Objective:To investigate the microsurgical efficacy of large primary intracranial solitary fibrous tumor and influencing factors for its prognoses.Methods:From January 2010 to December 2022, 47 patients with large primary intracranial solitary fibrous tumor admitted to and accepted microsurgery in Department of Neurosurgery, Wuhan Central Hospital and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, were enrolled. The clinical data, microsurgical efficacy and follow-up results of these patients were retrospectively analyzed, and influencing factors for total resection and prognoses were determined.Results:Thirty-two patients had tumor within the supratentorial region and 15 in the mandibular region, including 24 with sinus involved tumor. According to 2021 WHO Classification of Tumors of the Central Nervous System, 5 patients (10.6%) had grading 1, 32 (68.1%) grading 2, and 10 (21.3%) grading 3. Total resection was achieved in 31 patients (66.0%) and subtotal resection in 16 patients (34.0%). Postoperative complications, such as intraoperative hemorrhage, distant epidural hematoma and subcutaneous effusion, occurred in 7 patients (14.9%) and they were cured after secondary hematoma removal or conservative treatment; residual limb mobility disorder occurred in 3 patients, visual impairment in 3, and postoperative seizures in 2. Adjuvant radiotherapy was performed in 13 patients (27.7%). Follow-up was performed for (69.1±29.6) months and 29 patients (61.7%) had recurrent tumors (6 with intracranial and extracranial metastases and 4 deaths). Mean progression-free survival was (57.5±25.1) months; the 1-, 3-, and 5-year progression-free survival rates were 95.7%, 87.2%, and 59.6%, respectively. Sinus involvement was the independent influencing factor for total tumor resection; and total resection was an independent protective factor for progression-free survival for large primary intracranial solitary fibrous tumor ( HR=4.291, 95% CI: 1.555-11.838, P=0.005). Conclusion:Patients with large primary intracranial solitary fibrous tumor have a high recurrent risk after surgery; and gross-total resection should be strived to prevent tumor recurrence.

Objective To compare the effectiveness and safety of ketamine and etomidate for rapid sequential intubation. Methods Randomized controlled trials and cohort studies with ketamine and etomidate for RSI in patients with acute and critical illnesses published by China National Knowledge Infrastructure, Wanfang Data, VIP Network, PubMed, Embase, Cochrane Library and Clinicaltrials.gov from the date of database creation to May 1, 2023 were searched by computer. The literatures were screened according to inclusion and exclusion criteria, and the data of literatures were also extracted for quality assessment. Meta-analysis was performed by RevMan 5.3 software. Results A total of 15 literatures with 20 839 patients were included, including 3 RCT studies and 12 cohort studies. Meta-analysis showed that there were no significant differences in the success rate of primary intubation (RR=0.99, 95 %CI, 0.98 to 1.00, P=0.10), incidence of cardiac arrest (RR=1.00, 95 %CI, 0.62 to 1.62, P=0.99), time of mechanical ventilation (MD=0.33, 95 %CI, -0.34 to 1.01, P=0.33), and mortality rate (RR=1.05, 95 %CI, 0.95 to 1.16, P=0.31) between the ketamine group and the etomidate group, but the incidence of adrenal insufficiency (RR=0.54, 95 %CI, 0.41 to 0.70, P < 0.001) and ICU stay (MD=-0.44, 95 %CI, -0.70 to -0.18, P=0.001) in the etomidate group were significantly lower and shorter than those in the ketamine group, while the incidence of hypoxemia was significantly higher in the etomidate group (RR=1.50, 95 %CI, 1.27 to 1.79, P < 0.001). Conclusion During the process of RSI with sufficient preoxygenation, ketamine is a safe and effective alternative drug, and compared with etomidate, it has a lower incidence of adrenal insufficiency and shorter ICU stay.

