Volume 88  ·   Issue 21  ·  2008

Editor's Note After the devastating earthquake in Wenchuan on May 12th, a large number of medical workers responded to the call of the Party and the state and devoted themselves to the front line of earthquake relief without hesitation.

Objective To investigate the effect and safety of sequential therapy of levofloxacin in prevention of peri-operative infection among female patients undergoing surgery for stress urinary incontinence (SUI).Methods 85 female SUI patients,aged 58,with the average body weisht of 63 g,underwent transvaginal tape(TVT)procedure.Levofloxacin 500 mg was given to 24 of the 85 patients who underwent simultaneous hysterectomy by intravenous iniection since l day after the operation once a day and then given orally once a day for 4-8 days when the condition was improved.And levofloxacin 500 mg was given by intravenous injection to 61 of the 85 patients who were to underwent simple TVT 30 min before the operation and then was given orally 500 mg once a day for 4 days.The clinical efficacy and side reaction were observed.ResulIs The average duration of intravenous iniection of levofloxacin in the patients who underwent hysterectomy was 2.5 d.and the duration of oral administration of levofloxacin was 5.7 d.The duration of oral administration of levofloxacin in the patients who underwent simple TVT was 3.2 d.No infection Wris seen in 85 patients with an eficient rate of 95.3%.No infection was found in all the 61 patients who underwent simple TVT with an efficient prevention rate of 100%.The overall side reaction rate was 5.9%.Only 3 patients showed mild gastroenterological reaction and 2 patients showed rashes. Conclmion Sequential therapy of levofloxacin is effective and safe in prevention of peri-operative infection in female patients undergoing surgery for stress urinary incontinence.

Objective To evaluate the efficacy of multiple cranial nerves monitoring under partial neuromuscular relaxation during cerebellopontine angle(CPA)tumor resection.Methods Seventy elective patients undergoing CPA tumor resection via microneurosurgery were randomly allocated to 2 equal groups: Group FN receiving intraoperative facial nerve(NF)monitoring and Group MN receiving monitoring of multiple nerves:trigeminal nerve,glossopharyngeal nerve,accessory nerve or hypoglossal nerve other than the FN which were considered at risk by the neurosurgeon preoperatively.The manipulation procedure were modified according to cranial nerves monitoring and neuromuscular relaxation was maintained at train of four stimulation(TOF)=3 by continuous vencronium infusion during the acoustic neuroma resection.The function of the cranial nerves monitored were evaluated preoperatively and 8 days postoperativelv.Results Discernable and legible images of electromyographic wave complex were obtained during cranial nerve mapping and monitoring under intraoperative partial neuromuscular relaxation form all the patients.The facial nerve function of 4 patients exacerbated(from H-B grade Ⅰ-Ⅱ to gradeⅢ-Ⅳ)in both groups,and one new glossopharyngeal nerve function deficiency was found in Group FN,and one new hypoglossal nerve function deficiency was found in Group MN postoperatively.Conclusion Intraoperative cranial nenves monitoring under partial neuromuscular relaxation is feasible.Multiple cranial nerves combined with facial nerve monitoring seems unable to increase the short-term protective effects of nerve function after CPA tumor resection.

Objective To assess the effects of metoprolol on perioperative cardiovascular events in patients with risk or at high risk for coronary artery disease(CAD)who were to undergo non-cardiac surgery.Methods 102 patients with definite CAD or at high risk for CAD who were tO undergo selective non-cardiac surgery Were randomized to 2 equal groups:Group A(blank control group)and Group B given metoprolol orally or intravenously from 2 h before surgery to 30 days after surgery.The dosage of metoprolol Was adjusted according to the blood pressure and heart rate.The changes of peri-operative heart rate(HR),level of creatine kinase(CK)-MB,cardiac events such as unstable angina pectoris(UAP)and myocardial infarction(MI),death,and stroke were recorded.Results The HR values,intra-operative and 6 h,1 d,and 2 d after operation of Group B were all significantly lower than those of Group A(a11 P<0.05).One patient from each group had MI.One ease of death and two cases of strokes occurred in Group A.The occurrence rate of at least one cardiovascular event were 9.8%in Group A(5/5 1)and 2.0%in Group B (1/51)without significant difference between these 2 groups(P>0.05).Conclusions Metoprolol reduces the incidence of postoperative severe cardiovascular episodes in patients with risk of or at high risk for CAD undergoing non-cardiac surgery.

