individuated.The patients in acute stage should get anticoagulation,anti-platelet therapy and angiography re-examination.According to the clinical manifestation and cerebral angiography,the next step for the treatment should be done.

BACKGROUND:With the extensive application of anterior titanium plate, postoperative complications such as dysphagia, titanium loose, screw exit and disc degeneration of neighboring segments induced more and more attention of researchers. However, the application of anterior cervical cage is expected to avoid these complications. ＜br> OBJECTIVE:To observe primary curative effect of anterior cervical cage ROI-C in anterior cervical spine surgery. ＜br> METHODS:A total of 32 patients with cervical spondylosis were treated with anterior cervical cage ROI-C in the Wuxi Ninth Hospital Affiliated to Soochow University from April to December 2013. The cage was implanted to promote interbody fusion. Of 32 cases, 23 cases affected cervical spondylotic myelopathy, 2 cases affected nerve root type cervical spondylosis, 3 cases affected cervical hyperextension injury, 1 case affected cervical disc herniation, 2 cases affected cervical instability and 1 case affected segmental cervical ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association and NDI scores were determined to assess neurological symptoms and functional improvement before internal fixation and during final fol ow-up. Simultaneously, adverse reactions were recorded. ＜br> RESULTS AND CONCLUSION:A total of 32 patients finished the regular fol ow-up for 4 to 8 months. Clinical symptoms and spinal cord function of al patients were obviously improved. No ROI-C loosing or displacement or secondary surgery was found. The average fusion time was 4.2 months (3 to 5 months). Mean score of Japanese Orthopaedic Association was increased from 9.2 points pre-surgery to 13.8 points post-surgery. Japanese Orthopaedic Association and NDI scores were higher during final fol ow-up than before fixation (P＜0.05). These data indicated that ROI-C effectively restored intervertebral height in anterior cervical spine surgery, stably reconstructed cervical vertebra, obtained interbody fusion, effectively avoided related surgical complications induced by plate implantation, improved neurological symptoms and function, and showed good short-term effects.

Objective To investigate the value of lower limbs fixation methods for the treatment of intussusception in children with air enema with.Methods 2 1 1 pediatric patients with intussusception who had accepted the treatment of air enema with two dif-ferent fixation methods on lower limbs were enrolled.Comparisons of median treatment duration and therapeutic effect between the two methods were investigated.Results In 32 patients with knee-joint fixation method,27 were successful with median treatment duration 4.84 minutes.Meanwhile in other 179 ones with lower limbs fixation method,152 were successful with median duration 7.96 minutes.And the duration difference between two methods was found (P<0.05).Conclusion Knee-joint fixation may help significantly shorten the median treatment duration for the treatment of intussusception with air enema in children.