Volume 87  ·   Issue 47  ·  2007

Objective to investigate the rapid intraoperative diagnostic method and clinical value of detection of sentinel lymph node (SLN) in patients with early cervical carcinoma. Methods SLN was detected in 30 patients with early cervical carcinoma by combined radioisotope and blue staining method. According to FIGO stage, 14 patients were in stage ⅠB1 and 16 were in stage ⅡA. Preoperatively, 99mTc-sulfur colloid 0.4mci/0.4ml were injected into 3 ', 6', 9 'and 12' of the cervix, and after laparotomy, methylene blue was injected into 4 identical parts of the cervix. SLN, i.e., blue stained lymph node and/or hot spot lymph node, was identified during operation, and SLN was removed in situ, and then extensive transabdominal hysterectomy + pelvic lymphectomy was performed. Imprint cytology and rapid freezing examination were performed to detect whether SLN metastasized. The results of imprint cytology, rapid freezing examination and HE staining were compared. Results SLN was detected in 29 of 30 patients, the detection rate was 96.7%, and HE examination showed pelvic lymph node metastasis in 9 cases. Among 29 cases, SLN was detected, 8 cases were SLN positive and 20 cases were SLN negative The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of rapid frozen section and imprinted cytology in SLN were 92.3%, 100%, 98.9%, 100%, 98.8% and 92.3%, 97.6%, 96.8%, 85.7% and 98.8%, respectively. SLN detection is predictive of pelvic lymph node metastasis from cervical cancer.

Objective to investigate the efficacy and safety of aspirin in the prevention of venous thrombosis after artificial joint replacement. Methods 240 patients underwent total knee and total hip replacement were retrospectively reviewed, including 157 cases of total knee replacement and 83 cases of total hip replacement. They were divided into two groups: 100 cases in group A were given aspirin anticoagulation from the first day after operation; The efficacy and safety of aspirin in the prevention of thromboembolic diseases after artificial joint replacement were evaluated by observing and comparing the incidence of lower extremity deep vein thrombosis, pulmonary embolism, cardiovascular and cerebrovascular accidents and the occurrence of hemorrhage and infection. Results in group A, 13 cases (13.0%) of deep vein thrombosis, 7 cases (7.0%) of symptomatic deep vein thrombosis, 3 cases (3%) of suspected pulmonary embolism and 2 cases (2%) of cardiovascular and cerebrovascular accidents occurred after aspirin treatment. In group B, there were 10 cases (7.1%), 4 cases (2.9%), 3 cases (2.1%) and 8 cases (5.7%) of deep vein thrombosis, symptomatic deep vein thrombosis, suspected pulmonary embolism and cardiovascular and cerebrovascular events, respectively. The differences between the two groups were not statistically significant (P values were 0.129, 0.130, 0.675 and 0.156, respectively). The postoperative hemorrhage, hemoglobin decrease, hematoma incidence and infection incidence in aspirin group were (693±480) ml, (32.9±18.0) g/L, 1 case (1%) and 0 cases (0%), respectively, and the LMWH group were (649±521) ml, (36.4±21.9) g/L, 3 cases (2.1%) and 2 cases (1.4%), respectively. The differences between the two groups were not statistically significant (P values were 0.501, 0.177, 0.495 and 0.230, respectively). Conclusion The preventive efficacy of aspirin and low molecular weight heparin on venous thromboembolism after joint replacement is similar, and there is no significant difference in the risk of bleeding and infection.

Objective to establish a three-dimensional finite element model of the whole human pelvis and provide a mathematical model for the study of pelvic biomechanics.Methods the CT scan images of the whole pelvis of normal adult men including the adjacent third lumbar vertebra and the upper 1/3 of the femur were obtained.The three-dimensional finite element model of the whole human pelvis was constructed by using ANSYS finite element analysis system and the method of generating elements and nodes directly from the original picture.Results the three-dimensional finite element model of the whole human pelvis including the third lumbar vertebra and the upper 1/3 of the femur was established, which consisted of 721 820 elements and 207 248 nodes.Conclusion The three-dimensional finite element model of the whole human pelvis can reflect the anatomical structure and mechanical characteristics of the human pelvis objectively, and can be used as a tool for the study of pelvic biomechanics.