Objective To investigate the association of abnormal fatty acid oxidation(FAO), endothelial function activation, and oxidative stress in pathogenesis of severe preeclampsia (S-PE).Methods Placema tissues were obtained from 70 S-PE patients with onset in different gestational weeks with or without liver damage.The protein expression of long chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD),tumor necrosis factor(TNF)-α,vascular cell adhesion molecule(VCAM)-1,and peroxisome proliferator activated receptor(PPAR)γ were analyzed using immunohistochemistry.54 samples from normal prenancy in first,second and third trimester were collected as controls. Results Protein expression of LCHAD.TNF-α,VCAM-1,and PPAR-γ could be seen in both placenta of normal pregnancy and S-PE.The protein expression level of LCHAD of the cases of S-PE that came down of the disease before 32 gestational weeks,especially of the cases complicated with liver damage,Was significantly lower than that of the controls(P<0.05).However,no differences in the LCHAD protein expression were found between the S-PE patients with the onset after and 32 gestational weeks and the controls.The TNF-α protein expression levels of the S-PE patients with different onset weeks were all significantly higher than those of the controls (all P<0.05).The VCAM-1 protein expression levels of the S-PE patients with the onset after 34-gestational weeks was significantly higher than that of the controls(P<0.05).There Was no significant diffference in the PPARγ protein expression between the S-PE patients and the controls.The placental LCHAD protein expression of the S-PE patients with the onset before 32 gestational weeks,especially of the cases with liver function damage,was dramatically decreased in comparison with the controls.and the placental TNF-α protein expression was dramatically increased,however,there was no linear cofrelation between LCHAD and TNF-α expression.There was no significant difference in expression of PPARγ and VCAM-1 between the S-PE patients and the controls.There was no linear correlation among the exDIlession levels of LCHAD,TNF-α,VCAM-1,and PPARγbetween the S-PE patients with the onset before and after 32 gestation weeks. Conclusion Abnormal FAO may be one of the factors related to some cases of PE with the onset before 32 gestational-weeks,especially those with liver damage.The Correlation among LCHAD,TNF-α,VCAM-1,and PPARγare complicated.

Objective To evaluate the prognostic factors of colorectal carcinoma in the elderly aged over 70 after radical surgery.Methods 263 colorectal carcinoma patients aged 74.9,147 males and 115 females.underwent radical surgery,including right hemieolectomy(n=48),left hemicolectomy(n:11),transverse colectomy(n=8), sigmoid resection(n=27),low anterior resection(n=103),abdominoperineal rlesection(n=58),and Hartmann's operation(n=7). Survival analysis was condueted using Kaplan-Meier method, and multivariate analysis wag conducted with Cox regressmn to analyze the prognostic factors.Results The post-operative complication rate was 14.4%.The 30-day mortality wag 1.1%.The overaill 5-year survival rate was 70.5%,and the 5-year survival rates of the patients with ASA grades Ⅰ,Ⅱ,and Ⅲ were 84.8%,71.8%,and 61.9%respectively.Univariate analysis showed that the Dredictors of survival were age,co-morbidity,ASA score,postoperative complication,preoperative serum albumin conccntration.preoperative hemoglobin level,gross tumor configuration,tumor stage, neoplastic intestinal obstruction,and lymph node metastasis. Multivariate analysis showed that patient sex,complication, operative complication, gross tumor configuration,depth of infiltration, lymph node metastasis,and tumor staging were independent influencing factors od prognosis. Conclusion The prognosis of colorectal carcinoma in the elderly after radical surgery is good.The prognostic factors include age,postoperative complication, and pre-operative serum albumin concentration,and gross tumor configuration,depth of tumor invasion,lymph node metastasis,and tumor stage.

