Volume 90  ·   Issue 27  ·  2010

Objective To explore the clinical characteristics of the benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease (MD) in retrospect in an effort to improve the diagnosis and efficacy of treatment Method Fifteen cases (1 male and 14 female, aged 46 to 68 years old) of BPPV associated with MD from July 2007 to June 2009 were retrospectively analyzed. Patient clinically characterized with positional paroxysmal vertigo were diagnosed as MD by ECochG and glycerol test and were confirmed as BPPV associated with MD by Dix Hallpike test or roll test They were treated with Epley maneuver or Barbecue rol maneuver according to the type of BPPV, and the efficacy was evaluated. Result (1) Most cases involved female patients in this study; (2) BPPV occurred after MD in al of the cases, of which 13 cases were posterior semicircular canal lithiasis (9 cases in the same ear, 2 in the other and 2 in both) and 2 cases were horizontal semicircula canal lithiasis (cupula lithiasis in the same ear) ; (3) in this study, 10 patients were cured after 3-4 times of posture treatment (66.7% ), 4 patients were cured after 5 times and 1 patient received endolymphatic sac decompression because of recurrent vertigo. Conclusion (1) BPPV can result from MD, for which a possible mechanism may be the hydrolabyrinth that lead to eardust falling off. (2) Most cases of BPPV occurred in the posterior semicircular canal in the same ear. Most cases in incidence rate have obvious sexual bias in female. (3) Eardust reposition is an effective treatment for BPPV caused by MD; while it is refractory compared to ordinary BPPV and requiremultiple treatments, which may be related to the recurrence of hydrolabyrinth.

Objective To evaluate the efficacy and safety of interventional radiology in the treatment for delayed hemorrhage post-pancreaticoduodenecomy. Methods From August 2004 to March 2009, interventional radiology treatments were offered in 18 cases of delayed hemorrhage postpancreaticoduodenecomy. The patients consisted of 14 males and 4 females with an age range of 23-75 years old. There were pancreas carcinoma (n = 8) , cystadenoma of pancreas (n =2) , Vater's papilla carcinoma (n = 4) and pancreatitis (n = 4) . The interventional radiology treatments included the embolization of splenic artery, the embolization of stump of gastroduodenal artery, the embolization of hepatic artery, transcatheter infusion of vasopressin in the branches of superior mesenteric artery and cover stent placement in hepatic artery. Results A total of 29 interventional procedures were performed in 18 patients. Hemorrhage was ceased in 16 cases after interventional radiology treatment, no active bleeding was demonstrated and no embolization of assumed site of hemorrhage was performed in 2 cases after diagnostic angiography. Surgery was performed and hemorrhage ceased post-operatively. The average survival time of 18 cases was 18 months (range: 1 week - 50 months). Conclusion Interventional radiology treatment can be safely and effectively performed in the cases of delayed hemorrhage post-pancreaticoduodenecomy. It should be the first-choice therapy for this medically refractory condition.

：Objective To examine andanalyze the expression of estrogen receptor-α( ERα) inmyometrium of endometrial-myometria interface (EMI) of adenomyosis and normal myometriumand explore the pathogenesis of adenomyosis (ADS). Methods The myometrium specimens wereobtained from 41 cases undergoing hysterectomy, including 20 adenomyosis patients in ADSgroup and 21 other patients in control group. EMI was located and acquired by anatomy andimmunohistochemistry. The EMI smooth muscle cells were isolated immediatelypost-operatively for primary culture. RT-PCR and Western blot were used to detect ERa inmyometrium of EMI in two groups. Results (1) Uterine smooth muscle cells of EMI were in anexcellent condition and cell viability was fair; (2) the expression of ERa in myometriumof EMI of ADS group showed no cyclic change. While in myometrium of EMI in control group,it showed obvious cyclic change. The expression level was significantly higher inproliferative stage than that in secretory stage (P < 0. 05); (3) there was nosignificant difference in the expression of ERa between the ADS (0. 18 ±0. 023) andcontrol groups (0. 19 ±0.024) during the proliferative phase. During the secretory phase,it showed significant difference in ERαexpression. Andthe ADS group (0. 17 ±0.032) was much higher than the control group (0.12 ± 0. 015 ) ( P> 0. 05 ). Conclusion The loss of periodic expression of ERαin myometrium of EMI of adenomyosis may beassociated with an abnormal regulation of estrogen in adenomyosis.

