Volume 89  ·   Issue 41  ·  2009

The atlantoaxial vertebra is the connecting hub and important anatomical part of human head and trunk. The atlantoaxial dislocation often involves the bulbar vital center and the vertebrobasilar artery. The operation of this part is difficult and risky, and it is called the "dangerous area" or "forbidden area" of orthopedic surgery. Besides, atlantoaxial vertebra is an important segment of cervical vertebra, and its rotational activity accounts for more than 50% of the rotational activity of the whole cervical vertebra.

Objective To evaluate the radical debridement and single stage posterior spinal fusion and inatrumentation for the treatment of spinal tuberculosis. Methods From 1999 to 2004,57 patients(29 males,26 females)with spinal tuberculosis were operated at our department. The age range was 20 to 77 years old(mean:39 years old).There were 30 cases of thoracic vertebra and 27 cases of lumbar vertebra All the patients received a standard pre-operative 4-8-week anti-tuberculosis treatment. Results The followup period ranged from 1-4 years and 95.9%of patients achieved an excellent outcome. Solid bony fusion was seen at last in all cases.The mean post-operative kyposis angle reduced to 20.from 32.pre-operation.Conclusion Single stage anterior spinal fusion and instrumentation iS curative for spinal tuberculosis.

Objective To report a group of special patients showing a normal signal intensity of MRI with a positive discography and discuss its pathogenesis and clinical significance.Methods From August 2003 to November 2008,288 patients with chronic low back pain were treated.Of these patients,12 showed a normal intensity signal of MRI in lumbar intervertebral discs with a positive discography.There were 7 males and 5 females aged 20-44 years with an average of 29.6 years.The duration of disease was 8 months to 3 years with an average of 1.8 years.Dallas CT grading method was used for assessing the degree of annular disruption.Results Of these 12 patients,33 lumbar discs underwent discography.Twelve discs in 12 patients showed annular disruption and low back pain reproduction.Among 12 painful discs.3 showed grade 2 annular disruption and 9 showed grade 3 annular disruption.Conclusion Patients who are refractory to conservative care and have normal signal intensity in lumbar disc MRI and who are suggested as discogenic origin and might need further treatment such as minimal invasive surgery or lumbar interbody fusion should still be examined by discography.

Objective To investigate whether polymorphisms of SIM2 gene are associated with congenital scoliosis(CS)in a Chinese Han population.and explore the relationship of between polymorphisms of SIM2 and clinical phenotypes of CS. Methods A case-control design was employed in this study.A total of 127 patients(55 boys,72 girls, mean age 12.90 y/o)diagnosed with CS admitted at Peking Union Medical College(PUMC)Hospital were enrolled between October 2005 and September 2007.The scoliosis-free control subjects(127 cases)at the same hospital during the same study period were frequency-matched to the cases on age(±3 years)and gender.Genomic DNA was extracted by QIAamp DNA Blood Mini Kit from peripheral blood leukocytes of each subject who had signed informed consent.Based on genotype data from the International HapMap project,the main functional single nucleotide polymorphisms(SNPs)initially were selected.Case group were classified into different clinical phenotypes according to vertebral defect type,location of deformity,extent of developmental disruption,combined rib malformations and neural canal deformity.Genotying of all selected SNPs was done by SNPstream technology (Beckman Coulter SNPstream).All the data of SNPs with polymorphism were analyzed by association analysis based on a single SNP.the association analysis between phenotypes and SNPs.And pairwise linkage disequilibrium was calculated in the control population using Haploview 4.1 software.Results SNPI (rs2073601),SNP2(rs2073417)and SNP3(rs2051397)of SIM2 are genotyped.SNP2 and SNP3 in linkage disequilibrium.No association(P＞0.05)is observed between SNP1,SNP2 and SNP3 genotypes/allele polymorphisms and risk of CS and different clinical phenotypes.Conclusion Genetic variants of SIM2 gene may not be associated with the susceptibility to CS and different clinical phenotypes of CS in Chinese Han population.

