Volume 89  ·   Issue 31  ·  2009

In recent years, with the continuous deepening of research on lumbar spine diseases, the development of society and the improvement of people's requirements for quality of life, the concept of treatment of low back pain is also constantly advanced.The improvement of scientific and technological level provides realistic possibilities for realizing various treatment concepts,which makes various new methods,new technologies,related surgical equipment and instruments emerge and be rapidly developed and applied in clinical practice [1]. But at the same time, it also causes fierce debate and brings a lot of confusion to clinicians. Faced with many new products and technologies,how to grasp and choose the most effective, reliable and economical treatment for patients is a problem that we must think about and solve.Here, I mainly talk about some personal opinions.

Objective To understand the natural history and prognosis of patients with discogenic low back pain so as to offer a better guide on its clinical treatment. Methods From December 2003 to November 2004, we consecutively hospitalized 72 patients with discogenic low back pain diagnosed by lumbar discography. These patients were randomized into two groups. One group (n = 36) received an intradiscal methylene blue (MB) injection immediately after discography while another group (n = 36) received a placebo. Both Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used to assess the back pain symptoms and the lumbar function respectively during a 4-year fallow-up period. Results In total, 32 of 36 patients who received a placebo injection underwent a 4-year follow-up. Of these patients, 4 cases (12.5%) had their low back pain symptoms alleviated, 1 case (3. 1%) slightly improved, 3 cases (9. 4%) aggravated and 22 cases (68. 8%) had no change in symptoms. According to VAS and ODI scores taken at different time points, these two scores gradually decreased over time; however, no statistical significances were found (VAS:F=3.049, P>0.05; ODI:F=2.272, P>0.05).Conclusion The disease course of discogenic low back pain is chronic and persistent so that its symptoms show no improvement over time.

Objective To investigate the correlation between position of the spinal cord with increased signal intensity (ISI) on magnetic resonance images (MRI) and the outcome of surgical treatment for cervical spondylotic myelopathy (CSM). Methods Seventy-two patients with CSM who underwent pre-operative MRI were selected. Pre- and post-operative clinical status was evaluated by modified Japanese Orthopedic Association (JOA) score. ISI was evaluated according to the T2-weighted sequences. The JOA score and the recovery ratios among patients with ISI in gray matter (group A), in both gray and white matter (group B) and ISI-negative group were compared. Results Forty patients were in ISI-negative group. ISI presenting only in gray matter included 21 cases (group A) and 11 cases were in both gray and white matter group (group B). Preoperative JOA score of ISI positive and negative group had significant difference, but the recovery ratios had no significant difference [recovery ratios of two groups at week 1, week 14, and week 52 were (20.8 ± 14.5)%, (51.1 ± 15.6)%, (60.1 ± 14.2)% and (20.3± 14. 3) %, (54. 4 ± 22. 3) % and (61.2 ± 22. 3) % respectively; P > 0. 05]. The recovery ratios of negative group and group A in week 104 were superior to group B [recovery ratios of negative group, group A, and group B in week 52 were (61.2±22.3)%, (64.3 ± 13.3)% and (50. 1 ± 11.2)% respectively; P< 0. 05]. Conclusion Patients with ISI in the gray matter alone on T2-weighted MR images have no significantly different surgical outcomes as compared with those without ISI. Patients with ISI in both gray and white matter have worse surgical outcomes than those without ISI.

