Volume 89  ·   Issue 01  ·  2009

Health is everyone's most precious wealth, no matter how much right you have, no matter how much property you have, once you lose health, you will lose everything. On the contrary, if you have health, you will have the foundation of having everything, having the future and having happiness.

Objective To evaluate the mechanical response of L3-L4 segment after posterior interfixation with a transpediele screw system. Methods Spiral CT machine was used to conduct continuous parallel scan on the L3-IA section of a 40-year-old healthy male Chinese. The image data thus obtained were introduced into MIMICS software to reconstruct the 2-D data into volume data and obtain 3-D models of every element.. Pro/3-D model construction software system was used to simulate the 3-D entity of L3-L4 fixed by screw robs through spinal podicle via posterior approach that was introduced into the finite element software ABAQUS to construct a 3-D finite element model. The stress changes on the vertebrae and screw under the axial pressure of 0.5 mPa was analyzed. Results Under the evenly distributed pressure the displacement of the L4 model was 0. 00125815 ram, with an error of only 0. 8167% from the datum displacement. The convergence of the model was good. The stress of the fixed vertebral body, intervertebral disc, and internal fixators changed significantly. The stress concentration zone of the intervertebral disc turned from the posterolateral side to anterolateral side. The stress produced by the fixed vertebral bodies decreased significantly. Obvious stress concentration existed in the upper and lower sides of the base of screw and the fixed screw at the upper vertebral body bore greater stress than the lower vertebral body. Conclusions Integration of computer aided device and finite element analysis can successfully stimulate the internal fixation of L3-L4 visa posterior approach and observe the mechanic changes in the vertebral column more directly.

Objective To summarize the surgical experience of aortic arch operation under deep hypothermic circulatory arrest. Methods 22 patients suffering from aortic dissection or descending aorta aoeurysm with the involvement of aortic arch received operation under deep hypothermic circulatory arrest. Eight patients underwent ascending aorta and partial aortic arch replacement, one patient received aortic root, ascending aorta, and partial aortic arch replacement, 2 patients received ascending aorta and total arch replacement, 2 patients received aortic valve replacement plus ascending aorta and partial aortic arch replacement, 8 patients underwent ascending aorta and total arch replacement plus elephant trunk technique (stinted elephant trunk used in 6 cases), and 1 patient received left partial aortic arch and descending aorta replacement. Coronary artery bypass grafting was performed concomitantly in 4 cases. Results Three patients died peri-operatively with a mortality rate of 13.6%. One patient had aortic dissection rapture before operation leading to cardiac tamponade, acute inferior myocardial infarction, and cardiac arrest. This patient received operation while resuscitation. After operation, the patient had severe right heart failure and died 16 hours later. One patient had bleeding and multi-organ failure, and died 3 days later. The third patient, with acute aortic dissection did not awake after operation, had pulmonary infection and multi-organ failure, and died 39 days later. Re-thoracotomy for bleeding was required in 3 cases; delayed awakenness occurred in 3 cases; and 2 cases had renal failure after operation. Conclusions Aortic arch operation includes partial aortic arch replacement, total arch replacement, and total arch replacement with elephant trunk technique. The operation procedure is selected according to the primary lesion and how aortic arch has been affected. Deep hypothermic circulatory arrest with selective cerebral perfusion facilitates complicated aortic arch operation, resulting in a reduction of mortality and morbidity for arch aneurysms or dissection.

