Volume 89  ·   Issue 09  ·  2009

Objective To investigate the spatial nature of mental number line. Methods Number bisection test was conducted on 8 right-brain-damaged patients with persistent left neglect, 8 right-brain-damaged patients without spatial neglect, and 8 healthy control subjects, all aged- and education-level-matched and right-handed. Results The error rate in subjective midpoint of the 8 neglect patients was (44.63±12.49)% (forward direction) and (46.00±12.10)% (reverse direction), both significantly higher than those of the right brain damage control group [(3.34±4.32)% and ( 5.21±5.21)% respectively] and healthy control group [(0.00±0.00)% and (0.00±0.00)% respectively] (all P<0.01). The longer the interval between the numbers, the higher right-shift error rate: corresponding to the interval sizes as 3, 5, 7, and 9,the mean deviation rates of antrorse presentation were(-4.25±7.87)%, (12.63±19.06)%, (58.38±24.30)%, and (111.50±53.54)% respectively, and the mean deviation rates of reverse presentation were( -18.40±25.35)%, (-1.60±21.4)%, (56.80±27.04)%, and (108.20±55.10)% respectively. Analysis of variance of the antrorse presentation and reverse presentation showed the result: F=1.705 and P=0.262. Correlation analysis of the mental number bisection task and line bisection task showed the result : r=0.887 and P=0.045. The control subjects made very few errors in subjective midpoint and their performance was not affected by interval sizes. The magnitude of numbers used did not influence the performance in any group. Conclusion The performance of neglect patients in bisecting mental number line closely mirrors their difficulty in bisecting physical lines. This demonstrates the spatial nature of the mental number line isomorphism to physical lines. The mental number line is orientated in a left-to-right manner. Disorder exists at the characterization level in neglect patients.

Objective To compare the effects of surgical and non-surgical treatments for high-grade intracranial arteriovenous malformation (AVM) , identify the determinants of neurological function deterioration after surgery, and calculate the annual hemorrhage rate. Methods 98 high-grade intracranial AVM patients underwent surgery, and 44 high-grade intracranial AVM patients underwent conservative treatment. Follow-up was conducted on 141 of these 142 patients for (54±36) (6 - 118) months. MRI and DSA were conducted before and/or after treatment on most of the patients. Glasgow outcome score (GOS) was used to evaluate the neurological functions early and more then 6 months after discharge. The clinical data of these 142 patients were retrospectively analyzed. The annual hemorrhage rate associated with these lesions was calculated. Results The annual hemorrhage rate of these 142 patients was 2.1%. The integrated rate of late disability and mortality of the operative group was 10.1%, remarkably higher than that of the non-operative group (25.0%). AVM size, adjacent brain functional region, Spetzler-Martin grade, deep perforating arterial supply, and intra-operative bleeding volume were significantly correlated with early and permanent neurological function deficits. Conclusion The long-term outcome of operatively managed intracranial high-grade AVMs is superior to that of the non-operatively treated ones. Spetzler-Martin grade and deep arterial perforating supply are the most important determinants of neurological deficit after microsurgical resection of AVM.

Objective To verify the accuracy of measurement of humeral head retroversion angle with multislice spiral computerized tomography (MSCT) volume rendering technique. Methods Twenty cadaveric humeri, 9 left and 11 right, free from traumatic or degenerative disfigurement, were harvested from embalmed cadavers. Before all soft tissues were removed by sharp dissection these humeri were scanned with 16 slice spiral CT scanner (CT1 group) ; then underwent anatomical measurement (anatomical measuring group); and at last, these humeri with marked anatomic neck were scanned with 16 slice spiral CT scanner again (CT2 group). The measurement was done by 2 orthopedists independently so as to diminish the measuring error. The differences in the humeral head retroversion angle between the CT1 group and anatomical measuring group, and the CT2 group and anatomical measuring group were analyzed with paired-samples T test. Results It showed that the results have no significant difference among them. The difference in the average value of humeral head retroversion angle between the CT1 group and anatomical measuring group was 1.64°, and that between the CT2 group and anatomical measuring group was 0.65°. Conclusion Simple, fast, and precise, and suitable for clinical application, MSCT volume rendering technique can be used preoperatively, thus helping to realize the idea of individualization of shoulder arthroplasty and shoulder prosthesis. Although this technique is easy to be influence by the subjective factors of the observers, increase of experience and rational measurement may minimize the measurement error.

