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Gout in the spine and adnexa is rare in clinical practice and can also be easily misdiagnosed, we reported a patient with nerve root compression due to lumbar gout stones in the lumbar spinal canal.A 51-year-old male was admitted to the hospital with lumbar pain with numbness in the left lower limb for more than 6 months. The physical examination showed that tenderness and percussion pain were present at L4-S1 spinous process. Straight leg raise test: 50° on the left side were positive. Laboratory tests showed that the sUA was 669 μmol/L, MRI of the lumbar spine showed that cystic T1WI low signal and T2WI mixed high signal shadows were seen in the spinal canal at the level of L4-L5.Combining with lab examinations, imaging examinations, and histopathological results, the patient was diagnosed with lumbar spinal canal tophi.After active improvement of all examinations, the patient underwent surgical treatment with decompression and internal fixation of the L4-L5 segment.After surgery, the patient's symptoms improved and muscle strength returned to normal. Among the 95 previously reported patients with lumbar gout, the ratio of men to women was 2.96:1, and the peak age group of incidence was 56 to 65 years. The onset of the disease was mainly in a single segment of the lumbar spine, with 34.41% of all cases occurring at the L4-L5 level. 61.05% of the patients had a history of gout attacks or hyperuricemia, and the most frequently involved site was the foot and ankle, followed by the wrist. Sixty-seven patients underwent surgical treatment, and 22 chose conservative treatment, with overall satisfactory results.The incidence of lumbar gout is low and relatively rare in the clinic and pathological biopsy is still the gold standard. Vertebral plate incision and decompression are often selected for surgical treatment, and whether to perform fusion should be comprehensively considered for the destruction of vertebral bone by gout and the reasonable selection of the extent of surgical resection. Whether choosing surgical treatment or conservative therapy, the control of uric acid levels should be emphasized.

Background This study aimed to evaluate the correlation between neutrophil to lymphocyte ratio (NLR) with overall survival (OS) of esophageal squamous cell carcinoma (ESCC) patients. Method Records of patients with diagnosed ESCC were reviewed. Leukocyte counts and patients' characteristics were extracted from their clinical records to calculate NLR. Correlation between NLR and baseline characteristics with overall survival (OS) was then analyzed using Cox regression. The patients were then separated into higher and lower NLR groups according to median NLR. OS was further compared between the 2 groups. Results A total of 1281 patients were included in the study. Cox regression analysis showed a significant correlation of NLR with OS of ESCC patients. The median pretreatment NLR was identified as 2.86. Higher NLR was associated with worse prognosis in terms of OS. Conclusions Pretreatment NLR is independently associated with OS of ESCC patients. Therefore, NLR may be used as a predictive indicator for pretreatment evaluation and adjustment of treatment regimen.

Background: Deep brain stimulation (DBS) is the most commonly performed surgery for the debilitating symptoms of Parkinson disease (PD). However, DBS systems remain largely unaffordable to patients in developing countries, warranting the development of a safe, economically viable, and functionally comparable alternative. Objective: To investigate the efficacy and safety of wirelessly programmed DBS of bilateral subthalamic nucleus (STN) in patients with primary PD. Methods: Sixty-four patients with primary PD were randomly divided into test and control groups (1:1), where DBS was initiated at either 1 month or 3 months, respectively, after surgery. Safety and efficacy of the treatment were compared between on- and off-medication states 3 months after surgery. Outcome measures included analysis of Unified Parkinson's Disease Rating Scale (UPDRS) scores, duration of “on” periods, and daily equivalent doses of levodopa. All patients were followed up both 6 and 12 months after surgery. Results: Three months after surgery, significant decrease in the UPDRS motor scores were observed for the test group in the off-medication state (25.08 ± 1.00) versus the control group (4.20 ± 1.99). Conclusions: Bilateral wireless programming STN-DBS is safe and effective for patients with primary PD in whom medical management has failed to restore motor function.

Epidemiological studies demonstrate that pain frequently occurs comorbid with depression. Gentiopicroside (Gent) is a secoiridoid compound isolated from Gentiana lutea that exhibits analgesic properties and inhibits the expression of GluN2B-containing N-methyl-D-aspartate (NMDA) receptors in the anterior cingulate cortex of mice. However, the effects of Gent on the reserpine-induced pain/depression dyad and its underlying mechanisms are unclear. Reserpine administration (1 mg/kg subcutaneous daily for 3 days) caused a significant decrease in the nociceptive threshold as evidenced by the reduced paw withdrawal latency in response to a radiant heat source and mechanical allodynia. Behavioral detection indicated a significant increase in immobility time during a forced swim test, as well as decreased time in the central area and total travel distance in an open field test. Furthermore, reserpinized animals exhibited increased oxidative stress. Systemic Gent administration dose-dependently ameliorated the behavioral deficits associated with reserpine-induced pain/depression dyad. At the same time, the decrease in biogenic amine levels (norepinephrine, dopamine, and serotonin) was integrated with the increase in caspase-3 levels and GluN2B-containing NMDA receptors in the amygdala of the reserpine-injected mice. Gent significantly reversed the changes in the levels of biogenic amines, caspase-3, and GluN2B-containing NMDA receptors in amygdala. However, Gent did not affect the expression of GluN2A-containing NMDA receptors. The inhibitory effects of Gent on oxidative stress were occluded by simultaneous treatment of GluN2B receptors antagonist Ro25-6981. Our study provides strong evidence that Gent inhibits reserpine-induced pain/depression dyad by downregulating GluN2B receptors in the amygdala.

