Volume 90  ·   Issue 01  ·  2010

<National Medical Journal of China is a Journal of the Chinese Medical Association under the supervision of China Association for Science and Technology and sponsored by the Chinese Medical Association. It was founded in 1915 when the Chinese Medical Association was founded. It is the oldest and most influential comprehensive academic Journal of Chinese medicine in China.

peritumoral brain edema (PTBE) is a common clinical problem in neurosurgery, which directly affects the diagnosis, treatment and prognosis of PFBE. The purpose of this paper is to deepen the understanding of neurosurgeons about PFBE in nervous system, clarify the basic principles of diagnosis and treatment of PTBE, and provide practical and standardized drug treatment suggestions.

Objective To investigate the long-term characteristics of both clinical manifestation and esophageal motor disturbance in achalasia patients after Heller's myotmy. Methods After 3 to 10 years' follow-up, clinical manifestation, esophageal motor function and 24-hour continuous esophageal pH monitoring in 72 post-operative cases of achalasia were recorded. Results The mean LES pressure decreased from 44 ± 12 mm Hg to 10 ±5 mm Hg , and the rate of L ES relaxation rised from 49% ±20% to 84% ±15% (paired t test, P<0.05). Of 24 cases with choking feeling, 11 had the high LES pressure and dysfunction in two directions and 7 in three. During swallowing, incomplete lower esophageal sphincter relaxation and aperistalsis were detected in all patients. Conclusions The long-term characteristics of esophageal function following successfully surgical treatment to patients with Achalasia are:

Objective To compare the variations of hemodynamics or respiratory parameters and postoperative complications incidence in gynecological laparoscopy to perform Laryngeal Mask Airway (LMA) , Streamlined Liner of the Pharynx Airway (SLIPA~(TM) ) or Tracheal Tube(TT) and to appraise the safety or superiority SLIPA~(TM) in gynecological laparoscopy. Methods 90 patients as ASA I -Ⅱ grade for gynecological laparoscopy to divide randomly into three groups ( n = 30 ) :SLIPA~(TM) group ( S ) , LMA group ( L), IT group(T). Patients were intubated with SLIPA~(TM), LMA or TT respectively after general anesthesia induction. Record and count baseline or variable values on heart rate, mean arterial pressure, peak inspiratory pressure, flat inspiratory pressure, airway compliance, airway resistance as pre- and post-intubation. To observe intra- and post-complications on backflow or aspiration, airway shifting, oral mucosa damage, cough or expectoration, pharyngodynia, trachyphonia and to appraise patient' s comfort as extubation. Results S or L group is more stable than T on hemodynamic (P < 0.05) during intubation, S group is more stable than L or T group on respiratory parameters (P <0. 05). Intraoperative incidences are significantly lower in S group than I, group on backflow or aspiration, airway shifting or oral mucosa damage ( P <0. 05 ) , postoperative incidences are significantly lower in S group than L or T group on pharyngodynia, trachyphonia or cough or expectoration ( P < 0. 05). In addition, extubation comfort degree is better to patient as resuscitation(P<0. 05). Conclusions SLIPA~(TM) are safely or conveniently applicable in gynecological laparoscopy. It impacts little on variations of hemodynamics or respiratory parameters after general anesthesia and reduces intra- or post-operative complications significantly compared to L or T group, increases patient's comfort as extubation. SLIPA~(TM) is superior to other two on clinical applications.

Objective To investigate the correlation between length of hypertension history with plasma level of A Phospholipids Component with the Similar Solubility of Lyso-Phosphatidic Acid ( APCSSLPA or briefly AP). So that to farther understand the changes accompanied with prolongation of hypertension history. Methods This is a small cross-sectional study. 170 patients with primary hypertension and 79 normal controls without hypertension history were enrolled. The lengths of case history were recorded and compared with their plasma levels of AP. Similar study were also conducted on other 11 clinical makers as references. Results AP correlated significantly with the length of hypertension history. Correlation coefficient β is 0. 186, P =0.015. But AP did not correlated significantly with systolic or diastolic pressure of patients. The age of patients did not correlated with AP either (β=0. 027, P =0. 71). The patient's number with middle or high level of AP was significantly larger in the group in which hypertension history was 10 years or more, than in the group in which hypertension history was less then 10 years. X~2 =6. 51 ,P =0.012. OR =2.444, 95% CI = 1. 219 -4.903. However, lysophosphatidic acid and other 10 bio-makers which often be used in cerebrovascular and cardiovascular diseases, such as blood lipid, blood sugar, different kinds of lipoprotein and D-dimer etc. did not correlated significantly with hypertension history. Conclusion Comparing with 11 clinical makers, AP was the only one correlated with the length of hypertension history. Our findings suggest: the prolongation of hypertension history may accompanied with increased oxidative damages. The patients with prolonged hypertension history should prevent this possible threaten. Furthermore, AP is a very promising marker with unique worth in cardiovascular and cerebrovascular diseases.

