Volume 89  ·   Issue 17  ·  2009

Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic intestinal nonspecific inflammatory diseases. The etiology of IBD is unknown, and the pathogenesis may be related to genetic, environmental and immune factors.

Objective To evaluate the effect of Leksell Gamma Knife(LGK)on elderly patients with large vestibular schwannomas(VS)and to summarize the indiclltions for LGK in patients with large VS.Methods From July 1994 to July 2000,50 elderly patients(age range:60.0-81.0 years)with large VS were treated bv LGK as primary treatment modality.The maximal tumor diameter ranged from 31.0 to 61.0 mm[mean,(36.0±6.1)mm]and mean tumor volume was(14.8±8.0)cm3(range,7.5-54.0 cm3).The maximal dose irradiated to tumor ranged from 22.0 to 28.0 Gy[mean:(25.0±1.6)Cy]and the mean tumor marginal dose was(12.3±0.9)Gy(range,9.5-14.OCy).The mean follow-up duration wast(86±12)months(range:68-138 months).Results of the 50 patients with follow-up data,4 Were deceased and 46 survived.Two patients with giant VS died at 6 and 9 months post-LGK respectively because of tumor swelling.Another two pailents died of stroke or heart attack at 3 years and 4 years after LGK respectively.but their tumors decreased in volume.Clinical response:hearing:14(28%)pailents preserved useful hearing as pre-LGK;32 patients had unchanged or deteriorated hearing.Facial palsy:two patients developed mild facial palsy at 4 and 8 months respectively,one of them recovered and another improved later.Seven patients developed hydrocephalus around 6 months post-LGK and had V-P shunt.Eighteen patients had deteriorated facial unmbness because of tumor swelling,15 of them improved 3 years later.Tumor response:in 46 surviving patients,43 tumors decreased markedly in.size,2 tumors remained stable in volume,1 tumor progressed at five years and had second LGK.In this series tumor control rate was 94% (47/50).Conclusion LGK provides an effective treatment for some selected large VS(maximal diameter≤40 mm)in elderly patients,especially when the brain stem compression was not obvious and VS had non-enhanced area or small cysts within tIle tumor on contrast MRI.

Objective To investigate the ultrsstructural features of mitochondrial cytopathies and its diagnostic value.Methods Muscle biopsy specimens from 33 cases of mitochondrial cytopathies were examined by routine pathological and electron microscopic examinatiom.Results The main pathologic changes included ragged red fibers in modified Gomori staining,hyper-intense staining myotibers in SDH,COX-negative fibers while dark counterstaining with SDH in COX/SDH double staining technique.Ultrastructural findings included subsarcolemmal and intramyofibrillar prolireration of mitochondrin and the appearance of abnormal mitochondria,paracrystalline inclusions,concentric dystrophic cristae and excessive subsarcolemmal glycolipid compounds in subsarcolemmal.Conclusion The presences of proliferation and abnormality of mitochondria,electro-dense granule and paracrystalline inclusions in mitochondria provide key diagnostic evidence for the diagnosis ofthis ditease.

Objective To explore the process and technique of neuroendoscopie operation to treat obstructive hydrocephalus caused by cysts located in the pathway of CSF circulation.Methods The cine MRI examinations and endoscopic operations were taken to treat 30 cases with obstructive hydrocephalus.Among all the cases,there are 11 intraventricular cysts(8 latera]yentricular cysts,4 fourth ventricular cysts),4 suprasellar arachnoid cysts,1 quadrigeminal cistern arachnoid cyst,6 Dandy-Walker malformations and 8 posterior fossa arachnoid cysts.Results CSF dynamic of all patients improved to difierent extents post-operation.It Was observed that CSF passed through the stoma after ETV in all patients.The volume of 9 intraventricular cysts,4 suprasellar arachnoid cysts,1 quadrigeminal cistern arachnoid cyst and 4 posterior fossa arachnoid cysts diminished for different degrees.There were no surgery-related serious complications or deaths.There were not cyst enlarged and stoma obstructed cases.Conclusions Obstructive hydrocephalus caused by cysts in the pathway of CSF circulation is the optimal indication for neuro-endoscopic surgery.After reseeting cyst partially,we should take the endoscopic third ventriculostomy to rebuild the paasway of CSF and elevate the cranial compliance.Cine MRI and radionuclide cistemography are helpful to undemtand the CSF dynamic and absorption.