Objective To evaluate the effect and safety of piperacillin/tazobactam on neutropenic febrile patients with Malignant Hematopathy. Methods 218 patients with malignant hematopathy complicated by infectious fever, 162 (74.31%) with fever of unknown origin (FUO), 33 (15.14%) with clinically defined infection (CDI), and 23 (10.55%) with mierobiologically defined infection (MDI), underwent intravenous drip of piperacillin/tazobactam at the dose of 4.5 g for 30 min every 8 hours till 4 ～ 5 d after the temperature returned to normal or neutropenia was relieved. Twenty hours before and after treatment blood routine, blood biochemical and electrolytes, and bacteriological examination, chest X-ray examination were conducted. The changes of symptoms and signs were observed. Results The total effective rate was 65.60%, the bacteria clearance rate was 71.43%, and the adverse reaction rate was 5.04%. The average defervescence time was (2.5±1.2) days, and the duration of antibiotic therapy was (9.4±8.1) days. There were not significant differences in the curative effect and defervescence time between the patients undergoing chemotherapy and those undergoing hematopoietic stem cell transplantation (X2 =2.058,P >0.05, and t = 1.892,P >0.05). After the piperacillin/tazobactam treatment the white blood cell count and absolute neutrophile granulocyte count of the patients significantly increased(t =4.092, P <0.01 ;t = 4.248, P < 0.01). However, the hepatic and renal functions did not change obviously after tratmemt. Conclusions Piperaeillin/tazobaetam therapy is effective and safe empirical antibacterial therapy in febrile neutropenie patients with hematological malignancies.

Objective To investigate the characteristics of hydrogen proton magnetic resonance spectroscopy (H-MRS) in posterior portion cingulate gyrus and the correlations thereof with the results of mini-mental state examination (MMSE), Alzheimer disease assessment scale-cognitive (ADAS-cog) in patients with mild-moderate Alzheimer's disease (AD). Methods H-MRS in posterior portion cingulate gyms was conducted in gender, age, and educational background-matched 24 patients with AD, 8 patients with vascular dementia (VD) ,and 11 normal controls (NC group) to measure the values of NAA(N-acetyl aspartate)myo-inositol (mI),and creatine and phosphocreatine (Cr). All the4 subjects underwent MMSE and assessment with ADAS-cog as well. The correlations among these results were assessed. Results The NAA/Cr ratios in posterior portion cingnlate gyrus of the AD and VD groups were (1.24±0.12) and (1.25 ±0.15) respectively, both significantly lower than that of the NC group [(1.46±0.19), P = 0.003, P =0.017] without significant difference between the AD and VD groups (P =0.800). The ml/Cr value of the AD group was (0.74±0.15), not significantly different from that of the VD group [(0.65±0.15), P = 0.153], and significantly higher than that of the NC group [(0.62±0.09), P= 0.007], however, the mI/Cr value of the VD group was not significantly different from that of the NC group (P = 0.662). If the NAA/Cr ratio < 1.31 was used as criteria of AD,the positive predictive value of AD was 73% and negative predictive value was 71% . The NAA/Cr ratio was positively correlated with the MMSE score (r =0.731 ,P = 0.000), and negatively correlated with the ADAS-cog score (r = - 0.541, P = 0.011). Conclusions The NAA/Cr ratio decreases in the posterior portion cingulate gyrus of AD patients, and has statistical significant correlations with the score of MMSE and ADAS-cog. The H-MRS characteristics of posterior portion cingnlate gyrus cannot effectively differentiate the early AD from early VD.

Objective To compare the outcome of ropivaeaine plus sufentanil for patient-controlled epidural analgesia between nulliparous women presenting in latent and active labor. Methods 360 nulliparous parturients were randomized according to cervix dilation. Latent group (cervix dilation < 3 cm) received 0.1% ropivacaine with 0.5 μg/ml sufentanil and active proup (cervix dilation≥3 cm) receive0.15% ropivaeaine with 0. 5 μg/ml sufcntanil, both followed by an infusion of 0.1% ropivaeaine with 0.5 μg/ml sufentanil through PCEA. The PCEA pump was programmed to infuse a 6 ml bolus with a lockout interval of 15-20 min. The following were recorded: (1) pain intensity evaluated using VAS (0-10), (2) motor block assessed using modified Bromage scale, (3) onset of analgesia after epidural injection, (4) fetal heart rate, (5) maternal vital signs, (6) apgar score, (7) labor process, (8) mode of delivery and (9) the total amount of analgesic consumed. Results Both groups provided good analgesia. Early administration of epidural analgesia did not prolong the duration of first and second stage of labor. However, group L had a significant higher caesarean section rate and a significant lower instrumental delivery rate than group A. The reasons of cesarean section in both groups were arrested active phase and fetal distress. The reasons of instrumental delivery in both groups were fetal distress. The neonates had good outcome in both groups. Conclusions Compared with epidural analgesia in active phase of labor, early administration of epidural analgesia in latent phase did not prolong labor, however, the caesarean section rate was increased and instrumental delivery rate was decreased.

