BACKGROUND: Surgical spinal cord injury (SSCI) is often inevitable in patients with intramedullary lesions. Although regional hypothermia (RH) has been demonstrated neuroprotective, the value of priming RH in SSCI has never been studied. Herein, the authors investigated the impact of pre- and post-RH on neurologic recovery in a clinically relevant model. METHODS: An SSCI model was established at T10. RH was conducted by focal 4 degrees C saline perfusion; room temperature (RT) saline was used as controls. Animals were randomized into 6 groups: SHAM-RT/RH, Pre-RT/RH, and Post-RT/RH. Motor and sensory functions were evaluated using the Basso, Beattie, and Bresnahan rating scale and Plantar test 2 weeks after surgery. TUNEL assay and Fluoro-Jade C staining were conducted to examine the cell death, and the alterations of apoptotic markers including total and cleaved casepase 3, Bcl-2, and Bax, as well as the pyroptotic proteins including NLRP3, ASC, and caspase 1, were determined. RESULTS: RH perfusion successfully created an intramedullary hypothermia approximately at 24 degrees C, while RT controls remained above 30 degrees C. Animals receiving post-injury RH had the least cell death and the best motor performance, while pre-RH showed the most dead cells and worst hind limb movements. Immunoblotting depicted that post-RH suppressed both apoptotic and pyroptotic death as the cleaved/total caspase 3, Bcl-2/Bax ratio, and NLRP3/ASC/caspase 1 signaling were inhibited. Priming cooling, on the contrary, elevated pyroptosis and did not affect apoptosis significantly. CONCLUSIONS: Priming RH before surgical incision could not be supported as it caused excessive cell death. In contrast, instant introduction of RH is beneficial in rescuing neurologic function.

Background Spinal cord injury (SCI) has imposed a great impact on the quality of life of patients due to its relatively young age of onset. The pathophysiology of SCI has been proven to be complicated. Microglia plays an important role in neuroinflammation and second injuries after SCI. Different environment and other factors may determine the microglial activation profile and what role they play. However, neither accurate time-course profiles of microglial activation nor influence factors have been demonstrated in varied SCI models. Methods A rat compressive SCI model was used. Microglial activation profile and contents of inflammatory factors including IL-1β, IL-6 and TNF-α were detected. Myelination status as well as levels of iron and glutamate concentration, adenosine triphosphate (ATP) and potassium are also assessed. Results Our results showed that the activated microglia participating in immune-mediated responses peaked at day 7 post SCI and gradually decreased during the following 3 weeks. Contrarily, myelination and oligodendroglia showed an opposite trend, indicating that microglia may be a key factor partly through inflammatory reaction. Iron and glutamate concentration were found to be the highest at day 7 after SCI while both ATP and potassium reached a low valley at the same time. Conclusion These findings showed a microglial activation profile and the alterations of associated factors after experiment SCI model. Moreover, our data suggest that high iron and glutamate concentration may be released by damaged oligodendroglia and contribute to the activation of microglial after SCI.

The article describes the epidemiology of spinal cord injury (SCI), the measurement methods and affecting factors of post-traumatic growth of SCI patients and treatment strategy of promoting post-traumatic growth of SCI patients. The purposes of the article are to provide help of promote positive psychological changes and improve the quality of life of SCI patients.

目的:探讨颈前路椎间盘切除植骨融合术(ACDF)治疗单节段颈椎间盘突出对患者颈椎功能及预后影响.方法:选择单节段颈椎间盘突出症患者23例为研究对象,均给予ACDF治疗,观察治疗后优良率、颈椎关节JOA评分、疼痛评分、伤椎前缘高度百分比以及颈椎前凸Cobb角改善情况.结果:23例患者治疗后优良率为86.96％;术后1周、3个月以及末次随访VAS疼痛评分(3.23±1.58)分、(2.69±1.64)分、(1.94±0.12)分,椎前缘高度百分比(94.27±5.33)％、(92.64±5.83)％、(90.78±3.53)％,Cobb角(6.02±1.17)°、(7.72±1.42)°、(7.89±1.36)°,JOA评分(13.87±5.91)分、(14.66±5.23)分、(15.45±3.04)分,均优于治疗前VAS疼痛评分(7.13±2.97)分,椎前缘高度百分比(56.46±5.21)％,Cobb角(16.58±2.05)°,JOA评分(11.68±4.24)分,差异有统计学意义(P<0.05).结论:采用ACDF治疗单节段颈椎间盘突出症患者,手术创伤小且能显著改善患者颈椎功能及活动评分,临床疗效较好,同时可以减轻其痛苦,并改善预后,有较好的应用价值.

