Volume 88  ·   Issue 05  ·  2008

Objective To explore the effects of fixation of pedicle of vertebral arch in treatment of atlantoaxial fractures and dislocation.Methods Pedicle screw instrument was used in fixation of pedicle of vertebral arch in 24 patients with atlantoaxial fractures and dislocation.Twelve cases with irreducible atlas dislocation were treated surgically with anterior soft tissue release combined with posterior reduction and pedicle screw instrument.Preoperative CT and radiography as well as intraoperative screw placement and bone grafting were administered in all cases.Cervical collar was as external support for 3 months.Result A total of 84 screws were successfully placed in the atlas.22 of the 24 cases were followed up for 18.9 months(3-48 months)without the complication of internal fixation failure.Bony union occurred within 4～6 months without the complications of internal fixation.fixation failure.and re-dislocation.Four screws were penetrated into the medial rim of the vertebroarterial foramen;however,no vertebral artery injury was documented.Neurological recovery was improved significantly in 22 cases.Conclusion With the advantages of screw placement under direct vision,short-segment fusion,intra-operative reduction,and high fusion rate,internal fixation through pedicle of vertebral arch is a good method for atlantoaxial fractures and dislocation.

Objective To investigate the effects of delivering phentolamine via pulmonary artery combined with aortic infusion of norepinephrine in the treatment of patmnts with low cardiac output syndrome and refractory pulmonary hypertension.Methods Twenty-one open heart surgery patients who developed pulmonary hypertension crisis after removal of the cross-clamp. Routine therapy,including central venous influsion of vasodilator and/or inotropics,and inhaled NO,couldn't wean the patients from cardiopulmonary bvpass(CPB).Then they were treated with pulmonary arterial infusion of phentolamine and aortic infhsion to 0ptimized hemodynamies.If continuous infusion was anticipated,a Swan-Ganz catheter was advanced 35-40 cm through the femoral artery into aorta to substitute the aortic infusion.Hemodynamic data and the time to wean from CPB were recorded. Results All the patients were weaned from CPB successfully.The CPB time was 90±33(52-184)min,the aortic clamping time was 52±20(31-100)min.Three minutes after the administration of phentolamine and norepinephrine the pulmonary artery pressure,pulmonary vascular resistance index,and pulmonary-to-systemic vascular resistance ratio were significantly lower than those before the infusion(both P＜0.01).The systemic pressure and cardiac index significantly increased within 5 minutes after the infusion(both P＜0.01).Six patients underwent femoral arterial catheterization successfully,norepinephrine infusion continued until 12-18 h postoperatively. Nineteen patients survived and were discharged,one patient died of cardiac arrest three days postoperatively,and one died of pulmonary infection one week after surgery. Conclusion Combined through pulmonary artery infusion of Dhentolamine and aorta infusion of norepinephrine effectively control pulmonary hypertension crisis following CPB.

Objective To explore the survival time of the patients with small cell lung cancer (SCLC)treated with postoperative chemotherapy and the factors affecting the prognosis.Methods The clinical data of 111 patients treated with postoperative chemotllerapy,88 males and 23 females,aged 57(32-81),were reviewed retrospectively.Resuits The overall median survival time(MST)was 38 months,and the 1-,3-,and 5 year survival rates were 85.6%,50.6%.and 38.7%respectively.The 5 year survival rates of the patients at the stage Ⅰ was 61.4%,significantly higher than those of the patients at the stages Ⅱ and Ⅲ(40.2%and 29.9%respectively,both P=0.001).The 5 year survival rate ofthe male patients was 33.7%,significantly lower than that of the female patients(56.5%,P=0.042),the 5 year survival rate of the patients with lymph node metastasis was 32.5%,significantly lower than that of the patients without lymph node metastasis(59.6%,P=0.001);and 5 year survival rate of the patients,with lymphovascular invasion Was 21%,significantly lower than that of the patients without lymphovascular invasion(46%,P=0.001).Cox's multivariate analysis identified TNM stage,lymphovascular invasion,sex,lymph node metastasis,and chemotherapy cycles as independent prognostic variables.Conclusion For SCLC treated with postoperative chemotherapy,TNM stage system is an important prognostic factor;and sex,lymphovascular invasion,lymph node metastasis,and chemotherapy cycles also affect the survival outcome.

