Identification of Somatosensory Pathways by Focal-Cooling-Induced Changes of Somatosensory Evoked Potentials and EEG-Activity – an Experimental Study

Summary  Object. Function-preserving neurosurgery requires methods to identify functionally important CNS-areas intraoperatively. We investigated whether a combination of focal cerebro-cortical cooling and monitoring of somatosensory evoked potentials (SEP) is suited for this task, i.e. whether it is able to outline structures belonging to the somatosensory pathway.  Methods. In 17 Wistar rats the somatosensory cortex was focally cooled by 20°C below the initial tissue temperature for periods of five minutes. A cryoprobe with a tip diameter of 3 mm was used and tissue temperatures were measured below and at different distances to the cryoprobe. Tibial nerve evoked SEPs and EEG-spectra were recorded continuously.  Results. During cortical cooling the SEP-responses showed a marked delay and amplitude increase of the cortically generated components P13 and N18 and a small latency increase of the subcortically generated wave III. EEG-spectra were depressed mainly in the low frequency range. All cooling effects were reversible and in light- as well as electron-microscopic examinations no tissue damage was found.  Conclusions. Focal cooling of the cortex induces easily recognizable and reversible changes of the bio-electrical activity without causing any histological damage. Therefore the method seems suitable for identifying eloquent areas. It can be expected that clinical application of the cooling technique in combination with intraoperative electrophysiological monitoring will be helpful to further lower the risk of neurosurgical operations.  We propose that cooling mainly interferes with the synaptic transmission within the somatosensory cortex, because the observed amplitude increase can be explained by cold-induced depression of inhibitory cortical activity (disinhibition).     

MCM2p、p16INK4A和Ki-67在肝癌组织中的表达

目的 探讨MCM2p在肝癌中的表达及其与肿瘤细胞增殖活性的关系.方法 采用免疫组织化学法检测MCM2p、p16INK4A和Ki-67在肝细胞肝癌及其相应的癌旁正常组织中的表达.结果 肝癌组织MCM2p和Ki-67的表达显著高于癌旁肝组织(P《0.01),而p16INK4A表达显著低于癌旁肝组织(P《0.01).MCM2p的表达和Ki-67的表达状况关系密切,呈正相关,而与p16INK4A表达呈负相关.结论 MCM2p和Ki-67在肝癌组织中呈高表达,并与肝癌的发生发展及肿瘤的增殖活性有关.     

Association Between Nonreentrant Supraventricular Tachycardia and Atrioventricular Node Reentrant Tachycardia: A Presentation of Dual AV Node Physiology

Persistent simultaneous conduction of P waves over a fast and a slow nodal pathway defines the nonreentrant type of supraventricular tachycardia, usually not associated with reciprocating movements. We report a unique association between this uncommon tachycardia and a usual AV nodal reentrant tachycardia, made possible by the existence of three different nodal pathways.     

Cognitive and educational outcome of very-low-birthweight children in early adolescence

A cohort of 138 very-low-birthweight (VLBW) 12-year-old children and matched control children were assessed on objective cognitive and educational measures. School performance was rated by teachers and by the children themselves. VLBW children were shown to have lower IQ scores, and poorer scores on all objective educational measures compared with control children. Controlling for IQ differences, mathematics and reading-comprehension scores remained significantly lower for VLBW children. Teachers rated VLBW children lower in all curriculum areas. Significantly more VLBW children were found to be 'failing' in one or more subject and an increased proportion compared with the control children had received remedial education. The VLBW group showed no evidence of 'catch up' between 6 and 12 years of age. Multiple regression analyses were used to identify predictors of cognitive and educational outcome. The duration of mechanical ventilation in the neonatal period was inversely related to outcome. Full-Scale IQ at 6 years, motor-skills score at 6 years, and head circumference at 12 years all predicted outcome at 12 years, as did maternal education, family income and size. Individually, many VLBW children perform satisfactorily, but as a group VLBW children appear to be at a long-term disadvantage to peers in the areas of cognitive and educational performance.     