Objective To study the effects of 16-multi-detector row CT(MDCT)aortography with lower tube current in diagnosis of aortic diseases.Methods The study was conducted in 2 Steps.In the first step,58 patients with suspicious aortic disease or after operation on the aorta underwent 16-MDCT aortographv for 70 times.Ten of them underwent scanning with conventional tube current of 175 mAs and the other 60 patients were divided into 3 groups according to their bogy weights:<65 kg group(n=20)receiving the lowest tube current of 25 mAs,65-75 kg group(n=20)receiving the lowest tube current of 50 mAs,and>75 kg group(n=20)receiving the lowest tube current of 75 mAs.In the second step 60 patients with dissecting aneurysm.underwent 16-MDST aortography and were divided into 3 groups according to their bedv weight too:<65 kg group(n=20)receiving the lowest tube current of 50 mAs,65-75 kg group(n=20)receiving the lowest tube current of 75 mAs,and>75 kg group(n=20)receiving the lowest tube current of 100 mAs.all 25 mAs more compared with the corresponding groups in the first step. The weighted CT dose index(CTDI),scanning length,and dose length produce(DIJP)were recorded.The diagnostic accuracy rates of the images from the lOW dose groups were compared with those of the higher dose grouDs.Results The data of the first step showed that the CTDI values of the patients who received 25 mAs.50 mAs.and 75 mAs tube current were 11.3%,29.0%,and 42.7% that of the conventional tube current group(all P<0.001),and the DLP values of the 3 low dose groups were also significantly lower than that of the conventional tube current group(all P<0.001).,The diagnostic accuracy rate of the 25 mAs.50 mAs,and 75 mAs groups were 60%,85%,and 85% that of the conventional tube current group.The results of the second step showed that the CTDI values of the 50 mAs,75 mAs,and 100 mAs groups were 29.0%.42.7%,and 57.3% that of the conventional tube current group respectively,and the DLP values of the 3 low dose groups were also significantly lower than that of the conventional group(all P< 0.001);and the 50 mAs,75 mAs,and 100 mAs groups all showed good three-dimensional reconstruction imaging qualities,all with the diagnostic accuracy rate of 100%.The crossing section and three-dimensional images all showed excellent diagnostic image quality.Conclusion 16-MDCT aortography with the tube current at the doses 50 mAs to 100 mAs suffices to diagnose aortic diseases in patients with different body weights.Higher tube current should be used in dissecting aneurysm.The tube current at the dose of 100 mAs satisfies the imaging and diagnosing of all kinds of aortic diseases in the patients with any body weight.

Objective To explore the clinical features,prognosis,and optimal treatment strategy of clear cell sarcoma(CCS).Methods Nineteen patients,12 males and 7 females,aged 30.9,with histologically confirmed CCS.3 with tumors≥5 cm and 16 with tumors<5 cm,5 tumors being located in the upper extremity,2 in the hand,6 in the lower extremity,2 in the foot,3 in the tnmk,and 1 in the head.were hospitalized from March 1973 to March 2007.The primary tumors of all the cage8 were marginally excised before admission and 10 cases had local relapse at admission.Two presented local lymph node metastasis and 2 presented distant metastasis.Ten patients witll tumor relapse underwent re-operation. Eight patients received chemotherapy.8 radiotherapy and 1 combined chemotherapy and radiotherapy.The patients were followed up for 51.4 months(3-144 months).Results Tumor recurrence occurred in 1 of the 10 patients who received re-operation.3 patients developed lymph node metastasis and 2 developed pulmonary metastasis.of the 9 patients who did not undergo re-operation 7 developed lymph node metastasis,6 developed pulmonary metastasis and 6 died.The overall 5-year survival mte was 75.2%and the 10-yeat survival rate was 37.5%.Condusion CCS iS a rare and hish grade soft tissue sarconla with high incidence rates of local recurreuce and metastasis.and poor prognosis.The role of chemotherapy and radiotherapy for CCS should be investigated further.The best choice after local recurrence is re-operation.