Rationale: Chiari type I malformation (CM1) and occult tethered cord syndrome (OTCS) are considered to be malformations associated with subtle structural abnormalities of the terminal filum. Few studies have reported patients with CM1 and OTCS. Treatment strategy for patients of CM1 associated with OTCS is controversial. Patient concerns: A 14-year-old child was admitted with intermittent pain and numbness in the right upper limb. And he had urinary frequency, neck pain, back pain, and numbness simultaneously. The imaging examinations showed CM1, syringomyelia, small fat in the filum at the level of the L2 vertebral body but the conus medullaris at the aspect of the L1 vertebral body. Diagnoses: The child was diagnosed with CM1 associated with OTCS. Interventions: Patient underwent sectioning of filum terminale (SFT) under electrophysiological monitoring during the first hospital and posterior fossa decompression (PFD) during the second hospital. Outcomes: After first discharge pain of the right upper limb was relieved, but he still felt numbness. And his numbness was relieved after second discharge. The imaging examinations also showed corresponding improvement during the 2-year follow-up period. Lessons: For pediatric patients with CM1 and TCS, treatment trouble is not only to choose the staging operation or simultaneous operation but also staging procedures for treatment of 2 lesions. Detailed preoperative evaluation is essential for development of individualized surgical plan. Staging operation of firstly minimally invasive SFT and later PFD may be helpful for such cases owing to its positive effect on both the symptoms and imaging findings.

In this study, we investigated the anticancer potentials of Rhein, an anthraquinone derivative of most commonly used Chinese rhubarb on the rat F98 glioma cells. The experimental studies revealed that Rhein induced cell cycle arrest, caspase mediated apoptosis. It results in the formation of intracellular acidic vesicles in cytoplasm, leading to autophagy. Differentiation of viable cells towards elongation of matured astrocytes was proved by monitoring dramatic changes in morphological characteristics as well as identified from the elevation of glial fibrillary acidic protein (GFAP) expression. Rhein treatment did not alter the phosphorylated MAPKs activation including p-38, JNK and NF-κB, transcription unit whereas rhein significantly inhibited ERK1/2 activation in F98 glioma cells. PD98059, a specific inhibitor for ERK activation imitates rhein effects on morphology and expressions of GFAP but did not help to induce any apoptosis or autophagy. Collective data exhibited that potentials of rhein in anti-cancer property in ERK-independent apoptosis and autophagy in association with downregulated ERK-dependent differentiation process of glioma cell lines.

OBJECTIVE:The primary focus of this study was to investigate the effects of local profound hypothermia and to explore the possible mechanism in adult rats with spinal cord injury.STUDY DESIGN AND METHODS:Spinal cord injury models were established by placing aneurysm clips on T10. An epidural perfusion device was applied to maintain a steady temperature (18 °C) for 120 min with gradual rewarming to 37 °C Total hypothermic duration lasted up to about 170 min. The expression of axon regeneration inhibitors was tested by Western blot and real-time PCR. Luxol Fast Blue (LFB) stain and Bielschowsky silver stain were used to observe spinal cord morphology. Motor function of the hind limbs (BBB score) was monitored for 21 days.RESULTS:The expressions of RhoA, ROCK-II, NG2, Neurocan, Brevican, and Nogo-A were downregulated by regional hypothermia (RH) after spinal cord injury. Subsequent observation showed that rats that had received RH had an alleviated demyelinating condition and a greater number of nerve fibers. Furthermore, the RH group achieved higher BBB scores than the spinal cord injury (SCI) group.CONCLUSIONS:Recovery of hind limb function in rats can be promoted by local profound hypothermia; this may be caused by the suppression of axon regeneration inhibitors.