Objective To investigate the enhancement pattern of thyroid carcinoma with contrast-enhanced ultrasound (CEUS) for the diagnostic value. Methods Thirty-one cases with thirty-five thyroid Occupied were retrospectively reviewed. The final diagnosis was confirmed by biopsy pathology. Contrast agent SonoVue and contrast pulse sequencing (CPS) technique were used in this study. Results Thirty-five thyroid carcinoma presented three enhancement patterns with CEUS. Type I : twenty-three lesions enhanced in a pattern of ring with centripetal fill-in,however, the central part of no contrast agent filling . Type Ⅱ : five lesions enhanced regularly and homogeneously . Type Ⅲ: seven lesions enhanced irregularly and homogeneously. Thyroid benign and malignant lesions perfusion time curve, compared to papillary thyroid carcinoma with nodular goiter in the AT, TTP and WT indicators P <0. 05 ; papillary thyroid carcinoma and thyroid adenoma, compared to WT alone an indicator of P < 0.05. Conclusions Identification of the different enhancement patterns of thyroid carcinoma could improve the diagnostic ability of CEUS.

Objective To conclude the experience of diagnosis and therapy , the effect analysis and the prognosis factors of acute upper limbs deep venous thrombosis ( ULDVT). Methods We retrospectively analyzed the etiological factor, clinical manifestation, diagnosis, therapy and prognosis of 28 patients treated for acute ULDVT admitted in our hospital between 1988 and 2009. The patients were divided into two groups according to the time of admission and management in hospital. Group I , from 1988 to 1998, and group Ⅱ , from 1999 to 2009. Results There were 28 patients diagnosed as acute ULDVT, which was 8. 1% of lower limbs deep venous thrombosis in synchronization. There were 14 men and 14 women, and the mean age was 46. 1 years. 17 patients developed in left upper limbs, and 11 patients developed in right upper limbs. There were 9 patients in group I and 19 in group Ⅱ. A significant difference was observed between two groups in their risk factors,primary and secondary cause. 8 patients (28.6%) were relevant to venepuncture catheterization, and 13 patients (46. 4% ) have tumors. There is clear difference between the two groups in the way of primary disease and risk Factors , which means that the probability of ULDVT caused by malignant tumors or other factors in group Ⅱ is apparently higher than group I , and the prognosis of group Ⅱ is worse compared with group I . All the patients in the group were made a definite diagnosis by ultrasound, after that our policy were thrombolysis and anticoagulation followed by Warfarin oral administration for 6 months. All the conditions of the patients were well improved, and the symptoms were relieved obviously and discharged . The mean follow-up duration was 2.2 years. 2 recurred , 1 was pulmonary infarction , and 6 was died. Conclusion The incidence of ULDVT is much lower than LLDVT. The motivations are blood hypercoagulabale state , such as tumor , vein catheterization etc. The final diagnosis is mostly based on clinical manifestation combined with ultrasound. Thrombolysis , anticoagulation in time have an obvious therapy effect. After that the anticoagulation therapy through oral administration can prevent recurrence.

Objective To investigate factors associated with mortality in non-AIDS patients with cryptococcal meningitis. Methods We retrospectively reviewed 154 cases of non-HIV cryptococcal meningitis in a tertiary care hospital in China, from 1997 through 2007. Results The 1-year attributable mortality was 19.6% (28/143), and overall mortality was 28.7% (41/143). Advanced age (≥60 years) , delay in diagnosis ( >4 months) , hematologic malignancy, solid malignancy, altered mental status (coma, seizure, herniation) , and CSF drainage or shunting were factors associated with increased death; factors associated with increased survival were amphotericin B based initial therapy and flucytosine containing therapy. In multivariate analysis, age ≥60 years, the time from symptom onset to diagnosis > 4 months, coma, cerebral herniation, and non-amphotericin B based initial therapy were independently associated with increased overall mortality; factors independently associated with cause-specific mortality were time from symptom onset to diagnosis > 4 months, cerebral herniation and non-amphotericin B based initial therapy. Conclusion A variety of factors were associated with mortality in non-AIDS cryptococcal meningitis. Amphotericin B based initial treatment was independently correlated to improved 1-year survival.