Objective To evaluate the orthopedic effects of internal fixation of cervical pedicle screw on cervical spondylotic myelopathy with cervical kyphosis.Methods Seventeen patients with cervical spondylotic myelopathy with cervical kyphosis with the Cobb's angle>10.underwent internal fixation of cervical pedicle screw.The patients were followed up for 13.8 months.The Cobb's angle of cervical kyphosis was measured before operation,one week after-operation,and upon the finsl follow up.The neural function and cervical spine stability were evaluated using Japanese Orthopedic Association(JOA)scoring system.Results The average preoperative Cobb's angle of cervical kyphosis was.16.1°before operation.Was-3.3°one week after operation,and was-3.8°at the final follow-up.Follow-up 6 months after operation and at the final follow up showed that the fused segments were stable.The JOA score improved by 5.2±1.6(P<0.05)with a mean JOA score improvement rate of 64.3%.No neurovascular and instrumentation-related complications occurred.Condusion Internal fixation of cervical pedicle screw is effective and safe in treatment of cervical spondylotic myelopathy with cervical kyphosis.

Objective To survey the incidence of psychological adverse events in critical conscious Patients dunng their ICU stay and analyze the relationship between the incidence and the sevetitu of illness.Methods 234 conscious patients,133 males and 101 females,aged(55.4±19.6).80 with internal medicine diseases and 154 with surgical diseases,were treated in the ICUs of 31 grade 3 A hospitals over the country consecutively during the period of 2 months and then successfully transferred to other departments.The patients were interviewed with specific questionnaire within the 2 days after transfer to investigate the incldence of anxiety and depression and the tolerance of invasive medical and nursing procedures of the patients.Results The overall incidence of psychological adverse events(PAE)was 69.6%.Multi.variate Logistic analysis showed that acute physiology and chronic health evaluation(APACHE) Ⅱscore was an independent high risk factor of PAE(OR=1.07,95%CI:1.02.1.13,P<0.05).The relative risk(RR)values of the patients with APACHE Ⅱ scores 1-10,11-20,and>20 were 1.29.2.53.and 4.85respectively.The higher the APACHE Ⅱ score,the more invasive interventions received(P<0.01).and the lower the mental stress threshold(P<0.01)the higher the incidence of PAE(P<0.01).The APACHE Ⅱ scores of those who failed to tolerate noise and medical and nursing procedures were 15.8±5.7 and 16.5±6.1 respectively,both significantly higher than those of the patients who tolerated(1 2.1±4.4.P<0.05:conscious ICU patients with higher APACHE Ⅲ scores receive more invasive medical and nursing procedures.Low mental stress threshold greatly contributed to the incidence of PAE in ICU conscious critical patients with high APACHE Ⅱ score.

Objective To identify the recurrence-related factors in patients with myasthenia gravis (MG)after extended thymectomy.Methods Followed up was conducted on 271 MG patients,127 males and 146 females,aged 31(4-57),who underwent extended thymectomy for 18-84 months.Post.operational pathological examination showed 32 cases of thymoma and 239 cases of diseases other than tnymoma. Atter operation the patients were treated with pyridostigmine only or combined with adrenocortical hormone.The relevant factors of the 135 patients with relapse were evaluated:sex,Ossemlan classification,age while being operated on,duration of preoperative period,pathologic type of thymus.use of steroid before operation,infection after operation, whether only taking anticholinesterase drugs after operation. use of steroid immediately after operation,stopping medicine or decreasing the dose of medicine within 1-3 months after remission of symptoms. Results COX univariate analysis revealed that failure to take steroid immediately after operation(OR=2.914,P=0.000),infection after operation(OR=3.441,P=0.000).only taking anticholinesterase drugs after operation(OR=5.947,P=0.000),and immediately stopping medicine use or decreasing the dose of medicine within 1-3 months after the remission of symptoms(OR= 2.242,P=0.000) were prognostic factors for postoperative recurrence. On the other hand.multivariate logistic regression analysis revealed that infection after operation(OR=47.63,P=0.000),only taking anticholinesterase drugs after operation(OR=62.38,P=0.000),and stopping medicine or decreasing the dose of medicine 1-3 months after remission of symptoms(OR=32.76,P=0.000)were indeDendent influencing factors of recurrence after operation. Conclusion Post-operative infection, onlv taking PYridostigmine,and stopping medicine too early are independent factors of postoperative relapse.Regular treatment and timely use of adrenocortieal hormone decrease the recurrence after operation.

