Volume 89  ·   Issue 45  ·  2009

It is estimated that the number of severe and death cases of new type influenza A (H1N1) in China may increase significantly in the near future, and the situation of prevention and control is grim. In the previous stage, the prevention and control measures against influenza A (H1N1) in China were active and effective, which restricted the introduction and spread of the epidemic, delayed and reduced the peak of incidence, and won time for vaccine research and development, population vaccination, production and storage of antiviral drugs and preparation for treatment.

Deep vein thrombosis of lower limbs is one of the most common complications in clinical inpatients, which can occur in various clinical departments, especially in elderly patients and patients after major surgery. More and more domestic clinical data have confirmed the danger and severity of deep vein thrombosis of lower limbs.

In March 2009, an outbreak of "human-infected swine influenza" broke out in Mexico and spread rapidly all over the world. The World Health Organization (WHO) initially called this type of influenza "human-infected swine influenza", and later renamed it "influenza A (H1N1)".

Objective To explore the method and effectiveness of treatment for severe acute deep venous thrombosis (DVT) in lower extremity.Methods Eighteen patients with severe acute DVT treated in our hospital from January 1,2002 to December 31,2008 were retrospectively analysed.All the patients had limb edema and pain,sixteen had limb cyanochroia (one had calf skin ulcer and foot gangrene),two had limb pallor,ten had weakened dorsalis pedis artery pulsation,eight had silent dorsalis pedis artery pulsation.Colour Doppler ultrasonngraphy revealed DVT and superficial venous thrombosis in all diseased limbs.One patient underwent above knee amputation for limb gangrene.Seventeen underwent surgical thrombectomy,of which three were simple thrombectorny,five were supplemented with suprapubic saphenous vein bypass,six with suprapubic PTFE graft bpass,three with iliac vein lysis angioplasty.Results One patient died (5.6%) on the third day after surgery.Limb edema relieved in seven patients (41.2%),reduced in ten patients (58.8%).All diseased limbs regained normal artery pulsation and skin appearance except for one limb amputated.Sixteen patients (94.1%) were followed up by a mean of 34 months.Limb edema disappeared in five patients (31.3%),reduced in eight patients (50%),recurrent in three patients (18.7%).Among three recurrent patients,one died of malignant tumor 9 months after operation,two had their graft occluded resulting from intimal hyperplasia.Conclusions Surgical thrombectomy is an effective method for treating severe acute DVT in lower extremity.

Objective Multicentre clinical observation for therapeutic efficacy and clinical safety of anticoagulation and thrombolysis in deep venous thrombosis (DVT).Methods 127 patients with DVT in left leg were randomly divided into four groups.Group A:treated with batroxobin.Group B:use Low Molecular Weight Heparin (LMWH).Group C:batroxobin and LMWH.Group D:urokinase and LMWH.Observing the perimeter of thigh and calf periodically,monitoring coagulation function,registering the frequency and degree of the complication.Results All the treatments in four groups can relieve the swell level of the affected legs(P＜0.05).We got the best efficacy when we use batroxobin together with LMWH (P＜0.05),especially in treating the patients with a long course of treatment.Batroxobin can obviously reduce the level of blood FBG (P＜0.05),and have no significant effect with other index of coagulation function (P＞0.05).Inject ing batroxobin into affected legs with the micro pump got a better efficacy and much safer than intravenously guttae from peripheral vein.Conclusion Treating DVT with batroxobin got a definite efficacy,especially in cases with a long course of treatment;micro pumping can give a better effect and a high safty.

