Volume 87  ·   Issue 13  ·  2007

In the 1980s, the microsurgical treatment of intracranial aneurysms (IA) made great progress, and the mortality rate dropped to below 2%, which became a successful symbol of skull base surgery. However, the subarachnoid hemorrhage caused by ruptured aneurysms is still an important cause for the treatment of aneurysms due to its high mortality and morbidity rate.

Objective to evaluate the guiding significance of intraoperative microvascular Doppler ultrasound (MDU) in intracranial aneurysm surgery. Methods 47 craniotomies were performed on 51 aneurysms in 46 patients with intracranial aneurysm. The blood flow velocity of aneurysm and adjacent blood vessels was examined by MDU before and after aneurysm clipping. Results MDU confirmed that the adjacent blood vessels were narrowed or occluded in 6 of 47 aneurysm surgeries due to the position of tumor clip, but it was not found by naked eye (12.76%); In addition, among 51 aneurysms, MDU found that 1 aneurysm was not completely occluded after clipping (1.96%). The incidence of stenosis or occlusion after clipping and incomplete clipping of aneurysms is closely related to the size of aneurysm. The incidence of stenosis in anterior communicating and internal carotid artery aneurysm surgery is relatively high. Conclusion Intraoperative MDU should be routinely used in intracranial aneurysm surgery, especially for huge aneurysm and aneurysm without obvious neck, as well as anterior communicating and internal carotid artery aneurysm.

Objective to investigate the diagnostic value of three-dimensional CT angiography (3D-CTA) in intracranial aneurysm and its guiding value in evaluating the aneurysm clipping after surgery. Methods Thirty-two patients with clinical suspicion of intracranial aneurysm were retrospectively analyzed and examined by CT angiography (CTA) and digital subtraction angiography (DSA). The diagnostic value of 3D-CTA was evaluated with DSA and surgery as reference standards. Five cases of aneurysm clipping were evaluated after surgery, and CTA examination was performed before and after surgery. The aneurysm clipping was evaluated by comparing the results of two CTA. Results According to DSA data and surgical results, the sensitivity, specificity and accuracy of CTA in detecting intracranial aneurysm were 100%, 100% and 93.9%. Five cases of aneurysm clipping with titanium clip were followed up by CTA. Compared with preoperative CTA, there was no stenosis or occlusion of intracranial large vessels. Conclusion 3D-CTA has good specificity and sensitivity in diagnosing intracranial aneurysm, as well as good three-dimensional display ability, and is a reliable and minimally invasive method for diagnosing intracranial aneurysm rapidly. It provides detailed imaging data for surgery and helps to formulate treatment plan.

Objective to investigate the feasibility and efficacy of minimally invasive surgery on complex intracranial aneurysms by keyhole approach.Methods A total of 31 cases of 42 complex intracranial aneurysms, including 2 aneurysms of internal carotid artery bifurcation, 1 aneurysm of anterior cerebral artery, 12 aneurysms of posterior communicating artery, 2 aneurysms of anterior choroidal artery, 7 aneurysms of middle cerebral artery, 6 aneurysms of anterior communicating artery, and 2 aneurysms of basilar artery [aneurysm of bifurcation of basilar artery and superior cerebellar artery (BA-SCA), 1 aneurysm of bifurcation of basilar artery and posterior cerebral artery and superior cerebellar artery (BA-SCA-PCA)], 2 aneurysms of vertebral artery, 4 aneurysms of posterior cerebral artery, 4 aneurysms of ophthalmic artery, 10 aneurysms of multiple artery, 14 aneurysms of giant artery, 7 aneurysms of posterior circulation, 8 aneurysms of posterior circulation, and 4 aneurysms were clipped after abrasion of anterior bone process.Results 31 aneurysms were clipped and 2 aneurysms were encapsulated There were 5 clipping plus giant aneurysm body resection, 2 isolated plus partial tumor body resection, 1 isolated operation, and 1 rupture before surgery. Recent postoperative GOS evaluation showed that 27 cases were good, 2 cases were mildly disabled, and 2 cases died. Conclusion Keyhole approach can effectively control aneurysm bleeding and perform anterior clinoid bone abrasion, giant aneurysm resection, tumor-bearing vascular shaping, etc. Based on individualized surgical design and exquisite microsurgical technique, keyhole minimally invasive approach is safe, simple and effective for the treatment of complex intracranial aneurysm.

