Volume 86  ·   Issue 31  ·  2006

Objective to enrich the therapeutic methods of hip dysplasia and elderly developmental hip subluxation.Methods Extracapsular groove bone grafting, external plate clamping and clamped acetabular enlargement were used to treat 15 children (20 hips, 5 cases were both hips) with developmental hip dysplasia and elderly hip subluxation.The efficacy evaluation criteria of congenital hip dislocation were used to evaluate the subjective sensation, clinical examination and X-ray examination of the children. Charnley score and Harris score were used as the control.Results the clamped acetabular enlargement with crossed mesh external plate clamping and bone grafting could greatly improve the acetabular containment, the maximum improvement was increased from 65% to 85%, and the minimum improvement was increased from 75% to 90% in 20 hips.The acetabular coverage was more than 85%, and the acetabular index was less than 25°.Conclusion clamped acetabular enlargement is a safe and complex anatomical design of external plate clamping and crossed mesh bone grafting, which can effectively enlarge the acetabular containment area and make it more stable.

Objective to investigate the methods and complications of treatment of adult cubitus varus deformity after trauma. Methods From April 1999 to September 2005, 32 cases of adult cubitus varus deformity were treated by lateral closed wedge osteotomy. Complete follow-up data were obtained in 28 cases. The average follow-up was 40 months. The relationship between the surgical approach, ulnar nerve management, internal fixation method and external fixation time and the final results and complications was analyzed. Results Of the 28 cases, 27 cases healed well after osteotomy, 1 case healed delayed, 18 cases were corrected well, 6 cases had varus less than 10 degrees, 4 cases were over-corrected, 5 cases had ulnar neuritis or aggravated ulnar neuritis symptoms after operation, and 1 case had median nerve injury. The average elbow flexion decreased by 11 degrees and elbow extension decreased by 3.4 degrees after operation, of which 5 cases elbow flexion decreased by more than 20 degrees, 4 cases elbow flexion decreased by 120 degrees or less, and 2 cases of postoperative internal fixation failure, all of which were fixed by Kirschner wire after osteotomy. Conclusion Precise osteotomy plan before operation, good soft tissue protection during operation, Appropriate ulnar nerve management and relatively stable internal fixation are important factors in determining elbow function and reducing complications after lateral closed wedge osteotomy.

Objective to investigate the anatomy of the medial temporal lobe and its relationship with the surrounding structures. Methods Twenty cadaveric heads infused with colored latex were dissected under microscope, and the image data were observed and obtained. Results the hippocampus, umbrella, amygdala and choroidal fissure in the medial temporal lobe were intraventricular structures, while the uncinate, parahippocampal gyrus and dentate gyrus were extraventricular structures. The anterior segment of the uncinate faced the lateral fissure cistern, internal carotid artery and middle cerebral artery, the posterior segment faced the cerebral foot, and the tip of the uncinate pointed to the oculomotor nerve and posterior communicating artery. The medial side of the uncinate was adjacent to the posterior cerebral artery, anterior choroidal artery and optic tract.

Objective to evaluate the effects of evoked potentials,continuous EEG monitoring and transcranial Doppler on the monitoring of brain function and prognosis of patients with severe cerebrovascular disease.Methods 32 patients with severe cerebrovascular disease admitted to nerve enhancement ward (N-ICU) were collected and divided into two groups according to GCS scores: severe group (GCS ≤8 scores) and non-severe group (GCS>8 scores). After admission, the brainstem auditory evoked potentials and somatosensory evoked potentials were monitored by Poseidon electromyograph and divided into three grades according to CANT. The performance of auditory evoked potentials and somatosensory evoked potentials in severe group and non-recombinant brainstem were compared, and the relationship between different grades of brainstem auditory evoked potentials and somatosensory evoked potentials and prognosis was compared. The bedside continuous EEG monitoring was carried out with the Solar 2000 multi-function monitor of Sun Technology Co., Ltd., and the EEG grading was carried out by Young's EEG grading standard. The EEG manifestations of the severe and non-severe groups were compared, and the relationship between different EEG grades and prognosis was compared. Using Nicolet-EME TC-2002-Ⅲ transcranial Doppler instrument and 2 MHz pulsed Doppler probe, the blood flow velocity of cerebral arteries was measured through temporal window or ocular window. According to the blood flow velocity, the blood flow velocity of cerebral arteries was divided into: (1) group with increased blood flow velocity; (2) decreased blood flow velocity group; Results (1) The mortality rate of the severe group was 42.86%, which was significantly higher than that of the non-severe group (22.22%), while the good rate of the non-severe group was 33.33% and the improvement rate was 44.44%, both of which were significantly better than that of the severe group. (2) The mortality rate of the severe group was higher than that of the non-severe group (P<0.05), and the prognosis was relatively good. (3) The results of continuous EEG monitoring in 32 cerebrovascular patients showed that most of them showed Young grade Ⅰ and Ⅱ, and the mortality rate of grade Ⅱ (63.64%) was significantly higher than that of grade Ⅰ (14.29%), while the prognosis of grade Ⅰ EEG patients was relatively good. (4) The relationship between the severity of the disease and prognosis of the patients with increased blood flow velocity, decreased blood flow velocity or normal blood flow velocity by transcranial Doppler is still uncertain, Conclusion Continuous bedside monitoring of brainstem auditory evoked potentials, somatosensory evoked potentials and EEG can accurately and objectively evaluate the brain function of patients with severe cerebrovascular disease, and can predict the prognosis and guide the treatment. The relationship between blood flow velocity and mild and severe disease and prognosis of severe cerebrovascular disease needs further research.

