Volume 90  ·   Issue 39  ·  2010

The aim of cancer pain treatment is to relieve pain, improve quality of life, prolong life and restore function to the greatest extent. By actively treating the primary disease, systematically applying analgesics and other adjuvant therapies, about 80% of cancer patients can satisfactorily relieve pain, but still 20% of cancer patients, especially those with advanced tumors, have stubborn pain and are insensitive to analgesics, or have untolerable side effects.

Objective To address the clinical features of malignant lymphoma(ML)occurring in primary Sj(o)gren's syndrome(pSS), understand their similarities and differences and explore their risk factors.Methods Medical records of 17 cases of pSS/ML inpatients admitted to our hospital from January 1980 to August 2010 were systemically reviewed.And 163 cases were randomly selected as controls from 4485 pSS/nML inpatients at our hospital during the same period.Results There were 14 females and 3 m ales with the diagnostic age of pSS at(53 ± 13)years old.And the disease duration was(8 ± 9)years.There was no significant difference between two groups in three general aspects(P ＞ 0.05).The gap between pSS and M L was(4 ± 4)years.Several significant differences existed between two groups(P ＜ 0.05)in clinical features and laboratory findings: lymphadenopathy, parothydomegalia and leucopenia.The pathologic categories of ML in pSS/ML included NHL(n = 15)(14 cases of B-cell origin), HL(n = 1)and lymphosarcoma(n = 1).Conclusion During the course of pSS, the occurrence of such manifestations as lymphadenopathy, parothydomegalia and leucopenia, etc.tends to have a complication of ML with a dominance of NHL.And a worse prognosis is expected.

Objective To evaluate the clinical value of video-assisted thoracoscopic extended thymectomy for myasthenia gravis(MG).Methods Sixty-two MG cases underwent video-assisted thoracoscopic extended thymectomy.The operative extension included thymus tissue and adipose tissue in anterior superior mediastinum.Results All operations were performed successfully.The mean operating duration, mean intraoperative blood loss and mean postoperative hospital stay was 98 ± 26 minutes, 60 ± 29 ml and 8.2 ± 2.5 days respectively.All cases were followed up for 5 to 48 months.Among them,20(32.3%)patients achieved a complete relief, 32(51.6%)had their improved symptoms, 8(12.9%)remained stable and 2(3.2%)became worse.And the overall relief rate was 83.9%.Conclusion Videoassisted thoracoscopic extended thymectomy is both feasible and reliable for MG with the advantages of a minimal trauma and a rapid recovery.

Objective To analyze the prognostic factors for patients with stage Ⅰ non-small cell lung cancer.Methods A total of 224 patients with stage Ⅰ non-small cell lung cancer operated from 1999 to 2004 were retrospectively reviewed.The clinical profiles of age, gender, T grade, type of resection, tumor pathological typing, tumor cell differentiation and post-operative chemotherapy were analyzed by SPSS 13.0 statistic software.Results The five-year survival of stages Ⅰa and Ⅰb non-small cell lung cancer were 78.7% and 51.5% respectively.In univariate analysis, T grade and tumor cell differentiation were independent prognostic factors respectively.In multivariate analysis, T grade and tumor cell differentiation were independent prognostic factors for overall survival.Conclusion There are significant differences in the five-year survival of stages Ⅰa and Ⅰb non-small lung cancer.Both tumor stage and tumor cell differentiation were independent prognostic factor for overall survival.

Objective To explore the dynamic magnetic resonance(MR)imaging findings of chromophobe cell renal carcinoma and evaluate its pathological correlation.Methods Twelve cases with chromophobe cell renal carcinoma confirmed by surgical pathology underwent MR plain scanning and dynamic enhancement scanning before operation.And the MR data were reviewed and analyzed retrospectively in comparison with surgical and pathological results.Results Twelve lesions were located in right kidney(n =9)and left kidney(n =3)with a mean tumor diameter of 7.3 cm(range:3.2-12.6 cm).They were located in renal cortex(n = 1), renal medulla(n = 9)and the middle of cortex and medulla with a relatively normal renal shape.Nine lesions appeared global and 3 elliptic in shape.Well-defined margin was showed in 12 lesions and a thin capsule was observed in all lesions.The tumor presented a low to middle homogeneous signal intensity on T1 WI and intermediates homogeneous signal intensity on fat saturated FSE-T2WI with a hypointense thin capsule and a hyperintense central scar.A mild-to-middle degree of tumor enhancement in cortical phase(tumor SI change 120.3% with a standard deviation of 84.3 and a median of 115.2%)was slightly lower, isointense or slightly higher than renal medulla.And obvious enhancement in portal venous phase(tumor SI change 173.7% with a standard deviation of 92.4 and a median of 171.5%)was lower than renal medulla.Conclusion Chromophobe cell renal carcinoma typically forms large and wellcircumscribed global solid masses in renal medulla.With a relatively normal renal shape and a thin capsule,it shows intermediate homogeneous signal intensity on T1WI and T2WI.And a middle degree enhancement with central stellate scar is found in some patients.