Objective To observe whether the severity of white matter lesions(WML)is related to iachemia in elderly.Methods WML were divided into 2 categories (centmm semiovale and periventricular regions)and four grades(grade 0,grade 1,grade 2 and grade 3)according to the severity of wML showing on the FLAIR sequence of MRI using modified Fazekas scale.The values of regional cerebral blood flow (rCBF)within WML and other brain regions were measured using Xenon contrast CT.Results Mean rCBF (ml·100 g-1·min-1)within lesions around periventricular areeas,in right and left centrum senfiovales were 20.8±2.8,22.3±1.9 and 22.2±2.1 in grade 0:20.3±2.5.21.3±1.0 and 21.0±1.8 in gradel:16.3±2.0.15.6±1.7 and 15.9±0.9 in grade 2:14.1±2.6.14.5±2.2 and 14.2±1.9 in grade3 reapectively.The severity of WML is associated significantly with reduction of rCBF within lesions both in centrum semiovale and periventricular region8(all P＜0.05).There was no significant difference in rCBF values between grade 0 and 1,but significant differences existed between grade 0 and grades 2 and 3,between grade 1 and grades 2 and 3(all P＜0.05).Statistical significance also existed between the severity of white matter lesions and rCBF in bilateral temporal lobes and lentiform nucleuses(P＜0.05).Conclusions The severity of WML both in centrunl sanfiovale and periventrieular regions is associated significantly with reduction of rCBF vithin lesions.

Objective To elucidate the clinical and imaging chalaeters of reversible posterior encephalopathy syndrome(PRES)and to discuss the etiological factors and the pwbable pathogenesis.Method Retrospective analysis of basal diseases,clinical manifestations and imaging characters of 13 PRES patients was conducted with follow-ups.Results The comlmon associated diseases are various kinds of kidney disease and renal inadequacy,eclampsia of gravidity and postpartum,connective tissue disease and immunosuppressives,et al.The main clinical manifestations are headache,convulsion,poor vision,changes of psychology or consciousness.The radiological findings are multifocal,symmetrical and posteriorly dismbuted in the cerebral hemispheres involving bilateral grey and white matter abnormalities in occipital,parietal and frontal regions.The majority of patients with PRES have all excellent prognosis.Conclusion The etiological factors and pathogenesis of PRES ale different and not all of them are reversible.Thus it is decisive to take Bpecific and appropriate measures.

Objective To investigate the clinical and radiographic outcomes for varying degrees of degenerative lumbar scoliosis using difierent surgical options with a minireal 5-year follow-up.Methods From May 1998 to November 2002.31 pailents with degenerative lumbar scoliosis underwent operations at our hospital.The mean age of 19 females and 12 males was 55.8 years old(Fange:45 to 71).All patients were divided into 4 groups:Group A,mild coronal deformity with obvious sagittal deformity,13 case;Group B,obvious coronal deformity with mild sagittal deformity;Group C,both significant coronal and sagittal deformities;Group D,both mild coronal and sagittal deformities.Posterior decompression,internal fixation and bone graft fusion were performed in Groups A,B and C.And posterior decompression was performed in Group D.All patients were followed up for at least 5 years.Patients answered the Oswestry low back pain disability questionnaire at pre-operation,and 1 year,5 year post-operation.Results Thirty patients were followed up for the whole process.According to Cobb's ansle methods,there was great postoperative imprevement for pailents with internal fixation(Groups A,B,C)while there was no significant difference for patients with posterior decompression at pre-and post-operation.After surgery,the average Oswestry Disability Index score in the patients with intemal fixation(Groups A,B,C)was significanfly lower than the preoperative score(25.8 vs 58.0;P＜0.001).However there was statistical difierence for patients with internal fixation between 1 year and 5 year postoperatively.No perioperative death or major medical complications occurred.Ten patients had adjacent segment degeneration.Conclusions The surgical aim for adults with a spinal deformity is to achieve a stable,balanced and pain-free spine.Surgical treatments should consist of decompression and fusion with segmental instrumentation to avoid instability and curb progression.Despite the complexity of adult lumbar degenerative scoliosis,it might improve the quality of life for patients by choosing an appropriate operation option on the basis of varying degrees of lumbar deformity.