Objective The purpose of the study was to investigate the relationship between peripheral arterial disease (PAD)and coronary artery disease or stroke in Chinese. At the same time, investigate the prevalence of symptoms, include cold, numb, pain, intermittent elaudication and ulcer, then investigate the relationship between abnormal ABI and them. Methods Hospitalized patients in department of cardiology , neurology and vascular were enrolled from March 2006 to December 2007 consecutively. ABI was measured and the disease history was collected. Ejective Fraction(EF), cardioangiography of coronary artery, and ultrasound examination of cervical artery were recorded too to analyze the relationship between them and ABI. The degree of cold, numb, pain, intermittent clandicatian and ulcer were recorded in patients with PAD, to analyze the relationship between the prevalence and ABI. Results In 132 patients of department of cardiology, the prevalence of ABI < 0.9 was 29.5%, In 124 patients of department of neurology, the prevalence of ABI <0.9 was 17.7%. When ABI decreased, the EF decreased too, and the disease of coronary artery and cervical artery became more serious. In patients of vascular department, when ABI decreased , the symptoms of cold, numb, pain, intermittent claudication and ulcer aggravated. Conclusions In Chinese, in patients with coronary artery disease , the prevalence of PAD is 29.5%, and in patients with stroke the prevalence of PAD is 17.7%. 7.2% patients have these three disease. PAD has relationship with the severity of these two diseases. In patients with PAD, the symptoms will aggravate when ABI decreased. When ABI < 0.4, the symptoms all aggravate significantly.

：Objective To explore thefeasibility and value of trans-fissure approaches in brain surgery through individuallydesigned craniotomy. Methods Ninety patients with intracranial space-occupying lesions, 47males and 58 females, aged (43±14) (1 ～68), weretreated by individualized trans-fissure approach surgeries. Linear scalp incision or"horseshoe shape" scalp incision were designed to perform the operation, with abone flap 3～4 cm in diameter. The shortest approach to reach the lesion wasdecided under the guidance of neuro-navigation and real-time B-mode uhrasonography. Thenthe lesions were removed through natural cortical fissures. Another 79 patients withintracranial space-occupying lesions, 53 males and 51 females, aged (42±11) (15～73),undergoing classical surgeries in the same period were used as control group. The averageoperation time, size of bone flap, amount of blood loss, hospitalization time, andhospitalization cost were compared between these 2 groups. Results The operation time ofthe individually designed trans-fissure approach group was (3.1±1.6) hours (1.33～10.83hours), significantly shorter than that of the control group [(4.8±1.9) hrs, P <0.05]. The amount of blood loss of the individually designed trans-fissure approach groupwas (173±168)ml (20 ml±500 ml), significantly less than that of the control group [(410±61)ml, P <0.01]. The size of bone flap of the individually designed trans-fissure approachgroup was (12±5) era2 [(1 ～ 25) cm2], significantlysmaller tthun that of the control group [(20.±9) cm2, P < 0.01]. Four of the 90patients of the individually designed trans-fissure approach group received retransfusion,compared to 15 in the control group, during operation. No infection or other significantcomplications occurred after operation in the individually designed trans-fissure approachgroup. The hospitalization time of the individually designed trans-fissure approach groupwas (20±6)days (9～39 days), significantly shorter than that of the control group [(24±7) days,P<0.01]. The average hospitalization cost of the individually designed trans-fissureapproach group was (23171±7280) yuan RMB; significantly lower than that of the controlgroup [(28096±10822) yuan, P <0.01]. Conclusions One of the land markers of minimallyinvasive neurosurgery, individualized trans-fissure approach has been proved to be aneffective minimally invasive approach that leads to better outcome and fewer complicationsafter operation.