Objective To investigate the relationship of dynamic cord impingement of sagittal diameter on flexion-extension cervical magnetic resonance(MR)imaging with disease severity and prognosis in cervical spondilotic myelopathy. Methods A total of 53 patients with cervical degenerative disease were evaluated with regards to the dynamic cord changes of sagittal diameter at neutral and flexion-extension 1.5 T MR imaging from February 2006 to November 2008.The mean follow-up period was 14.6(11-36)months. The factors of age, sex, duration of disease, cervical range of motion and cord signal intensity were considered. The patients were divided into two groups according to the extent of dynamic cord changes of sagittal diameter on MRI(groups of high and low dynamic cord changes).Statistical analyses were performed with SPSS 13.0.Results The preoperative JOA scores were 9.17±2.45 and 13.76±2.81respectively with a recovery rate of 57.02%±16.23% at the final follow-up. There was no significant difference between the two groups in terms of recovery rate and age. The cervical range of motion and cord signal intensity in group of high dynamic cord changes were higher than those in group of low dynamic cord changes. The preoperative JOA score and duration of disease were lower than those in group of low dynamic cord changes. According to linear regression test between the recovery rate, the preoperative JOA score and the extent of dynamic cord changes, the correlation coefficient were 0.07(P=0.643)and-0.27(P=0.04)respectively. Conclusion With the precondition of a short disease duration in cervical spondilotic myelopathy, the extent of dynamic cord changes is correlated with disease severity but shows no relationship with prognosis.

Objective To understand the prevalence, investigate the correlation of clinical features, explore the early-stage diagnosis and treatment of pulmonary arterial hypertension(PAH)in patients with connective tissue disease(CTD).Methods All cases with pulmonary arterial hypertension in 1892 CTD patients were analyzed retrospectively. The risk factor of PAH was evaluated and the prognostic influence of difierent treatments and primary diseases analyzed. Results The prevalence of PAH in patients with connective tissue disease wag about 4.2%(79/1 892).In these patients, systemic sclerosis (SSc)and mixed connective tissue disease(MCTD)had the highest incidence of PAH(18.18%and 12.00%)(P＜0.01).It was obviously higher than polymyositis/dermatomyositis(6.2%),systemic lupus erythematosus(4.4%),Sjogren syndrome(3.8%),rheumatoid arthritis(0.8%)and anti-phospholipid syndrome(0.5%),etc.(P＜0.01).Raynaud's phenomenon was related to a higher pulmonary arterial pressure(P＜0.01).There was a positive correlation(P＜0.01)between the presence of Raynaud's phenomenon and pulmonary arterial pressure. Abnormal lung function was a common finding. There were associations(P＜0.05)between the degree of pulmonary hypertension and IgG,anti-U1RNP antibody positive, antiphospholipid antibody positive, pericardial effusion and interstitial pneumonia. Conclusion PAH is common in connective tissue disease. SSc and MCTD have the highest prevalence of PAH. The presence of Raynaud's phenomenon anti-U1RNP antibody is positively correlated with pulmonary arterial pressure. It can predict the development of PAH. It is useful to perform ultraechocardiogrphy for an earlystage diagnosis and prognostic analysis.

Objective To evaluate the complications of different approaches of hysterectomy based on analyzing the records of patients with long post-operative hospitalization. Methods The records of 3722 patients undergoing hysterectomy due to benign gynecologic disorders were retrieved. A total of 162 patients with ultra-long post-operative hospitalization(＞9 days defined as delayed discharge)were analyzed to evaluate the complications of hysterectomy. Results (1)Of 162 patients classified into delayed discharge group,114(30.6%o)had post-operative fever in which 82 cases(71.9%)could be explained with complications.(2)The most common procedure-related complications included pelvic hematoma/vaginal stump bleeding(n=46,12.4‰),wound dehiscence/infection(n=24,6.4‰),organ injury(n=20,5.4‰),postoperative urinary retention(n=20,5.4‰),postoperative infection(n=20,5.4‰)and lower extremity deep venous thrombosis(n=10,2.7‰).(3)Organ injury appeared to be relatively more common in abdominal hysterectomy than in laparoscopic and vaginal hysterectomy(7.6‰,2.1‰and 0 respectively)while pelvic hematoma/vaginal stump bleeding more common in laparoscopic and vaginal hysterectomy than in abdominal hysterectomy(16.5‰,30.8‰ and 7.6‰ respectively).(4)Wound dehiscence/infection only occurred in abdominal approach and it Was closely related with some concurrent disorders.Conclusion Complications of hysterectomy are related to the approach of surgery, disease characteristics and surgeon experiences. A more accurate evaluation of compli cations might be performed on the basis of the data of patients with delayed discharge.

