Apopotic gene Bax expression in carotid plaque

The expression of BAX in carotid atherosclcrosis and its regulation is far from defined. Objectives To investigate BAX expression in stable/fibrous and instable/vulnerable carotid plaque and its clinical significance. Methods 25 cases of carotid plaque specimens obtained from endarterectomy were divided into two groups, stable/fibrous 14 cases, vulnerable/instable 11 cases; aortic artery and its branches from hepatic transplantation donors 6 case as control. The expression of proapoptotic BAX was detected by immunohistochemistry (IHC), in situ hybridization(ISH) and in situ TdT dUTP nick end labeling (TUNEL). Results 5 eases of BAX ( ) were detected by ICH and ISH, 4 case of TUNEL ( ) were detected by TUNEL in stable/fibrous carotid plaque, while 10 cases were BAX ( )by IHC(P<0.05) , 11 case by ISH and 9 case by TUNEL were detected in instable/vulnerable carotid plaque (P<0.01), respectively. The intensity of BAX ( ) cells by IHC and ISH was 8.63±2.62 and 10.32±3.12 in fibrous plaques, whereas 122±21.64 and 152±23.35 in vulnerable plaques, respectively. No expression of BAX was found in controlled group. Conclusion The higher expression of Bax in vulnerable carotid plaque may be one mechanisms in molecular pathogenesis of carotid atherosclerosis which affect plaque stability and be the cause of higher incidence of stroke than fibrous carotid plaques, the regulation of BAX expression in different stage of atherosclerosis may provide targets in gene therapy for carotid atherosclerosis.     

经蝶垂体腺瘤手术后残留原因分析

目的：探讨经蝶切除垂体腺瘤手术后残留的原因，提高治疗效果；方法：回顾性分析自1992年10月至2003年1月，在我院及外院经蝶手术治疗后，MRI检查证实仍有残留的118例垂体腺瘤。结果：肿瘤主体残留在海绵窦占46．6％，鞍内37．3％，鞍上5．1％，混合9．3％，颅外1．7％；影响肿瘤根除的主要因素，肿瘤侵袭海绵窦46．6％，术者经验不足36．4％，肿瘤侵润生长9．3％，肿瘤体积巨大3．4％，出血多4．2％。针对残余瘤组织再手术者为10．1％，普通放射治疗39．0％，r刀治疗38．2％，药物治疗11．0％。结论：经蝶手术残瘤的主要原因是肿瘤侵袭海绵窦，这些病例不能或很难单纯手术根除；其次是术者经验不足和技术问题而造成。在有残瘤的病例中，有半数以上病例可以通过提高技术水平达到肿瘤的全切或次全切除。     

Surgical management of large and giant cavernous sinus hemangiomas

Cavernous sinus hemangiomas (CSH) are rare vascular tumors within the cavernous sinus. Gamma Knife radiosurgery (GKS) is less effective for large and giant CSH than for smaller ones. In one of the largest single-institution series reported thus far, we present 22 patients with large (3–4 cm-diameter, six patients) and giant (>4 cm, 16 patients) CSH treated surgically between 1994 and 2011. We also review related reports published since 1999 and further compare the treatment outcomes of surgery and radiosurgery. In the present study, a modified Dolenc’s epidural approach was performed in 18 patients and the intradural approach was used in four. Gross total or near-total resection was achieved in 18 patients, subtotal resection was achieved in three patients and partial resection was achieved in one patient. Postoperative ophthalmoparesis occurred in seven patients (two improved, four unchanged to preoperative, one new deficit), and decreased visual acuity occurred in one patient. The reviewed literature and our experience suggest that surgical treatment of large and giant CSH is a reasonable option. A relatively low postoperative morbidity can be achieved with minimal disturbance of cranial nerve (CN) III, particularly with early localization and preservation of CN VI. GKS could be an adjunct treatment for residual tumor.     

The status quo of neurosurgery in China

With the application of great effort, much progress has been made to date in each specialty of neurosurgery in mainland China. In this article, we briefly review the present status of neurosurgery in China. The components and function of the Chinese Neurosurgical Society, the national organization for neurosurgery in China, are discussed. Neurosurgeons' acceptance of the concept of minimally invasive procedures has marked the start of an era of minimally invasive neurosurgery in China. Progress is evident in clinics, basic research, infrastructure, resident training, and multidisciplinary collaboration. Some weaknesses that need improvement are also mentioned. The current program offers a good basic foundation for development to meet future demands.     

