Volume 121  ·   Issue 12  ·  2008

The economy of China in the past three decades has boosted the development of neurosurgery in China.Currently,thousands of active neurosurgeons,all over the mainland of China,practise their clinical and basic research in all the fields of neurosurgery。

Abstract：Background Recent studies have revealed that the reason for the low surgical resection rate of pancreatic carcinoma partly lies in its biological behavior,which is characterized by neural infiltration.This study aimed to investigate the clinical significance of radical pancreatOduodenectomy combined with retroperitoneal nerve,lymph,and soft-tissue dissection for carcinoma of the pancreatic head.Methods Forty-six patients with pancreatic head cancer were treated in our hospital from 1995 to 2005.The patients were divided into two groups:radical pancreatoduodenectomy combined with retroperitoneal nerve,lymph and soft-tissue dissection (group A,n=25) and routine Whipple's operation (group B,n=21).There were no significant differences between the two groups in relation to age,gender and preoperative risk factors,and perioperative conditions,pathological data and survival rates were studied.Results There were no significant differences in tumor size,surgical procedure time,postoperative complications,and time of hospitalization.However,the number and positive rate of resected lymph nodes in group A were significantly higher than those in group B (P＜0.05).The 1-and 3-year survival rate in group A were 80% and 53%,respectively,which was higher than those in group B (P＜0.05).There were significant differences in the survival rates between patients with and without nerve infiltration in group A (P＜0.05).Conclusions Radical pancreatoduodenectomy combined with retroperitoneal nerve,lymph and soft-tissue dissection,can effectiveoly remove the lymph and nerve tissues that were infiltrated by tumor.Meanwhile,this method can reduce the local recurrence rate so as to improve the long-term survival of patients。

Abstract：Background The radiaI artery is currently regarded as a useful vascular access site for coronary procedures.This study was conducted to investigate the feasibility and safety of the percutaneous radial artery approach for angioplasty in the elderly.Methods Two thousand and fifty-eight consecutive patients (762 elderly,age≥65 years;and 1296 non-elderly,age ＜65 years,respectively) who underwent transradial coronary angioplasty were recruited in this study.Study endpoints included procedure success rate,procedure time,vascular complications at access site,and major adverse cardiac and cerebrovascular events during hospitalization.Results Elderly patients were more likely to present with unstable angina and renal dysfunction.The incidence of radial and brachiocephalic trunk anatomical tortuosity was higher in elderly patients than that in non-elderly patients (11.5% vs 3.7%;8.9% vs 2.6%,P＜0.01,respectively).However,procedural success rate(94.7% vs 95.6%)and total mean procedure time ((67.9±27.3)minutes vs (58.6±38.5) minutes) for transradial coronary angioplasty were not significantly different between the two groups.Clinical course during the hospitalization was slightly worse in the elderly patients because of more adverse cardiac and cerebrovascular events after the procedure.However,the incidence of vascular complications was not significantly different between the elderly and non-elderly patients.Conclusion Although the incidence of radial and brachiocephalic trunk anatomical tortuosity is higher in elderly patients,transradial coronary intervention can be performed with similar safety and procedural success in these patients as compared with non-elderly patients。

Abstract：Background Ascorbic acid (AA) represents one of the most important enzyme co-factors,antioxidants and neuromodulators and plays an important role in the cerebral system.Increasing evidence has suggested that AA could treat certain kinds of vertigo diseases such as Meniere's disease.To elucidate the neurochemical functions associated with AA in vertigo,the change of extracellular AA in the brain cortex following caloric vestibular stimulation (CVS) was evaluated.Methods An on-line electrochemical detection was coupled with in vivo microdialysis to continuously monitor the change of extracellular AA in the primary somatosensory (SI) area of guinea pigs following a caloric vestibular stimulation.Sixteen guinea pigs were divided into three groups,i.e.,experimental group with irrigation of the ear canal with ice water (O℃) (n=8),and two control groups,one with irrigation of the ear canal with warm water(38℃)(n=4) and the other with irrigation of the auricle with ice water (n=4).Results In the experimental group.the ice water irrigation of the left external ear canalinduced a horizontal nystagmus towards the right side lasting about 45 seconds.No nystagmus was induced by warm water irrigation of the external ear canal or by ice water irrigation of the auricle.The extracellular AA concentration significantly increased following the ice water vestibular stimulation,reaching a maximum of (130±90)% (n=8) of the basal dialysate level (2.61±0.92)μmol/L (n=8),lasting at least for an hour.AA level did not change distinctly after the irrigation of the left external ear canal with warm water or the irrigation of the auricle with ice water.Conclusions The concentration of extracellular AA in the brain cortex of the SI area increased following the ice water vestibular stimulation.This demonstration may be useful for the investigation of the neurochemical processes associated with AA in the process of vertigo。