objective To investigate the clinical significance of ultrasonic umbilical artery flow analysis in pregnaney with gestational diabetes mellitus(GDM).Methods Ultrasonic Doppler umbilical artery blood flowmeter was used to detect the systolic/diastolic blood pressure(S/D)ratio,pulse index,and resistance index of umbilical artery in 102 GDM women,aged(29±4),and 105 aged-matched normal pregnant women.The delivering and pefinatal outcomes were observed. Results The S/D ratio,pulse index.and resistance index of the GDM women were 2.55±0.52,1.03±0.23,and 0.59±0.68respectively,all significantly higher than those of the control group(2.11±0.22,0.81±0.13,and 0.52±0.47 respectively.all P＜0.01.The rates of premature rupture of fetal membrane,postpartum hemerrhage,fetal macrosomia,and bad outcome of perinatal infant in the GDM group were 12.7%,7.8%,17.7%,and 12.7%respectively,all significantly higher than those in the control group(1.9%,1.9%,6.7%,and 1.9%,all P＜0.05).The rates of premature labor,premature rupture of fetal membrane,postpartum hemorrhage,fetal macrosomia,and bad outcome of pefinatal infant of the GDM women with the S/D.S/D≥2.5(n=47)were 36.2%,21.3%,17.0%,55.3%,and 21.3%respectively,all significantly higher than those of the GDM women with the S/D＜2.5(n=55)12.7%,3.6%,1.8%,7.3%and 3.6%,(all P＜0.05).Conclusion Ultrasonic umbilical artery flow analysis in pregnancy with GDM is a good method to forecast the placenta function and perinatal outcomes.The poor perinatal outcome is associated with the S/D≥2.5 in GDM.

Objective To screen the mitochondrial DNA mutations in patients with polycystic ovary syndrome(PCOS).Methods Peripheral blood samples were collected from 57 patients with PCOS and 38 normal women.Full length sequencing was conducted on the mitochondrial DNAs.Analysis of the differences in the mutations was carried out using χ2 test.Results 233 single nucleotide variations wereidentified in the mitochondrial DNA of the PCOS patients and normal controls without significant difference between these 2 groups.One repeat sequence variation in mitochondrial DNA was identified to be located at nt 8281 of the mitoehondrial DNA.consisting of the 9-bp CCCCCTCTA repeat in both groups,howeyer,the positive rate of this one repeat sequence variation of the PCOS group was 93.8%; significantly higher than that of the normal control group(71.4%,P＜0.05).Conclusion PCOS may be associated witll the 9-bp CCCCCTCTA repeat sequence at nt 8281 of human mitochondrial DNA.

Objective To investigate the correlation between neuromyelitis optica(NMO)and tuberculous infection,to confirm whether central nervous system(CNS)infection is involved,and to test whether antituberculous chemotherapy can cure NMO.Methods Thirteen NMO patients who failed to recover after treatment with high dose corticosteroids underwent trial chemotherapy against tuberculosis without concomitant immunosuppressive treatment.Disability was scored by means of expanded disability status scale(EDSS).Cerebrospinal fluid samples were collected to undergo MPB64-targeted nested PCR to test Mycobacterium tuberculosis and magnetic resonance imaging changes were evaluated before and after treatment,long-term observations were followed up.Resuits Antimycobacterial therapy leaded to important neurological recovery.Visual acuity was improved markedly,most abnormal signals in spinal cord disappeared during the follow-up,and the EDSS score decreased after the treatment even to 3 from pretreatment scores(such as 9).Nested PCR to test M.tuberculosis was positive in 3 patients.After antituberculous chemotherapy all the patients showed an excellent response, Conclusions Tuberculous infection may be the main cause of NMO.Direct CNS tuberculous infection is involved in the pathogenesis.Antituberculous chemotherapy is beneficial for the patients failing to respond to corticosteroid treatment.