Objective To make preliminary cross-sectional study on epidemiology of deep vein thrombosis of lower extremity of inpatients with high risk in Zhongshan hospital,and analyze risk factors in these patients.Methods From Sep 2008 and Feb 2009,we performed compressed ultrasound to detect deep vein thrombosis of lower extremity of in-patients with high-risk in Zhongshan hospital,including bedrid stroke patients,post-surgery bedrid patients from department of orthopaedics,gynecology,general surgery and vascular surgery and patients of surgical intensive care unit.Prevalence rate of DVT of the whole study group as well as each department were calculated and analyzed.We collected detailed clinical information of each recruited patient.We made statistical single-factor and then Logistic regression multiple-factor analysis of these data with SPSS 16.0,to determine high risks of deep vein thrombosis of in-patients.Results (1)Totally 372 patients were enrolled in our study with 38 patients detected with DVT of lower extremity,so the prevalence rate of whole series was 10.2% (38/372).(2) High risks of lower extremity deep vein thrombosis for the whole series were bedrid time (30 day boundary) (P=0.000),thrombin time (P=0.007) and history of vascular surgery(P=0.009).(3) The prevalence rate of DVT of lower extremity of department of neurology,orthopaedics and gynecology were 12.7% (13/102),of 10.0% (10/100) and 6.3% (7/111)respectively.(4)High risk for DVT in pest-surgery gynecological patients was resection of uterus and both attachments (P=0.032).Conclusion In our study,the prevalence rate of DVT of lower extremity for high-risk in-patients was high,most of whom were asymptomatic and left-sided.High risk factors were bedrid time (30 day boundary),thrombin time and history of vascular surgery.It is necessary to strengthen prophylactic anticoagulation in these patients.

Objective To investigate the characteristics of decision-making impairment in Pakinson's disease (PD) patients.Methods A total of 20 individuals with idiopathic PD were compared with matched health controls on the Iowa Gambling Task,A series of battery including the assessment working memory,visual spatial ability and verbal fluency was also administered.The severity of disease was assessed based on the Hohen and Yahr scale.Results The results showed that PD group impaired on verbal fluency,working memory and decision-making task.In Iowa gambling task,the PD group selected more disadvantageous cards than health controls (51.6±5.8,46.8±8.2 respectively),the difference between two groups is significant (t(38)=2.12,P=0.04).A 2(group)×5 (block) ANOVA (analysis of variance) on the scores of advantageous from the gambling task revealed a significant main effect of group (F(1,38)=6.16,P=0.01).The ANOVA also revealed a significant main effect of block (F(4,152)=2.43,P=0.04).The results showed that health controls gradually shifted their selections toward the good decks as the game progresses,but the PD group did not exhibit this stable advantageous shift in decision-making.Meanwhile,the study indicated the total number of disadvantageous cards for PD was positive con,elation to the degrees of severity to clinical symptom.Conclusion The present study suggests that the decision-making impairment might be in early PD.The deficit of decision-making for PD might be attributed to the dysfunction of the orbito-frontal cortex.

Objective To summarize and report the clinical features,laboratory findings and imaging appearances of venous diethylene glycol poisoning in patients with liver disease.Methods The clinical features of 15 venous diethylene glycol poisoning patients with liver disease were analyzed and summarized,their laboratory findings and imaging appearances were comparative analyzed before and after poisoning.Results All poisoned patients presented oliguric acute renal failure with anuria after a mean of 6 days.Carbon dioxide combination power of 13 patients was dropped after a mean of 9 days with trough value at the 10th day,and metabolic acidosis was developed.Gastroenteric symptoms or aggravation of gastroenteric symptoms were displayed in 11 patients after a mean of 9 days.Neurological system impairment was observed in 10 patients after a mean of 14 days.Seven patients hod low fever after a mean of 6 days.Causes of death of 14 patients included multiple organ dysfunction syndrome,severe lung infection and massive haemorrhage of digestive tract.Blood creatinine and urea nitrogen were abnormal after a mean of 5 days with peak value at the 11th and 14th days respectively.Serum calcium had no obvious change,and phosphorus was increased distinctly.Liver functions did not change significantly.Poisoned patients had higher white blood cell counts,lower red blood cell counts and hemoglobin value.Of the 7 patients exhibited mild,moderate and severe patchy consolidation shadowing in the lung,2 manifested mild or severe gaseous distention and dilation of gastroenteric tract.Conclusion Main features of venous diethylene glycol poisoning in patients with liver disease include oligurie acute renal failure,metabolic acidosis,gastroenteric symptoms or aggravation of gastroenteric symptoms,neurological system impairment and low fever,with a mortality of 93.33% of poisoned patients;higher white blood cell counts and anemia;patchy consolidation shadowing in the lung;gaseous distention and dilation of gastroenteric tract,which occures later than mild patchy consolidation shadowing and earlier than moderate patchy consolidation shadowing do in the lung.