Objective to observe the occurrence and changes of depression in patients undergoing coronary artery bypass grafting (CABG) before and after surgery. Methods the patients were divided into CABG group under cardiopulmonary bypass (ONCAB) and CABG group without cardiopulmonary bypass (OPCAB). The Beck depression questionnaire (BDI) was self-assessed within one week before surgery, three months after surgery and six months after surgery. The preoperative total score was greater than 5.77 points, showing a depressive state, and the postoperative improvement was 4.12 and 3.06 points, respectively; At different times after operation, although the scores of the depression group decreased, they were still relatively high (14.18 and 12.76 at 3 and 6 months after operation, respectively, and 4.07 and 23.06 in the group without significant depression); In the postoperative depression group, most of them left their original jobs (16% and 21% continued to work, respectively, compared with 25% and 30% in the non-obvious depression group), angina pectoris occurred relatively more (12% and 15% at 3 and 6 months after operation, respectively, and 5% and 24% in the non-obvious depression group), and the proportion of women gradually increased (23% and 27% at 3 and 6 months after operation, respectively, and 16% and 18% in the non-obvious depression group); There was no significant difference in depression scores between OPCAB and ONCAB groups before and after surgery. Conclusion CABG patients had different degrees of depression before surgery; The depression after operation improved significantly with the prolongation of time; Preoperative depression may predict the occurrence of postoperative depression; There was no statistically significant difference in depression scores between the ONCAB and OPCAB groups at different postoperative time points.

Objective to evaluate the clinical value of anti-cyclic citrulline peptide (CCP) antibody in the diagnosis of rheumatoid arthritis (RA). Methods Cochrane Library, PubMed database, EMBASE database, OVID evidence-based medicine database and Chinese biomedical literature database were searched from January 2000 to December 2005, and Ann Rheum Dis and related gray literature were specially searched. The literature was screened according to the inclusion criteria recommended by Cochrane Collaborative Network, and the included studies were comprehensively and quantitatively evaluated by MATLAB software, Review Manager 4.2 software and "Adjusting SROC method". Results A total of 22 Chinese and English literatures were included. The sensitivity and specificity of anti-CCP antibody in the diagnosis of RA ranged from 39.2% to 84.6% and 90% to 97.9%. The weighted sensitivity, specificity and 95% confidence interval calculated according to the random effects model were 77.3% (63.1%, 89.2%) and 93.85% (85.5%, 98.1%), respectively. The corresponding positive and negative likelihood ratios were 12.0 and 0.24. The area under the fitted SROC curve was 0.8976 and the Q value was 0.87. Further pooled analysis of the course of disease less than 1 year and more than 1 year showed that the sensitivity and specificity of the study layer were 43%, 94.2%, 70.2% and 95.2%, respectively, and the difference in sensitivity and specificity was statistically significant (P<0.001) but not statistically significant (P =0.94). Conclusion Anti-CCP antibody has high sensitivity and specificity in diagnosing RA, which can guide clinical diagnosis on the premise that it may affect the evaluation results comprehensively.

