Atypical meningioma accounts for about 4.7% to 7.2% of all kinds of meningiomas, which is invasive with a relatively high recurrence and mortality. The objective of this study was to investigate the clinical manifestations and therapeutic strategies of atypical meningioma.A total of 74 patients who underwent surgical treatment and pathologically confirmed for atypical meningioma in Neurosurgery Department of Beijing Tiantan Hospital from January 2003 to December 2008 were enrolled in this study. The characteristics of the tumors as well as therapeutic regimens and follow-up data were reviewed. After surgery, 56 patients underwent radiotherapy. Patients were followed up for about 3.5 years (range, 0.5 - 6.0 years), and 58 patients completed follow-up.Of the 58 patients who completed follow-up, good recovery was found in 30, neurological dysfunction in 15, and death in 13. Of the 58 patients, 21 had recurrent meningioma and 18 underwent a second surgery.Atypical meningioma is difficult to manage, with a high recurrence rate and poor survival. The extent of tumor resection and histological grade are the key determinants of outcome. Radiation therapy can be used as an adjunctive treatment after total or partial resection.
To study the role of neuro-endoscope in the intracranial aneurismal surgery, analyzing its benefits, and disadvantages.Endoscopy was used as an adjunct in the microsurgical treatment of clipping aneurysms on 88 patients with 89 aneurysms, of which 82 aneurysms in 81 patients were located in the anterior circulation and 7 were located in the posterior circulation. Keyhole approach was performed on all patients, and micro-Doppler ultrasound technique was used before and after clipping. In 84 aneurysms, endoscope-assisted microneurosurgery (EAM) was used in addition to microsurgical dissection and clipping so as to observe the neck anatomic features and perforators and to verify the optimal clipping position. Endoscope-controlled microneurosurgery was used for 5 aneurysms to observe the anatomy around aneurysm, such as the posterior communicating artery and the opposite anterior communicating artery behind the internal carotid artery.Postoperative angiography performed on 86 patients showed satisfactory aneurysm clipping. Operative mortality was 0. There were 7 cases of postoperative complications, with an incidence rate of 7.95%, and none case was directly related to endoscopy.Improving observation of regional anatomy because of its ability in magnification, illumination, and looking around dead angle, neuro-endoscopy is very useful for complex aneurysms.
This paper summarizes the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions revised by the Agency for Healthcare Research and Quality (AHRQ) and introduces how to use Revman software make risk of bias graph or risk of bias summary. AHRQ tool can be used to evaluate following study designs: RCTs, cohort study, case-control study (including nested case-control), case series study and cross-sectional study. The tool evaluates the risk of bias of individual studies from selection bias, performance bias, attrition bias, detection bias and reporting bias. Each of the bias domains contains different items, and each item is available for the assessment of one or more study designs. It is worth noting that the appropriate items should be selected for evaluation different study designs instead of using all items to directly assess the risk of bias. AHRQ tool can be used to evaluate risk of bias individual studies when systematic reviews of health care interventions is including different study designs. Moreover, the tool items are relatively easy to understand and the assessment process is not complicated. AHRQ recommends the use of high, medium and low risk classification methods to assess the overall risk of bias of individual studies. However, AHRQ gives no recommendations on how to determine the overall bias grade. It is expected that future research will give corresponding recommendations.本文对美国卫生保健研究和质量机构（Agency for Healthcare Research and Quality，AHRQ）推荐的干预性研究偏倚风险评价工具的主要内容进行详细解读，并展示如何使用Revman软件制作偏倚风险评价图。AHRQ偏倚风险评价工具是一种综合评价工具，可用来评价常见的研究设计类型（随机对照试验研究、有对照的临床试验研究、队列研究、病例对照研究、病例系列研究、横断面研究）的偏倚风险。该工具从选择偏倚、实施偏倚、随访偏倚、测量偏倚、报告偏倚5个领域来评价研究的偏倚风险，每个领域含有不同的条目，每个条目适用于评价1种或几种研究设计类型。值得注意的是应根据不同的研究设计类型选择相应的条目进行评价而不是直接使用所有条目进行偏倚风险评价。当1个干预性研究的系统综述纳入了多种研究设计类型时，只需要用AHRQ工具就可以评价纳入研究存在的常见偏倚风险，省去了使用不同偏倚风险工具进行偏倚风险评价的繁琐过程。该工具条目相对简单易懂，评价流程不复杂。AHRQ推荐使用高、中、低的偏倚风险分类方法评价纳入研究总体偏倚风险的高低，但是，其对如何判定总体偏倚风险的高低没有给出推荐意见，如何具体判定干预性研究偏倚风险等级的界值，仍有待更多这方面的研究结果。.