Objective A comparative dose distribution study has been undertaken between proton beam therapy (PBT),3-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) in the treatment of hepatocellular carcinoma (HCC),so as to assess the potential advantages of PBT.Methods Dose volume histograms (DVHs) were compared between PBT and 3D-CRT or IMRT planning at total dose of 66 Gy and 86 Gy in stage Ⅰ patients (n=10,diameter≤5 cm),60 Gy and 72 Gy in stage Ⅱ A patients (n=12,diameter=5.1-10 cm).Results For patients with stage Ⅰ,the mean liver dose (Dmean),V10,V20 and V30 were 13.01 Gy,51.89%,36.13% and 21.24% for 3DCRT,whereas they were 6.34 Gy,30.23%,17.86% and 10.66%,respectively,for PBT(P＜0.002).With dose escalation to 86 Gy,the Dmean,V10,V20 and V30 were 16.91 Gy,67.51%,46.84% and 27.61% for 3D-CRT,whereas they were 8.26 Gy,39.31%,23.22% and 13.86%,respectively,for PBT (P＜0.002).Compared with 3D-CRT with dose of 66 Gy,PBT reduced the Dmean,V10,V20 and V30 even with dose escalation to 86 Gy (P＜0.042).For patients with stage Ⅱ A,the Dmean,V10,V20 and V30 were 29.18 Gy,72.25%,58.17%,44.01% and 24.92 Gy,73.32%,56.15%,37.75% for 3DCRT and IMRT,respectively,with dose of 60 Gy,whereas they were 16.28 Gy,43.93%,33.54% and 22.78%,respectively,for PBT(P＜0.002).With dose escalation to 72 Gy,the Dmean,V10,V20,V30 were 35.02 Gy,86.70%,69.80%,52.81% and 29.90 Gy,87.98%,67.74% and 45.30% for 3D-CRT and IMRT,respectively,whereas they were 19.54 Gy,52.72%,40.25% and 27.34%,respectively,for PBT (P＜0.002).Compared with 3D-CRT and IMRT with total dose of 60 Gy,PBT reduced the Dmean,V10,V20 and V30 even with dose escalation to 72 Gy(P＜0.05).In all of the 22 cases,compared with 3D-CRT,PBT reduced the doses to the nonliver OARs(organs at risks) including spinal cord,right kidney and stomach(P＜0.002).Compared with IMRT,PBT also reduced the dose to the right kidney and stomach significantly,while no significant difference was found respect to the dose to spinal cord (P＞0.05).Conclusion Compared with 3D-CRT,PBT reduced the dose to the normal liver tissues and nonliver OARs significantly,even with 20 to 30.3 percent of dose escalation.Compared with IMRT,PBT reduced the dose to the normal liver tissues significantly,even with 20 to 30.3 percent of dose escalation.PBT reduced the dose to the right kidney and stomach significantly.No significant difference was observed respect to the dose to spinal cord.

Objective To assess the indications,efficacy and safety of applying interspinous implants for degenerative lumbar diseases.Methods From September 2007 to September 2008,68 cases with degenerative lumbar diseases were treated with interspinous implants.The clinical outcome was assessed by VAS of pain in back and lower extremities,lumbar JOA score and Prolo functional score;the radiological results including implant position,segmental lodosis and segment movement degree were assessed by lumbar X ray including dynamic post-operative versus pre-operative X ray.Results Sixty-four cases had a complete follow-up and the average time was 11.4 months.At the final follow up,lumbar VAS 1.7±1.5,lower extremity VAS 1.3±1.0,lumbar JOA score 23.5±3.1 and Prelo functional score 8.6±1.4.They were better than those at pre-oporation (1.7±1.5,1.3±1.0,23.5±3.1,8.6±1.4).Segment lodosis angle (15.4±4.2)° was less than (19.6±4.7)° at pre-oporation;segment movement degree was (10.3±4.5)°.Two cases with lumbar disc herniation relapsed and received a second operation.Conclusion The application of interspinons implants for degenerative lumbar diseases is still in its infancy and the selection of indication is very important.Its efficacy and safety have been confirmed by a short follow-up.