Objective To discuss the surgical indications, outcomes and complications of anterior multilevel corpoctomy for the treatment of severe ossification of posterior longitudinal ligament (OPLL) in the cervical spine. Methods Between April 2006 and March 2008, a total of 25 patients (20 males and 5 females, age range: 42 -75 yr, mean: 53. 2 yr) underwent anterior multilevel corpectomy for severe ossification of posterior longitudinal ligament in the cervical spine. Radiological studies showed that the type of OPLL was distributed as follows :7 local, 5 segmental, 8 continuous and 5 mixed. The OPLL extended an average of 2.8 vertebrae (2-4) and the stenotic rate of spinal canal was 68.4% (50% -97%). After corpectomy and removal of OPLL, titanium mesh cage and anterior plate were employed to restore cervical stabihty in all patients. Results Among these patients, 16 underwent two-level corpectomy and 9 three-level corpectomy. After a follow-up of 2 - 18 months, the mean JOA score increased from 9. 3 (5 - 12) points pre-operatien to 14. 2 (11-16) points post-operation. The mean improvement rate of neurological status was 63.2% (22. 2% - 87. 5%). The complications included CSF leakage in 6 cases (intermittent CSF pseudocyst in 4), nerve root palsy in 2, hematoma in 1 and transient neurological deterioration in 1. Conclusion Anterior multilevel corpextomy can achieve a better clinical outcome in the treatment of severe cervical ossification of posterior longitudinal ligament. But it is technically demanding and carries a higher risk.

Objective To reveal the pre-operative chemotherapy for long-term of small cell lung cancer. Methods From January 1994 to January 2005, 263 patients with small cell lung cancer underwent combined therapy. The comparison of long-term survival rates was made between pre-operative chemotherapy group (n = 111) (group A) and post-operative chemotherapy (n = 96) (group B). Results The analyses disclosed that the overall 5-year survival rate was 42. 16%. The 5-year survival rate of group A was 38. 25% while in group B it was 46. 57%. 5-year survival rate of group A for NO-1 and N2 was 40. 12% and 39.22%, that for stage Ⅱ , Ⅱ, Ⅲ ,Ⅲ<,b>, Ⅳ was 60.15%, 35.70%, 40.16%, 14.29% and 0 respectively. 5-year survival rate of group B for NO-1 and N<,2> was 51.91% and 42.69%, that for stage Ⅰ , Ⅱ,Ⅲa, Ⅲb, Ⅳ was 61.1%, 50.23%, 42.32%, 26.47% and 0 respectively. Conclusion The comparison of the survival rate between patients with the pre-operative chemotherapy and those with chemotherapy post-operatively revealed trend of variation. Operation plus post-operative chemotherapy mode is indispensable for better prognosis of small cell lung cancer.

Objective To explore the influence of early hepatic artery ischemia on the occurrence and prognosis of biliary complications after orthotopic liver transplantation (OLT), and the value of early hepatic arterial interventional therapy. Methods In the 720 recipients who received OLT in our hospital from October 2003 to June 2007, 32 cases were detected hepatic artery stenosis (HAS, 30 cases) or hepatic artery thrombosis (HAT, 2 cases) by color Doppler Ultrasound from 4 to 65 days (mean, 25 ± 15) after OLT. All of them were confirmed by DSA and/or CT angiography. Of the 32 patients, 20 were treated by hepatic arterial interventional therapy. The end-point of follow-up was the time of patient's death and retransplantation. Results In this study, 20 cases developed biliary complications, including the common bile duct stenosis in 2 cases, intra- and extra hepatic bile duct stenosis in 13 cases and multiple intrahepatic bile duct stenosis in 5 cases. Among them, 2 patients complicated with bile leakage, 4 with biloma and 3 with liver abscess. Of the 20 patients, 8 with HAS received successful hepatic arterial interventional therapy which was performed two weeks after HAS detected; 10 with HAS didn't receive hepatic arterial interventional therapy; 1 with HAT received successful thrombolysis; 1 with HAS received failed hepatic artery stent implantation. During a median follow-up of 262 days (range, 22 -517 days), 10 patients died, 6 underwent retransplantation, and the other 4 survived; cumulated survival rates at 6, 12 and 24 mouths were 60. 0%, 34. 9% and 0, respectively. 12 cases didn't develop biliary complications. Nine of them received successful hepatic arterial interventional therapy within 2 weeks HAS-detected, 2 with acute rejection received flushing anti-rejectian therapy, 1 with HAT received retransplantation because of unsuccessful thrombolysis. During a median follow-up of 952 days (range, 14 - 1398 days), 3 patients died, 1 underwent retransplantation, and the other 8 survived; cumulated survival rates at 6, 12 and 24 months were 75%, 66. 7% and 66. 7%, respectively. Conclusion Early hepatic artery ischemia after OLT is an important agent for biliary complications. Early and successful hepatic arterial interventional therapy helped to reduce the incidence of biliary complications and improve the patients' prognosis.