Abstract：Background Isocitrate lyase (ICL) was previously demonstrated to play a pivotal role in the intracellular metabolism of Mycobacterium tuberculosis (MTB).Presently severallines of evidence suggest that ICL from MTB (MTB-ICL) may play some roles in the interaction between MTB and host macrophage.However,there has been no research on the interaction between MTB-ICL and host macrophage.Methods MTB-icl and M. smegmatis (MS)-icl genes were amplified by polymerase chain reaction (PCR) and cloned into the E. coli-mycobacterium shuttle plasmid pUV15 to obtain recombinant shuttle plasmids PMTB-icl and pMS-icl.Following transformation into MS by electroporation,the expression of pMTB-icl and pMS-icl was verified by reverse transcriptase (RT)-PCR.The expression of recombinant plasmids derived from pUVl 5 when rMS was phagocytized by macrophage was also verified via fluorescence microscope.Ms 1-2c,rMS-pUV15,rMS-pMS-icl and rMS-pMTB-icl were used to infect RAW264.7 cells and the survivaI of intracellular MS was monitored by bacterial culture at 0.24 and 48 hours after infection.The culture supernatants from macrophage;nfected by Ms 1-2c,rMS-pUV15,rMS-pMS-icl and rMS-pMTB-icl were collected and the interferon (IFN)-V and nitric oxide (NO) concentrations were measured by ELISA or by Griess assay,respectively.The apoptosis of macrophage was assayed by the in situ TUNEL technique.Results RT-PCR showed that both pMTB-icl and pMS-icl could be expressed in MS.Fluorescence microscopic observation showed that recombinant plasmids derived from pUV15 (pUV15-IG) could also be expressed in MS when MS were phagocytized by macrophage.Bacterial culture data demonstrated that rMS-pMTB-icl exhibited significantly increased intracellular survival in the murine macrophage cellline RAW264.7 compared with Ms 1-2c.rMS-pUV15 and rMS-pMS-icl.This increased intracellular survival was not accompanied by the upregulation of IFN-Y and NO in host macrophage.But a lower apoptosis rate of macrophages infected with rMS-pMTB-icl was observed when compared with macrophages infected with other strains of MS.Conclusions MTB-ICL could promote the intracellular survival of MS.Suppressing the apoptosis of host macrophage may be one of the impoRant mechanisms involved in this increased intracellular survival。

Abstract：Background Nitric oxide (NO) is a biologically active molecule which has been reported to protect the heart against ischemia and reperfusion injury in different species.This study aimed to test the hypothesis that nitric oxide may induce the expression of heat shock protein 72 (HSP72) which may protect the heart against ischemia.Methods Rabbits were given intravenous saline or S-nitroso-N-acetyIpenicillamine (SNAP),a nitric oxide donor,or Zaprinast,an inhibitor of cyclic guanosine monophosphate (GMP)-phosphodiesterase,which may increase myocardial cyclic GMP content.Twenty-four hours later,the rabbits were either sampled to measure HSP72,or induced with a 30-minute coronary occlusion followed by a 120-minute reperfusion,and then the infarct size was measured.Meanwhile,chelerythrine (CHE,an inhibitor of protein kinase C) was given intravenously 5 minutes before SNAP injection and the effect on HSP72 expression and infarct size was determined.Results Twenty-four hours after pretreatment,immunoblotting showed HSP72 expression increased in the SNAP group compared with control groups,and this was blocked by CHE.Myocardial infarct size in the SNAP group was smaller than that of the control group ((32.4±5.8)% vs (51.1±4.7)%,P＜0.05).Pretreated with CHE abolished the infarct size-limiting effect of SNAP((46.0±5.1)%).Pretreatment with Zaprinast neither induced HSP72 expression nor reduced infarct size((55.4±5.4)%).Conclusion NO induced HSP72 expression and a delayed protection to the heart via the activities of protein kinase C by a cyclic GM P-independent pathway。

