Microsurgical resection of ventral foramen magnum meningiomas via a far-lateral suboccipital approach

BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial. OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach. DESIGN: Retrospectively clinic case investigation. SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three. METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up. MAIN OUTCOME MEASURES: Operative effect. RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans. CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up.     

Large animal models of human cauda equina injury and repair: evaluation of a novel goat model

Previous animal studies of cauda equina injury have primarily used rat models, which display significant differences from humans. Furthermore, most studies have focused on electrophysiological examination. To better mimic the outcome after surgical repair of cauda equina injury, a novel animal model was established in the goat. Electrophysiological, histological and magnetic resonance imaging methods were used to evaluate the morphological and functional outcome after cauda equina injury and end-to-end suture. Our results demonstrate successful establishment of the goat experimental model of cauda equina injury. This novel model can provide detailed information on the nerve regenerative process following surgical repair of cauda equina injury.     

Follow-up evaluation with ultrasonography of peripheral nerve injuries after an earthquake

Published data on earthquake-associated peripheral nerve injury is very limited. Ultrasonography has been proven to be efficient in the clinic to diagnose peripheral nerve injury. The aim of this study was to assess the role of ultrasound in the evaluation of persistent peripheral nerve injuries 1 year after the Wenchuan earthquake. Thirty-four patients with persistent clinical symptoms and neurologic signs of impaired nerve function were evaluated with sonography prior to surgi- cal repair. Among 34 patients, ultrasonography showed that 48 peripheral nerves were entrapped, and 11 peripheral nerves were disrupted. There was one case of misdiagnosis on ultrasonogra- phy. The concordance rate of ultrasonographic findings with those of surgical findings was 98%. A total of 48 involved nerves underwent neurolysis and the symptoms resolved. Only five nerves had scar tissue entrapment. Preoperative and postoperative clinical and ultrasonographic results were concordant, which verified that ultrasonography is useful for preoperative diagnosis and postoperative evaluation of injured peripheral nerves.     

Changes in compressed neurons from dogs with acute and severe cauda equina constrictions following intrathecal injection of brain-derived neurotrophic factor-conjugated polymer nanoparticles

This study established a dog model of acute multiple cauda equina constriction by experimental constriction injury (48 hours) of the lumbosacral central processes in dorsal root ganglia neurons. The repair effect of intrathecal injection of brain-derived neurotrophic factor with 15 mg encapsulated biodegradable poly(lactide-co-glycolide) nanoparticles on this injury was then analyzed. Dorsal root ganglion cells (L7) of all experimental dogs were analyzed using hematoxylin-eosin staining and immunohistochemistry at 1, 2 and 4 weeks following model induction. Intrathecal injection of brain-derived neurotrophic factor can relieve degeneration and inflammation, and elevate the expression of brain-derived neurotrophic factor in sensory neurons of compressed dorsal root ganglion. Simultaneously, intrathecal injection of brain-derived neurotrophic factor obviously improved neurological function in the dog model of acute multiple cauda equina constriction. Results verified that sustained intraspinal delivery of brain-derived neurotrophic factor encapsulated in biodegradable nanoparticles promoted the repair of histomorphology and function of neurons within the dorsal root ganglia in dogs with acute and severe cauda equina syndrome.     

MRI evaluation of vascular dementia

OBJECTTVE: To explain the association between vascular dementia and the cranial MRI manifestations, and recognize the value of cranial MRI in the early diagnosis of vascular dementia and the assessment of disease conditions.DATA SOURCES: Pubmed database was searched to identify articles about the cranial MRI manifestations of patients with vascular dementia published in English from January 1992 to June 2006 by using the key words of “MRI, vascular dementia“. Others were collected by searching the name of journals and title of articles in the Chinese full-text journal database.STUDY SELECTTON: The collected articles were primarily checked, those correlated with the cranial MRI manifestations of patients with vascular dementia were selected, while the obviously irrelative ones were excluded, and the rest were retrieved manually, the full-texts were searched.DATA EXTRACTION: Totally 255 articles were collected, 41 of them were involved, and the other 214 were excluded.DATA SYNTHESIS: MRI can be taken as one of the effective methods for the early diagnosis and disease evaluation of vascular dementia. White matter lesions are the important risk factors of vascular dementia.Vascular dementia is accompanied by the atrophy of related brain sites, but further confirmation is needed to investigate whether there is significant difference. MRI can be used to quantitatively investigate the infarcted sites and sizes of patients with vascular dementia after infarction, but there is still lack of systematic investigation on the association of the infarcted sites and sizes with the cognitive function of patients with vascular dementia.CONCLUSTON: Cranial MRI can detect the symptoms of vascular dementia at early period, so that corresponding measures can be adopted to prevent and treat vascular dementia in time.     