颈动脉狭窄支架成形术中应对血流动力学变化的临床探讨

目的探讨颈动脉狭窄支架成形术中应对血流动力学变化处理措施的有效性。方法对前期80例患者术中未作特殊处理;后期125例行支架成形术的患者术中严格控制血压在个体正常值的下限,心率升高至80次／min后开始扩张狭窄并放置支架。结果前80例患者并发症为8．8％,严格调控血流动力学的125例患者未见明显并发症。随访1个月～5年,均无严重再狭窄发生。结论重视调整颈动脉狭窄支架成形术中的血流动力学变化对减少并发症,提高治疗效果有益。     

颅内外血管搭桥治疗复杂动脉瘤及搭桥血管闭塞的防治

目的 探讨颅内外血管搭桥技术在复杂动脉瘤治疗中的应用和移植血管闭塞的原因.方法 回顾分析2006年11月至2008年11月以颅内外血管搭桥治疗的20例颅内复杂动脉瘤,并总结大隐静脉闭塞的原因.其中男性8例,女性12例,年龄27～65岁,平均54.5岁.动脉瘤位于海绵窦内13例,床突旁动脉瘤4例,床突上动脉瘤2例,基底动脉干动脉瘤1例;动脉瘤＜15 mm者4例,15～25 mm者12例,＞25 mm者4例.结果 1例术中出现血管闭塞,1例术后出现血管闭塞,出院时格拉斯哥预后评分(GOS)4～5分者17例(17/20),3分(重残)2例(2/20),1分(死亡)1例(1/20).19例生存患者术后6个月随访GOS评分4～5分者18例(18/19),3分(重残)1例(1/19).结论 颅内外血管搭桥技术治疗颅内复杂动脉瘤是有效、安全的,机械因素和血流动力学因素是移植血管闭塞最主要的原因,移植血管的长期通畅率还有待进一步观察.

Abstract：

Objectives To study the revascularization techniques in the treatment of intracranial complex aneurysms and occlusive reasons of bypass vessel. Methods The 20 complex intracranial aneurysms who underwent saphenous bypass treatment from November 2006 to November 2008 were retrospectively analyzed and the occlusive reasons were studied. Of the 20 patients, 12 were female and 8 were male, mean age was 54.5 years (ranged 27-65 years). The distribution of the lesions inclued 13 cavenous sinus aneurysms, 4 paraclinoidal aneurysms, 2 supraclinoidal aneurysms, and 1 basilar trunk aneurysm. Four aneurysms were giant (diameter ＞25 mm), 12 aneurysms were large( 15-25 mm), and 4 aneurysms were medium( 10-15 mm) size. Results One saphenous vein was occlused intraoperativly and one saphenous vein was occlused postoperativly. At discharge, 18 out of the 20 patients had Glasgow Outcome Scale (GOS) score of 4 orS, 2 patients had score of 3, and 1 patient had score of 1. At 6 months follow up, 18 of 19 survivors had GOS score of : or 5 and 1 patient had score of 3. Conclusions Extracranial-intracranial revascularization technique is a safe and effective method in the treatment of complex aneurysms. Mechanical and hemodynamic factors are two leading reasons for occlusion of bypass vessels. Long-term bypass vessels patent rate still needs further observation.     

Apopotic gene Bax expression in carotid plaque

The expression of BAX in carotid atherosclerosis and its regulation is far from defined. Objectives To investigate BAX expression in stable/fibrous and instable/vulnerable carotid plaque and its clinical significance. Methods Twenty-five cases of carotid plaque specimens obtained from endarterectomy were divided into two groups, stable/fibrous 14 cases, vulnerable/instable 11 cases; aortic artery and its branches from hepatic transplantation donors 6 case as control. The expression of proapoptotic BAX was detected by immunohistochemistry (IHC), in situ hybridization(ISH) and in situ TdT dUTP nick end labeling (TUNEL). Results Five cases of BAX ( + ) were detected by ICH and ISH, 4 case of TUNEL ( + ) were detected by TUNEL in stable/fibrous carotid plaque , while 10 cases were BAX ( + )by IHC(P < 0.05) , 11 cases by ISH and 9 cases by TUNEL were detected in instable/vulnerable carotid plaque ( P < 0.01 ), respectively. The intensity of BAX ( + ) cells by IHC and ISH was (8.63 +/- 2.62) and (10.32 +/- 3.12) in fibrous plaques, whereas (122 +/- 21.64) and (152 +/- 23.35) in vulnerable plaques, respectively. No expression of BAX was found in controlled group. Conclusion The higher expression of Bax in vulnerable carotid plaque may be one mechanism in molecular pathogenesis of carotid atherosclerosis which affect plaque stability and be the cause of higher incidence of stroke than fibrous carotid plaques, the regulation of BAX expression in different stage of atherosclerosis may provide targets in gene therapy for carotid atherosclerosis.     