Objective To compare the effects of treatment of spasmodic torticollis (ST) by neurovascular decompression, myotomy, and botulinum toxin type A and to investigate the mechanism of ST. Methods Nine ST patients who failed to respond to other conservative treatment methods underwent neurovascular decompression of accessory nerve. The effect of decompression was compared with that by botulinum toxin in 22 patients and that by myotomy in 13 patients. Results The symptoms and signs were improved to a certain degree by botulinum toxin treatment at first, but recurred and gradually worsened in several months. None of the 22 patients had reached a real cure by botulinum toxin type A treatment. Four of 13 patients undergoing myotomy improved a lot in the symptoms and 9 improved only a bit. However, weakness in neck movement was found in all patients after myotomy. Neurovascular decompression was performed on 9 patients, 5 of which had had botulinum toxin treatment and 1 had undergone myotomy, and found that all of them had severe vascular compression in the accessory nerve. Obvious alleviation of symptoms was achieved 2 ～ 14 days after the operation in 8 patients, and 3 months later in 1 patient. All of the 9 patients resumed their normal work and life 6 months after the operation. No complication, such as nerve damage, infection, hemorrhage, leakage of eerebrospinal fluid, and weakness of neck, was found. Conclusions Neurovascular compression may be the most important cause of ST. Microneurovascular decompression is effective for some patients. However, it is still difficult to judge its indication.

Objective To explore the indications and key points of anterolateral minimally-invasive total hip arthroplasty. Methods 110 baseline indexes matched patients admitted for unilateral total hip arthroplasty were randomly assigned to 2 equal groups to undergo surgery through a short anterolateral incision of ≤ 10 em or a standard posterolateral incision. All operations were done by the same surgeon. The demographic data, perioperative indexes, and postoperative function indexes were recorded and statistically analyzed. Results No significant differences were detected with respect to operation time, abduction angle, anteversion angle, stem alignment, and stem fixation between these 2 groups. The incision length, blood loss, perioperative transfusion, and 100 -mm visual analogue pain scale (VAS) score at the first 24 hours of the anterolateral approach group were (7.49±0.86) cm, (376.18±168.30) ml, (410.09 ± 136.46) ml, and (30.76±21.77) respectively, all significantly shorter, less, or lower than those of the standard posterolateral approach group [(15.2±1.8) cm, (605.0±225.1) ml, (629.5±232.9) nd, and (50.3 ±13.7) respectively, all P <0.01]. The Harris hip score and Barthel index 3 months after operation of the anterolateral approach group were (83.80± 5.64) and (93.45±6.37) respectively, both significantly higher than those of the standard pesterolateral approach group [(75.0±7.5) and (94.6±7.5) respectively, both P <0.01)], however, there were not significant differences in the Harris hip score and Barthel index 3 years after operation between these 2 groups. Conclusions Fewer traumas, less blood loss and rapid recovery can be obtained through this new total hip arthoplasty approach. But experienced doctors and special instruments are prerequisite.

Objective To determine the clinicopathological factors predicting residual lesions after conization in patients with cervical intraepithelial neoplasia (CIN) and microinvasive carcinoma of cervix (MIC). Methods The clinical data of 77 patients with CIN3, 20 patients with stage lal cervical cancer, and 8 patients with stage Is2 cervical cancer, totally 105 patients, aged (43 + 6), who received further surgery within 3 months after eonization, 95 receiving hysterectomy, 2 receiving repeated conization, and 8 receiving radical hysterectomy and pelvic lymph node dissection, were evaluated. The demographic features, clinical and pathological parameters, and the correlation thereof with the post-eonization residual lesions were analyzed retrospectively. Results Residual lesions were found in the specimens obtained from hysterectomy or repeated conizafion of 53 of the 105 patients (50.5%), among which 38 were CIN2 or less severe lesions. Univariate analysis showed that menopausal status, procreation status, cervical cytology, method of eonization, and range of resection were not correlated with the presence of post-conization residual lesion, while age ≤45 (P<0.05, odd ratio [OR] =4.68) and positive resection margin (P<0.05, OR=5.40) were risk factors of residual lesion. There were no differences in the proportion of post-conization residual lesion among the patients with MIC, CIN 3, CIN2 or less severe lesions. Multivariate logistic analysis showed that only the positive resection margin was an independent risk factor of residual lesion after conization (P <0.05, OR = 4.20). Conclusions Although severity of the cervical disease is the most important factor in determining post-conization treatment, it is not a predicting factor for post-conization residual lesion. Only the positive resection margin was an independent risk factor of residual lesion after conization.