MRI evaluation of vascular dementia

OBJECTIVE: To explain the association between vascular dementia and the cranial MRI manifestations, and recognize the value of cranial MRI in the early diagnosis of vascular dementia and the assessment of disease conditions. DATA SOURCES: Pubmed database was searched to identify articles about the cranial MRI manifestations of patients with vascular dementia published in English from January 1992 to June 2006 by using the of "MRI, vascular dementia". Others were collected by searching the name of journals and title of articles in the Chinese full-text journal database. STUDY SELECTION: The collected articles were primarily checked, those correlated with the cranial MRI manifestations of patients with vascular dementia were selected, while the obviously irrelative ones were excluded, and the rest were retrieved manually, the full-texts were searched. DATA EXTRACTION: Totally 255 articles were collected, 41 of them were involved, and the other 214 were excluded. DATA SYNTHESIS: MRI can be taken as one of the effective methods for the early diagnosis and disease evaluation of vascular dementia. White matter lesions are the important risk factors of vascular dementia. Vascular dementia is accompanied by the atrophy of related brain sites, but further confirmation is needed to investigate whether there is significant difference. MRI can be used to quantitatively investigate the infarcted sites and sizes of patients with vascular dementia after infarction, but there is still lack of systematic investigation on the association of the infarcted sites and sizes with the cognitive function of patients with vascular dementia. CONCLUSION: Cranial MRI can detect the symptoms of vascular dementia at early period, so that corresponding measures can be adopted to prevent and treat vascular dementia in time.     

Current landscape in motoneuron regeneration and reconstruction for motor cranial nerve injuries

The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future directions in the field of motor cranial neuron research.     

Carotid endarterectomy for ameliorating the symptoms of transient ischemic attack☆○ A six-month postoperative follow-up

BACKGROUND: Carotid endarterectomy has certain risks, but it has obvious effects on preventing the occurrence of stroke. OBJECTIVE: To identify the effects of carotid endarterectomy on ameliorating the clinical symptoms and physical signs of patients with cerebral ischemia. DESIGN: A follow-up study. SETTING: Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. PARTICIPANTS: Sixteen patients with carotid atherosclerotic stenosis accompanied by ischemic symptoms were selected from the Department of Vascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from March 2005 to May 2007. There were 11 males and 5 females, aged from 40 to 81 years old with a mean age of 60 years old, and they were all clearly diagnosed by carotid color Doppler ultrasound. Informed consent was obtained from all the patients. The study was approved by the hospital ethical committee. METHODS: ① All the 16 patients were performed with unilateral stripping of arteriosclerotic plaque and Carotid endarterectomy, and 6 of them with bilateral stenosis was operated on the side with more serious stenosis. ② The clinical symptoms, physical signs before and after operation, and the operative complications were observed. ③ The patients were followed up for 6 months postoperatively. The smoothness of carotid arteries was detected with color Doppler ultrasound. The degrees of satisfaction to the quality of living were evaluated. MAIN OUTCOME MEASURES: ① Amelioration of clinical symptoms postoperatively; ② Smoothness of carotid arteries postoperatively; ③ Degrees of satisfaction to the quality of living; ④ Postoperative complications. RESULTS: All the 16 patients were involved in the final analysis of results. ① Amelioration of clinical symptoms and physical signs: The postoperative muscle strengths of 3 patients with stroke history were significantly ameliorated; For the 8 patients with TIA symptoms, and the symptoms disappeared completely in 6 cases of them; For the 5 patients with atypical nervous symptoms, the symptoms disappeared completely in 3 cases, and obviously alleviated in 2 cases. ② All the patients were good in smoothness of carotid arteries. ③ The degree of satisfaction to the quality of living was a little satisfied in 2 patients, very satisfied in 1 patient, and satisfied in the others. ④ Postoperative complications: The complications were injury of hypoglossal nerve in 4 patients (25%) and injury of recurrent laryngeal nerve in 1 patient (6%), and the complications recovered or turned better after conservative treatments for 1–3 months. CONCLUSION: Carotid endarterectomy can ameliorate the symptoms and physical signs of patients with cerebral ischemia, and it has mild postoperative complications.     

