Volume 88  ·   Issue 47  ·  2008

In the past half century, the primary prevention of cardiovascular and cerebrovascular diseases has accumulated sufficient evidence, and it has been paid widespread attention worldwide. Most developed countries in Europe and America have made remarkable achievements in primary prevention, and the incidence rate of cardiovascular and cerebrovascular diseases has decreased obviously, while the incidence rate of cardiovascular and cerebrovascular diseases in China is still increasing.

emergency department surge refers to the state of large and continuous increase in emergency department medical demand or abnormally complicated demand in a short time. It can be caused by daily factors and disasters, and it is an imbalance between the number of injured patients and the required medical resources, which can cause emergency department crowding, disorder and even work paralysis. At present, sudden mass casualties and other public health events can lead to extremely serious emergency department medical demand surge problem [1].

Objective To investigate the influence of a catastrophic event to the physical and mental health of inhabitants in "5.12 serious earthquake in Wenehuan county".Methods The analysis of descriptive epidemiology on the spot was made in 3006 servicemen who were living in the disaster area of Wenchuan county and Dujiangyan city.Results The diseases were mainly found in both psychological syptoms and respiratory system, and the incidences were 62.16% and 51.78%, respectively.It was obviously showed that these children and juvenils less than 14 years had the most apparent psychological syptoms, and the incidence was 85%.On the contrary, the diseases were testified to be low in the incidence of digestive system, and the incidences were only 31.21%.Conclusions The physical and mental health of inhabitants who experienced a catastrophic earthquake disaster was harmed in various degree, and the corresponding measures should be made in the medication or mental intervention.

Objective To explore the causes of death and risk factors in patients of war wound and trauma of extremities.Methods This retrospective study involved 352 patients of war wound and trauma of extremities admitted to 303rd Hospital of People's Liberation Army during the period between 1968 to 2002.All the data were reviewed and the causes of death of 15 patients were analyzed by autopsy, and a computer's logistic regression model analysis was performed to approach the risk factors of death.Results Fifteen of the three hundred and fifty-two patients were died (4.3 % ).The causes of death included acute renal failure(ARF) (46.7%,7/15), lung embolism( 20.0%,3/15), clostridial myonecrosis(20.0%,3/15) and multiple organ system failure (MOSF)(13.3%, 2/15 ).In the univariate analysis, the risk of death increased by shock, time admitted to hospital, amputation,time of tourniquet,associated injury of head, thoracic region, abdomen or blood vessel (P < 0.05 ).In the logistic regression model analysis, shock and amputation were the two factors most strongly associated with the death of patients of war wound and trauma.(P < 0.05).Conclusion Acute renal failure(ARF) was the main cause of death of patients of war wound and trauma of extremities.Its should be helpful for minimize the mortality of patients of war wound and trauma to manage the shock in time and have a correct choice of amputation promptly.

Objective To investigate the genetic differences and their relativity with multi-drug resistance of Pseudomonas aeruginosa isolated.Methods Forty-nine Pseudomonas aeruginosa isolates were characterized by antimicrobial susceptibility and four-enzyme (I-Ceu I,Spe I,Swa I,Pac I) pulsed-field gel electrophoresis (PFGE).Results 85.7% of the P.aeruginosa isolates were MDR strains.Strains with PFGE pattern A were all susceptible to amikacin and cefepime, but were resistant to levofloxacin and meropenem.Strains with PFGE Patterns H and P had resistance to 6-8 different kinds of antibiotics.Strains with PFGE Patterns I and J were susceptible to all antibiotics tested in this study.Strains with other PFGE Patterns had intermediate resistance.PFGE pattern A was the dominant pattern, which accounted for 61.2% of all P.aeruginosa strains, 100 % (2/2) in 2001, 65% (13/20) in 2002, 44.4% (8/18) in 2003 and 77.8% (7/9) in 2004.Conclusion Four-enzyme combined PFGE analysis is highly discriminatory for the subtyping of MDR P.aeruginosa isolates.