Objective To investigate the feasibility and clinical significance of single-stage posterior vertebrectomy with reconstruction for the treatment of spinal tumor. Methods Twenty-six consecutive patients with spinal tumor, 5 with giant cell tumor, 6 with metastatic tumor of breast cancer, 8 with metastatic tumor of lung cancer, 2 with plasmacytoma, 3 with metastatic tumor of renal carcinoma, and 2 with lymphoma, 12 males and 14 females, aged 49 (20 - 74), underwent single-stage posterior vertebrectomy through bilateral transpedicular route via posterior miclline approach. Anterior column reconstruction was performed with non-expandable cages. Anterior and posterolateral arthrodeses were achieved using autograft. Posterior segmental instrumentation was used in all cases. Follow-up was conducted for 10 - 48 months. Results The mean operative time was 4.5 hours and the mean blood loss was 1600 ml. Sagittal deformity correction was performed for the four patients with preoperative kyphosis. 15 patients were neurologically intact preoperatively (at Frankel grade E) and remained intact postoperatively. 11 patients with functional disorders of spinal cord or nerves (Frankel grade D) preoperatively showed improvement to Frankel grade E postoperatively. Local pain disappeared in 19 patients and reduced in 7 patients. Conclusion A safe and effective technique for the treatment of spinal tumor, single-stage posterior vertebrectomy with reconstruction fully decompresses the neurological structures, corrects kyphosis, and achieves early weight-beating, thus significantly improving the quality of life of the patients with spinal tumor.

Objective To evaluate the added value of single breath-hold diffusion-weighted imaging (DWI) in detection of small HCC lesions (≤3 cm) in patients with chronic liver disease, by comparing the detection sensitivity of DWI/conventional dynamic contrast enhancement (DCE) MRI and that of conventional DCE MRI alone. Methods A total of 54 patients with chronic liver diseases underwent abdominal MRI at 1.5T, including T1 -weighted (T1WI), T2-weighted (T2WI), and 2 D conventional DCE. For each patient study, axial DWI was performed with a single-shot echo-planar imaging (EPI) sequence using modified sensitivity encoding (mSENSE) with b-value of 500 seconds/mm2. A total of 20-24 slices were obtained during a 15-17-second breath-hold. Two observers independently interpreted the combined DWI/conventional DCE MRI images and the conventional DCE MRI images in random order. For all small HCC lesions and micro-hepatocellular carcinoma(smaller than 10 mm MHCC), the diagnostic performance using each imaging techniques were evaluated by ROC analysis. Sensitivity and positive predictive values were also calculated. Results The mean areas under the ROC curve (Az) of combined DWI/conventional DCE MRI images (0.945,0.86) were statistically higher than those of conventional DCE MRI alone (0.86, 0.64) for all small HCC lesions and MHCC (micro hepatocellular carcinoma) lesions (P<0.01). The lesion detection sensitivities using the combined technique of both observers were significantly higher than those using the conventional DCE MRI alone for all small lesions and for MHCC (P<0.01). For MHCC, the sensitivities using the combined technique and the conventional DCE MRI alone were 95.8%-96.0% and 62.5% -68.0%, respectively. The positive predictive values for MHCC using the combined imaging technique (95.8%-96.0%) were higher than those using the conventional DCE MRI alone (94.1%-94. 4%) (P<0.05). For all small HCC lesions, the positive predictive values using the combined imaging technique and the conventional DCE MRI alone were 98.6%-98.7% and 95.5%-95.7%, respectively and there was no statistical difference. Conclusion Combined use of Breath-hold DWI with conventional DCE MRI helped to provide higher sensitivities than conventional DCE MRI alone in the detection of small HCC lesions in patients with chronic liver disease. Furthermore, DWI could provide additional valuable information that benefits the differential diagnosis.