Clinical characteristics, neurophysiological grade and outcome of patients with carpal tunnel syndrome——A retrospective study

BACKGROUND: Carpal tunnel syndrome (CTS) is diagnosed mainly according to clinical symptoms, physical sign and neurodiagnostic laboratory examination. The therapeutic effect of conservative management and surgical operation in treating CTS need to be further observed and evaluated. OBJECTIVE: To analyze the clinical characteristics, neurophysiological grade and outcome in patients with CTS. DESIGN: Retrospective case-analysis. SETTING: Department of Neurology, First Affiliated Hospital, Medical College, Xi'an Jiaotong University. PARTICIPANTS: Totally 161 patients with suspected CTS from National Neuroscience Institute of Singapore referred to the Neurodiagnostic Laboratory for the confirmatory testing between January and September 2002. The involved patients, 137 male and 24 female, were aged 21–85 years. METHODS: ①The condition of diabetes mellitus complicated by abnormal thyroid function was observed. ② The effect on predominant hand, and paraesthesia were observed. ③Neuroelectrophysiological studies were performed and the results were graded into mild, moderate and severe CTS according to the American Association of Electrodiagnostic Medicine (AAEM) criteria. ④ Conservative management and surgical intervention were followed up 3 months later, and symptoms and physical sign basically disappeared, and function was basically recovered, which indicated that disease condition improved. MAIN OUTCOME MEASURES: ①Condition of CTS complicated by metabolic disease; ②Effects on predominant hand and paraesthesia; ③Electrophysiological grading; ④Prognosis. RESULTS: Totally 161 patients participated in the final analysis. ①Condition of CTS complicated by metabolic disease: Among 161 patients, 17.4% (28/161) were documented to have diabetes mellitus and 7(4.3%) had hypothyroidism. ②Effects on predominant hand and paraesthesia: Dominant hand involvement was present in 134 patients (83.2%) and more than 75% had onset of symptoms in the dominant hand. Sensory symptoms like numbness and paresthesias were the predominant symptoms, accounting for 89.1% (134/161), this discomfort was felt in all 5 digits of the hand in 47.6%, and lateral three and half digits in 21.4%. The noctural symptoms were present in 30.4% (49/161) patients. ③Electrophysiological typing: The most frequent abnormality was that of the prolonged mid-palm median and ulnar latency difference in 146(54.7%) hands; 103(38.6%) hands had prolonged median motor distal latency. Absent response from thenar muscle was present in 35 (13.1%) hands. Nerve conduction study showed bilateral CTS in 105 (65.2%) patients and unilateral CTS in 56 (34.8%) patients. Sixteen patients with bilateral CTS had symptoms in one hand only. Overall, 36.8% had mild, 49.2 % had moderate and 13.9 % had severe CTS, with median duration of symptoms of 6, 9 and 14 months, respectively. ④Delay in diagnosis: 37(22.9%) patients delayed in diagnosis from 1–4 months, 16(43.2%) were misdiagnosed as cervical spondylosis; 6(16.2%) were ignored due to their condition by busy work; 15(40.5%) were unware of their symptoms. ⑤Prognosis: Follow up data was available for only 72.7% (117/161) patients. Conservative management was conducted in 73.5% (86/117). Clinical symptoms were resolved or improved in 65.1% (56/86) patients with 17 mild CTS, 29 moderate CTS, and 10 severe CTS. 26.5% (31/117) patients underwent surgery for CTS release, and clinical symptoms were improved in 12(38.7%) with moderate CTS and 2 (6.5%) with severe CTS at 3 months of follow up. CONCLUSION: ①Sensory symptoms in CTS are more in severe and common in dominant hand. ②Conservative management showed resolution or improvement for mild and moderate CTS. Surgical intervention shows either resolution or improvement in clinical symptoms in moderate CTS. ③ The common reasons for delay in diagnosis were due to misdiagnosis as cervical spondylosis and lack of awareness of the condition. ④Assessment on severity of CTS by electrophysiological grade is of important significance for determining therapeutic mean.     

