Volume 90  ·   Issue 37  ·  2010

Objective To study the related factors of patients with intracerebral hemorrhage (ICH)so as to guide treatment and predict prognosis. Methods The prognostic factors of 463 cases with intracerebral hemorrhage were analyzed with single factor and Logistic regression analyses. Results Age,Glasgow coma scale, amount of hemorrhage, NIHSS score, mean arterial blood pressure, with or without ventricular breakage, with or without midline shift and the incidence of complications at random blood glucose levels were analyzed for the correlation with the prognosis of patients. The poor prognosis group had significant differences with the good prognosis group with regards to these factors. The average age of patients with a poor prognosis was 71 years old, the average hematoma volume 29 ml and the average GCS score 11. 2versus 65 years old, 15 ml, 15. 1 for those with a good prognosis ( P ＜ 0.05 ). Logistic regression analysis showed that age, amount of hemorrhage and disturbance of consciousness was an independent adverse prognostic factor for cerebral hemorrhage at three months. The OR values were 1.32, 8.66 and 1.08respectively. Conclusion The etiologies of ICH are diverse. Maintaining normal blood pressure is an important preventive measure for ICH. Hematoma volume, disturbance of consciousness and age may be used to predict the prognosis of cerebral hemorrhage.

：Objective Surgicalresection remains the cornerstone of treatment for esophageal carcinoma. Mediastinallymphadenectomy including subcarinal nodes has always been considered to be a reasonableextent, because of close anatomical relationship between subcarinal nodes andtracheobronchial tree. Metastatic involvement of subcarinal nodes alone is rare inesophageal carcinoma. In view of special anatomical features of subcarinal lymph nodes, itis worth exploring and discussing whether or not subcarinal lymph nodes dissection shallbe routinely performed for thoracic esophageal carcinoma. Methods The data from a cohortof 676 patients with thoracic esophagus carcinoma who underwent esophagectomy withlymphadenectomy were analyzed retrospectively with respect to the impact of subcarinallymph nodes dissection or non-dissection on the incidence of postoperative complicationsand patient survival. Results The rate of subcarinal lymph nodes metastasis was 10. 4%.The metastasis rates in upper, middle and lower esophageal carcinoma were 0%, 13.2% and 6.8% respectively ( P =0. 001 ); for Tis, T1, T2, T3 and T4, they were 0%, 0%, 6. 5%, 13.3%and 28. 6% respectively ( P = 0. 008 ). The overall incidence of postoperativecomplications with and without subcarinal lymph nodes dissection was 36. 8% versus 26. 6%(P = 0. 013 ). And the incidence of pulmonary complications were 22. 2% versus 14. 1% ( P =0. 020 ).Survival analysis showed that: the 5-year survival rates were 50. 9% versus 62.8% in the groups A and B of NO patients ( P =0. 083 ); 14. 7% versus 29. 3% in N1 patients( P =0. 112). In the group with metastasis of subcarinal lymph nodes, the 5-year survivalrate was 22. 6% versus 31.7% in those without metastasis (P = 0. 142 ). Conclusion It maybe unnecessary to dissect the subcarinal lymph nodes routinely for upper thoracicesophageal carcinoma. Elective subcarinal lymph nodes dissection can be planned formiddle,lower, T3 or T4 thoracic esophageal carcinoma, or highly suspected subcarinalmetastasis based on radiological imaging.

Objective To investigate the effect of oral midazolam on sedation, on perioperative emotion and on behavior in children with sevoflurane general anesthesia. Methods 48 children undergoing cataract surgeries were randomly divided into two groups and respectively received 0. 5 mg/kg oral midazolam (Group Ⅰ )and placebo (Group Ⅱ ) 30 minutes before the operation. Perioperative behavior and emotion status were assessed. Results Satisfactory sedation ratio in group Ⅰ was better than that in group Ⅱ(58. 3% vs 12. 5% , P ＜ 0. 05). There were no differences in emergence time, PACU stay and incidence of emergence agitation between two groups ( P ＞ 0. 05 ). Conclusion 0. 5 mg/kg oral midazolam before sevoflurane general anesthesia in children is safe. It is effective on anxious relief, however it does not decrease the incidence of emergence agitation.

