Humans ; Data Warehousing ; East Asian People ; Intracranial Hemorrhages/diagnostic imaging* ; Asian People ; Cerebral Hemorrhage/diagnostic imaging*

Objective To investigate the correlation between different postoperative serum cortisol cut-off values measured in different periods and the long-term outcomes in patients with Cushing's disease (CD). Methods The clinical data of 102 CD patients undergoing transsphenoidal surgery (TSS) in Peking Union Medical College Hospital from May 1985 to July 2008 were analyzed retrospectively. The differences of long-term outcomes were compared between patients with cortisol levels below 2 μg/dl (2 μg/dl group) and levels between 2 and 5 μg/dl (5 μg/dl group) in the 1postoperative day and 3 and 6 months after surgery. Results The mean follow-up duration was (10.7±1.7) years (range:5-29.1 years). Among these 102 patients,the disease was cured in 74 patients (72.5%) and recurred in 28 patients (27.5%). On the 1postoperative day,there were 63 patients in the 2 μg/dl group,in which 48 patients (76.2%) achieved long-term cure;there were 39 patients in the 5 μg/dl group,in which 26 (66.7%) achieved long-term cure. The difference was not statistically significant (χ=1.097,P=0.295). Three months after TSS,the long-term cure rate was 84.2% (48/57) in the 2 μg/dl group,which was significantly higher than that (65.0%,26/40) in the 5 μg/dl group (χ=4.795,P=0.029). Six months after TSS,the long-term cure rate was 88.7% (47/53) in the 2 μg/dl group,which was significantly higher than that(69.2%,27/39) in the 5 μg/dl group(χ=5.400,P=0.020). Conclusion The serum cortisol level of below 2 μg/dl is more useful than 2-5 μg/dl 3 months and 6 months after surgery in predicting the prognosis of CD patients.
Follow-Up Studies ; Humans ; Hydrocortisone ; blood ; Pituitary ACTH Hypersecretion ; blood ; surgery ; Postoperative Period ; Prognosis ; Recurrence ; Retrospective Studies

Objective Analyzing the construction process and application of health appropriate technology database in Zhejiang province and proposing related considerations and recommendations for the database construction.Methods To design and construct the technology database system,and using excel software to calculate statistic data.Results Established a health appropriate technology database,which contains 826 technologies that can be selected and promoted by the demonstration bases in the whole province.Conclusions The establishment of the technology database increased the efficiency of health appropriate technology transformation at the provincial level,and also provided a reference for the national-wide generalizing of health appropriate technology.

The neural stem cells (NSCs) can migrate into the injured area and differentiate into neurons or oligodendrocytes.Endogenous neurogenesis may potentially be harnessed as a putative therapy for neural injury.But the complex micro-environment due to TBI will be one of the biggest challenges for endogenous NSCs to perform neural regenerations.Exogenous NSCs have been shown to be able to survive in host tissues and regulate microenvironment via paracrine effects.Thus, transplantation of NSCs to assist neural regeneration has become an attractive option.Recently, rapid advances in the stem cell biology have raised appealing possibilities of replacing damaged or lost neural cells by transplantation of in vitro-expanded stem cells and/or their neuronal progeny.

OBJECTIVE:To investigate the effects of 3 types of antihypertensive drugs on cognitive function in elderly hyper-tensive patients after acetabular surgery. METHODS:Ninety hypertensive patients receiving antihypertensive drugs for a long term (not changed antihypertensive drugs within 2 weeks before surgery)undergoing selective acetabular surgery were included sequen-tially and divided into angiotensin receptor blocker(ARB)group,angiotensin converting enzyme inhibitor(ACEI)group and cal-cium channel blocker(CCB)group according to the types of antihypertensive drugs,with 30 cases in each group. All patients re-ceived acetabular surgery under epidural anesthesia. The cognitive function of patients was evaluated by using MMSE 1 d before sur-gery(T0),1 d after surgery(T2)and 3 d after surgery(T3). The concentration of S100β protein serum was determined 1d before surgery (T0),immediately after surgery (T1) and 1 d after surgery (T2). RESULTS:Compared with T0,MMSE score of ARB group at T2,those of ACEI group and CCB group at T2 and T3 were decreased significantly,with statistical significance(P<0.05). Compared with ARB group,MMSE score of ACEI group and CCB group at T2,T3 were decreased significantly,with statistical sig-nificance(P<0.05). Compared with ACEI group,MMSE score of CCB group at T2,T3 were decreased significantly,with statisti-cal significance(P<0.05). Compared with T0,the concentration of S100β protein in serum 3 groups were increased significantly, with statistical significance (P<0.05). Compared with ARB group,the concentration of S100β protein serum in ACEI group and CCB group were increased significantly,with statistical significance(P<0.05). Compared with ACEI group,the concentration of S100β protein serum in CCB group at T1,T2 were increased significantly,with statistical significance(P<0.05). The incidence of cognitive dysfunction was in ascending order of ARB group (30%)

