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.

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.

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 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.

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

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 assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.

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.

Objective The purpose of this study was to assess the technical feasibility, safety and effectiveness of percutaneous transluminal angioplasty (PTA)for the treatment of severe limb ischemia caused by tibioperoneal arteries occlusion. Methods From June 2004 to May 2007,35 patients with critical limb ischemia (CLI)were treated on an intention-to-treat basis with tibioperoneal arterial PTA. Main outcome measures were technical success rate, primary patency rate, limb salvage rate and complications. Results The technical success rate of tibioperoneal arterial PTA Was 83%.Mean follow-up time was 11.5 months, primary patency rate and limb salvage rate were 57%and 82%,respectively.Mean length of tibioperoneal arterial PTA was 9.5 cm(4.5～14 cm),concurrent treatment of iliac artery or femoral-popliteal artery was carried out in 19 patients via either angioplasty or combined with stenting.There were three complications including arterial spasm and thrombosis in one, which Was relieved by thrombolysis and antispasmodics, and artery perforation in 2 cases, which was treated conservatively. Conclusion In tibioperoneal arterial occlusions in CLI patients, PTA is feasible with a high initial technical success rate and high limb salrage rate,tibioperoneal arterial PTA carries a lower morbidity and less severe complications. PTA is a safe, effective and good treatment alternative for CLI patients of tibioperoneal arterial occlusions.

Objective To explore the clinical application of blood perfusion quantitatively by contrastenhanced ultrasonography(CEUS) to grade cerebral gliomas during operation. Methods Thirty-one patients with cerebral gliomas were examined by CEUS with Sonoliver software during operation. Maximum intensity (IMAX), time to peak (TTP), rising time (RT) and mean transit time(mTT) of the regions of interest (ROIs) of normal brain tissue and high- and low-grade gliomas were respectively determined and comparatively analyzed. Results Fifteen high-grade gliomas and sixteen low-grade gliomas were postoperatively confirmed by pathologic results. The administration of contrast agent led to higher echo enhancement in cerebral gliomas than normal brain tissues in all cases. The TTP of high- and low-grade gliomas were significantly shorter than that of normal cerebral tissues ( P ＜0.05) ,and the mTT was longer than that of normal brain tissue( P ＜0. 05). There was significant differences of IMAX and TTP between high- and low-grade gliomas(P ＜0.05), but there was no significant difference of RT and mTT between the two groups ( P ＞0.05). Conclusions CEUS with quantitative analysis software on blood perfusion of the tumors can provide valuable information to grade cerebral gliomas.