Abstract：Background Men who have sex with men (MSM) have become one of the most risky populations for HIV infection in China.Though several cross-sectional sero-prevalence studies have been conducted.the annual HIV incidence remains unknown in this population.Methods We applied IgG-capture BED-enzyme immunoassay (BED-CEIA) to define the recent HIV-1 infections among MSM in Beijing in the years 2005 and 2006 and the annual HIV incidence was estimated.Results Overall,1067 MSM samples were collected,including 526 samples in the year 2005 and 541 in 2006.In 2005,0f 17 HIV seropositive samples.7 were identified as recent HIV-1 infections and the estimated HIV infection incidence was 2.9% per year (95%CI,0.8%-5.0%).In 2006,of 26 HIV seropositive samples,9 were identified as recent HIV-1 infections and the estimated annual incidence was 3.6% (95%CI,1.3%-5.9%),which was 0.7% higher than that in 2005.Individuals engaging in male group sexual intercourse (5.17% vs 0.87%,P=0.019) and having receptive anal sexual intercourse more than five times (2.79% vs 0.33%,P=0.047) in the past 6 months significantly increase the risk of being infected by HIV-1.Conclusions A high level of annual HIV-1 infection incidence was observed among MSM in Beijing for the consecutive years 2005 and 2006 with a continuous increasing trend.The rising incidence and related high risk behavior among MSM alarmed the health authorities and calls for more effective intervention strategies among this population。

Abstract：Background There are conqenital and acquired choanal atresias and many approaches have been used for their repair.We assessed the clinical effect of power instrument.endoscopic repair of acquired choanaI stenosis and atresia.Methods Nineteen patients,aged from 32 to 61 years,with acquired choanal stenosis and atresia (from trauma in 5 cases and from radiotherapy after nasopharyngeal carcinoma in 14:6 bilateral and 13 unilateral cases),underwent transnasal endoscopic repair of choanal stenosis and atresia.No patient had stenting.Antibiotic and local glucocorticoid were administered postoperatively.Results Eiqhteen patients remained free of symptoms for 12-40 months after the surgery,and the diameter of the neochoana was more than 1 cm after the procedure.One patient required revision surgery and recovered completely with no restenosis at 12 months after the second surgery.There were no postoperative complications.Histology of the resected tissue revealed respiratory epithelial-lined stromal tissue with chronic inflammation,edema and fibrosis,but no tumor cells.Conclusions Transnasal endoscopic approach is a useful procedure for the repair of acquired choanal stenosis and atresia:it is highly successful,safe and effective with swift recovery and short time of hospitalizalion.It is very important in postoperative care to remove any granulation or polyps at the site of the neochoana at that time。

Abstract：Background Previous brain imaging studies suggested that the brain activity underlying the perception of chronic pain maV differ from that underlying acute pain.To investigate the brain regions involved in chronic spontaneous pain due to brachial plexus avulsion(BPA),fluorine-18fluorodeoxygIucose (19F-FDG) positron emission tomography (PET) scanning was applied to determine the glucose metabolic changes in patients with pain due to BPA.Methods Six right-handed patients with chronic spontaneous pain due to left-BPA and twelve right-handed age-and sex-matched healthy control subjects participated in the 18F-FDG PET study.The patients were rated by visual analog scale (VAS) during scanning and Hamilton depression scale and Hamilton anxiety scale after scanning.Statistical parametric mapping 2 (SPM2) was applied for data analysis.Results Compared with healthy subjects,the patients had significant glucose metabolism decreases in the right thalamus and S I(P＜0.001,uncorrected),and significant glucose metabolism increases in the right orbitofrontaI cortex (OFC) (BA11),left rostral insula cortex and left dorsolateral prefrontal codex (DLPFC) (BA10/46) (P＜0.001,uncorrected).Conclusion These findings suggest that the brain areas involved in emotion.aRention and internal modulation of pain may be related to the chronic spontaneous pain due to BPA。