Objective To study the relationship between smoking and hyperhomoeysteinemia (Hhe) in ischemie stroke patients.Methods The clinical data of 329 ischemie stroke patients with H He and 306 age-matched ischemic stroke patients without Hhe, including sex, symptoms, signs, history of smoking, and plasma homocysteine (Hey), folate, and vitamin B12 concentrations were compared.The isehemie stroke lesions were divided into 2 subtypes, large vessel disease group and small vessel disease group according to the TOAST system.Result The number of cigarettes smoked per day, cumulative year of smoking, and smoking index(number of cigarettes smoked per day X cumulative year of smoking), and ratio of males of the Hhe group were all significantly higher than those of the non-Hhe group, and the plasma homoeysteine, folate, and vitamin B12 concentrations of the Hhe group were all significantly lower than those of the non-Hhe group(all P < 0.01 ).Smoking index was positively correlated with the Hey concentrations and negatively correlated with the folate and vitamin B12 concentrations(all P < 0.01 ).The smoking proportion and Hey concentration of the male patients were significantly higher than those of the female patients( both P <0.01), and the plasma folate and vitamin B12 concentrations of the male patients were all significantly lower than those of the female patients(P < 0.01 and P < 0.05 ).The number of cigarettes smoked per day, cumulative year of smoking, smoking index, and Hey concentration of the large vessel disease group were all significantly higher than those of the small vessel disease group(all P < 0.01 ).Conclusion Smoking and being male may be the risk factors of Hhe in iscbemic stroke patients.Smoking and Hhe are prone to cause lesion in large vessel.

Objective To investigate the relationship of basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF) and proliferation of endogenous neural stem cells (NSCs) after human cerebral infarction.Methods Paraffin-embedded brain tissues of 22 human fatal cases of CI from the brain tissues around subventricular zone and subgranular layer zone were stained with HE and immunohistochemistry stain.The endogenous neural stem cells were marked by nestin.The expression changes of EGF,bFGF and nestin in the perihematomal tissues were analysised with the SPSS 13.0 system.Results(1) Compared with the controls,the number of nestin-positive cells increased at 24 - 72 h (14±6)/HP in the ipsilateral SVZ and began to rise at 4.5 -10 h (11 ±5)/HP in the ipsilateral SGZ, reached maximum at 120 - 144 h(( 38 ± 7 )/HP in the SVZ,(54 ± 17 )/HP in the SGZ, and decreased markedly at 216 -336 h,but it was still elevated compared with the controls (P <0.05).(2) The number of bFGF-positive cells increased at 4.5 - 10 h (8.1±2.9)/HP in the SVZ,(19.0± 8.2)/HP in the SGZ, reached maximum at 24 -70 h(15.6 ±3.5)/HP in the SVZ, (32.0 ±5.7)/HP in the SGZ and decreased at 72 - 96 h, but it was still elevated compared with the controls(P < 0.05 ).③ The number of EGF- positive cells increased at 4.5 - 10 h (4.3 ± 1.6 )/HP in the SVZ,(7.0 ± 3.7 )/HP in the SGZ, reached maximum at 120 - 144 h (27.0 ± 1.4)/HP in the SVZ, (51.5 ± 4.9)/HP in the SGZ and decreased at 216 -336 h, but it was still elevated compared with the controls (P <0.05).Conclusions Perhaps the increased expression of EGF and bFGF after CI was a reaction of endogenous reparation and it correlated with the proliferation and endogenous of neural stem cells in human.

Objective To explore the relationship between apolipoprotein B (apoB) gene G12669A polymorphism and cerebral infarction with family history,and to evaluate the effect of G12669A polymorphism on plasma lipid levels.Methods Peripheral blood samples were collected from 147 members of 15 cerebral infarction families, including 47 cerebral infarction patients with positive family history(CIFH-P), 43 firstdegree relatives(CIFH-Ⅰ), 28 second-degree relatives(CIFH-Ⅱ), and 29 third-degree relatives(CIFH-Ⅲ), 83 sporadic cerebral infarction (SCI) patients, and 100 healthy controls.Polymerase chain reactionrestriction fragment length polymorphism was used to detect the apoB gene G12669A polymorphism.Oxidase method was used to detect the levels of triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL).The serum levels of lipoprotein (a) [ LP(a) ],apoB-100, and apoAI were determined by immune method.Results(1 )The frequencies of A allele in the CIFH-P, CIFH-Ⅰ,CIFH-Ⅱ,CIFH-Ⅲ, and SCI groups patients and control group were 0.106, 0.081, 0.036, 0.034, 0.090, and 0.045 respectively, that of the CIFH-P group being significantly higher than that of the control group(P < 0.05), and those of the CIFH-Ⅰ,CIFH-Ⅱ, CIFH-Ⅲ, and SCI groups not being significantly different from that of the control group.(2) In both CIFH-P and SCI groups, the TC and LDLC levels of the patients with G/A gene type were significantly higher than those of the G/G gene type, while the HDL-C level of the patients with G/A gene type was significantly lower than that of the G/G gene type(all P < 0.05 ).Conclusion A allele in G12669A polymorphism may be one of the genetic factors influencing the susceptibility to CI in the individuals with a positive family history, and it may play its role through its influence on the blood lipid levels.