Objective To investigate the relationship between the intestinal barrier function and pigment gallstone formation.Methods Ninety Guinea pigs were divided randomly into 3 groups:normal control(CON)group receiving normal forage,pigment gallstone(PS)group receiving pigment gallstoneforming forage,and intestinal mucosa protection group receiving pigment gallstone-forming forage with supplemental glutamine intestinal(GLN),a mucosa protector.The guinea pigs were observed for 8 weeks,the gallstone-forming rate,plasma diamine oxidase(DAO),serum endotoxin,proportionality of urine lactulose/mannitol,and biliary β-glucuronidase were detected.PCR was used to detect the bacteria in abdominal lymph node taking 16SrRNA as the target gene commnon in most bacteria.32 gallstone patients,16 with cholesterol gallstone and 1 6 with pigmental gallstone,and 27 patients with non-gastroenterological diseases,as controls,underwent detection of the plasma DAO and serum endotoxin.Another 109 gallstone patients,31 with cholesterol gallstone and 78 with pigmental gallstone,and 21 patients with nongastroenterological diseases,as controls,underwent detection of urine technetium-labeled diethylenetriamine-pentacetate(99mTc-DTPA).Results The gallstone-forming rate of the guinea pigs of the GLN group was 44.4%Was,significantly lower than that of the PS group(73.9%.P<0.05).The plasma DAO,serum endotoxin levels,proportionality of urine lactulose/mannitol,and activity of biliary βglucuronidase of the PS group were all significantly higher than those of the CON group(P<0.05 or P<0.01).The plasma endotoxin level of the GLN group was significantly lower than that of the PS group ( P<0.01).The positive rate of bacteria in abdominal lymph node of the PS group was 80%,significantlv higher than those of the CON and GLN groups(30%and45%respectively,P<0.01 andP<0.05).The level of plasma DAO and endotoxin of the pigmental gallstone patients were significantly higher than those of the controls(P<0.05 and P<0.01).The urine 99mTc-DTPA excretion rate of the pigrnental gallstone patients was 11.4%.significantly higher than that of the controls(4.7%,P<0.01).Conclusion Intestinal barrier function is correlated with pigment gallstone forming.Intestinal barrier function disorder may promote pigment gallstone formation through bacteria translocation, endotoxemia, and increase of biliary βglucuronidase.

：Objective To study theexpression level of caveolin-1 in articular chondrocytes in patients withosteoarthrits(OA),and whether catabolic factor IL-1β stimulate caveolin-1 expression in articular chondrocytes. Methods In human OAcartilage, caveolin-1 mRNA wag investigated by quantitative real-time RT-PCR whilecaveolin-1 protein was detected by immuohistologic analysis in 8 cases OA model wasprepared by unilatcral anterior cruciate ligament and medial collateral ligamenttransection in 20 rats.In cuItured OA chondrocytes,caveolin-1 mRNA expression was studiedby RT-PCR and quantitative real-time RT-PCR,and caveolin-1 protein was analyzed by Westernblouing.Results In 6 of 8 OA cases,human OA articular cartilage,higher expression levelsof both caveolin-1 mRNA and caveolin-1 protein were found in advanced degeneratedcartilage than less degenerated cartilage of the same joints.In rat OA model, uDregulatedcaveolin-1 expression wag found,which was associated with the degree of cartilagedestruction.IL-1β(10 ng/ml)upregulated caveolin-1 mRNA/proteinexpression in cultured OA chondrocytes for at least 48 hours.Conclusion Enhancedexpression level of caveolin-1 is associated with cartilage degeneration in OA.IL-1β stimulates caveolin-1 expressionin articular chondrocytes,which may be responsible for OA development.