Abstract：Background The anatomic value of the aortic root is important for aortic valve repair.This study was to determine the normaI diameters of the aortic valve annulus (AVA) and sinus-tube ioint (STJ) in the healthy adults of Chinese Han ethnic group,and to provide a morphological foundation for potential clinical application.Methods Echocardiography was performed in 326 normal subjects,who were divided into 5 groups according to their age.The diameters of the AVA and STJ were measured in the parasternal long-axis view.and normalized to body surface area (BSA).They were averaged for each age group and for each gender.Differences were then determined between the normalized diameters for each age group and for both genders.Pearson's product-moment correlation coefficient was used to determine the differences between AVA and STJ diameters.It was also used to determine any positive or neqative correlations between the above two variables and age,BSA,weight,and height.Results The diameters of the AVA and STJ of Han nationality patients increased with an increase in age,BSA,weight,and height.The correlation coefficient between AVA diameter and BSA was 0.4944 (P＜0.0001),between AVA diameter and age,0.1138 (P＜0.05),between AVA diameter and weight,0.4521 (P＜0.001),and between AVAdiameter and height,0.471 3 (P＜0.001).The correlation coefficient between STJ diameter and BSA was 0.3910 (P＜0.0001),between STJ diameter and age,0.3667 (P＜0.0001),between STJ diameter and weight,0.4586 (P＜0.0001),and between STJ diameter and height,0.3736 (P＜0.0001).The difference between the above two diameters was statistically significant at 2.42±2.45 mm (paired t-test:t=-17.25;P＜0.0001).AVA and STJ diameters were similar in both genders of each group when indexed to BSAConclusions The diameters of the AVA and STJ of adults of Chinese Han ethnic group increase with age,BSA,weight,and height.The diameters of the AVA and the STJ are similar in both genders.when indexed to BSA.The diameter of the AVA js shorter(about 10%) than that of the STJ,and the difference between the two diameters was 2.42±2.45 mm。

Abstract：Background Deafferentation pain is a kind of chronic pain syndrome and hard to manipulate.To evaluate the effectiveness and safety of junctional dorsal root entry zone (DREZ) coagulation,23 consecutive patients with intractable deafferentation pain syndrome were studied.Methods Twenty-three patients underwent junctional DREZ coagulation (C5-T1 for upper extremities and L2-S1 for lower extremities) under general anesthesia.The pain severity was evaluated by the short McGill pain questionnaire (MPQ) and the visual analog scale (VAS),and the depression and anxiety of patients were assessed by Hamilton rating scale for depression (HRSD),Hamilton anxiety scale (HAMA),self-rating anxiety scale(SAS)and self-rating depression scale (SDS).Results All the patients experienced significant pain reduction immediately after surgery.The scales of short MPQ and VAS at pre-operation,6-month and 12-month follow-up were 31.5±3.4 and 8.8±1.5,6.5±1.9 and 2.5±2.2,7.1±2.1 and 2.9±1.9,respectively.The postoperative scores comparing to pre-operative scores showed a statistically significant difference (P＜0.01).The depression and anxiety state was also significantly relieved.At 12-month follow-up 6 patients had complete pain relief,11 had excellent results with more than 75% pain relief,17 had good results with more than 50% pain relief (73.9%).The main postoperative complications were transient slight hemiplegia(8),hypesthesia and paresthesia (15),a bearing down feeling of affected extremity (6),and deep sensory disability in the lower Iimbs(4)on the operated side.Because of the long time and prone position of the operation.13 cases had a transient hyperalgesia in the upper chest.Conclusion DREZ coagulation is a safe and effective procedure in the treatment of deafferentation pain syndromes。