Objective to summarize and analyze the research history of lateral sella cavernous hemangioma (LSCC), with emphasis on the new understanding of LSCC and the latest microsurgical strategies. Methods According to the different stages of understanding of LSCC, it was divided into 4 stages, a total of 102 patients, including 32 in the first stage, 18 in the second stage, 36 in the third stage and 16 in the fourth stage. The progress of each stage, including neuroimaging, anatomy and pathology, was analyzed one by one, and the advantages and disadvantages of surgical management measures in the corresponding stages were summarized. Results The number of total resection cases in the first, second, third and fourth stages was 4, 5, 17 and 12, and the number of subtotal resection cases was 3, 4, 10 and 2, respectively. The rest were partial resection. The intraoperative blood loss and the disability rate were significantly improved in the fourth stage. The main postoperative complications were oculomotor nerve palsy, abducent nerve palsy and trigeminal nerve injury. There were no deaths in the whole group. Conclusion With the gradual deepening of understanding of LSCC, The surgical treatment of LSCC is becoming more and more mature. Intraoperative controlled hypotension and epidural surgical resection should be the first choice for LSCC.

Objective to investigate the effectiveness and superiority of laparoscopic total colectomy and rectal resection in the treatment of familial polyposis. Methods We performed laparoscopic total colectomy and anastomosis with ileal pouch and anal canal in 8 patients with familial polyps. The safety of operation, postoperative recovery and follow-up results were observed and compared with 6 patients who underwent open total colectomy before 2001. Results All 8 patients underwent laparoscopic total colectomy successfully without conversion to open surgery, and the mean operation time was 178 min (165~210 min). The difference was not statistically significant (P>0.05). The average bleeding volume was 110 ml (70-200 ml), the anal exhaust time was 1.2 d (1-3 d), and the hospital stay time was 12.5 d (10-18 d), which was statistically significant compared with the open group (P>0.05). No serious complications occurred after operation. The follow-up period was 32-58 months, with an average of 46.8 months. There was no local recurrence in the laparoscopic group, and 1 patient in the open group had rectal recurrence and cancer 25 months after operation. Three months after operation, defecation 4~8 times a day can control the shaped stool, but it is difficult to control the watery stool and gas; Six months after operation, defecation 3~5 times a day, can control the shaped stool, basically can control the watery stool and gas; Conclusion Laparoscopic resection of total colon and rectum in the treatment of familial polyposis has the advantages of safety, effectiveness, minimal invasion, less postoperative pain and short hospital stay. Skilled laparoscopic technique is the guarantee of successful operation.

Objective to investigate the role of maspin and P53 protein in the occurrence and development of gastric carcinoma and their correlation with gastric carcinoma, and to provide a new effective index for the prognosis of gastric carcinoma. Methods Western blot, immunofluorescence and immunohistochemistry (immunohistochemistry) were used to detect the expression of maspin and P53 protein in fresh and paraffin-embedded tissues of 32 patients with gastric carcinoma after surgery. The difference of expression rate in different histological types and different clinicopathological stages was statistically significant (P<0.05); The expression rate in gastric cancer tissues with or without lymph node metastasis was statistically significant (P<0.05); The difference between the two groups was statistically significant (P<0.05) in patients with survival period of more than 3 years and less than 3 years. By Spearman grade correlation test, P<0.01, maspin protein and P53 protein were negatively correlated. Conclusion The expression of maspin protein and P53 protein was negatively correlated in gastric cancer, and the combined detection of the two is helpful to judge the prognosis of gastric cancer.