Background: As a well-known cancer with high mortality, lung cancer has been implied to be closely associated with brain metastasis. Despite notable advances, effective treatment methods are still in urgent need. This study aims to investigate the value of serum microRNA-let-7a (miR-let-7a) expression in predicting efficacy and prognosis of radiotherapy in patients with lung cancer brain metastasis. Methods: To begin with, reverse transcription quantitative polymerase chain reaction (RT-qPCR) was performed for better understand of the correlation between miR-let-7a and lung cancer. Afterwards, the relationship between serum miR-let-7a expression and radiotherapy efficacy was analyzed by receiver operating characteristic curve analysis. Following successful transfection, RT-qPCR and Western blot assay were utilized for evaluating the involvement of miR-let-7a in regulation of DICER1 expression in lung cancer cell line. Then, whether miR-let-7a was implicated in proliferation and cell cycle distribution of lung cancer cells were confirmed by cell counting kit-8 assay and flow cytometry respectively. Results: Initially, it was revealed that serum miR-let-7a expression was decreased in lung cancer. Later, we found that decreased miR-let-7a displayed an unfavorable role in radiotherapy efficacy and overall survival rate of patients with lung cancer brain metastasis. After the successful transfection, the inverse relationship between miR-let-7a and DICER1 expression was uncovered. Meanwhile, biological behaviors of lung cancer cells were presented to be limited after transfection of overexpressed miR-let-7a. Conclusion: Our findings demonstrated that the lower expression of miR-let-7a in patients with lung cancer brain metastasis was closely related to unfavorable efficacy and prognosis of radiotherapy, and it may be an important predictive biomarker by regulation of DICER1.

Objective This study evaluated the feasibility, safety, and efficacy of embolization of dural arteriovenous fistula via a very small, short feeding artery with the assistance of a balloon placed proximal to the tip of the microcatheter, such that the balloon serves as a plug. Methods Eight patients who underwent treatment of DAVF by balloon-assisted transarterial embolization with Onyx were retrospectively reviewed. Gender, age, angiography findings, procedure details, clinical and angiographic outcomes, complications, and follow-up were recorded and analyzed. Results Nine embolization procedures were performed in eight male patients via extracranial arteries. Balloon-assisted embolization was successful in all eight patients. A Hyperglide balloon was used in five patients, and a Hyperform balloon was used in three patients. Angiographic resolution of the fistula was achieved in all patients without complications. All patients recovered uneventfully. During the follow-up period of 7–19 months, all patients were asymptomatic except for one patient who experienced mild headaches. Conclusions Treatment of DAVF by balloon-assisted embolization with Onyx achieved promising results, even in patients with very small and short feeding arteries. This technique allowed the treatment of DAVF cases where other techniques have failed.

The nucleus accumbens (NAc) has been considered as a novel target of deep brain stimulation (DBS) for intractable psychiatric disorders. Quite a few questions exist about this new treatment, and might be explored in nonhuman primate models. There are several reports on DBS of brain nucleus other than NAc in nonhuman primates. Therefore, we stereotactically implanted the electrodes into bilateral NAc under the guidance of MRI using a clinical Leksell stereotactic system in normal rhesus monkeys. NAc could be recognized as the area of continuity between the caudate nucleus and putamen in the coronal sections, which is beneath the internal capsule, and the gray matter nucleus between the ventromedial prefrontal cortex and anterior commissure in axial sections, which is medial to the putamen. NAc is mainly at a point 2.0-3.0 mm inferior, 3.0-4.0 mm anterior, and 4.5-5.5 mm lateral to the anterior commissure. The electrodes were implanted accurately and connected to an implantable pulse generator subcutaneously. After recovery from surgery, stimulation with a variety of parameters was trialed, and continuous stimulation at 90 μs, 3.5 V, 160, or 60 Hz was administered individually for 7 days. The behaviors and spontaneous locomotor activity of the animals did not change significantly during stimulation. This is the first report on DBS of NAc in nonhuman primates to the best of our knowledge. Bilateral electrical stimulation of NAc is a safe treatment. This model could be helpful in further studies on the clinical use of NAc stimulation for psychiatric disorders and for a better understanding of the functions of this nucleus.

Objective: To investigate the long-term outcome and changes of the personality and psychopathological profile of opiate addicts after bilateral stereotactic nucleus accumbens (NAc) ablative surgery. Methods: 60 patients were followed up for 5 years and abstinent status and adverse events were evaluated. NAc lesion volumes and locations were obtained by postoperative MRI scans. The Chinese version of the Eysenck Personality Questionnaire (EPQ-RSC), the Symptom Checklist-90-Revised (SCL-90-R), the Beck Depression Inventory (BDI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the World Health Organization’s Quality of Life Questionnaire – Brief Version (WHOQOL-BREF) were administered to the patients before and 5 years after the stereotactic surgery. Results: The total abstinence rate of all patients in their 5th postoperative year was 47.4%. The abstinent patients had a significantly larger lesion volume than the relapsed ones, but a larger lesion volume also increased the risk of adverse events. 5 years after surgery, the abstinent patients showed significant decreases on the Psychoticism (EPQ-P) and Neuroticism (EPQ-N) scores by EPQ-RSC, a significant decline on the Global Severity Index and the subscores in all 10 dimensions by SCL-90-R, significant decreases on the BDI and Y-BOCS scores, and significant improvements on the scores of all domains by WHOQOL-BREF, while for the relapsed patients, only the subscores of obsessive-compulsive by SCL-90-R and the Y-BOCS scores significantly decreased. Postoperative analysis revealed that the abstinent patients had a significantly better score than the relapsed ones by various instruments, and NAc lesion volumes and locations did not correlate with the outcome of any of these instruments. Conclusion: The bilateral ablation of NAc by stereotactic neurosurgery was a feasible method for alleviating psychological dependence on opiate drugs and preventing a relapse. Long-term follow-up suggested that surgery can improve the personality and psychopathological profile of opiate addicts with a trend towards normal levels, provided persistent abstinence can be maintained; relapse, on the other hand, may ruin this effect.