Objective To investigate the influence of rapid nongenomic effect of androgen on the insulin sensitivity of mature adipocytes and the molecular mechanism thereof.Methods Fetal rat preadipocytes of the line 313-L1 were cultured to develop into mature adipocytes.3T3-LI adipocytes were pretreated with testosterone of the concentration of 10-9～10-5mol/L for a short-time (0-30 minutes)or a long-time(24 hours).Insulin(Ins)200μl at the concentration 100 μmol/L and 2-deoxy[3H]glucose were added to examine the glucose uptake.Phosphorylation and protein expression of Ins receptor(InsR) and its downstream signaling molecules(Akt and GSK3 13)were analyzed by Western blotting.Results The Ins-stimulated glucose uptake after the pretreatment of testosterone for 30 min and 24 h decreased gradually in response to the increasing of the concentration of testosterone with the nadir both at the testosterone concentration of 10-5mol/L(both P<0.05).The phosphorylation levels of InsR,Akt,and GSK3β were significantly down-regulated by adding of testosterone at the concentration of 10-6mol/L for 3-30 minutes (all P<0.05)or by adding of testosterone at the concentrations of l0-7-10-6mol/L for24 hours (all P<0.05).The protein expression levels of InsR,Akt,and GSK3 B,however,were not significantly affected by testosterone treatment.Conclusion Rapid nongenomic effect of androgen may contribute to the insulin resistance in adipoeytes.

Objective To investigate quantitatively the proliferation of tumors in characteristic of either expansive or infihrative growth pattern.Methods The CT/MRI images of 34 tumor patients with 6 different pathological types were adopted to undergo quantitative evaluation of the growth pattern of these tumors.Three key parameters,fractal dimension(Df)of the border between the tumor and neighboring tissues,degree of heterogeneity(H),and clumpiness(C)inside the tumor,were computed numerically.Results The Df values of the infiltrative tumors were higher than those of the expansive tumors.thus revealing the more evident complexity and openness of the border of infiltrative tumor.Heterogeneity and clumpiness existed within both expansive and infihrative tumors.The clumpiness derived from heterogeneitv and they were correlated positively with each other.The growth coefficient of clumpiness of the expansive tumor was greater than that of the infiltrative tumor.Conclusion The method to anaiyze the fractal dimension of tumor border,and degrees of heterogeneity and clumpiness within a tumor presented in this paper gives some enlightenment to the fundamental research in characterizing tumor growth and shows practical value in clinical diagnosis of tumor,and may be of benefit to the quantitative eyaluation of radiological images and computer.aided diagnosis.

Recent neuroanatomical and imaging results suggest that the lesions in patients with depression involve multiple brain regions, and their neural connections include limbic-thalamic-cortical structure and limbic-striatal-cortical-thalamic structure [1-2]. The impaired connection of this circuit leads to abnormal overall neuromodulation function, and predicts that depression is a neurological disease with psychiatric symptoms [3].

Case 1: A 58-year-old female was admitted to hospital due to edema for 1 year and proteinuria for 3 months. Hepatitis B virus for 3 years. Physical examination showed that bilateral thyroid gland was enlarged at second degree, and a 4.5 cm ×2.0 cm mass was palpable at the lower pole of the left thyroid gland. The heart and lungs were not different, the liver and spleen were not reached, and the face and both lower limbs were moderately edema.

A 67-year-old male was admitted to the First Hospital of Jilin University with increased blood pressure for 13 years, aggravated with stomach discomfort, dizziness and hematemesis for 5 days.