Objective To study the effect of mycophenolic acid(MPA)on maturation, endocytotic capacity and allostimulatory properties of human myeloid dendritic cell ( MDC ). Methods The peripheral blood mononuclear cells were isolated freshly from healthy volunteers (n = 15). The study group was treated by MPA. Co-stimulatory and adhesion molecular on MDC were analyzed by flow cytometry. After isolation of blood dendritic cell antigen-1 + ( BDCA-1 + ), the cellular uptake of FITC-dextran was measured by flow cytometry. After mixed lymphocyte reaction, the percentage of allogenic CD+4 T cell in G0 phase was analyzed by flow cytometry. Results ( 1) Maturation: Compared to control group, MPA down-regulated the level of CD40, CD62L, HLA-DR, CD54, CD80, CD83 and CD86 on MDC significantly in study group (t = -3. 713,P> 0.010). (2) Endocytotic capacity: MPA enchanced significantly the endocytotic capacity of MDC in study group (t= 10. 171 ,P =0.000). (3) Allostimulatory capacity: Compared to control group, MPA reduced the ability of MDC to stimulate markedly the T cell proliferation in study group. Conclusion MPA may enhance the phagocytic capacity of human peripheral MDC, inhibit the maturity of MDC and impair its allostimulatory capacity of CD+4 T lymphocyte.

：Objective To compare thehemodynamic responses to orotracheal intubation with Laryngeal Mask Airway CTrachTM andLaryngoscope under general anesthesia. Methods 60 adult patients, scheduled for theelective gynecologic surgery under general anesthesia requiring the orotrachealintubation, were randomly allocated to either the CTrach ( C) group or the Laryngoscope (D) group. After a standard intravenous anesthetic induction, the orotracheal intubationwas performed. Noninvasive blood pressures and heart rates were recorded before (thebaseline values ) and after anesthesia induction (the postinduction values),at intubationand every minute for the first 3 minutes after intubation. Results The mean intubationtime was longer in the C group than in the D group. The tracheal intubations causedsignificant increases in blood pressures and heart rates in the two groups compared totheir postinduction values. In the D group, HR at intubation and after intubation weresignificantly higher Compared to the baseline values. In the C group, BP and HR atintubation and after intubation were not significantly diferent from the baseline values.BP and HR at intubation and after intubation were significantly higher in the D group thanin the C group. Conclusion The CTrach had advantage of attenuating the hemodynamicresponses to the orotracheal intubation compared to the laryngoscope.

Objective To determine the therapeutic efficacy of augmentation plate fixation in nonunion of long-bone fracture after interlocking intramedullary nailing. Methods From April 1998 to April 2009, 14 patients with long-bone hypertrophic nonunion after intramedullary nail internal fixation were treated with augmentative plate. There were nine patients with nonunion of femur, three of humerus and two of tibia. After implanting the intramedullary nail in situ, an augmentative plate fixation was applied to the fracture site to counter the rotational instability. A general plate with at least two screws reaching the opposite cortical bone above and below the fracture was fixated to the lateral side of bone shaft In all patients, the rotational instability of fracture site was verified intra-operatively in all cases. However, motion disappeared after plate augmentation. Results All patients achieved radiological solid union at an average of 8 months ( range: 6-11). Hardware was removed in six cases at 6-11 months post-operation. No infection, hardware loosening or rupture was found. Conclusion The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. Augmentation plate fixation is indicated for femoral and tibial nonunion of proximal or distal metaphyseal-diaphyseal junctional areas, primary comminuted fracture and humeral nonunion after intramedullary nailing.