Marrow transplantation for patients in accelerated phase of chronic myeloid leukemia

The records were reviewed of 58 patients receiving transplants in Seattle with unmanipulated marrow from HLA-identical siblings during the accelerated phase (AP) of chronic myeloid leukemia. Variables examined for association with survival and relapse included the interval from diagnosis to transplant, the reasons for categorization as AP, age, regimen, and cytomegalovirus serology. Four patients relapsed. The 4-year probabilities of survival, relapse-free survival, nonrelapse mortality, and relapse were 0.49, 0.43, 0.51, and 0.12, respectively. After completion of the stepwise multivariate analysis, age less than 38 years and categorization as AP solely on the basis of chromosomal abnormalities emerged as being independently significantly associated with improved survival. The 4-year probability of survival for the 16 patients categorized as AP because of chromosomal abnormalities and receiving transplant less than 1 year from diagnosis was 0.74. The low probability of relapse in these patients suggests that more aggressive preparative regimens are not indicated for patients receiving transplants in AP because of the increased risk of transplant-related mortality.     

Gli1在喉癌组织中的表达及意义的研究

目的:探讨Gli1蛋白在喉癌组织中的表达及其与临床及病理因素之间的关系,为喉癌的诊断和治疗提供新思路。方法:采用免疫组织化学方法,检测Gli1蛋白在40例喉癌组织、10例喉癌旁黏膜组织中的表达情况,对Gli1在喉癌中的表达喉癌临床病理因素的关系进行统计分析。结果:癌旁喉黏膜Gli1蛋白阳性表达评分为(1.50±0.70)分,喉癌组织中Gli1蛋白表达阳性表达评分为(4.60±3.52)分,喉癌Gli1蛋白表达较癌旁黏膜显著增高,两者有极显著差异,P<0.01。结论:Gli1蛋白高表达与喉癌发生发展和侵袭转移性有关。     

热休克蛋白在良恶性嗜铬细胞瘤中的表达及其意义

目的通过检测热休克蛋白90（HSP90）在良、恶性嗜铬细胞瘤（PC）组织中的表达情况,探讨HSP90能否成为一项用于评估嗜铬细胞瘤潜在恶性程度的有效分子标记物。方法选取1986年10月～2006年8月在我院泌尿外科行手术治疗、且有完整的临床、病理和随访资料的嗜铬细胞瘤患者存档石蜡标本38例,其中良性嗜铬细胞瘤（BP）21例,恶性嗜铬细胞瘤（MP）17例。采用免疫组化技术Envision二步法,检测良、恶性嗜铬细胞瘤中HSP90的表达情况。恶性组经首次手术确诊后随访28～179月,良性组经首次手术确诊后随访93～264月。结果在MP组中HSP90的阳性表达率为70.59%,明显高于BP组中阳性表达率28.57%,两组热休克蛋白的表达具有显著的统计学差异（P〈0.05）。结论 HSP90有望成为区分嗜铬细胞瘤良恶性的一项指标。     

CT-guided aspirations for the body: comparison of hand guidance with stereotaxis

Forty computed tomography (CT)-assisted aspirations performed with only hand guidance were prospectively compared with 40 performed with a CT body-stereotaxic system. Although there was no statistically significant difference in lesion size and path length between the two groups, use of stereotaxis compared with hand guidance decreased by 75% the number of needle manipulations required to place a needle within a lesion. With the stereotaxic method, only 43 needle manipulations were required to confirm a needle placement in 40 lesions, with no lesion requiring more than two attempts. Use of stereotaxis decreased the number of localization scans by 80% and biopsy time by 50%. It is concluded that CT-guided needle placements with hand guidance are often inaccurate and, unless the lesion is large, require multiple needle manipulations to place a needle within the lesion. Stereotaxis-guided biopsies, on the other hand, decrease radiation exposure, biopsy time, and trauma from multiple needle punctures.