Volume 88  ·   Issue 31  ·  2008

cerebral vasospasm is a common clinical problem in neurosurgery, and its basic and clinical research is one of the hot issues in the field of neurosurgery at home and abroad, especially aneurysmal subarachnoid hemorrhage (aSAH) is an important cause of death and disability.

Objective To evaluate the efficacy and adverse effects of 5-nitroimidazole derivatives in treatment of bacterial vaginosis (BV). Methods 278 BV patients were randomly divided into 8 groups to be treated with (1) oral metronidazole sustained release tablet 750 mg/day for 7 days, (2) oral metronidazole sustained release tablet 750 mg/day for 7 days and vaginal tinidazlole 250 mg for 7 days, (3) oral tinidazlole 1 g/day for 3 days (2 g for the first dose), (4) oral tinidazlole 1 g/day for 3 days (2 g for the first dose), (5) oral ornidazole 2 x 500 mg/day for 3 days and vaginal tinidazlole 250 mg for 7 days, (6) oral ornidazole 2 × 500 mg/day for 3 days, ( 7 ) oral secnidazole 2 g in a single dose and vaginal tinidazlole 250 mg for 7 days, and (8) oral seenidazole 2 g in a single dose. Results The clinical cure rates of the oral administration groups were 56. 76% - 62. 50%, all significantly lower than those of the oral/vaginal combination groups (80. 00% -86. 11% , all P < 0. 05 ). There was nit significantly difference in efficacy level among the only oral treatment groups and the oral/vaginal combination groups (all P>0.05). Conclusion Combination of oral and vaginal administration of 5-nitroimidazole derivatives is more effective in treatment of BV than oral administration only.

Objective To investigate the relationship of certain skeletal maturity indicators of hand and wrist with adolescent growth spurt. Methods 14 757 normal urban children, 7373 boys and 7384 girls, aged 7 -20, all of Han nationality, from Shanghai, Guangzhou, Wenzhou, Dalian, and Shijiazhuang underwent measurement of height and weight, and left wrist anterior-posterior radiography. The incremental curve was fitted graphically according to the differences between the means for height at series ages. The ages of attainment of eleven skeletal indicators were defined by regression analysis for middle phalange 3, radius, and adductor sesamoid of the first finger. Results The accelerative phase of adolescent growth spurt was accompanied by becoming square of middle phalange 3 and the appearance of adductor sesamoid of the first finger. Peak growth velocity (PGV) was reached at about the time of epiphysis capping in middle phalange 3 and ossification of the adductor sesamoid of first finger. Decelerated phase of growth was indicated by the beginning of epiphysis fusion in radius and full maturity in adductor sesamoid of first finger. When the epiphysis of middle phalange 3 and the half of epiphysis of radius were respectively fused with their diaphyses, the growth spurt was ended. Conclusion Certain skeletal maturity indicators of hand and wrist can be used to indicate the period of adolescent growth that a child has reached.

Objective To investigate the clinical effect of laparoseopie-assisted radical distal resection of invasive gastric cancer. Methods Forty-seven patients with advanced gastric cancer, 33 males and 14 females, aged 58. 2 ( 36 - 77 ), underwent laparoseopie-assisted radical resection and then were followed up for 17 months (2 -33 months). Results All the 47 patients survived. The operation time was (29±75) rain (200 -420 min). The blood loss was (150±65) ml (50 -500 ml). The number of dissected lymph nodes was (32.4 ± 22. 3 ) (15 -48 ). The gastrointestinal peristalsis recovery time after operation was (2.7±1.2) d (2 -6 d). The hospital stay time was (9.0±3.5) d (5 -19 d). Post- operational complications were seen in 3 cases: pulmonary infection in 2 cases and incision infection in 1 case, and all the 3 patients recovered well after proper treatment. Conclusion Laparoseopie-assisted radical resection of invasive gastric cancer is safe and feasible, with the advantages as minimal invasion, less pain, shorter hospital stay, faster bowel function recovery.

Objective To investigate the diagnosis and treatment of saerocoecygeal teratoma in adults. Methods The clinical data of 17 patients with sacrococeygeal teratoma confirmed by pathological examination, 9 males and 8 females, aged 20 -53, were analyzed retrospectively. Result Correct diagnosis was made pre-operatively in 13 of the 17 patients. Two cases were misdiagnosed as with leiomyoma, and 2 cases as with saerococcygeal cyst. Pathological examination confirmed the diagnosis of teratoma in all 17 cases. Thirteen patients were followed up for 1 -5 years post-operatively. Malignant change was seen in 1 case, and 1 patient died 1 year after operation. Two patients suffered a relapse and then fully recovered after re-operation, and the other 15 patients all recovered without relapse. Conclusion Saerocoeeygeal teratoma in adults usually has no typical clinical symptom and signs and is often misdiagnosed. The pathologic examination is the base to make a definite diagnosis. Complete excision is necessary to prevent local recurrence and potential malignant transformation. The sacroeoecygeal approach or combined abdominal- sacral approach is recommended.