Objective To discuss the diagnosis and treatment of intradural extramedullary tumors.Methods The clinical data, including manifestations,images,pathological features,and operative approaehes of 31 intradural extramedullary tumors admitted from 2000 to 2006 were analyzed retrospectively.Resuits Seventeen cases(54.8%)suffered from meningioma.Eleven of the 17 cases were located with craniospinal meningioma,9 of which were located in the ventral and ventrolateral sides of foramen magnum;and 6 of the 17 cases were with spinocranial meningioma,4 of which were located in the lateral and dorsal sides.All 31 cases underwent operation under microscope,and of tumor,total removal and major removal were achieved in 26 and 5 cases respectively.Lateral suboccipital approach,far lateral transcondyle approach,and median suboeeipital approach were applied according to the location and size of tumors,and the approaches were divided into three categories based on their position relationship with the underlying cranial nerves.Conclusion Intradural extramedullary tumors are benign mostly,and the therapeutic effect of surgical removal is ideal.

Objecfive To study the clinicopathological characteristics of pneumonia in elderly.Methods The clinical and pathological data of 165 patients with autopsy-proven pneumonia,160 males and 5 females,aged≥65(66-102),hospitalized 1980 to 2000 in Beijing Hospital were reviewed.Results 99.4% of the cases had one or more of the 6 diseases concomitantly:coronary heart disease (CHD)(n=113,68.5%),neurological diseases (n=82,49.7%),malignancies (n=75,45.5%),COPD (n=50,30.3%),renal insufficiency (n=47,28.5%),and diabetes mellitus (DM) (n=39.23.6%).Malignancies were found in 75 patients.Bronchial pneumonia predominated the pathological findings,whereas lobar pneumonia was found only in 3 patients.A definite locale was identified in 127 patients,with bilateral involvement in 88 patients,right and left lung involvement in 22 and 17 patients respectively,and 38 patients had the involvement of＞2 lobes.Unilateral or bilateral hydrothorax developed in 79 patients.33 patients were diagnosed as with aspiration pneumonia,in which 25 patients were complicated with small abscess formation,29 with organizing pneumonia,10 with fungal pneumonia,4 with viral pneumonia,and7 with active tuberculosis.111 cases were diagnosed clinically with an accordance rate with the pathological diagnosis of 67.3%.The manifestations were mainly those of exacerbation or acute onset of the underlying diseases or those of the complicating diseases,which was the main reason of missed diagnosis and misdiagnosis.Only 92 cases(55.7%)were febrile,and rigor was absent.109 patients(66.0%)produced purulent respiratory expectoration.Moist rale was present at aUscultation in 81 cases(49.1%).Leucocytosis was seen in 78 cases(47.2%).Pneumonia was diagnosed by chest X-ray examination in 53 cases(32%)and pleural effusion was diagnosed by chest X ray examination in 28 cases(16%).Conclusion The atypical clinical presentations of pneumonia in the elderly cause missed diagnosis and misdiagnosis clinically. Chronic basic disease is the most important risk factor for senile Dneumonia.Aspiration pneumonia accompanied with small abscess is common pathologically.Clinicians should pay attention to the infections of some special pathogens in elderly pneumonia.

Objective To clarify the anatomic basis and present the accurate Plane of total mesorectal excision (TME). Method 23 pelvises(12 male and 11 female)harvested from embalmed cadavers were studied by dissection.The relationships of the"mesorectum"with the fascias and nerves of the pelvic cavity were observed. Results Three layers were found surround the rectum and different nerve existed in different layers.Visceral fascia,parietal fascia and vesicohypogastric fascia were found side by side in a inside-outside direction. Conclusion The layer of TME dissection contains visceral fascia.The correct laver of posterior and lateral resection can be identified by hypogastric nerve and pelvic plexus respectively.