目的：探讨采用后路钉棒系统内固定融合技术治疗上颈椎不稳的效果。方法对13例上颈椎不稳行后路钉棒系统内固定融合术，其中11例行钉棒系统枕颈融合术，2例行钉棒系统环枢椎融合术，术后随访3~24个月，平均6.5个月。结果术中无脊髓、神经根及椎动脉损伤，术后神经症状均得到不同程度的改善；影像学复查钉棒位置均良好，均形成良好骨性融合，脊髓无受压。术后3个月日本骨科协会评分改变率为（65.5±35.5）%。结论后路钉棒系统内固定融合术是治疗上颈椎不稳安全而有效的手术方式。

Chiari 0 malformation (CM-0) with syringomyelia syringobulbia and syrinx cavity in pons simultaneously is rare. We present a case of 31-year-old man, review the available literature, and discuss the experience of therapy from the neurosurgical perspective.

Objective To investigate the clinical application of vertebroplasty in spinal neurosurgery. Methods From June 2012 to May 2015, the clinical data of 40 patients with spine disease treated by using vertebroplasty (including 35 cases of percutaneous surgery and 5 cases in combination with 2 ways in open spinal surgery) at the Department of Neurosurgery, Nanjing General Hospital of Nanjing Military Command were analyzed retrospectively. The application effect of vertebroplasty in the spine neurosurgery were analyzed and assessed. Results A total of 58 vertebrae were injected bone cement in 40 patients of this group. Five vertebrae were treated with combined application of open spinal surgery in 5 patients and the efficacy was good; 53 vertebrae were treated with percutaneous surgery in 35 patients. The leakage of cement occurred in 7 vertebrae in 7 patients. In addition to 1 patient gave up further treatment, others all became well after treatment; 38 patients were followed up for 6 to 36 months (mean 15.4 months), the efficacy of 26 patients with hemangioma and osteoporosis was good. One patient had multiple myeloma. The pain of 6 patients with metastatic carcinoma was relieved. Three patients with metastases, 1 with primary spinal tumor, and 1 with multiple myeloma died of the progress of primary disease 1 year later. Conclusions Vertebroplasty has the advantages of simple operation, short learning curve, and curative effect etc. It is best adapted for the elderly, weaker constitution, and other patients who can not be implemented in general anesthesia. It can simultaneously address multiple spinal diseases in the combined application of open spine surgery. Key words: Spinal disease; Vertebroplasty; Neurosurgical procedures

Objective To discuss the clinical application of vertebroplasty (VP) in the treatment of vertebral tumors. Methods The clinical data of 19 patients with vertebral tumors, of whom, 14 only underwent percutaneous VP for compression fracture and 5 open surgery for decompression and internal fixation and VP from June, 2012 to August, 2015, were analyzed retrospectively. The outcomes and complications were discussed. Results The percutaneous VP were carried out in 24 vertebras of 14 patients. The leakage of bone cement occurred in 6 vertebras of 6 patients undergoing percutaneous VP (6/24). Of 14 patients undergoing percutaneous VP, 11 received obvious relief of pain, 2 mild relief and 1 deterioration of pain 3 days after VP. The pain was significantly relieved after the operation in 5 patients undergoing the open surgery and VP. Conclusions The vertebroplasty, which was a minimally invasive, safe and effective method to relieve the pain induced by compression fractures in the patients with vertebral tumors, should be spread clinically.

At present, one of the most life threatening types of adult brain tumor is glioblastoma multiforme (GBM). The molecular mechanism underlying the progression of GBM remains to be fully elucidated. The modern method of clinical treatment has only improved the average survival rates of a newly diagnosed patients with GBM by 15 months. Therefore, the discovery of novel molecules, which are involved in glioma inhibition is required. In the present study, U118 and U138 human glioma cells were transfected with all-trans retinoic acid (RA)-incorporated glycol chitosan (GC) nanoparticles. An MTT assay was used for the analysis of cell proliferation and flow cytometric analysis and ssDNA detection assays were performed for the determination of induction of cell apoptosis. Cell cycle distribution was analyzed by flow cytometry. Exposure of the U118 and U138 human glioma cells to the RA-incorporated GC nanoparticles for 24 h resulted in a concentration-dependent inhibition of cell proliferation. Among the range of experimental RA concentrations, the minimum effective treatment concentration was 10 mu M, with a half maximal inhibitory concentration of 25 mu M. The results also demonstrated that RA transfection resulted in the inhibition of cell proliferation, inhibition of the expression of Ezh2, and apoptosis through the mitochondrial signaling pathway by a decrease in membrane potential, the release of cytochrome c, and cell cycle arrest in the G(0)/G(1) phase.