A three-dimensional digital visualization model of cervical nerves in a healthy person*

Three-dimensional reconstruction nerve models are classically obtained from two-dimensional images of ＂visible human＂ frozen sections. However, because of the flexibility of nerve tissues and small color differences compared with surrounding tissues, the integrity and validity of nerve tissues can be impaired during milling. Thus, in the present study, we obtained two-dimensional data from a healthy volunteer based on continuous CT angiography and magnetic resonance myelography. Semi-automatic segmentation and reconstruction were then conducted at different thresholds in different tissues using Mimics software. Small anatomical structures such as muscles and cervical nerves were reconstructed using the medical computer aided design module. Three-dimensional digital models of the cervical nerves and their surrounding structures were successfully developed, which allowed visualization of the spatial relation of anatomical structures with a strong three-dimensional effect, distinct appearance, clear distribution, and good continuity, precision, and integrality. These results indicate the validity of a three-dimensional digital visualization model of healthy human cervical nerves, which overcomes the disadvantages of milling, avoids data loss, and exhibits a realistic appearance and three-dimensional image.     

Nervous function and manifestations of mental psychology in patients with post-stroke depression of different syndrome types of traditional Chinese medicine

BACKGROUND： Poly-criteria pathogenesis of patients with stroke causes diversity of syndrome types of traditional Chinese medicine （TCM）; meanwhile, complexity and diversity of pathological mechanism also play a key role in determining severity so as to induce effects on nervous function and manifestation of mental psychology in patients with post-stroke depression （PSD）. OBJECTIVE： To analyze the syndrome types of TCM with nervous function and manifestations of mental psychology in PSD patients so as to provide evidence for the treatment based on the syndrome differentiation. DESIGN： Contrast observation. SETTING： Departments of Neurology and Traditional Chinese Medicine, General Hospital of Fuxin Mining Industry Group. PARTICIPANTS： A total of 469 outpatients or inpatients with stroke were selected from the Department of Neurology, General Hospital of Fuxin Mining Industry Group from April 2002 to July 2005. All subjects met the diagnostic criteria of stroke established by the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were finally diagnosed with CT and MRI. Totally, 177 PSD patients were involved in the final analysis and provided the confirmed consent. There were 121 males and 56 females aged from 46 to 79 years. METHODS： （1） All the enrolled subjects were diagnosed for syndrome differentiation by senior TCM physicians within 1 week before discharge based on Diagnostics of Traditional Chinese Medicine, which was classified into 5 types, including sputum-stasis stagnation syndrome, qi stagnation and blood stasis, kidney-essence deficiency, deficiency of the spleen and stomach and phlegm-fire disturbing the heart. In addition, they were also assessed by neurologic deficit scale （NDS; 45 points in total; the higher the scores were, the severer the deficit was）, Fugl-Meyer assessment, （FMA; 100 points in total, including 66 points of upper limbs and 34 points of lower limbs; the higher the scores were, the stronger the motor function was）, modified Barthel index [BI; 100 points in total; the higher the scores were, the better the activity of daily life （ADL） was], symptom checklist-90 （SCL-90; including total scores, positive scores, mean and average scores of positive items）, Hamilton depression rating scale （HAMD） and Hamilton anxiety rating scale （HAMA, the higher the scores were, the severer the degree was）. （2） Patients were divided into one symptom type, two symptom types and ≥ 3 symptom types; meanwhile, they were also divided into deficiency symptom, excess symptom and deficiency-excess symptom. Scores among various groups were compared simultaneously. MAIN OUTCOME MEASURES： Comparison of nervous function and mental psychology of PSD patients with various symptoms. RESULTS： （1） Differences of various symptoms： Among 177 patients, there were 43 subjects in the types of sputum-stasis stagnation, 64 in qi stagnation and blood stasis, 21 in kidney-essence deficiency, 33 in deficiency of the spleen and stomach, and 16 in phlegm-fire disturbing the heart. In the comparison of the scores of nervous function and psychological tests among different syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency were obviously lower than those of the total samples and PSD patients of deficiency of the spleen and stomach and phlegm-fire disturbing the heart, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items in the former three groups were all obviously higher than those in the latter three groups （P 〈 0.05 - 0.01）. （2） Different number of syndrome types： In the comparison of the scores of nervous function and psychological tests among the PSD patients with different number of syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients with one or two syndrome types were obviously higher than those of the total samples and the PSD patients with three or more syndrome types, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items were all obviously lower in the former two than in the latter two （P 〈 0.05 - 0.01）. （3） There were no obvious differences in the scores of most items of nervous function and psychological tests among the PSD patients of deficiency syndrome, excess syndrome and the deficiency-excess syndrome （P 〉 0.05）. CONCLUSION： The damages of nervous function and mental psychology are more serious in PSD patients with the syndrome types of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency, as well as those with several （three or more） syndrome types, and the conditions may be improved by the treatment based on TCM syndrome differentiation.     

