Volume 90  ·   Issue 47  ·  2010

Objective To explore the relationship between cervical spondylosis and male erectile dysfunction (ED) and to evaluate the clinical characteristics of male cervical spondylosis patients with ED. Methods Nineteen cases of male cervical spondylosis patients under 55 years old, who experienced some problems of their erectile function after the onset of cervical spondylosis, were surgically treated between March 2008 and March 2009 at our hospital. Their clinical characteristics were reviewed and clinical data prospectively analyzed. Preoperative and postoperative international index of erectile function (IIEF-5)and JOA (Japanese Orthopedic Association) scores and the correlation of improvement rate of these two scores were analyzed statistically. Results The average age of this patient group was 48. 8 years old. Twelve cases underwent anterior approach surgery while the other 7 cases posterior approach surgery. The mean follow-up period was 11.8 (5 - 18) months. All cases showed the clinical and radiological findings of spine cord compression. The preoperative and postoperative IIEF-5 scores were 12. 1 ± 5.6 and 17. 6 ± 5.5 respectively. There was obvious statistical difference between two scores (P = 0. 002). Among all patients,the erectile function of 84. 2% improved on the last follow-up. The mean improvement rate of erectile function was 39. 8% while the mean improvement rate of JOA scores 59. 3%. But there was no correlation .between these two rates (P = 0. 172). The improvement rate of erectile function showed no statistical difference between two surgical approaches (P = 0. 934) either. Conclusion Cervical spinal cord compression may be related with male erectile dysfunction besides motor and sensory dysfunctions. Surgical decompression may help to improve the erectile function. However, there is no correlation between the improvement rate of IIEF-5 scores and that of JOA scores. Future studies of a larger sample size are needed to further elucidate the underlying mechanism.

Objective To study the correlation of compensation by collateral circulation and clinical locations in ischemic stroke cases. Methods A total of 25 ischemic stroke cases were retrospectively analyzed. MRI (magnetic resonance imaging) and DSA (digital subtraction angiography) were performed in all cases. Each patient was found to have at least one cerebral artery occlusion by DSA. The quantity relationship between collateral circulation and ischemic stroke location was analyzed by SPSS 11.5 statistics software. Results Among all cases, 46 arterial occlusions were found by chance. DSA demonstrated internal carotid artery occlusion (n = 24) and vertebral & basilar artery occlusion (n = 22). And all cases had at least one collateral circulation. Among 23 cases of single collateral circulation, there were 8 cases of single ischemic stroke locations and 15 cases of multiple ischemic stroke locations; among 23 cases of multiple collateral circulations, there were 18 cases of single ischemic stroke locations and 5 cases of multiple ischemic stroke locations. Conclusion Effective collateral circulation can be established spontaneously through multiple ways when cerebral artery occlusion takes place if an intact Wills circle is present. Multiple collateral circulations may significantly decrease the quantity of ischemic stroke locations.

Objective To observe the clinical efficacy and adverse effects of taxel plus carboplatin （TP） or gemcitabine plus carboplatin （GP） in patients with advanced non-small-cell lung carcinoma. Methods A total of 86 patients with advanced non-small-cell lung carcinoma with a histologically confirmed diagnosis at our department were treated with at least two cycles of drug therapy according to the WHO standard. There were 43 cases in TP group and 43 cases in GP group. TP group： taxel 150 mg/m2, d1, carboplatin 300 mg/m2 in d1; GP group：gemcitabine 1000 mg/m2, 30 min, d1, 8, carboplatin 300 mg/m2 in d1, 3 weeks a cycle. The efficacy and side effects were analyzed after two cycles of chemotherapy. Results When TP and GP groups were compared, the effective rate was 44. 2% vs 39. 5%; disease control rate （CR ＋ PR ＋SD）： 81.4% vs 74. 4%; median time to progress （TTP）： 4. 6 vs 4. 5 months; medium survivals： 8.6 vs 8. 8 months; 1-year survival rates： 17. 2% vs 18. 1%; 2-year survival rates： 8% vs 10%. The statistic analysis showed that the two groups had no significant difference. The main cytotoxicities of GP and TP groups were predominantly thrombocytopenia and leucopenia respectively. The two groups had no significant statistical difference. The incidences of allergen, alopecia and peripheral neurotoxicity were higher in the TP group. The two groups had statistical difference. Tolerance was excellent in both groups. Conclusion The therapeutic effect and tolerance are excellent for advanced non-small cell lung carcinoma. The efficacy and survival rate of two groups show no statistical difference.

