Volume 86  ·   Issue 11  ·  2006

Objective to summarize the clinical manifestations, treatment and prognosis of neuropsychiatric lupus (NPSLE). Methods 240 patients with NPSLE were retrospectively analyzed. According to the classification criteria of American College of Rheumatology (ACR) in 1999, the patients with NPSLE were classified, and the efficacy of intrathecal injection of methotrexate (MTX) and dexamethasone (DXM) in the treatment of NPSLE was analyzed. Results 240 patients showed 15 kinds of neuropsychiatric symptoms, the most common were lupus headache and epileptic seizure, and 64.2% (154/240) patients had two or more neuropsychiatric symptoms at the same time. 109 patients received intrathecal injection. The activity index of lupus disease (SLEDAI, 6 ± 5), mean hospitalization days (39 days ± 22 days) and hospitalization mortality (6.6%) were significantly lower than those in the control group (10 ± 6, 46 days ± 26 days, 14.8%) (P<The incidence of side effects of intrathecal injection was 11.0% (12/109). Among the 130 follow-up patients, 23 cases had recurrence, and 7 cases were relieved after intrathecal injection. Conclusion The clinical manifestations of neuropsychiatric lupus are diverse, and the common ones are lupus headache and epileptic seizure.Intrathecal injection of MTX and DXM can significantly improve the prognosis of NPSLE.

Objective to summarize the experience of surgical treatment of cardiac tumors.Methods the data of 494 cases of cardiac tumor in Fuwai Cardiovascular Hospital of Chinese Academy of Medical Sciences in the past 30 years were retrospectively analyzed, aged 43 ± 16 years (4 months ~78 years), including 432 cases of myxoma, 27 cases of non-mucinous benign tumor and 35 cases of malignant tumor.Results 11 cases died from myxoma operation (2.5%), none died from non-mucinous benign tumor and 3 cases died from malignant tumor operation (8.6%). 241 cases of myxoma operation from January 1990 to July 2004 were followed up, 17 cases were lost to follow-up, the follow-up rate was 92.9%, the average follow-up period was 70 months ± 36 months; There were 10 long-term deaths, 5 cases of recurrence, 5 cases of unknown cause, 10 cases (28.6%) of malignant tumors were completely resected, 15 cases (42.9%) of malignant tumors were mostly resected, and 10 cases (28.6%) of malignant tumors were only biopsied due to extensive invasion and metastasis; The mean follow-up time was 21 months ± 12 months (4-38 months); 18 cases (51.4%) died of recurrence or metastasis within 3 months to 2 years; 5 cases were lost to follow-up.Conclusion Surgical treatment of benign cardiac tumors has good short-term and long-term effects, but the surgical treatment of malignant cardiac tumors is very poor.

Objective to investigate the clinical characteristics and surgical strategies of cervical and lumbar spine diseases. Methods The clinical characteristics and follow-up results of 53 cases of cervical and lumbar spine diseases were summarized. 19 cases underwent simple cervical spine surgery, 16 cases underwent simple lumbar spine surgery, and 7 cases underwent combined cervical and lumbar spine surgery. All patients were recorded by JOA score. Results The lesions of cervical and lumbar spine were mostly cervical and lumbar spine stenosis. 31.4% (11/35) patients underwent sequential cervical and lumbar interruption surgery, the improvement rate was 78.4%, the excellent and good rate was 78.5%, 13.6% (6/44) patients underwent simple cervical and lumbar spine surgery, the improvement rate was moderate, and 6.8% (3/44) patients underwent two surgeries, the improvement rate was moderate. 5 cases missed diagnosis at the first surgery, 29 cases were judged to have main lesions before surgery, and 25 cases were followed up, the improvement rate was 76.5%, the excellent and good rate was 96.0%. Conclusion Cervical and lumbar spine lesions are mostly cervical and lumbar spinal stenosis, and the common basis of spinal stenosis and intervertebral disc herniation is spinal degeneration.