Objective To study the effects of angiogenesis on tumorogenesis and the progression of breast carcinoma and precancerous lesion. Methods Real time ultrasound contrast enhanced microvascular imaging(MVI) and time-intensity curve quantitative analysis were conducted on 30 normal controls,30 cases with simple hyperplasia, 30 cases with atypical hyperplasia (AH), 20 cases with intraductal carcinoma in situ, and 50 cases with invasive ductal carcinoma, all female. Specimens of breast tissues were obtained and immunohistochemistry was used to detect the expression of CD34, a marker of vascular endothelial cells, and vascular endothelial growth factoor (VEGF) and its receptor Flk-1/KDR. Results With the progression of malignant transformation of breast tissue, the expression levels of VEGF and Flk-1/KDR increased gradually, the framework of the vessels became disordered, the levels of MVD and the perfusion parameters, such as peak intensity (PI), area under the curve (AUC), and wash-out time (WOT), increased. Obvious changes in these parameters began since the AH stage. There were not significant differences in the PI, AUC, and WOT levels between the groups of AH and in situ cancer, however, the VEGF and Flk-1/KDR levels of the in situ carcinoma group were significantly higher than those of the AH group (both P<0.05). Conclusion Angiogenesis plays an important role in the development of breast carcinoma. Contrast MVI and the main perfusion parameters reflect the rule of angiogenesis activity changing in different precancerous lesions, and can be used as non-invasive methods to screen high risk population.

Objective To investigate the distribution of polymorphism of glutathione S-transferase P1 (GSTP1) in different kinds gastric intestinal metaplasia (IM), and the carcinogenesis risk of different types of IM . Methods Peripheral blood samples were collected from 87 gastric cancer patients, 87 intestinal metaplasia patients, and 87 healthy persons as controls. Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) were used to analyze the distribution of different alleles of GSTP1. Biopsy specimens of gastric mucous membrane were collected by gastroscopy. Histochemical staining for mucin was used to identify the kinds of IM. Results The G allele rates of the IM and gastric cancer groups were both significantly higher than that of the control group (χ2=6.921, P=0.009; χ2 =28.787, P=0.000). The risk of IM of those with G allele was 1.944 times higher then that of the normal controls (95% CI: 1.177-3.209), and the risk of gastric cancer of those with G allele was 3.605 times higher (95% CI:2.217 - 5.863). The G allele rate of the gastric cancer group was significantly higher than that of he IM group (χ2=7.687, P=0.006). The G allele rates of the type Ⅱ and Ⅲ IM were significantly higher than that of the normal controls (χ2=9.981, P=0.001;χ2=8.845, P=0.002). The risk of type Ⅱ IM of the subjects with G allele was 2.747 times higher than that of the normal controls (95% CI: 1.475 - 5.114), and the risk of type Ⅲ IM of the subjects with G allele was 3.451 times higher (95% CI:1.556 - 7.657). The risks of type Ⅱ IM, type Ⅲ IM, and gastric cancer of the subjects with allele G of GSTP1 gene were 2.905, 3.650, and 3.813 times higher than those of the normal controls respectively (95% CI: 1.341 - 6.293,1.455 - 9.153 and 1.953 - 7.444 respectively). Conclusion The individuals with G allele show an increased risk of developing IM and gastric cancer, especially type Ⅱ and Ⅲ IM . IM patients with G allele have the genetic characteristics similar to those of gastric cancer, so they should be regarded as high-risk individuals of gastric cancer and followed up regularly.