Objective To investigate whether frozen-thawed embryo transfer(FET)instead of fresh embryo transfer for the first embryo transfer(ET)in a controlled ovarian hyperstimulation(COH)cycle improves the in vitro fertilization-ET clinical pregnancy rate.Methods The investigators retrospectively analyzed the clinical data of 1341 IVF-ET cycles under COH,including 1169 fresh ET cycles(Group T1)and 172 FET cycles as the first embryo transfer in COH cycle(Group C1).Logistic regression was used to model the probability of clinical pregnancy rate based on age,ET method and other cycle-specific factors.Results The clinical pregnancy rate was significantly higher in Group C1 than in Group T1(63.4%vs 49.4%.P＜0.01).Muhivariate logistic regression analysis revealed significant associations between the nnnlber of high-quality embryos transferred,patient age and ET method in clinical pregnancy rate.After adjusting for the number of high-quality embryos transferred and age,the clinical pregnancy rate remained significantly higher in Group C1 than in Group T1(odds ratio:1.75,95%confidence interval:1.25-2.46;P＜0.01).Significant differences were found in age(＜35 years old)and the number of retrieved oocytes (≥15).Conclusion Using FTET instead of fresh embryo transfer can improve the clinical pregnancy rate and the efficiency of IVF-ET.

Objectives To investigate the relationship between the birth weight of fetus and the P70s6K from ribosome in ceHs of placental tissues and investigate whether insulin can affect the P70 S6K by the P13 K/AKT/mTOR(P70S6K)signaling pathway in the cells of the placental tissues and more regulate the birth weight of fetus. Methotis (1)60 cases of mature placental tissues after uterine-incision delivery without complications in the gestational period were selected as the investigated subiects.they were divided into three groups according to their birth welights. groupl. the weigh of the fetus≥4000 g,group2.3000 g≤the weisht of the fetus＜4000 g,group3.the weight of the fetus＜3000 g,(2)10 cases of mature placental tissues and 20 cases of villus in the early pregnant the fetus that were divided into insulin group.rapamycin group and control group according to stimulating factors. investigations on the insulin affection activities of P70s6K were carned out by immunoprecipitation, incoparation of[r-32P]ATP,tissue cell culture, Westem blotting. Results (1)P70S6K activities in mature placental tissues(2546±357),(2333±318),(2111±315)cpm/mg,there were significant statistical differences in the comparison every two groups.(2)The P70S6K activities in the placenta from the insulin stimulation group was significantly elevated. the P70 S6K activities in the placenta from the rapamycin stimulation group was significantly declined. there were statistical significance when each was compared with control group(P＜0.01).(3)P70S6K activities in the nutrient cells of earlier pregnant period and protein expression will be elevated under insulin stimulating. However, that would be declined under rapamycin stimulating, it was statistical significant when each group compared with the control group(P＜0.01).Conclusion The activities of p70 S6K increased with the increase in the birth weight of the fetus, there was certain relationship between the activities of p70S6K in the placental tissues and the birth weight of the fetus and Insulin can regulate the activities of P70 S6K in the placenta and earlier nutrient cells.

Objective To explore the influence factors of cognitive impairment fouowing first onset of stroke. in order to predict the existence of cognitive impairment in patients with stroke and help for future clinical intervene.Metbods 364 survivors of first onset of stroke were evaluated by the mini-mental state examination(MMSE)in this study. Data were collected on age,gender, education level, location of brain lesion, diagnostic stroke subtype and so on.Logistic regressions analyzing is used to determine those factors tllat could predict cognitive impairment of stroke patients by MMSE assessment score. Resuits The factors including location of brain lesion, area of the lesion, high homocysteine, side of the lesion,complications,education level and age can ioin in the logistic regression analysis fornmat. The R of the format is 0.849 and these seven factors Can explain 72.1% variation of the scores of MMSE.Conclusion The logistic regression analysis revealed that location of brain lesion, area of the lesion, high homocysteine, side of the lesion. complications, education level and age were predictors of the cognition function assessment of stroke patients. The prevalence of cognitive impairment Can be mainly influenced by these factors.