Objective to investigate the curative effect of different surgical methods on the correction of idiopathic scoliosis. Methods 94 patients with idiopathic scoliosis were treated with Harrington surgery, combined with Harrington-Luque (H-L) surgery, C-D and TSRH three-dimensional correction. The long-term clinical data before and after operation were summarized, and the curative effect of different surgical methods was analyzed. Results The average correction rate of Harrington surgery, combined with Harrington-Luque (H-L) surgery, C-D and TSRH three-dimensional correction was 36.42%, 45.18%, 55.68% and 63.28%, respectively. The correction degree of H-L, C-D and TSRH surgery was higher than that of Harrington method, among which TSRH three-dimensional correction system was the most significant.

Objective to compare the efficacy of different approaches of interlocking intramedullary needle fixation in the treatment of humeral shaft fractures. Methods 92 cases of closed humeral shaft fractures were treated with interlocking intramedullary needle, including 67 males and 25 females, with an average age of 37 years (18-72 years). 69 cases underwent antegrade intramedullary needle and 23 cases underwent retrograde intramedullary needle. The average postoperative follow-up period was 2 years and 4 months (1-5 years and 10 months). Results There was no statistically significant difference in the operation time between antegrade intramedullary needle and retrograde intramedullary needle groups, the difference in the incidence of intraoperative complications, the difference in fracture healing rate, the difference in Constant-Murley shoulder function score and the difference in Mayo elbow function score were not statistically significant.

Objective to study the application value of pulmonary impedance diagram in judging the correctness of tracheal intubation position.Methods 36 patients with general anesthesia who needed intubation were successfully intubated with a tracheal tube of the same diameter inserted into the esophagus.One person connected the threaded tube to the trachea or esophagus and then squeezed the respiratory skin sac, and the other two (experienced and inexperienced) used pulmonary impedance diagram, end-of-breath carbon dioxide diagram (PetCO2) method and auscultation method to judge whether the trachea or esophagus was connected, respectively.The correctness and the time required to make the judgment were recorded. Results A total of 216 judgments were made. In those with experience in auscultation (n =72 times), the trachea was misjudged as esophagus twice, and the esophagus was misjudged as trachea once; The trachea was misjudged as esophagus 5 times and esophagus was misjudged as trachea 9 times in meta-experienced auscultation patients (n =72 times). The total accuracy rate (81%) was statistically significant compared with that of experienced patients (96%) (P<0.01), and the difference was statistically significant compared with impedance method and PetCO2 method (P<0.01); The total sensitivity and specificity of impedance method and PetCO2 method were 1, the total sensitivity and specificity of auscultation method were 0.90, and the specificity of auscultation method was 0.86. Time required to make judgment: There was no statistically significant difference in the time required between impedance method and auscultation method in the three methods, regardless of whether to judge trachea or esophagus; The PetCO2 method took the longest time to make judgment (3.4 s ± 1.3 s and 3.7 s ± 1.4 s), compared with the impedance method (1.6 s ± 0.3 s and 2.1 s ± 1.1 s) and auscultation method (1.7 s ± 0.7 s and 2.5 s ± 1.7 s) The difference was statistically significant (P<0.01). The time required to judge the trachea by impedance method or auscultation method (1.6 s ± 0.3 s) was shorter than that by the same method (2.1 s ± 1.1 s), and the difference was statistically significant (P<0.01). Conclusion The correct rate of judging the position of tracheal intubation by impedance method is consistent with that of PetCO2 method, but the time required is shorter than that of PetCO2 method, which is one of the effective methods to judge the correct position of tracheal intubation.