Objective To investigate the inhibiting effects of interleukin-10 (IL-10) on the expression of E-selectin and L-selectin in cerebral ischemia-reperfusions. Methods Seventy-two adult male Sprague-Dawley rats were randomly divided into 4 equal groups, cerebral ischemia-reperfusion (I/R) group undergoing middle cerebral artery occlusion with Longa's thread method, IL-10 group undergoing lateral ventricle injection of IL-10 after the establishment of I/R model, Vehicle group undergoing lateral ventricle injection of nonnM aaline after the establishment of I/R model, and sham operation (Sham) group. Twenty-four hours later the rata were killed with their brains taken out. Immunohistochemistry, RT-PCR and Western blotting were used to detect the mRNA and protein expression of E-selectin and L-selectin. Results The E-selectin and L-selectin expression levels of the I/R group were significantly up-regulated compared with the Sham group (both P < 0.05). The numbers of E-selectin and L-selectin positive vessels of the IL-10 group were 18.8±1.9/10 HP fields and 15.8 + 2.4/10 HP fields respectively, both significantly less than those of the vehicle group (24.7±2.4/10 HP fields and 20.9 + 3.3/10 HP fields respectively, both P <0.05). The E-selectin and L-selectin gene mRNA expression levels of the IL-10 group were (0.431±0.029) and (0.318±0.048) respectively, both significantly lower than those of the Vehicle group [(0.497±0.019) and (0.433±0.087) respectively, both P < 0.05]. The E-selectin and L-selectin protein expression levels of the IL-10 group were (0.349±0.037) and (0.296±0.035) respectively, both significantly lower t6han those of the Vehicle group [(0.421±0.043,) and (0.348±0.044) respectively, both P < 0.05]. Conclusions IL-10 suppresses the expression of E-selectin and L-selectin in cerebral ischemia- reperfusion.

Objective To investigate whether the infusion of propofol during early reperfusion provides ischemic postconditioning (I-postC) on myocardial ischemia-reperfusion injury in rats. Methods Sixty adult rats were randomly divided into 5 groups (n = 12 each) : sham operation (group S) ; normal saline (group C); propofol 1 mg/kg (group P1); propofol 2 mg/kg (group P2); propofol 5 mg/kg (group P3). The left anterior descending coronary artery (LAD) was occluded for 60 min and reperfused for 120 mira Normal saline, propofol 1 mg/kg, 2 mg/kg or 5 mg/kg (propofol diluted to 2.5 ml with normal saline equally) were intravenously infused 3 min before reperfusion until 5 min after reperfusion. The heart were obtained for determination of (1) the size of area at risk and infarct size (Evans Blue and Trc staining) ; (2) expression of Caspase-3 (immunohistochemistry staining) ; (3) percentage of apoptotic cardiomyocytes (flow cytometry) ; (4) levels of phosphorylated Akt (Western blot). Results Compared with group C [size of area at risk (41.5±1.0) %, infarct size (45.5±1.0) %, expression of caspase-3 (5.87± 0.29), percentage of apeptotic cardiomyocytes (26.8±1.3)%, level of phosphorylated Akt (10.8± 1.9)%], propofol 1 mg/kg and 2 mg/kg significantly reduced the size of area at risk and infarct size [size of area at risk (38.3±1.0) % and (37.3±1.2) % ; infarct size (33.8±1.2) % and (30.2±1.7) %, P < 0.05], inhibited the expression of caspase-3 (1.50±0.36 and 1.48±0.30, P < 0.05), decreased the percentage of apeptotic cardiomyocytes [(16.3±1.2) % and (16.5±1.0) %, P < 0.05] and promoted the phosphorylation of Akt [(68.7±4.0) % and (58.3±2.8) %, P < 0.05]. Conclusion Propofol 1 mg/kg and 2 mg/kg can provide I-postC to myocardial ischemia-reperfusion injury in rats by activation of Akt pathway.