Objective To explore the value of color Doppler ultrasound in evaluating the therapeutic effects on ankylosing spondylitis ( AS ) patients. Methods Color Doppler high-frequency ultrasound images and blood flow in 30 healthy volunteers and 50 AS patients, changes of high-frequency ultrasound images and blood flow of involved sites in AS patients pre- and after-Etanercept treatments, as well as erythrocyte sedimentation rate (ESR) , C-reactive protein (CRP) and the Bath AS disease activity indices pre- and post-treatment were compared. Results Positive rates were significantly different between healthy volunteers and AS patients in terms of sacroiliac joints, Achilles tendon attachments, patellar ligament attachments, and rectus femoris tendon attachments by ultrasonograph (P < 0. 05); and the fibular collateral ligament attachments positive rates had no significant difference with those at pre-treatment (P > 0. 05). There was significant difference between patients with Bath AS disease activity index (BASDAI) ≥ 4 and those with BASDAI < 4 with respects to peripheral enthesis positive rate, Bath AS functional index (BASFI) , patient's global assessment VAS (PGA) , nocturnal back pain and general back pain VAS, morning stiffness duration, ESR and CRP ( P < 0. 05 ). Positive rates of sacroiliac joints, Achilles tendon attachments, patellar ligament attachments and rectus femoris tendon by ultrasonograph significantly decreased at Weeks 12 and 24 at post-treatment compared to that at pre-treatment (P <0. 05); there was significant difference for patient's BASDAI, BASFI, ESR and CRP at pre-treatment and weeks 12 and 24 post-treatment ( P < 0. 05). Conclusion Ultrasound can sensitively detect the pathological changes of joint synovium and enthuses so that it may be used as a routine method of monitoring diseases in these soft tissues, following up AS patients and evaluating clinical efficacy.

Objective To investigate the effects of parecoxib sodium preemptive analgesia on perioperative cytokine responses and stress respses and postoperative analgesia in patients undergoing ophthalmology surgery. Methods One hundred ASA Ⅰ- Ⅱ patients undergoing ophthalmology surgery were randomly divided into 2 groups of fifty: the parecoxib group received parecoxib 40 mg by muscle injection, the control group received an equal volume of 0. 9% normal saline two ml. Venous blood samples were obtained at 10 minutes before parecoxib or 0. 9% normal saline was injected (T1) , 30 minutes ( T2) and 60 minutes (T3) after surgery was initiated, the moment when surgery was finished ( T4), 6 hours (T5 ), 12 hours(T6)and 24 hours (T7 ) after surgery was finished for determination of the plasma levels of IL-6, IL-8,IL-1RA,TNF and IL-1β. At the same time, the plasma levels of epinephrine, norepinephrine, cortisol and adrenocorticotropic hormone at Tl - T6 were measured. VAS scores with patients were recorded at 1,2, 6,12,24 h after surgery. Result The change of the plasma levels of IL-6, IL-8, IL-1RA, TNF, IL-1β in the two groups:in the parecoxib group the plasma levels of TNF and IL-1β did not decreased significantly as compared with the control group ( P > 0. 05 ) . The plasma levels of IL-6, IL-8 at T4 - T6 decreased significantly as compared with the control group (P < 0. 01) . The plasma levels of IL-1RA at T3 - T6 decreased significantly as compared with the control group ( P < 0. 01 ). The change of the plasma levels of epinephrine, norepinephrine, cortisol and adrenocorticotropic hormone in the two groups: in the parecoxib group the plasma levels of epinephrine, norepinephrine at T2 ,T3 decreased significantly as compared with the control group ( P < 0. 01 ). In the parecoxib group the plasma levels of cortisol at T2 - T4 decreased significantly as compared with the control group(P <0.01 ). In the parecoxib group the plasma levels of adrenocorticotropie hormone at T2 - T5 decreased significantly as compared with the control group ( P <0. 01 ). Postoperation VAS scores:VAS scores of the parecoxib group were less than that of the control group (P < 0. 05). Conclusion Preoperatively-administered pareeoxib during ophthalmology surgery can produce better analgesia effect, reduce the production of cytokines, decrease central nervous system sensitization so as to improve the quality of postoperative pain relief. At the same time, it can reduce perioperative stress hormone release so as to have a positive effect on post operative recovery.