Objective To build a 3D finite element model of whole lumbar spine and verify its efficiency and analyze tIle biomechanieal change of L3-4 motion segment.Methods L1-L5 segment data were obtained from computed tomography(CT)scans of the lumbar spine of a 40-year-old man with no abnormal findings.A three-dimensional finite element model of the human whole lumbar spine was built in the Mimics and the ABAQUS software.The model was composed of bony vertebrae,articulating facets,intervertebral disc and associated ligaments.The basic stress analysis of L3-4 motion segment was made under the considerations of different material properties of bone,ligaments and facet joints contacting frictional property.The stress on annulus fiber,nucleus pulposus,endplate and facet joints under axial pressure(0.3 MPa,0.5 MPa,1.0 MPa,2.0 MPa & 4.0 MPa)were analyzed.Results A threedimensional finite element model of human L3-L4 motion segment has 272,619 elements,the stresses were higher in the posterior of annulus fiber,the Max pressure stress(S33)distributed in nucleus pulposus and the center of endplate.The stresses increased a8 axial pressure rose.Conclusion 3D finite element model of whole lumbar spine and L3-4 motion segment were established successfully and the stress analyses were feasible and reliable.

Objective Programmed death-1(PD-1)up-regulation can impair vires-specific CD8+T-cell responses during chronic viral infection.Whether PD-1 affects virus-specific CD8 T cells in humans with acute hepatitis B virus(HBV)infection remains unknown.This study aimed to characterize the PD-1 expression during acute hepatitis B(AHB),and further addressed how PD-1 regulates the apoptosis of CD8+T cells in this disease.Methods PD-1 expression on HBV env-183-191-.env-335-343-and CMV pp65-specific CD8+T cells were quantitatively analyzed by flow cytometry in pefipheral blood from 15 HLAA2-positive AHB patients.The spontaneous apoptosis indicated by annexin V expression was performed for analyses of the impact of PD-1 expression.We also confirmed the effects of PD-1/PD-L1 pathway on the in vitro apeptosis of CD8+T cells through PD-1 blockade assay.Results PD-1 expression on HBV-specific CD8+T cells was significantly up-regulated compared with CMV-specific CD8+T cells in the early phase of acute HBV infection.High levels of PD-1 expression significantly correlated with the apoptosis of HBV-specific CD8+T cells.Blockade of PD-1 iigation using anti-PD-L1 rescued the HepG2.215-induced CD8+T cell apoptosis.Conclusion PD-1/PD-L1 inhibitory pathway is actively involved in the apoptotic regulation of HBV-specific CD8+T cells at early phase of acute HBV infection,and high PD-1 expression by HBV-specific CD8+T cells appear to efficiently temper liver damage.

