Objective To investigate the pattern of nodal recurrence after curative resection in adenocarcinoma of the gastroesophageal junction ( AGE ) , and to provide a basis for delineation of the radiation range in the high-risk lymphatic drainage area.Methods A retrospective analysis was performed in 78 patients with locally advanced AGE who were newly treated in our hospital from January 2009 to December 2013 and had complete clinical data.All patients received curative resection and were pathologically diagnosed with stage T3/T4 or N (+) AGE.Those patients were also diagnosed with SiewertⅡor Ⅲ AGE by endoscopy, upper gastroenterography, macroscopic examination during operation, and pathological specimens.None of the patients received preoperative or postoperative radiotherapy.All patients were diagnosed by imaging with postoperative nodal recurrence.The computed tomography images of those
patients were accessible and had all the recurrence sites clearly and fully displayed.Results The median time to recurrence was 10 months ( 1-48 months) , and 90%of the recurrence occurred within 2 years after surgery.The lymph nodes with the highest risk of recurrence were No.16b1( 39%) , No.16a2( 37%) , No.9 (30%), and No.11p (26%), respectively.There was no significant difference in the recurrence rate within each lymphatic drainage area between patients with SiewertⅡandⅢAGE ( P=0.090-1.000) .The lymph nodes with the most frequent recurrence were No.16b1, No.16a2, No.9, No.16b2, No.11p, and No.7 in patients with stage N3 AGE and No.11p, No.16b1, No.16a2, No.9, No.8, and No.7 in patients with stage non-N3 AGE.Patients with stage N3 AGE had a significantly higher recurrence rate in the para-aortic regions (No.16a2-b2) than those with stage non-N3 AGE (67%vs.33%, P=0.004, OR=4.00, 95% CI=1.54-10.37) .Conclusions The lymph nodes with the highest risk of recurrence are located in the celiac artery, proximal splenic artery, and retroperitoneal areas ( No.16a2 and No.16b1) in patients with SiewertⅡorⅢlocally advanced AEG.Moreover, patients with stage N3 AGE have a higher risk of retroperitoneal recurrence.The above areas should be involved in target volume delineation for postoperative radiotherapy.

Objective To analyze the epidemiologieal features and treatment of brain injury in Chinese Wenchuan earthquake so as to provide the experiences for improving treatment level. Methods A total of 685 patients with earthquake-induced brain injury in the City of Deyang were collected to ana-lyze age, injury type, injury localization and treatment characteristics. Results Of large number of earthquake victims, the number of the patients with brain injury ranked the second place, mainly minor and moderate brain injuries involving scalp laceration for the most and skull fracture and extradural hema-toma for the next. As for the age distribution of the patients, young and middie-aged patients accounted for the most, for they were at school or at work when the earthquake happened. Obvious position distribu-tion features were found in depressed fracture of skull and extredural hematoma but not in the scalp lacera-tion. Depressed fracture of skull occurred mostly at forehead and occiput while extradural hematoma could be most seen at froutotemple. Most brain injuries were combined with other injuries. Mainly extremity and pelvic fractures. Conclusions Self-protection sense and measures during earthquake are very important for decreasing incidence and severity of brain injuries. The management of rospimtory tract in prehospital care should be strengthened to avoid asphyxia and hence raise the success rate of treatment.

BACKGROUND: The activation of hypothalamus-pituitary-adrenal cortex axis may play key role in the increasing expression of hypothalamic corticotropin-re-leasing hormone (CRH) during stress reaction. However by what way to induce the CRH expression in hypothalamic neuron, and whether CRH can activate hypothalamic neurons are still not very clear.OBJECTIVE: To observe the changes of intracellular cyclic adenosine monophosphate (cAMP) and cytoplasmic Ca2+ concentration in the hypothalamic neurons cultured in vitro due to exogenous CRH stimulation.DESIGN: Comparative observation experiment.SETTING: Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA; Department of Neurosurgery , Tiantan Hospital, Capital University of Medical Sciences MATERIALS: This experiment was carried out in the Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA between December 1999 and March 2002. Hypothalamus was obtained from fetus rat at pregnancy of 17 days for the in vitro culture of hypothalamic neurons.METHODS: Hypothalamic neurons were co-cultured with exogenous CRH,with or without pretreatment with specific CRH 1 receptor antagonist -CP-154526. hypothalamic neurons were randomized into: ① CRH (10-12,10-10, 10-8, 10-6 mol/L) stimulation group. ② CP-154526(500 μmol/L)pretreatment aud CRH ( 10-12, 10-10, 10-8,10-6 mol/L) stimulation group. ③Hypothalamic neurons in corresponding normal control group were exposed to the isotonic saline stimulation. PTI fluorescence image system was used to determine and analyze the change of cytoplasmic free Ca2+ concentration in hypothalamic neurons due to exogenous CRH stimulation and RIA was used to detect the neuronal cAMP content.MAIN OUTCOME MEASURES: ①Cytoplasmic free Ca2+ concentration in hypothalamic neurons. ②cAMP content in hypothalamic neurons.RESULTS: The cytoplasmic free Ca2+ concentration and cAMP content were relatively lower in the hypothalamic neurons in normal control group,which obviously increased due to CRH stimulation [(240±22),(153±11)nmol/L; (3.26±0.19),(0.44±0.02) pmol/dish,P ＜ 0.01];CP-154526 could remarkably suppress the CRH (10-6 mol/L)induced increase in cytoplasmic free Ca2+ concentration and cAMP content in hypothalamic neurons [Ca2+ concentration: (240±22),(171±16)nmol/L; cAMP content:(3.26±0.19), (2.33±0.21) pmol/dish, P ＜ 0.01].CONCLUSION: CRH can directly act on hypothalamic neurons via type 1-receptor,thereby increase the cytoplasmic free Ca2+ concentration and cAMP content in hypothalamic neurons,playing the key role in the modulation of the synthesis and secretion of CRH during the activation of hypothalamic neurons.