Objective To investigate the anticoagulant methods and characters of hemodialysis patients in hospitals of Grade Ⅲ Level A. Methods A questionnaire survey was conducted in 7 hemodialysis centers of class 3 first level general hospital in Beijing, Shenyang, Harbin, and Dalian, on the hemodialysis status, primary diseases, anticoagulation methods, and complications. Results 808 of the 842 patients (95.9%) underwent hemodialysis, and 34 patients (4.1%) were subjected to hemodialysis filtration. 606 hemodialysis patients (74.9%) used heparin as the anticoagulant, and the doses and using method were different among different centers. 223 patients (26.5%) used low molecular weight heparin (LMWH) with different kinds, doses and using methods. The underlying diseases included diabetes (15.1%), hypertension (9.4%), and other diseases (75.5%). There was no significant difference in the dosage of heparin among different diseases, while the dosage of LMWH was lower for the diabetes and hypertension patients. 171 patients (20.3%) had hemorrhagic tendency, and 67 patients (20.3%) suffered from thrombus. The dosage of heparin was lower in the patients with hemorrhagic tendency while no difference was found in the dosages of LMWH among the patients with different diseases. Antiplatelet agents were co-administrated in 172 hemodialysis patients (20.4%). The percentages of co-administration of antiplatelet for patients with thrombus and hemorrhagic tendency were 14% and 12.8% respectively. The dosages of heparin and LMWH were higher in the patients with co-administration than those without co-administration. Coagulation marker examination was conducted in only 385 patients (45.7%), and no difference in the frequency of coagulation marker examination was found among the patients with hemorrhagic tendency, thrombus, and other diseases. Conclusion Heparin is the main anticoagulant in hemodialysis. The anticoagulant methodology in hemodialysis is still empirical without clotting monitor and standard for usage of anticoagulants.

Objective To study the feasibility of ovarian tumor cells lysates pulsed dendritic cells (DEs) in the immunotherapy of tumor prevention via cytotoxic test in-vitro. Methods Forty rats were randomly divided into 2 gropups: experimental and control groups. Ten rats from each group were killed and DCs were isolated and cultured. Frozen-thawed antigen of in the study group, rat's Ovarian cancer cells of the line NuTu-19 were cultured, freeze-meh antigens were added at day 3. Two groups co-cultured with T lymphocytes from the other rat's spleen on the 14th day. Then observed the shape of DCs, contrasted the proliferation and killing rate. Results In the study group, DCs could significantly stimulate T lymphocytes multiplication and produce tumor specific cytotoxic T lymphocytes (CTL). When the ratios of stimulating cells (SC) to reaction cells (RC) were 1: 3,1: 10,1:30 and 1: 100,the stimulating index (SI) in the study group were much higher than those in control group (P<0.01). When the ratios of SC is the same with RC (SC: RC=3: 1,10: 1,30: 1) :the killing and wounding rate to tumor cells of study group [(40.9±1.2)%, (69.8±1.8)%, (89.0±0.4%)] is significantly higher than those of contol group [(30.9±1.9)%, (34.4±2.1)%, (51.0±1.5)%] (P<0.01). Conclusion DC could activate T lymphocytes proliferation and produce CTL to kill and wound tumor cells in-vitro.

Objective To investigate the effects of ovarian carcinoma cells on the differentiation, maturation, and function of the dendritic cells (DC) . Methods Human epithelial ovarian carcinoma cells were isolated from specimens of ovarian carcinoma from 12 patients obtained during operation, and cultured. Peripheral blood samples were collected from these patients. DC were isolated and co-cultured with recombinant human tumor necrosis factor (TNF)-αto promote their maturation. Immunostaining and flow cytometry (FC) were used to detect the DC specific marker CD1a ,maturation marker CD83, co-stimulating factors CD86 and human leucocyte antigen (HLA) -DR. FITC-labeled glucan was added and FC was used to detect the phagocytic function. T cells were co-cultured with immature and mature DC of different concentrations respectively for 96 h, 18 h before the end of culture 3H-TdR was added, liquid scintillation counter was used to measure the level of count per minute (cpm) Ovarian carcinoma cells and peripheral mononuclear cells were put into Transwell to contact each other directly or indirectly, TNF-α was add to promote the maturation, and then FC was used to detect the CD1a, CD83, CD86, and HLA-DR levels, and the glucan uptake level. ELISA was used to detect the levels of IL-12, IL-10, and interferon (IFN)-γ, and Western blotting was used to detect the p-38 protein and phospharylated p-38 protein in the supernatant. Results After stimulation of TNF-α the expression; levels of CD1a, CD86, CD83, and HLA-DR of the DCs were remarkably increased. Immature DCs showed a strong ability at phagocytosis of glucan, and this ability was decreased by the stimulation of TNF-α. The proliferative function of mature DCs on allogrenic T lymphocytes was significantly increased dose-dependently (P<0.05). Co-culture with ovarian carcinoma cells decreased the expression levels of CD1a, CD86, and HLA-DR, increased the expression level of CD83, and decreased the ability in uptaking glucan by 43.05%. The proliferative function of the DC cultured in direct contact with ovarian carcinoma cells was decreased by 56.35%, and such inhibitory function of the DCs cultured not in direct contact with ovarian carcinoma cells was weaker, and the levels of CD1a, CD86, CD83, and HLA-DR expressed by the DC cultured not in direct contact with ovarian carcinoma cells was between those of the DC cultured in direct contact with ovarian carcinoma cells and those of the DC undergoing routine culture. The levels of IL-12 and phospharylated p-38 protein were decreased in the supernatant of the DC co-cultured with ovarian carcinoma cells. Conclusion Ovarian carcinoma cells suppress the differentiation of monocyte into DC, negatively regulates the phagocytotic and antaean managing functions of DC, thus the DC can not effectively stimulate the proliferation of T lymphocytes and inhibit the activity of cytotoxic T lymphocytes. That may be one of the underlying mechanisms of immune escape of tumor and immune tolerance of T lymphocytes.