Objective To investigate whether hyperIgEaemia is associated with Hirayama disease in China. Methods Serum total IgE were examined in 123 patients and 82 control subjects from 2006 to 2009at this hospital and their correlations with clinical profiles investigated. The data were analyzed by t, Chisquare and nonparametric tests. Results Past or present history of allergy/atopy was found in 14 ( 11.4% )patients and 11 ( 13.4% )controls. The median value of serum total IgE were 87.97, 59.21 and 51.39 IU/ml in patients, controls and health controls respectively. There were no significant difference between the patient and control groups ( Z = - 0.947, P = 0. 344 ) and the health control groups ( Z = - 0. 914, P =0. 361 ). Serum IgE was elevated in 57 (43.6%) patients and 30 ( 36.6% ) controls. HyperIgEaemia was present in 29 ( 23.6% ) patients and 13 ( 15.9% ) controls. There was no significant difference in the frequency of history of allergy/atopy, IgE elevation or hyperIgEaemia ( P ＞ 0. 05 ) between cases and controls. Even after analyzing the length of duration or the severity of clinical disabilities, there was no difference neither ( P ＞ 0.05 ). Conclusion Whether the length of duration or the severity of clinical disabilities, the serum total IgE level has no significant difference between all groups. HyperIgEaemia is not associated with Hirayama disease.

Objective To investigate the expression of MIF on the gastric adenocarcinoma, evaluate the relation between the MIF expression and tumor differentiation, lymph node metastasis and other clinical patho-features. Methods 120 gastric adenocarcinoma cancer tissues, 40 tissues besides cancer and 40common mucosa tissues specimens are collected. Detect the expression of MIF with immunohistochemistry method (Streptavidin -Peroxidase). Results Positive rate of MIF expression in gastric cancer is 80. 8%(97/120). Those in poorly differentiated, moderately differentiated and well-differentiated gastric adenocarcinoma are 97. 5% (39/40), 82. 5% (33/40) ,62.5% (25/40), analytical factor of Spearman rank correlation rs is 0. 458( x2 =27. 046, P ＜0.001 ). Positive rate of MIF expression in tissues besides cancer is 40% (16/40)and that in normal gastric mucosa is 7.5% (3/40). Positive rate of MIF expression in gastric adenocarcinoma without lymph node metastasis is 40% (22/55) and the rate with lymph node metastasis is 67% (44/65). Conclusions There is overexpression of MIF in the gastric adenocarcinoma.Expression of MIF in different differentiated cancer is different. Expression in poorly differentiated is higher than that in moderately differentiated and well-differentiated caner. The level of expression of MIF malignancy has positive correlation with malignancy degree of gastric adenocarcinoma. MIF expression has nothing to do with age, gender, tumor sizes or location.

：Objective To identifythe safety and efficacy of individualized vaginal surgery for anterior pelvic organprolapse (POP) in elderly women so as to provide a clinical basis for studies on improvinglife quality by treatment in elderly women. Methods The individuaation group consisted of90patients with a diagnosis of anterior POP. All over 60 years old, they underwentindividualized vaginal surgery. The safety and efficacy, POP quantitative examinationPOP-Q change, cure and recurrence rate and life quality scores on incontinence and pelvicfloor distress and impact were assessed. The control group ( n = 60) was composed ofpatients ( ＞ 60 yr old ) with a diagnosisof anterior POP were performed with Kelly-Kennedy operation. Their safety, efficacy, cureand recurrence rates were compared. Results Individualized vaginal surgery in elderlywomen was both safe and effective. The post-therapeutic recovery time was shorter(P＜ 0. 05 ), the cure rate higher and the recurrencerate lower( P ＜ 0. 05 )than that of controlgroup. The life quality after individualized surgery improved (P＜0.01 ). Conclusion Theindividualized vaginal surgery is safe and effective for a correction of anterior POP inelderly women. The life quality improves after operation.

