Volume 90  ·   Issue 31  ·  2010

Since the invention of CT in the 1970s, it has experienced nearly 40 years of development. The early CT machine, as a single imaging device, can only provide two-dimensional tomographic images. Modern CT can not only provide high-resolution two-dimensional tomographic images and more intuitive and fine three-dimensional images, but also accomplish functions such as coronary angiography, cardiac function analysis, virtual endoscopy of colon, plaque analysis of vascular sclerosis, three-dimensional interventional guidance, bone mineral density measurement, early diagnosis of stroke, evaluation of tumor treatment effect, etc.

The traditional teaching mode of clinical medicine emphasizes the purpose of imparting knowledge, experience and skills, and the goal of cultivating talents with knowledge and skills. The teaching material period is long, the teaching content is relatively obsolete, and the textbooks often quote outdated guidelines or "principles" from clinical experience and logical reasoning, which lacks the verification of large-scale randomized controlled studies. Teachers focus on knowledge indoctrination when teaching, which is easy to make students develop the habit of passively accepting ready-made knowledge.

Objective Explore the anatomic variations of adult sphenoid sinus and delineate the precise relationship between sphenoid sinus and adjacent structures.MethodsUsing multi planner reformation (MPR),the images of 260 spiral computed tomography (CT) scans were reviewed through a doctor station.Results The sphenoid was divided into 6 types:no development,conchal,pre-sellar,half-sellar,full-sellar and post-sellar.The prevalence was 0.19%,1.54%,8.08%,22.88%,20.58% and 46.73% respectively.And there was no difference between left and right.The prevalence of accessory septa or bone spur inside sphenoid sinus was 51.5%.With the gasification spreading,the prevalence was rising.And there was statistical significance among them.The dorsum sella was divided into three types:Ⅰ,Ⅱ,Ⅲ.And its prevalence was 48.08%,25.19% and 26.73% respectively.The difference of sphenoethmoid distribution among the various type sinus had no statistical significance.The prevalence of vidian canal and foramen rotundum protrusion was 39.2% and 15.8% respectively.And all occurred in pterygoid process cells.Internal carotid artery (ICA) was divided into 4 types.And the prevalence of type 0 to 3 was 13.5%,50.0%,26.9% and 9.6% respectively.With the gasification spreading,the prevalence of types 2,3 was rising.And there were statistical significance among them.The prevalence of type 0 to 4 CN Ⅱ was 4.4%,19.2%,26.0%,29.0% and 21.4% respectively.With the gasification spreading,the prevalence of type 3,4 CN Ⅱ was rising.And the difference had statistical significance.Conclusion MPR and multislice spiral CT can facilitate a precise study of anatomic variations in adult sphenoid sinus and delineate the relationships between sphenoid sinus and adjacent structures.Caution must be exercised during sphenoid and trans-sphenoid surgery to minimize the risk of inadvertently injuring the adjacent structures.

Objective To study diagnostic value of 64 multislice CT in typing of congenital aortic anomaly in neonates and infants.Methods 120 pediatric patients (under one year of age) with congenital heart disease (CHD) underwent 64 contrast-enhanced MSCT before a corrective operations.The diagnostic sensitivity,specificity and accuracy of 64 MSCT were evaluated and also compared with those of echocardiography with Doppler.The patients were randomly assigned to two groups (72 and 48 persons)respectively according to tube tension of 80 and 100 kV.The differences of the image qualities were compared between them.Results 36 congenital aortic anomalies were found (36/120,30%) by 64 MSCT,which were furtherly distinguished into 2 cases in double aortic arch,2 cases in left-sided aortic arch with aberrant right subclavian artery,22 cases in right aortic arch (6 cases in right-sided aortic arch with aberrant left subclavian artery,12 cases in right aortic arch with mirror image branching),10 cases in coarctation ofaorta.Diagnostic sensitivity,specificity and accuracy of 64 MSCT were all 100%.By contrast,those of echocardiography with Doppler were 27.8%,97.6%,76.7%,respectively.The quality scores were 4.69 ±0.52,4.58±0.58 at 80 kV and 100 kV,respectively.No significant statistical difference was found between them(t = 1.08,P = 0.28 ).Conclusion MSCT allows a detailed assessment of the anatomy of congenital aortic anomaly,which can be used as an important supplementary method in diagnosing CHD and offer important information for operation.80 kV should be selected in CHD patients less than one year old for CT examination to reduce radiation exposure.

