Volume 90  ·   Issue 19  ·  2010

The discovery of X-ray by Roentgen in 1895 marked the birth of medical imaging technology based on anatomical structure and morphology. The development of medical imaging has made an indelible contribution to the diagnosis and treatment of diseases for more than 100 years.

Objective To investigate the clinical efficacy of clot aspiration in the treatment of intracerebral hemorrhage (ICH) by reviewing literatures. Methods All studies assigned into two groups of hard or soft tunnel aspiration of clots ( HTAC or STAC) on the basis of surgical approaches were obtained by searching four major Chinese medical databases.And the surgical outcomes were descriptively analyzed. Results A total of 1205 reports (72 855 patients) met the eligibility criteria.The trials (34. 0% ) with 80%-89% of clot removal ratio were the most in all HTAC papers and those (37.7%) with 50%-69% of clot removal ratio were the most in all STAC papers. The mortality and re-bleediag rate in HTAC and STAC group were 14. 0% vs 14. 5% and 7. 2% vs 7. 6% respectively ( P＞ 0. 05 ). As compared with the conventional medical group, the mortalities in HTAC and STAC groups were 13. 4% vs 36. 0% and 14. 3% vs 36. 1% (P ＜0. 001 ) and the re-bleeding rates 9. 3% vs 10. 6% and 12. 2% vs 16. 1% (P ＞0. 05) respectively. As compared with the eraniotomy group, the mortalities in HTAC and STAC groups were 14.4% vs24. 1% and 16.7% vs 24.8% (P＜0.01 ) and the re-bleeding rates 9. 1% vs 13.9% (P＞0.05) and 7. 1% vs 14.7% (P＜0.01) respectively. Conclusion Aspiration of clots can effectively remove hematoma and reduce the mortality. But it does not increase the risk of re-bleeding. The outcome of HTAC is similar to that of STAC. HTAC has the advantage of clot removal over STAC.

Objective To assess the feasibility and benefit of lung auto-transplantation technique in surgical treatment for stage Ⅲ central lung cancer. Methods From Aug 2000 to June 2007 eight patients,who were proved to be malignant pathologically through fiber-bronchoscope before operations and could not tolerate pneumonectomy, underwent lung auto-transplantations. The "cutdown" lower lobe was flushed with heparin solution at 20℃. Since the length of resected bronchus or pulmonary artery involved by tumor was too long to perform tension-free anastomosis, we transplanted the inferior pulmonary vein to the proximal stump of the superior pulmonary vein. The bronchus and pulmonary artery were anastumosed in turn. Then radical hilar and mediastinal lymphadenectomy was performed. Results No anastomotie stoma fistula occurred inthese 8patients.Until Jan 2008,sixof theeightpatients who underwentlung autotransplantations, had been free of tumor recurrence for 7-90 months with good quality of life. And the median time was 33months. Radioisotope scanning of the replanted lobes of three patients revealed normal perfusion 18, 24 and 72 months postoperatively. One patient received resection of the replanted lobe because of pulmonary vein thrombus on the 2nd day after transplantation, and died of respiratory failure caused by pulmonary relapse on 15th month postoperatively.Another patient died of brain metastases 31 months postoperatively. Conclusion Lung auto-transplantationisanalternativetechnique for pulmonary preservation for patient with stage Ⅲ centrally placed lung cancer, whose cardio-pulmonary functions is too poor to undergo pneumonectomy.