Traumatic brain injury (TBI) induces cognitive impairments, motor and behavioral deficits. Previous evidences have suggested that neural stem cell (NSC) transplantation could facilitate functional recovery from brain insults, but their underlying mechanisms remains to be elucidated. Here, we established TBI model by an electromagnetic-controlled cortical impact device in the rats. Then, 5 μl NSCs (5.0 × 10

It has been established that a postsynaptic scaffolding protein, gephyrin, is essential for anchoring two main groups of inhibitory receptors, GABAA receptors (GABAARs) and glycine receptors (GlyRs), to the postsynaptic sites of neurons. The present study was primarily attempted to examine if expression patterns of gephyrin might be different between jaw-closing (JC) and jaw-opening (JO) motoneurons. The JC- and JO-motoneurons in the rat trigeminal motor nucleus (Vm) were located in the dorsolateral (Vm.dl) and ventromedial (Vm.vm) divisions, respectively (Mizuno et al.,1975). Thus, immunoreactivity (IR) for gephyrin was investigated in the Vm: immunofluorescence histochemistry for gephyrin was combined with retrograde tract-tracing of fluorogold (FG), which was injected into nerves innervating JC-muscles or nerves innervating JO-muscles; neuronal cells were counterstained with propidium iodide (PI). The Vm.dl was discriminated from the Vm.vm by the presence of vesicular glutamate transporter 1 (VGLUT1)-immunopositive axon terminals, which were distributed in the Vm.dl but not in the Vm.vm (Pang et al., J Comp Neurol2009;512:595–612). Gephyrin-IR showed a punctate pattern of fluorescence, and motoneuronal profiles were coated with small clusters of gephyrin-immunopositive puncta throughout the Vm. The distribution density of such clusters was apparently higher in the Vm.dl than in the Vm.vm; this was confirmed quantitatively by a method similar to that described by Lorenzo et al. (Eur J Neurosci2006;23:3161–3170). On the basis of the present results, possible correlation between the distribution density of gephyrin clusters in the submembrane region of Vm motoneurons and that of axon terminals making inhibitory synapses on Vm motoneurons was discussed. Anat Rec, 2012. © 2012 Wiley Periodicals, Inc.

The oscillatory activity in the basal ganglia is believed to have an important function, but little is known about its actual mechanisms. We studied the resonance characteristics of subthalamic nucleus (STN) neurons and their ionic mechanisms using whole-cell patch-clamp recordings in rat brain slices. A swept-sine-wave current with constant amplitude and linearly increasing frequency was applied to measure the resonance frequency ( f res ) of STN neurons. We also used single-frequency sine wave current to evoke firing. We found that the resonance of STN neurons was temperature- and voltage-dependent. The f res of STN neurons was about 4 Hz when the temperature was maintained at 38 °C and holding potential was at −70 mV. The f res increased with more negative holding potentials and decreased with lower temperature. Action potentials fired most readily when the input frequency was near f res . After application of drug ZD7288 (20 μM), the resonance of STN neurons was blocked and the spikes evoked by both impedance amplitude profile (ZAP) current and single-frequency sine wave current arose readily at the lowest frequencies, indicating that hyperpolarization-activated cation current ( I h ) generated the resonance and mediated a preferential coupling at frequencies near f res between inputs and firing. In conclusion, there is a θ -frequency resonance mediated by I h in STN neurons. The resonance characteristics are temperature- and voltage-dependent. The resonance mediates a frequency-selective coupling between inputs and firing.

Gypenosides (GP), the saponin extract derived from the Gynostemma pentaphyllum Makino, a widely reputed medicinal plant in China, has been reported to have some neuroprotective effects. We used a rat model of chronic cerebral hypoperfusion to investigate the protective effects of GP on the cortex and hippocampal CA1 region and the underlying mechanisms for its inhibition of cognitive decline. Daily doses of 100 and 200 mg/kg GP were orally administered to adult male Sprague-Dawley rats for 61 days after inducing cerebral hypoperfusion experimentally, and spatial learning and memory were assessed using the Morris water maze. Antioxidative capability was measured biochemically. The levels of lipid peroxidation and oxidative DNA damage were assessed by immunohistochemical staining for 4-hydroxynonenal and 8-hydroxy-2'-deoxyguanosine, respectively. Activated astrocytes were assessed by immunohistochemical staining and western blotting with GFAP antibodies. Rats receiving 200 mg/kg GP had better spatial learning and memory than saline-treated rats. GP 200 mg/kg/day were found to markedly enhance antioxidant abilities, decrease lipid peroxide products and oxidative DNA damage, and reduce the activation of inflammatory astrocytes. However, GP 100 mg/kg had no significant effects. GP may have therapeutic potential for the treatment of dementia induced by chronic cerebral hypoperfusion and further evaluation is warranted.