Objective To compare the serum HCG levels in pregnant women of routine IVF versus ICSI during fresh transplantation cycles so as to explore whether ICSI influenced the serum HCG levels. Methods A total of 934 IVF pregnant cycles during March 2005 to September 2006 were divided into 7 groups: biochemical pregnancy (A), first-trimester miscarriages (B), ectopic pregnancy (C), single-pregnancy (D), twin-pregnancy (E), triplet-pregnancy (F) and heterotopic pregnancy (G). The median of serum HCG level at Days 14 and 21 was calcniated among 7 groups. Results The serum HCG value was lower by ICSI than that by IVF only in biochemical pregnancy group at Day 14 (P=0.032). Conclusion ICSI is associated with relatively low HCG values in the biochemical pregnancies at Day 14 after embryo transplantation. There is no statistical difference of HCG level for clinical pregnancy between IVF and ICSI.

Objectives To study the relationship of the number and quality of embryos transferred with clinical pregnancy rate and multiple pregnancy rate in frozen-thawed embryo transfer (FET) cycle. Methods Retrospective analysis of the clinical data of 995 FET cycles. Patients were stratified as age < 35 or ≥35, Both groups' clinical pregnancy rate and multiple pregnancy rate were compared according to the number of embryos and high-quality embryos transferred. Results (1)The clinical pregnancy rates were 50. 0%, 56. 6% and 56. 5%, and twin pregnancy rates were 6. 3%, 43.8% and 30. 6% respectively in < 35 group when one, two or three embryos were transferred. There is not any significantly statistic difference among these subgroups (P > 0. 05). However, the twin pregnancy rate in one-embryo transferred subgroup was significantly lower than that of two-embryo transferred subgroup (P < 0. 05). Moreover, the clinical pregnancy rate was not different among single high-quality embryo transferred subgroup and other high-quality embryo transferred subgroups, the multiple pregnancy rate was lower than the others. (2) The clinical pregnancy rates were O, 47.3% and 53.8%, and twin pregnancy rates were 0, 25.7% and 25. 7% respectively in ≥35 group when one, two or three embryos were transferred. The clinical pregnancy rate and twin pregnancy rate between two-embryo and three-embryo transferred subgroups were not significantly different (P > 0. 05). Moreover, the clinical pregnancy rate was not different among two-embryo transferred containing one high-quality embryo subgroup and other high-quality embryo transferred subgroups, the multiple pregnancy rate was lower than the others. Condusions There is a close relationship between the number and quality of embryos transferred and clinical pregnancy rate, multiple pregnancy rate in FET cycles. For the patient aged < 35, we recommend performing single high-quality embryo transfer in order to reduce the multiple pregnancy. For the patient aged ≥35, two-embryo transfer containing one high-quality embryo is enough to obtain a satisfied clinical pregnancy rate and an acceptable multiple pregnancy rate.

Objective To identify the significant protein peaks and establish the diagnostic model of myasthenia gravis (MG) by serum proteomics profiling analysis. Methods The serum samples from 56 MG patients and 16 healthy controls were detected by the technology of surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF MS). The differentially expressed protein peaks were identified to establish a MG diagnostic model And preliminary validation was performed. Results Thirty-eight specific protein peaks with significant differences were found in the serum protein pattern of 56 MG patients and 16 healthy controls. Systemic optimization identified 2 protein peaks of M4168.94 and M1122. 57. And they were used to build the MG diagnostic model of differentiating 56 cases from 16 controls. Conclusion The serum protein profiling can be a novel, effective and sensitive tool to screen for MG-related protein peaks and establish a diagnostic model.