Nervous function and manifestations of mental psychology in patients with post-stroke depression of different syndrome types of traditional Chinese medicine

BACKGROUND: Poly-criteria pathogenesis of patients with stroke causes diversity of syndrome types of traditional Chinese medicine (TCM); meanwhile, complexity and diversity of pathological mechanism also play a key role in determining severity so as to induce effects on nervous function and manifestation of mental psychology in patients with post-stroke depression (PSD). OBJECTIVE: To analyze the syndrome types of TCM with nervous function and manifestations of mental psychology in PSD patients so as to provide evidence for the treatment based on the syndrome differentiation. DESIGN: Contrast observation. SETTING: Departments of Neurology and Traditional Chinese Medicine, General Hospital of Fuxin Mining Industry Group. PARTICIPANTS: A total of 469 outpatients or inpatients with stroke were selected from the Department of Neurology, General Hospital of Fuxin Mining Industry Group from April 2002 to July 2005. All subjects met the diagnostic criteria of stroke established by the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were finally diagnosed with CT and MRI. Totally, 177 PSD patients were involved in the final analysis and provided the confirmed consent. There were 121 males and 56 females aged from 46 to 79 years. METHODS: ① All the enrolled subjects were diagnosed for syndrome differentiation by senior TCM physicians within 1 week before discharge based on Diagnostics of Traditional Chinese Medicine, which was classified into 5 types, including sputum-stasis stagnation syndrome, qi stagnation and blood stasis, kidney-essence deficiency, deficiency of the spleen and stomach and phlegm-fire disturbing the heart. In addition, they were also assessed by neurologic deficit scale (NDS; 45 points in total; the higher the scores were, the severer the deficit was), Fugl-Meyer assessment, (FMA; 100 points in total, including 66 points of upper limbs and 34 points of lower limbs; the higher the scores were, the stronger the motor function was), modified Barthel index [BI; 100 points in total; the higher the scores were, the better the activity of daily life (ADL) was], symptom checklist-90 (SCL-90; including total scores, positive scores, mean and average scores of positive items), Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA, the higher the scores were, the severer the degree was). ② Patients were divided into one symptom type, two symptom types and ≥ 3 symptom types; meanwhile, they were also divided into deficiency symptom, excess symptom and deficiency-excess symptom. Scores among various groups were compared simultaneously. MAIN OUTCOME MEASURES: Comparison of nervous function and mental psychology of PSD patients with various symptoms. RESULTS: ① Differences of various symptoms: Among 177 patients, there were 43 subjects in the types of sputum-stasis stagnation, 64 in qi stagnation and blood stasis, 21 in kidney-essence deficiency, 33 in deficiency of the spleen and stomach, and 16 in phlegm-fire disturbing the heart. In the comparison of the scores of nervous function and psychological tests among different syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency were obviously lower than those of the total samples and PSD patients of deficiency of the spleen and stomach and phlegm-fire disturbing the heart, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items in the former three groups were all obviously higher than those in the latter three groups (P < 0.05–0.01). ② Different number of syndrome types: In the comparison of the scores of nervous function and psychological tests among the PSD patients with different number of syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients with one or two syndrome types were obviously higher than those of the total samples and the PSD patients with three or more syndrome types, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items were all obviously lower in the former two than in the latter two (P < 0.05–0.01). ③ There were no obvious differences in the scores of most items of nervous function and psychological tests among the PSD patients of deficiency syndrome, excess syndrome and the deficiency-excess syndrome (P > 0.05). CONCLUSION: The damages of nervous function and mental psychology are more serious in PSD patients with the syndrome types of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency, as well as those with several (three or more) syndrome types, and the conditions may be improved by the treatment based on TCM syndrome differentiation.     