Objective To explore the feasibility and efficiency of CT-guided percutaneous ethanol ablation (PEA) in the treatment of malignant tumors with pleura] or chest wall invasion.Methods Nine patients of malignant tumors with pleura] or chest wall invasion that failed to respond to operation, radiotherapy, or chemotherapy were treated by PEA under CT guidance.The improvement of quality of life (QOL) during the treatment was observed and the efficiency was evaluated by CT scan.Follow-up was conducted for 6 - 24 months.Results After successful ethanol ablation, cancer pain of the patients was relieved obviously and pain degree reduced to 0 -3 score according to the numerical rating scale (NRS).Cough and hemoptysis disappeared.Appetite and sleeping were improved markedly.Body weight increased and the Karnofsky performance status (KPS) score was over 90.No serious adverse effect and complication occurred during and after PEA.PEA was performed successfully 34 times in 18 lesions of these 9 patients.In follow-up, local recurrence and new tumors appeared in 2 patients, but good results were achieved after the second PEA treatment.One tumor came to recurrence in a patient of lung cancer, but it was well controlled after another two times of PEA treatment.One patient with lung cancer gave up treatment and came to recurrence after successful PEA treatment 7 months later.Two patients of primarily hepatocellular carcinoma died of brain metastases 8 and the 9 months after treatment.Condusion With little damage and few complications, CT-guided PEA is convenient and effective in treatment of malignant tumors with pleural invasion.

Objective To approach an anatomic pathological classification scheme for the intracardiac leiomyomatosis (ICL), and to guide the choice of the surgical strategy for ICL treatment.Methods Retrospectively reviews the data of 13 cases of ICL from February 1995 to March 2007 in Anzhen Hospital.They were surgically treated under the CPB with different surgical strategy, and a quaternary classification scheme was used to classify them according to their anatomic pathological features of ICL Results There was no operative death.One patient with YBOR type of ICL died from recurrence due to the incomplete excision 5 months after the primary operation.The 5yrs survival rate calculated by the Kaplan-Meier survival curve was 93% ±5%.Of the surviving 12 patients, 9 were in NYHA functional class Ⅰ,and 3 in class Ⅱ.Conclusion The surgical treatment of ICL can get a good mid-long term survival rate and living quality, and a quaternary classification scheme for ICL can be used to guide the choosing of surgical strategy and to understand the symptoms of ICL.

Objective To discuss the application value of video-assisted thoracoscopic surgery (VATS) in treatment of esophageal leiomyoma.Method Clinical data of patients with esophageal leiomyoma treated by VATS from Junary 1999 to August 2007 were analyzed.Results VATS esophageal leiomyoma enucleations were performed successfully in 23 patients, and 18 patients of them were performed by pure VATS, 5 patients of them were performed with mini-thoracotomy.M1 the procedures of operations were completed smoothly without mortality and postoperative complications.22 patients were pathologically diagnosed as esophageal leiomyoma after surgery (2 patients' leiomyoma came from mnscularis mucosa).1 patient was esophageal muscularis neurilemmoma.Conclusion VATS leiomyoma enucleations must be a routin operation while treat thoracic esophageal leiomyoma.

Objective To study the expression of epidermal growth factor receptor (EGFR) and Ki67 antigen in human brain ependymoma and the correlation between them.Methods Immunohistocbemistry was used to detect the expression of EGFR and Ki-67 antigen in 40 specimens of brain ependymoma, 8 specimens of normal brain tissues, and 8 specimens of glioblastoma, all obtained during operation.Results The EGFR positive rate of the Ⅲ - Ⅳ grade ependymoma tissues was 75%, significantly higher than that of the grade Ⅰ - Ⅱ grade ependymoma tissues (25%, P < 0.05 ).The specimens of glioblastoma were all EGFR positive.The EGFR positive rate of the recurrent ependymoma tissues (5/6) was significantly higher than that of the primary ependymoma tissues (9/34, P < 0.05 ).The positive rate of Ki-67 L1 in the Ⅲ - Ⅳ grade epondymoma tissues was (9.5 ± 5.6) %, significantly higher than that in the grade Ⅰ - Ⅱ grade ependymoma tissues [(2.2 ± 1.4)%,P <0.05) ].The positive rate of Ki-67 L1 in the glioblastoma tissues was (9.8 ± 6.3 )%.The positivity of EGFR was positively correlated with the grade level of ependymoma and Ki-67 L1 positivity(both P < 0.01 ).Conclusion EGFR expression positive rate increases with tumor grading The positive rate of recurrent ependymoma is higher than that of the primary ependymoma.The expression of Ki-67 antigen is positively correlated with the expression of EGFR in difference grades.