Objective to investigate the treatment of calcaneal fracture malunion. Methods 21 male patients with calcaneal fracture malunion were treated with peroneal tendon release, calcaneal lateral wall osteophyte resection and single subtalar joint fusion or triple joint fusion. Results The follow-up period was 8~47 months, and the average follow-up period was 16 months. The treatment results were evaluated. The calcaneal deformity was significantly improved, the pain of the affected foot disappeared or significantly reduced, and the gait of the affected foot was significantly improved. The patients were satisfied after operation. According to the score of American Foot and Ankle Trauma Association, the average score rose from 36.7 (18~56) before operation to 71.3 (44~85) after operation. The pain score was 8.2 (7~10) before operation to 2.0 (0~4) after operation. Conclusion The main manifestations of calcaneal fracture malunion were calcaneal widening and the pain caused by calcaneofibular impingement and peroneal tendon entrapment, as well as different degrees of subtalar arthritis and posterior foot varus deformity. CT scan can clearly understand the situation of calcaneal deformity and traumatic arthritis of various related joints, In order to facilitate classification and guide treatment, a single subtalar arthrodesis can achieve satisfactory curative effect.

Objective to investigate the clinical characteristics and treatment of amyotrophic cervical spondylosis. Methods to summarize the clinical manifestations, imaging and electromyographic examinations, therapeutic effect and prognosis of 9 patients with amyotrophic cervical spondylosis and 15 patients with cervical spondylosis of nerve radiculopathy and cervical spondylosis who underwent simultaneous surgery. Among the patients with amyotrophic cervical spondylosis, 7 cases underwent simple discectomy and cage implantation, 2 cases underwent posterior open-door decompression of cervical vertebra and anterior subtotal resection of cervical vertebra and plate internal fixation, 12 cases underwent anterior cervical discectomy and cage implantation, and 3 cases underwent posterior open-door decompression of cervical vertebra and anterior subtotal resection of cervical vertebra and plate internal fixation. Results MRI showed single-two-segment cervical disc herniation in 77.7% (7/9), and 3-segment or more cervical disc herniation in only 22.2% (2/9). EMG showed that all cases showed neurogenic damage of affected upper limb muscles, and all cases showed no neurogenic damage of sternocleidomastoid muscle and fibrillation potential of tongue muscle. The muscle strength of 9 patients with amyotrophic cervical spondylosis was significantly improved. In 6 months after operation, the muscle strength of 6 cases recovered from preoperative grade Ⅰ ~ Ⅱ to postoperative grade Ⅳ ~ Ⅴ, with an improvement rate of 75% ~100%. The muscle strength of 2 cases recovered from preoperative grade Ⅲ to postoperative grade Ⅳ ~ Ⅴ, with an improvement rate of 50% and 100%, respectively. Eight cases were followed up for more than 12 months, 7 cases recovered to grade V, with an improvement rate of 100%, and 1 case recovered to grade IV, with an improvement rate of 80%. In the patients with cervical spondylotic radiculopathy and cervical spondylotic myelopathy operated at the same time, the muscle strength of 15 patients improved to varying degrees during the follow-up period of 12 to 36 months, and the muscle strength of the patients recovered from preoperative grade Ⅱ to Ⅳ to postoperative grade Ⅲ to Ⅴ, with an improvement rate of 20% to 100%, and 15 cases were followed up for more than 12 months, and 11 cases recovered to grade V, with an improvement rate of 100%, and 3 cases recovered to grade IV, with an improvement rate of 20% to 50%, and 1 case remained at grade 3, without improvement. Conclusion Amyotrophic cervical spondylosis is a rare type of cervical spondylosis in clinic.Its clinical symptoms and signs are easily confused with neuronal diseases such as lateral sclerosis, MRI and electromyography are helpful to confirm the diagnosis, and its mechanism may be related to the compression of anterior horn of spinal cord with ischemic disorder. Timely surgical decompression treatment can obviously help the recovery of muscular atrophy, and the surgical prognosis of single-segment lesion is better than that of multi-segment lesion.