Objective to establish an animal model of chronic optic nerve injury and provide a basis for further experimental studies.Methods A balloon was implanted under the chiasmatic optic nerve in cats by imitating the clinical pterional approach.The balloon was gradually enlarged by fractional injection of contrast medium, which caused chronic compression of the chiasmatic optic nerve.Retinal ganglion cells (RGC) were retrograde labeled with DiI 2 weeks before surgery, and flash visual evoked potential (F-VEP) was recorded at 1, 2, 4 and 8 weeks after compression, respectively.The retina and optic nerve were observed under light microscope and electron microscope, and the RGC was counted. The optic nerve began to appear demyelination at 2 weeks, and the lesions aggravated with time. The axonal degeneration appeared at 4 weeks, and the degeneration was more obvious at 8 weeks. Slight demyelination and cytoskeletal disorder were observed in optic nerve at 2 weeks, demyelination and axonal degeneration were further aggravated with time, and remyelination was observed at 8 weeks. RGC count showed a decrease of about 37% (293/465) at 8 weeks. F-VEP began to appear abnormal in 4 weeks group, and the change was more obvious in 8 weeks group. Conclusion The established chronic optic nerve compression injury model is stable, reliable and easy to repeat. The pathological changes after chronic optic nerve compression gradually aggravated with the prolongation of compression time and the increase of compression degree, and secondary degeneration of retina occurred, which was obviously later than axonal degeneration.

Objective to investigate the effects of biomarkers FHIT, Bcl-2 and Bax on the choice of postoperative chemotherapy and the prognosis of patients with chemotherapy. Methods 100 cases of invasive ductal carcinoma of breast were retrospectively analyzed by HE and SP immunohistochemical staining. The relationship between the expression of biomarkers in invasive ductal carcinoma of breast and tumor biological characteristics, tumor-free survival time and overall survival time was studied. Results The positive rates of biomarkers were 73% for FHIT, 50% for Bcl-2 and 34% for Bax, respectively. The expression of FHIT and Bcl-2 was positively correlated (r =0.3290), and the expression of FHIT and Bcl-2 was negatively correlated with histological grade, the higher the grade, the lower the expression. The tumor-free survival time and overall survival time of patients with positive expression of FHIT and Bcl-2 were longer than those with negative expression of FHIT and Bcl-2. The average tumor-free survival time after chemotherapy (56.8 months) was longer for those with positive expression of FHIT than that of those with negative expression of FHIT (35.8 months), and the average tumor-free survival time after chemotherapy (54.8 months) for those with positive expression of Bcl-2 The mean tumor-free survival time of 55 months and the overall survival time of 58.8 months were longer in patients treated with CAF alone than those treated with other chemotherapy regimens, and the tumor-free survival time and the overall survival time were 27 months and 36 months, respectively. The expression of Bax was not related to the prognosis of patients. Conclusion The expression of FHIT and Bcl-2 was correlated with the tumor-free survival time and the overall survival time of patients treated with other chemotherapy regimens.

Objective to analyze the application of lumbar discography and computed tomography (CTD) after discography in the diagnosis and treatment of lumbar intervertebral disc diseases and compare it with magnetic resonance imaging (MRI). Methods The results of 298 cases of 256 patients with discography and CTD were retrospectively analyzed and compared with the results of MRI. Among them, 177 males and 79 females, aged (39 ± 16) years, all of them had a history of lumbar and leg pain. According to the manifestations of discography and CTD, the discs were divided into 7 types. 237 patients (257 discs) had complete MRI data, which were also classified according to the MRI results and compared with the previous types. Results 245 patients underwent surgical treatment, and 247 discs could be seen directly during the operation, and 238 cases (96.4%) had accurate discography and CTD. In the group comparison between CTD and MRI, The difference of positive rate between the two diagnostic methods in judging disc structural changes was statistically significant (P<0.01). MRI has limited ability to predict negative discography results. Conclusion Lumbar discography is an effective, reliable and safe auxiliary diagnostic method.In addition, plain CT scan after angiography can obtain some clinical data about disc condition that cannot be obtained by other methods.Multiple group comparative studies show that MRI and CTD cannot replace each other.MRI can be used as a screening method for the diagnosis of disc lesions.However, MRI has limited ability to predict negative disc lesions.Discography and CTD still need to be used to judge whether the adjacent disc structure is complete before spinal internal fixation and fusion.