Objective To compare the survival time of surgery combine with chemotherapy with non-surgery chemotherapy in SCLC.Methods 37 SCLC post operation patients were received 4-6 cycles of chemotherapy of "etoposide + cisplatin or carboplatin".37 SCLC patients were selected be control group,whose age 、stage and site of tumor were similar to surgery combine with chemotherapy group,and received 6 cycles of chemotherapy of "etoposide + cisplatin or carboplatin".Two groups were followed up 5 year and compared with the survival time.Results The 1,3,5 year survival rate of surgery combined with chemotherapy group were 72.97%,35.13%,21.62%.The 1,3,5 year survival rate of control group were 54.05%,13.51%,5.41%.The survival rate of stageⅠ(P = 0.01) was significantly different,but stage Ⅱ(P =0.06) and stage Ⅲ (P = 0.836) were no difference between the two group of SCLC.Conclusion It was found that surgery combined with chemotherapy got satisfactory effects in stage Ⅰ SCLC.

Objective The aim of this study was to determine the medium effective volume required to produce an effective retrograde infraclavicular block using an ultrasound (US)-guided technique.Methods Thirty adults undergoing elective upper limb surgery received a US-guided retrograde infaclavicular block.The initial concentration of 0.5% ropivacaine injected was 30 ml,which was subsequently varied at a ratio volume (EV50) was determined using the Dixon and Massey up-and-down method.The effective volume in 95% of patients ( EV95 ) was calculated using probit regression.Results The medium effective volume and calculated effective volume in50% and 95% of patients were 23.6 ml (95% confidence interval,21.3-26.2ml) and 32.3 ml,respectively.No patient required a general anesthesia.Conclusion The appropriate volume of 0.5% ropivacaine required for US-guided retrograde infraclavicular block was 30 ml in clinical practice.

Objective To evaluate the influence of the recombinant human type Ⅱ tumor necrosis factor receptor-antibody Fc fusion protein (rhTNFR:Fc) on cytokines and bone metabolism in patients with juvenile idiopathic arthritis (JIA).Methods This was a prospective,non-randomized,controlled and openlabel study.Thirty-one patients with JIA in active state were enrolled at our hospital from December 2006 to June 2009.The mean age was 12.7±2.3 years.Exclusive criteria included infection with tuberculosis and hepatitis B etc.,abnormal renal or hepatic function.Study consists of two phases.During the first phase (0-3 months),according to the economic status,all JIA patients were divided into treatment and control groups.The treatment group consisted of 18 patients (enthesitis-related arthritis,n = 15;polyarticular-onset arthritis,n =2;systemic-onset type,n = 1 ) on a regimen of rhTNFR:Fc 0.4 mg/kg,subcutaneously injected twice weekly.The control group contained 13 patients (enthesitis-related arthritis,n = 9;polyarticular-onset arthritis,n=2;systemic-onset type,n =2) on a regimen of MTX 10 mg·m-2·w-1 Two intolerance patients were given suffasalazine (SASP) 30-50 mg·kg-1·d-1.During the second phase (3-6 months),the responding patients continued the original therapy.The rhTNFR:Fc group received a reduced dosage of 0.4 mg·kg- 1 ·w-1.All patients of both groups who became complicated with peripheral arthritis or were non-responding had the addition of SASP.Follow-up was conducted at baseline,1 month,3months and 6 months.And TNF-α,MMP-3,IL-1β,osteocalcin (BGP),β-collagen fragment (β-CTx),alkaline phosphatase,erythrocyte sedimentation rate (ESR),c-reactive protein (CRP) and bone mineral density dynamic changes were examined respectively in the treatment process.Results Alkaline pbosphatase and lumbar spine bone mineral density increased while TNF-α,IL-1β,ESR and CRP decreased significantly in two groups (P<0.05).ESR were 16±8.0 mm/h vs 60±38 mm/h,CRP 10±7 mg/L vs 47 ±37 mg/Land β-CTx 2.1±0.8 vs 1.1±0.9 μg/L at 1 month in two groups respectively with statistic difference ( P<0.05).BGP increased and MMP-3 decreased in both groups with no statistic difference.Femur Ward's triangular area and forearm bone mineral density had no statistic difference between two groups.Interestingly,one case with bone fracture for two years has healed after a 6-month therapy of rhTNFR:Fc as proved by X-ray.Conclusion Both rhTNFR:Fc and traditional DMARDs both can reduce the levels of TNF-α,IL-1β,ESR and CRP and increase lumbar spine bone mineral density and ALP significantly.RhTNFR:Fc improves the acute phase index and bone metabolism index earlier than the traditional therapy.Thus disease and bone destruction are controlled more earlier.