Objective To investigate the effects of micro-encapsulated bifidobacteria on gut harrier and bacterial translocation after hemorrhagic shock and resuscitation. Methods Sprague-Dawley rats were divided into 6 groups : PBS + sham shock group fed with PBS for 7 days and then undergoing sham shock, bifidobacteria + sham shock group fed with bifidobacteria (109cfu/d) for 7 days and then undergoing sham shock, micro-encapsulated bifidobacteria + sham shock group, fed with micro-encapsulated bifidobacteria (109 cfu/d) for 7 days and then undergoing sham shock, PBS + hemorrhagic shock group fed with PBS for 7 days and then undergoing hemorrhagic shock, bifidobacteria + shock group fed with bifidobacteria for 7 days and then undergoing hemorrhagic shock, and micro-encapsulated bifidobacteria + shock group, fed with micro-encapsulated bifidobacteria for 7 days and then undergoing hemorrhagic shock. Three hours after resuscitation laparotomy was performed, distal cecum was resected to undergo bacteriological analysis of the cecal content, mesenteric lymph nodes (MLNs), a liver lobe, and the middle part of spleen were resected to undergo bacterial culture for bacterial translocation, and the terminal ileum was resected to observe the villous damage. Results There was no significant difference in the amount of blood loss among the 3 hemorrhagic shock groups. The amounts of aerobes in cecum of the bifidobactefia + shock and micro-encapsulated bifidobacteria + shock groups, especially that of the latter group, were significantly lower than that of the PBS + shock group. The amounts of anaerobes and the amounts of bifidobacteria in cecum of the bifidobacteria + shock group and micro-encapsulated bifidobacteria + shock group, especially those of the latter group, were significantly higher than those of the PBS + shock group. No bacterial translocation to liver was observed in all groups. The magnitudes of total aerobes translocation in spleen of the bifidobacteria +shock and encapsulated bifidobaeteria + shock groups were significantly lower than that of the PBS + shoc group, however, there were not significant differences in the translocation in the MEN of total aerobes ad bifidobacteria among different groups. The percentage of ileal villous damage of the bifidobacteria + shock and encapsulated bifidobacteria + shock groups were significantly lower than that of the PBS + shock group. Conclusion Bifidobacteria effectively protects the gut barrier, reduces bacterial translocation from the gut after hemorrhagic shock and resuscitation. And micro-encapsulated Bifidobacteria can enhance those effects further.