Objective To explore the therapeutic efficacy of thymic diseases by bilateral videoassisted thoracoscopes. Methods A total of 46 cases with thymic diseases, including benign or malignant thymoma and myasthenia cravis (MG), were operated by bilateral video-assisted thoracoscopes. It was compared with 33 cases undergoing traditional thymic operations. Results The resection rate was 100%.There was no perioperative mortality. All cases were followed up for 3 years. The 1,3-year survival rates were 95.7% (44/46) and 91.3% (42/46) versus 93.9% (31/33) and 90.9% (30/33) for a traditional thymic operation respectively. And the difference was insignificant ( P ＞ 0. 05 ). The effective remission rate of MG was 91.7% (11/12) versus 92.9% (13/14) for a traditional thymic operation. And the difference was insignificant (x2 =0. 17, P ＞0. 05). Conclusion The treatment of thymic diseases by bilateral videoassisted thoracnscopes can achieve a comparable clinical efficacy of employing a traditional thymic operation.But it is superior in terms of surgical trauma and postoperative recovery.

ObjectiveTo investigate the clinical significance of the Octopus 101 kinetic and Static combined automatic perimetry in Anterior Ischemic Optic Neuropathy (AION). To assess the merit and demerit of Octopus 101 kinetic and static combined automatic perimetry performed in AION cases. Methods 45 AION patients were detected with Octopus 101 with kinetic and static 30° ,60°scope static program from June 2006 to September 2008. The mean defect(MD) ,loss variance(LV), areas of isopter, and reaction time were analyzed. The correlation between MD,areas of isopter and reaction time were analyzed. Results In AION, there are kinds of visual field defect related to the optic lesions in static perimetry examing.Kinetic programme display the isopter deletion.Isopter areas usingⅠ-2e and Ⅲ- 4e stimulus are significantly different ( P ＜ 0. 05 ). Smaller stimulus can find more periphery changes in AION. Conclusions The Octopus 101 perimeter can provide static and kinetic program in the same sitting. In clinical practice it is necessary to perform both static and kinetic examination in patients with AION because the visual field defects are diverse, and the data provided by static and kinetic program are complementary.

Objective To investigate the causes for changes in optic nerve head and visual impairment caused by fibrous dysplasia (FD) of optic canal stenosis. Methods A total of 12 FD patients,diagnosed by CT, received the fundus and optical coherence tomography (OCT). Those with FD involving optic canal underwent decompression. The examination of OCT showed that lamina cribrosa located at the top was the exposure factor for retinal pigment epithelium (RPE). There were decreased vision or edematous optic nerve and atrophic lesion. Odds ratio was calculated by Fisher's exact test. Results The examination of CT showed the results of optic canal stenosis caused by lesions involving 18 sides : 8-sides with normal vision.Among which, 6 showing that lamina cribrosa was located below RPE and a lamina cribrosa plate near RPE at follow-up, 1 side OCT showing lamina cribrosa above RPE with normal optic nerve; a lateral lamina cribrosa was located above RPE with edematous optic nerve. Visual impairment at 10 sides, normal papillary 2 sides, atrophic papillary 8 sides, OCT showed that lamina cribrosa was located above RPE,postoperatively OCT showed that lamina cribrosa below with 7 sides having improved visual acuity. Fisher's exact test was performed ( P = 0. 000, odds ratio = ∞ ). Conclusion The optic canal stenosis causes a rising pressure of lamina cribrosa zone to shift above RPE. The channel becomes distorted so as to squeeze and cut the ganglion cell axons of optic nerve, block the axoplasmic transport and result in blood circulation disorder. The above factors are the etiologies of visual impairments. Postoperatively lamina eribrosa zone pressure drops so that depressed lamina cribrosa and channel deformation recover and visual acuity improves.