Objective To study the clinical effects of vertebral pedicle-screw placement in selected thoracic vertebrae with fresh fracture in reduction and fixation. Methods Twenty-five patients with thoracic vertebrae fracture, involving 1 vertebra in 13 cases,2 vertebrae in 7 cases, and 3 vertebrae in 5 cases, underwent vertebral pedicle-screw placement in selected unilateral or bilateral injured vertebrae with relatively complete pedicle of vertebral arch. Pedicle-screw was inserted into the pedicle of the injured vertebra guided by fluoroscopy to achieve posterior pedicle screw fixation, the height of the collapsed vertebral body was recovered by popping up or extruding the vertebral pcdicle-screw. The patients were followed up for 18 -24 months. Results The postoperative X-films showed that the direction and length of the screws were satisfying without screw looseness and breakage of the internal fixation. No loss of spinal height of the injured vertebrae was seen after reduction. Conclusion Pcdicle-screw fixation of the injured thoracic vertebrae is effective in treatment of fresh thoracic vertebrae fracture.

Objective To investigate the clinical characteristics of herpes simplex encephalitis (HSE) and to discuss the mechanism of its relapse. Method The clinical data of 6 patients with relapsing encephalitis, 4 male and 1 female, aged 14 -49, out of 150 encephalitis cases were analyzed: 5 of them were suspected as with HSE clinically, and HSE was confirmed by pathology via biopsy in 2 of the 6 patients. The 5 patients were followed up for 2 -6 years. Result The duration between the onset and relapse was 1 -26 months. Brain MRI or CT showed new lesions in the temporal lobe in 5 patients. Necropsy revealed intracellular inclusions,positive in HSV-1 antigen, in the neurons and glial cells of temporal lobe in one case. Second course of acyclovir therapy was effective in 5 of these 6 patients. One patient died 10 months later. Conclusion Direct invasion of activated virus into the central nervous system and insufficiency of acyclovir treatment are the causes of relapse of HSE. Acyclovir treatment should be early, with sufficient amount, and individualized.

Objective To investigate the relationship of expression of vascular endothelial growth factor(VEGF)-D to microvessel density(MVD), microlymphatic vessel density (MLVD), and lymph node metastasis in lung adenocarcinoma. Methods Fresh specimens of lung adenocarcinoma were collected form 48 patients with lung adenocarcinoma, 28 males and 20 females, aged 35 -78, during operation. Semi- quantitative RT-PCR was used to detect the mRNA expression of VEGF-D, and immunohistochemistry was used to detect the protein expression of VEGF-D, CD34 (marker of MVD) , and VEGF receptor (VEGFR)- 3 (marker of MLV). Results The expression of VEGF-D mRNA in the lung cancer was significantly higher than that in the normal lung tissue, and the expression of VEGF-D protein in the cancerous invasive edge was significantly higher than that in the center of cancerous tissues. Twenty-one of the 29 lung adenocarcinomu patients at stages Ⅲ - Ⅳ were VEGF-D positive, a proportion significantly higher than that of the patients at stages Ⅰ - Ⅱ (7/19, P =0.015). The MLVD of the VEGF-D positive group was 10.25 ± 2. 50, significantly higher than that of the VEGF-D negative group (6. 8±2. 2, P <0. 01 ). Twenty-three of the 28 VEGF-D positive patients showed lymph node metastasis, a proportion significantly higher than that of the VEGF-D negative group (9/20, P = 0. 012). Conclusion VEGF-D is related with the lymphangiogenisis and lymph node metastasis in lung adenocarcinoma, but not with angiogenisis.