Objective To explore the applications of blood oxygenation level dependent-functional magnetic resonance imaging(BOLD-fMRI), diffusion tensor imaging(DTI)and cortical somatosensory evoked potentials(Co-SEP), motor evoked potentials(MEP)and lectrocorticogram(ECoG)in secondary epileptic surgery of primary motor area(M1).Methods In 19 patients, preoperative BOLD-fMRI were performed to display the relationship between active zone, fiber bundle and epileptogenic lesions.Besides,Co-SEP, MEP and ECoG were also carried out intra-operatively to direct the resection of epileptogenic lesion and epileptogenic focus.At the same time, the nervous functions were protected as much as possible.Then fMRI was performed again to ensure that the post-operative nervous function was excellent.Results In preoperative BOLD-fMRI and DTI examinations, active zone and fiber bundle could be seen at the edge of lesions(n = 12);range reduced, become deformed or removed(n = 6);glioma epileptogenic lesion was close-up with M1(n = 1).The central sulcus was confirmed by Co-SEP in all cases.And two cases were inconsistent with anatomical location;Stimulating precentral gyrus, MEP were elicited post-operatively from orbicularis oris, muscle of thenar, hypothenar muscle or flexor digitorum brevis.Under the monitoring of ECoG, spike-wave was monitored in all cases.Of these, epileptogenic focus was in M1(n = 15).After treatment, spike-wave were reduced significantly or disappeared.At a post-operative follow-up of 6-12 months, seizure improvement has achieved Engel Ⅲ level or above(n = 18).On re-examinations of BOLD-fMRI and DTI, active zone became bigger than before and fiber bundle was symmetric with opposite side.Two of 19 cases had transient motor aphasia incompletely or hemiparesis.No permanent neurological dysfunction occurred.There was no relapse in cases of glioma.Conclusion BOLD-fMRI and Co-SEP, MEP and ECoG are complementary in M1 of secondary epilepsy surgery.It is effective to preserve nervous functions and enhance the quality of life for patients with epilepsy.

Medical imaging examination is a commonly used diagnostic method in clinical practice. Imaging changes are the reflection of pathological changes, but different pathological changes often have similar imaging findings, which brings great difficulties to diagnosis. In order to promote the exchange of clinical imaging diagnosis experience and improve the level of diagnosis and differential diagnosis, Chinese Medical Journal has opened the column "Clinical Medical Imaging" since the first issue of 2001, which provides a display garden for special, rare but clinically inspiring imaging manifestations, so that local and personal experiences can be used for reference by clinicians as soon as possible, and valuable first-hand information can be accumulated for clinical medical imaging diagnosis.