OBJECTIVE We wanted to evaluate the clinical value of intraoperative ultrasonography for real-time guidance when performing microneurosurgical resection of small subcortical lesions. MATERIALS AND METHODS Fifty-two patients with small subcortical lesions were involved in this study. The pathological diagnoses were cavernous hemangioma in 25 cases, cerebral glioma in eight cases, abscess in eight cases, small inflammatory lesion in five cases, brain parasite infection in four cases and the presence of an intracranial foreign body in two cases. An ultrasonic probe was sterilized and lightly placed on the surface of the brain during the operation. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation. RESULTS All the lesions were located in the cortex and their mean size was 1.3 ± 0.2 cm. Intraoperative ultrasonography accurately located all the small subcortical lesions, and so the neurosurgeon could provide appropriate treatment. Different lesion pathologies presented with different ultrasonic appearances. Cavernous hemangioma exhibited irregular shapes with distinct margins and it was mildly hyperechoic or hyperechoic. The majority of the cerebral gliomas displayed irregular shapes with indistinct margins, and they often showed cystic and solid mixed echoes. Postoperative imaging identified that the lesions had completely disappeared, and the original symptoms of all the patients were significantly alleviated. CONCLUSION Intraoperative ultrasonography can help accurately locate small subcortical lesions and it is helpful for selecting the proper approach and guiding thorough resection of these lesions.

Objectives: Our purpose was to assess the feasibility, safety, and effectiveness of a modified predilation for middle cerebral artery (MCA) stenosis. Background: Wingspan stenting of MCA remains a technical challenge, and rates of residual stenosis and restenosis must be lowered. Methods: A series of 48 patients with symptomatic MCA stenosis greater than 50% and refractory to medical therapy underwent Wingspan stenting with different balloon/artery ratios before (group 1, Boston guidelines predilation) or after (group 2, modified predilation) July of 2008. Technical success, periprocedural complications, recurrent symptoms, and restenosis were assessed retrospectively, and risk factors for restenosis were analyzed using logistic regression. Results: Successful stenting occurred in 48 of 49 (98%) lesions. Primary endpoints within 30 days included one (2.12%) minor stroke and two (4.26%) transient ischemic attacks. Stenoses were reduced from 77.11% ± 10.09% to 27.50% ± 6.91% in group 1 versus from 72.56% ± 10.46% to 8.20% ± 5.41% in group 2. A total of 43 patients were followed up for 12.92 ± 5.08 months, and recurrent stroke or transient ischemic attack occurred in two (4.65%) patients. Vessels were followed with transcranial Doppler (43 vessels), angiography (23 vessels), or computed tomographic angiography (one vessel). The restenosis rate was 8 of 18 (44%) in group 1 and 3 of 25 (12%) in group 2. Restenosis was associated with residual stenosis and diabetes. Conclusions: Wingspan stenting for symptomatic MCA stenosis can be performed with high success and low complication rates, and modified predilation with the Gateway balloon can reduce the rates of residual stenosis and restenosis. © 2010 Wiley-Liss, Inc.

VGLUT1 and VGLUT2 have been reported to show complementary distributions in most brain regions and have been assumed to define distinct functional elements. In the present study, we first investigated the expression of VGLUT1 and VGLUT2 in the trigeminal sensory nuclear complex of the rat by dual-fluorescence in situ hybridization. Although VGLUT1 and/or VGLUT2 mRNA signals were detected in all the nuclei, colocalization was found only in the principal sensory trigeminal nucleus (Vp). About 64% of glutamatergic Vp neurons coexpressed VGLUT1 and VGLUT2, and the others expressed either VGLUT1 or VGLUT2, indicating that Vp neurons might be divided into three groups. We then injected retrograde tracer into the thalamic regions, including the posteromedial ventral nucleus (VPM) and posterior nuclei (Po), and observed that the majority of both VGLUT1- and VGLUT2-expressing Vp neurons were retrogradely labeled with the tracer. We further performed anterograde labeling of Vp neurons and observed immunoreactivies for anterograde tracer, VGLUT1, and VGLUT2 in the VPM and Po. Most anterogradely labeled axon terminals showed immunoreactivities for both VGLUT1 and VGLUT2 in the VPM and made asymmetric synapses with dendritic profiles of VPM neurons. On the other hand, in the Po, only a few axon terminals were labeled with anterograde tracer, and they were positive only for VGLUT2. The results indicated that Vp neurons expressing VGLUT1 and VGLUT2 project to the VPM, but not to the Po, although the functional differences of three distinct populations of Vp neurons, VGLUT1-, VGLUT2-, and VGLUT1/VGLUT2-expressing ones, remain unsettled.

Background and Purpose: Dural arteriovenous fistulas (DAVF) can affect a variety of cerebral venous structures and can present at various clinical stages. This study was designed to introduce the characteristic manifestation of DAVF detected with both carotid and transcranial color-coded duplex ultrasonography (CDUS) and to evaluate the diagnostic value of CDUS in DAVF. Methods: Nineteen patients with DAVF confirmed by cerebral angiography were studied with CDUS. The sonogram and spectrum of the affected area were observed. Hemodynamic parameters such as peak systolic velocity, end-diastolic velocity, mean velocity and resistance index (RI) were measured and recorded in the feeding artery, draining vein and extracranial artery. All results were compared with cerebral angiography. Fifty healthy volunteers were enrolled as a control group. Related hemodynamic changes were compared between the patients and normal controls. Results: The blood flow of fistulas presented as an irregular mosaic color bolus with a clear boundary detected with CDUS. Blood flow imaging of fistulas was abnormal in 12 cases and absent in 7 cases. The detection rate was 63% (12/19). Fifty-three main feeding arteries (73.6%) were detected by ultrasonography. All the venous drainages through the transverse sinus and superior ophthalmic vein were detected, while the ones through the superior sagittal sinus and cortical vein were not. There was a significant difference in average diameter, flow velocity and RI of the occipital artery and superficial temporal artery between the patients and normal controls (p < 0.05). Conclusions: CDUS could indicate DAVF by analyzing both imaging results of the diseased region and hemodynamic changes of the relative vasculature. It is a promising technique for the diagnosis and follow-up study of DAVF.