Objective To evaluate the value of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in identification of tumor element and grading of brain astrocytoma.Methods Thirty-three patients with histologically confirmed aatrocytoma underwent diffusion weighted imaging(DWI), diffusion tensor imaging(DTI), and conventional MRI before operation.The values of ADC and FA of different regions in the same tumor and of astrocytoma of different grades were measured and compared.Results The ADC values of the tumor parenchyma, necrotic region, peritumoral edema region were (1.28 ± 0.44),(1.97 ± 0.53), and(1.74 ± 0.47) respectively, all significantly higher than that of the corresponding normal brain tissues [(0.80 ± 0.18), P = 0.009, P = 0.000, P = 0.000 ] with significantly differences between the tumor parenchyma and necrotic region and peritumoral edema region(both P < 0.05), however, there was not significant difference between the necrotic region and peritumoral edema region.The FA values of the tumor parenchyma, necrotic region, and peritumoral edema region were(0.18 ± 0.07), (0.14 ± 0.05), and (0.16 ± 0.05) respectively, all significantly higher than that of the corresponding normal brain tissues [(0.58 ±0.10), all P =0.000], without significant differences among the former 3 groups.There were no significant differences in the ADC and FA values among the tumors at different grades, however, there was a tendency of ADC to decrease and of FA to increase along the increase of grade of tumor, although not significantly.Conclusion ADC value plays an important part in distinguishing tumor components and determining tumor boundary, and plays a certain role in judging the grade of astrocytomas.FA value is vital to determine the tumor boundary, and has certain value in differentiating high-grade from low-grade astrocytomas.

Objective To investigate the correlation between onset of myasthenia gravis (MG) and the changes of the number and distribution of thymus mature dendritic cells (mDC).Methods The specimens of thymus were obtained during operation from 39 MG patients who hadn' t received immunosuppressive therapy before thymectomy and 19 sex- and nge-matched patients who underwent cardiosurgery as controls.Immunohistochemistry with antibody against DC-LAMP, specific surface marker of DC, was used to examine the number and distribution of thymus mDCs.Results(1) mDCs were restricted in the medulla and cortex-medulla junctional zone of thymus in the control group; while were irregularly distributed in the cortex, medulla, and stroma in the MG group.(2) mDCs presented a roughly uniform distribution in the medulla of thymus in the control group, while clustering distribution was more often in the MG group, especially dense around the germinal center.(3) The relative ratio and numbers of mDCs per average field of vision in the positive areas of the MG group were(10.9% ± 2.2%) and(50 ± 9), beth significantly higher than those of the control group [ (8.5% ± 1.5%) and (41 ±7) respectively, both P < 0.05 ].Conclusion The number and ratio of the thymus mDCs in MG are high, high, and the distribution abnormal.mDC actively may be actively involved in the pathogenesis of MG.

Objective To summarize the clinical characters and therapeutic strategies of isolated superior mesenteric artery dissection, a rare disease.Methods The clinical data of 101 patients of isolated superior mesenterie artery dissection, including 2 cases treated in the Peking Union Medical College Hospital and 99 cases collected from the literatures were analyzed.Results 84.16% of the patients were males.The average age of the patients was 53.95.70% conservative treatment was successful in 70% of the patients.The symptoms were alleviated in 52 patients, of which 36 had undergone surgeries and 16 had endovascular therapy.The restenosis rate of endovascular therapy was 12.50%.Conclusion Surgery and endovaseular therapy are more effective than conservative treatments for isolated superior mesenteric artery dissection.The therapeutic strategies depend on the clinical symptoms and imaging examinations.

