Volume 91  ·   Issue 01  ·  2011

In the past year of 2010, this journal published a total of 736 essays, of which 572 were clinical studies (accounting for 77.7%). Among the clinical studies, retrospective studies accounted for about 63.0%, while prospective and randomized controlled studies only accounted for 37.0%. However, prospective randomized controlled studies are an important symbol reflecting the level of clinical research. At present, well-designed large-scale multicenter randomized controlled clinical trials are still rare in China. Among the published prospective studies, many studies lack statistical hypothesis and sample size calculation in design; In the comparative study of the efficacy between the two groups, it is not scientific enough to simply conclude that the difference in efficacy between the two groups is not statistically significant with P>0.05.

In recent 30 years, CT technology has been improved and matured after several leapfrogging technological progress. With the "back 64-slice CT machine" being put into clinical application one after another, CT technology has gradually developed into volumetric scanning, dynamic and functional imaging and lower radiation dose, which provides a better application platform for medical treatment, teaching and scientific research. Several articles published in this issue on the application of multi-slice CT in chest, discussed the clinical application value of multi-slice CT (MSCT) from the perspective of different system disease diagnosis.

Objective To investigate the impact of hart rate (HR) and reconstruction timing on image quality by a 320-detector row dynamic volume CT system (DVCT). Methods A total of 80 patients were examined by DVCT angiography. There were 43 males and 37 females with a mean age of 64 ± 8 years old. The heart rate (HR) was 47 - 128 beats per minute. The data were reconstructed by 10% steps throughout the R-R interval. And the data sets were evaluated by 2 independent readers for each major coronary vessel, namely right coronary artery, left anterior descending artery and left circumflex artery. The motion score for each vessel was graded from 1 ( no motion artifacts) to 4 ( severe motion artifacts over an entire vessel). The HR dependency of image quality was determined by an analysis of linear regression. The linear regression between HR and the optimal image quality in diastole or systole was also calculated.Results The average HR was 71 ± 15 beats per minute. And the image quality was significantly affected by HR (y = -0.154 +0. 022x, t = 11.0, P ＜0.01 ). According to this equation, images of grades 1 and 2 could be achieved at HR ＜98 beats per minute. The proportion of systole was influenced by HR statistically (t = 10.84, P＜0.01 ). With the increase of HR, the optimal systolic and diastolic reconstruction intervals all shifted to the later phases. The cut-off heart rate at which optimal reconstruction interval turned from diastole to systole was 93 bpm. Conclusion Coronary DVCT angiography provides quality diagnostic images within a wide range of heart rates. And the study of optimal reconstruction interval will help to reduce the imaging artifacts and lower the patient absorption dose.

Objective To study diagnostic and surgical significance of the multiplanar reconstrudion ( MPR)of spiral CT in sacral fracture with sacral neurological damage. Methods From April 2007 to April 2009, 10 cases of sacral fracture with sacral neurological damage in Shengjing Hospital of China Medical University were examined by double-oblique MPR of sacrum to show a total length of the sacral neural tube ,and observate course of sacral neural tube and the relationship between fracture and the neural tube. There were 7 males and 3 females, aged 30-55 years. The time from injury to hospitalization varied from 1 day to 1 months. The injury was caused by traffic accident in 6 cases, smash of heavy object in 3 cases and crush in 1 cases. All patients were examined with double-oblique MPR ( coronal oblique 45 degrees and 30 degrees oblique-shaped bit lost)to display the course of sacral neural tube and the condition of clearly, which was confirmed by operation and clinical validation. Results The clinical manifestations and international standards for Neurological Classifi cation of Spinal Cord Injury recommended by American Spinal Injury Association International Spinal Cord Society were the basis for clinical diagnose. Nerve injury diagnosed by clinical manifestation were S1 (6 cases), S2 (2 cases) ,S1 and S2(2 cases). After double-oblique MPR in patients ,we found 3 patients have fractures in sacral neural tube of S1, 1 patients in S2,and 2 patients both in S1 and S2,whom recovered average 12 month after operation( S1 and S2 nerve were pressed by fractures according to operating observation); And there were no fractures in sacral neural tube of other patients ( 3cases in S1, 1 cases in S2),these were contund, whom were recoverd average 13 month after expectant treatment. Conclusions Double-oblique MPR of sacrum has important clinical significance in diagnosis of nature and location with sacral nerve injury, as well as surgical planning. It can be used as routine examination of patients with sacral fracture.