Objective To investigate the causes of non-surgical candidates after presurgical evaluation for epilepsy surgery.Methods A retrospective review was conducted for the clinical data of 112 non-surgical candidates after presurgical evaluation for epilepsy surgery.Potential surgical candidates were identified through a detailed seizure and medical history,physical examination,and uses of video electroencephalography and neuroimaging.Results The common causes of non-surgical candidates after presurgical evaluation for epilepsy surgery were patients and their families giving up intracranial electrode positioning for various reasons ( 42/112,37.5% ),multifocal epileptogenic zones ( 29/112,25.9% ),generalized seizures( 15/112,13.4% ),pseudoseizure or slight seizure( 10/112,8.9%;7/112,6.3% ),epileptogenic zone in functional areas(6/112,5.4% )and so on.Conclusion Epilepsy surgery is less likely in patients with a history of severe encephalitis and perinatal brain injury and diffuse,multiple,bilateral abnormality on cranial MRI.Unnecessary presurgical evaluation can be avoided by distinguishing generalized seizures,pseudoseizure and progressive brain disease.Patients and their families still have doubts about the surgical risks,costs and effects.It is important to inform the patients of the potential risks and benefit of surgery.

Objective To evaluate the change of CSF dynamics using MR PC Cine for neuroendoscopic third ventriculostomy.Methods 146 cases of hydrocephalus were treated by neuroendoscopic third ventriculostomy including 36 cases checked with MR PC Cine study randomly.The successful result was assessed by clinical symptom and imaging study.All the patients were given 3 mouthes to 1 year followup.Results The symptoms of 121 (83%) patients were recovered soon.CT,MRI and MR PC Cine demonstrated the CSF velocity,flow rate and dynamics change to the normal level compared with preoperative check.The effective rate of this group was 75.3% with one year follow-up.Conclusion The method of MR PC Cine to evaluate the CSF dynamics result for neuroendoscopic third ventriculostomy is simple,fast and safe.It is worth the clinical application.

Objective To investigate the polymorphism of human leukocyte antigen (HLA)-DRB1 and-DQB1 alleles among young women with cervical squamous cell carcinoma (SCC) and elucidate its relationship with human papillomavirus (HPV) type 16 infection.Methods From January 2005 to August 2009,166 women diagnosed with cervical SCC at our hospital were enrolled.Thsse patients were divided into two groups based on age,including 59 cases in young age group ( ≤35 yrs) and 107 cases in non-young age group.In the mean time,50 cases with uterine myoma treated by hysterectomy were selected as controls.HPV 16 DNA in cervical tissues was amplified by polymerase chain reaction (PCR).HLA-DRB1 and -DQB1 typing were carried out by PCR-sequence specific primer (PCR-SSP) and the allele frequencies calculated.Results (1)The allele frequency of HLA DQB1 * 0301 at 29.6% was detected among HPV 16positive cervical SCC cases in young age group.And it was significantly higher than 12.9% of non-young age group (P<0.05 ).The allele frequencies of HLA-DRB1 * 04 and -DRB1 * 09 were significantly higher among HPV 16 negative cervical SCC cases in young age group as compared with non-young age group (14.1%,26.6% vs 5.9%,10.5%) (P<0.05).The HLA-DRB1 *07 allele was not detected among HPV 16 negative cervical SCC cases in young age group,But 14 cases (9.2%) were detected in non-young age group (P<0.05).(2)The allele frequencies of HLA-DQB1 * 0501 at 7.4% and 6.3% respectively were detected among HPV 16 positive and negative cervical SCC cases in the young age group.And they were significantly lower than 25.8% and 20.4% of non-young age group ( P<0.05 ).Conclusion The distribution patterns of HLA-DRB1 and -DQB1 alleles among young women with cervical SCC are different from those of older ones.And it has something to do with the HPV 16 infection status.