Objective To analyze the different success rates of air enema in intussusception cases at different ages and evaluate the value of plain film in assessing the pathogenetic condition of intussusception and intussusception with vascular compromise in children. Methods A retrospective analysis was performed on the success rates of air enema in 1119 pediatric cases of intussusception at different ages. The radiographic findings of 190 cases were analyzed. Air enema reduction failed in 95 cases. And 95 control cases were randomly selected for reduction by air enema. Their operative and pathological data were analyzed and compared with the findings of plain film. Intestinal obstruction with vascular compromise was analyzed by a comparison of plain film and pathology. The plain films of patients were analyzed by two experienced radiologist independently. Whenever there was dissension, they discussed and reached an agreement. Results In all cases of intussusception, the successful reduction rate was 91.5%. The cases within l-year-old were 627 cases, air enema success rate was 87.1% and the success rate of air enema was 97.2% in beyond 1-year-old group. There was significant difference between two groups （x2 = 36. 01, P 〈0. 01）. In 95 cases of failed air enema reduction, 14 cases were ileoileal, 10 ileocaecal and 25 ileocolic.And 44 cases were ileoilealcolic and 2 ileocoliccolic. Eleven cases had intestinal necrosis. Four cases had small bowel duplication cyst and 3 with Meckel＇s diverticulum. Intestinal obstruction with vascular compromise in plain film had a high concordance with pathology （kappa = 0. 7128）. The pathology type was somewhat correlated with the finding of plain film （P 〈 0. 01）. As assessed by plain film, there were intussusceptions with vascular compromise （n = 30） with a coffee-bean sign or banana sign, a paucity of bowel gas （n = 36）, quadrant gas （n = 51） and mass or crescent （n = 73）. Through an analysis between plain film signs and the onset of symptom by Spearman correlation （nonzero correlation = 20. 67, P 〈 0. 01）,there was statistical significance. Conclusion The successful rate of air enema in intussusception is lower in within 1 -year-old group than beyond 1 -year-old group. The sign of plain film is more significant in assessing the pathogenetic conditions of intussusception. And it has a high concordance with pathology in assessing the intestinal obstruction with vascular compromise.

Objective To analyze the characteristic of atypical adenomatous hyperplasia (AAH) in lungs though its computerized tomogaphy (CT) scan, pathology and surgical mode. Methods The investigators retrospectively evaluated 10 atypical adenomatous hyperplasias (AAH) that were histologically confirmed and that manifested pure ground glass opacity (GGO) on thin-section helical CT scans. There were 2 males and 8 females with a median age 54. 4 years old. All patients had the surgery. Their characteristic of CT scan and pathology were compared. All received a follow-up. Results In all cases,peripheral nodules were located at left upper lobe (n =4), left lower lobe (n =2) and right lower lobe (n =4). GGO at a diameter of 0.5 -1.2 cm was manifested on thin-section helical CT scans. The borderline of GGO was distinct and there was an equal density. Two of 10 cases underwent a wedge resection and 8 lobectomy. Postoperative patients recovered quickly without severe complications. Microscopically it manifested an apparent local pattern of alveolus epithelium hyperplasia in lungs. The alveolar interval had a slight increase. Local hyperplasia of fibrous cells was present with a slight degree of nucleus heteromorphism. The follow-up period was 2 months to 5 years. Ten patients with an excellent life quality survive without recurrence and metastasis. Conclusion The preoperative diagnostic rate of AAH is boosted by high-differentiation enhancement CT scan and CT number histograms. But a definite diagnosis still requires the histological evidence. Surgery is one of the most reliable therapy for AAH.