Objective To discuss the effect of SB Charité lumbar artificial disc position on intervertebral range of motion(ROM)and clinical management.Methods Between 2004 and 2007, 30 discogenic low back pain patients confirmed by discography underwent 1/2-level total disc replacement (TDR)implantation with 32 prostheses.There were 12 males and 18 females with a mean age of 44 years old (range:28-55).All indexed levels were inserted between L4-S1 involving L4-5(n =9), L5S1(n = 19)and L4-S1(n =2).The clinical outcome was measured by Oswestry disability index(ODI)and visual analogue scale(VAS).Radiographic outcome measures included flexion/extension ROM, restoration of operative level intervertebral disc height, maintenance of disc height at the final follow-up.A technique previously described by McAfee was used to evaluate TDR position in three groups.Paired t test was used to compare the preoperative and postoperative ROM and clinical ODI, VAS scores.Results Twenty-eight patients were followed-up for 24-60 months with an average of 38 months.All the prostheses were solidly immobilized with the vertebral endplate.No disc prosthesis rupture, dislocation, subsidence or heterotopic ossification was observed.Preoperative ODI, VAS back pain and VAS leg pain scores were 70.34 ± 9.21, 7.46 ± 2.65,4.81 ± 2.75;and postoperative corresponding scores 7.65 ± 8.61, 0.68 ± 0.69, 0.35 ± 0.32respectively.The positions of disc prostheses were graded as Group Ⅰ , excellent, n = 17;Group Ⅱ,suboptimal, n = 6;Group Ⅲ, poor, n = 5.Preoperative mean intervertebral flexion/extension ROM (degree)of Group Ⅰ to Group Ⅲ were 9.75 ± 2.80, 10.30 ± 1.20 and 10.08 ± 2.43 respectively.The postoperative mean intervertebral flexion/extension ROM(degree): 6.68 ± 3.83, 4.22 ± 3.51 and 3.48 ± 3.56 respectively.Postoperatively all clinical outcome scores were lower than preoperative ones.Disc height was significantly restored.Mean intervertebral ROM decreased versus preoperative.Although there was a tendency of mean intervertebral ROM increasing with a better disc position, no statistical difference was observed.Conclusion The mid-term clinical outcome of TDR is generally satisfactory.The TDR position influences intervertebral ROM to some extent.Efficient clinical management can reduce prosthetic malposition.

Objective To investigate the relationship between imaging and pathological findings of avascular necrotic of the femoral head(ANFH).Methods A comparison among of conventional radiography, computerized tomography(CT), magnetic resonance imaging(MRI), gross section and pathological examinations was performed in 20 femoral heads in 15 patients undergoing total hip replacement for established ANFH.Results ANFH involved the anterosuperior aspect of femoral head in all hips.Necrotic femoral heads consisted of cartilage, necrotic area, reactive repaired area and extralesional area. The reactive repaired area surrounded necrotic area. Imaging findings;① on conventional radiography and CT, as compared with the extralesional area, the necrotic area appeared to be of an equal density(11),a lower density(7)and a higher density(2)On MRI, the necrotic areas revealed adipose intensity(3), bloodlike intensity(1) , aquatic intensity (2) ,fibrous intensity (9) and non-homogeneous intensity(5); ②the reactive repaired area separated the necrotic and extralesional areas.Both on plain radiography and CT,the reactive repaired area showed a sclerotic band surrounding the necrotic area and a hypo-density inner line adjacent to sclerotic band was seen in 11 femoral heads on CT and 7 on conventional radiography.A band of low signal in the proliferative zone was seen on MRI in all hips and a rim of high signal intensity inside the low-signal margin(double-line sign)was seen in 3 hips on T2W images.Conclusion Conventional radiography, CT and MRI can display the grossly discernable necrotic, reactive repaired and extralesional areas accurately.Characteristic imaging findings are observed in the reactive repaired area.

Objective To investigate the radiographic and computerized tomographic features of chest in patients with acute chlorine poisoning and its diagnostic value.Methods Twenty-eight cases of chlorine poisoning were reviewed.And their radiographic and computerized tomographic features were compared and analyzed.Results Radiographic findings: Among 28 patients, 9 cases were normal and 2 cases had no abnormalities on the first chest X-ray and became abnormal one or two days later.And there were abnormal findings in first chest X-ray in 17 patients: acute tracheal inflammation of peribronchitis (n = 3), acute chemical bronchopneumonia(n = 6)and diffuse interstitial and central pulmonary edema (n = 8).CT manifestations: At Days 1-3, the patients of mild poisoning had scattered patchy dense shadow;those of moderate to severe poisoning showed multiple patchy or diffuse infiltration(ground-glass opacity).And partial consolidation, air bronchogram and pleural effusion could be observed.At Days 4-10, the manifestations of mild poisoning were largely absorbed;those of moderate to severe poisoning manifested the absorption of diffuse or multiple patchy effusion and a fading of shadow.And the size of lung consolidation became smaller than before.At Day 10 after onset, 4 patients completely recovered.At Days 30-40, 6 cases showed traces of fibrous shadow and one case showed small punctiform opacities in both lungs.And at Day 42, there was slight ground-glass change.Conclusion Acute chlorine gas poisoning in varying degrees may manifest acute bronchial pneumonia and acute pulmonary edema.During treatment, a series of chest X-ray examinations will help to follow the changes of disease.And CT examination can offer a more accurate evaluation of lung lesions.