Objective To provide more evidence sources to the standard treatment for patients with advanced hepatocellular carcinoma,the writer analyze patients' time to progression (TTP) and overall survival (OS) after patients receiving transcatheter arterial chemoembolization (TACE) combined with sorafenib as a treatment of advanced hepatocellular carcinoma (HCC);observe the healing effect embolization combined with anti-angiogenic treatment for advanced hepatocellular carcinoma;and also analyze treatment of security.MethodsThere are 36 patients,33 male and 3 female had been Pathologically or clinical diagnosis.After receiving Transcatheter Arterial Chemoembolization (TACE)therapy,in the following 3 to 7 days,this group of patients continuously take sorafenib ( brand name:Nexavar) ( per tablet 200 mg),2 tablets each time,2 times a day.Every 4 to 8 weeks is called as one period of treatment.Referring to RECIST Evaluation,the writers mainly observe patients' tumor progression (TTP) and overall survival (OS),record adverse events.Using life table method to analyze survival rate,using Kaplan-Meier method to analyze all the survival curves.Results Till March,2010,14 of 36evaluable patients died and 22 survive;the median time to tumor progression (mTTP) to 8.62 months (95%CI:6.51-10.24 months);the median survival time (mOS) of 12.41 months (95% CI:9.57-14.80months).The overall survival rate to observation period is 61.1%;36 patients had been studied,22survive.Among the survivals,there is no CR cases,and 1 case PR,15 patients SD,6 patients PD;disease control rate (DCR) (CR + PR + SD) is 44.4%.The side effects of taking Sorafenib mainly are hand-foot skin reaction,diarrhea,fatigue and loss of appetite.These side effects can be markedly eased after symptomatic treatment.Conclusion Combined with sorafenib treatment may give patients with advanced hepatocellular carcinoma a longer longevity and keep the disease in a steady state.This therapy can be added into the treatments to patients with advanced hepatocellular carcinoma.The side effects of taking Sorafenib (Nexavar) could be stand.

Objective To investigate the therapeutic effect and biological changes of hepatic arterial perfusion of p53 gene via port catheter system (PCS) on advanced hepatocellular carcinoma.Methods A total of 48 cases of advanced hepatocellular carcinoma were divided into the experimental group(30)and the control group(18).Transiliaca external artery PCS implantation was performed in all cases.p53 gene was perffused into target artery confirmed by angiography.In the experimental group,1012 VP of p53 gene and 20 mg OPT were employed everyweek as a course for 21 days.In the control group,only 20 mg OPT was used.KPS,AFP and the survival period,RECIST ( response evaluation criteria in solid ) tumor were analyzed.Flow cytometry (FCM) and micronucleus (MN) assay in vivo were used to detect p53 gene mutation and spontaneous micronucleus formation in peripheral blood of the experimental group.Results The experimental group were performed 1 to 8 courses.There was a significant difference with AFP level and KPS in the experimental group( P<0.05 ).However there was no significant difference ( P >0.05 ) in the control group.After one month,survival rate of the the experimental group and the control group was 96.6% and 94.4%,there was a significant difference between the two groups in objective tumor relieve (P<0.05).After three months,survival rate of the the experimental group and the control group was 83.3% and 55.6%,there was a significant difference between the two groups in objective tumor relieve (P<0.05).After six months,survival rate of the the experimental group and the control group was 50.0% and 11.1%,there was a significant difference between the two groups in objective tumor relieve ( P<0.05 ).After nine months,survival rate of the the experimental group and the control group was 23.3% and 0%,there was a significant difference between the two groups in objective tumor relieve (P< 0.05 ).After twelve months,survival rate of the the experimental group and the control group was 6.67% and 0%,there was a significant difference between the two groups in objective tumor relieve ( P<0.05 ).The depression of p53 expression was observed in the HCC patients who were employed four times of intervention operations.The difference of p53 expression between before and after interventional rAd-p53 therapy were statistically significant (P <0.01 ).The frequency of MN depressed by the rAd-p53 was seen in the patients,and the differences of the frequency of MN between before and after interventional rAd-p53 therapy were statistically significant ( P <0.05).Conclusion p53 gene sequential infusion via hepatic artery is effective for advanced hepatocellular carcinoma.The biological study will play a important role in selecting the therapeutic dose and judging therapeutic efficacy by means of guiding and monitoring.