Objective to evaluate the effect of conservative treatment on the stability of distal radius fractures. Methods 103 patients with distal radius fractures were selected as the study subjects. All patients were treated with closed plaster external fixation in the emergency department of our hospital, and were re-examined at 1, 2 and 4 weeks respectively. The patients underwent standard anterolateral X-ray examination before and after reconstruction and each re-examination. These fractures were classified by Cooney classification, and the displacement value, palm inclination angle, ulnar deviation angle, radius shortening were accurately measured on each X-ray, and the separation and collapse of the radiocarpal joint surface were marked. Combined with Lidstrm scoring system, the imaging effects after plaster removal were divided into acceptable and unacceptable groups. Finally, the imaging effects of different Cooney classifications were evaluated by Pearson Chi-Square test, likelihood test and Kendall correlation analysis. Results 69.9% of 103 fractures were acceptable after conservative treatment. Among them, the results of distal radius fractures of Cooney classification type 1, type 2 and type 3 were satisfactory after conservative treatment. The proportions of acceptable results were: 90%, 88.5%, 88.9%.Only 28.1% of type 4 fractures reached the acceptable standard after conservative treatment.There was a significant difference between the effects of different Cooney classifications.19 cases (36.8%) of type 2 fractures remained displaced after conservative treatment,84.2% of them were displaced within 1 week of plaster fixation.21 cases (65.6%) of type 4 fractures remained displaced after conservative treatment, and 85.7% of fractures were displaced within 1 week of plaster fixation.Conclusion Most of the distal radius fractures can achieve good results after conservative treatment.Type 1, 2 and 3 of distal radius fractures in Cooney classification are more stable after manual reduction,so manual reduction and plaster external fixation should be the first choice for treatment. However, type 4 is extremely unstable, and the proportion of unsatisfactory effects of conservative treatment is higher, so it is best to use surgical treatment to obtain better therapeutic effect.Moreover, we should pay attention to the re-examination of these fractures within 1~2 weeks after manual reduction, so as to take effective measures in time.

Objective to analyze the risk factors affecting the survival rate of severe multiple trauma complicated with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Methods the data of 171 patients with severe multiple trauma complicated with ALI/ARDS (76 cases in ALI group and 95 cases in ARDS group) were retrospectively analyzed, and 20 possible risk factors affecting the survival rate were analyzed by multivariate stepwise Logistic regression.Results the risk factors affecting the survival rate of ALI group were smoking (B = -5.235, OR =0.005, P =0.001), secondary sepsis after trauma (B = -2.753, OR =0.064, P =0.031), gastrointestinal hemorrhage (B = -2.876, OR =0.056, P =0.033); The risk factors affecting the survival rate in ARDS group were: trigger persisted until onset (B =3.524, OR =33.933, P =0.008), secondary sepsis after trauma (B = -5.183, OR =0.006, P =0.004), renal insufficiency (B = -4.745, OR =0.009, P =0.009), gastrointestinal hemorrhage (B = -6.335, OR =0.002, P =0.007). Under the condition of severe multiple trauma, the earlier the onset of ALI/ARDS, the lower the predicted survival rate; Under the condition of lung damage, if renal insufficiency is complicated, MODS is easily induced; Sepsis and gastrointestinal hemorrhage are still the risk factors of infectious or induced infection that affect the survival rate after trauma, and the primary disease leading to infection must be actively treated.