Objective: The goal of the present study was to evaluate the effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on olfaction in patients with Parkinson’s disease (PD). Methods: 15 patients suffering from sporadic PD-related dysosmia were implanted with bilateral electrodes aimed at the STN. One week before the surgery, odor detection threshold (DT) and identification threshold (IT) were evaluated in all patients using the ‘five odor olfactory detection arrays’ in both medication-off and medication-on conditions. 15 healthy age-matched controls also received the same olfactory evaluation. Patient evaluations were repeated at 6 and 12 months postoperatively in a medication-off/stimulator-on or medication-off/stimulator-off condition. Odor DT and IT scores were compared pre- and postoperatively, as well as between the medication-off/stimulator-on or -off conditions. Results: The motor symptoms of all 15 PD patients, including rigidity, tremor, bradykinesia, postural instability, and gait were significantly improved after stimulator implantation. The UPDRS motor (UPDRS III) scores decreased significantly in the medication-off/stimulator-on condition (p < 0.01). The odor DT and IT scores of PD patients were higher than those of healthy controls (p < 0.01). In the medication-off/stimulator-off condition, there was no significant difference in the odor DT and IT scores in PD patients pre- vs. postoperatively (p > 0.05). Notably, there were no significant alterations to DT scores in the stimulator-on and -off conditions at the 6- and 12-month follow-up (p > 0.05), whereas IT scores were significantly improved in the stimulation-on relative to the stimulation-off condition at the 6- and 12-month follow-up. Conclusions: STN DBS can significantly improve olfactory cognitive function in PD patients. The possible mechanisms include an improvement in striatal metabolism and neuronal activity in the orbitofrontal cortex mediated by STN DBS, as well as increased glucose metabolism in the striatum, midbrain, cingulate gyrus, and motor and higher-order somatosensory association cortices.

Background: The nucleus accumbens (NAcc) has been proven to be associated with drug and food craving. NAcc ablative neurosurgery has been suggested to modulate the balance of the brain reward system and thus alleviate drug dependence in patients. It has been hypothesized that it would also alleviate food craving in patients as well as altering their nutritional status. Aims: This study aimed to estimate the effect of NAcc neurosurgery on drug craving and nutritional status in patients with drug dependence at 5 years postoperatively. Methods: The study included 100 patients with NAcc surgery and 92 patients without surgery. Body mass index (BMI) and body fat percentage (BF%) were examined to assess nutritional status, and questionnaires were administered to assess drug craving. Results: Compared with the nonsurgery group and the relapse patients from the surgery group, the nonrelapse patients from the surgery group had higher BMI and BF% but lower drug craving. There were no significant differences between the nonsurgery group and the relapse patients in BMI, but the relapse patients had higher drug craving than the nonsurgery group. Conclusions: Long-term follow-up suggested that NAcc ablative neurosurgery would alleviate drug craving and yield a better nutritional status if individuals sustained abstinence. It would increase drug craving but would not ruin the nutritional status of patients even when individuals relapsed postoperatively.

Objective Dural arteriovenous fistula (DAVF) of the anterior cranial fossa is usually treated by surgical disconnection or endovascular embolization via the ophthalmic artery. The middle meningeal artery is a rarely used approach. This study investigated the safety and efficacy of embolization of DAVF of the anterior cranial fossa with Onyx through the middle meningeal artery. Methods A retrospective review of a prospective cerebral vascular disease database was performed. Patients with DAVF of the anterior cranial fossa managed with embolization through the middle meningeal artery with Onyx were selected. Information on demography, symptoms and signs, angiographic examinations, interventional treatments, angiographic and clinical results, and follow-up was collected and analyzed. Results Five patients were included in this study, four of whom had hemorrhage. All fistulas were fed by the bilateral ethmoidal arteries arising from the ophthalmic artery and by the anterior branch of the middle meningeal artery. The abnormal shunt unilaterally drained into the superior sagittal sinus with interposition of the cortical veins all five patients. All endovascular treatments were successful with evidence of an angiographic cure. No complications occurred, and all patients recovered uneventfully without neurologic deficits. There were nearly no symptoms among the patients during follow-up. Conclusion Embolization of DAVF of the anterior cranial fossa via the middle meningeal artery with Onyx is safe, effective, and a good choice for management of DAVF. More cases are needed to verify these findings.

The vesicular glutamate transporters, VGLUT1 and VGLUT2, reportedly display complementary distribution in the rat brain. However, co-expression of them in single neurons has been reported in some brain areas. We previously found co-expression of VGLUT1 and VGLUT2 mRNAs in a number of single neurons in the principal sensory trigeminal nucleus (Vp) of the adult rat; the majority of these neurons sent their axons to the thalamic regions around the posteromedial ventral nucleus (VPM) and the posterior nuclei (Po). It is well known that trigeminothalamic (T-T) projection fibers arise not only from the Vp but also from the spinal trigeminal nucleus (Vsp), and that trigeminocerebellar (T-C) projection fibers take their origins from both of the Vp and Vsp. Thus, in the present study, we examined the expression of VGLUT1 and VGLUT2 in Vp and Vsp neurons that sent their axons to the VPM/Po regions or the cortical regions of the cerebellum. For this purpose, we combined fluorescence in situ hybridization (FISH) histochemistry with retrograde tract-tracing; immunofluorescence histochemistry was also combined with anterograde tract-tracing. The results indicate that glutamatergic Vsp neurons sending their axons to the cerebellar cortical regions mainly express VGLUT1, whereas glutamatergic Vsp neurons sending their axons to the thalamic regions express VGLUT2. The present data, in combination with those of our previous study, indicate that glutamatergic Vp neurons projecting to the cerebellar cortical regions express mainly VGLUT1, whereas the majority of glutamatergic Vp neurons projecting to the thalamus co-express VGLUT1 and VGLUT2.