Objective:To explore the clinical features, surgical treatments and treatment effects of children with skull defect.Methods:Sixty children with skull defect, admitted to our hospital from January 2010 to December 2020, were chosen in our study. These children were divided into encephalocele group ( n=28) and non-encephalocele group ( n=32) according to the imaging results (whether brain tissues were 1.5 cm higher than the bone window plane or not). The time and area of skull defect were compared between the two groups. Titanium mesh or polyether ether ketone material were used to repair the skull defect; 24 children without nerve fiber bundle distribution from encephalocele group underwent resection of the encephalocele tissues additionally. All children were followed up for 3-10 years in the outpatient department, and the prognoses of children from the two groups were evaluated by Glasgow Outcome Scale (GOS) one year after surgery. Results:As compared with the non-encephalocele group, children in the encephalocele group had significantly younger age accepted skull removal, significantly longer skull defect course, significantly higher incidence of epilepsy, significantly more common secondary changes in the brain tissues around the defect, but statistically smaller skull defect area ( P<0.05). There was no bleeding, severe edema, wound infection or cerebrospinal fluid leakage after surgery in both groups, and primary healing was achieved. In the encephalocele group, 16 children were complicated with epilepsy; 10 got complete seizure control, and 6 got seizure improvement. In the non-encephalocele group, 8 children were complicated with epilepsy; 6 got complete seizure control, and 2 got seizure improvement. Postoperative follow-up showed that GOS scores in the non-encephalocele group were significantly higher than those in encephalocele group ( P<0.05). Conclusion:As ompared with skull defect children without encephalocele, skull defect children with encephalocele have earlier defect age, longer course of disease, higher incidences of ventricular perforation malformation and epilepsy, and a relatively poorer prognosis.

Objective:To investigate the clinical pathological and epidemiological characteristics of primary esophageal malignant melanoma (PMME).Methods:The clinical pathology data of 180 PMME patients in the esophageal cancer database of the key laboratory of esophageal cancer research in Henan Province from 1973 to 2016 were collected, of which 136 were male, aged (58.5±9.0) years, 44 were female, aged (56.7±12.2) years. Kaplan-Meier and Log rank test were used for survival analysis, Cox regression scale model was used for risk factor analysis.Results:The incidence of PMME is 0.036% (180/500, 000), mostly were male (about 3∶1 for men: female). The common sites of PMME were the lower part of the esophagus (48.9%, 85/174), followed by the middle section of the esophagus (46.0%, 80/174) and the upper part of the esophagus (5.2%, 9/174). No black particles were seen in the PMME cells of 3 patients under microscope, and strong positive expressions of Melan-A and HMB453 were observed in these 3 patients by immunohistochemical results. Of the 129 patients who had a routine preoperative esophageal biopsy, 69 were undiagnosed with PMME (53.5%). The medium survival time of the whole group was 7.9 months, and the survival rates of 1, 2, 3, 5 years were 25.0%, 7.9%, 6.6% and 1.3%, respectively. The univariate analysis showed that N, M, TNM phase and radiotherapy were related to the overall survival of patients ( P<0.05). Multivariate analysis showed that TNM phase and radiotherapy were the independent risk factors for overall survival of patients ( P<0.05). Conclusions:PMME is more common in men, the common site of the disease is the lower part of the esophagus. The preoperatively missed diagnosis rate of Chinese PMME is high. TNM phase and radiotherapy are the independent risk factors for overall survival of patients.

Objective:To investigate the clinical pathological and epidemiological characteristics of primary esophageal malignant melanoma (PMME).Methods:The clinical pathology data of 180 PMME patients in the esophageal cancer database of the key laboratory of esophageal cancer research in Henan Province from 1973 to 2016 were collected, of which 136 were male, aged (58.5±9.0) years, 44 were female, aged (56.7±12.2) years. Kaplan-Meier and Log rank test were used for survival analysis, Cox regression scale model was used for risk factor analysis.Results:The incidence of PMME is 0.036% (180/500, 000), mostly were male (about 3∶1 for men: female). The common sites of PMME were the lower part of the esophagus (48.9%, 85/174), followed by the middle section of the esophagus (46.0%, 80/174) and the upper part of the esophagus (5.2%, 9/174). No black particles were seen in the PMME cells of 3 patients under microscope, and strong positive expressions of Melan-A and HMB453 were observed in these 3 patients by immunohistochemical results. Of the 129 patients who had a routine preoperative esophageal biopsy, 69 were undiagnosed with PMME (53.5%). The medium survival time of the whole group was 7.9 months, and the survival rates of 1, 2, 3, 5 years were 25.0%, 7.9%, 6.6% and 1.3%, respectively. The univariate analysis showed that N, M, TNM phase and radiotherapy were related to the overall survival of patients ( P<0.05). Multivariate analysis showed that TNM phase and radiotherapy were the independent risk factors for overall survival of patients ( P<0.05). Conclusions:PMME is more common in men, the common site of the disease is the lower part of the esophagus. The preoperatively missed diagnosis rate of Chinese PMME is high. TNM phase and radiotherapy are the independent risk factors for overall survival of patients.