Objective to compare the mitochondrial oxidative phosphorylation function of placenta of Tibetans living in plateau and immigrant Han nationalities, and to explore the mitochondrial mechanism of hypoxia adaptation of Tibetans living in plateau. Methods the mitochondrial state III respiration (ST3), state IV respiration (ST4) and respiratory control rate (RCR) of placenta of Tibetans living in plateau and immigrant Han nationalities were detected by Clark electrode method, and the oxidative phosphorylation efficiency (OPR) was calculated. Weighing the placental weight and neonatal weight of Tibetan and Han nationalities; Results (1) The placental weight, volume and neonatal weight and length of Tibetans living in the plateau were significantly higher than those of Han nationalities 0.509 kg±0.090 kg vs 0.429 kg±0.099 kg (t =0.695, P =0.004), 657.66 cm3±167.10 cm3 vs 500.46 cm3±140.69 cm3 (t =1.834, P =0.001), 3.495 kg±0.439 kg vs 2.952 kg±0.388 kg (t =3.365, P =0.004), 49.81 cm±2.56 cm vs 48.10 cm±2.30 cm (t =2.025, P =0.000)]; (2) Placental mitochondrial RCR, ST3 and OPR of Tibetans living in plateau were significantly higher than those of Han nationalities [4.22 ± 0.97 vs 3.21 ± 0.37 (t =3.232, P =0.004), (67.78 ± 13.57) nmol O · min-1 · mg pro-1 vs (41.27 ± 10.49) nmol O · min-1 · mg pro-1 (t =5.257, P =0.000), (117.93 ± 32.69) nmol O · min-1 · mg pro-1 vs (68.94 ± 28.88) nmol O · min-1 · mg pro-1 (t =2.985, P =0.001)], ST4 There was no significant difference between the groups [(16.58±3.53) nmol O·min-1·mg pro-1 vs (14.79±4.69) nmol O·min-1·mg pro-1 (t =1.069, P =0.297)]. Conclusion The degree of oxidative phosphorylation in placenta of Tibetans living in plateau generations was significantly higher than that of immigrant Han nationalities, which suggests that Tibetans living in plateau generations have stronger ability to use oxygen than immigrant Han nationalities in plateau hypoxia environment, which may be an important mechanism of their adaptation to plateau hypoxia.

Objective to investigate the incidence of anxiety/depression and health-related quality of life of inpatients in neurology department of general hospitals. Methods The Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Scale (HAMD-17), Hamilton Anxiety Scale (HAMA) and Brief Health Status Questionnaire (SF-36) were used to evaluate the emotional status and health-related quality of life of inpatients in neurology department of general hospitals at admission (within 48 h) and at discharge (within 48 h), respectively. Results A total of 610 patients completed the assessment at admission, and 123 (20.2%) and 161 (26.4%) patients had clinically significant depressive symptoms (HAMD ≥18 scores) and anxiety symptoms (HAMA ≥14 scores) at admission, respectively. Among these 284 patients, 96 patients achieved clinically significant depression and anxiety at the same time. 405 patients completed the assessment at discharge, and the patients with clinically significant depressive symptoms (HAMD ≥18 scores) and anxiety symptoms (HAMA ≥14 scores) at discharge were Fifty-two of the 161 cases reached clinically significant depression and anxiety at the same time.Multiple regression analysis using SF-36 score as dependent variable at admission showed that gender, anxiety and depression were associated with quality of life related to health status.59 cases (20.8%) were treated with drugs during hospitalization.The total scores of HAMA and HAMD decreased in the drug-treated group compared with the non-treated group at discharge; Conclusion the incidence of anxiety and depression in neurological inpatients is higher, and anxiety and depression affect the health-related quality of life of patients. Treatment of physical diseases alone cannot relieve anxiety and depression, and anxiety and depression affect the evaluation of the outcome of physical diseases negatively. Antidepressant and antianxiety treatment should be given to neurological inpatients with anxiety and depression.