Objective To investigate the efficacy of enalapril combined with folic acid in lowering both blood pressure and plasma total homocysteine (Hcy) in essential hypertensive patients. Methods A randomized, community-based clinical trial was conducted. Subjects with hypertension were randomly assigned to one of three treatment groups:enalapril 10 mg/d alone (control), enalapril 10 mg plus folio acid 0.4 mg daily (low-dose group) and enalapril 10 mg combined with folic acid 0. 8 mg daily (high-dose group) for a total of 8 weeks. Resting blood pressures of all subjects was measured at baseline, 2nd, 4th, 6th and 8th week of therapy. Plasma Hcy levels were measured at baseline, 4th week and the end of study. Results A total of 273 hypertensive patients were enrolled. All analyses were pedormed according to the intention to treat. Compared with control group, both low- and high-dose group had significantly a greater efficacy in lowering both blood pressure and plasma Hcy level, orin lowering either blood pressure or plasma Hcy level, or in lowering Hcy leveL The proportion of subjects showing a marked reduction in both blood pressure and plasma homocysteine in control group, low-dose group and high-dose group were 3.8%, 15.2% and 17. 1% respectively; the priportion of subjects showing a marked reduction in either blood pressure or plasma homocystoine in contnol group, low-close group and high-dose group were 43. 8%, 70. 9% and 58. 5% respectively. Effect upon blood pressure lowering was not significantly different among these three regimens. Conclusion As compared to enalapril alone, enalapril combined with folio acid showed a better efficacy in reducing both blood pressure and plasma Hcy level in hypertensive subjects.

Objective To evaluate the visual performance of patients with Tecnis ZM900 aspherical diffractive multifocal intraocular lens (MIOL) as compared with aspherical monofocal intraocular lens (IOL). Methods A prospective nonrandomized controlled study was conducted. Consecutively 114 senile cataract patients (114 eyes) received phacoemulsificatien and IOL implantation, 57 patients (57 eyes) were implanted Tecnis ZM900 MIOL (multifocal group) and 57 patients (57 eyes) were implanted aspherical Tecnis ZA9003 IOL (monofocal group). All patients were assessed at 3 months postoperatively: uncorrected and best corrected visual acnities for distance and near, distance corrected near visual acuity, higher-order aberrations of IOL, modulation transfer function, contrast visual acuity at different contrast levels and different distance (40 cm, 63 cm and 100 cm) and pseudoaccommedation. Patient satisfaction (spectacle independence, photic phenomena and overall satisfaction) was assessed by a questionnaire. Results At 3 months post-operation, beth uncorrected near visual acuity and distance corrected near visual acuity were significantly better in multifocal group than monofocal group (t =-7.62, - 9. 89, P < 0. 05). The accommodative range was (4. 74 ± 1.05) D in multifocal group and (1.65 ± 0. 68) D in monofocal group (P<0. 01). There was no statistically significantly difference between the two groups in IOL higher-order aberration with different pupil sizes (3 mm vs 5 mm). At the distance of 40 cm and 63 cm, visual acuity scores were higher in mnltifocal group than in monofocal group(P <0. 01). Modulation transfer function was similar in the two groups and there was no statistically significantly difference. The spectacle independence was 85.9% in multifocal group versus 24.6% in the monofocal group (χ2 = 43.46, P<0. 05). Conclusion Compared with aspherical monofocal IOL, the Tecnis ZM900 aspherical diffractive MIOL not only provided certsin pseudoaccommodation with a better useful near visual acuity, but also provided a better quality of vision, resulting in higher levels of spectacle independence and patient satisfaction.