We investigated the value of intraoperative sonography in improving the prevalence of total tumor resection and the survival time of patients who underwent resection of cerebral gliomas.One hundred thirty-seven patients who underwent sonographically guided surgery were followed for 6 to 60 months. In addition, 60 randomly selected patients (30 with low-grade gliomas and 30 with high-grade gliomas) who had surgery in our hospital without sonographic guidance served as the control group. Follow-up included the survival time, and the difference in the survival time between the study and control groups was statistically analyzed.Total removal of the lesion was achieved in 77 cases (69%), and partial removal was achieved in 35 (31%). In the control low-grade glioma group, 6-month survival was 96.7%; 1-year survival was 73.3%; and 2-year survival was 53.3%. In the study low-grade glioma group, survival rates at 6 months, 1 year, and 2 years were 98.0%, 96.1%, and 88.2%, respectively. In the control and study high-grade glioma groups, survival rates at 6 months, 1 year, and 2 years were 83.3% and 93.4%, 43.3% and 59.2%, and 13.3% and 32.8%. When comparing survival at 6 months, 1 year, and 2 years between the control and study groups, there was no significant difference at 6 months (P.05), but survival at 1 and 2 years was significantly different (P.05).Sonographically guided resection of cerebral gliomas helps the surgeon understand the relationship between the lesion and the surrounding structures. It is of value in improving the prevalence of total tumor resection and the patient's survival time.

CD24 is overexpressed in glioma cells in vitro and in vivo. However, the correlation of its expression with clinicopathological parameters of gliomas and its prognostic significance in this tumor remain largely unknown. To address this problem, 151 glioma specimens and 10 nonneoplastic brain tissues were collected. Quantitative real-time PCR, immunochemistry assay, and Western blot analysis were carried out to investigate the expression of CD24. As per the results, CD24 was overexpressed in gliomas. Its expression levels in glioma tissues with higher grade ( 𝑃 < 0 . 0 0 1 ) and lower KPS ( 𝑃 < 0 . 0 0 1 ) were significantly higher than those with lower grade and higher KPS, respectively. Cox multifactor analysis showed that CD24 ( 𝑃 = 0 . 0 2 ) was an independent prognosis factor for human glioma. Our data provides convincing evidence for the first time that the overexpression of CD24 at gene and protein levels is correlated with advanced clinicopathological parameters and poor prognosis in patients with glioma.

Epilepsy is a chronic neurological disorder characterized by spontaneous recurrent seizures, which also occur in demyelinating diseases of the central nervous system (CNS) with a higher prevalence. Meanwhile, demyelination occurrings have been occasionally observed in CNS of epilepsy patients, indicating an association between demyelination and epileptic seizures by an unknown mechanism. However, no confirmative experimental evidence has yet been given. Thus, by using a rat pentylenetetrazol model, electroencephalogram (EEG), Western blotting, enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry, the present study provided direct evidence that myelin sheath damage in rat hippocampus and cerebral cortex started in the early stage of epileptic seizures induction and lasted with no further increase in severity in the development of epileptic seizures. It was illustrated that myelin sheath damage was not the result of oligodendrocyte destruction, but the autoantibodies against myelin basic protein (MBP) produced in peripheral circulation accompanied by increased permeability of blood-brain barrier (BBB) formed in the development of epileptic seizures. This study firstly provided experimental evidence for myelin sheath damage in PTZ-induced rat's epileptic seizures and further demonstrated that its possible cause was autoimmunoreaction.

Objective: To evaluate the efficacy of Fluoro Jade-C staining (FJC) in the assessment of brain injury after deep hypothermia circulatory arrest (DHCA). Methods: Six healthy adult miniature male pigs underwent DHCA, the rectal temperature was down to 18 °C, circulation was stopped , circulatory arrest was maintained for 60 minutes. On postoperative day 1, perfusion-fixation was performed on brain tissue. Cerebral cortex, hippocampus, cerebellum were taken for sampling. FJC, hematoxylin–eosin staining (HE), nissl staining (NISSL), terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) were performed to detect the histological and pathological changes. Histological scores of all slices were ranked. Comparison between the FJC and other techniques was done by analysis of variance (ANOVA) according to histological scores. Results: All animals survived the operation. On the cerebral cortex, in comparison of FJC between HE, NISSL and TUNEL, the p value was 0.90, 0.40, 0.16 respectively ( p > 0.05). On the hippocampus, the comparison of FJC with HE, NISSL and TUNEL had a p value of 0.12, 0.23, 0.62 respectively ( p > 0.05). On the cerebellum, in comparing FJC with HE, NISSL and TUNEL, the p value was 0.96, 0.77, 0.96 respectively ( p > 0.05). On representative regions, the results of FJC were in accordance with that of TUNEL, NISSL and HE. Furthermore, ascertainment of brain injury is easier with FJC. Conclusion: FJC is a reliable and convenient method to assess brain injury after DHCA.