Objective To evaluate the gain on the life quality of NPC from efforts to reduce the radiotherapy-induced xerostomia after IMRT. Methods From August 2002 to December 2008, 235 patients with nasopharyngeal carcinoma were treated with IMRT in the First Affiliated Hospital of Wenzhou Medical College. Ninety-one patients with minimum 2 years of survival and no replaces and metastasis were enlisted.XQ and QOL questionnaires were completed at baseline, then 0, 3, 6, 9, 12, 18 and 24 months after IMRT. Results The XQ scores were substantially higher at the end of IMRT compared with baseline and descended over time. At 9 months post-RT, the XQ scores improved significantly( P = 0. 024)and recovered nearly to baseline at 18 months post-RT. Likewise, the QOL scores were siguifieanfly higher at the end of IMRT compared with baseline( P = 0. 012) and had a sequential trend towards improvement over the study period. At 18 months post-RT, the QOL scores almost recover to baseline (P = 0. 020 ).Multiple comparisons testing revealed that communication, eating and pain sub-scale scores were significantly higher at the end of IMRT compared with baseline( P ＜0. 05 )with the exception of emotion domain. There was a significant correlation between XQ scores and QOL scores in general in all the study time( r =0. 976, P ＜0. 001 ) ,also a significant position correlation was found between XQ scores and communication, eating subscale scores and overall bother scores. Conclusions IMRT technique can reduce the incidence of postradiation xerostomia significantly and can improve the quality of life in many domains.

Objective To compare the the similarities and differences during the surrounding operation of endovascular repair (EVAR)and open surgical repair (OSR) for abdominal aortic aneurysm. Methods112 patients with abdominal aortic anenrysms ( AAA ) were selected from 2004 to 2009 : among them, 66 patients were treated with EVAR, 46 patients with OSR. Data of two groups were collected and analyzed during surrounding operation. Results Compared to OSR group , the mean blood lost,bloed transfusion and intra-operative fluid in EVAR group were significantly less than OSR group( P ＜0. 05 ). The mean time of operation , observation period in ICU and being in hospital in EVAR group were shorter than OSR group(P ＜0. 05). But the cost of hospitalization in EVAR was far higher than that of OSR group ( P ＜0. 05). In short term postoperative complications the OSR group was higher than the EVAR ( P ＜0. 05), however, there was no statistically significant difference in death rate of the two groups during surrounding operation(P ＞ 0. 05). Conclusion EVAR has the advantages of mild trauma, less blood loss,quicker recovery after operation, and less disturbance to internal environment. Especially, it is suitable for the patients who can not undergo open surgery repair,but its cost is still higher.

Objective To determine the clinicopathologieal characteristics of borderline ovarian tumors and to evaluate their prognostic factors and pregnancy rotes/fertility outcomes after conservative surgery. Methods A total of 186 patients with borderline ovarian tumors receiving treatment at our hospital from 1990 to 2007 were retrospectively studied and followed-up pest-operatively for at least six months. The effects of clinicopathological characteristics upon recurrence and mortality were analyzed by independent sample t test, Chi-square test, Kaplan-Meier and Cox proportional hazard model. Results The median follow-up time was 44 months.One hundred and nine patients underwent conservative surgery and 77 patients underwent radical surgery.Thirty-one relapses were reported.Only 3 died of disease.As demonstrated by multivariate analysis, surgical procedure, stage and pseudomyxoma peritonei were the independent prognostic factors for recurrence. Conclusion The recurrence rate of conservative surgery is higher than that of radical surgery. However, conservative surgery is safe as it does not result in a higher mortality rate.

Objective To assess Mimics as a new measurement method in Cobb angle in a comparison with traditional measurement and try to explore the advantages and disadvantages of the new method. Methods Twenty X-ray plates of scoliosis were chosen randomly. Two experienced physicians measured the Cobb angles via Mimics and traditional methods twice with an interval of 1 week.And statistical analyses of Cobb angle and difference between two measurements were carried out. Results The overall correlation was 0. 986 for Mimics and traditional measurements. ANOVA demonstrated no significant difference between these two methods. A significant difference existed between the first and second values of Cobb angle in Mimics and traditional measurements. However the absolute difference was small. Conclusion Mimics can be a new method for measuring the digital radiographs. And its precision is superior to that of the traditional measurement.