BACKGROUND:Bullet-induced brain wounds are common among military personnel in war zones and among civilians with gun accidents or crime-related gun injuries. The goal of this study was to develop a nonfatal porcine model of penetrating craniocerebral gunshot wound (PCGW) by firing a projectile in live swine to induce PCGW in such a realistic manner as to reconstruct their physical characteristics.MATERIALS AND METHODS:We established a nonfatal porcine model of PCGW based on a custom-designed experimental gun that emulates the shooting of a 5.56-mm NATO standard rifle at 800 m (317 m/s; 200.9 J). Commercial swine (n = 20) were subjected to a ballistic wound to the bilateral frontal lobe, and four swine were used as controls. Surviving swine were used in subsequent first-aid, management, and monitoring experiments for neurosurgeons. Various physiological variables were measured continuously. After computed tomography (CT) scanning and three-dimensional CT reconstructions, all pigs underwent primary lifesaving emergency interventions, including emergency decompressive craniotomies and hemorrhage control.RESULTS:In our nonfatal porcine model of PCGW, injuries were comparable in their morphology to real gunshot wounds, as evidenced by analysis of wound characteristics and CT scan images. The survival rates of the pigs were 100% within 2 h, 95% within 6 h, 85% within 12 h, and 85% within 24 h (P < 0.01). Hemodynamics, hematology, blood routine biochemistry, coagulation, and other physiological parameters also exhibited significant changes in the PCGW pigs.CONCLUSIONS:This model makes possible the laboratory reproduction of real ballistic wounds in a live large animal model that is close to humans.