Objective to evaluate the symptoms and signs of patients with acute pulmonary thromboembolism (PTE) and summarize the improvement of clinical manifestations after treatment. Methods A prospective descriptive study was performed. 516 patients with definite diagnosis of PTE were divided into large-area and sub-large-area PTE groups (246 cases) and non-large-area (excluding sub-large-area) PTE groups (270 cases). The large-area and sub-large-area PTE groups were randomly treated with urokinase or recombinant tissue plasminogen activator (rt-PA) for thrombolytic therapy, while the non-large-area PTE group was randomly treated with unfractionated heparin or low molecular weight heparin anticoagulation. The symptoms of dyspnea, chest pain (including pleural inflammatory chest pain and angina pectoris-like chest pain), cough, hemoptysis, syncope and pulmonary and cardiac signs were observed before and 14 days after treatment, and the incidence of various clinical manifestations in different time periods were calculated. Results The most common symptom of acute PTE patients was dyspnea (88.6%), followed by chest pain (59.9%) and cough (56.2%). The incidence of dyspnea, palpitation, syncope, panic and near-death sensation was significantly higher in the massive and sub-massive PTE group than in the non-massive PTE group (P<0.01), while the incidence of pleurisy chest pain in the non-massive PTE group was significantly higher than that in the massive and sub-massive PTE group (P<0.01). The dyspnea of the patients with massive and sub-massive PTE was mainly moderate to severe, while the dyspnea of the patients with non-massive PTE was milder. The common signs of acute PTE were increased respiratory rate (51.7%). In the massive and sub-massive PTE group, 22.8% had syncope, 21.5% had systemic hypotension or shock, cyanosis (45.9%) and P2 hyperactivity (63.0%) were more common. The symptoms and signs of the patients after thrombolysis and anticoagulation were gradually improved with the prolongation of the treatment time. Conclusion Dyspnea is the most common symptom in the patients with acute PTE, and its degree increases with the increase of PTE area. The increased respiratory rate is the most common sign of PTE. Both thrombolysis and anticoagulation therapy can significantly improve the patients

A 15-year-old male was admitted to the hospital with distortion of the angle of the mouth for 1 month and weakness of the left hand for half a month without any symptoms of intracranial hypertension.Physical examination: consciousness.Visual acuity of the left eye 0.5, visual acuity of the right eye 0.6, mild edema of the fundus papilla of both eyes.Bilateral frontal lines were symmetrical, and the angle of the mouth was deviated to the right.The fine movement of the left hand was not flexible, the muscle strength of the left upper limb was V-, the pathological reflex of both lower limbs was not elicited, and the genital development was adulterated.

A 23-year-old female was admitted to the hospital on January 7, 2005 due to fever and joint swelling and pain for 2 weeks. The patient developed fever 2 weeks ago, body temperature 37.5~40℃, swelling and pain of the proximal interphalangeal joint and metacarpophalangeal joint of both hands, accompanied by sore throat and cough. The three lines of blood routine in another hospital were all low, considering "viral infection", and did not improve after treatment with antibiotics and antiviral drugs. One week later, she developed a flaky rash on the back of both hands. She went to another hospital, and the three lines of blood routine were still low, and the chest radiograph showed that the texture of both lungs was heavy. She was given antibiotics and traditional Chinese medicine treatment, but the symptoms did not alleviate and came to our hospital for treatment. The patient had hair loss and oral ulcer since the onset of the disease, no photoallergy, no dry mouth and dry eyes. A medical history of "abnormal liver function" for more than 1 year. 　　

ulinastatin (UTI) is a protease inhibitor isolated and purified from human urine. Studies by Japanese scholars have shown [1]: When the human body is stimulated by infection, fever, shock, surgery, etc., the activity of UTI in human urine increases, but the concentration of UTI returns to normal when the body recovers, which indicates that UTI can resist external stimulation, reduce the damage of external damaging factors to the body, and maintain the balance of human internal environment.

Clinical data A 69-year-old male was admitted to the hospital on 24 September 2004 mainly because of "3 months after valve replacement, cough and sputum for 2 months".

Cardiovascular disease is the leading cause of death and disability in diabetes.Previous studies have shown that diabetes can increase the risk of stroke by 2 to 5 folds.Impaired glucose tolerance is an intermediate state between normal blood glucose and diabetes.The blood glucose level in non-fasting state is between 7.8 and 11.0 mmol/L. About 1/4 of patients who have previously had transient ischemic attacks (TIA) or mini-ischemic stroke have impaired glucose tolerance. It has been confirmed that impaired glucose tolerance can increase the risk of stroke in patients with coronary heart disease. Whether impaired glucose tolerance will increase the risk of stroke in patients with previous TIA or mini-ischemic stroke is still inconclusive.Therefore, Sarah et al. conducted a 2.6-year prospective study on 3127 patients with previous TIA or mini-ischemic stroke who participated in the Dutch TIA trial. The results of the study were published in<Stroke>J. Stroke, 2006, 37:1413-1417.