Objective To investigate the cutaneous adverse reactions to antiepileptic drugs (AEDs), clinical characteristic and the association with HLA-B * 1502.Methods A retrospective analysis of four cases of antiepileptic drug hypersensitive syndrome(AHS)were performed on the basis of clinical data, cutaneous adverse reactions to carbamazepine(CBZ)(n = 2)including Stevens-Johnson syndrome (SJS)(n = 1)and hypersensitivity syndrome(HSS)(n = 1);phenobarbital-induced HSS(n = 1)and oxcarbazepine(OXC)-induced HSS(n = 1).All patients received the examinations of polymerase chain reaction(PCR)with sequence specific primers to analyze HLA-B * 1502.Two healthy subjects had no history of using antiepileptic drugs as the control.Results All patients had manifestations of fever,eruption, mucosal involvement and visceral injury.Two cases were diagnosed as Stevens-Johnson syndrome associated with apparent bullae formation.Genotype positive for HLA-B * 1502 was association with 2 patients with CBZ/OXC-induced SJS while the other 1 case of CBZ and 1 case of phenobarbital-induced HSS were genotype non-HLA-B * 1502.Conclusion AHS usually occurs within 1 to 2 weeks after initiation of AEDs therapy.The typical presentations are fever, eruption and internal organ involvements, etc.The epileptic patients with CBZ/OXC-induced SJS are related with HLA-B * 1502 genotype.But it is not found in HSS patients.

Objective To investigate the role of autophagy in oxidized low density lipoprotein(ox-LDL)induced injury of human umbilical vein endothelial cells(HUVEC).Methods The cultured HUVECs were randomly divided into four groups of control, ox-LDL, ox-LDL + rapamycin and ox + 3-methyladenine(3-MA).The cells were used to detect the ratio of LC3-Ⅱ/LC3- Ⅰ by Western blot while the proliferation and apoptosis of cells measured by MTT and flow cytometry.The lactate dehydrogenase(LDH)activity and endothelin-1(ET-1)content in the supernatant were detected with enzyme linked immunosorbent assay.Results The Ox-LDL treatment up-regulated the ratio of LC3-Ⅱ/LC3-Ⅰ in HUVEC (P ＜ 0.01).It increased the activity of LDH(P ＜ 0.01)and content of ET-1(P ＜ 0.05)in the supernatant.Also it induced the proliferation(P = 0.028)and apoptosis(P ＜ 0.05)of cells.The autophagic inducer rapamycin increased the up-regulation of autophagic level induced by ox-LDL, decreased the activity of LDH and content of ET-1(P ＜ 0.05)and inhibited the ox-LDL-induced proliferation of cells.Conversely, the autophagic inhibitor 3-MA decreased the elevation of LC3 - Ⅱ/LC3 - Ⅰ induced by ox-LDL(P ＜ 0.01)and increased the cell apoptosis and death.Conclusion Ox-LDL exposure can increase the secretion of LDH and ET-1 and induce the proliferation and apoptosis of cells so as to cause a harmful effect in the survival of HUVEC.The injury may be reduced by rapamycin, an autophagic inducer, and elevated by the autophagic inhibitor 3-MA.