Objective To evaluate the expression of vascular endothelial growth factor (VEGF) and thrombospodin1(TSP1)in epithelial ovarian cancer and tlleir correlations with tumor angiogenesis and prognosis.Methods Fifty-seven samples of primary epithelial ovarian cancer and 22 samples of normal ovary from patients with hysteromyoma obtained during operation underwent immunohistochemistry with antiVEGF,anti-TSP1,and anti-CD34 antibodies.Microvessel density(MVD)in the tumor tissue was evaluated on the base of CD-34 immunostaining.The correlations of VEGF and TSP1 expression with clinico-pathologic characteristics and 3-years survival rates were analyzed retrospectively.Results The positive rate of VEGF protein of the epithelial ovarian cancer was 70.2%,significantly higher than that of the normal ovarian tissue (45.5%,P＜0.05).The positive rate of TSP1 protein of the epithelial ovarian cancer was 47.4%,significantly lower than that of the normal ovarian tissue(72.7%,P＜0.05).The MVD of the epithelial ovarian cancer was(30±9),significantly higher than that of the normal ovarian tissue(20±8,P＜0.05).The VEGF Dositive expression and TSP1 negative expression were positively correlated with the FIGO stage,omentum metastases,and malignant ascites(P＜0.01,＜0.01,and＜0.05 respectively).VEGF expression was positively correlated with MVD(P＜0.01),and TSP1 expression was negatively correlated with MVD(P＜0.01).Increased expression of VEGF and decreased expression of TSP1 with were reversely correlated with the Datients' survival.The 3-year survival rate of the patients positive in VEGF and negative in TSP1 was 24.0%.significantly lower than that of the patients negative in VEGF and positive in TSP1 (83.3%.P＜0.01).Conclusion Increased expression of VEGF and decreased expression of TSP1 in epithelial ovarian cancer are closely related to its angiogenesis.Detection of these two proteins contributes to identifying their biological behavior and prognosis.

Objective To investigate the neuroprotection of insulin against 1-methyl-4-phenylpyfidinium ion (MPP+)-induced pheochromocytoma ceils.Methods Pheochromocytoma cells of the line PC123-were cultured with nerve growth factor(NGF)added into the cultured fluid,inoculated in 96-well plate,and then divided into 6 groups to be treated with regular insulin(R!),MPP+,MPP++RI,MPP++RI+LY294002,a PI-3-K/Akt inhibitor,MPP++RI+LY294002,or nothing(control group).Twenty-four hours later(4,5-dimethyhhiazol-2-yl)-2,5-diphenyhetrazolium bromide(MTT)assay wasperformed to evaluate the viability of the PC12 cells.The apoptosis induced by MPP+was determined by Hoechst 33258 staining method and flow cytometry(FC).Microtiter immunocytochemical ELISA assay was used to detect the phosphorylation of protein kinase B(Akt),glycogen synthase kinase-3β(GSK3β),and tau.Results MTT assay showed that the vitality of the RI group was signifieantly higher than that of the control group(P＜0.01),the vitality of the group was 89%±5%that of the control group(P＜0.05),and the vitality of the MPP++RI group was 98%±7%that pf the control group and significantly higher than that of the MPP+group (P＜0.05).Hoechst 33258 staining showed that RI pretreatment protected the PC12 cells against the apoptotic eflfect of MPP+.FC showed that the apoptotic rate of the MPP+ group was significantly higher than that of the control group(P=0.007),the apoptotic rate of the MPP+group was significantly lower than that of the control group(P=0.04).and the apoptotic rate of the MPP++RI+LY294002 group was significantly higher than that of the group(P=0.02).The expression level of phosphorylated Akt(pS473)was increased after treatment with 100 nM insulin for 2 h(P=0.008),and the phosphorylated Akt(pS473)expression level of phosphorylated Akt pS473 of the MPP++RI+LY294002 group was not significantly different from that of the control group(P=0.74).The expression level of phosphorylated GSK3 β ser-9(pS9)after treatment with RI for 2 h was significantly higher than that of the control group(P=0.005),however,RI did not increase the expression of GSK3β itself(P=0.59).The expression of phosphorylated tau pS199 of the RI group was significantly lower than that of the control group(P=0.003);however,pretreatment with RI and pretreatment with MPP did not change the phosphorylation degree at the tau pT231 site.Conclusion Insulin protects PC12 cells from the eytotoxity of MPP+ by activating Akt and GSK3 β.