Objective To investigate the value of X-ray guided desmopressin (DDAVP) stimulated bilateral inferior petrosal sinus sampling (IPSS) in diagnosing the recurrence of ACTH dependent Cushing disease or ineffectiveness after surgery or radiotherapy. Methods Retrospective analyses of patients with recurrent ACTH dependent Cushing disease (31 cases) or ineffective (3 cases) treatment after surgery or radiotherapy from January 2013 to October 2014 in our hospital was conducted. Bilateral inferior petrosal sinus angiography showed the same side of the cavernous sinus to prove successful intubation. The cases with discontinuous of the inferior petrosal sinus and cavernous sinus were excluded by this study. Finally, there were 34 cases of the patients in this study. Diagnosis was based on the ratio of ACTH level in IPS to peripheral vein after desmopressin test.The gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary. Diagnosis was confirmed by gold standard to investigate the value of X-ray guided desmopressin (DDAVP) stimulated bilateral IPSS. Results The IPS gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary in 30 patients. A total of 22 (22/30) patients underwent surgery with a final diagnosis of ACTH adenoma. The symptoms were obviously relieved in 8 (8/30) cases after sellar area gamma knife treatment and lesions were confirmed in the pituitary. IPS gradient<2 at baseline or gradient<3 after desmopressin test was found in 4 cases. One case (1/4) was found to have for ACTH adenoma after pituitary surgery. The other 3 cases (3/4) were confirmed to have lung carcinoid and clinical symptom alleviated after surgery. The sensitivity of desmopressin stimulated IPSS was 96.8%, the specificity was 100%, and the accuracy was 97.1%. Conclusion Desmopressin stimulated IPSS is an effective diagnostic procedure in diagnosing ACTH dependent Cushing disease recurrence or ineffectiveness after surgery or radiotherapy.

Objective To explore the walking ability and cognitive function changes in normal pressure hydrocephalus patients after cerebrospinal fluid ( CSF ) tap test for helping clinicians choose evaluation time and methods.Methods Twenty-seven patients with probable normal pressure hydrocephalus in Peking Union Medical College Hospital from 2013 to 2014 were included.All patients were evaluated using Minimum Mental State Examination, the Montreal Cognitive Assessment, Ability of Daily Life, and Idiopathic Normal Pressure Grade Scale, underwent 1.5 T head MRI scan and had ventriculo-peritoneal shunt after informerd consent.A lumbar tap with removal of 30 ml of CSF was performed in all patients.Evaluations included the 10 m walking time and steps, Trail Making Test A, number code and Stroop test.Those tests were performed 1 day before and 4, 8, 24, 72 hours after CSF tap test.The walking test and neuropsychological test results were compared between those before and after the CSF tap test.Correlation analysis was conducted between the normal pressure hydrocephalus featured MRI characters and CSF tap test responses including Evan′s index, callosum corpus angle, mismatch between narrowed high-convexity and medial subarachnoid spaces and enlarged Sylvian fissure associated with ventriculomegaly . Results Compared with 0 h walking time (23.56(14.00) s), the 10 m walking time on the 8 hours and 24 hours after CSF tap test, which were 19.41 ( 9.00 ) s and 19.67 ( 11.00 ) s respectively, were significantly improved ( Z values in Wilcoxon signed ranks test were -3.416 and -3.443 respectively,both P<0.01).There were no statistically significant differences on every evaluation time point.The neuropsychological tests changings were significant on 24 hours and 72 hours.Compared with 0 h neuropsychological test z scale (-10.28(21.60)), the z scale on the 24 hours and 72 hours after CSF tap test, which were -6.29 (26.72), -3.37(36.15)respectively, were significantly improved (Z values in Wilcoxon signed ranks test were -3.506,-2.701 respectively, both P<0.01).The Evan′s index, callosum corpus and the feature of mismatch between narrowed high-convexity and medial subarachnoid spaces and enlarged Sylvian fissure were not statistically correlated with the response of CSF tap test.Conclusions Walking ability in normal pressure hydrocephalus patients was improved after the CSF tap test.The Evan′s index, callosum corpus and the feature of mismatch between narrowed high-convexity and medial subarachnoid spaces and enlarged Sylvian fissure might not be correlated with the response of CSF tap test.