Objective To investigate the effect of focal cerebral ischemic preconditioning on the expression of nuclear factor kappa B(NF-κB)and its target gene inducible nitric oxide synthase(iNOS)and to explore its role in ischemic tolerance in rats.Methods A total of 32 SD rats were divided into 4 groups.The control group received sham surgery(SS)twice only.The IPC +SS group received 10 minutes of ischemic preconditioning(IPC)followed by SS 3 days later.And the other two groups received 2 hours of middle cerebral artery occlusion(MCAO)followed by 22 hours of reperfusion with or without IPC 3 days before.The ultrastructure, NF-κB activation and iNOS mRNA transcription were evaluated in each group by electron microscope, immunohistochemistry staining and reverse transcriptase polymerase chain reaction (RT-PCR)respectively.Results(1)In contrast with the SS + SS group, there was a lower NF-κB immunoreactivity(57.3 ±6.3)and iNOS mRNA level(29.1% ±3.1%)in the IPC +SS group while no ultrastructural abnormality was identified.(2)The expression of NF-κB/iNOS was down-regulated in the IPC + MCAO group(81.2% ±7.3%/89.0% ± 5.3%)than in the SS + MCAO group(98.9% ±9.4%/132.8% ± 7.9%, P ＜ 0.01)with minor ultrastructure abnormality.Conclusion A down-regulated expression of NF-κB/iNOS is a key event in the molecular mechanism of cerebral ischemic tolerance.And the NF-κB/iNOS pathway might play a dual role in endogenous neuroprotection induced by focal IPC.

Objective To investigate the expression of Arc mRNA in insular electrical kindled and single electrical stimulated rats and its significance.Methods Male SD rats were divided randomly into kindled group, single electrical stimulated group, sham-operated group and control group.Each group was divided into 2 sub-groups at different time points.Kindled group: establishing chronic insular electrical kindled model, decapitating to perform RT-PCR of Arc mRNA on hippocampus and to applying in situ hybridization of Arc mRNA on dentate gyrus;Single electrical stimulated group: using the same method as the kindled group with only electrical stimulation twice;Sham-operated group: using the same method to the kindled group without electrical stimulation;Control group: no surgery.Results Expression of Arc mRNA in the hippocampus of single electrical stimulated, sham-operated and control groups were 0.72 ± 0.14,0.75 ±0.16 and 0.71 ±0.14 respectively.They were significantly less than the kindled group of 1.78 ±0.43(P＜0.01)at 3 h.The expression of Arc mRNA had no significant difference(P ＞0.05)among 4 groups at 6 h;in situ hybridization(cell count)of Arc mRNA showed the expression of Arc mRNA in the kindled group was 112.8 ±6.0.And it was significantly higher than the other three groups of 46.25 ±4.35,45.25 ± 6.23, 44.75 ± 6.49(P ＜ 0.01)after 3 h, there were no significant difference among 4 groups at 6 h (P ＞ 0.05).Conclusion Insular epilepsy increase the expression of Arc mRNA in hippocampus.Arc may play an important role in the synaptic plasticity of insular epilepsy.

Objective The vaccines currently developed against infectious diseases fail to induce effective antiviral immune responses to control an abrupt outbreak of viral diseases epidemic in a short space of time.Hence there is an urgent need to develop emergency vaccines capable of producing prophylactic effects against infectious diseases.RNA interference(RNAi)is a mechanism that inhibits gene expression by causing the degradation of specific RNA molecules or hindering the transcription of specific genes.The rapidity and uniqueness of RNAi responses can make up for the current inadequacy of antiviral preventive regimes.Here we evaluate the antiviral potential of short hairpin RNA(shRNA)targeting C(core)gene of hepatitis B virus(HBV).It plays essential roles in HBcAg encoding and viral attachment to susceptible cells during its life cycle.The present study was intended to investigate the inhibitory effect of C-specific shRNAs on HBV replication and expression in BHK-21 cells.Methods The reporter gene expression vector of pC-EGFP-N1 was constructed by cloning the DNA(PCR product)of HBV C into the EcoR Ⅰ-Hind Ⅲ sites of pEGFP-N1 to fuse C to enhanced green fluorescent protein(EGFP)for providing a reporting system for monitoring siRNA function.Plasmid pC was constructed by cloning the DNA of HBV C into the EcoR Ⅰ-Hind Ⅲ sites of pCDNA3.1B(-)directly under the control of cytomegalovirus promoter.Two plasmids(S1 & S2)were constructed to express shRNAs targeting C of HBV with the length of 24 nucleotide(nt)homologous in sequence to the HBV C gene.Plasmids were designed and synthesized according to the HBV genome(HBV genotype B, ayw1 subtype)of chronic hepatic B patients from 56 ethnic minorities in China.After cloning and sequencing, the investigators registered them with the GenBank accession numbers of AY517488(CYN/2002)and AY517489(CYN/2000), etc.Simultaneously, one of nonspecific shRNA-S3 with a length of 24 nt was also designed randomly for negative control.After cloning into vector pU6 for constructing shRNA-expressing plasmids, they were then cotransfected into BHK-21 cells along with reporter gene expression vector of pC-EGFP-N1.First, upon a determination of the number of cells exhibiting EGFP expression in BHK-21 cells as detected by an Olympus BH-2 fluorescence microscope and FACS-440 flow cytometry(Becton-Dickinson, USA)at different times after cotransfection, the investigators evaluated the gene inhibitory efficiency of both plasmids by an EGFP reporter system in BHK-21 cells.Subsequently, the antiviral efficacy of both plasmids in BHK-21 cells was further investigated by real-time quantitative polymerase chain reaction.Results In comparison with single plasmid transfection pC-EGFP-N1 or pEGFP-N1, fluorescence microscope and flow cytometry detection at 24 h post-cotransfection revealed that the expression of reporter gene EGFP in cotransfection group involving S1 or S2 and S1 + S2 cotransfection group was reduced significantly by about 90% in EGFP signal versus the control.And the EGFP expression in control plasmid cotransfected S3 or pU6 was not significantly reduced in BHK-21 cells(P ＜ 0.01).It was found that the expression of mRNAs of HBV C and EGFP gene as detected by real-time quantitative PCR was the same as that detected by fluorescence microscope and flow cytometry(P ＜ 0.01), thereby further corroborating the antiviral efficacy of RNAi.The antiviral efficacy extended to almost 48 hours.The results indicted that a DNA vector-based RNAi technology could effectively and specifically inhibit the replication and expression of HBV in BHK-21 cells.Conclusion For the first time it has been found that RNAi induced by shRNA targeting C gene exerts an effective and unique inhibition of HBV replication and expression in BHK-21 cells.Thus RNAi may provide an effective emergency vaccine against major infectious diseases such as HBV infection.