Hepatitis B virus (HBV) is an admitted oncogenic virus. Many epidemiological and molecular biological studies have demonstrated that chronic infection with HBV is a major risk factor associated with the development of hepatocellular carcinoma (HCC) and intrahepatic bile duct cancer.1-4 Compared with hepatocytes and intrahepatic bile duct epithelial cells,extrahepatic bile duct epithelial cells have autoploid in embryogenesis,continuity in anatomy and a similar internal environment.The question arises whether extrahepatic bile duct epithelial cells can receive HBV infection or not? The role of hepatitis viral infection in the pathogenesis of bile duct carcinoma has not yet been clarified.although a causative relationship between HBV or HCV infection and extrahepatic bile duct carcinoma has been reported in the literature.5,6 In this study,we focused on the evidence of hepatitis viral infection in tissue of bile duct carcinoma。

Meningiomas are the second most common intractranial benign tumors and represent about 15%-24% of primary brain tumors.1 Most meningiomas grow slowly at a rate of only 2.4 miTt annually.2 Due to their slow growth,few clinical symptoms occur until the tumor reaches a large size.If the meningioma grows at the front or rear of the cranial cavity,it can grow to be very large before that area's vital functions are affected.Therefore,giant meningiomas are not infrequent,and actually account for 11.9% of meningiomas in our hospital。

Dumbbell tumors have both intraspinal and anterior paraspinal components connected through an intervertebral foramen. Most of these tumors are neurogenic and include schwannomas,neurofibromas,ganglioneuromas and neuroblastomas.1 Fortunately,more than 90% of these tumors are benign.2 Dumbbell tumors of the thoracic spine are particularly difficult to expose and remove by virtue of their location and relationship with vital structures of the thoracic cavity.The traditional surgical approach for removing these tumors has been using either combined anterior thoracotomy and posterior neurosurgical procedures or the lateral extracavitary approach.3-5 We present our experience with resection of three dumbbell tumors with a combined microneurosurgical and thoracoscopic procedures in a single stage。

The extremely complex anatomic relationships among bone,tumor,blood vessels and cranial nerves remains a big challenge for cranial base tumor surgery.Therefore.a good understanding of the patient specific anatomy and a preoperative planning are helpful and crocial for the neurosurgeons.Three dimensional (3-D) visualization of various imaging techniques have been widely explored to enhance the comprehension of volumetric data for surgical planning.1 We used the Destroscope Virtual Reality (VR) System (Singapore,Volume Interaction Pte Ltd,software:RadioDexterTM 1.0) to optimize preoperative plan in the complex cranial base tumors.This system uses patient-specific,coregistered,fused radiology data sets that may be viewed stereoscopically and can be manipulated in a virtual reality environment.This article describes our experience with the Destroscope VR system in preoperative surgical planning and simulation for 5 patients with complex cranial base tumors and evaluates the clinical usefulness of this system。

Chordoma as a rare malignant tumor arising from remnants of the fetal notochord accounts for 1%-4% of primary bone tumors.It is usually predominant in males.Local recurrences are common (44%-78%)1-3 and distant metastases may occur years after the initial presentation.The reposed rates of metastases range from 10% to 48%,4-6 which are usually accompanied by a sacrococcygeal chordoma.Cases of surgical seeding and intradural spinal seeding also have been reported clinically.7-9 To our knowledge,the present case is the first one concerning cerebrospinal fluid metastases and fatal progression of a sacrococcygeal chordoma。

There are very few reports concerning the failure of devices used in carotid artery stenting.Here we report a fracture of the dishal part of the guiding wire of a cerebral protection device during carotid artery stenting for management of a restenotic lesion after carotid endarterectomy。

As a non-atherosclerotic chronic cerebral vasculopathy,moyamoya disease is characterized by progressive steno-occlusion of the arteries of the circle of Willis with a developed collateral vascular network mainly at the cerebral base.1 And it is named moyamoya disease because of a characteristic "puff-of-smoke" angiographic appearance。