BACKGROUND: Through what signal pathway does corticotropin release hormone (CRH) regulate hypothalamic neuronal neuroendocrine activity during acute stress?OBJECTIVE: To probe into the regulatory effects of CRH on CREB secretion in hypothalamic neurons.DESIGN: Repetitive measurement design.SETTING: At Field Surgery Research Institute of Daping Hospital, Third Military Medical University of Chinese PLA; Neurosurgery Department,Tiantan Hospital Affiliated to the Capital University of Medical Sciences.MATERIALS: This experiment was carried out in Daping Hospital of Third Military Medical University of Chinese PLA between December 1999and March 2002. Rat fetuses were selected from Wister rats of 17-day gestation.METHODS: In vitro cultured cells were divided into the following groups:① CRH (10-12, 10-10, 10-8 and 10-6 mol/L) stimulation groups. ② Pretreated with nimodipine (5 μmol/L) or CP-154526 (500 μmol/L) followed by CRH (10-12, 10-10, 10-8 and 10-6 mol/L ) stimulation groups. ③ Corresponding control groups stimulated with isotonic physiological saline. PTI fluorescence imaging system was used to detect the changes of neuronal cytoplasmic free calcium concentration; meanwhile, Western blot technique was used to determine the changes of neuronal P-CREB content.MAIN OUTCOME MEASURES: ① Changes of neuronal cytoplasmic free calcium concentration. ② Changes of neuronal P-CREB content.RESULTS: The content of cytoplasmic free calcium in hypothalamic neurons was lower in normal control group, and it increased immediately after exogenous CRH stimulation. However, such increase could be suppressed by pretreatment with nimodipine or CP-154526 before CRH stimulation,and the increase of neuronal P-CREB content was also obviously suppressed.CONCLUSION: During acute stress, the combination of CRH with hypothalamic neuronal CRH 1 receptor leads to the opening of membrane Ltype calcium ions channels, thus enhancing the influx of calcium ions and increasing cytoplasmic free calcium ions content, which would further activate P-CREB signal transduction pathway in neurons. It suggests that CRH may play a vital role in hypothalamic neuronal activation.

Objective To analyse the therapeutic outcome of cavernous sinus meningiomas by gamma knife radiosurgery. Methods Retrospective analysis was conducted of 37 patients with cavernous sinus meningiomas. The median maximum diameter was 2.6 cm (1.4～3.2 cm) with the median dose to the tumor margin of 15.7Gy(8～22 Gy), the isodose curve to the tumor margin of 40%～60% and the target numbers of 1～9. The radiosurgical dose to the optic nerve and brain stem was not more than 10 Gy and 15 Gy, respectively. Results After an average follow up of 22.6 months(ranging 4～43 months), unchanged symptoms were found in 22 cases(59.5%), alleviated in 12 cases(32.4%) and complications of optic and trigeminal nerve in 3 cases(8.1%). By MR image analysis, unchanged size was found in 18 cases(48.6%), smaller size in 15 cases(40.5%) and larger size in 4 cases(10 8%). One factor analysis of variance revealed that tumor recurrence was associated with marginal dosage(