Objective to study the difference of brain function activation area between patients with Alzheimer's disease (AD) and Alzheimer's disease with depression (dAD) under the affective Stroop task, and to explore the influence of affective factors on the onset of AD with depression. Methods Twenty patients with mild AD (DSM-Ⅳ standard, CDR 1.0) were collected, among which 9 patients with dAD (NIMH-dAD standard, CSDD scale>12), and there were no statistical differences in age, gender, hand sharpness (right sharpness), education level, course of disease and MMSE score. Another 10 normal elderly patients were used as the control group. Functional magnetic resonance imaging (fMRI) was used, and the affective Stroop task was used as the stimulus. The response time, error rate and false positive rate of completing the task were calculated as behavioral indexes. At the same time, fMRI brain function images were collected and analyzed by SPM2 software.Results The response time of completing the affective Stroop task in dAD, AD group and normal control group was 1528 ms ± 302 ms, 1173 ms ± 237 ms and 875 ms ± 320 ms, respectively. The error rates were 9.7%, 7.6% and 0.5% respectively; The reaction time of AD patients in the two groups was significantly slower than that of the normal control group (P<0.001), and the dAD group was slower than that of the AD group (P =0.04), but there was no significant difference between the error rate (P =0.22) and the false report rate (P =0.29) between the two groups. During the affective Stroop task (P<0.001), the right amygdala, bilateral prefrontal cortex, bilateral occipital lobe and left parietal lobe were activated in the normal elderly group. Only a small amount of bilateral parietal lobe and left prefrontal cortex were activated in the AD group.

Objective to observe the growth inhibition, cell cycle arrest and tumor suppressor gene expression of human lung adenocarcinoma cells A549 by using histone deacetylase inhibitor tricotin A (TSA). Methods the growth inhibition of human lung adenocarcinoma cells A549 was observed by MTT colorimetry. The cell cycle was analyzed by flow cytometry. The mRNA and protein expressions of histone deacetylase 3, p21WAF1/CIP1 in A549 cells were detected by RT-PCR and Western blot, respectively. Results the growth of A549 cells was inhibited after TSA treatment (the inhibition rates of control group and each treatment group were 6.2%±1.1%, 18.5%±2.3%, 28.9%±3.6%, 39.4%±3.7%, 45.6%±2.7% at 24 h, P<0.05, and 8.1%±2.3%, 26.9%±4.2%, 35.6%±3.8%, 56.5%±6.1%, 69.8%±5.7% at 48 h, respectively Conclusion TSA may induce the expression of P21WAF1/CIP1 gene by inhibiting histone deacetylase 3 and increasing the level of histone acetylation.

Objective to establish a human lung adenocarcinoma drug-resistant cell model Anip973/NVB (norvincristine) and identify its biological characteristics.Methods the human lung adenocarcinoma cell line Anip973 was used to induce the drug-resistant cell model Anip973/NVB by increasing the dose of NVB, and its growth regularity was observed. Identification of drug resistance by MTT assay; The cell morphology and ultrastructure were observed; The cell cycle distribution was detected by flow cytometry; The concentration of NVB in Anip973/NVB cells was determined by high performance liquid chromatography (HPLC). Results the half lethal concentration (IC50) of NVB in Anip973/NVB cells increased by 21.81 times compared with Anip973 cells by MTT assay. There was no significant difference in the doubling time between the two cell lines. The structure of the two cell lines changed greatly under light and electron microscope. Conclusion Anip973/NVB cells are a definite multidrug resistant cell model with the basic biological characteristics of drug resistant cells.

Objective to investigate the expression of hypoxia-inducible factor 1 α (HIF-1 α) in lung non-small cell lung cancer (NSCLC) and its relationship with the expression of apoptosis-related proteins Survivin and Bax. Methods The expression of HIF-1 α, Survivin and Bax in 52 cases of NSCLC was detected by immunohistochemistry. Results The positive expression rates of HIF-1 α, Survivin and Bax in NSCLC tissues were 38.5% (20/52), 48.1% (25/52) and 42.3% (22/52), respectively. The expression of HIF-1 α was correlated with the clinical stage of tumor (x2=8.271, P<0.05) and lymph node metastasis (x2=6.370, P<0.05), but there was no significant correlation with the pathological type of tumor (x2=0.561, P>0.05) and the degree of differentiation (x2=0.326, P>0.05). The expression of HIF-1 α was positively correlated with the expression of Survivin (γ =0.496, P<0.05) and Bax (γ =0.681, P<0.05). Conclusion The expression of HIF-1 α was correlated with the invasive development and metastasis of NSCLC