Neuromyelitis optica spectrum disease (NMOSD) refers to a group of related disease, in which potential pathogenesis is similar to neuromyelitis optica (NMO), but clinical involvement does not exactly correspond to the diagnosis of NMO. Owing to varied clinical manifestations, it is apt to be misdiagnosed. We report a case of NMOSD with cervical spondylosis and discuss the experience of diagnosis. A 44-year-old woman was admitted to our hospital with a 10-day history of ache of double upper limbs and numbness on the trunk below the chest and bilateral thighs. Ten days before, she had an onset of ache of double upper limbs without apparent inducement. At the same time, she developed trembling on hands when writing and numbness between the chest and bilateral knees, which were unable to be alleviated. At admission, she presented with hypoesthesia of superficial sensibility from bilateral costal margins to knees, positive bilateral Hoffman sign, and Babinski sign. Magnetic resonance imaging (MRI) [Figure 1a] of cervical vertebrae showed: (1) Cervical intervertebral disc herniation (C3–C7); (2) Intramedullary lesions with edema (C2–T2); (3) Cervical spondylolisthesis (C3–C5). She was admitted to our hospital with a presumptive diagnosis of cervical spondylosis and intramedullary lesions with edema (C2–T2). After admission, she was given dehydration, anti-inflammatory, nerve nutrition, and symptomatic treatment immediately. Subsequent lumbar puncture showed results of cerebrospinal fluid routine were normal with normal protein, glucose, and chloride levels. Serum aquaporin-4 (AQP-4) antibody was tested by enzyme-linked immunosorbent assay and showed positive. Also, visual evoked potential, brainstem auditory evoked potential, and somatosensory evoked potential were normal. All told that she was diagnosed as NMOSD as well as cervical spondylosis. Then, she received methylprednisolone (500 mg) impact therapy and sequential reduction of hormone therapy. Fifteen days later, MRI [Figure 1b] showed cervical and thoracic spinal cord lesions were significantly reduced. Her symptoms of upper limbs pain, numbness of chest, and abdomen had improved markedly and was discharged. Figure 1 Sagittal T2-weighted magnetic resonance imaging of neuromyelitis optica spectrum disease. (a) Scan on first admission demonstrating cervical intervertebral disc herniation (C3–C7), intramedullary lesions with edema (C2–T2). (b) Fifteen ... After discharge, oral prednisone tablets in sequential treatment had been given, and drug dosage had been reduced to 1 tablet/day gradually. Three months later, the patient developed upper limbs and armpit pain, and lightning like feeling on bilateral thighs when she dipped her head. Serum AQP-4 antibody showed strongly positive. Cervical MRI [Figure 1c] showed cervical and thoracic spinal cord lesions like last time. NMOSD recurrence was considered. Methylprednisolone impact therapy and sequential reduction of hormone therapy were given. And after treatment, review of MRI [Figure 1d] showed the lesions significantly reduced. The symptoms of the patient partly alleviated and she was discharged. Followed up to date, the patient had taken drugs all the time and showed no recurrence [Figure 1e]. NMOSD is a kind of autoimmune disease with single or recurrent course, which causes selective, invasive injury of optic nerve and/or spinal cord. It is characterized by inflammation and necrosis in pathology. It is more common in women and young adults. Because of its diverse clinical manifestations, it is easy to misdiagnose.[1] The definition of NMOSD was proposed by Wingerchuk et al. in 2007.[2] According to the criteria, this case showed lesions with longitudinally extensive transverse myelitis (more than three vertebrae) mainly located in the cervical and thoracic spinal cord. The lesions involving most of the gray matter and white matter located in the central spinal cord. Originally, the patient was diagnosed as cervical spondylosis owing to the clinical manifestations and MRI findings. As the relevant examination including AQP-4 antibody had been gradually improved, the final diagnosis of NMOSD was achieved. In 2004, Lennon found a specific NMO-IgG antibody in the serum of patients with NMO and used it as a marker of biological, immunological diagnosis for NMO. Its sensitivity and specificity were 73% and 91%, respectively. In 2005, Lennon et al.[3] confirmed the specific target antigen of NMO-IgG was AQP-4 by double indirect immunofluorescence. In 2006, Wingerchunk et al.[4] bringed positive serum AQP-4 antibody into the main support standard included in the NMO diagnostic criteria revised. The guide for diagnosis and therapy of NMO by European Union on neurology in 2010 not only defined the NMOSD, but also put forward positive serum or cerebrospinal fluid AQP-4 antibody as the main support standard in the path for NMOSD diagnosis. This NMOSD patient was accompanied by cervical spondylosis. As clinical manifestations and MRI findings of this patient are very similar to cervical spondylosis with spinal cord degeneration simply, it is easy to be misdiagnosed. Positive serum AQP-4 antibody is very helpful for diagnosis. Although NMOSD has a severe disability rate, it often shows spontaneous remission and relapse.[5] In acute exacerbation, hormone therapy can achieve good relieve rate. Because it is easy to relapse, immunosuppression drugs are recommended to prevent its recurrence. Symptoms of this case improved obviously after hormone therapy. And one recurrence had appeared in this case until now. In conclusion, NMOSD is easily misdiagnosed as cervical spondylosis when the lesions are confined to the cervical and thoracic spinal cord. It will result in a severe outcome without timely diagnosis. Thus, early diagnosis is very important. In addition to typical clinical manifestations and imaging, detection of serum AQP-4 antibody is significant for a diagnosis. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

目的 探讨神经电生理监测在椎管内肿瘤的显微外科治疗中的作用.方法 2013年5月至2015年5月显微手术治疗椎管内肿瘤49例,术中采用体感诱发电位(SEP)联合运动诱发电位(MEP)监测辅助.结果 术中诱发电位结果:真阳性26例(26/29),假阳性3例;真阴性17例(17/20),假阴性3例.肿瘤全切除34例,次全切除6例,部分切除9例;无手术死亡.术后41例随访6个月至2年,神经功能改善31例(75.6％),无变化4例(9.8％),加重6例(14.6％);复发9例.结论 对于椎管内肿瘤的显微外科治疗,术中采用SEP和MEP联合监测,有助于提高肿瘤全切率,减少术后并发症,改善脊髓神经功能.