Scleroderma, also known as systemic sclerosis, is an autoimmune connective tissue disease, which can cause microvascular damage, excessive skin fibrosis, and lung, heart, kidney and gastrointestinal tract lesions. Within 10 years of onset, the mortality rate of patients with severe restrictive pulmonary ventilatory dysfunction (reflected in the percentage of forced vital capacity (FVC) less than 50% of the predicted value) caused by scleroderma-related interstitial lung disease is about 42%. In the past, a large number of drugs have been evaluated for the treatment of scleroderma-related interstitial lung disease, and only cyclophosphamide has shown to slow down or even improve the decline of FVC. However, due to the lack of randomized and prospective studies, it is difficult to draw reliable conclusions on its effectiveness, toxicity and risk-benefit ratio.

Inflammation is not only closely related to infectious diseases,but also involved in the pathogenesis of atherosclerosis,diabetes,neurodegenerative diseases.A large amount of oxygen free radicals are produced during inflammation process.Antioxidant therapy can protect tissues from oxygen free radicals damaged.Caffeine, polyphenols including coffee tannic acid,volatile aromatic complex,heterocyclic complexes and other effective components in coffee have antioxidant effects,which can effectively absorb and increase plasma antioxidant capacity.Epidemiological investigations have shown that coffee is related to biological markers that reduce oxidative stress.Can coffee consumption reduce the risk of morbidity and death of inflammation-related diseases? Scholars led by Andersen LF, University of Minnesota, studied the relationship between mortality and coffee consumption in postmenopausal women in Iowa, and found that coffee consumption suppresses inflammation and reduces the risk of death from cardiovascular and inflammatory diseases in postmenopausal women.<American Journal of Clinical Nutrition >(American Journal of Clinical Nutrition, 2006, 83:1039-1046).

Pulmonary fibrosis is one of the common causes of death in the late stage of acute respiratory distress syndrome (ARDS) [1, 2]. Recent studies have shown that low tidal volume (VT) ventilation can reduce the mortality of ARDS [3]. However, the effect of mechanical ventilation on pulmonary fibrosis is not clear [1, 2]. Increased collagen synthesis is the main characteristic of pulmonary fibrosis. Peroxisome proliferation activated receptor γ (PPAR-γ) is a member of nuclear hormone receptor protein superfamily, mainly distributed in adipose tissue, lung tissue and immune system. Nuclear factor κ B (NF-κ B) is an important transcription factor that regulates the expression of various cytokines, chemokines, growth factors and cell adhesion genes.

acinetobacter baumannii (aba) is an important pathogen causing nosocomial infection, and it is resistant to most commonly used antibiotics. From October 2001 to August 2002, aba infection rate increased abnormally in the cardiosurgical intensive care unit (CICU) of Zhongshan Hospital in Shanghai, and aba was isolated from blood or sputum samples successively. To understand whether there is cross-transmission of aba in CICU, 28 aba strains isolated from different patients were collected and analyzed by pursed-field gel electrophoresis (PFGE). Through genotyping and genetic identification, the epidemiological correlation of these strains was clarified.

In the past ten years, with the continuous improvement and development of monitoring and treatment technology, the mortality rate after subarachnoid hemorrhage has been obviously reduced. At the same time, with the continuous increase of the elderly population, the number of surgical treatment of elderly intracranial aneurysms is also increasing. For the surgical effect of elderly intracranial aneurysms, some foreign authors have made some reports on this, and it is generally believed that compared with adults, the surgical mortality and postoperative disability rate of elderly intracranial aneurysms are higher. The main reasons are brain damage caused by subarachnoid hemorrhage and past chronic diseases of elderly patients. In order to improve the surgical effect of elderly intracranial aneurysms, in recent years, Beijing Tiantan Hospital has adopted minimally invasive surgery for elderly patients with intracranial aneurysms. The clinical results are reported as follows.

Primary retroperitoneal mucinous cystadenoma is rare in clinic, and the giant retroperitoneal mucinous cystadenoma adjacent to the kidney is easily diagnosed as a giant renal cyst. One case was treated in Sir Run Run Shaw Hospital Department of Urology, Zhejiang University School of Medicine in May 2005. The report is as follows.