Objective To investigation the effect of ropivacaine on the contraction of the isolated human umbilical artery and the mechanisms involved. Methods Endothelium-denuded human umbilical artery rings obtained from healthy full-term paturients were prepared. Using isometric force transducers and a fluorometer, the effect of ropivacaine in cumulative concentration on the contraction response induced by KCl in the presence or absence of verapamil, or verapamil plus ruthenium red or verapamil plus heparin was observed. Furthermore, the effect of ropivacaine on the contraction response of the artery rings incubated in different concentrations of extracellular Ca~(2+) was also observed. Results Ropivacaine induced a dose-dependent biphasic contractile response of human umbilical artery rings; increasing at concentrations of 1.0 × 10~(-5) to 1.0 ×10~(-4) mol/Land decreasing from 3. 0 × 10~(-4) to 3.0×10~(-3) mol/L, which was inhibited by verapamil, or verapamil plus ruthenium red, or verapamil plus heparin. No difference was found between pre-treatment of verapamil, verapamil plus ruthenium red and verapamil plus heparin. Ropivacaine induced no contractile response in Ca~(2+) -free solution and a extracellular Ca~(2+) dose-dependent increasing contractile response(1.0 × 10~( -4) to 3.0 × 10 ~(-2)mol/L ). Conclusion Ropivacaine induced a dose-dependent biphasic contractile response of human umbilical artery rings. The increase in intracellular Ca~(2+) concentrations by the extracellular Ca~(2+) influx, not by the release from the sarcoplasmic reticulum, is involved in ropivacaine-induced vasoconstriction of human umbilical artery smooth muscle.

Objective To review the clinical data of a group of patients with multi-level lumbar spine fractures treated with TSRH-3D pedicle screw system and to investigate the effect and post-operative efficacy of this technique. Methods Eighteen patients diagnosed as multi-level lumbar spine fracture were treated with TSRH-3D pedicle screw system. The operations were performed at 4 hours to 2 days after injury and the follow-up period was 15-32 months (mean; 23 months). The X-ray and CT scan were taken both preoperatively and postoperatively. Results ( 1 ) Twelve patients became injured from height falling (67%), 5 from traffic accident (28%) and 1 from crush (5%). (2) The improvement rate of spine motion, back pain and lower extremity pain was 67% , 94% and 78% respectively. (3) Compared with preoperative status, the height of anterior border of vertebra improved by 59. 2% , lost by an average of 5.2% (P<0.01) and the Cobb angle was corrected by 19.5°, lost an average of 5.4°. Conclusion It is feasible to treat the multi-level lumbar spine fractures with TSRH-3D pedicle screw system. And the outcome of reduction and fixation is satisfactory. This technique is excellent at improving the height of injury vertebra, physiological curvature and neural function. It also can relieve lumbocrural pain with a definite postoperative efficacy.

Objective To collect the radiological data of the presacral space for axial lumbosacral interbody fusion (AxiaLIF) and to provide theoretic rationales for research work and clinical application of AxiaLIF in China. Methods The distance between inner margin of bilateral anterior sacral foramina at the level of S1 was measured radiographically. The distance between iliac vessels and the midline at the level of S1 was measured on enhanced computed tomography (enhanced-CT) . The minimum distances between mesorectum and each sacral level or the center of each sacral vertebra were measured on the median sagittal plane of magnetic resonance imaging in order to measure the lengths of relevant instrumentation and fusion device. Results The distance between inner margin of bilateral anterior sacral foramina at the level of S1 was found to be 34. 7 ± 3. 5 and 32. 2 ± 3. 0 mm in Chinese males and females respectively ( P <0. 05 ). There was no statistical significance between the design lengths of sleeve and fusion device. The nearest vessel from sacral intervertebral space at the level of S1 was found to be the bilateral internal iliac vein on enhanced-CT with a distance of 57. 6 ± 5. 2 and 70.0 ± 9. 1 mm in males and females respectively (P < 0. 05 ). The distance from mesorectum to the center of vertebral body of S2-S5 was found to be statistically significant between males and females ( P < 0.05 ). Conclusion It is feasible to design suitable instrumentation and fusion device for the Chinese. And a safe operating zone has been designated.

Objective To investigate retrospectively the adult metatarsal fractures within last five years and analyze their epidemiological characteristics. Methods The X-ray films taken from January 1, 2003 to December 31 , 2007 at department of radiology of Hebei provincial orthopedic hospital were reviewed to screen and classify according to OTA fracture comprehensive classification method. The epidemiological characteristics of adult metatarsal fractures were summarized and analyzed. Results A total of 1949 adult metatarsal fractures were included. The single and multiple types were 1465 and 484 respectively. The 31-50-yr age group was the largest one with 45. 26% of the patients. The fifth metatarsal fracture was the most common metatarsal fracture accounting for 42. 45% of the total; 58. 37% of metatarsal fractures occurred in proximal metaphysis; 87. 61% of multiple metatarsal fractures occurred in adjacent metatarsals; 81-A1 group fracture was the most common metatarsal fracture accounting for 35.42% of the total. Conclusion Epidemiological studies of metatarsal fracture offer aids in the diagnosis and treatment of metatarsal fractures.