Objective To study the characteristic of chronic motor axonal neuropathy and the prognosis of it.Methods 16 chronic motor axonal neuropathy (CMAN) patients were diagnosed by clinical manifestation and neurophysiologic manifestation.Follow-up study was clone including living state,medicine they taken,change of physical sign and motor unit number estimation.60 patients with amyotrophic lateral sclerosis were studies at the same time.The prognosis of these patients was compared.Results After being treated with intravenous immunoglobulin therapy,the patients with CMAN showed a good chnical recovery except 6 patients who had the characteristic of ALS in the 18 months follow-up study,and the MUNE changed from 68±17 to 154±25.On the contrary,the patients with ALS had worse clinical manifestation,and the MUNE changed from 64±6 to 55±9.Conclusions Immunological factor may be involved in the mechanism of chronic motor axonal neuropathy which has a better prognosis and is difficult to differentiate from amyotrophic lateral sclerosis in the earlier stage.

Objective To compare surgical and non-surgical therapy of the upper extremity after acute arterial occlusion.To analyze the relation between prognosis and relevant factors of different therapeutic methods.Methods Sixty patients with acute upper extremity arterial embolism treated between January 1990 and October 2007 were retrospectively studied in The First Hospital of China Medical University.Results There were 60 patients,32 men and 28 women,with a mean age of 63 years (21-86 years).Among them,31 underwent thrombembolectomies with the Fogarty catheter and 29 received anti-coagulation and thrombolytic therapy.Therapeutic effects were evaluated by Cooley's standard.Therapeutic efficacy was better in the surgical group than in the non-surgical group (P＜0.05).There was no relationship between post-operative ischemic recovery and pre-operative ischemia severity and the site of embolism in the surgical group,while there were significant relationships in the nonsurgical group.The result of Cox propprtional hazard regression model showed that the age and Cooley's standard of the patient was correlated with survival time.Conclusions A more active surgical approach is better for the treatment of acute arterial occlusion of the upper extremity.

：Objective To evaluatethe effect of prostatic iachemia in rabbit and approach the significance of ischemia inthe development of benign prostatic hyperplasia.Methods Male rabbits underwent surgicalprostatic ischemia for durations of 1,2,4,8 and 12 weeks and sham-operated rabbits servedas controls.The weight of prostate was examined and a histological examinationconducted.Ki67 immunohistochemical stain for the generation of prostatic cells and TUNELtest for the apoptosis of prostatic cells were used.Results In sham-operated rabbits,themean (SD) weight of prostate were 0.831 (0.127)g,the mean (SD) positive Ki67 stainingprostatic epithelial cells 2.1 (0.8) in 100 prostatic epithelial cells and stromal cells2.6 (1.1) in 100,mean (SD) positive TUNEL teat prostatic epithelial cells 2.0 (1.0) in 100and stromal cells 2.5(0.7) in 100.In operated rabbits,the generation of prostatic stromalcells increased and the apoptosia of prostatic stromal cells decreased over 1-12 weeks.Thegeneration of prostatic epithelial cells increased and the apoptosis of prostaticepithelial ceils decreased over 2-12 weeks,but in the first week,there were nosignificantly difference between operated and sham-operated rabbits in the generation andapoptosis of prostatic epithelial cells.The weight of prostate in operated animalsincreased at Weeks 4,8 and 12,were significantly heavier than sham-operated rabbits,1 weekpost-op and 2 weeks post-op rabbits,there were no significantly difference between thelatter 3 groups.Conclusion Ischemia can induce the gain of prostatic weight by improvingthe generation and inhibiting the apoptosis of prostatic cells.And the effect of ischemiato prostate is correlated with ischemic time.Ischemia may play an important role in thedevelopment of benign prostatic hyperplasia.The first response to ischemia is the changeof prostatic stromal cells.