Objective to investigate the inhibitory effects of vascular endothelial growth factor (VEGF) antisense oligonucleotide (VEGF) and low molecular weight heparin (LMWH) alone or in combination on the growth and metastasis of Lewis lung cancer in mice. Methods Forty mice with Lewis lung cancer were replicated and randomly divided into control group, VEGF antisense oligonucleotide (ASODN) group, VEGF missense oligonucleotide (MSODN) group, low molecular weight heparin (LMWH) group and combination treatment group. Eight mice in each group were given normal saline, VEGF-ASODN, VEGF-MSODN, faramine and VEGF-ASODN + faramine subcutaneous injection once every other day for 15 times. The microvessel density (MVD) of tumor tissue was detected by immunohistochemistry; The expression of VEGF protein in tumor tissues was examined by Western blot. Results the tumor inhibition rates of ASODN, LMWH and combined therapy groups were 47.34%, 27.31% and 59.03%, respectively; The lung metastasis rates were 37.5%, 37.5% and 25%, respectively; The expression of MVD and VEGF protein was decreased; Compared with the control group and MSODN group, the tumor inhibition rate and MVD were significantly different (P<0.05). Conclusion VEGF-ASODN and phamamine have down-regulated VEGF expression and anti-angiogenesis effects; The combination of the two has a synergistic anti-tumor effect.

Objective to investigate the effects of carotid thrombolysis on regional cerebral blood flow and cerebral water content in rabbit cerebral venous sinus thrombosis model.Methods Thirty-nine New Zealand rabbits were divided into thrombolysis group (12 rats, urokinase 0.4 kg·1·d-1 through carotid artery for 5 days), anticoagulation group (12 rats, heparin 2 mg·kg-1·d-1 through external jugular vein for 5 days) and control group (15 rats, normal saline pumped into carotid artery). The changes of regional cerebral blood flow and cerebral water content were measured by laser Doppler instrument before and after treatment. Results The percentage of regional cerebral blood flow after treatment was significantly higher in the thrombolysis group (94.8%±0.3%) than that in the anticoagulation group (88.6%±0.3%) and the control group (80.9%±0.3%, both P<0.01), and the difference between the anticoagulation group and the control group was statistically significant (P<0.01); After treatment, the cerebral water content in the thrombolytic group (78.9%±0.3%) was lower than that in the anticoagulant group (81.8%±0.7%) and the control group (82.1%±1.0%, both P<0.05). Conclusion The effect of urokinase suppository injected into the carotid artery in the treatment of venous sinus thrombosis is positive. Even if the venous sinus cannot be opened, the local cerebral blood flow and cerebral water content still improve significantly.

Objective to investigate the mechanism of peroxisome proliferator-activated receptor γ (PPAR γ) agonist blocking renal interstitial fibrosis induced by transforming growth factor (TGF) β 1 and to explore its potential effect against renal interstitial fibrosis. Methods Rat renal fibroblast cell line (NRK/49F) was cultured in vitro to observe the effects of PPAR γ ligand 15d-PGJ2 and its agonists troglitazone and zioglitazone on the expression of fibronectin (FN) mRNA induced by TGF β 1. The effects of PPAR γ agonist on the expression of FN and Smad protein induced by TGF β 1 were observed by Western blot technique. Results (1) Compared with 1ng/ml TGF β 1 group, the expression of FN mRNA in 5ng/ml TGF β 1 group increased by 3.6 times (P<0.01), 5 ng/ml TGF β 1 increased by 2.4 times when stimulated for 24 h compared with that before stimulation (P<(2) Compared with the 5 ng/ml TGF β 1 group, the expression of FN mRNA in the 10 μ mol 15d-PGJ2, troglitazone and zioglitazone pretreated groups decreased by 37.3%, 41.5% and 22.7%, and the expression of FN protein decreased by 20.6%, 38.1% and 28.6%, respectively. (3) The expression of p-Smad2/3 protein increased in a time-dependent manner (0~2 h) by 5 ng/ml TGF β 1, and reached the peak at 1 h; The expression of p-Smad2/3 protein in the 5 ng/ml TGF β 1 group increased by 3.42 fold and 0.97 fold compared with the control group and the 2 ng/ml TGF β 1 group, respectively. (4) The expression of p-Smad2/3 protein in the 15d-PGJ2, troglitazone and sioglitazone pretreated groups decreased by 61.2%, 53.0% and 59.5% compared with the 5 ng/ml TGF β 1 group, respectively. There was no statistically significant difference in the expression of p-Smad2/3 protein between the three drug intervention groups, and there was no significant change in the expression of Smad2 and Smad3 protein in each group. Conclusion PPAR γ agonist can inhibit TGF β 1-induced extracellular matrix synthesis in renal interstitial fibroblasts, and its mechanism may be related to blocking TGF β 1/Smad signaling pathway, which suggests that PPAR γ agonist has a potential effect on anti-renal interstitial fibrosis, and may be one of the new therapeutic methods to delay end-stage renal failure.