Objective To evaluate the long-term clinical outcomes and complications of coronary stent placement for hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT) retrospectively. Methods Eighteen of the 26 patients with HAS or hepatic artery thrombosis confirmed by digital subtraction angiography underwent hepatic artery stenting with coaxial catheter technique and then followed up for 21.7 months (2. 3 -37. 2 months). Liver function tests, color Doppler uhrasonography and CT angiography were conducted. Results Three patients died and 1 patient underwent re-transplantation within 2 months after stenting procedure. Seven patients' hepatic arteries looked normal after stenting. Restenosis was seen in 4 patients (28. 5% ). Two of them needed re-transplantation 20. 5 and 5.1 months after stenting respectively. Three patients died of septic multiple-organ failure, liver abscess, and biliary infection respectively though their hepatic arteries were patent. Kaplan-Meier curve showed that the 1-, 2-, and 3-year survival rates were 76% ,76%, and 76% respectively, and the 1-, 2-, and 3-year graft survival rates after stenting were 69. 5%, 69. 5%, and 48. 0% respectively, and the primary hepatic artery patency rates were 63%, 63%, and 63% respectively. Conclusion HAS after OLT can be successfully treated with stent placement with an acceptable 1-, 2- and 3-year patient, graft survival and primary stent patency rates.

Objective To investigate the curative effect of incorporation of the regimen of standard dose of paclitaxel combined with cisplatin into concurrent radiotherapy as pre-operative treatment for patients with esophageal carcinoma. Methods Twenty-six patients with primary diagnosis of esophageal carcinoma, 17 in stage Ⅱ and 9 in stage Ⅲ, underwent conventional fraetionated radiotherapy with a total dosage of 40 Gy (2 Gy per day, 5 doses per week). Paclitaxel were given intravenously at a dose of 135 mg/m2 for 3 h on dayl and day 22. Cisplatin was given intravenously at a dose of 20 mg/m2 on D1 - D3 and D22 - 24. 4 - 6 weeks after the completion of chemo-radiotherapy, left thoracic incision and transhiatal esophageetomy with anastomosis in the neck was performed. The patients were followed up for 42. 28 months. Kaplan-Meier method was used to analyze the overall survival (OS) and disease-free survival ( DFS), and Log-rank test was performed to assess the survival rates statistical significance among groups. Results The radical resection rate was 96. 15%. The pathologic response to chemoradiotherapy were grade Ⅰ in 9 patients, grade Ⅱ in 6 patients , and grade Ⅲ in l l patients. The pathological complete remission (PCR) rate was 42. 31% (11/26). Toxicity grade 3 -4 included leueopenia (7.69% , 2/26), thromboeytopenia (7.69%, 2/26), and radiation esophagitis (11. 54%, 3/26). Surgery-related complications included anastomotie leakage (3.85% , 1/26) , recurrent laryngeal nerve injury (7.69% , 2/26) , and ehylothorax (3.85% , 1/ 26). The 3- and 5-year overall survival rates were 62. 96% and 54. 56% respectively. The 3- and 5-year disease-free survival rates were 59. 94% and 55.65% respectively . The 3-year overall survival rates of the patients with different pathologic responses were 25.40% (for those of grade Ⅰ ), 60% (for grade Ⅱ ) ,and 90. 91% ( for grade Ⅲ ) respectively ( P < 0. 05 ). The 5-year overall survival rates were 0 ( for grade Ⅰ ) , 60% (for grade Ⅱ), and 81.82% (for grade Ⅲ) respectively (P <0. 05).Conclusion Preoperative chemoradiotherapy containing full dose of paclitaxel and cisplatin increases the 5-year overall survival for the patients with postoperative pathologic response grade Ⅱ and above, and does not increase the treatment- related complications.

Objective To investigate the clinical epidemiological features of adult spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture, a special kind of fracture. Methods The clinical data of 1685 cases of adult tibial and fibular shaft fracture were analyzed retrospectively. The cause and mechanism of spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture were studied in detail. Results The male and female ratio in adult tibial and fibular shaft fracture was 4. 52: 1. Most of adult tibial and fibular shaft fracture occurred in the persons aged 31 -40 (26. 0% ) and type A fracture accounted for 57.7% of the cases. The male and female ratio in adult spiral tibiul fracture was 2. 95: 1. Most of the adult spiral tibial fracture occurred in those aged 41 -50 (32. 6% ). With a male and female ratio of 6:1 (24:4) and mostly occurring in the persons aged 41 -50, spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture composed 9. 7% (28/288) of total tibial fractures and 1.7% (28/1685) of total spiral tibial and fibular fractures. Missed diagnosis rate of spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture was 67.9% (19/28) in the Department of Radiology and 53.6% in the Department of Orthopedics. Conclusion With a high incidence, spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture was caused by a low energy but not an iatrogenic damage. With a high rate of missed diagnosis, the spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture should be paid more attention to clinically.