缺血性脑血管病患者颈内动脉狭窄程度的观察

通过尸检材料对缺血性脑血管病病人颈内动脉进行研究 ,探讨颈内动脉狭窄程度和斑块内脂质含量与缺血性脑血管病发生的关系。 10例脑血管病病人生前均有缺血性脑血管病病史 ,死后尸检将颈内动脉颅外段完整剥离 ,固定后每隔 4mm取材并切片 ,然后光镜观察并通过计算机图象分析测定管腔的横截面积和斑块内脂质坏死中心的面积。 10例对照组病人生前均无缺血性脑血管病病史 ,研究方法和测量指标同上。结果发现 ,10例缺血性脑血管病组颈内动脉共 15 1个组织块中 ,管腔最大横截面积为 6 .2mm2 ,最小为 3.2mm2 ,平均为 4 .7± 0 .3mm2 。而对照组 134个组织块中 ,管腔最大横截面积为 6 .5mm2 ,最小面积为 3.6mm2 ,平均 4 .8± 0 .4mm2 ,两组比较无显著性差异。斑块内脂质坏死中心的平均面积在有症状组和对照组分别为 3.4± 0 .4mm2 和 1.8± 0 .2mm2 ,差异显著(P <0 .0 1)。另外 ,有症状组 11个斑块表面可见血栓 ,而对照组无血栓形成。结果表明 :缺血性脑血管病病人颈内动脉狭窄程度与对照组比较无明显差别 ,但斑块内脂质坏死中心却明显比对照组大 ,提示狭窄程度可能并非脑缺血症状的主要原因。斑块脂质坏死中心的大小可能起重要作用。     

白塞病并发肺血管病变的多层螺旋CT表现

目的 探讨白塞病并发肺血管病变的多层螺旋计算机断层扫描（MSCT）诊断要素及特点。方法 回顾性地分析2012年3月至2014年4月复旦大学附属华东医院和同济大学附属肺科医院收治的13例白塞病合并肺血管病变患者的临床及影像学资料,分析其临床和CT表现的特点。结果 13例患者CT显示肺血管栓塞11例（10例同时合并肺动脉瘤）、弥漫性肺小管炎1例、肺出血1例,其中9例合并心包积液、6例合并胸腔积液、8例合并纵隔淋巴结肿大、1例合并心脏及下腔静脉血栓形成。胸部MSCT结合肺动脉造影（CTPA）三维重建技术可清晰地显示以上病变的各种表现：肺动脉瘤表现为肺动脉的局限性扩张,扩张部分的强化程度和方式与正常肺动脉相仿;肺血管栓塞表现为强化的肺动脉腔内充盈缺损影;弥漫性肺小血管炎表现为多发棉絮状磨玻璃影;肺出血表现为以出血部位为中心的磨玻璃影。结论 白塞病合并肺血管病变的CT表现多样,MSCT对诊断白塞病合并肺血管病变有重要价值,可作为检查与常规随访的首选手段。     

Left lower lobectomy and systematic lymph node dissection by complete video-assisted thoracic surgery

A 50-year-old female was administered with left lower lobe lesion for 10 days. A preoperative chest computed tomography (CT) revealed a mass in the left basilar segment of the lung, about 2.1 cm × 1.7 cm in size. Therefore, video-assisted thoracic surgery (VATS) left lower lobectomy was performed. The operation takes 60 minutes. During the operation, the estimated blood loss was 15 mL. The patient was discharged on postoperative day (POD) 6 with no complications. And the pathological results confirmed the diagnosis of adenocarcinoma with no lymph nodes metastasis.