Objective to integrate the concept of minimally invasive keyhole surgery into the distal lateral approach, and design the distal lateral transcondylar and jugular nodule keyhole approach with the assistance of neuronavigation, so as to explore the feasibility of accurately abrasion of some occipital condylar and jugular nodules, and provide evidence for clinical application. Methods Eight Chinese adult cadavers fixed with formalin and intracranial arteriovenous latex perfusion were used to establish intraoperative navigation data before the experiment. The range of occipital condylar and jugular nodules to be abrased was marked with different colors in the navigation system. The "S" 7 cm incision of posterior occipital condylar keyhole surgical approach was used, and the muscles were flipped layer by layer, and the bone window with a diameter of about 3 cm was made. With the assistance of neuronavigation, the occipital condylar 1/3, 1/2 and jugular nodules were abrased in sequence. The differences in exposed structures were observed and the exposed length was measured, and the maximum visual field exposure angle before and after occipital condylar abrasion was calculated. Results (1) The incision of posterior occipital condylar keyhole surgical approach can fully meet the requirements of transcondylar and jugular nodule keyhole approach. (2) Under the premise of preoperative planning, Neuronavigation can assist in accurate abrasion of 1/3~1/2 of occipital condyle and jugular vein nodules, thus avoiding craniocervical instability caused by blind abrasion of condyle. (3) The maximum visual field exposure angles before abrasion, 1/3 and 1/2 of occipital condyle abrasion are (39.2±3.3) °, (51.5±2.5) ° and (57.5±2.7) °, respectively; The maximum visual field exposure angle after 1/3 and 1/2 of occipital condyle abrasion was significantly different from that before abrasion (P<Conclusion the distal lateral transcondylar transjugular nodule keyhole approach is feasible; Abrasive part of occipital condyle can significantly increase the exposure angle of surgical field, and abrasive jugular vein nodule can increase the exposure of middle slope.

Objective to investigate the effect of human leukocyte antigen (HLA) DRB1·0405 small interfering RNA (siRNA) on the expression of HLA-DRB1*0405 protein associated with rheumatoid arthritis (RA). Methods HLA-DRB1*0405 protein expression plasmid siCHECKTM-2/HLA-DRB1*0405 was constructed. Six short hairpin RNA (shRNA) expression plasmids and one shRNA expression plasmid against unrelated sequence were designed and constructed for HLA-DRB1*0405 gene sequence. Two plasmids were transiently co-transfected into human embryonic kidney cells 293 with liposomes. Only HLA-DRB1*0405 protein expression plasmid was transfected as a negative control. The expression of HLA-DRB1*0405 mRNA in 293 cells was detected by real-time fluorescence quantitative PCR. The levels of HLA-DRB1*0405 protein in 293 cells were analyzed by measuring luciferase intensity. Results the six HLA-DRB1*0405 siRNAs designed could inhibit HLA-DRB1*0405 to different degrees

Emergency medical service network is an important component of public health system, which directly relates to people's life and health and the overall situation of reform, development and stability. How to plan and build emergency medical service network, so that it can adapt to the development of social economy and people's demand for emergency medical service, is an important task in front of governments at all levels and health administrative departments. In recent years, we have discussed the planning and construction of emergency medical service network in combination with the construction of emergency medical service network in Xuzhou.

A 47-year-old female suffered from numbness on the left side of her face for more than 2 months, accompanied by paroxysmal headache and intermittent tinnitus for more than 1 month, aggravated for 1 week. Two months ago, she developed numbness on the left side of her face without obvious trigger, and was treated symptomatically in another hospital, but the curative effect was not good. One month ago, she developed headache and dizziness, each time lasting for about 2~3 minutes, and tinnitus from time to time. 　　