Objective This study was designed to observe the regulatory volume decrease (RVD) process in human lung adenocarcinoma cells (A549) and to investigate its ion channel mechanism.Methods Electric measurement system of cell volume was used to detect the cell volume changes following exposure to hypotenic solution.Whole-cell patch clamp recordings were applied to investigate the characteristics of the volume-sensitive Cl~- channel in A549 cells.Results Extracelluar hypotenicity induced cell swelling followed by a typical RVD process,which can be inhibited by Cl~- channel blocker (NPPB 100 μmoL/L) and K~+ channel blocker (CsCl 5 mmol/L).Meanwhile,a outward-rectifying chloride currents which was sensitive to NPPB and DIDs was recorded in A.549 using the whole cell patch clamp.Conclusions The human lung adenacarcinoma cells has RVD process which is dependent on the parallel activation of Cl~- channel and K~+ channel.The volume-sensitive Cl~- channel is involved in volume regulation of lung adenocarcinoma cells.

Objective To investigate the changes of cytoskeleton and induced apeptosis in human umbilical venous endothelial cells (HUVEC) and WISH cells during the invasion of staphylococcus anreus.Methods S.aureus suspension was collected routinely and used to infect HUVEC and WISH cells for 10,30,60 and 120 min respectively.The cell-invading ability of S.aureus was observed by microscope and the rearrangement of cytoskeleton of these cells observed under fluorescent microscope.DAPI fluorescent staining and DNA agarose electrophoresis were performed to analyze the apeptosis in HUVEC cells induced by S.aureus.Results There was bacterial invasion after staphylococcus aureus was co-incubated with HUVEC and WISH cells for 10 min.The rates of infection were (54.9±2.4)% and (56.1±2.4)% at 60 min respectively.The ratios of F-actin rearrangements at 10 min,30 min,60 min and 120 min after the invasion of HUVEC and WISH cells with S.aureus were different at (54.7±2.8)%,(63.0±2.9)%,(71.0±2.6)%,(39.5±2.7)% and (63.3±2.6)%,(65.0±2.9)%,(77.0±2.4)% and (44.0±1.8)% respectively.The ratios of F-actin rearrangements at 10 min,30 min and 60 min were higher than those at 120 min (P＜0.05).There was no change of microtubule observed in both cells at the same time.The apoptotic appearance was observed after the invasion of HUVEC cells with s.aureus at 60 min.Conclusion S.aureus may invade the HUVEC and WISH cells through F-actin rearrangement.Apeptosis is induced in HUVEC cells at 60 min.

reversible posterior encephalopathy (RPE) was first proposed by Hinchey et al. [1] in 1996. It means a clinical-radiological syndrome caused by multiple causes, with acute or subacute onset, prominent manifestations such as epileptic seizures, headache, nausea and vomiting, mental abnormalities, visual loss or cortical blindness, involving the posterior white matter of bilateral cerebral hemispheres on imaging, and the pathological changes are angiogenic edema.

Tissue hypoxia and hypoperfusion often occur in critically ill patients. If they cannot be detected and corrected effectively in time, organ dysfunction or multiple organ dysfunction syndrome (MODS) will occur, which can lead to death in severe cases. At present, the clinical measures of systemic tissue oxygenation include blood lactate, pH, oxygen delivery and oxygen uptake, mixed venous oxygen saturation or central venous oxygen saturation, etc. These measurements are insensitive to local tissue hypoxia.

On July 24, 2009, more than 100 experts and scholars from all over the country in rheumatology immunology and related disciplines participated in the 4th Yisaipu Summit Forum sponsored by Shanghai CITIC Guojian Pharmaceutical Co., Ltd. The main contents of the meeting are summarized as follows.

Fungal infection is one of the main factors affecting survival after liver transplantation, among which the urinary fungal infection accounts for about 14.30% ~20.83% ~ ([1-2]). Aspergillus infection after liver transplantation is the second most common fungal pathogen after Candida infection, and the imaging manifestations of renal aspergillus abscess are rarely reported in literature.