Objective To study the differences on the immunogenicity of the leaflets, arterial wall and myocardium of conduit valved homograft (CVH) cryopreserved with liquid nitrogen. Methods Mono-cell suspension of leaflets cells and arterial cells of CVH were respectively co-cultured with human lymphatic cells whose blood groups were the same with that of CVH donors. Expressive levels of CD25 and HLA-DR of these lymphatic cells were detected by flow cytometry in the different cultural duration and compared with that of lymph cells alone cultured (comparative group). Results The immunogenicity of CVH artery walls was more severe than that of CVH leaflets, and expressive level of whose CD25 and HLA-DR was higher. The immunogenicity of CVH myoeardium was not studied because the myocardial cell suspension were not be acquired in this study. Conclusion It is proved that in vitro experimental study that the immunogenicity of arterial walls of cryopreserved CVH is more severe than that of leaflets.

Objective To investigate the expression of metabotropic glutamate receptor 5 (mGluR5) in spinal cord of morphine tolerant rats and understand the influence of mGluR5 antagonist MPEP upon the expression of mGluRS. Methods Male Sprague-Dawley rats were randomly divided into four groups with 8 rats each:control group (NS), morphine group, morphine plus MPEP group and MPEP group. A morphine tolerance model of rat was established by repeated administration of 10 μg morphine intrathecally twice daily for 7 days. The effects of morphine co-administrated with MPEP upon the thermal pain threshold were examined by tail flick test. Tail flick latency (TFL) was measured at 30 min pre- and post-dosing. MPE% (percentage of maximal possible effect) was calculated by the equation: MPE (%) = [(test response time-basal response time)/(cut-off time-basal response time)] × 100%. The rats were sacrificed and L4-5 spinal cord tissue was removed. The expression of mGluR5 in every group was examined by immunofluoreacence and Western blot. Results MPE% of morphine group decreased gradually after chronic administration of morphine intrathecally. There was no significant difference between morphine group and control group at Day 7 (P > 0. 05). Morphine plus MPEP group had significant analgesic effect as compared with morphine group at Day 7 (P < 0. 05). The expression of mGluR5 was up-regulated in the dorsal horn of spinal cord in morphine tolerant rats. The protein level of mGluR5 in morphine plus MPEP group was lower than that in morphine group (P < 0. 05), but higher than control group (P < 0. 05). Conclusion The mGluR5 antagonist MPEP can prevent the development of morphine tolerance. The expression of mGluR5 protein increases in the spinal cord of morphine tolerant rats. MPEP plays its role in morphine tolerance by partly inhibiting the expression of mGluR5.

Objective To study the role of nitric oxide (NO) in the pathogenesis of cold nerve injury and to explore its mechanism. Methods Cold nerve injury model was established in rat's sciatic nerve. Consistent and intermittent cooling of 4℃ for 2 hours were respectively applied to the sciatic nerves. Nerve samples were taken at different time points: immediately post-cooling and 4 h, 1 d & 3 d post-cooling. The group of aminoguanidine (AG) intervention was also established. Then NO levels in the nerves and blood serum were detected. Induced nitric oxide synthase (iNOS) in ganglion was determined by immunohistochemistry. Morphology of cooled sciatic nerves in the AG groups (consistent & intermittent cooling AG groups) and control groups (1 d time point of consistent & intermittent cooling groups) was observed by light microscope and electron microscope. Results At the time points of immediacy, 4 h, 3 d in the consistent cooling groups and the time points of immediacy, 4 h, 1 d in the intermittent cooling groups, different incremental degrees of NO levels in the cooled nerves (0. 146±0. 047), (0. 216± 0. 048), (0. 137±0. 035), (0. 154 ±0. 027), (0. 260±0. 027), (0. 218±0. 042) μmol/g as compared with those of controls (0. 098±0. 022), (0. 158 ±0. 030), (0. 085 ±0. 020), (0. 127 ±0. 016), (0. 172± 0. 027), (0. 174 ± 0. 026) μmol/g, P < 0. 01, P < 0. 05). And NO levels in the cooled nerves at the time points of 4 h, 1 d, 3 d in the intermittent cooling groups were higher than those in the consistent cooling groups (P < 0. 01, P < 0. 05). NO levels in blood serum at the time points of immediacy and 1 d in the intermittent cooling groups (4. 98 ± 1.33) μmol/L, (4. 02 ±0. 68) μmol/L were higher than those in the consistent cooling groups (2.47±0. 36) μmol/L, (3.00 ±0. 67) μmoL/L, P <0. 01). Both in consistent cooling and intermittent cooling groups, different incremental degrees of areas and integrated optical density (IOD) of iNOS positive staining in ganglions were found in cooled side as compared with the control side at different time points (P < 0. 01, P < 0. 05, P > 0. 05), while those at the time point of immediacy in the intermittent cooling groups (131 686 ±24 549), (4. 1 ±0. 13) ×109 were higher than those in the consistent cooling groups (78 558 ± 34 849), (2. 1 ± 0. 93) ×109, P < 0. 05. NO level of cooled nerves in the intermittent cooling AG group (0. 178 ±0. 030) μmol/g was lower than those at the time point of 1 d in intermittent cooling groups (0. 218 ±0. 042) μmol/g, P <0. 05). Also a reduction of NO levels of blood serum, areas and IOD of iNOS positive staining was found in the AG groups as compared with the control groups (P < 0. 05) while the reduction was more significantly found in the intermittent cooling AG group (P <0. 01, P <0. 05). Through light microscope and electron microscope, more severe pathological injury of cooled nerve was seen in the intermittent cooling group as compared with 1 d time point of the consistent cooling groups, and a marked reduction of pathological injury was found when AG was administered. It was also more significant in the intermittent cooling AG group. Conclusion NO plays a causative role in the pathogenesis of cold nerve injury, especially in intermittent cold nerve injury. The expression of iNOS is the main source of NO. Production of free radicals and the resulting toxic injury may be its main mechanism.