Objective To evaluate the imaging features of different subtypes of renal cell carcinoma (RCC) by double-phase helical computed tomography (CT) and to enhance its pre-operative diagnosis level.Methods A total of 460 RCC were reviewed retrospectively.Tumor size,enhancement degree,enhancement drop between corticomedullary (CMP),nephrographic (NP),enhancement pattern,and tumor density (homogeneity,degeneration or necrosis,calcification) were observed respectively.The clear cell,chromophobe and papillary types were analyzed for statistical analysis.Results They had difference in enhancement pattern and tumor density of clear cell,chromophobe ( P<0.05 ) and papillary types ( P <0.05).There were differences in enhancement degree,enhancement drop and combine degeneration or necrosis in all subtypes of RCC ( P<0.05 ).The clear cell type was of hypervascular tumor and showed a stronger enhancement (80.9%) than other types.The enhancement drop was also higher than other types and 57.9% of it was ≥30 HU.As for ≥30 HU,the clear cell type was diagnosed with a 57.9% sensitivity and a 91.9% specificity.Clear cell type tended to appear as peripheral and heterogeneous enhancement (66.3%,94.6% );it was likely heterogeneous in density (91.6%) with frequent degeneration or necrosis (60.5%).The chromophobe type was of moderate vascular tumor and it exhibited middle-level enhancement (77.1%).The enhancement drop was low ( <30 HU,80.0%).As for 0-30 HU,the chromophobe type was diagnosed with an 80.0% sensitivity and a 66.1% specificity.Its pattern ended to appear as homogeneous enhancement (65.7%);Homogeneous density,degeneration and necrosis were characteristic signs of chromophobe type.The papillary type was of hypovascular tumor and it exhibited slight or no enhancement (70.4%).The enhancement drop was low ( <30 HU,92.6% ) and the gradual enhancement (63.0%) was characteristic of this type.As for 0 Hu,the papillary type was diagnosed with a 63.0% sensitivity and a 91.8% specificity.It tended to appear as homogeneous density (63.0% ).The unclassified type tended to appear as peripheral (9/12 cases) and stronger enhancement (7/12 cases) and heterogeneous density with degeneration or necrosis (9/12 cases).The multilocular cystic RCC appeared as complex cyst.And cystic wall enhancement was an important diagnostic point of cystic RCC.Conclusion Doublephase helical CT plays an important role in the pre-operative differentiation of subtypes of RCC.Each type of RCC has its own features.A clinician may reach a correct pre-operative diagnosis.

Objective To study the effect of rotating cell culture system (RCCS) on the in vitro constructing of tissue engineering nucleus pulposus.Methods Nucleus pulposus cells from rabbit thoracic and lumbar intervertebral discs were proliferated in vitro to the third generation and seeded into PLGA ( polylactide-co-glycolide) scaffolds (3 × 107/ml).Experimental group was subjected to the RCCS while the control group was cultured under a normal condition.Both groups were cultured in vitro.The complex of nucleus pulposus and scaffolds was observed after 4 weeks.Tissue texture,scanning electron microscope,type Ⅱ collagen,content of GAG (glycosaminoglycan) and DNA were assessed.Results After 4 weeks,the tissue engineered nucleus pulposus under RCCS were morphologically thicker and bigger.And the content of GAG,DNA and percentage of type Ⅱ collagen were more than those in the control group.The structural arrange of tissue engineering nucleus pulposus was visualized directly.Conclusion The RCCS promotes intervertebral disc cells to secrete collagen and GAG.It may benefit the construction of tissue engineering intervertebral disc.

Vascular dementia (VD) has become one of the main diseases that harm the health and quality of life of middle-aged and elderly people [1], but its pathogenesis is not completely clear, and the clinical intervention methods are lack of specificity [2]. Basic fibroblast growth factor (bFGF) is a kind of neurotrophic factor, and a large number of studies have confirmed that it has a protective effect on nerves [3-6].

hepatocyte growth factor (HGF) is a polypeptide growth factor, which is a heparin-binding glycoprotein containing 728 amino acids [1]. The active form of HGF consists of a disulfide bond-linked α chain and a β chain. The α chain includes an N-terminal hairpin domain and four krilnle domains (K1-K4), and the β chain is a folded region with serine protease (SP) catalytic activity [2].

A 17-year-old male suffered from right femoral shaft fracture due to sprain when descending the steps (Figure 1), and was treated with traction and antegrade interlocking intramedullary nailing of the femur in a local hospital (Figure 2). Within 1 month after operation, the patient had continuous fever, and obvious swelling of right thigh and knee.

Mitochondrial encephalopathy is a group of multisystem diseases, mainly brain involvement caused by abnormal mitochondrial structure and function. Both nuclear and/or mitochondrial gene abnormalities can lead to the occurrence of mitochondrial encephalopathy, and there are obvious heterogeneity of genetic genes and clinical phenotypes.

A 57-year-old male was admitted to the hospital on January 20, 2009 due to intermittent fever accompanied by pain in the waist and abdomen for 1 month. The patient began to develop fever without obvious trigger on December 21, 2008, with the highest body temperature of 38.5 ℃, accompanied by fatigue, without cough, sputum, sore throat, nasal congestion, runny nose, diarrhea, abdominal pain and other discomfort.