Objective To confirm whether it is feasible to detect HBV cecDNA based on an analysis of its stability and clearance dynamics in the blood of ducks.Methods Twelve 1-week-old ducklings were randomized into group A and group B,and each duckling was intravenously injected with 1 milliliter of serum containing 1.2×109 copies of HBV virion(group A)or plasmid pBS HBV 3.6 Ⅱ(group B).At 0.25,2,4,6,8,12,24 and 32 h post-injection,serum HBV DNA levelin each duckling was quantified by Real-time fluorescent PCR.Results Both of HBV virion and plasmid pBS HBV 3.6Ⅱ could be detected from 0.25 h to 24 h after intravenous administration,and declined approximately by 1 log10 every 2 hours within 8 h and was more slowly cleared at 8 h.and became undetectable at 32 h.Both of them are characteristic of one-phase exponential decay-as indicated by the relative index of the one-phase exponential curve ranging from 0.9593 to 0.9976.The mean half-life of HBV virion and plasmid(cecDNA)was 4.536±0.769 h(range:3.5-5.4 h)and 4.5±0.8 h(range:3.9-6.1 h)respectively.No significant difference was observed in the half-life between HBV virion and plasmid/cccDNA(t=0.0523.P=0.9593).Conclusions HBV cceDNA is similar to HBV virion in its characteristics of clearance dynamics in blood.Thus it is feasible to detect serum HBV cccDNA.The clearance half-life of Hepatitis B virus in serum is not as long as previously believed at 1.0-1.2 d

Objective To study the effects of ketamine anesthesia and surgery on cognition and synaptic structure in hippocampus of senile rats.Methods Fifty-six rats aged 18 monks were randomly divided into 3 groups:Groups C(control group),A(ketsmine 40 mg/kg,i.P.)and O(ketamine anesthesia & splenectomy).Morris water maze test was used to observe cognition at Days 1,3 & 7 after ketamine anesthesia or operation respectively.Accordingly Groups A and O were divided into 3 subgroup,i.e.A1.A3,A7 and O1,O3,O7.The time of Morris water maze test was recorded and the synaptic structure was measured in the polymorphic layer of the rat hippocampal field CA3.Results Compared to Group C.the latency period and swimming distance significantly increased in Groups A1,O1 and O3(P＜0.05),and the numbers passing the original platform decreased significantly in Groups O1 and O3(P＜0.01).The latency period was significantly longer in Group O1 than that in Group A1(P＜0.05)while the swimming distance was unchanged.Compared to Group C,the width of synaptic cleft(P＜0.01)increased,the length and area of postsynaptic densities(P＜0.05 or P＜0.01)as well as synaptic curvature(P＜0.01)decreased in Groups O1 and O3.The percentage of perforated synapses also decreased in Groups O1 and O3.Conclusion Surgical injury can impair cognition of senile rats and the synaptic plasticity might be involved in postoperative cognitive dysfunction.

Objective To investigate the roles of signal transducer and activator of transcription 4 (STAT4)and suppressor of cytokine signaling 3(SOCS3)in differentiation and cytokine secretion of T helper(Th)cells by separate silencing.Methods Th0 cells were induced to differentiate to Th1 or Th2 cells by interleukin 12(IL-12)or interleukin 4(IL-4).The mRNAs of STAT4 and SOCS3 were silenced separately by small interfering RNA(siRNA)in Th0.Th1 and Th2 cells and then the lyraphecytes cultured in Th1 or Th2 medium with IL-12 or IL-4 for another 48 h before cells and supernatants were collected for the detection of Th1 and Th2 type cvtokines by reverse transcriptase polymerase chain reaction(RT-PCR)and enzyme-linked immunosorbent assay(EHSA).By comparing different amounts of cytokines between before and after silencing the target mRNAs.the roles of STAT4 and SOCS3 in the differentiation and cytokine secretion in T helper cells were evaluated.Results Th1 type cytokine significantly decreased and,Th2 type cytokine increased after silencing STAT4 in Tho and Th1 cells;minimal changes were detected in both Th1 and Th2 type cvtokines after silencing SOCS3.Conclusion STAT4 mediates the IL-12.induced differentiation of T cells to Th1 subset and maintains the cytokine secretion of,Th1 cells;STAT4 direcfly inhibits the development and cytokine secretion of Th2 cells:STAT4 deficiency results in impaired development and cytokines secretion of Th1 cells and the enhanced development and cytokines secretion ofTh2 cells.SOCS3 has minimal effects on IL-12 or IL-4 induced differentiation and cytokine secretion of T helper cells.