Objectlve To study the ability to repair large segmental bone detects of vasculanzed bone of tissue engineering constructed by co-seeding mesenchymal stem cells(MSCs)and endothelial cells (ECs)induced from the MSCs in porous β-tricalcium phosphate(TCP).Methods Rabbit MSCs were obtained,cuhured,and induced to differentiate into ECs. 1.5 cm ulna diaphyseal defects were made bilaterally in 32 rabbits.The 64 bone defects were randomly divided into 4 equal groups Group A:without treatment,Group B,implanted with β-TCP,Group C,implanted with tissue-engineered bone(MSCs+β-TCP),and Group D,implanted with vascularized bone of tissue engineering(MSCs+ECs+β-TCP).Xray and ECT examination,HE staining of tissue slices of the implants,and biomechanical test of the specimens were carried out 4,8,12,and 16 weeks postoperatively to evaluate the repairing effect of the bone defects and vascularization of the implants.Results The bone defects of Group A showed little trace of osteogenesis.The bone defects of Group D showed a more perfect repairing effect and vasculanzation of implants than Group C.Conclusion The vascularized bone of tissue engineering constructed by MSCs and ECs induced from MSCs co-seeded in porous β-TCP can accelerate the vascularization and osteogenesis process of the implants,and is more effective in repairing large segmental bone defects.

Objective To explore the effects of curcumin on the synaptic transmission of the cultured hippocampal neurons of rats.Methods Hippocampal neurons were obtained from 18-day-old fetal SD rats,cultured for 9 days,and then divided into 2 groups:curcumin group,with curcumln of the final concentration of 10 μmol/L added into the culture fluid for 24 h,and control group with DMSO added into the cultured fluid.Simultaneous excitatory postsynaptic current(sEPSC)and miniature excitatory postsynaptic current(mEPSC)of the rat hippocampal neurons in these two groups were observed usmg the method of patch clamp,whole cell recording,and gap free mode. Results (1)The frequency of sEPSC in the neurons treated with curcumin was 1.4 Hz±0.5 Hz,significantly higher than that of the control group (0.8 Hz±0.4 Hz,P＜0.01).The amplitude of sEPSC of the neurons treated with curcumin was 1834 pA±244 pA,not significantly different from that of the control group(1721 pA±391 pA,P=0.115).(2)The frequency of mEPSC in the neurons treated with curcumin was 6.4 Hz±0.8 Hz,significantly higher than that of the control group(5.1 Hz±0.9 Hz,P＜0.001).The amplitude of mEPSC in the neurons treated with curcumin was 34 pA±10 pA.Not significantly different from that in the neurons treated with DMSO(30 pA±9 pA,P=0.057).Conclusion Curcumin modulates or enhances the synaptic transmission,which possibly contributes to the cognition enhancing effect of curcumin in rats suffering from cerebral ischemia.

Objective To investigate the signal pathway by which cyclosporine A(CsA)improves the invasiveness and migration of the first trimester human trophoblast cells. Methods Human first trimester trophoblast cells obtained during artificial abortion and human chorioepithelioma cells of the line JAR were cultured and put into the upper chamber of Transwell cell invasion system.Dimethyl sulfoxide (DMSO)or CsA of the concentrations of 0.0001,0.001,0.01,0.1 and 1.0 μmol/L respectively were added into the upper chamber for 48 h. Some of the upper chambers underwent pretreatment of U0126,a specific inhibitor of MAPK/ERK1/2,for 20 min.The invasiveness and migratory capabilities of the human trophoblast cells was examined.ELISA was used to detect the MAP kinase(MAPK)activity of the human trophoblasts in response to CsA stimulation.JAR cells were inoculated in 96-well plate and co-transferred with p-nuclear factor of activated T cells(pNFAT)-luciferase and internal control plasmid pRL-sV40 for 24 h,and then stimulated with CsA,ionomycin,and phorbol myristate acetate for 4 h;luciferase reporter system was used to detect the activity of the luciferase so as to calculate the activity of NFAT.Results The invasiveness and migration of the human trophoblast cells were enhanced by CsA in a dose-dependent manner,peaked at the CsA concentration of 1.0μmol/L,and then decreased.Activation of MAPK/ERK1/2 in the trophoblasts was observed as early as 10 min after the stimulation of CsA(1.0 μmol/L), and peaked 30 min after the stimulation. Moreover,the CsA-induced ERK1/2 activation remained at a higher level for at least 1 h,and then decreased significantly 2 h following the CsA treatment.Pretreatment with U0126 inhibited the invasion and migration of the trophoblasts.Activation of Ca2+/calcineurin/NFAT by ionomycin inhibited the invasion and migration of human trophoblasts,which were restored by CsA as well as NFAT inhibitor.The promotion of the invasion and migration of human trophoblasts by CsA was stronger than that by the NFAT inhibitor,and no synergy was seen between these 2 factors.U0126 blocked the MAPK/ERK1/2 signal pathways,but not influenced the NFAT transcription activity.Conclusion CsA promotes the invasiveness and migration of human trophoblast cells by activating the MAPK/ERK1/2 and inhibitingCa2+/calcineurin/NFAT signal pathways independently.