Objective To investigate the neuroprotective effect of preconditioning with eannabinoid (CB) receptor agonist WIN 55,212-2 on focal cerebral ischemia. Methods Fifty male SD rats were randomly assigned to 5 equal groups: control group undergoing middle cerebral artery occlusion (MCAO) for 2 h only without any preconditioning; 3 WIN 55,212-2 preconditioning groups (wiN1 -3) injected intraperitoneally with WIN 55,212-2 at the doses of 0. 3, 1, and 3 mg/kg respectively 24 h before MCAO for 2 h, and DMSO group injected intraperitoneally with dimethyl sulfoxide (DMSO), solvent of WIN 55,212-2 24 h before MCAO for 2 h. 24,48, and 72 hours after reperfusion the neurological function score (NFS) was evaluated the rats were then decapitated with their brains taken out. Brain infarct volume was evaluated with 2% 2, 3, 5-triphenyltetrazolium chloride (TTC) staining Results The NFS values of the rats in WIN 55, 212-2 preconditioning groups were all significantly higher than those of the control and DMSO groups ( all P<0. 05) while the infarct volumes of the WIN 55,212-2 preconditioning groups were all significantly smaller than those of the control and DMSO groups ( all P < 0. 05) 24, 48, and 72 h after reperfusion. The infarct volumes of the WIN2 and WIN3 groups were both significantly smaller than that of the WINI group (both P < 0. 05 ). However, there was no significant difference in the infarct volume between WIN2 and WIN3 groups (P = 0. 928). Conclusion WIN 55,212-2 preconditioning has neuroprotective effect on focal cerebral ischemia with a dose-dependent manner.

Objective To evaluate the effectiveness of autologous adipose derived mesenchymal stem cells (ADSCs) tranduced by adenovirus-mediated human transforming growth factor 2 (Ad-hTGF-β2) gene in the repair of articular cartilage defects. Methods Rabbit ADSCs were obtained, cultured, and transfected with Ad-hTGF-β2 containing human transforming growth factor (hTGF) - β2. Three days later RT-PCR was used to detect the mRNA expression of hTGF- β2 in the ADSCs, and ELISA was used to detect the protein expression of hTGF-β2 in the supernatant, phosphorylation of Smad was examined by Western blotting. Articular cartilage defects at the femoral trochlea were made on 20 rabbits (40 sides) so as to establish animal models. The culture-expanded rabbit ADSCs transfected with Ad-hTGF- 2 were seeded on poly (L-lactic-co-glycolic acid) (PLGA) scaffolds. The cell-adhered PLGA scaffolds were implanted into the articular cartilage defects. Plain PLGA was implanted into the left-side defects of 10 rabbits as control group and the defects of 10 sides remained untreated as blank control group. The rabbits were sacrificed 4, 12, and 24 weeks after the operation respectively. The specimens of defects were examined histologically and stained immunohistochemically for type Ⅱ collagen. Results After transfection the ADSCs expressed mRNA and protein expression of hTGF- β2 and Western blotting showed bands of phosphorylated Smad. The cartilage specimens harvested from the experimental group rabbits demonstrated hyaline cartilage formation mingled closely with the nearby tissues and expression of type Ⅱ collagen. However, only fibroblasts, not cartilage-like cells, were seen in the control groups that lacked the expression of type Ⅱ collagen too. Conclusion Culture-expanded autologous ADSCs adhered with PLGA composites facilitate the formation of hyaline-cartilage.