Objective to investigate the method and curative effect of minimally invasive unicondylar knee arthroplasty assisted by virtual image navigation.Methods 26 cases of minimally invasive unicondylar knee arthroplasty with small incision were performed under the navigation system.The incision size, operation time, bleeding volume and 48 h drainage volume were counted, and HISS score was analyzed to measure the force line and joint mobility.Results 26 cases of minimally invasive unicondylar knee arthroplasty with small incision were successfully completed under the navigation system.The incision size was (7.4±0.6) cm, the operation time was (78±12) min, the bleeding volume was (122±13) ml and 48 h, and the drainage volume was (114±18) ml. The preoperative HISS score was (72±6), (98±2) 2 weeks after operation, and the preoperative hip-knee-ankle angle was (7.6±1.8) °, (0.8±0.6) ° 2 weeks after operation. The preoperative flexion contracture was (6.8±1.6) °, the range of knee joint motion was (107.5±6.2) °, the postoperative flexion contracture was (1.8±1.1) °, and the range of knee joint motion was (132.6±3.5) °. All 26 cases were followed up for (8.2±2.4) months. There were no complications such as infection, poor position of prosthesis and patellofemoral joint pain. Conclusion The application of computer navigation system solves the limitation of visual field during MIS-UKA operation, and at the same time, it can observe the change of force line of lower limbs, rotation and alignment of knee prosthesis and the balance of soft tissue and ligament in real time and dynamically, and provide geometric and morphological data to reconstruct the knee joint biomechanically and anatomically, which improves the accuracy of prosthesis replacement.

Objective to investigate the effects of oligofectamine-mediated vascular endothelial growth factor (VEGF) antisense oligonucleotide (ASODN) transfection on the expression of VEGF, Flt-1 and KDR mRNA and protein levels, growth, proliferation and apoptosis of human gallbladder cancer cells in vitro. Methods the expression of VEGF, Flt-1 and KDR mRNA in GBC-SD cells was detected by semi-quantitative RT-PCR, and the concentration of VEGF protein in the cell culture supernatant of each group was measured by ELISA. Results the expression of VEGF, Flt-1 and KDR mRNA was significantly inhibited by ASODN group and ASODN + Oligofectamine group, and the inhibitory effect of VEGF ASODN + Oligofectamine was stronger than that of ASODN (P>0.05). The results of ELISA showed that both ASODN group and ASODN + Oligofectamine group inhibited the secretion of VEGF protein (P<0.05), and the concentration of VEGF protein in ASODN + Oligofectamine group was lower than that in ASODN group Oligofectamine can significantly enhance the inhibitory effect of VEGF ASODN.

Objective to compare the effects of different target-controlled plasma sufentanil combined with 0.9 minimum alveolar effective concentration (MAC) inhalation anesthesia on hemodynamics and spontaneous respiratory recovery after operation.Methods Sixty patients undergoing elective general anesthesia, ASA Ⅰ ~ Ⅱ, aged 18~65 years, weighing 45~80 kg,were randomly divided into three groups (groups S3, S4 and S5), namely, the groups with 0.3, 0.4 and 0.5 ng/ml target-controlled plasma infusion of sufentanil combined with 0.9 MAC inhalation anesthesia.Blood pressure, heart rate, postoperative respiratory recovery time and extubation time during anesthesia were recorded, and the application of vasoactive drugs and other intravenous anesthetics during operation was recorded. Results The blood pressure and heart rate of patients in the three dose groups were stable during anesthesia, and the blood pressure and heart rate after tracheal intubation and at the time of skin incision were within ±20% of the basal value; Respiratory recovery time (S3:3.3 min±2.0 min, S4:2.8 min±2.5 min, S5:6.1 min±3.4 min) was not significantly different between the three groups, and extubation time (S3:9.6 min±8.0 min, S4:9.4 min±6.4 min, S5:14.6 min±10.9 min) S5 Two patients in S4 and S5 groups each had postoperative respiratory depression. Conclusion When the combined inhalation anesthesia reaches 0.9MAC, the satisfactory depth of anesthesia can be achieved with 0.3ng/ml target-controlled plasma concentration of sufentanil, and sufentanil infusion can be stopped 50 min before the end of operation, and patients can recover safely and quickly.