Objective To investigate the protective effects of uric acid on nigrostriatal system injury induced by 6-hydroxydopamine in rats. Methods Thirty male SD rats were divided into four groups. Uric acid of 100 mg/kg, 200 mg/kg, 250 mg/kg were injected intrapefitoneally (ip) into 5, 10, 5 rats twice daily at a 2-hour interval for five days and saline was injected ip into 10 rats as controls. At Day 6, 6hydroxydopamine was injected into striatum to establish Parkinsen's disease (PD) model in rats. Then uric acid was injected ip into three groups and saline into controls for five days. Locomotion test, amphetamineinduced rotation and forepaw adjusting step test were performed at Weeks 3 and 4 respectively after injection of 6-hydroxydopamine. HPLC-MS/MS was performed to detect the contents of dopamine and its metabolite homovanillic acid (HVA) in striatum at Week 5. Results The scores of locomotion in 2 minutes of 200 mg/kg uric acid group ( 14 ±4/2 min) was higher significantly than saline group (4±5/2 min,P ＜0. 01 ).The amphetamine-induced rotation number in the 200 mg/kg uric acid group (10. 8 ± 7.5 ) was lower significanfly that in the saline group ( 19. 3 ± 5.2, P ＜ 0. 01 ). Forepaw adjusting step test scores of 200 mg/kg uric acid group were higher significantly than those in the saline group (9. 89 ±3.41 vs 4. 36±3.72,P＜0.01). HPLC-MS/MS showed that the contents of DA (0.29 +0. 19) and HVA (1.22 ±0.5) in injured striatum of 200 mg/kg uric acid group were higher significantly than those in the saline group (0.05 ±0.03,P＜0.01;0.24±0.13,P＜0.05). Conclusion An appropriately elevated level of uric acid may protect the dopamine neuron of nigrostriatal system from injury of 6-hydroxydopamine in rats.

Objective To explore the effect of enhanced green fluorescence protein(EGFP) labeling mediated by lentivirus on the biophysical properties of mesenchymal stem cells(MSC),and whether the EGFP gene expression is permanent and stable.Methods MSC were infected with EGFP lentivirus at different virus multiplicity of infection(MOI).EGFP positive rate was measured with fluorescent-activated cell scanning(FACS)analysis,and EGFP expression in MSC was investigated under a fluorescence microscope.Cell viability,proliferation,apoptosis and cell cycle were detected with trypan blue stain,MTT ciorimetric assay,Hoechst stain and FACS analysis respectively.To evaluate the stability of EGFP expresion,EGFP lentivirus infected MSC were harvested after cultured continuously in vitro for 2.4,8 or 16 weeks,and EGFP positive rate and fluorescence strength were detected with FACS analysis.Results After infected with EGFP lentivirus(MOI=20)for 96 h,EGFP positive rate of MSC was 97.39%±0.68%.Cell viability,proliferation,apoptosis and cell cycle of MSC infected with EGFP lentivirus were unaffected,as compared with control MSC(P＞0.05).When cultured in vitro continuously for 2,4,8 or 16 weeks,EGFP positive rates of EGFP-MSC were 97.50%±0.54%,97.32%±0.51%,97.39%±0.11%,and 97.48%±0.13% respectively,while EGFP fluorescence strength were 440 ±13,445 ±12.458 ±13 and 456 ±16 respectively.Both EGFP positive rate and fluorescence strength kept in a stable level.Conclusion EGFP lentivirus can efficiently label MSC and has no significant effect on the biophy8ical Droperties of MSC.EGFP gene expression in MSC is permanent and stable.EGFP-MSC can be used for further cell tracing researth.