Objective To discuss the feasibility about the widely implementation improved skin preparation for craniotomy in neurosurgery.Methods Improved strategies about skin preparation in PUMCH′s neurosurgery were established by evidence-based medicine.From December 2011 to January 201 2,80 cases were randomly assigned to traditional and modified group,40 cases in each one.Traditional group applied the disposable blade to shave head preoperation,while intervention group used modified strategic method.The incidence of surgical sites infection and satisfaction of doctor-nurse-patient were compared of between two methods. Results Satisfaction of doctor-nurse-patient of intervention group was better than the traditional group (P <0.01 ).A total of 1 294 cases participated the research from January 2009 to July 201 4.There were 24 cases infected and 684 uninfected in intervention group,comparing with 70 infected and 51 6 uninfected in the traditional group (χ2 =34.83,P <0.01 ).Conclusions The improved preoperative skin preparation can improve clinical quality of care,increase productivity,and prevent intracranial infection after craniotomy positively,which can be widely applied in neurosurgery.

Objective To investigate the expression of eukaryotic initiation factor 4E(eIF4E) ,vascular endothelial growth factor (VEGF)‐A and VEGF‐C in gastric cancer tissues and their correlation with invasion and metastasis of gastric carcinoma .Methods The expressions of eIF4E ,VEGF‐A and VEGF‐C were detected in tissues of 58 gastric carcinomas and 25 normal gastric mucosa by using immunohistochemical method .Results The positive rate of eIF4E、VEGF‐A and VEGF‐C protein expression were 89 .7%(52/58) ,65 .5% (38/58) ,60 .3% (35/58) in gastric carcinoma ,which were higher than those in normal gastric mucosa tissues which were 4 .0% (1/25) ,12 .0% (3/25) ,8 .0% (2/25) respectively .Expressions of eIF4E ,VEGF‐A and VEGF‐C were significantly correlated with the depth of invasion and lymph node metastasis(P<0 .05) ,but not with the age ,sex of patients(P>0 .05) .Ex‐pressions of eIF4E and VEGF‐C were significantly correlated with tumor differentiation .The expression of eIF4E was being found positively correlated with VEGF‐A and VEGF‐C .Conclusion eIF4E may play certain roles in the oncogenesis and progression of gastric carcinoma .VEGF‐A and VEGF‐C may be helpful in lymph metastasis .Combined detection of eIF4E ,VEGF‐A and VEGF‐C may be helpful to assess the malignant degree and prognosis of gastric carcinoma .

OBJECTIVE: To investigate the structural abnormalities of brain in patients with antisocial personality disorder (ASPD) but without alcoholism and drug abuse. METHODS: Volunteers from Hunan Reformatory (n=36) and the matched healthy subjects (n=26) were examined by high-spatial resolution magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Voxel-based morphometry and fractional anisotropy (FA) maps were generated for each subject to reveal structural abnormalities in patients with ASPD. RESULTS: Compared with the healthy controls, ASPD patients showed significantly higher gray matter volumes in the inferior parietal lobule (P≤0.001, uncorrected), white matter volumes in the precuneus (P≤0.001, uncorrected), FA in the left lingual gyrus, bilateral precuneus, right superior frontal gyrus and right middle temporal gyrus (P≤0.01, uncorrected). CONCLUSION Our results revealed the abnormal neuroanatomical features in ASPD patients, which might be related to the external behavioral traits in ASPD patients.
Anisotropy ; Antisocial Personality Disorder ; diagnosis ; Brain ; anatomy & histology ; Case-Control Studies ; Diffusion Tensor Imaging ; Humans ; Magnetic Resonance Imaging