Objective To summarize the experiences in intraarterial neoadjuvant chemotherapy for extremity osteosarcoma.Methods Between January 2002 and December 2007,111 patients with stage ⅡB extremity osteosarcoma received preoperative intraarterial chemotherapy after placing chemotherapy pump subeutaneously,en bloc resection and postoperative adjuvant chemotherapy.There were 63 males and 48 females with an average age of 18 years old(range:14-39).The time from symptom onset to hospitalization varied from several days to 6 months.The induction chemotherapy regimen included epirubicin [50-70 mg/m2 by 4-hour intraarterial infusion/day for 3 days]and epirubicin plus adriamycin[100-120 mg/m2 by 2-hour intraarterial infusion/day for 3 days]repetitively every 2-3 weeks.Among which 24 cases only received 2 cycles of induction chemotherapy was assigned into the nonstandard chemotherapy group and 87 eases receiving 3-6 cycles of induction chemotherapy the standard chemotherapy group.The number of preoperative chemotherapeutical cycles of standard chemotherapy group depended on the clinical and radiographic evaluation of chemotherapy efficacy.Results The median follow-up time was 28(8-48) months.The rate of extremity preservation surgery was 89.53%(77/86)in the standard chemotherapy group and 37.5%( 9/24)in the nonstandard chemotherapy group.Kaplan-Meier survival analysis showed that the 3-year overall survival rate and disease-free survival rate of au 111 cases were 68.3%and 65.9% respectively.There were significant difierenees in overall survival rate(38.9%,80.0%,P=0.000),disease-free survival rate(30.1%,79.5%,P=0.000),distant metastatic rate(66.67%,16.09%,P=0.0000)and local recurrence rate(58.33%,13.79%,P=0.0000)between two groups.Conchsion Standard intraarterial ueo-adjuvant chemotherapy is more effective than nonstandard intraarterial induction chemotherapy to treat stage Ⅱ B extremity osteosarcoma.

Objective To describe the technique,efficacy,and safety of muhimodality interventional treatments for biliary complications after orthotopic liver transplantation(OLT).The core of muhimodality interventional treatments is percutanous transhepatic biliary drainage(PTBD).Methods From January 2006 to May 2008.seventy-two patients with biliary complications afte OLT were closed in our study.On the basis of the cholangiographic appearance,patients were classified into 4 groups:anaatomotic biliary stricturos(n=19),hilar biliary strictures(n=16),multifocal/diffuse biliary strictures(n=31),and anastomotic biliary fistulae(n=6).All patients were treated in our hospital,including PTBD only in 6 patients,PTBD combined with balloon dilation in 50 patients,balloon dilation and plastic stent implantation in 10 patients.balloon dilation and metallic stent implantation in 6 patients.Their data were analyzed retrospectively,including serum hemobilirubin,cholangiographic appearance and complications.Results PTBD were successfal in all cases.The clinicsl symptoms improved or eliminated were observed in 66 cases.the effective rate was 91.7%(66/72).Among 72 patients,26 patients were free of drainage tube,8 patients underwent second PTBD for the obstruction of biliary stents.and 38 patients maintained drainage tube for long-term.In 66 patients with biliary obstruction,the direct bilirubin was(145±106)μmol/L before treatments and 76μmol/L±59 μmol/L one month after PTBD(t=3.78,P＜0.001).The rate of biliary tract infection was 14.3%and 43.8%respectively with the tip of drainage tube placed in biliary duct and in duodenum.There was a significantly statistical difference between these tWO iterns(X2=4.886,P=0.027).Conclusion PTBD combined with balloon dilation and biliary stent implantation is a effective therapeutic modality for biliary complications after OLT,which can improve patients' clinical symptoms,elevate patients'quality of life.The tip of drainage tube being placed in biliary duct can decrease the rate of biliary tract infection significantly.