Objective to provide relevant technical parameters for the introduction of mechanical factors in cartilage tissue engineering.Methods Eight New Zealand rabbits, the left knee joint was observed by HE staining method, and the right knee joint was digested by 0.4% streptolysin and 0.025% type Ⅱ collagenase.The cell survival rate was detected by trypan blue exclusion assay.The diameter of the chondrocytes on tissue sections and after complete digestion was measured respectively.The mechanical properties (Young's modulus and viscoelasticity) of the chondrocytes were analyzed by microtubule suction technique combined with semi-infinite body model.Results HE staining showed that the normal cartilage was divided into four layers: superficial layer, transition layer, radiation layer and calcification layer.The average cell survival rate after complete digestion was 98.2%.The average diameter of the chondrocytes on sections and after digestion was (14.2±2.9) and (14.9±2.2) μ m, respectively.The differences between the two were not statistically significant (t =1.31,P =0.19). Under certain negative pressure, the normal chondrocytes first had instantaneous elastic response, followed by creep process with monotonically decreasing deformation rate, and finally reached stability The aspiration length of chondrocytes usually reaches 3 times the radius of microtubules, but the cells cannot be completely aspirated into microtubules, and the chondrocytes recover completely after unloading. The Young's modulus of normal chondrocytes is (0.57±0.43) kPa, and the viscoelastic parameters of the chondrocytes are (0.37±0.07), (0.29±0.04), (6.36±1.12) kPa-s, respectively. Linear correlation analysis showed that only k1 had a weak correlation with chondrocytes diameter, but it was statistically significant (r =0.4, P =0.031). Conclusion Normal chondrocytes show typical viscoelastic solid creep characteristics; Microtubule suction technique can be used as a reliable method to measure the mechanical properties of articular chondrocytes.

Case abstract A 70-year-old male was found to have a protrusion on the lateral side of the left knee joint for 5 years and felt pain for 3 months. Physical examination showed that the lateral side of the left knee joint was slightly swollen, the inner and upper side of the left knee joint was tender, the protrusion could be palpable at the outer and lower fibular head, and the joint movement was basically normal. X-ray showed: left fibular osteochondroma (Figure 1).

Adult Still disease (AOSD) is a rare disease involving multiple systems in the whole body, with complicated clinical manifestations and difficult diagnosis. It is often accompanied by peak fever, transient rash, arthralgia and/or arthritis, sore throat, hepatosplenomegaly, etc. The laboratory examination often finds leukocytosis, abnormal liver function, elevated C-reactive protein (CRP) and serum ferritin (SF), etc. Some patients have a self-limiting course of disease, but most patients have repeated clinical symptoms, which are intermittent systemic or chronic arthritis type [1]. Traditional treatments include non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, immunosuppressants and intravenous gamma globulin (IVIG), etc. However, the above treatments are ineffective in some patients.

On October 6, 2006, a 41-year-old woman experienced left shoulder pain and limited shoulder lifting after a fall. No abnormalities were found in the local soft tissue. On the same day, an orthopedic X-ray examination of the left shoulder joint in the outpatient clinic of another hospital showed low-density cystic change of the large tubercle of left humerus. To confirm the diagnosis, she came to our hospital for CT and MRI examination. The X-ray manifestation showed that the large tubercle of humerus was oval-shaped and translucent, and the local trabecular bone was sparse and uneven, which was clearly distinguished from the adjacent bone structure (Figure 1). On October 9, CT axial scan showed that the low-density area in the large tubercle of humerus was sparse and the edge was not clear and smooth (Figure 2).

Symptomatic cerebral hemorrhage is a common complication of tissue plasminogen activator (tPA) thrombolytic therapy for ischemic stroke. tPA activates metallomatrix protease-9 (MMP-9) in vascular endothelium, which is related to blood-brain barrier and can reduce vascular basement membrane. Current studies suggest that the tPA-MMP-9 pathway mediates the destruction of blood-brain barrier after ischemia, and then causes cerebral hemorrhage. Activator protein C (APC) is a plasma serine protease with systemic anticoagulant, anti-inflammatory and anti-apoptotic activities, and can directly protect neurons.