The patient was a 14-year-old illiterate female who was admitted to hospital on August 28, 2006 due to subcutaneous nodular ulcer for 10 years, polydipsia and polyuria for 8 years, aggravated with fever for half a month. The 4-year-old child was found to have a softening of the left cranial parietal mass, and was operated as "scalp abscess" in the other hospital. After operation, the left skull had a huge defect, with subcutaneous nodules, softening, ulcers, pus and scars all over the body, accompanied by intermittent fever. The routine diagnosis and treatment according to "skin tuberculosis, fungal and suppurative bacterial infection" was ineffective.

Recent studies have shown that hematopoietic stem cells are not the only stem cells existing in bone marrow. Bone marrow stromal cells, also called bone marrow mesenchymal stem cells, are another important type of stem cells existing in bone marrow. These cells can differentiate into osteogenic, muscle, adipose, nerve, lung and other tissue cells, so they have attracted much attention of researchers. The research progress of mesenchymal stem cells and lung injury is summarized as follows.

Narcolepsy is a kind of chronic sleep disorder neurological disease with four sleep-related symptoms: irrepressible sleep during the day, cataplexy, sleep-related hallucinations and transient general paralysis. The etiology is unknown. Since the discovery of hypocretin/orexin in 1998, more and more studies have shown that there is a necessary relationship between hypocretin and narcolepsy.

Video-assisted thoracoscopic techniques (VATS) are increasingly used in thoracic surgery, which requires single-lung ventilation to fully expose the visual field on the surgical side. In the past, single-lung ventilation is generally realized by inserting double-lumen bronchial tube (DLT), Univent tube [1-3], Fogarty tube [4-5] or ordinary tracheal tube into the bronchus, etc. Each of these techniques has its own limitations.

Many studies have shown that long-term exposure to air pollutants can increase mortality and decrease lung function. At present, it is believed that lung function is one of the important determinants of cardiopulmonary health and life extension of individuals. More and more studies have proved that stopping smoking can effectively slow down the deterioration of lung function, but there are relatively few studies on reducing the protective effect of air pollution on lung function.

A 33-year-old male suffered from intermittent involuntary movements of limbs for 2 years. In September 2004, he developed headache and fever. A few days later, he developed pain in left knee, elbow and wrist joints and involuntary movements of left limbs. The involuntary movements were mainly at the distal end of the limbs, manifested as wrist flip-like movements, fine movements could not be completed (could not tie buttons, etc.), and involuntary movements of toes; Accompanied by involuntary facial movements, such as squeezing eyebrows, pouting, etc. The symptoms gradually aggravated. Except for the low muscle tone of the left limb, there was no abnormality in physical examination.

The child was the third child and the third child, with a gestational age of 34+6 weeks. Prenatal color ultrasound showed peritoneal effusion. Cesarean section was performed due to intrauterine distress and polyhydramnios. Apgar score after birth was 3 at 1 min and 7 at 5 min. After birth, the child had systemic edema, bruise, no spontaneous breathing. After tracheal intubation and cardiopulmonary resuscitation, ventilator-assisted breathing was transferred to the neonatology department. The mother of the child was 35 years old, physically fit, blood type O RH positive; The father was 37 years old, healthy, blood type B. The first child of the couple was a baby boy, who died of acute aplastic anemia at the age of 10. The second child was interrupted by fetal edema found by B-ultrasound at 6 months of pregnancy.