Objective to investigate the relationship between the electrical activity of subthalamic nucleus (STN) cells and the position of deep brain stimulation (DBS) electrode contacts and the improvement of Parkinson's disease (PD) symptoms. Methods the electrical activity and limb EMG of 19 patients with PD were collected while receiving STN DBS. The relationship between the cellular activity and symptoms in different discharge patterns was investigated by single cell analysis and correlation test. The efficacy of PD comprehensive scale was used to evaluate the efficacy before and after operation. Results The discharge activity related to tremor (12.6%) of 278 STN neurons was mostly distributed in the upper part of STN, while the tension (32.7%) and irregular (54.7%) discharge activity were mostly distributed in the lower part of STN. Further comparison of the distribution of various cells in the upper and lower parts of STN showed statistical significance (P<0.05). The efficacy analysis of DBS stimulation contacts showed that the upper contacts significantly improved tremor, while the lower contacts significantly improved stiffness and retardation. Conclusion The neurons with different discharge patterns of STN are intrinsically related to PD symptoms.

Objective to investigate the value of 11C-choline PET-CT dual-phase imaging in the diagnosis of mediastinal diseases.Methods CT, PET-CT and video mediastinoscopy were performed in 35 patients with mediastinal lesions difficult to be diagnosed by ordinary imaging within 4 weeks.11C-choline was used as PET tracer, standard uptake value (SUV value) and changes of two imaging ( △ The emission images were collected for the first time 5~10min after 11C-choline injection, and the emission images were collected again 25~30min after 11C-choline injection. Results 35 cases of mediastinal lesions were diagnosed as sarcoidosis in 11 cases, tuberculosis in 6 cases, lymphoma in 5 cases, primary or metastatic mediastinal carcinoma in 11 cases (lung cancer with mediastinal lymph node metastasis in 8 cases, and mediastinal lymph node enlargement in 2 cases as reactive hyperplasia in 2 cases). △ The SUV was-0.12 (-0.9-1.0). The SUV value of 16 cases of malignant lesions was 6.17 (3.2-9.8), 6.48 (3.0~11.2) after delayed imaging, △ SUV was 0.31 (-0.4~1.4). There was no statistically significant difference in SUV values of early imaging of benign and malignant lesions (F =0.505, P =0.09); of both △ The difference of SUV was statistically significant (F =1.939, P =0.04), △ The accuracy of benign and malignant mediastinal tumors were 54.3% (19/35), 74.3% (26/35), 82.9% (29/35) and 100% (35/35), respectively, with CT, primary PET-CT, dual-phase PET imaging and video mediastinoscopy (χ 2=6.563, P =0.010). Dual-phase PET imaging is better than CT (χ 2=6.629, P =0.010). Conclusion Video mediastinoscopy is accurate and reliable in the differential diagnosis of benign and malignant mediastinal diseases. CT alone and single PET (SUV value) imaging have a higher misdiagnosis rate. Two-time PET-CT imaging can improve the diagnostic accuracy and have certain value in the differential diagnosis of benign and malignant lesions.

Objective to investigate the neurobiological mechanism of abnormal emotional behavior and impaired cognitive function caused by severe psychological stress.Methods Based on the rat predation stress model, the expression characteristics and dynamic changes of the expression of cyclic adenosine monophosphate (cAMP) response element binding protein (CREB), phosphorylated CREB (pCREB) and CREB binding protein (CBP) in nerve cells of stressed rats were observed by immunohistochemistry and Western blot. Results Immunohistochemical studies showed that the CREB positive immune response signal in brain tissue of stressed rats was significantly weaker than that in control group 12 h after predation stress (1.78±0.40 and 1.18±0.26 in hippocampus and frontal cortex, respectively, and 0.55±0.13 and 0.88±0.20 in stressed rats, respectively, P<0.01), and the changes in hippocampal structure were more obvious (P<0.01 compared with frontal cortex); The positive immune response signals of pCREB and CBP were significantly higher than those of the control group (P<0.01), and the expression of pCREB was significantly enhanced in hippocampal cells (compared with frontal cortex, P<0.05). Immunoblot detection of hippocampal tissue further revealed that the CREB in the hippocampus of stressed rats was significantly lower than that of the control group at 1 h after predation stress (2.82±0.65 in stressed rats and 11.86±2.47 in control group, P<0.01), and was still significantly lower than that of the control group at 24 h (5.12±1.13 in stressed rats and 10.56±2.38 in control group, P<0.01); The expression of CBP increased significantly simultaneously (1.77±0.39 and 2.44±0.55 in 1 and 24 h stress rats, respectively, and 1.06±0.24 and 0.86±0.20 in control group, respectively, P<0.01); However, the expression of pCREB increased significantly only at 1 and 12 h (2.56±0.59 and 1.93±0.41 in stress rats and 1.04±0.22 and 0.96±0.21 in control group, respectively, P<0.01). Conclusion The changes of CREB transcription pathway in central nervous system, especially in selective hippocampus, may play an important role in long-term emotional behavior abnormalities and impaired cognitive functions such as spatial learning and memory caused by transient severe psychological stress.