Chronic low back pain is the most common disease in orthopedics. It has been believed that lumbar intervertebral disc herniation is the main cause of low back pain for a long time. Recent studies have found that low back pain mainly originates from the interior of lumbar intervertebral disc, the appearance of lumbar intervertebral disc is normal, there is no lumbar intervertebral disc herniation, and the myelography and CT scan are normal.

Juvenile idiopathic scoliosis (AIS) is a disease manifested by asymmetric spinal rotation. Just as "idiopathic" in its name, although scholars have done a lot of research, its etiology is still unknown, which brings difficulties to its early intervention and early treatment. Epidemiological research of AIS can help people to further understand the development law of AIS disease. We summarize the epidemiological research progress of AIS from the aspects of distribution law, risk factors, early screening and prognosis of AIS.

In recent years, with the increase of public attention to public health problems and health emergencies, more units and individuals join in the statistical reporting of public health results, so it is very necessary to standardize the statistical model standards of public health survey results reporting. Cardiovascular diseases are the main threat to public health nowadays. In the past 20 years, many research groups have found that: the performance of statistical results organizers in the process of cardiovascular prevention and health care will affect the accuracy of statistical results; At present, some national public health reporting systems are based on the registration system of clinical cases in hospitals, and the performance of registrants is directly related to the accuracy of statistical results and the quality of medical care.

Noise is an environmental harmful factor that people are exposed to extensively in life and production. It is known that long-term exposure to noise can cause damage to many human organs and systems, and the cumulative effect and dose-response relationship of noise on health hazards can be observed in human and animal experiments. In the study of biological effects caused by noise, the harm of complex noise on health is a problem that has not been completely solved. Based on the previous research work, we systematically introduce the research progress of kurtosis in evaluation of biological effects caused by noise.

Behcet's disease is a kind of multisystem vasculitis with unknown etiology, which is typically manifested as a triad: recurrent oral ulcer, vulvar ulcer and membranitis pigmentosa. Besides, it often involves joints, large blood vessels, digestive system and nervous system, etc. The involvement of nervous system is called neuro-Behcet's disease.

status epilepticus (SE) can cause selective apoptosis of neurons in hippocampus and other structures [1]. growth arrest and DNA damage-inducible protein 153 (GADD153) is one of the important molecules that mediate endoplasmic reticulum stress-related apoptosis [2]. Whether it is involved in SE-induced apoptosis is not reported by the author. In this study, the expression changes of GADD153 mRNA in hippocampus were dynamically observed by using lithium chloride-pilocarpine SE model in rats.

Human leukocyte antigen G (HLA-G) is a non-classical human leukocyte antigen class I gene, which plays an important role in maternal-fetal immune tolerance. In this study, the expression of HLA-G in placental tissues of patients with normal pregnancy and severe preeclampsia was compared at mRNA and protein levels by real-time fluorescence quantitative RT-PCR and Western blot, respectively, to explore the role and clinical significance of HLA-G in the pathophysiological process of preeclampsia.

9 patients (13-25 years old, median age 16.6 years old) with pectus excavatum complicated with congenital heart disease were admitted to our hospital, including 2 cases with Marfan syndrome, 4 cases with ventricular septal defect and 3 cases with atrial septal defect. All patients had symptoms such as chest pain, shortness of breath, easy fatigue and repeated respiratory tract infection at the time of admission. Congenital heart disease was confirmed by color ultrasound examination. Two cases showed right bundle branch block and ST segment elevation of V3 lead (maximum 2 cm) on electrocardiogram. Chest X-ray showed different degrees of heart compression. Almost all patients had different degrees of psychological problems, manifesting as depression, autism, obvious reduction in social activities and contact with people. At the same time, they showed a unique so-called "pectus excavatum posture", namely oblique shoulders, hunched back and convex abdomen.