0引言<br>　　胸椎旁肿瘤种类众多，有良性肿瘤，也有恶性肿瘤。包括：骨瘤、骨软骨瘤、动脉瘤样骨囊肿、神经鞘瘤、浆细胞瘤、淋巴瘤、骨巨细胞瘤、骨肉瘤等原发肿瘤，还有来自肺、乳腺、前列腺、胃肠等部位的转移性肿瘤。日常工作中常因缺乏经验而误诊。现将2015年4月23日我院教学大查房中1例T8椎体旁病变的诊断、治疗过程整理报道如下，以期为此类疾病的诊疗提供借鉴。

Charcot joint (CJ), also known as neurotrophic arthropathy, is secondary to diabetes, syringomyelia, spinal tuberculosis, etc. The clinical manifestations are varied. The main performance includes pain, slightly restricted joint movement and very obvious swelling and damage of joint. It is easy to be misdiagnosed when the joint is the first symptom. We report a case of Charcot elbow joint as the initial symptom in Chiari malformation with syringomyelia. A 44-year-old woman was admitted to our hospital with a 3-month history of left elbow pain. Three months ago, she had an onset of left elbow pain without apparent inducement. The pain was mild and intermittent. Her left elbow got swelling and deformity but the activities were not limited. Shortly afterward atrophy of the left-thenar muscle and numbness of ulnar two fingers on left hand had begun to surface. Her physical examination indicated left elbow deformity, swelling, bone rubbing feeling after the activity, without pain or tenderness in joint activity. The tactile, pain and temperature sensation below the left elbow decreased. The topesthesia and graphesthesia were normal yet. Double Hoffman and Babinski signs were also negative. X-ray films [Figure 1a] in outer court showed the destruction and abnormality of the left elbow joint. Cervical magnetic resonance imaging (MRI) [Figure 1b] in our hospital pointed out: Chiari malformation associated with syringomyelia.Figure 1: X-ray radiograph of the left Charcot elbow joint and sagittal T2-weighted magnetic resonance imaging demonstrating the evolution of Chiari malformation associated with syringomyelia. (a) X-ray radiograph of the left elbow demonstrating destructive arthropathy and slight calcification. (b) Sagittal T2-weighted of preoperative magnetic resonance imaging demonstrating type I Chiari malformation with syringomyelia from cervical region to thoracic region. (c) Seven days after surgery demonstrating good cerebellar retraction and significant reduced syringomyelia. (d) Half a year after surgery demonstrating no significantly changed syringomyelia.Patient underwent local brake of the left elbow joints immediately and craniocervical decompression within 3 days after initial admission. After symptomatic treatment postoperation, the pain of left elbow and the numbness on the left hand were relieved. Three days after the operation, MRI [Figure 1c] showed that the cerebellar retraction was good, and syringomyelia was significantly reduced. Half a year after discharge, review of MRI [Figure 1d] showed syringomyelia had no significant change. CJ was described in detail for the 1st time by a French Doctor Charcot in 1868, which was a destructive joint disease due to abnormal sensory nerve and nervous nutritional disorders. It is more common in adults and patients over the age of 40. Mostly one joint is involved, and sometimes two or three joints maybe. CJ has an occult onset. It has only sensory nerve involvement and no motor nerve invasion, so it would not affect body movement. Frequent symptoms include the swelling and relaxation of the joint, abnormal activity, numbness of the affected limb, hypalgesia or analgesia, walking instability. It even has a deformity or overactive joint, which has the touch of cystic sensation or mobilizable lumps. The severity of joint destruction and symptoms of patients are disproportionate.[1] Correspondingly, our patient displayed elbow deformity, the mild pain of left elbow, numbness on left ulnar two fingers without pain or tenderness in joint activity. Nevertheless, correct diagnosis of CJ needs further assistant examination due to nonspecific clinical manifestations. As the X-ray examination can display the bone change well, X-ray combined with the clinical situation are the first choice for the diagnosis of CJ. According to the X-ray manifestations, CJ is divided into the hardening type, the absorption type and the mixed type.[2] The X-ray film in our case showed narrow elbow space, dislocation of the joint, bone resorption and ossification in the surrounding soft tissue. Thus, our case belonged to the absorption type, which was consistent with the diagnostic criteria of CJ. However, treatment of CJ should first focus the primary disease, and it is important to find the primary disease. MRI has received more and more attention in virtue of its role and value in the examination of the joints lesions. It is very useful for the cause of CJ. MRI findings of our case confirmed the existence of Chiari malformation and syringomyelia. Cases of elbow CJ as the initial symptom in Chiari malformation associated with syringomyelia are rare so far. The treatment focuses on the early treatment of the primary disease, which refers to craniocervical decompression mainly. In general, lesions of the joints do not need surgical treatment. Instead, the temporary brake can protect the joint well.[3] Our example took above methods and achieved good results. With regard to the late CJ, the knee fusion can be considered for the greatest degree of retention of limb function and improvement of the quality of life. In conclusion, for CJ induced by Chiari malformation with syringomyelia, early diagnosis is the key to improve the prognosis. Since the pain of CJ patients is not obvious, they rarely receive regular treatment in the early stage, and more of them see a Doctor in Department of Orthopedics or Department of Rheumatism. It is important that doctors should not only pay attention to the joint performance while ignoring the signs and symptoms of the nervous system but also interrogate history at length, make a careful physical examination and combine with imaging examination to make comprehensive analysis to avoid misdiagnosis. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