Objective To study the expression of p53 and DNA index(DI) and S-phase fraction (SPF) in pterygium, and explore their contribution of pathogenesis of pterygium. Methods Surgically excised pterygia of 84 cases (96 eyes) with newly developed pterygium and 30 samples of normal conjunctiva as control were collected for immunohistochemistry to detected the expression of p53. The DI value and the SPF value were detected in all specimens with FCM. Results The expression of p53 in pterygium was significantly higher than that of normal conjunctiva ( P < 0. 001). The DI value and the SPF value in pterygium were higher than that of normal conjunctiva but without statistical significance (P>0. 05). Conclusions The high expression of p53 and high level of DI value and SPF value suggest the pathogenesis of pterygium may be out of balance of cell apoptosis and cell proliferation.

Objective To assess the characteristics and influencing factors of non-motor symptoms (NMS) in patients with Parkinson's disease(PD). Methods A total of 111 patients with PD and 46 healthy controls (HC) matched with age, gender, education status and occupation were investigated by NMS questionnaire. They were all outpatients of Beijing hospital. The distribution of NMS items was analyzed between two groups. And their clinical characteristics were also collected to assess the dominant influencing factors for the prevalence of NMS. Results There was significant difference in the prevalence of NMS between two groups (P<0. 01). Each PD patient had an average of 12 NMS throughout the disease stages and the number of NMS was increasing with the degree of disease severity. UPDRS-Ⅲ (united Parkinson's disease rating scale) , daily dose of levodopa and age showed a positive correlation with NMS-T ( NMS Total) and they accounted for 26.9% of the variance of NMS-T. Daily dose of levodopa, Hoehn-Yahr stage, UPDRS-Ⅲ and NMS-T showed a positive correlation with UPDRS- Ⅱ and they accounted for 70. 3% variance of UPDRS- Ⅱ. Conclusion NMS are more commonly seen in PD patients than in controls. NMS is present throughout every stages of PD and its number increases with the degree of disease severity and age. The quality of life is impaired significantly by NMS in PD patients.

Objective To study the feasibility of using amniotic cells plus collagen Ⅰ complex for fetal membrane healing. Methods Human amnion mesenchymal cells were embedded in three-dimensional (3D) collagen Ⅰ and epithelial cells placed on the top. The amniotic cells plus collagen Ⅰ complex was created to mimic the architecture of native amnion. As judged by DAPI staining, the number of amniotic cells cultured in 3D collagen Ⅰ was counted after incubation for 2 and 8 days. The tensile strength of collagen Ⅰ with a varying number of amniotic mesenchymal cells was measured after a 15-day incubation. Results At Days 2 and 8, the mean number of mesenchymal cells was (121 ± 5)/cm2 and (124 ±4)/cm2(P>0.05). The size of collagen Ⅰ matrix was reduced to 45% , 15%, 14% at Days5, 10, 15 respectively. Mesenchymal cell was capable of remodeling collagen Ⅰ(P <0.01) and it could not be inhibited by GM6001 and/or aprotinin. The tensile strength of amniotic cells plus collagen Ⅰ scaffold complex was strengthened with an increasing number of amnion mesenchymal cells (P < 0. 01). Conclusion The amniotic cells plus collagen Ⅰ complex may be useful for healing preterm premature rupture of the membrane (PPROM).

Objective To investigate the effect of estradiol (E2) on tryptophan hydroxylase (TPH) and 5-hydroxytryptamine (5-HT) content in raphe nuclei of rats under forced swimming stress and explore the role of estrogen and stress in disease mechanism of depression in women. Methods At Week 3 postovariectomy, 35 ovariectomized (OVX) female SD rats were randomly divided into 5 groups (n =7) :nonstress group, control group, estradiol (E2) group and fluoxetine (FLX) group and E2 plus FIX group. Animals were administered with different drugs for 2 weeks. At Day 14, animals except those in the nonstress group were subjected to the 15 min forced swimming test (FST). At 2 hours post-FST, all animals including those in the non-stress group were perfused with 4% paraformaldehyde and brains removed for TPH and 5-HT immunofluorescence staining. We compared the content of TPH and 5-HT by observing and calculating the integrated optical density ( IOD ) of immunofluorescent-positive signals in raphe nuclei. Results (1) The IOD value of TPH- and 5-HT-positive region in raphe nuclei of rats in the control group was significantly lower than that of the non-stress group ( P <0.01); (2) the IOD value of TPH- and 5-HT-positive region in raphe nuclei of rate in the E2, FLX and E2 plus FLX groups was significantly higher than that in the control group (P < 0. 05). Conclusion Forced swimming stress can decrease the TPH and 5-HT content in raphe nuclei. Such changes can be prevented by a pre-administration of estradiol. Similar results are observed with antidepressant fluoxetine. These effects may underlie the role of estradiol and stress in the disease mechanism of depression in women.