Validation of hyperintense middle cerebral artery sign in acute ischemic stroke Comparison between magnetic resonance imaging and angiography

We performed a retrospective analysis of non-contrast computed tomography (CT) scans, immediately subsequent magnetic resonance imaging (MRI), and cerebral angiography data from 30 consecutive patients with acute ischemic stroke within 6 hours after symptom onset. Results showed that eleven patients developed subsequent hemorrhagic transformation at follow-up. A hyperintense middle cerebral artery sign on MRI was found in six hemorrhagic patients, all of who had acute thrombosis formation on magnetic resonance angiography and digital subtraction angiography. No patients in the non-hemorrhagic group had hyperintense middle cerebral artery sign on MRI. The sensitivity, specificity, and positive predictive values of the hyperintense middle cerebral artery sign on MRI T1-weighted image for subsequent hemorrhagic transformation were 54.5%, 100%, and 100% respectively. Hyperdense middle cerebral artery sign on non-contrast CT was observed in nine patients, five of who developed hemorrhagic transformation. These data suggest that hyperintense middle cerebral artery sign on MRI T1-weighted image is a highly specific and moderately sensitive indicator of subsequent hemorrhagic transformation in patients after acute ischemic stroke, and its specificity is superior to CT.     

脑室-腹腔分流术中分流管腹腔端无需特殊处理

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.     

脑室-腹腔分流术中分流管腹腔端无需特殊处理

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.     

左侧坐骨神经切割伤的二维磁共振神经成像：个案报告

Magnetic resonance neurography (MRN) is used to determine traumatic changes within nervous trunks. A 21-year-old male was treated for neurotmesis of the left sciatic nerve. At 41 days after micro-neurosurgery, two-dimensional MRN (2-D MRN) was performed with plain and contrast scans in the left injured sciatic nerve. More than 2 years after trauma, 2-D MRN images were collected to re-examine the left sciatic nerve. Results from the first 2-D MRN examination revealed a swollen left sciatic nerve. Furthermore, T1WI revealed a local nodule with slightly high intensity, and T2WI revealed hyperintensity. The nodule was significantly enhanced. Upon 2-D MRN re-examination more than 2 years after injury, the injured left sciatic nerve trunk was thinner, and the nodule margin in the left sciatic trunk was clearer. The supero-inferior diameter was enlarged by 2 mm compared with previous films. The degree of enhancement became weaker in the nodule. 2-D MRN revealed continuity, traumatic neuroma, and atrophy of the injured sciatic nerves in detail. Thin-slice technique was crucial for this method, as well as fat-suppressed and blood flow-suppressed imaging. Key Words: Two-dimensional magnetic resonance neurography; neurotmesis; traumatic neuroma; sciatic nerve; peripheral nerve injury; neural regeneration     

吸烟对精神分裂症男性患者精神病理症状的影响

Objective To compare the differences of psychopathologic symptoms between smokers and non-smokers in chronic and first-episode,drug-nalve schizophrenics.then it was attempted to explain the reasons why there is higher rate of smoking behavior in schizophrenia.Methods In all.427 male chronic schizophrenic patients(332 smokers and 95 non-smokers)and 63 male first-episode drug-naive patients with schizophrenia(22 smokers and 41 non-smokers)were collected.All patients were assessed with the Positive and Negative Syndrome Scale(PANSS).Results In chronic patients.the item scores of poor rapport and passive/apathetic social withdrawal of PANSS negative subscale were significantly lower in smokers than non-smokers(3.9 ±1.5 vs.4.4±1.7;3.6±1.6 vs.4.0±1.7.respectively,P＜0.05),and so was the total scores of PANSS negative subscale(24.0±8.2 vs.26.3±9.5).In first-episode.drug-ndive patients.the itern scores of emotional withdrawal and passive/apathetic social withdrawal of PANSS negative subscale were significant lower in smokers than non-smokers(2.7±1.3 vs.3.5±1.3:2.7±1.3 vs.3.5±1.4,respectively,P＜0.05).Conclusion It is suggested there are positive effects of cigarette smoking on the psychopathological symptoms of patients with schizophrenia,which misht be one of the mechanisms for higher rates of smoking behavior in schizophrenia.     