Objective To study the expression of NASP in platinum resistance ovarian cancer cell clones (C0C1/DDP). Methods The proteins of C0C1 and C0C1/DDP were separated by highly sensitive two-dimensional differential gel electrophoresis (2-D DIGE) coupled with matrix-assisted laser desorption/ ionization-time of flight ( MALDI-TOF-MS) to identify the proteins differentially expressed in cisplatin sensitive and cisplatin resistance cell lines. Results The inestigators found a group of the distinct expressed proteins between C0C1 and C0C1/DDP. Among them, NASP was one of the down-regulated proteins by 21% (Student's t-test; P = 0. 01). Conclusion The identification of NASP in C0C1/DDP has laid a foundation for future in-depth researches into the mechanisms of ovarian cancer platinum resistance.

Objective To evaluate the dual-labeling efficiency of magnetic and luminescent quantum dots bifunctional nanoparticles to rat bone mesenchymal stem cells ( BMSC). Methods Rat BMSC were isolated, purified, and expanded. Magnetic/luminescent bifunctional nanoparticles (Fe_3O_4@ CdTe@SiO_2) , were prepared by using silicon dioxide(SiO_2) to encapsulate simultaneously Fe_3O_4 and CdTe quantum dots. BMSC were incubated with the Fe_3O_4@ CdTe@ SiO_2 nanoparticles which iron concentration was 25 μg/mL Fluorescence microscope was used to detect the fluorescence of the intracellular nanoparticles. The dual-labeled BMSC with various concentration underwent ex vivo MR imaging with T_1, WI, T_2WI and T_2~* WI sequences. To show the intracellular iron of labeled cells, prussian blue stain was performed. Spectrophotometer was used to detect the iron concentration in the cells. Results Intracellular red fluorescence of Fe_3O_4@ CdTe@ SiO_2 can be observed via fluorescent microscopy. Rat BMSC could be effectively dual-labeled with approximately 90% efficiency. The MR images with T_2WI and T_2~* WI sequences, especially with T_2~* WI sequence, showed that the signals of the dual-labeled BMSC were lower than those of the unlabeled cells. Cellular total iron is 14.05 ± 4. 15 pg per cell. Iron containing intracytoplasmic vesicles could be observed with Prussian blue staining. Conclusion Rat BMSC can be dual-labeled successfully with Fe_3O_4@ CdTe @ SiO_2 magnetic/luminescent bifunctional nanoparticles successfully, and might serve as a tool for magnetic resonance imaging and in vivo optical imaging.

A 67-year-old female was admitted to hospital on January 22, 2008 due to fever, shortness of breath and myalgia for 4 months, cough and sputum for half a month. The patient developed low fever, shortness of breath and systemic myalgia without obvious trigger 4 months ago. Self-administered antibiotics were ineffective.

The chemical name of letrozole is 4,4'- (1H-1,2,4-triazole-1-methylene) dibenzonitrile. It is a third generation non-steroidal aromatase inhibitor first developed by Noartis. It was first marketed in Britain in 1996 and in the United States in 1997, and has been approved by FDA. At present, it has been used in more than 30 countries and regions for the first-line treatment of advanced breast cancer and widely used as the second-line drug for breast cancer. Since the first application of letrozole in PCOS cases with clomiphene failure in ovulation induction in 2000 and achieved success ~ ([1]), many studies at home and abroad have affirmed the effect of letrozole on ovulation induction. This article intends to review the pharmacokinetics of letrozole and its application in ovulation induction treatment of PCOS patients.

In this study, RT-PCR, PCR and sequencing were used to detect gene mutation in a Chinese Han adult with sporadic progeria syndrome (WS). 1. Subjects and methods 1. Subjects: A 30-year-old female patient was diagnosed with WS by the Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University. The visual acuity of both eyes was decreased, the face was aged, the skin of the limbs was rough, the subcutaneous tissue and muscle atrophy, and the skin was sclerodermal. Cataract was found in both eyes by follow-up examination, and space-occupying lesions of left cavernous sinus, dorsum saddle and slope were found by head MRI. The postoperative pathological diagnosis was endothelial meningioma. The patient was diagnosed as WS according to the clinical manifestations.

The World Stroke Organization (WSO) was jointly formed by the former International Stroke Society (ISS) and the former World Stroke Federation (WSF) in October 2006. The WSO successfully held its first general meeting in September 2008 during the World Stroke Conference in Vienna ~ ([1-12]).