Pain after joint surgery can affect the implementation of rehabilitation plan and increase postoperative complications, such as delaying the recovery of muscle strength, prolonging the time of joint stiffness and joint pain, thus affecting the surgical outcome. Especially for arthroscopic surgery, although it reduces surgical trauma, reduces postoperative complications and shortens the rehabilitation time, the incidence of moderate and severe postoperative pain is still as high as 76% [1].

Objective To explore the clinical utility of penile augmentation with prepuce retrocession for redundant prepuce.Methods From May 2008 to May 2010, 80 patients of redundant prepuce were surgically corrected by the following steps: injecting physiological saline to make penile erect,sliveing penile inner board, maintaining subcutaneous tissue, fascia, blood vessel, lymphatic ducts and nerve between inner and outer board, pushing and flattening fat and clumsy tissue and keying approximation so as to augment penile diameter.Results Excellent penile functions were achieved.After a 6-month followup, the operative outcome was satisfactory without any complication.The operation with modified circumcision with penile augmentation had the following advantages of a lesser blood loss, mild postoperative edema, no secondary hemorrhage or infection, a quick recovery and a good appearance of penis.Conclusion Treatment of redundant prepuce by penile augmentation with prepuce retrocession is an effective method.

Patient 1, male, 34 years old, cough and sputum for half a month, fever for 6 days, cough and sore throat appeared half a month ago, fever 6 days ago, body temperature 39.9 ℃, slightly improved 2 days after cefoperazone and sulbactam treatment, blood in sputum 3 days ago, body temperature 38.0 ℃, fatigue, blood gas analysis 2 days ago: pH 7.24, PCO2 53 mm Hg (1 mm Hg =0.133kPa), PO253 mm Hg, BE-5.1 d Anterior obvious dyspnea, chest CT: diffuse lesions in both lungs; Throat swabs of A H1N1 M gene, NP gene and HA gene (+) were transferred to our hospital after ventilator-assisted ventilation.

A 56-year-old male was diagnosed with gallstones in many hospitals due to recurrent right upper abdominal pain for more than 1 year. He went to a hospital and asked for laparoscopic cholecystectomy.

At present, there is a serious disconnect between basic research and clinical work in the medical field. Many basic researchers are not concerned about whether their research results can solve actual clinical problems; However, the clinical medical staff do not know the latest basic research results and progress [1]. This phenomenon makes the two can't serve each other effectively.