Objective To study the impact of avian influenza virus H5N1 neuraminidase mutationsI117V,I314V and I117V+I314V on the sensibility of neuraminidase inhibitors(NAIs) and the activity of neuraminidase (NA).Methods The mutations were intreduced into NA genes of virus strain A/Vietnam/1203/04 (H5N1)by site-directed mutagenesis.With the A/WSN/33 (H1N1)background,recombinant influenza viruses containing NA mutations were rescued by reverse genetics.After viral propagation in chicken embryos,fluorimetric assays were conducted to assess the sensibility to NAIs and NA activity(IC50,Km&Ki).Results Compared to the wild-type viruS VNl203.the mutation I117V decreased the susceptibility to osehamivir(17-fold increment of IC50 value,20-fold increment of Ki value)and the NA activity(23-fold increment of Km value)while there Was little impact on zanamivir sensitivity(2-fold increment of IC50 value,3-fold increment of Ki value).The mutation 1314V had no marked influence on either the NA activity or the NAIs susceptibility.Conclusion It aDpears that the NA mutations of I117V and I314V Can not cause NAIs resistanee.Oseltamivir or zanamivir may still be prescribed for anti-viral treatment.

Anesthesia and stress response have influence on the immune function of perioperative patients, especially may affect the prognosis of patients undergoing tumor surgery. At the annual meeting of the European Association of Anesthesiologists (ESA) in 2009, a new treatment concept of "anti-cancer anesthesia technology" was put forward, aiming at finding out the most suitable anesthesia method for tumor patients. There are clinical evidences that the application of local anesthesia can improve the prognosis of tumor patients, and significant progress has been made in the research on how anesthesia affects the mechanism of tumor immunity.

Hemodialysis or peritoneal dialysis is a kind of treatment method commonly used in end-stage patients with chronic kidney disease, which replaces the kidney toxin clearance function and maintains the patient's life. Because of underlying diseases, reduced immunity, frequent contact with blood, blood transfusion or blood products and other various iatrogenic factors, the incidence of hepatitis C in this group of people is significantly higher than that in the general population. Hepatitis C virus (HCV) infection is an important factor in the increase of mortality of patients with maintenance dialysis of chronic kidney failure [1]. The antiviral treatment of these patients is also different from that of patients with common hepatitis C virus infection. This article mainly reviews the research on antiviral treatment of patients with chronic kidney failure who have undergone long-term dialysis treatment with hepatitis C virus infection.

The patient was a 42-year-old farmer. She was admitted to our hospital in May 2009 due to "progressive limb weakness and mobility disorder for 5 years". Five years ago, she developed pain after moving her right heel without inducement, and then she developed weakness in both lower limbs, which developed from the foot upward and slowed down her movement speed. After moving, she felt stiffness in the muscles of both lower limbs, which could be relieved after rest or massage. Muscle soreness and tenderness were denied. Still, she could persist in working in the field. Two years after the onset of the disease, she progressed to difficulty in walking and began to see a doctor. There were no abnormalities in electromyography, muscle enzyme spectrum and lumbar MRI examinations in other hospitals. In 2007, she was hospitalized in other hospitals. The electromyography showed that the time limit of motor unit of left tibialis anterior muscle was shortened, the polyphasic wave was increased, and the recruitment of bilateral quadriceps, left tibialis anterior muscle and deltoid muscle was decreased.

A 38-year-old female was admitted to the hospital on November 13, 2009 due to neck, shoulder, chest and back pain for 2 months. The patient developed paroxysmal pain in the neck, shoulder and back without obvious inducement 2 months ago, and the pain was significant at night, and progressively aggravated. MRI found "neck 7~ chest 2 tumors". The patient had a history of uterine leiomyoma resection 4 months before admission, and the pathological diagnosis was benign uterine leiomyoma.