吸烟对精神分裂症男性患者精神病理症状的影响

Objective To compare the differences of psychopathologic symptoms between smokers and non-smokers in chronic and first-episode,drug-nalve schizophrenics.then it was attempted to explain the reasons why there is higher rate of smoking behavior in schizophrenia.Methods In all.427 male chronic schizophrenic patients(332 smokers and 95 non-smokers)and 63 male first-episode drug-naive patients with schizophrenia(22 smokers and 41 non-smokers)were collected.All patients were assessed with the Positive and Negative Syndrome Scale(PANSS).Results In chronic patients.the item scores of poor rapport and passive/apathetic social withdrawal of PANSS negative subscale were significantly lower in smokers than non-smokers(3.9 ±1.5 vs.4.4±1.7;3.6±1.6 vs.4.0±1.7.respectively,P＜0.05),and so was the total scores of PANSS negative subscale(24.0±8.2 vs.26.3±9.5).In first-episode.drug-ndive patients.the itern scores of emotional withdrawal and passive/apathetic social withdrawal of PANSS negative subscale were significant lower in smokers than non-smokers(2.7±1.3 vs.3.5±1.3:2.7±1.3 vs.3.5±1.4,respectively,P＜0.05).Conclusion It is suggested there are positive effects of cigarette smoking on the psychopathological symptoms of patients with schizophrenia,which misht be one of the mechanisms for higher rates of smoking behavior in schizophrenia.     

吸烟对精神分裂症男性患者精神病理症状的影响

Objective To compare the differences of psychopathologic symptoms between smokers and non-smokers in chronic and first-episode,drug-nalve schizophrenics.then it was attempted to explain the reasons why there is higher rate of smoking behavior in schizophrenia.Methods In all.427 male chronic schizophrenic patients(332 smokers and 95 non-smokers)and 63 male first-episode drug-naive patients with schizophrenia(22 smokers and 41 non-smokers)were collected.All patients were assessed with the Positive and Negative Syndrome Scale(PANSS).Results In chronic patients.the item scores of poor rapport and passive/apathetic social withdrawal of PANSS negative subscale were significantly lower in smokers than non-smokers(3.9 ±1.5 vs.4.4±1.7;3.6±1.6 vs.4.0±1.7.respectively,P＜0.05),and so was the total scores of PANSS negative subscale(24.0±8.2 vs.26.3±9.5).In first-episode.drug-ndive patients.the itern scores of emotional withdrawal and passive/apathetic social withdrawal of PANSS negative subscale were significant lower in smokers than non-smokers(2.7±1.3 vs.3.5±1.3:2.7±1.3 vs.3.5±1.4,respectively,P＜0.05).Conclusion It is suggested there are positive effects of cigarette smoking on the psychopathological symptoms of patients with schizophrenia,which misht be one of the mechanisms for higher rates of smoking behavior in schizophrenia.     

吸烟对精神分裂症男性患者精神病理症状的影响

Objective To compare the differences of psychopathologic symptoms between smokers and non-smokers in chronic and first-episode,drug-nalve schizophrenics.then it was attempted to explain the reasons why there is higher rate of smoking behavior in schizophrenia.Methods In all.427 male chronic schizophrenic patients(332 smokers and 95 non-smokers)and 63 male first-episode drug-naive patients with schizophrenia(22 smokers and 41 non-smokers)were collected.All patients were assessed with the Positive and Negative Syndrome Scale(PANSS).Results In chronic patients.the item scores of poor rapport and passive/apathetic social withdrawal of PANSS negative subscale were significantly lower in smokers than non-smokers(3.9 ±1.5 vs.4.4±1.7;3.6±1.6 vs.4.0±1.7.respectively,P＜0.05),and so was the total scores of PANSS negative subscale(24.0±8.2 vs.26.3±9.5).In first-episode.drug-ndive patients.the itern scores of emotional withdrawal and passive/apathetic social withdrawal of PANSS negative subscale were significant lower in smokers than non-smokers(2.7±1.3 vs.3.5±1.3:2.7±1.3 vs.3.5±1.4,respectively,P＜0.05).Conclusion It is suggested there are positive effects of cigarette smoking on the psychopathological symptoms of patients with schizophrenia,which misht be one of the mechanisms for higher rates of smoking behavior in schizophrenia.