Objective This study was to compare the 5-year survival rate,the surgical resection rate, the post-operative complications and mortality of patients who underwent saurgical resection for carcinoma of esophagus with or without neoadjuvant chemotherapy.To evaluate neoadjuvant chemotherapy in the treatment of esophageal carcinoma.Methods Forty-two patients with locally advanced esophageal carcinoma undergoing neoadjuvant chemotherapy and snrgical resection(CS group),and 75 patients with the same phase undergoing surgical resection alone(S group)from August 2003 to March 2009 in Sun Yat-sen Universitv Cancer Center were reviewed.The 5-year survival rate,the surgical resection rate,the postoperative complications and mortality between the two groups were analyzed.Results Forty-two patients after neoadjvant chemotherapy,the complete response rate was 11.9%,the partial response was 47.6%,the total clinical response rate was 59.5%.The surgical resection rate of CS group and S group were 100% and 89.5%(P=0.029).There was no statistically difierence in the post.operative complications and mortality between two groups.The overall 5-year survival for CS group and S group were 31.7%and 26.4%,respectively(P=0.266).In the subgroup analysis,the 5-year survival of patients with clinical response was significant higher than S group(P=0.010).Conclusions The neoadjuvant chemotherapy can improve surgical resection rate and long-term survival of esophageal carcinoma patients with clinical response without increasing the post-operative complications and mortality.

Objective To observe viral dynamic change in patients with HBeAg positive chronic hepatitis B by lamivudine treatment.Methods A multi-center clinical trial.Both outpatients and inpatients with HBeAg positive chronic hepatitis B have been administrated lamivudine 100 mg/d for 24 weeks.To detect the hepatitis B virus(HBV)deoxyribonucleic acid(DNA)levels of the baseline,12hours,1 day,2 days,3 days,1 week,2 weeks,4 weeks,12 weeks,24 weeks after lamivudine treatment by real time polymerase chain reaction(PCR).To estimate the parameters of viral dynamics through regression analysis.Results 172 patients were enrolled,145 male,30.8±9.7(16-65)years old Significant decrease of HBV DNA level occurred 12 hours after administration,the average decrease was 0.45 lg(copies/ml),maximum was 3.86 lg(copies/ml),4 patients decreased not less than 2 lg(copies/ml).On day 2 and 7,the average decrease was 1.20 lg(copies/ml)and 2.01 lg(copies/ml),maximum was 4.41 lg(copies/ml)and 5.79 lg(copies/ml),respectively.Then HBVDNA level continued decreasing until week 24.24-week administration of lamivudine cause 4.10 lg(copies/ml)decrease of HBV DNA averagely and 6.68 lg (copies/ml)mostly.Half life of free virion was 2.57 days.Half life of infected hepatocyte was 63.0 days.Conclusion Lamiviudine could rapidly decrease the HBVDNA level of patients with HBeAg positive chronic hepatitis B rapidly.

Objective To study the mechanical properties of therapeutic sand for femur used in the Uyghur medicine. Methods Rabbits were randomly divided into the treatment group and the control group. Rabbits of both groups had arthritis. No treatment was carried out for the control group. Only sand therapy was offered for the treatment group. After sand therapy was completed, rabbits specimen were removed and grouped. The NJ-100B device was employed to measure the femur tensile and compressive strength and the analysis of finite element performed upon the experimental data. Results At different sand temperatures below 55℃,there was no significant difference in maximal stress and elastic modulus of tensile/compressive/bending of each femur sample. Conclusion Under different temperatures, the in vitro heating has no obvious effect upon the bio-mechanical performance of bone tissues. The static tensile strength of ex vivo femur shows no obvious decline. And the compressive strengthen improves somewhat over the normal group.

Objective To investigate if sevoflurane preconditioning attenuate neuronal apoptosis induced by ischemia-reperfusion.Methods Thirty-six male SD rats weiighing 250-300 g were randomly divided into three groups(n=12 each):control group(group C),ischemia-reperfusion group(group IR)(rats were established cerebral artery clamped and reperfusion model),sevonurane preconditioning group (group S)(rats were established cerebral artery clamped and reperfusion model after 1 h 2.4% sevoflurane preconditioning).Apoptosis nenrons were observed by Hematoxylin and Eosin(HE)staining and transmission electron microscope,TdT mediated Dutp nick end labeling(TUNEL)method wag used to count apoptosis neurons density,fresh ischemic brain tissue was taken out,while Caspase-3 zymogen and 20 000 segment were checked by Western blot.Results apoptosis neurons in group IR were more than ones in group S under HE staining and light microscope and transmission electron microscope,and apoptosis neurons density(cell number/0.1 mm2)by TUNEL staining:group C,13.0±1.4;group IR,189.8±6.8;group S,110.5±4.3,the relative gray values of the contents of procaspase-3 and its 20 000 cleavage fragment were 16.72±3.0,76.1±3.4,51.2±3.1 and 8.2±2.3,59.0±6.3,31.2±5.4 respectively.Conclusions Sevoflurane pretreatment can protect neuron on ischemia-reperfusion injury by attenuating neuronal apoptosis in rats.