Objective To investigate the neuronal activity in the ventrolateral thalamus in relation to essential tremor (ET). Methods Microelectrode recording in the ventral oral posterior (Vop) and ventral intermediate nucleus (Vim) of thalamus was performed on 10 patients with ET and 10 patients with Parkinson's disease (PD) who underwent thalamotomy for tremor during operation. Electromyography (EMG) was carried out on the contralateral limbs simultaneously. Single unit analysis was performed to measure the interspike interval (ISI) and histogram was constructed to evaluate the pattern of neuronal activity. Student t-test was employed to compare the mean spontaneous firing rate (MSFR) and ISI of neuronal firing in Vop/Vim between the ET patients and PD patients, and correlation test Results Two hundred and sixty-six neurons were identified from 20 trajectories, 38.0% being neurons with tremor-related neuronal activity Tremor cells, 31.9% of neurons related to tonic firing, and 30.1% of neurons related to irregular discharge. 131 of these thalamic neurons, were obtained from 10 ET patients. 38 of these 131 neurons (29.0%) were related to tremor-related neuronal activity, 54 (41.2%) neurons were related to tonic firing with a mean spontaneous firing rate (MSFR) of (55±21) Hz, and 39 neurons (29.8%) were related to irregular discharge with a MSFR of (32±17) Hz. In the meantime, 135 neurons were obtained from 10 PD patients . Of these 135 neurons 63 (46.7%) were related to tremor, 31 neurons (23.0%) related to tonic firing with a MSFR of (39±15) Hz, and 41 (30.3%) were related to irregular discharge with a MSFR of(21±8)Hz. The MSFR levels of pooled neurons in Vop/Vim with tonic firing and irregular discharge of the ET patients were significantly higher than those of the PD patents (t=2.74 and 2.99, both P<0.05). And the MSFR levels in Vop and Vim of the ET patients were significantly higher than those of the PD patients (both P<0.05). Conclusion Vim receives the projection from cerebellum. The increase of neuronal firing frequency observed in Vim suggests that the pathophysiology of ET may be correlated with excessive activity of cerebellum.

Objective To investigate the effects of different mutated sites in the vpr gene of HIV on the apoptosis of host cells, and the possible mechanism thereof. Methods Fourteen HIV-1 vpr fragments were obtained from HIV-infected persons. Eukaryotic expression vector pcDNA3.1 (+) plasmid was extracted, the PCR purified product was double-cut by Hind Ⅲ and BamH, and the cut products were legated to vectors, thus establishing the JM109 competent cells. Sequencing was used to confirm the reconstruction of pcDNA-vpr eukaryotic expression vectors that were then transfected into HeLa cells. Blank vectors were transfected as control group. Cells were harvested after 24 hours and underwent Hoechst 33258 staining and observed under fluorescence microscope. Annexin-FITC-PI staining and flow cytometry were used to observe the percentage of apoptosis. The caspase-3 activity was detected by enzyme labeling instrument. Results The apoptotic rates shown by Hoechst and annexin--FITC-PI staining methods, and caspace-3 activity levels of the HeLa cells transfected with the gene fragments with mutated sites 70, 85, 86, and 94 ells were all lower than the cells trasnsfected with the gene fragments without these mutated sites. The apoptosis causing ability levels of the No 1 -7 recombinant plasmids (all of the Vpr AE subtype) were all lower than those of the No 8 - 14 plasmids (of Vpr B, AB, C, and C/BC subtypes). Conclusion The apoptosis causing ability of the HIV with the vpr sequence with mutated sites 70, 85, 86, 94 is significantly lower than those without these sites. AE subtype induces lower apoptotic behavior in the hoist cells, and decreased activation of the caspase-3 pathway may be one of the mechanisms.

In recent years, with the continuous improvement of people's requirements for quality of life, female pelvic floor disorder (PFD) has gradually become an important issue concerning female health.

A 22-year-old female was admitted to the hospital on 28 March 2007 due to irregular vaginal bleeding for 8 months and repeated swelling and pain in the limbs for 5 months. The patient's menstrual period prolonged to 14-20 days/time in August 2006, with an interval of 5-10 days. In October of the same year, she developed redness, swelling and pain in the right lower limb, with subcutaneous cord sensation and hard texture, which was relieved by "anti-infection" treatment for several days.

brain-derived neurotrophie factor (BDNF) plays a very important role in the central nervous system. BDNF can promote neuronal differentiation, survival and synapse formation, and regulate various forms of activity-dependent synaptic plasticity [1].