Objective To observe influence of continuous lumbar cistern drainage on levels of amyloid β-peptide (Aβ) subtype (Aβ1-42) in cerebrospinal fluid and plasma in patients with diffuse axonal injury (DAI) and investigate its clinical significance.Methods Eighty-one DAI patients were enrolled and randomized into treatment group (42 cases) and control group (39 cases).Patients in control group received simple conventional therapy,while the patients in treatment group received not only conventional therapy but 14 days of continuous lumbar cistern drainage.Levels of Aβ1-42 in cerebrospinal fluid and plasma were detected by ELISA assay before therapy and at 1,5,9,and 14 days after therapy.Prognosis was assessed using GOS at 6 months after therapy.Results Levels of Aβ1-42 in cerebrospinal fluid and plasma showed a decrease in the first place and a gradual decrease afterwards in both groups,but a bigger and earlier drop of Aβ1-42 levels was observed in treatment group.Two groups showed significant difference of Aβ1-42 levels at day 14 (P ＜ 0.05).At 6 months after therapy,GOS score between treatment and control groups was (4.1 ± O.5) and (3.4 ± 0.3) points respectively (P ＜0.05).Conclusion Continuous lumbar cistern drainage improves the prognosis of DAI and this may relates to the decrease of Aβ1-42 levels in cerebrospinal fluid and plasma.

ObjectiveTo explore the short-term curative effect and safety of autologous bone marrow mesenchymal stem cells transplantation in patients with primary brain stem injury.MethodsFifty-four cases with primary brain stem injury were hospitalized during Jul.2007 to Jul.2010 at Liaocheng Brain Hospital,Shandong Province.All cases were randomized into transplantation group( n =30)or control group( n =24 ).The transplantation group was treated with autologous bone marrow mesenchymal stem cell transplantation by subarachnoid space injection (n =30).The control group were selected from primary brain stem injury patients without stem cell transplantation who were hospitalized at the same period with patients from the transplantation group.Respectively,National Institutes of Health Stroke Scale (NIHSS) score was employed to evaluate the condition of patients in the two groups one month after treatment,and Glasgow Outcome Scale (GOS) score was used to evaluate curative effects of the two groups at sixth months after treatment.Meanwhile,some other parameters were observed,including blood routine,clotting mechanisms,biochemicalitemsand tumor markers.ResultsThere was significant difference between the transplantation group and the control group in N IHSS score at one month after treatment [ ( 10.86 ± 7.48) vs.( 18.26 ± 8.74),t =2.681,P ＜ 0.05 ].GOS score was significantly different( Z =2.306,P ＜ 0.05 ) between the transplantation group and the control group at sixth month after transplantation.There was no significant difference between the two groups in the blood examination results during the followed-up period.Conclusion Autologous bone marrow mesenchymal stem cells transplantation is confirmed to be an effective and safe therapy in patients with primary brain stem injury in the short-term.Further evaluation still needs for its long-term efficacy on primary brain stem injury

Objective To investigate the treatment effect of lumbar subarachnoid continuous drainage on delayed hydrocephalus in patients with cerebral trauma after decompressive craniectomy.Methods Thirty-two patients with delayed hydrocephalus after decompressive craniectomy,admitted to our hospital from June 2009 to September 2013,were treated by lumbar subarachnoid continuous drainage;and the treatment effect was analyzed.Results After lumbar subarachnoid continuous drainage,14 patients got successful drainage tube being extracted in the first period,5 were in the second cycle;they all got avoidance ofventriculo peritoneal shunt operation.However,the other 13 patients,developed into shunt dependent hydrocephalus,were treated with ventriculoperitoneal shunt operation.No central nervous system infections were noted during the period of draining.Conclusion The treatment of lumbar subarachnoid continuous drainage,with the characteristics of small trauma and easy operating,can reduce the incidence of shunt dependent hydrocephalus,which is developed by delayed hydrocephalus.

OBJECTIVE：To optimize the synthesis process of dapoxetine hydrochloride. METHODS ：By chiral synthesis ， asymmetric reduction was carried out by using 3-chlorophenylacetone as raw material ，（1S，2R）-（-）-1-amino-2-indanol as catalyst，and borane- N，N-diethylaniline （DEANB） as reducing agent. Then ，it was reacted with α-naphthol etherification， sulfonation，dimethylamine substitution ，and HCl salt formation reaction to obtain the final products. The products were characterized by NMR and MS. The synthesis reaction of intermediate Ⅰ，intermediate Ⅱ，intermediate Ⅲ and the final product were optimized. RESULTS ：The final product was dapoxetine hydrochloride with purity of 99.8％ and yield of 58.9％. Compared with traditional splitting technology ，the chiral synthesis technology of this study did not need splitting ，and the yield of the technology was significantly higher than that of splitting technology reported in literature （31.9％）. The optimized technology reduced the generation of impurities and improved the product quality. CONCLUSIONS ：The improved technology has milder reaction conditions ，shorter synthesis route and higher yield.