Objective:To explore the application value in cerebral blood perfusion status of dynamic susceptibility contrast enhanced perfusion weighted imaging (DSC-PWI) in ischemic cerebrovascular disease (ICVD).Methods:Retrospective analysis of 31 cases ICVD head magnetic resonance imaging (MRI), diffusion weighted imaging (DWI), magnetic resonance angiography (MRA) and DSC-PWI image in clinical diagnosis, and selectively analyze parameters including relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit time (MTT) and time to peak (TTP) for generalize its characteristics.Results:31 cases of ICVD, 16 cases hypoperfusion, rCBF decreased significantly, rCBV decreased, MTT and TTP prolonged, include 7 cases of large vessel disease and 5 cases of small vessel disease. The collateral circulation formed 9 cases, including 3 cases with good compensation, rCBF normal, rCBV normal, MTT and TTP prolonged, 6 cases with bad compensation, rCBF decreased, rCBV normal or increased, MTT and TTP prolonged. The blood reperfusion in 3 cases, rCBF normal or slightly increased, rCBV increased, MTT shortened or normal, and TTP shortened. The excessive perfusion in 3 cases, rCBF significantly increased and rCBV significantly increased, with MTT and TTP shortened.Conclusions:DSC-PWI can reliably reflect the perfusion state and collateral circulation compensation of ICVD, so as to guide the selection of clinical treatment program and significantly improve the prognosis of patients.

Objective To analyze the efficacy and safety of tetrandrine in the adjuvant treatment of relapsed/refractory acute leukemia (except M3).Methods A total of 58 patients with relapsed/refractory acute leukemia (except M3) admitted to six tertiary hospitals in Jiangsu Province from January 2015 to December 2017 were included in this study.The tetrandrine-adjuvant standard chemotherapy regimen and standard chemotherapy regimen were given to treatment and control groups respectively.There were 17 and 41 patients in treatment and control groups.The treatment group was given tetrandrine for 5 days before the use of standard chemotherapy.The dose of tetrandrine was 4 mg ·kg-1 ·d-1,and patients had continuous oral administration of 5 days.After that,the patients in the treatment group started chemotherapy immediately.On the other side,the control group received standard chemotherapy without any other multidrug reversal medicine.Then the clinical efficacy and safety outcomes in both groups were analyzed.Results In the treatment group,5,3,and 9 cases achieved complete remission (CR),partial remission (PR),and nonremission (NR) respectively,and the total effective (CR+PR) rate was 47.06 ％ (8/17);in the control group,14,10,and 17 cases achieved CR,PR,and NR,and the total effective rate was 58.54 ％ (24/41).There was no significant difference in the total effective rate between the two groups (x2 =0.64,P =0.424).There was no significant difference in the efficacy between the two groups of patients with different genders (P ＞ 0.05).When the disease duration was 6-11 months,the difference of efficacy between the two groups was statistically significant (P =0.041).There was no significant difference in the proportion of myeloid leukemia cells,white blood cell count,platelet count,red blood cell count,and hemoglobin between the two groups before and after treatment (all P ＞ 0.05).There was no significant difference in clinical safety indicators (urine,faecal routine,liver and kidney function,and electrocardiogram) between the two groups (all P ＞ 0.05).Conclusions Tetrandrine is more effective in patients with relapsed/refractory acute leukemia (except M3) with shorter duration of disease.Compared with chemotherapy alone,the clinical efficacy of adding tetrandrine in chemotherapy cannot be considered superior to the former.

Objective To study the effect of chloral hydrate on click sound evoked auditory brainstem re-sponse (ABR) in healthy adult guinea pig .Methods A total of 20 healthy wild type albino male guinea pigs were se-lected for ABR assessment with click sound stimulation conscious and cholral hydrate anesthesia conditions .The ABR threshold was determined according to the wave that presents highest occurrence rate under different stimulus intensity .The latency ,interpeak latency of each wave at 90 dB peSPL stimulation as well as the amplitude of waveⅡ ,Ⅲ ,Ⅳ under different stimulus intensity were recorded .Results The ABR threshold in chloral hydrate anes-thesia was 25 .50 ± 2 .76 dB peSPL and at the waking state was 28 .5 ± 3 .66 dB peSPL from control group (P>0 .05) .The latencies of each wave recorded under chloral hydrate anesthesia state were prolonged compared to those of under waking state ,wave Ⅲ ,Ⅳ and Ⅴ had significance differences (P<0 .05) ,but wave Ⅰ ,Ⅱ had no significant differences (P>0 .05) .The interpeak latency between wave Ⅰ - Ⅴ ,Ⅲ - Ⅳ ,Ⅳ - Ⅴ in chloral hydrate anesthesia were longer compared to those of under waking state with significant differences (P<0 .05) ,while interpeak latency between Ⅰ - Ⅱ ,Ⅱ - Ⅲ had no significant differences (P> 0 .05) .The amplitude and occurrence rate of wave Ⅱwere the highest among all the waves in both experimental group and control group .The amplitude of wave Ⅱ and Ⅲ in chloral hydrate anesthesia was higher than that of the waking state under acoustic stimulation conditions ofhigh intensity(P<0 .05) while the amplitude of wave Ⅳ was lower than the waking state (P<0 .05) .Conclusion The chloral hydrate anesthesia may be able to apparently lengthen the ABR latencies of wave Ⅲ ,Ⅳ ,Ⅴ and affect the amplitude .This effect should be considered during the assessment of ABR under anesthesia state in guinea pig ;The ABR threshold of guinea pig could be determined according to the wave Ⅱ because it 's highest occurrence rate .

