Objective To explore the clinical characteristics of primary central nervous system malignant lymphoma (PCNSML). Methods The clinical data of 22 cases of PCNSML were analyzed retrospectively.Results The patients in our study mainly presented with headache (16 cases), vomiting (11 cases), weakness of extremities (5 cases) and numbness (1 case). The tumors were supratentorial in 19cases, infratentorial in 3 cases and multiple in 5 cases. CT scan showed same density or high-density lesions with surrounding mild edema. Brain MRI demonstrated slight-hypointense lesion of 9 cases and isointense lesion of 5 cases on T1-weighted imaging. On the T2-weighted imaging, the lesions were slight-hyperintense in 11 cases and isointense in 3 cases. Enhanced scanning showed that the lesions were contrasted evenly and obviously on CT and MRI. Misdiagnosis was given preoperatively in 17 patients. The pathological examination revealed B cell malignant lymphoma in all cases. In 18 cases of follow-up, 5 patients with multiple lesions who only received stereotactic biopsy all died within 6 months, the mean survival time of 6 patients who were treated with total resection of the tumors and radiotherapy was 27 months, 4 patients treated with partial resection and ?-radiotherapy was 21 months, 4 patients treated with partial resection and radiotherapy was 10 months. The patient who was treated with only total resection of the tumor died in 11 months because of recurrent. Two patients with only partial resection died in 5 and 8 months, respectively.Conclusions There are no specific clinical manifestations of PCNSML and the disease is often misdiagnosed preoperatively. Although certain characteristic performance may be found on CT and MRI scans, the final diagnosis of this disease depends on pathological examination. Comprehensive treatments may prolong the survival time of the patients.

Objective To discuss the effect of microsurgery of intracranial arachnoid cyst. Methods 42 cases of intracranial arachnoid cyst treated with microsurgery were studied retrospectively.Results Total resection was performed in 23 cases and partial resection in 14 cases. 5 cases received partial resection and communication between cystic cavity and brain cistern. CT scans of 29 cases after operation showed completely obliteration or marked diminution in cystic size. The symptoms and signs of all the patients were improved significantly after a 1-year follow-up.Conclusion The effect of microsurgery of intracranial arachnoid cysts is satisfactory. It is important to communicate cystic cavity with subarachnoid space or brain cistern.

Objective To observe the effects of fasudil hydrochloride injections on the levels of endothdin(ET)-1,nitric oxide(NO)in plasma and cerebrospinal fluid(CSF)in patients with subarachnoid hemorrhage(SAH),and analyze,its mechanisms in preventing cerebral vasospasm(CVS).Method Sixty SAH cases were randomly divided into fasudil group(30 cases)and control group(30 cases).On 2nd and 10th day after in hospital,the speed of cerebral blood flow was measured by transeranial Doppier(TCD),and the levels of ET-1,NO in plasma and CSF were measured by radio-immunity.Results The incidence of CVS in fasudil group were significantly less than those in control group[6.67%(2/30)vs 36.67%(11/30),P<0.05].On the 10th day,the levels of ET-1 in plasma and CSF in fasudil group were signitlcandy lower than those in control group[(118.23±14.56)ng/L vs(132.26±15.18)ng/L,(138.23±16.58)ng/L vs (156.24±17.54)ng/L ](P<0.05),the levels of NO were significantly higher than those in control group [(88.25±15.54)μmol/L vs(70.26±14.86)μmol/L,(104.27±16.52)μmol/L vs(92.43 ±12.51)±mol/L](P<0.05).But there were no significant difference on the 2nd day(P>0.05).Conclusion Fasudil can reduce CVS in patients with SAH by lowering the levels of ET-1 and increasing the levels of NO in plasma and CSF.

BACKGROUND: Bupivacaine is widely used to alleviate post-operation pain and cure acute and chronic pain caused by inflammation or cancer.Its analgesic time cannot meet the request that drug is released slowly to prolong the analgesic time in clinic.OBJECTIVE: To detect the alleviating effect of bupivacaine polylactic acid microspheres taking high molecular polymer-polylactic acid as vector in rabbits with high performance liquid chromatograph (HPLC) and traditional skin test method.DESIGN: A completely randomized controlled animal experimental study.SETTING: School of Pharmacy, Second Military Medical University of Chinese PLAMATERIALS: Sixteen New Zealand rabbits, weighing (2.58±0.17)kg were used in this experiment.INTERVENTIONS: The experiment was carried out at the Department of pharmaceutics, School of Pharmacy, Second Military Medical University of Chinese PLA between September and November 2002. ① Animal models were established according to traditional skin test method. ② Totally 16 New Zealand rabbits were randomly divided into 2 groups: Group A and Group B, with 8 in each one. 5 mg/kg bupivacaine parenteral solution was injected subcutaneously in Group A, 5 mg/kg bupivacaine polylactic acid microspheres were implanted between subcutaneous tissue and sarcolemma in Group B. We took 1.5 mL blood from ear border vein at 5, 10, 20, 30,45 minutes, 1, 2, 3, 4, 6, 8, 12 and 24 hours after administration of bupivacaine parenteral solution respectively in Group A and another 1.5 mL at 0.5, 1, 2, 3, 4, 5, 6, 8, 12, 24, 3 6, 48 and 60 hours after admistration of bupivacaine microsphere powder for index detection. ③ HPLC method was used to detect the concentration and releasing effect of bupivacaine in blood serum.MAIN OUTCOME MEASURES: Concentration change of bupivacaine in blood serum and efficacy diameter of local anesthetic.RESULTS:All the 16 rabbits entered the stage of result analysis. ①Change of bupivacaine concentration: Plasma bupivacaine concentration in Group A reached the peaked quickly after subutaneous injection with the high concentration of 2.466 4 mg/L, then declined quickly. Plasma bupivacaine concentration in Group B was relative stable, reached a peak much slowly after subcutaneous implantation, with peak concentration of 0.778 1 mg/L, and the plasma bupivacaine concentration maintained a relative low level, the mean retention time was obviously prolonged (P ＜ 0.05).② Alleviating effect of bupivacaine: The analgesic time was significantly longer in the bupivacaine microsphere group than in the bupivacaine parenteral solution group (P ＜ 0.05).CONCLUSION:Bupivacaine polylactic acid microspheres have sustained release effects in rabbits.