To describe the experience with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support of 100 patients.Retrospective analysis of the medical files of 100 patients submitted to the implant of extracorporeal membrane oxygenation system for cardiorespiratory assistance of acute and refractory cardiogenic shock from December 2004 to September 2008. There were 67 males and 33 females, age ranged from 5 d to 76 years with a mean of (28+/-26) years, body mass ranged from 3.8 to 100.0 kg with a mean of (42+/-30) kg. The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique. All patients were applied veno-artery ECMO and activated clotting time was maintained between 120 and 180 s and heparin usage dose was 5 to 20 Uxkg(-1)xh(-1). Mean blood flow was 40 to 220 mlxkg(-1)min(-1) during ECMO assistant period.The shortest ECMO time was 12 to 504 h with a mean of (119+/-80) h. Sixty-one patients (61.0%) weaned off successfully from ECMO, 55 of them (90.2%) were discharged and 6 died of post-operative complications. Thirty-nine patients could not weaned off from ECMO. Total survival discharge rate was 55.0%. Mean aortic pressure before ECMO in survived patients was significantly higher than that of dead patients (P=0.038). Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients (P=0.005).ECMO is an effective mechanical assistant therapy method for cardiac and pulmonary failure after cardiac surgery. Earlier usage of ECMO for heart lung failure patient and avoiding the main organs from un-recovery trauma are key success.

Urokinase-type plasminogen activator receptor (uPAR) is a glycosyl phosphatidylinositol-anchored protein involved in cell adhesion, proliferation, differentiation, migration, invasion, and tissue repair and remodeling. Our aim was to investigate uPAR expression in the frontal cortex of patients with intractable frontal lobe epilepsy and to explore the possible role of uPAR in intractable epilepsy. Tissue samples were obtained from the frontal cortex of 25 patients who had undergone surgery for intractable epilepsy and 15 histologically normal frontal cortex tissues from patients with orbital frontal lobe severe contusion (the control group). The frontal cortex expression of uPAR was studied by Western blot and immnohistochemistry. Double immunofluorescence was used to determine the expression of uPAR in astrocytes, microglia, and neurons. The normal frontal cortex uPAR protein level was shown to be low. In the brain tissue of patients with intractable epilepsy, the expression of uPAR protein increased dramatically. Based on the results of double immunofluorescence, many uPAR-positive cells are colocalized with the cell soma of NeuN-positive neurons, whereas only a few GFAP- and CD11b-positive cells colocalized with uPAR staining. These findings provide new information pertaining to the epileptogenesis of intractable epilepsy and suggest that increased expression of uPAR in human brain may be associated with human intractable epilepsy.

The non-linear dynamic specificity of the firing pattern discharged from neurons of the internal globus pallidus (GPi) was investigated by recording their spontaneous firing using a microelectrode during posteroventral pallidotomy in eight patients with Parkinson's disease. Raw data from the cells were processed to extract spiking events (discharges above a selected threshold) and the interspike interval was measured. Using the unstable periodic orbits extraction method, significant period-1, −2 and −3 orbits were identified in burst firing discharged from the GPi cells in all eight patients, suggesting that deterministic dynamics exist in the timing of the discharges. As well as providing a useful peri-operative technique for locating posteroventral pallidotomy targets in Parkinson's disease, this method also provides a promising basis for investigating characteristic neuronal discharges in other regions of the brain and for various other neurological disorders.

Nigrostriatal neurons expressing RET protein, a receptor protein tyrosine kinase of glial cell line-derived neurotrophic factor (GDNF) were investigated in rats using retrograde neural tracing with horseradish peroxidase (HRP) combined with immunohistochemistry. HR/RET double-labeled neurons were abundantly distributed in the substantia nigra pars compacta ipsilateral to the caudate-putamen stereotaxically injected with HRP. Almost all the HRP-labeled neurons in nigra exhibited RET-like immunoreactivity, which however constituted more than half of the RET-immunoreactive cells. Our results present morphological evidence that GDNF-RET interaction plays important roles in physiological processes of nigrostriatal neuronal circuits of mammals.

Background We investigated the safety of treatment of symptomatic intracranial atherosclerotic stenoses with the Gateway-Wingspan system and its initial effect on prevention of ischemic events. Methods Twenty-seven cases of symptomatic intracranial atherosclerotic stenoses were treated with angioplasty with a Wingspan stent. Location of stenoses, extent of stenoses before and after angioplasty, success rate of treatment, occurrence of procedural complications, and changes in recurrence of symptoms of ischemic events 30 days after treatment were recorded. Results Twenty-nine angioplasties with the Wingspan system were successfully carried out in 29 stenoses in 27 patients. Of 29 stenoses, 17 were in the posterior circulation, and 12, in the anterior circulation. The degree of stenoses was reduced from baseline 71.8% (56%-87.8%) to 24.9% (0%-45%) after stenting. Complications were seen in four patients (14.8%), 3 of which were lesion-related infarction of a perforated artery, and 1 was a non-lesion-related infarction. Two complications led to transient neurologic dysfunction, one led to defect of the visual field, and one led to hemiplegia. The prevalence of morbidity and serious morbidity were 7.4% and 3.7%, respectively, and no death occurred. No new ischemic events happened during 30 days after stenting. Conclusion Angioplasty with the Wingspan system to treat symptomatic intracranial atherosclerotic stenoses appears to be safe. Its initial effect on prevention of ischemic events is acceptable.