Objective To investigate the value of magnetic resonance diffusion weighted imaging (DWI) in the differential diagnoses of malignant and benign thyroid lesions. Methods Using echo planner imaging sequence with b value of 0, 100, 200, 300 and 400 s/mm2 respectively, DWI was performed in 60 patients of focal thyroid lesions. The diagnosis was confirmed by pathological examination (benign, n =30; malignant, n =30). Apparent diffusion coefficient (ADC) values were measured. The differences were analyzed between two groups. Results With b value of 0, 100, 200, 300 and 400 s/mm2 respectively,there were statistical differences in ADC values between benign and malignant lesions. The ADC value of malignant lesions was smaller than that of benign lesions (P ＜ 0. 05). Among different b values, 400 s/mm2 was the most optimal one to diagnose thyroid nodular lesions. DWI with a b value of 400 s/mm2 had a proper signal-to-noise ratio (SNO). And ADC value could be measured correctly. With a b value of 400 s/mm2 and ADC of 1. 475 × 10-3 mm2/s, receiver operating characteristic curve was plotted. In the diagnosis of malignant lesions, the sensitivity and specificity were 93.3% and 96.7% respectively. Conclusions The ADC value of malignant thyroid nodular lesions is smaller than that of benign lesions. The values of DWI and ADC are important in the differential diagnoses of nodular thyroid lesions.

Objective To evaluate the distributions of primary nasopharyngeal carcinoma (NPC) and the patterns of skull base involvement in NPC patients using magnetic resonance imaging (MRI).Methods After the approval of institutional review board and informed consent, 838 consecutive newlydiagnosed and untreated NPC patients were examined by MRI. Their MR images were reviewed by two independent radiologists. Results Among all cases, the incidence rates of superior side and post-superior side involvement were 98. 57% (826/838) and 98. 21% (823/838) respectively. The differences were not significant between these two sides (P ＞ 0. 05). Lateral side erosion was demonstrated in 784 (93. 56%)cases. Posterior side was involved in 391 (46. 66%) cases. The total incidence rate of skull base involvement was 65.51% (549/838). According to the anatomic site, the pathways of skull base involvement were classified into 5 spreading routes: anterior; superior; super-lateral; super-anterior and super-posterior. According to the incidence rates and the results of chi-square test, the anatomic sites around the nasopharynx were classified into three groups of risk grades: high-risk (≥35%), medium-risk (≥5%-35%) and low-risk (＜ 5%). Conclusion Skull base involvement of NPC spreads stepwise from proximal site to more distal sites. The area of skull base involvement in NPC is classified into high-grade,medium-grade and lower-grade groups respectively. The high and medium-grade groups are related with T3 stage while the lower-grade group T4 stage. Thus T3 stage should be subdivided into T3a and T3b. These schemes may be useful in a more accurate NPC staging and a delineation of clinical target volume for radiotherapy in NPC patients.

Objective To examine the prognostic factors and efficacy of myasthenia gravis (MG) in crisis on plasmapheresis and detect the reasons for ineffective plasmapheresis. Methods The investigators analyzed a total of 69 MG patients in crisis on plasmapheresis by case control study. Gender, age at onset of myasthenic symptoms, duration between the onset of crisis and plasmapheresis, pre-therapeutic use of glucocorticoids, pulmonary infections, other complications, nutritional status, history of thymectomy in 48 hours before crisis, thymic pathology, combined intravenous immunoglobulin (IVIG) and total sessions of plasmapheresis were measured retrospectively. Results Univariate analysis showed that pulmonary infections (P = 0. 000, OR = 29. 250), history of thymectomy in 48 hours before crisis (P = 0. 046, OR = 0. 267),combined intravenous immunoglobulin (P = 0. 003, OR = 0. 136) and total sessions of plasmapheresis (P =0. 022, OR = 0. 498) were all influencing factors of plasmapheresis. However the analysis of multivariate logistic regression revealed that pulmonary infections (P = 0. 000, OR = 23. 600) was an independent risk factor and combined intravenous immunoglobulin (P = 0. 047, OR = 0. 192) was an independent protection factor of plasmapheresis. Conclusion Plasmapheresis is ineffective in MG crisis with pulmonary infections.Control of pulmonary infections and combined intravenous immunoglobulin can improve the response to plasmapheresis in patients with MG crisis.