Objective To test the potential of bone marrow stem cells mobilized by granulcoyte macmphage colony stimulating factor(GM-CSF)to promote regeneration of myocyte and neovaseularization in a rat model of myocardial infaretion.Methods A myocardial infaretion model wag created by ligation of the left anterior descending coronary artery in adult Sprague-Dawley rats.Then the infracted rats were randomly assigned to receive GM-CSF injection subcutaneously 50 μg·kg-1·day-1 as experimental group or receive saline iniection as eontrol group.Enumeration of CD-34 stem cells in peripheral blood and bone marrow was performed by flow cytometric analysis.Histologic and immunohistological staining such as Factor Ⅷ,Ki67 and PIAH staining(phosphotungstie acid hematoxylin)was performed to assess angiogenesis and myogenesis,calculate myocardial infarction size in the heart.Results The CD+34 stem celLs in the blood and bone marrow increased from Day 3,peaked between Day 7(0.350%±0.026%,2.250%±0.140%)and Day 14(0.260%±0.022%,2.060%±0.110%)in experimental group compared with control group (0.170%±0.015%,1.24ID%±0.064%)(P＜0.01),declined on Day 28 and ilo difirerence versus control group(P＞0.05).Immunohistologieal staining showed apparent neovasculature formation and much more Ki67 expression in the infracted regions in experimental group(313±10,275±5)compared with control group(264±10,207±10)(P＜0.05).The Ki67 positive cells in the experimental hearts were significanfly positively correlated with CD+34 stem cells in the blood and bone marrow(r=0.961,P=0.019,r=0.975.P=0.005).Ki67 and PTAH double staining showed that the Ki67 positive nucleoli overlay the lymphocytes,fibroblasts and endothelial cellg but not myocyte&No significant decrease of infracted size occurred in experimental group(P＞0.05).Condusions Bone marrow and periphend blood stem cells could be mobilized effectively by GM-CSF after myocardial infarction which could oaly promote neovascularization without myogenesis.

According to the report of the U.S. Center for Health Statistics (AHSC), vaginal vault prolapse occurs in 1 out of 21 hysterectomies, and 1 out of 11 hysterectomies will require vaginal apical suspension or vaginal closure in the future [1]. Vaginal apical suspension corrects vaginal vault prolapse and small intestinal hernia after hysterectomy by suspending the vaginal tip on the sacrospinous ligament, rectococcygeal fascia, hysterosacral ligament or sacrum, and sacrospinous ligament fixation is widely used because it does not need to place mesh [2-3]. From June 2005 to March 2008, we analyzed 40 patients with severe pelvic organ prolapse who underwent hysterectomy and sacrospinous ligament fixation and suture in Peking Union Medical College Hospital to understand the safety and effectiveness of this operation.

A 43-year-old male was admitted to hospital for 3 months due to lumbosacral pain accompanied by proteinuria for 1 year. He was found to have double hydronephrosis and increased serum creatinine for 3 months. One year ago, the patient developed lumbosacral pain with increased foam in urine without inducement, and had no macroscopic hematuria. The blood pressure was measured at 110/70 mm Hg (1mm Hg =0.133 kPa), urine protein (+ + +), urine red blood cells 10/HP, but no attention was paid to it. Six months ago, he felt that nocturia increased spontaneously, 3~4 times/night. Three months before admission, the unit physical examination found double hydronephrosis with right kidney subcapsular effusion, serum creatinine increased by 193 μ mol/L, urea nitrogen 10.8 mmol/L, urine protein (+ +), and occult blood trace, and the diagnosis was "chronic renal insufficiency". Two months before admission, the serum creatinine 230 μ mol/L, urea nitrogen 11.5 mmol/L, creatinine clearance 33.5 ml/min, serum albumin 30.2 g/L, globulin 67 g/L, total cholesterol 3.1 mmol/L, 24 h urine protein quantification 0.32 g/d, hemoglobin 139 g/L, platelet 2

Refractory hepatitis C mainly refers to patients who did not respond or relapsed after 12 weeks of initial standardized treatment with interferon plus ribavirin; It also includes genotypes 1, 4 and high viral load (HCV RNA ≥1.5×106 IU/m1); Patients with other viral infections, such as dual infection with HIV, insulin resistance, obesity, weight>85 kg, patients who cannot tolerate conventional dose of interferon therapy due to various reasons (decreased WBC, thrombocytopenia) and other comorbidities related to autoimmune dysfunction, etc. "[1-2]. At present, various new anti-HCV drugs and methods are continuously being researched and developed to make the treatment of refractory hepatitis C better. This paper briefly reviews the research in this area.