Background: Repeat gamma knife radiosurgery (GKRS) is considered to be an effective treatment for refractory or recurrent trigeminal neuralgia (TN). Aims: The purpose of this report was to demonstrate the relationship between the outcome of repeat GKRS and prior operative procedures on patients with recurrent or refractory TN. Materials and Methods: A retrospective analysis was performed on 34 patients with refractory or recurrent TN who had undergone repeat GKRS; 21 patients had undergone other types of procedures, 11 of whom had undergone more than three such procedures prior to radiosurgery. The maximum dose of the repeat procedure was between 60 and 75 Gy. The mean follow-up time was 21.6 months. Statistical Analysis Used: The log-rank test and Fisher's exact test were used to analyze the data. Results: Excellent pain relief was achieved in 14 patients (41.2%) after repeat GKRS, while a successful outcome occurred in 29 of 34 patients (85.3%). Better pain relief occurred in the patients who did not have a prior procedure or who had undergone fewer than three prior procedures ( P = 0.042). Twenty-four of 25 patients (96.0%) who had recurrent pain had a successful operation and five of nine patients (55.6%) who did not have significant relief of pain after the first procedure had a successful operation. The difference was statistically significant ( P < 0.01). Only four patients had mild complications. Conclusion: It is more likely to relieve pain in patients with recurrent or refractory TN who did not have a prior procedure or who had fewer than three procedures before undergoing their first GKRS. Moreover, it seems that patients who had a good response following the initial GKRS had better results after a repeat procedure.

To investigate the effect of Matrix coil in prevention of recanalization of intracranial aneurysm after embolization with Matrix coils.Plan of follow-up was designed to make digital subtraction angiographies for Forty-eight intracranial aneurysm patients with 49 aneurysm s, 22 males and 26 females, aged 52 (15 ~ 67), underwent embolization with Matrix coil and were followed up for 11.75 months on average. Digital subtraction angiography was conducted immediately after the operation and during the follow-up. At least three projections, including anterior-posterior projection, lateral projection, and optimal working projection were adopted. The percentages of occlusion of the initial and the follow-up images were compared.DSA immediately after the operation showed a complete occlusion rate of 34.7%, near complete rate of 42.9% and an incomplete rate of 22.4%. The follow-up DSA revealed that the complete occlusion rate was 53.1%, near complete rate was 24.5%, and incomplete rate was 22.4%. The overall recanalization rate was 28.5%, 22.2% for small aneurysms and 46.1% for large aneurysms. The major recanalization rate was 14.3% and the improvement rate was 24.5%. The recanalization rate was 11.8% for total occlusion, 33.3% for near complete occlusion, and 45.5% for incomplete.The long-term angiographic outcome of intracranial aneurysms after embolization with Matrix coils is stable. The recanalization rate is acceptable and is not better than that of GDCs.

To study the effects of taurine (Tau) on early changes of excitatory amino acids (EAA) in hippocampus rabbit brain due to deep hypothermic circulatory arrest (DHCA).Sixteen New Zealand rabbits were randomly allocated into 2 groups: Tau 150 mg/kg group (group I, n = 8), control group (group II, n = 8). Cardiac pulmonary bypass (CPB) was set up after cerebral microdialysis model was established. High performance liquid chromatography was employed to monitor the continuous changes of glutamic acid (Glu), aspartic acid (Asp), Tau and glycine (Gly) in the hippocampus CA1 region at anaesthesia periods, CPB stage, pre 30 minutes in DHCA, post 30 minutes in DHCA, pre 30 minutes in rewarming, post 30 minutes in rewarming.The increase of Glu in group II was (5.1 +/- 1.5) and (4.1 +/- 1.4) times higher than that at anaesthesia periods (t = 3.74, 5.45, P0.01), and the increase of Glu in group I was (2.1 +/- 1.5) and (1.1 +/- 0.4) times than that at anaesthesia periods at pre 30 minutes and post 30 minutes rewarming stage respectively. Rising of Gly in group II was 6.7 (3.6, 13.6) times than that at anaesthesia periods (T = 75.00, P0.05), the rising of Gly in group I was 4.2 (3.8, 11.5) times at post 30 minutes in DHCA. Rising of Tau in group I was 6.9 (3.0, 14.2) and 10.6 (2.8, 22.5) times than that at anaesthesia periods (T = 75.00, P0.05 and T = 90.00, P0.05) and rising of Tau in group II was 4.0 (3.0, 5.7) and 3.2 (1.2, 7.6) times than that at anaesthesia periods at post 30 minutes in DHCA and pre 30 minutes rewarming stage respectively. Asp was no evident change at every periods.DHCA might increase the excitatory amino acids in the early phases of circulatory restoration. Exterior Tau 150 mg/kg could inhibit release of EAA.

Background To examine the expression of SMAD4 at gene and protein levels in glioma samples with different WHO grades and its association with survival. Methods Two hundreds fifty-two glioma specimens and 42 normal control tissues were collected. Immunochemistry assay, quantitative real-time PCR and Western blot analysis were carried out to investigate the expression of SMAD4. Kaplan-Meier method and Cox's proportional hazards model were used in survival analysis. Results Immunohistochemistry showed that SMAD4 expression was decreased in glioma. SMAD4 mRNA and protein levels were both lower in glioma compared to control on real-time PCR and Western blot analysis (both P < 0.001). In addition, its expression levels decrease from grade I to grade IV glioma according to the results of real-time PCR, immunohistochemistry analysis and Western blot. Moreover, the survival rate of SMAD4-positive patients was higher than that of SMAD4-negative patients. We further confirmed that the loss of SMAD4 was a significant and independent prognostic indicator in glioma by multivariate analysis. Conclusions Our data provides convincing evidence for the first time that the reduced expression of SMAD4 at gene and protein levels is correlated with poor outcome in patients with glioma. SMAD4 may play an inhibitive role during the development of glioma and may be a potential prognosis predictor of glioma.