The Bawang deposit, a newly discovered Fe-Zn-Sn deposit occurred in the paleokarst in the Youjiang Basin, South China, offers an excellent opportunity to understand the ore-forming process and genesis of this unique tin mineralization, thus enriching the tin mineralization theories. Mineralogy, X-ray photoelectron spectroscopy (XPS), and laser ablation-inductively coupled plasma-mass (LA-ICP-MS) analysis were performed on sphalerite to investigate the fluid evolution and mineralizing process of the Bawang deposit. The formation of the deposit involved hydrothermal-cassiterite-sulfides and oxidation periods. The hydrothermal-cassiterite-sulfides period is dominated by the mineralization of Zn- (stage 1), Sn- (stage 2), and Sb- (stage 3) in order. Three types of sphalerite were identified in these hydrothermal stages. Mineralogical studies and spectrum data show that the massive sphalerite in stage 1 (Sp1) is euhedral coarse-grained and characterized by high Fe contents (9.67–15.69 wt%), with obvious pyrrhotite blebs, pyrite laths, stannite and/or chalcopyrite solid solutions. The sphalerite with 5.56–11.31 wt% Fe contents in stage 2 (Sp2) occurs as fine-grained, euhedral to subhedral crystals (15–50 μm) and coexists with cassiterite, arsenopyrite, and quartz. The sphalerite in stage 3 (Sp3) is characterized by low Fe content (0.59–2.99 wt%) and is generally micro-fine-grained (10–25 μm) associated with stibnite, sulfosalts, and carbonates. LA-ICP-MS analyses of sphalerite suggest that Sp1 and Sp2 have similar characteristics and are enriched in Fe, Cu, Sn, Ga, and Cd, whereas Sp3 is enriched in Sb, Pb, Ag, Bi, and Tl. The principal component analysis (PCA), boxplots, and bivariate plots of trace elements from sphalerite, combined with previous Raman spectroscopy data for fluid inclusions and H-O-Cd isotopic compositions, indicate two types of ore-forming fluids were involved in the mineralization of the Bawang deposit. The early Fe-Zn-Sn-Cu-In-rich fluids originated from granitic magma and underwent Zn- and Sn-dominated mineralization in order in a slowly cooling closed system. The later hydrothermal fluids with the addition of oil field brine were enriched in Sb, Pb, Ag, and Bi elements in the Sb-sulfosalts-carbonates stage in an open system with a drop in temperature. The mineralization process of the Bawang deposit can be concluded as follows: The early ore-forming fluids derived from an inferred concealed intrusion infilled into the paleokarst (below 350 m of the altitude) and caused the massive euhedral ferroan sphalerite (stage 1) to precipitate. The deposition of sphalerite decreased sulfur fugacity (fS2) in a slowly cooling closed system, and increased relative oxygen fugacity (fO2) which promoted cassiterite to precipitate in stage 2. The foreign hydrothermal fluids lowered the temperatures of residual ore-forming fluids due to the addition of oil field brine. Then the Pb-Sb sulfides and Pb-Sb-Ag-Bi-bearing sulfosalts (stage 3) crystallized at shallow depths (350 to 500 m of the altitude).
Abstract Evidence for the treatment of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) is limited. The efficacy of N-acetylcysteine (an antioxidant and mucolytic agent) for patients with mild-to-moderate COPD is uncertain. In this multicentre, randomised, double-blind, placebo-controlled trial, we randomly assigned 968 patients with mild-to-moderate COPD to treatment with N-acetylcysteine (600mg, twice daily) or matched placebo for two years. Eligible participants were 40–80 years of age and had mild-to-moderate COPD (forced expiratory volume in 1 second [FEV1] to forced vital capacity ratio < 0.70 and an FEV1 ≥ 50% predicted value after bronchodilator use). The coprimary outcomes were the annual rate of total exacerbations and the between-group difference in the change from baseline to 24 months in FEV1 before bronchodilator use. COPD exacerbation was defined as the appearance or worsening of at least two major symptoms (cough, expectoration, purulent sputum, wheezing, or dyspnoea) persisting for at least 48 hours. Assessment of exacerbations was conducted every three months, and lung function was performed annually after enrolment. The differences between the N-acetylcysteine group and the placebo group in the annual rate of total exacerbations were not significant (0.65 vs. 0.72 per patient-year; relative risk [RR], 0.90; 95% confidence interval [CI], 0.80–1.02; P = 0.10). There was no significant difference in FEV1 before bronchodilator use at 24 months. Long-term treatment with high-dose N-acetylcysteine did not significantly reduce the annual rate of total exacerbations and did not improve lung function in patients with mild-to-moderate COPD. Chinese Clinical Trial Registration: ChiCTR-IIR-17012604.
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