Objective To investigate the suitable measures of diagnosis and treatment of cesarean scar pregnancy (CSP). Methods From May 2003 to February 2010, 52 cases were diagnosed as CSP on the basis of the history of cesarean section and the manifestations of pregnancy by transvaginal ultrasound and magnetic resonance imaging (MRI) examination. According to the blood level of β-HCG, 32 patients underwent uterine artery methotrexate perfusion and uterine artery embolization ( UAE), 20 cases received a protocol of methotrexate and leucovorin (CF) while UAE or Foley catheter balloon hemostasis was performed for massive vaginal bleeding cases. When β-HCG decreased 80%-90% and mass blood flow reduced or disappeared, focal resection was administered. Results Forty-six cases were diagnosed by transvaginal ultrasound and 6 cases by MRI. On admission, 11 patients with severe vaginal bleeding underwent UAE or Foley catheter hemostasis. Forty patients undergoing curettage had no uterine perforation or rupture with hysteroscopic guidance and laparoscopic monitoring if necessary. Among them, 39 ( 97.5% ) cases were successful. Six cases were directly treated by laparotomy or laparoscopic focal resection and uterine repair.And 6 cases underwent conservative treatment without focal resection. 52 patients were cured successfully without any case of hysterectomy. Conclusion Transvaginal ultrasound is the preferred diagnostic method of CSP while MRI is an auxiliary method for diagnosis. The treatment of CSP should be based on blood β-HCG levels and lesion location, size, muscle thickness of surface, the condition of blood supply and vaginal bleeding. Different measures may be selected to kill embryos, stop hemorrhage and resect lesions.

Objective To identify the molecular biomarkers for cervical cancer in peripheral blood lymphocytes by oligonucleatide microarrays. Methods Human genome oligonucleotide microarray analysis included 4 early-stage cervical cancer patients and 3 controls. The selected genes from the microarray analysis were validated in additional 20 early-stage cervical cancer patients and 15 controls by real-time reverse-transcription polymerase chain reaction (RT-PCR). Results Genes identified by gene selection program were expressed differently in the blood samples of early-stage cervical cancer from those of healthy controls. To validate the gene expression data, 5 genes were analyzed by real-time RT-PCR. In three of 5 identified genes, tenasin-c, nucleolin, and enolase 2 (ENO2) showed a significant up-regulation in blood samples of early-stage cervical cancer patients versus that of the controls. Conclusion The up-regulation of tenasin-c, nucleolin and ENO2 in peripheral blood may be used to identify novel blood biomarkers for detecting cervical cancer in a clinically accessible surrogate tissue. Thus it may offer a possibility of developing a non-invasive and predictive diagnostic tool for the disease.

Objective To investigate the clinical significance of D-dimer contents in peripheral blood for monitoring the efficacy of thrombolytic therapy in patients with return of spontaneous circulation (ROSC) of cardiopulmonary resuscitation ( CPR ) cardiopulmonary resuscitation after cardiac arrest. Methods Forty-seven patients with sudden cardiac arrest received CPR according to 2005 American Heart Association (AHA) guidelines for CPR and emergency cardiovascular care (ECC). At the early stage of ROSC, those patients underwent head and breast CT scan if they were in a state of unconsciousness and had unstable vital signs. If intracranial hemorrhage, dissection of aorta and pneumothorax were rule out, and those patients who maintained blood circulation for over 24 hours were included. The expression of D-dimer contents in peripheral blood was determined at 0, 1, 2, 4, 8, 12 h after CPR in all patients. And the patients were randomly divided into control and experiment groups. Prior to thrombolysis, the patients whose D-dimer more than 512 μg/L were classified as Group A (n = 17 ); those whose D-dimer below 512 μg/L Group B ( n = 14); and the remaining control group whose family members refused thrombolytic therapy Group C (n = 16). The general data, Glasgow coma scale, survival rate and the change of D-dimer in peripheral blood were analyzed. Results In Group A, D-dimer level began to increase significantly at CPR 1 hour. It peaked at CPR 2 hours then decreased gradually. The final survival rate was 67%. The survival rate and CCS were higher than those of Groups B and C. In Group B, the D-dimer concentrations began to increase gradually at CPR1 hour, peaked at CPR 12 hours and then decreased. The survival rate and GCS was lower than those of Group A and similar to those of Group C. Group C was control group with no thrombolysis. Conclusion For those ROSC patients with D-dimer concentrations significantly higher than usual, the pathogenesis of cardiac arrest may be concerned with thromboembolism, thrombosis in circulatory system and hyperviscosity. After an initiation of thrombolytic therapy, blocked blood vessels are recanalized,blood circulation improves and the cause of cardiac arrest is removed. Thus their survival rate becomes better. For those with D-dimer concentrations no higher than usual, the cause of cardiac arrest is not concerned with thromboembolism, thrombolytic therapy can not improve the patient outcome. And the final survival rate remains unchanged. The significance of thrombolytic therapy is none.