Objective To evaluate the outcomes of modified transforaminal lumbar interbody fusion in patients with lumbar disc herniation. Methods Forty-six cases of lumbar disc hemiation were treated by modified transforaminal lumbar interbody fusion. There were 32 males and 14 females with a mean age of 47 years old (range :27 - 65). The mean course of disease was 7.5 years (range :4 - 18). Eighteen cases were of single-level lumbar disc herniation, including L3/4 (n = 5), L4/5 (n = 8) and L5/S1 (n = 5).There were 28 cases with lumbar degenerative diseases at other levels. Preoperatively, the score of visual analogue scale (VAS) was 8. 9±1.3 and the score of Oswestry disability index (ODI) was 57. 3 ±5.2. All patients received a normal conservative treatment for at least 3 months with no therapeutic effect at preoperation. Results Forty-six cases had an average follow-up of 20 months (range:12-20). The operative duration was an average of 160 minutes (range: 120 - 180). And the average volume of intra-operative blood loss was 550 ml (range:400-800). There was no severe complication. The symptoms became stable after three months. At 3 months postoperatively, the score of VAS was 2. 0 ± 0. 4 and the score of ODI 15. 2 ±3.4. And there were significant differences between preoperative and postoperative values (P＜0. 05). The improvement rates of postoperative VAS and ODI were(80. 1 ±4. 7)%and(73.6 ±2. 8)% respectively. All patients achieved lumbar interbody bone fusion at 12 months post-operation with a fusion rate of 100%. For the therapeutic effect, 34 cases were regarded as excellent, 8 good and 4 fair with an excellent/good rate of 91.3%. All patients began to walk with orthosis after 3 days and resumed their jobs and normal lives after 3 months. Conclusion Modified transforaminal lumbar interbody fusion is effective for the treatment of lumbar disc hemiation. Making a detailed operative plan on the basis of preoperative images and symptoms is essential.

Objective To investigate the relationship between glenoid inclination or version and supraspinatus tendon full-thickness tears. Methods Forty-two cases of unilateral supraspinatus tendon fullthickness tears were confirmed by clinical examinations and MRI scans. The bilateral glenoid inclination and version angles, measured by the volume rendering technique (VRT) and multi-planar reformation (MPR) of multi-slice computed tomography (MSCT) under 16-slice spiral CT scans, were compared by paired t test in all cases. Results The average inclination angle was (97.6 ± 4. 0) ° and (96. 1 ± 2. 9) at affected and healthy sides respectively. And the difference had statistical significance(P = 0. 001); the average version angle was (- 3. 2 ± 5.0) ° and (- 3. 1 ± 4. 7) ° at affected and healthy sides respectively. And the difference had no statistical significance (P = 0. 79). Conclusion The glenoid inclination angles are correlated with supraspinatus tendon full thickness tears while but the glenoid version angles are not. A larger glenoid inclination angle may be a positive predictive factor of supraspinatus tendon full-thickness tears.

Surgical lung volume reduction in emphysema can improve exercise tolerance and prolong survival in appropriate patients.However, the use of this method is limited by high perioperative mortality and complications.Early uncontrolled studies of the transbronchoscopic technique demonstrated that the use of one-way valves placed in the airway can improve lung function and clinical symptoms with fewer complications.Sciurba et al. conducted a prospective randomized multicenter study and the results were published in the September 23, 2010 issue of the New England Journal of Medicine.

Objective To construct the lentiviral vector containing SOX9 gene and to detect its expression in MSCs derived from rabbit bone marrow. Methods Human sox-9 gene coding region fragment was obtained by RT-PCR (reverse transcription-polymerase chain reaction) and then cloned into the plasmid of Pwpxl-MOD2 to form Pwpxl-MOD2/SOX9. Pwpxl-MOD2/SOX9, pRsv-REV, pMDlg-Prre and pMD2G were co-transfected into 293T cells to obtain recombinant virus containing SOX9 gene. Meanwhile, Pwpxl-MOD2, pRsv-REV, pMDlg-pRRE and pMD2G were transfected into another group of 293T cells as a control group packing into blank lentiviral vector. Then the packed lentiviral vector was transfected into MSCs which derived from rabbit bone marrow. The expression of SOX9 was detected by both RT-PCR and Western blot. Identification and proliferation of MSCs was determined by MTT after transfection. Results The sequencing and restriction analysis showed that SOX9 gene fragment was correctly connected and cloned into the plasmid Pwpxl-MOD in lentiviral vectors. After transfection, the expression of SOX9 gene in MSCs was confirmed by RT-PCR and Western blot. MTT showed the growth of MSCs had no significant effect after transfection with lentiviral vector. Conclusion Lentiviral vector carrying SOX9 gene has been successfully constructed. There is a stable expression in transfected MSCs. Thus it will facilitate the exploratory development of gene and biological therapy for intervertebral disc degeneration.