Objective to compare the biocompatibility of poly (hydroxybutyrate-hydroxyvalerate) (PHBV) materials before and after low temperature plasma surface modification with NH3, CO2 and O2, in order to provide more ideal biomaterials for vascular tissue engineering by effective surface modification methods.Methods PHBV biomaterials were modified by low temperature plasma surface modification with NH3, CO2 and O2, and the contact angles of the unmodified biomaterials were measured by bubble method as the control group, and the surface elements were analyzed by photoelectron spectroscopy (XPS); Dog endothelial cells were inoculated, and the cell morphology was observed by FTTC fluorescence staining and electron microscopy, and the cell proliferation was analyzed by MTT assay. Results XPS confirmed that the oxygen and nitrogen elements on the surface of PHBV modified by NH3, CO2 and O2 increased significantly, and the performance of the surface modified membrane in contact angle, cell morphology and cell proliferation was better than that of the non-surface modified group.Conclusion The surface modification of PHBV biomaterials by low temperature plasma with NH3, CO2 and O2 can introduce active groups on the surface of the material, and effectively improve the cell compatibility of the material, thus providing an effective method for the surface modification of tissue engineered blood vessels.

Objective to investigate the effect of hypoxia-inducible factor (HIF) -1 α on osteoblast function and its role in bone formation. Methods HIF-1 α gene and its upstream regulatory VHL gene in osteoblast were conditionally knocked out in vitro and in vivo by Cre-Loxp recombinase technique. The expressions of vascular endothelial growth factor (VEGF), nuclear binding factor al (RUN χ 2), alkaline phosphatase (ALP) and osteocalcin (OC) were detected after the osteoblast was cultured at 2% oxygen concentration for 48 h in vitro. The distal femoral bone tissue of 3 months old mice was collected in vivo, and the histomorphometric indexes and bone mineral density (BMD) were detected by tissue section and Micro-CT method. Results After conditional knockout of HIF-1 α gene in osteoblasts in vitro, the expression of VEGF, RunX2, ALP and OC decreased due to the decrease of HIF-1 α expression, while the expression of these genes increased due to the upregulation of HIF-1 α expression after knockout of VHL gene.The bone histomorphometric indexes and BMD of mice with conditional knockout of HIF-1 α gene in vivo were inferior to those of wild type mice, while the above indexes of mice with conditional knockout of VHL gene in vivo were superior to those of wild type mice. Conclusion Under physiological and pathological conditions, due to the existence of hypoxic environment, HIF-1 α can regulate the bone formation process by promoting the function of osteoblasts.

A 45-year-old female was admitted to hospital on May 11, 2006 because her hands turned white and purple when exposed to cold for 5 years, cough and expectoration with low fever for 3 months.

In recent years, it has been found that abnormal centrosomes can be seen in almost all human malignant tumors, and the relationship between abnormal expression of centrosomal protein and tumor sensitivity to chemotherapeutic drugs has also been paid great attention.

Ankylosing spondylitis is a seronegative spondyloarthropathy, which mainly invades the sacroiliac joint, spine, hip and knee and other major joints. The etiology is unknown until now, and there is no effective treatment [1].

A 48-year-old male was admitted to the hospital on December 28, 2006 due to "hepatitis B history for 10 years, fatigue, yellow urine for 2 months, aggravation with disturbance of consciousness for 1 week". He was found to be positive for hepatitis B surface antigen (HBsAg) during physical examination 10 years ago, and his liver function was normal at that time, so he was not treated.