Objective To evaluate the therapeutic efficacy of gamma knife for the treatment of idiopathic trigeminal neuralgia Methods An analysis of 87 cases with idiopathic trigeminal neuralgia treated by gamma knife in our department in the past 5 years was performed In all cases, 4 mm isocenter was targeted at the proximal nerve at the root entry zone located by MRI The target dose varied from 70-90 Gy Results After a follow up of 6-67 months, complete relief of pain occurred in 66 patients (75 9%), 50%-90% relief in 18(20 7%), relief less than 50% in 2(2 3%) but no relief in 1(1 1%) Repeated radiosurgery was performed in 2 patients (2 3%) with recurrent pain After the second radiosurgical procedure, complete relief of pain was found in the 2 patients Two patients(2 3%) experienced facial numbness after radiosurgical procedure Conclusion Gamma knife radiosurgery is a minimally invasive technique for the treatment of trigeminal neuralgia with few complications Repeated radiosurgical procedure may result in relief of pain, but the long term outcome of gamma knife surgery for trigeminal neuralgia needs to be further studied

OBJECTIVETo study the influence of traumatic subarachnoid hemorrhage on secondary intracranial damage in GCS 13-15 head injuries and prognosis.

METHODSOne hundred and twenty-eight patients with mild head injury, including 64 with subarachnoid hemorrhage and 64 without subarachnoid hemorrhage, were selected and analyzed according to the changes of their conditions after injury.

RESULTSIntracranial abnormality was found in 14 patients (21.87%) with subarachnoid hemorrhage and only in 4 patients (6.25%) without subarachnoid hemorrhage (P<0.01). In the 14 patients, 4 were given surgical treatment. Mild disability was in 2 patients and 2 completely recovered. The rest were conservatively treated and achieved complete recovery at last.

CONCLUSIONSTraumatic subarachnoid hemorrhage, as a factor of intracranial complications in mild head injury should be given much attention. Early drainage of bloody cerebrospinal fluid by lumbar puncture is an effective method for prevention and treatment of complications in mild head injury.

Adolescent ; Adult ; Aged ; Brain Damage, Chronic ; etiology ; Craniocerebral Trauma ; complications ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Subarachnoid Hemorrhage ; etiology

OBJECTIVETo discuss the diagnosis and management of traumatic carotid cavernous fistula (TCCF).

METHODSIn all 15 patients with TCCF confirmed by angiography, 8 patients got early diagnosis and cure. With Seldinger technique adopted in the puncture of femoral artery, Magic 3 F-1.8 F BD catheters combining with balloon were used to embolize the fistula or the internal carotid artery.

RESULTSEarly diagnosis and cure were achieved in 8 patients within one week and no sequelae occurred. Seven patients with delayed diagnosis who were cured beyond one week had some sequelae such as hypopsia in 5 cases, incomplete oculomotor paralyses in 3 and incomplete abducent paralyses in 2. Among all the 15 cases, the internal carotid artery was preserved in 12 cases accounting for 80%. Occluding the fistula with sacrifice of the internal carotid artery was performed in 3 cases and no repatency of the fistula occurred by following up beyond three months.

CONCLUSIONSThe preferred therapy for TCCF is to occlude the fistula using detachable balloon. The diagnosis and treatment for TCCF can significantly reduce occurrence rate of the complications and sequelae.

Accidents, Traffic ; Adolescent ; Adult ; Arteriovenous Fistula ; diagnostic imaging ; therapy ; Carotid Artery Injuries ; diagnostic imaging ; therapy ; Cavernous Sinus ; injuries ; Cerebral Angiography ; methods ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Prospective Studies ; Risk Assessment ; Treatment Outcome

OBJECTIVE: To investigate the effect of endothel in and endothelin A receptors (ETAR) on regional cerebral blood flow after traum atic brain injury (TBI). METHODS: The changes of endothelin-1 (ET-1) content with radi oimmunoassay, mRNA expression and the location of ETAR with in situ hybridizatio n, and the function and effect of antagonist BQ123 on regional cerebral blood fl ow (rCBF) through intracisternal application were dynamically observed on 130 ad ult rabbits after TBI. RESULTS: ET-1 increased significantly in regional brain tissue s, and the expression of ETAR mRNA increased apparently and predominantly distri buted in the cerebromicrovascular endothelium after trauma. The rCBF declined si gnificantly, but by using selective ETAR antagonist BQ123 to treat the rabbits, the decrease of rCBF could be apparently prevented. CONCLUSIONS: It demonstrates that ET-1 may primarily contribut e to the rCBF decrease after TBI, while providing that the role of ET-1 is medi ated through ETAR.

AIM: To investigate the effects of internal change of serum insulin and plasma glucose levels on serum free fatty acid (FFA) concentrations after glucose loading. METHODS: Serum insulin, plasma glucose and FFA concentrations were measured simultaneously in 234 essential hypertension patients who were undergoing oral glucose tolerance test (OGTT) [ including 20 cases with 2 type diabetes mellitus (DM), 74 impaired glucose tolerance (IGT), 140 normal glucose tolerance (NGT); 98 males, 136 females]. RESULTS: Fasting serum FFA concentration (?mol/L) in DM ((1 048.47)?481.6) was higher than that in IGT (760.1?332.1) (P