At present, one of the most life threatening types of adult brain tumor is glioblastoma multiforme (GBM). The molecular mechanism underlying the progression of GBM remains to be fully elucidated. The modern method of clinical treatment has only improved the average survival rates of a newly diagnosed patients with GBM by ~15 months. Therefore, the discovery of novel molecules, which are involved in glioma inhibition is required. In the present study, U118 and U138 human glioma cells were transfected with all‑trans retinoic acid (RA)-incorporated glycol chitosan (GC) nanoparticles.An MTT assay was used for the analysis of cell proliferation and flow cytometric analysis and ssDNA detection assays were performed for the determination of induction of cell apoptosis. Cell cycle distribution was analyzed by flow cytometry. Exposure of the U118 and U138 human glioma cells to the RA‑incorporated GC nanoparticles for 24 h resulted in a concentration‑dependent inhibition of cell proliferation. Among the range of experimental RA concentrations, the minimum effective treatment concentration was 10 µM, with a half maximal inhibitory concentration of 25 µM. The results also demonstrated that RA transfection resulted in the inhibition of cell proliferation, inhibition of the expression of Ezh2, and apoptosis through the mitochondrial signaling pathway by a decrease in membrane potential, the release of cytochrome c, and cell cycle arrest in the G0/G1 phase.

Objective To evaluate the effect of cerebral revascularization on cerebral blood flow in patients with moyamoya disease (MMD) with CT perfusion (CTP) imaging. Methods Fourteen patients with moyamoya disease who received head CT angiography and CTP before procedure and at 7 days after cerebral revascularization from June 2012 to January 2013 were studied prospectively. All patients received combined revascularization (12 sides) and indirect revascularization (4 sides). The middle cerebral artery supplied cortical areas of the surgical sides on the CTP imaging were used as regions of interest (ROI). All the parameters were analyzed with the pair-sample t test. Results (1 ) At 7 days after the 2 methods of revascularizations, both cerebral blood flow and cerebral blood volume of the patients were decreased. The time to peak of the contrast agents was shortened in patients of the combined revascularization group and it was prolonged in those of the indirect revascularization group, but there was no significant difference (P > 0. 05). (2)The mean transit time of the contrast agents was increased at 7 days after procedure in patients of both groups. The combined revascularization group was 4.5 �� 0. 6 s before procedure and at 7 days after procedure was 4.7 �� 0. 6 s. There was significant difference ( P = 0. 045 ). Although the mean transit time of the contrast agents was increased in the indirect revascularization group, but there was no significant difference. Conclusion The combined cerebral revascularization methods can increase the cerebral blood flow perfusion in a short time; however, there is no significant change in the state of cerebral ischemia. After indirect cerebral revascularization, cerebral blood flow perfusion have no significant change.