Objective To study the morphological behavior ,the expression of MCP-1 and PDGF-B of distal anastomotic neointima after expanded polytetrafluoroethylene (ePTFE) bypass grafting. And to identify the effects of Batroxobin (BX) on distal anastomotic intimal hyperplasia. Methods 12 adult mongrel dogs underwent end to side bypass grafting in left common carotid artery using ePTFE vascular graft (6mm in diameter, 5cm in length) were divided randomly into two groups. All 12 bypass grafts were removed 28 days after grafting and distal anastomotic parts were obtained . Using HE, Masson , IHC, RT-PCR and western blot , we analyzed the thickness, relative content of ECM, SMC PCNA index, expression of MCP-1 and PDGF-B in distal anastomotic neointima. And we compared the differences between the two groups. Results 28 day after grafting , the neointima was formed by SMC and ECM and was covered by epithelial cells. After using BX , the thickness of neointima was reduced [(381.3±144.7) μm versus (213.8±29.0) μm, P <0.05] and the relative content of ECM were significantly decreased(P =0.006). The PCNA index(P = 0.109) and PDGF-B level (P =0.055 by RT-PCR and P = 0.337 by WB) between the two groups had no significant difference . MCP-1 level was markedly decreased (P = 0.025 by RT-PCR and P = 0.016 by WB). Conclusions Using BX after ePTFE grafting could effectively reduce the relative content of ECM ,rnduce the expression of MCP-1 and decrease the thickness of neointima in the early time.

A 21-year-old female was admitted to the Department of Rheumatology and Immunology of Peking Union Medical College Hospital on August 1, 2007 due to low fever for nearly 20 months, blurred vision, hearing loss, nasal congestion for more than 8 months and pain in both feet for more than 1 month.

A 39-year-old woman began to learn poorly and react slowly before the age of 9. At the age of 25, she gradually began to appear grumpy, like to throw things, and upset. She was diagnosed as schizophrenia in the local hospital and did not take medicine. Ten years ago, due to fever and poor eating, I went to the hospital for B-ultrasound and found enlarged liver and spleen, gallbladder stones and kidney stones, which improved after treatment.

Objective To investigate the effects of topical fluorescein on the preoperative diagnosis of rhinorrhea of cerebrospinal fluid (CSF) and intraoperative localization of CSF fistula. Methods Cotton pads soaked with 5% fluorescein were placed in the middle turbinate meatus, roof of ethmoid plate, and sphenoethmoidalis recesses via endoscopic endonasal technique of 15 patients with CSF rhinorrhea, 5 caused by accidental trauma and 10 spontaneous. Change of the color of fluorescein from yellow to green fluorescence denoted the presence of CSF, and thus the site of the leak could be traced. The accuracy rates of diagnosis and leak site identification by this technique were compared with those by glucose analysis, intraoperative findings, and follow-up. Results The preoperative diagnosis rate of CSF rhinorrhea and the CSF fistula site localization rate by fluorescein-soaked cotton pad were both 100%. No recurrence was found during the follow-up for 2 ～ 24 months. No complication had been reported. Conclusions Application of topical fluorescein is an easy, sensitive, safe, and highly accurate tool in the intraoperative localization of the site and extent of CSF fistulas and should be considered a viable noninvasive alternative to intrathecal fluorescein technique.