Objective To explore the effects of paeoniflorin on the proliferation and apoptosis of HeLa cells. Methods HeLa cells treated with paeoniflorin at different concentrations for different hours were assessed by the method of methyl thiazolyl tetrazolium (MTT). Cell apoptosis rate and cycle change were detected by flow cytometry with annexin V-fluorescein isothiocvanate (FITC)/propidium iodide (PI). The morphological change of HeLa cells was observed by transmission electron microscope (TEM). The expressions of Bcl-2, Bax and Caspase-3 in HeLa cells induced by paeoniflorin were detected by immunocytochemistry. Results After treatment with different concentrations of paeoniflorin for different hours, the proliferation of HeLa cells was inhibited in a dose and time-dependent manner with an IC50 value of 5054, 2965, 2459 μg/ml at 24, 48 and 72 hours respectively (P ＜ 0. 05). After treated by different concentrations of paeoniflorin (control group, 1000 and 2000 μg/ml), apoptosis was induced in HeLa cells at a rate of 0. 94%, 10. 94% and 13.95% respectively. Such effects were dose-dependent (P ＜0. 05) and the proportion of HeLa cells in Sphase was under a rising trend. Typical apoptotic changes of HeLa cells under the exposure to paeoniflorin were observed under TEM. There was a lowered expression of Bcl-2 and an elevated expression of Bax and Caspase-3 genes versus the control group after a 48-hour paeoniflorin treatment (P ＜ 0. 05). Conclusion Paeoniflorin can significantly induce the apoptosis of HeLa cells through a down-regulation of anti-apoptotic gene Bcl-2 and an up-regulation of pro-apoptotic genes Bax and Caspase-3.

The patient was a 63-year-old male who suddenly experienced nausea and vomiting after drinking alcohol. The vomit was coffee-like substance, accompanied by acid reflux and burning pain in the upper abdomen. He was admitted to hospital for 6 times, with a total amount of about 300 ml. He felt dizziness, fatigue and palpitations after defecation. Physical examination showed acute disease, mild anemia, unpalpable and swollen superficial lymph nodes throughout the body. Bilateral respiratory movement was symmetrical, and no dry and wet roar was heard in both lungs. The abdomen was flat, there was no tenderness in the whole abdomen, no mass was palpable in the abdomen, and the mobile voicing was negative. Blood routine: white blood cells 16.78×1012/L, NE 86.84%, red blood cells 3.02×1012/L, hemoglobin 82 g/L, platelets 195×1012/L. Gastroscopy: esophageal mucosa was smooth, with a small amount of fresh blood attached.

A 49-year-old woman appeared in the left medial corner of her eye without obvious trigger more than 10 years ago. She often felt itchy in the corner of her eye. Nine years ago, she went to a local hospital and was diagnosed as "benign tumor" by tissue biopsy (details unknown) without further treatment. In the past 5 years, the mass gradually increased to the size of a knuckle, and could be palpable under the upper and lower eyelids of the left eye on the nasal side. The mass partially protruded outside the orbit, accompanied by epiphora in the left eye, and the eyeball protruded, and the rotation to the medial side was slightly limited. There was no redness, swelling and pain of the eyelid, no diplopia and no visual loss. She was admitted to the hospital as "left orbital tumor".

The patient was a 34-year-old male. He was admitted to hospital on December 28, 2008 due to limb weakness for 12 days, ptosis of both eyelids, diplopia, dysphagia, and slurred speech for 10 days. The patient had a history of "upper respiratory tract infection" 6 days before the onset of the disease, and then gradually developed symmetrical limb weakness from distal to proximal end, difficulty going up and down stairs, easy tiredness, gradual inability to walk, inability to hold objects with both hands, accompanied by eye movement difficulty, double vision, vague speech, dysphagia, choking and coughing after drinking water, often feeling chest tightness and dyspnea. The symptoms worsened after exertion and alleviated after rest, without obvious light in the morning and heavy in the evening. He was healthy in the past. The physical examination on admission showed: breathing difficulty, vague and deep speech, ptosis of both eyelids, 1/3 of the pupils, fixed eyeballs, slightly poor muscle strength when closing eyes, weak bulging cheeks, air leakage from bilateral mouth corners, pharyngeal reflex, and weak lifting force of soft jaw; Shrugging weakness, distal muscle strength grade 2, proximal muscle strength grade 3, low muscle tone, tendon reflex disappeared; Bilateral symmetric peripheral pain hypopnosis below the wrist and below the knee.