Objective To investigate the correlation between MR diffusion weighted imaging with cellularity and PCNA-LI of rabbit liver VX2 tumor models in different periods. Methods 38 successful implanted rabbits were assigned randomly into 2 equal groups and were performed MR DWI in different periods (14 and 21 d) after implantation respectively. Specimens of all tumors were stained with HE and PCNA-LI after MR examination. Results (1) The ADC value (×10-3 mm2/s) in surrounding solid components of liver VX2 tumors in the group of 21 d was lower than that of the group of 14 d (0. 77±0. 19 vs 1.00±0. 24, P = 0. 007) ; (2) the cellularity and PCNA-LI in surrounding solid components of liver VX2 tumors in the group of 21 d were higher than those of the group of 14 d respectively (63% ±7% vs 43% ± 10%, P = 0. 011 ; 80% ± 11% vs 56% ± 8%, P = 0. 008) ; (3) there were negative correlation between ADC value and cellularity, PCNA-LI of the solid components of the tumors (r = - 0. 695, P = 0. 000; r = - 0. 698, P = 0. 000). Conclusion The cellularity may be the most important factor that affects ADC value in solid components of liver VX2 tumors. Since the degree of malignancy is closely connected with cellularity and PCNA labeling index, ADC value measurement may be a new method which could predict the degree of malignancies in vivo.