Objective To evaluate the effect of high volume hemofiltration (HVHF) and its therapeutic timing on mortality in patients with septic shock. Methods Randomized controlled trials (RCT), case-control studies and prospective cohort studies on HVHF treating septic shock patients from 1999 to 2009 were identified by electronic and manually retrieving related data. An Meta-analysis of HVHF on mortality in septic shock patients was conducted through the methods recommended by the Cochrane Collaboration. Results 3 RCTs, 1 case-control study and 5 prospective cohort studies were selected. A total of 167 cases in 4 studies (3 RCTs, 1 case-control study) involving 79 HVHF and 88 LVHF groups were included for a Meta-analysis. The mortalities of septic shock in HVHF and LVHF groups were 40. 5%(32/79) and 72. 7% (64/88) respectively. As compared with traditional LVHF, HVHF could reduce the mortality in patients with septic shock [OR 0. 33, (95% CI,0. 17-0. 64); P ＜0. 01]. For 170 patients with septic shock in 5 prospective cohort studies, their mortality rates were improved by HVHF [OR 0. 31,(95% CI, 0. 19-0. 49); P ＜ 0. 01]. It was consistent with the results of 4 control studies. Only 2 studies indicated the early HVHF group versus the late HVHF group could improve the survival of septic shock.Since there was significant heterogeneity between them ( P ＜ 0. 05 ), it was better not to perform a Metaanalysis. Conclusion There is a beneficial effect of high volume hemofiltration on mortality in septic shock patients. Further studies of a larger sample of high quality RCTs should be carried out to guide its use.

Objective To detect and track the presence of magnetically labeled bone marrow stromal cells ( MSCs ) in vivo with magnetic resonance imaging ( MRI ) after autologous transplantation.Methods The cultured and SPIO-labcled MSCs were transplanted into dog femoral head. The dog received regular MRI re-examination at post-operation. Samples were harvested at different weeks for analysis.Results The labeled cells showed an obviously low intensity of signal change in MRI. There were lots of labeled cells in the transplant area and more bone formation than the controls. Conclusion The labeled ceils can be visualized in vivo by MRI examination after transplantation into femoral head. The transplanted MSCs survive in vivo and increase bone formation.

Objective To evaluate the controllability and reproducibility of a acute thromboembolic cerebral ischemia model for studying molecular imaging and thrombolysis in mice by 7. 0Tesla magnetic resonance imaging (MRI). Methods Twenty-four male C57BL/6J mice were randomly divided into embolic group (n = 14) and sham-operated group (n = 10). To prepare rich fibrin and optimal length of clots and measure diameters of clots under microscope, the clots were injected into internal carotid artery via a microcatheter inserted from external carotid artery to bifurcation of common carotid artery in embolic group.In sham-operated group, phosphate-buffered saline containing bovine serum albumin was injected similarly.At 1, 3 or 24 h after injection of clots or phosphate-buffered saline containing bovine serum albumin, mice underwent 7. 0Tesla magnetic resonance imaging including sequences of magnetic resonance angiography (MRA), diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) by arterial spin labeling technology (ASL) and T2 weighted imaging (T2WI) so as to evaluate the occlusive rate of middle cerebral artery (MCA) and the change of relative cerebral blood flow (rCBF) and lesion volumes. Triphenyl tetrazolium chloride (TTC) stain was performed at 24 h. Results The diameters of clots were 162 ± 14 μm.In embolic group at 1,3 or 24 h after injection of clots, the occlusive rate of MCA was 78. 6%, 71.4% and 57. 1% respectively. And the vglues of rCBF decrease in mice showing occlusion of MCA in MRA images.The percents of rCBF value in embolic group were 26% ± 10% at 1 h and 26% ± 15% at 3 h respectively.They were significantly lower than the percents of rCBF value in sham-operated group at the same time points. The percents of infarct volumes at 24 h were 30% ±4% from T2WI images and 30% ± 16% from TTC images. In sham-operated groups, both MRI and TTC images were negative. Conclusion A murine model of acute thromboembolic cerebral ischemia has been successfully established. The improved method is both stable and feasible. It may be readily evaluated from multi-parameter imaging by 7.0Tesla magnetic resonance imaging.