Objective To study the auditory brainstem response (ABR) of normal adult CBA,C57BL,Kunming and 129 mice and analyze the ABR thresholds and latencies in order to obtain normal values and standardized testing process,thereby providing important reference for future auditory hearing research in mouse.Methods Six -week-old normal mice of CBA,C57BL,Kunming and 129(each strain containing 20 ears of 20 mice) were used in this study.ABR test with both the click and tone burst were carried on.The incidence of each wave and the thresholds and latencies of various strains of mice were recorded.Results For these four strains of mice,wave Ⅱ had the highest occurrence rate and was used to determine the thresholds.Four strains of mice all were sensitive to the sound at 8,12,16 kHz,most to 12 kHz.Under anesthesia condition,the latency of each ABR wave prolonged as testing time increase,especially the waves Ⅲ ～ V which reflected the functions of the part near the cerebral center.Conclusion Under anesthesia state,for these four strains of mice,wave Ⅱ has the highest occurrence rate and is used to determine the threshold.We determine the intensity level at which Wave Ⅱ just appeared as the ABR threshold.The stain of CBA mice is the best one to establish an animal model related to hearing function research because ABR of the other three strains are not stable as the CBA mice.Wave SP can reflect the hair cell functions indirectly.

Objective:To elucidate the factors influencing the differences in the survival rates of esophageal squamous cell carcinoma (ESCC) patients between the rural and urban regions in China. Methods:A total of 36,723 ESCC patients derived from the clinical data-bases containing 500,000 esophageal and gastric cardia carcinoma cases (1973-2015) of the Henan Key Laboratory for Esophageal Can-cer Research of the First Affiliated Hospital, Zhengzhou University, were analyzed. Of these patients, 33,625 were from the rural re-gions (91.6%), comprising 20,906 male patients with an average age of 58.98 ± 8.71 years and 12,719 females with an average age of 59.59 ± 8.53 years. The remaining 3,098 were from the urban regions and composed of 2,089 male patients with an average age of 60.84±9.10 years and 1,009 females with an average age of 62.46 ± 9.14 years. All the patients underwent radical esophagectomy, de-tailed histopathological diagnosis, and TNM staging. Chi square test, Kaplan-Meier, Log-rank, and Cox proportional hazards regression model were used to analyze the differences between ESCC patients from rural regions and those from urban regions and among the risk factors in prognosis. Results:Kaplan-Meier and Log-rank analysis results showed that the ESCC patients from the rural regions had significantly higher overall survival than the urban patients (χ2=12.971, P=0.000). Further analysis showed that rural patients≥50 years old and diagnosed with stage IIa and IIb (middle stage) ESCC had higher survival rates than urban patients in males and females (male:χ2=16.188, P<0.001;female:χ2=5.019, P=0.025). However, the survival rates of rural and urban patients with stage 0,Ⅰa,Ⅰb (early stage) and Ⅲa, Ⅲc, and Ⅳ (late stage) were similar (P>0.05). The results of Cox proportional hazards regression model analysis showed that age, gender, and TNM stages were independent risk factors for rural and urban ESCC patients. When the rural and urban ESCC patients were both considered, the Cox proportional hazards regression model analysis results showed that male ESCC patients≥50 years old, urban residence, and TNM stages were independent risk factors. Conclusion:Rural ESCC patients have significantly high-er overall survival than urban patients. Male, age of≥50 years old, urban residence, and TNM stages were independent risk factors for ESCC patient survival.