Objective To determine effect of central neuronal nicotinic receptor on synaptic lang-term potentiation (LTP) in the CA1 area of rats hippocampal slices. Methods Brain slice preparation transverse hippocampal slices were obtained from male Sprague-Dawley rats that were ether-anesthetized and decapitated. The hippocampus was rapidly removed, and slices were prepared in ice-cold artificial cerebrospinal fluid (ACSF), oxygenated with 95% O2 - 5% CO2. Seventy-seven slices were randomly divided into 11 equal groups (n = 7 each) :group LTP; group isoflurane 0.125 ; group isoflurane 0. 25 ; group isoflurane 0. 5 ; group nicotine 0. 1 ; group nicotine 1.0 ; group nicotine 10. 0 ; group nicotine 1.0 + isoflurane 0.25; group nicotine 10. 0 + isoflurane 0.25; group mecamylamine; group mecamylamine + isoflurane 0. 125. One recording electrode was positioned in the pyramidal cell layer of the CA1 area of rats hippocampal slices to simultaneously record evoked population spikes (PS). For LTP induction, high-frequency stimulation (HFS) conditioning pulses (100 Hz/s) were applied to the Schaffer collateral-commissural pathway of hippocampus using a bipolar stimulating electrode. The changes of PS amplitude after HFS were analyzed in each group. Results The PS amplitude of the rats hippocampal slices in group LTP after HFS was significantly increased by (52 ± 12)% compared with that of pre-HFS indicating the successful induction of LTP. Compared with group LTP, the PS amplitudes decreased significantly in group isoflurane 0. 125, 0. 25 and 0. 5 after HFS (P <0. 01) and increased significantly in group nicotine 1.0 and 10. 0 (P < 0. 01), but the PS amplitudes in group nicotine 0.1 was not significantly changed after HFS (P >0. 05). The PS amplitudes after HFS in group nicotine 1.0 + isoflurane O. 25 and group nicotine 10. 0 + isoflurane 0. 25 was dramatically increased compared with the value of group isoflurane 0. 25 (P < 0. 01), but did not differ significantly from group LTP (P > 0. 05). The PS amplitudes after HFS in group mecamylamine has no significant difference compared with the value of group isoflurane 0. 125, but it was significantly lower than that in group LTP (P < 0. 01) . The PS amplitudes after HFS in group mecamylamine + isoflurane 0. 125 significantly decreased compared with the value of group isoflurane 0. 125 and group LTP (P < 0. 05 or P < 0. 01). Conclusion The inhibition of LTP induction may contribute to isoflurane-induced deficits in memory, and the underlying mechanism is involved in the inhibition of nicotinic acetylcholine receptor activation in hippocampus of rats.

Objective To determine whether monneionality or different cell seeding densities could influence the differentiation potential of immortalized human mesenchymal stem cells (hMSC-TERT) and to find an effective cultural method of hMSC-TERT in vitro. Methods From the parental hMSC-TERT cell line, we derived 30 monoclonal cell lines and two independent cell lines based on different plating densities during expansion in culture. Their adipocytic, osteogenic, neuronal differentiation potential in vitro and multidirectional differentiation potential in vivo were analyzed by immunohistochemistry for pathologic tissue markers. Results Monoclonal cell lines and the cell line derived at low seeding density had a lower differentiation potential in vitro than the cell line derived at higher cell seeding density. The differentiation potential of monoclonal hMSC-TERT cells were dissimilar. Some of monnelonal hMSC-TERT lines expressed epithelial differentiation potential in vivo while the parental hMSC-TERT cells line did not Conclusion Multiclonal hMSC-TERT cells cultured in high seeding density can keep the differentiation potential, cloning the hMSC-TERT cells before transplantation to find the special clones for special purpose of transplantation.

Fetal ventricular dilatation refers to the excessive concentration of cerebrospinal fluid in the lateral ventricular system, which causes the lateral ventricle to appear in a dilated state during the development of brain tissues. Prenatal ultrasound diagnosis of fetal lateral ventricular dilatation is reliable and accurate [1]. Clinically, the posterior edge of the choroid plexus bulb is usually used to measure the lateral ventricular diameter, that is, the maximum distance between the inner edge of the medial wall of the lateral ventricle and the inner edge of the lateral wall. This value is more than 4 times the standard deviation of the mean value (7.6±0.6) mm, that is, 10 mm, can diagnose ventricular dilatation. The lateral ventricular diameter of 10~15 mm and other malformations visible by ultrasound are called mild lateral ventricular dilatation or borderline dilatation [2]. The etiology of lateral ventricular dilatation is complex, and the intrauterine outcome and clinical prognosis are still controversial.

A 41-year-old female was hospitalized for the second time in February 2008 due to recurrent chest tightness, lumbar distension and pain, and intermittent abdominal pain. Physical examination: blood pressure: 131/82 mm Hg (1 mm Hg =0.133 kPa), elongated and thin body, height: 180 cm, high zygomatic bone, high palate, wide eye distance, slender fingers (toes), spider-foot-like fingers, positive wrist sign.