Objective To observe the effects of uremia serum on monolayer permeability and Factin in cultured rat pulmonary microvascular endothelial cell (RPMVEC) and to investigate the mechanism of injury of RPMVEC induced by uremia serum.Methods RPMVEC was isolated and cultured from Wistar rat in vitro.The effects of serum of uremia patients on monolayer permeability of RPMVEC were observed with microfiher, and F-actin expression was evaluated by flow eytometry.Results Serum of uremia patients induced the increased permeability of RPMVEC monolayer for 6 h and 12 h( P <0.01), depolymerization of F-actin for 6 h and 12 h(P <0.01),the increased permeability of RPMVEC monolayer induced by serum of uremia patients is significandy correlated with the depolymerization of F-actin(r = - 0.927, P <0.01 ).Conclusion Serum of uremia patients may induce the elevation of permeability monolayer and the depolymerization of F-actin in RPMVEC.The elevation of permeability monolayer induced by serum of uremia patients in RPMVEC is significantly correlated with the depolymerization of F-actin.

Objective To establish a rabbit model of cerebral spinal flow metastasis, to analyze the growth rate of tumor, and to investigate the value of MRI in monitoring the biology of tumor compared with pathology.Methods Twenty-four New Zealand white rabbits were inoculated with suspension of VX2 tumor cells in the subarachnoid space via the foramen magnum (experimental group), and 6 rabbits were inoculated with normal saline (control group).MRI examination, including non-enhanced T1 WI, T2 WI, and FLAIR sequences and then T1WI, FLAIR after dynamic contrast enhanced with Gd-DTPA were done 7 ～ 22 days after inoculation with a 3-day intervaL The rabbits were killed after the Last MRI scan with their spinal cords, spinal meninges, and tumor taken out to undergo microscopy.Results(1) MRI plain scan showed that in the experiments] group 2 nodi in the medulla and 1 nodus in the cervical spinal cord were found with low signal on TI WI and high signal on T2 WI; and FLAIR imaging showed local lesions with medial signal in 6 rabbits (25%).And no abnormal signs were seen in the control group.(2) MRI enhancement showed that in the experimental group the images of 15 rabbit models were enhanced markedly with irregular thickening of meninges or nodules at the subarachnoid space on T1 WI, positive signs were confirmed on FLAIR sequence in 16 of the 24 rabbits, and positive signs were noted on DCE-MRI scanning in 18 of the 24 rabbits (75%).In the control group 5 of the 6 rabbits were negative in images.Microscopy showed thickened of meninges and spinal meninges in 20 of the 24 rabbits of the experimental group and spinal cord metastasis in 22 rabbits.No pathological changes were seen in the control group.Statistics showed a CSF metastasis rate of 91.67%.There were significant difference between the plain scan and T1 WI with enhancement(P < 0.01) and between FLAIR scan and FLAIR enhancement scans.There was a significant difference between T1 WI and FLAIR enhancement and pathological findings(P < 0.05 ).There was no significant difference between DCE-MRI method and pathological results (P > 0.05 ).Conclusion Gd-DTPA enhanced MRI scan sequences has a high sensitivity and specificity and can be used in monitoring the growth of CSF metastasis.There is a disparity between the MRI signs and pathological findings.It is a key that to improve the spatial resolution of machine and to investigate the best method for detecting early metastasis.

A 24-year-old male was admitted to the General Hospital of the People's Liberation Army due to repeated left chest pain accompanied by chest tightness and shortness of breath for 35 d. More than 3 months ago, the patient had undergone arthroscopic anterior cruciate ligament and meniscus repair in the local hospital due to left knee trauma.

Female pelvic floor dysfunction (FPFD) has been paid more attention in recent years, mainly including pelvic organ prolapse, stress urinary incontinence, etc. The epidemiological investigation of adult female urinary incontinence in Beijing by the Female Pelvic Floor Research Group of Peking Union Medical College Hospital showed that the prevalence of adult female urinary incontinence in Beijing is 38.5%, accounting for more than 1/3 of adult females [1].

A 48-year-old male was seen for "chest tightness, chest pain, dizziness and fatigue progressively aggravated for 4 months". Chest CT showed an irregular huge mass shadow in the anterior mediastinum with unclear boundary and uneven density, and a cystic degeneration area was seen in between, and the solid part was slightly enhanced after enhancement. The mass invaded the right superior vena cava and extended to the right atrial population, resulting in basic occlusion of the superior vena cava and dilatation of many surrounding collateral veins; Curved watery density shadow in left pleural cavity;