Objective To explore the effects of proBDNF on cell proliferation and differentiation in hippocampal dentate gyrus in Alzheimer' disease (AD) rat model. Methods The AD rat model was established. Alzet osmotic minipumps were connected to fight hippocampus of AD rat and filled with pmBDNF, sheep antibody to proBDNF or normal sheep serum respectively. Rats received the injection for 14 days at the speed of 0. 5 μ/h. 5-bromo-2'-deoxyuridine (BrdU, 50 mg/kg, ip) was injected twice daily for 14 days. BrdU immunohistochemistry was processed to determine the number of newly generated cells. To examine the phenotype of newly generated cells, immunofluorescent triple labeling was conducted to colocalize BrdU-positive cells with rabbit anti-doublecortine (DCX) or mouse anti-glial fibrillary acid protein (GFAP). Results proBDNF group had fewer BrdU positive cells in dentate gyrus (P ＜ 0. 01 ), while antiproBDNF group had more BrdU positive cells ( P ＜ 0. 01 ) as compared with control group respectively.Immunofluoresent triple labeling showed that there was no phenotypicdifference of BrdU positive cells between each group. Conclusion proBDNF can suppress the proliferation of hippocampal neuron in dentate gyms in AD rats while antiproBDNF has the opposite effect. These findings suggest that promoting the hippocampal neurogenesis by blocking the functions of endogenous proBDNF may be a potential therapeutic strategy for AD.

Objective To investigate the expression of neural growth-associated protein (GAP-43)and synaptophysin(P38)gene and protein in insular electrical kindled epileptic rats and its significance. Methods Seventy-two male adult rats were divided into kindled group ( n = 36) and sham group (n =36) randomly. Each group was further divided into 1,3, 7, 15, 30 and 60 d sub-groups (n =6) respectively.After kindling with immunohistochemical staining and hybridization in situ, the altered expressions of GAP-43 and P38 were detected in hippocampus of insular electrical kindled epilepsy rats. Results Epilepsy day 1 : GAP-43 mRNA and protein expression at hippocampus dentate gyrus granular cell layer, hilus and CA:3 pyramidal layer in the kindled group were higher than the sham group ( P ＜ 0. 05). The expressions declined at Day 3 ( P ＞ 0. 05 ). Expressions became elevated again at Day 7 and they were significantly higher than those in the sham group at Days 15 and 30 ( P ＜ 0. 05 ). There was no statistical difference between two groups at Day 60 ( P ＞ 0. 05 ). Expressions of P38 mRNA and protein:hybridization signal and immunostaining at hippocampus dentate gyrus granular cell layer, hilus and CA3 pyramidal layer began to rise at Day 7 and peaked at Day 15 ( P ＜ 0. 01 ). They lasted 4 weeks and then began to decline. Conclusion Insular epilepsy is closely related with temporal hippocampus. GAP-43 and P38 may be the pathological basis of insular epilepsy and the key molecular mechanism of synaptie plasticity.

Objective To investigate the effects of dietary factors on the pre-eclampsia-like mouse model development at multiple stages of gestation. Methods Pre-eclampsia-like model was established in C57 wild-type (WT) and apoE-/- pregnant mice at early, middle and late gestational stages by injecting nitric oxide synthase (NOS) inhibitor L-arginine methyl ester (L-NAME) subcutaneously. Control groups received normal saline (NS) simultaneously. Each group was subdivided into standard chow subgroup (SC, n =6)and high-fat diet subgroup (HF, n =6). Blood pressure, urinary protein and plasma lipid were measured and fetal outcomes compared.Data were analyzed statistically. Results In early and middle L-NAME subgroups, the plasma concentrations of cholesterol (TC), triglyceride (TG) and free fatty acid (FFA) all increased. And the early L-NAME subgroup in apoE-/- mice was the most remarkable (P ＜ 0. 05 ). In apoE-/- groups ( both L-NAME and NS groups), the plasma concentrations of total TC and TG were higher than those of WT groups ( P ＜ 0. 05 ). But there was no significant difference in FFA between them. The plasma lipid levels of apoE-/- HF + L-NAME group were the highest among all the groups ( P ＜ 0. 05 ). Fetal and placental weights significantly decreased in early and middle L-NAME groups in both apoE-/- and WT mice (P＜0.05). But no significant difference was found between late L-NAME subgroup and NS groups ( P ＞ 0. 05 ). Compared with WT groups, the weights were lower in apoE-/- mice. The fetal and placental weights in HF groups were lower than SC groups and the changes in early HF + L-NAME subgroup in apoE-/- mice were the most remarkable ( P ＜ 0. 05 ). A lower live fetal rate and a higher absorbed fetal rate were found in early L-NAME groups than those of the NS groups ( P ＜ 0. 05 ). Conclusion Pre-eclampsia occurring at an early stage is more likely to have abnormal plasma lipid levels and adverse feto-placental outcomes. High-fat dietary may aggravate the impact of L-NAME pre-eclampsia on pregnancy outcomes at an early gestational stage especially in ApoE-/- mice.