Objective To screen and identify the novel ovarian specific proteins to explore the possible mechanisms in the oogenesis and early embryo development. Methods The oocytes of BALB/C mice were collected for 2-D electrophoresis. After reaction with anti-citrulline antibody, three positive spots were selected for mass spectrometry. Based on the biologic informatic analysis, a novel peptide sequence was found and specific primers were designed for cloning. A full-length cDNA was identified by reverse transcription and rapid amplification of cDNA ends - polymerase chain reaction ( RACE-PCR ) . Its nucleotide and possible protein sequences were compared with those in the gene bank. And the tissuespecific characteristic of MOP53 was analyzed by Northern blot. Results A novel peptide sequence was found in murine oocytes, it came from a predicted protein with 330 amino acids. The predicted protein had ～53 400 and pI 8. 05 with conserved WD40, F-box motif. A full-length cDNA sequence with 1510 bp was cloned and named MOP53. Located at chromosome 9 F2, this new gene was specifically expressed in ovary.Conclusions An ovarian specific protein is found. It may be involved in the process of oogenesis and early embryo development based on its biologic informatic characteristics.

A 28-year-old female was admitted to our hospital on March 30, 2007 due to repeated fever, palpitations and shortness of breath after activity for half a year.The patient developed fever without trigger since November 2006, body temperature 37.5℃, no night sweats.The erythrocyte sedimentation rate (ESR) was 92 mm/h, antinuclear antibody and anti-DS-DNA were all (-), and tuberculin test (PPD) was (-). The anti-infection treatment was ineffective before, and the symptoms were improved after intermittent use of dexamethasone and prednisone, but the symptoms repeated after stopping the drug, so she was admitted to hospital for further diagnosis and treatment.

Neuropsychiatric lupus (NPSLE) is a serious complication of systemic lupus erythematosus (SLE), which can involve the central nervous system, peripheral nervous system and autonomic nervous system, and can also be manifested as a variety of psychiatric symptoms [1]. In 1999, the American College of Rheumatology (ACR) summarized the classification and definition of NPSLE, and divided NPSLE into 19 clinical subtypes [2]. The pathogenesis of NPSLE is still not completely clear, and most scholars believe that it mainly includes three aspects: vascular lesions, autoantibodies and inflammatory mediators [3]. Among them, autoantibodies have always been considered to play an important role in the pathogenesis of NPSLE, and the research has been the most in-depth at present. Anti-phospholipid antibody, anti-ribosomal P protein antibody and anti-RRNP antibody have been widely confirmed as antibodies related to NPSLE. In recent years, the correlation between anti-N-methyl-D-aspartate (NMDA) receptor antibody and NPSLE, especially the correlation between cognitive impairment and depressive state, has been increasingly paid attention to.

Castleman's disease, also known as giant lymph node hyperplasia or vascular follicular lymph node hyperplasia, is manifested as asymptomatic localized lymph node enlargement in the vast majority of patients clinically, and the prognosis is good after surgical resection of the tumor. However, this disease is accompanied by paraneoplastic pemphigus (PNP) is rare in clinical practice. Because such patients often have typical pemphigoid skin lesion as the first and main clinical manifestation, the diagnosis and treatment are delayed, or the prognosis is poor because of pulmonary lesion, so it should be paid great attention by clinicians. Since the first case of PNP in China was diagnosed and successfully treated in 1999, Peking University First Hospital has treated 8 patients with thoracic localized Castleman's disease with PNP. The clinical data are reported as follows.

The patient was a 29-year-old married female who was admitted to the hospital due to menopause for more than 2 months, vaginal bleeding for 20 days, lower abdominal distension and pain for 2 days. The patient was married for 7 years, had no contraception, had 0-0-3-0 childbirth, had a history of right ectopic pregnancy for 6 years, had two spontaneous abortions after operation, and the last abortion had been more than 3 years, and had a history of blood transfusion. Physical examination showed that the vital signs were stable, the uterus was anterior, slightly larger, the left adnex could reach 3.0cm ×3.0cm mass, tenderness (+), and there were no positive findings.

In order to understand the basic situation of gynecological urology work in China, during the third national gynecological pelvic floor academic conference on August 28, 2009, the pelvic floor group of obstetrics and gynecology branch of Chinese medical association conducted a survey on the diagnosis and treatment of urinary incontinence through a voting machine in the conference venue. 348 delegates were registered at the conference, and 240 voting machines were sent on the spot. The participants pressed the corresponding letters on the voting machine to select according to the options provided by the moderator on the big screen, and obtained various votes after the moderator stopped voting. According to the results of single selection by the voting machine, the data of domestic hospitals and gynecologists in the diagnosis and treatment of urinary incontinence are obtained, which are reported as follows.