The survival rate of patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) has been significantly improved with the application of low tidal volume and positive end-expiratory pressure (PEEP) techniques. However, determining the ideal PEEP has always been a difficult problem. Talmor et al. of Harvard University estimated the trans-pulmonary pressure through an esophageal balloon catheter, and believed that despite the technical limitations in measurement accuracy, this method can help to determine the PEEP value that can maintain oxygenation and thus prevent lung injury caused by repeated alveolar collapse or excessive expansion. The results of the study were recently published in the New England Journal of Medicine (N Engl J Med, 2008, 359: 2095-2104).

June 2008 Article entitled American College of Rheumatology (ACR) 2008 Recommendations for the Use of Abiotic and Biological (DMARD) Treatment of Rheumatoid Arthritis (RA) (hereinafter referred to as "Recommendations") published in the United States<This "recommendation" is based on sign-based medicine, with clear thinking and clear treatment orientation. It is of great benefit after reading it, and has important guiding significance for rheumatologists in the treatment of RA. It has set off an upsurge of interpretation of the "recommendation" in the world. For the first time in many years, ACR has put forward the recommendation for the use of biological agents, and it is also the first time since 2002 to update the recommendation for the use of abiotic DMARD. Its purpose is to provide corresponding guidance for the clinical diagnosis and treatment of specific diseases, instead of giving a treatment plan to specific patients. Clinicians must make specific diagnosis and treatment plan according to the individual situation of patients.

A 55-year-old female was admitted to the hospital on August 14, 2008 due to general numbness and fatigue for 5 months. The patient developed numbness below both knees in March 2008 and gradually progressed upward. 5 months numbness developed to the neck, and weakness of both lower limbs appeared; At 7 months, the weakness of both lower limbs was aggravated sharply, unable to walk and move, and at the same time, both upper limbs were weak, especially the left upper limb was unable to lift. The number of CSF cells was 6×106/L, and the monocytes increased; MRI of the head and spinal cord showed abnormal signals in the corpus callosum, bilateral frontal, parietal and occipital lobes, abnormal signals in the cervical cord from the medulla oblongata to the C6 level (Figure 1), and abnormal signals in the spinal conus. Multiple sclerosis (MS) was diagnosed, and the treatment of methylprednisolone 500mg/d, which was gradually reduced to maintenance dose and nerve nutrition after 5 days of medication had no obvious efficacy.

A 46-year-old female was admitted to the hospital due to "swelling and pain in both lower limbs for 3 days, aggravated with fever for 1 day". The patient had no special past medical history, but her physical constitution was weak at ordinary times, and there was no history of trauma before the onset of the disease. Physical examination on admission: body temperature 39.5℃, pulse 132 times/min, breathing 35 times/min, blood pressure 155/105 mm Hg (1 mm Hg =0.133 kPa). The patient showed painful appearance, confusion, fecal incontinence, no obvious rales in both lungs, soft abdomen without tenderness, no rupture in the skin of both lower limbs, swelling below the knee joint, with the left lower limb as the main factor, stains on the skin surface (Figure 1), obvious tenderness, twisting sensation on the skin, limited joint movement, and bruise at the end of the left toe.

primary central nervous system lymphoma (PCNSL) is a rare tumor, accounting for about 1% ~3% of primary intracranial tumors [1]. The clinical diagnosis and treatment experience is small, and it is easy to be misdiagnosed, which leads to delayed treatment and affects the prognosis. The diagnosis and treatment of a case of PCNSL confirmed by pathology admitted to our department is reported as follows.