Objective To evaluate a strategy of using TF siRNA loaded in a novel external stent prepared by hybrid uhrafine fibrous membrane consisting of PLGA/Chitosan nannoparticles as a therapy for vein graft disease.Methods Hybrid ultrafine fibrous membranes consisting of PLGA/Chitosan nannoparticles were fabricated via a specially designed electrospinning setup. After soaking in chloroform to dissolve PLGA. the amount of chitosan in the hybrid membranes was determined. The water uptake of the hybrid ultrafine fibrous membranes was investigated by incubation in phosphate buffer solution.Right jugular vein-carotid artery interposition grafting models in Spragne-Dawley rats were randomly divided into five groups:Group A(external stent consisting of PLGA/CS-TFsiRNA nanoparticles),Group B(external stent consisting of PLGA/CS.StealthTM RNAi negative control nanoparticles),Group C(external stent consisting of PLGA/CS blank nanoparticles),Group D(external stent consisting of PLGA),Group E(without perivenous extereal stent).BLOCK-iTTM Fluorescent Oligo was used to confirm its stability and successful transfer into the vein graft wall.The vein grafts were harvested at 1,3,7,14,28 d after operation,respectively.The TF protein expression of vein grafts was analyzed by Westem blot and immunochemistry at 1,3,7 d after operation,respectively.The expression of proliferating cell nuclear antigen(PCNA)was identified by immunochemistry methods. The thickness of neointima at 28 d was calculatod by computer imaging analysis system. Results The PLGA and CS amount in PLGA/Chitosan nannoparticles membranes could be well controlled by adjusting the flow rate for electrospinning of PLGA and chitosan nannoparticles, respectively. Because of the introduction of chitosan,which is a naturally hydrophilic polymer,the hybrid membranes exhibited good water absorption properties.BIOCK-iTTM Fluorescent Oligo could be detected in the graft wall even 12days after operation.The expression of TF protein in Group A Was significantly less than that in control groups at 3 d after operation(P＜0.05,0.40±0.03 vs 0.75 ±0.01、0.75 ±0.05、0.77 ±0.07)and at 7 d after operation(P＜0.05,0.30±0.03 vs 0.84±0.05、0.86±0.06、0.85±0.06).The expression of PCNA in Group A decreased significantly in comparison with control groups at 14 d after operation(P＜0.01,13.0%±2.6%vs 25.0%±2.8%、24.2%±3.9%、24.0%±4.1%、44.8%±3.7%).The thickness of neointima at 28 d after grafting in Group A Was significantly less than the untreated group(P＜0.01,18.8μm±2.9 μm vs 38.7 μm±5.0μm、37.3μm ±3.6 μm、37.2μm±2.6μm、67.5μm±4.8μm).Conclusion rrhe hovel external stent prepared by hybrid uhrafine fibrous membrane consisting of PLGA/Chitosan nannoparticles inhibits early neointima formation in rat vein grafts.This strategy may be a practicable and promising form of gene delivery against vein graft failure.

Delivery methods include vaginal natural delivery, vaginal assisted delivery and cesarean section. Different delivery methods can have different effects on the neonatal body, thus causing different manifestations of neonatal stress state and immune function [1-2]. 　　

A 78-year-old female was admitted to the hospital on September 10, 2007 due to fever for 20 days and cough for 7 days. The patient developed fever without obvious trigger 20 days ago, showing relaxation fever, and body temperature fluctuated from 35.0 to 38.9℃. After 7 days of antibiotic treatment in the local hospital, body temperature did not change obviously, and edema of both lower limbs gradually appeared, and she could not lie down at night.

A 24-year-old male was admitted to the hospital on March 12, 2008 due to abdominal pain, fever and subcutaneous mass for one month. One month ago, the patient had no sudden severe distension and pain in the upper abdomen, accompanied by nausea and vomiting, poor exhaust, and relieved black paste stool, 1~2 times/d, with little amount. Intermittent fever in the afternoon, the highest body temperature was 38.3℃, no fear of cold and chills, and excessive sweating at night.