Objective To study possibility of dynamic monitoring tumor angiogenesis in vivo by 3DCTA on a 64-row multidetector CT and 4D-CE-MRA on a 3T MR scanner; compare the advantages and faults of these two methods; and analyze the relationship between tumor angiogenesis and tumor growth. Methods This study had been approved by the institutional animal care and use committee. Thirty New Zealand white rabbits with implanted VX2 tumors in the fight thigh muscle were randomly divided into five groups according to survive time (n = 6). The rabbits were scanned by a 64-row multidetector CT and a 3T MR at 4, 7, 10,13, 16 days after tumor implantation respectively, and then sacrificed to extract the tumor. The tumors' long diameters, short diameters and volume measurements derived from CT and MR imaging were compared with pathological data. The minimum tumor diameter and the number of new tumor blood vessels detectable by 3DCTA and 4D-CE-MRA were also compared. The morphologic process of tumor angiogenesis was monitored and described. Results ( 1 ) The volume of tumors measured by CT imaging, MR imaging and pathological data had no significant difference ( P ＞ 0. 05 ).(2) The minimum diameter of tumor vessels displayed on 3D-CTA and 4D-CE-MRA images was 0. 68 mm ± 0. 07 mm and 0. 85 mm ± 0. 12 mm respectively. The minimum diameter of tumor vessels displayed on 3D-CTA imaging was significantly smaller than 4D-CE-MRA imaging (t = -6. 5075, P =0. 005 ). (3) The number of tumor vessels on 3D-CTA imaging and 4D-CE MRA imaging had no significant difference at 4, 7, 10 days after tumor implantation. The number of tumor vessels on 3D-CTA images were significantly more than that on 4D-CE-MRA images at 13, 16 days after tumor implantation ( all P ＜0. 01 ). (4) The morphoiogic process of tumor angiogenesis was demonstrated as sprouting from pre-existing blood vessel, forming lots of new vessels around tumor, and forming the immature vessels web with lots of tortuous, dilated,irregular vessels penetrating into the tumor at last. Conclusions Volume CT and high magnet field MR can monitor tumor growth in vivo. 3D-CTA and 4D-CE-MRA can dynamicly monitor morphological changes of tumor angiogenesis in vivo.Of the two methods, 3D-CTA has better spatial resolution, but 4D-CE-MRA allows better temporal resolution of tumor angiogenesis monitoring.

Although the academic research on depression has extended to many fields, and it is recognized that mental disorders of the brain are closely related to many kinds of physical disorders, who is the direct material basis of depression has always been one of the topics of concern in the industry.

A 34-year-old male was admitted to the hospital on April 29, 2009 due to "sore throat for 1 week, aggravated with chest and back pain for 2 days". A week ago, he developed sore throat after exertion, aggravated when swallowing, accompanied by fever, about 38.0~38.6 ℃, accompanied by vomiting yellow pus, no obvious odor, no hemoptysis, no obvious cough and sputum, no choking with drinking water, no nausea and vomiting. He went to the local hospital 4 days ago and was given "levofloxacin lactate tablets" for anti-inflammation.