ObjectiveTo investigate the incidence of bacterial meningitis in patients who underwent intracranial neurosurgery and to explore the pathogen distribution and related risk factors.MethodsThe patients were selected by cluster systematic sampling method from the patient population who underwent intracranial neurosurgery for at least one time in Huashan Hospital affiliated to Fudan University in 2008.Chi-square test and Logistic regression model were used to analyze the data.ResultsA total of 1165 patients were included in this study.Seventy-nine of them were diagnosed with bacterial meningitis,while eight of them bad positive results for bacterial culture,including 3 cases of Acinetobacter baumannii,and 1 case each of Acinetobacter lwoffii,Klebsiella pneumoniae,Staphylococcus epidermidis,Enterococcus and Streptococcus intermedius. The common neurosurgical diseases with high incidence of postoperative bacterial meningitis were neurilemmoma 15.85％(13/82),glioma 12.21％ (21/172) and hydrocephalus 10.34％ (3/29).Logistic regression analysis identified male,implant,enteral nutrition,external ventricular drainage and wound negative pressure drainage as independent risk factors for postoperative bacterial meningitis.ConclusionsPostoperative central nervous system infection is the most common and severe complication after the intracranial neurosurgery.The results highlight the importance of improving pathogen detection rate and enhancing the prevention in high risk patient populations.

With the development of medicine technology and the increasing of people’s demand for quality of life, the complexity of doctor-patient relationships is also increasing. Pediatrics is one of the departments with the most concentrated and complex doctor-patient conflicts, therefore, it is necessary to analyze the sick roles and doctor-patient relationships in pediatrics. This paper explained the connotation of the sick role and the doctor-patient social interaction pattern based on Parsons’ theory of "sick role", and analyzed the particularity of the pediatric sick roles in China according to China’s national conditions. Meanwhile, combining the group characteristics and social background of pediatric sick role, this paper elaborated the sociological crux of pediatric doctor-patient relationship in China, and conducted a critical analysis on Parsons’ theory of "sick role".

Objective: To evaluate the safety of clinically-indicated replacement of peripheral intravenous catheters (PIVCs) in old adults. Methods: Total of 1 627 patients with peripheral intravenous catheters in emergency wards at a tertiary hospital in shanghai were recruited. Patients were randomly divided into an experimental group (817 cases) and control group (810 cases) by random digits tale method. PIVCs in the experiment were replaced only when clinical indications appeared, while PIVCs in the control group were routinely changed every 72-96 hours. Indwelling time, complications associated with PIVCs and nurse compliance were compared after indwelling peripheral intravenous catheters. Results: PIVC indwelling time was (3.43±1.36) days in the experimental group, and (3.18±1.16) days in the control group ,there was significant difference between two groups (t value was 4.07, P<0.05). The incidence of phlebitis, occlusion, infiltration, and accidental removal in experimental group was 11.26% (92/817), 17.97% (146/817), 10.77% (88/817), 3.91% (32/817), while in the control group 9.88% (80/810), 15.06% (122/810), 11.23% (91/810), 3.70% (30/810). The two groups showed no statistically difference in catheter phlebitis, occlusion, infiltration, and accidental removal (χ² values were 0.82, 2.33, 0.09, 0.05, P>0.05). The severity of phlebitis in the experiment group was higher than that in the control group, and there was significant difference between two groups (χ² value was 20.99, P<0.05). Nurse compliance achieved in the experimental group 100.00% (817/817) was higher than that in the control group 87.65% (710/810), which showed statistically difference (χ² value was 107.47, P<0.05). Conclusion Indwelling time in the clinically- indicated replacement group was longer than that of the routine replacement group. Peripheral intravenous catheters in old adults can be remove as clinically-indicated with a close monitoring of complications.