Objective To investigate the changes myocardial enzymes related to glycolysis and fatty acid metabolism in chronic myocardial ischemia and to evaluate the relationship between the gene expression of glycolytic metabolism related enzymes and myocardial viability. Methods Fourteen Chinese experimental pigs underwent placement of arterial ring into the left anterior descending coronary artery so as to establish models of myocardial ischemia and infarction. <'18>F-2-deoxy-2-fluoro-D-glucose single photon emission computed tomography was conducted to observe the viability of the myocardium. One week later the pigs were killed with their hearts taken out. Specimens of ischemic zone, infarction zone, and non-ischemic zone were obtained. RT-PCR was used to detect the mRNA expression of glucose transporter (GLUT)1, GLUT4, medium-chain acyl-CoA dehydrogenase (MCAD), and heart-fatty acid binding protein (H-FABP). Immunohistochemistry was used to examine the protein expression of Glut1 and Glut4. Periodic Acid Schiff- hematoxylin staining was conducted to detect the glycogen. Results Pathological examination showed 5 pigs with myocardial infarction and 5 pigs with ischemia. In the pigs with ischemia, the mRNA expression levels of GLUT1 and GLUT4 in the ischemic zone were 9466 ± 9033 and 60 398 ± 64 699 respectively, both significantly higher than those in the control zone (5854 ± 5287 and 34 188 ± 44 714 respectively, P = 0.043, P=0.043). The RNA expression of H-FABP in the ischemic zone was 18 123 ± 15 925, significantly lower than that in the control zone (50 718±62 412, P =0. 043), and there was no significant difference in the mRNA expression level of MCAD. In the pigs with infarction the mRNA expression of level of H-FABP in the infarction zone was 21 919 ± 15 224, significantly lower than that in the control zone (87 545±92 990, P =0. 043), and there were not significant differences in the mRNA expression levels of the GLUT1, GLUT4, and MCAD genes ( all P > 0. 05). The mRNA expression of GLUT1 in the myocardial segments with perfusion/metabolism mismatch was significantly higher than that in the myocardial segments with perfusion/metabolism match ( 19 794 20 454 vs 5134 + 6022, P = 0. 046 ). The ischemic cardiac myocytes showed hypertrophy and positive staining of anti-GLUT1 polyclonal antibody. Conclusion The changes of mRNA and protein expression of enzymes related to glycolysis and fatty acid metabolism after myocardial ischemia play an important role in glycolytic metabolism during myocardial ischemia.

Objective To built an expression vector of angiostatin (AG) gene with recombinated replication defective adenovirus and investigate the therapeutic effect of human AG gene on ovarian cancer. Methods (1) Human AG K ( 1-3 ) cDNA was inserted into the vector pShuttle to build the recombinant plasmid pShttle-AG ( K1-3 ). pAdeno-X-AG (K1-3) was built by double-cut and recombinated pShttle-AG (K1-3) to vector pAdeno-X, and then recombinant adenovirus was finally prepared by transinfection of pAdeno-X-AG (K1-3) into to the human embryo kidney cells of the line 293. (2) Human ovarian cancer cells of the line SKOV3 were inoculated subcutaneously into nude mice of the line BALB/c nu/nu to establish model of human ovarian cancer. Then the mice were randomly divided into 3 groups to be injected with Ad = AG (K1-3), Ad-LacZ, or phosphate buffered saline (PBS) around the cancer every 5 days. The tumor size was measured every 5 days to calculate the tumor volume and tumor inhibition rate. Three days after the last injection the mice were killed. The tumor tissues, livers, and kidneys of the mice underwent imunohistochemistry to calculate the microvessel density (MVD) and expression of vessel endothelial growth factor (VEGF) and AG. Results The tumor volume and weight of the Ad-AG ( K1-3 ) group were significantly less than those of the PBS and Ad-LacZ groups ( all P <0. 01 ), however, there were not significant difference between the latter two groups ( both P > 0. 05). The expression levels of CD34 and VEGF of the Ad-AG( K1-3 ) group were both significantly lower than those of the PBS and Ad-LacZ groups (all P < 0. 01 ), however ( both P > 0. 05 ). Conclusion Human angiostatin mediated by adenovirus suppresses the angiogenesis and the growth of human ovarian cancer in the nude mice model, which suggests that it is promising in clinical application.

Peroneal muscular atrophy (CMT) is a kind of peripheral neuropathy with high clinical and genetic heterogeneity. According to electrophysiological and pathological characteristics, it can be divided into two types: CMT1 (demyelinating type) and CMT2 (axonal type).

A 63-year-old man was seen in the Department of General Internal Medicine of Peking Union Medical College Hospital on December 26, 2006 due to fever and diarrhea for 2 days. The body temperature was 38.5℃, accompanied by chills, periumbilical colic, nausea and vomiting. He defecated yellow watery stool more than 20 times/day, with a large amount each time. 　　

Valproic acid is a broad-spectrum anti-epileptic drug commonly used in clinic. It can effectively control absence seizures, myoclonic seizures and generalized tonic-clonic seizures, and also has certain curative effect on simple or complicated partial seizures.

A 42-year-old female suffered from sudden abdominal pain, nausea and vomiting for 1 d. "Acute superficial gastritis" was ineffective after 3 d of conventional treatment, and gastroscopic biopsy was performed. The pathological report was "chronic superficial gastritis". A small amount of ascites was found by B-ultrasound, considering exudative peritonitis, and she was transferred to the emergency department of our hospital on June 18, 2005.