OBJECTIVEIncreased vascular endothelial growth factor (VEGF) and VEGF receptor expression is the important biological response under shear stress, ischemia and hypoxia conditions. Mechanical vibration induced cochlea shear stress and trauma obviously upregulate VEGF and VEGF receptor 2 (VEGFR2) expression in the cochlea. To evaluate the possibility of VEGF varying the transport in blood-labyrinth barrier and blood-perilymphatic barrier.

METHODSEleven guinea pigs, male and female, weighing from 300 g to 900 g were kept under general anaesthesia with xylazine (16 mg/kg) and ketamine (60 mg/kg) for both drug delivery and MRI measurement. VEGF (6 ears) and phosphate-buffered saline (PBS, 5 ears) were delivered to the inner ear via the round window membrane (soaked in gelfoam). The T1 contrast agent gadodiamide (Gd-DTPA-BMA) chelated bound paramagnetic gadolinium was used as the inner ear barrier transportation tracer. A Bruker Biospec Avance 47/40 experimental MRI system with a magnetic field strength of 4. 7 Tesla and a 40 cm bore was used for the 2-dimensional cochlea MRI evaluation. The Paravision software was used for image intensity measurement and the Adobe Photoshop 6.0 software was used for image presentation.

RESULTSVEGF induced significant Gd uptake in the scala tympani and scala vestibuli, but had little effect on the uptake of Gd in the scala media.

CONCLUSIONSVEGF significantly increased the transportation of blood-perilymphatic barrier and adapted the inner ear for compensation and repair.

Animals ; Blood-Brain Barrier ; drug effects ; Blood-Retinal Barrier ; drug effects ; Ear, Inner ; drug effects ; metabolism ; Female ; Guinea Pigs ; Magnetic Resonance Imaging ; Male ; Vascular Endothelial Growth Factor A ; pharmacology

OBJECTIVETo clarify the expression and subcellular localization of merlin in vestibular schwannoma.

METHODSFifty four paraffin embedded vestibular schwannoma samples confirmed by pathology after resection were included in the study. The expression of merlin in vestibular schwannoma was analyzed by immunohistochemistry. Nerve tissues that were resected during surgical treatment for trigeminal neuralgia and Meniere's disease were used as control. Western blotting was used to analyze the electrophoresis migration of merlin in the acoustic neuroma. Image analysis was used to calculate the positive expression percentage of merlin in each individual. The expression percentage of merlin in the tumor tissue was compared with age and gender of the patients, clinical course of the tumor, tumor growth index, tumor diameter and clinical stage.

RESULTSMerlin was expressed in 0 to 87.5% of the cells in vestibular schwannoma tissue with a mean of (46.66 +/- 5.75)%. There was a negative correlation between merlin expression percentage and tumor growth index. There were no correlations between merlin expression percentage and the age, gender, tumor diameter and clinical stage. There exists a difference for the location of merlin, mainly in the nucleus and perinucleus. There was also a cytoplasmic location. Merlin in the tumor tissue was shown by western blot to be in 65000 and 125000 positions.

CONCLUSIONSMerlin was expressed in vestibular schwannoma tissue, with a different intra-cellular location. Merlin might also exist as a complex with other proteins in the tumor tissue.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neurofibromin 2 ; metabolism ; Neuroma, Acoustic ; metabolism ; pathology ; Young Adult

Objective To investigate the clinical effect of five-step sequential method for hemorrhagic radiation cystitis.Methods From April 2015 to April 2018,512 cases of hemorrhagic radiation cystitis patients in 6 provincial tumor hospital were retrospectively analyzed.12 cases were male patients,and 497 cases were female.Patients'average age was (60.1 ± 8.2) years (53-71 years).Hematuria appeared in 2.9 years on average after radiotherapy(ranged 0.5 to 13 years).According to the severity of hematuria,480 patients were classified as mild and 32 patients as severe.The step 1 was drug conservative symptomatic treatment.Thrombin solution or sodium hyaluronate was used for bladder perfusion in step 2.The step 3 was transurethral electrocoagulation.The step 4 was interventional embolization.The step 5 was hyperbaric oxygen therapy.Mild patients were treated from the first step,and the severe patients were treated rom step 3,and combined with step 1.Overactive bladder symptom score (OABSS) was used to assess the improvement of patients'symptoms.Results No obvious complications occurred in step 1,2,3,5.Mild hip pain occurred at step 4.Recurrent hemorrhage rate were 6.7％ (2/30) in mild patients group and 10.5％ (2/19) in severe respectively in step 4.The total effective rate of step 1 in mild patients group was 65.2％ (313/480),step 1 + 2 was 84.2％ (404/480),step 1 + 2 + 3 was 95.6％ (459/480),step 1 + 2 + 3 + 4 was 98.3％ (472/480),and step 1 +2 +3 +4 +5 was 100％ (480/480).The effective rate of step 3 + 1 treatment was 59.4％ (19/32) in severe patients group,step 3 + 1 + 4 was 68.8％ (22/32),and step 3 + 1 +4 +5 was 100％ (32/32).The OABSS scores of mild and severe patients decreased after treatment (P＜0.01).Condusion Five-step sequential therapy could be an effective method for the treatment of hemorrhagic radiation cystitis.