Objective To evaluate the diagnostic performances of CT and MRI in patients with lumbar intervertebral disc herniation through the Meta analytical method. Method The relevant English and Chinese articles published between 1980 and 2010 were searched in PubMed, Medline, Ovid database,Cochrane library and Chinese Periodical Web. According to the criteria for diagnostic researches published by Cochrane Method Group on Screening and Diagnostic Tests, each article was critically appraised and screened with regards to the absolute numbers of true-positive, false-negative, true-negative and falsepositive. Statistical analysis was performed by the Meta-Disc version 1.4, SPSS 13. 0 and Comprehensive Meta-analysis version Ⅱ. Heterogeneity was tested and publication bias analyzed. And the pooled weighted sensitivity and specificity and the corresponding 95% CI were calculated. The summary receiver operating characteristic (SROC) curve was performed and the area under the curve (AUG) calculated to summarize and evaluate the diagnostic efficiency of CT and MRI in lumbar intervertebral disc herniation. Finally a sensitivity analysis was performed. Results According to the criteria of internalization, 9 articles were included. Among them, the themes were CT ( n = 3 ), MRI ( n = 3 ) and CT & MRI ( n = 3 ). Eight was prospectively studied and one retrospectively. At the diagnosis of lumbar intervertebral disc herniation, the pooled weighted sensibility and specificity and 95% confidence interval and area under SROC curve for CT to the lumbar intervertebral disc herniation was 0. 73 ( 0. 68-0. 77 ), 0. 78 ( 0. 72-0. 82 ) and 83.5%respectively. The MRI was 0. 88 ( 0. 83-0. 91 ), 0. 79 ( 0. 71-0. 87 ) and 88. 8% respectively. There was statistically significant difference in the pooled weighted sensibility ( P ＜ 0. 05 ); No statistically significant difference was found in the pooled weighted specificity ( P ＞ 0. 05 ); And there was statistically significant difference in the AUG curve ( P ＜ 0. 05 ). Conclusion After a meta-analysis of the diagnostic value of CT and MRI for the lumbar intervertebral disc herniation, MRI is more accurate than CT in the diagnosis of lumbar intervertebral disc herniation.

Objective To analyze the computed tomographic (CT) features of invasive pulmonary fungal infections ( IPFI ) and evaluate the value of CT-guided percutaneous biopsy. Methods Seventeen IPFI cases diagnosed by CT-guided percutaneous biopsy were recruited. The distribution, extent, density and size of IPFI were analyzed in correlation with the final diagnosis retrospectively. And the relationship with the causative factor of mycosis was also assessed. Results ① Candida albicans (n = 7 ) and cryptococcosis & aspergillus (n = 5 ) were identified. ② It showed segmental on lobar consolidation within lung field (n =6), mixture of patterns and nodule (n =4) and mass (n =7). ③The overall diagnostic accuracy of fiberoptic bronchoscopy examination was 35. 3％. ④The incidence of complicated pneumothorax was 11.8％ (2/17). These cases were self-limited without any special treatment. Conclusion The CT findings of PFI are too complex to be easily distinguished from other diseases. And the CT-guided percutaneous is a safe and effective procedure.

Objective To evaluate the characteristics of papillary structure of thyroidal lesions on MSCT (multiple-slice spiral computed tomography ) for the diagnosis of thyroidal diseases. Methods Thirty-five cases of thyroidal diseases pathologically confirmed with plain and contrast MSCT data from March 2003 to April 2010 were retrospectively analyzed. The number, margin, shape, enhancement behavior,location, calcification and the delineation of papillary structure were compared by the stata 10.1 software.Results There were statistically significant differences between thyroidal carcinoma, thyroidal adenoma and nodular goiter in margin, shape and location of papillary structure ( P ＜ 0.05 ). Papillary structure of thyroidal carcinoma was most commonly located in central part with an indistinct margin. Psammoma, such as microcalcification, was characteristic of thyroidal cancer. Coarse and peripheral calcification was commonly observed in nodular goiter. No statistical difference existed in the number and internal septa of papillary structure among thyroidal carcinoma, thyroidal adenoma and nodular goiter ( P ＞ 0.05 ). It could offer a more distinct visualization of papillary structure during the venous phase. Conclusion The features of papillary structure on MSCT of various thyroidal lesions may help make the differential diagnosis of thyroidal lesions.

Objective To analyze the high-resolution computed tomographic (HRCT) findings of IPF (interstitial pulmonary fibrosis), NSIP (nonspecific interstitial pneumonia) and COP (cryptogenic organizing pneumonia) retrospectively through quantification methods and to explore their distinguishing features. Methods Observers with no prior knowledge of the diagnosis evaluated the frequency, extent and distribution of various thin-section CT findings in 29 males and 17 females. The mean age was 50 ± 10 years old ( range: 25 - 76). They had a histological diagnosis of IPF ( n = 19), nonspecific interstitial pneumonia (NSIP) (n = 14) and cryptogenic organizing pneumonia (COP) (n = 13). Results Ground-glass opacity,thickening of bronchovascular bundles and interlobular septal thickening were frequent features of IPF and NSIP. The frequency and extent of honeycombing and bronchiolectasis were more found in IPF than in NSIP and COP ( P ＜0. 05). The frequency and extent of air space consolidation were more found in COP than IPF ( P ＜ 0. 05 ). There were more number of segments with traction bronchiectasis and less extent of air space consolidation in IPF than NSIP and COP. The number of segments with traction bronchiectasis was less in NSIP than that of IPF and COP. Conclusion The various subtypes of idiopathic interstitial pneumonias often have the distinguishing characteristics easily identified on HRCT. Bronchiolectasis and honeycombing are valuable features for IPF; air space consolidation is a valuable feature for COP. The features of NSIP are also found in both IPF and COP so that additional features are required for both.

Objective To assess the rate of complications of spine surgery and the therapeutic efficacy in the patients with Parkinson's disease (PD) and characterize the special needs of this unique population. Methods The data of 25 PD patients undergoing the spinal surgery from January 1998 to December 2006 were analyzed. The patients not followed on a regular basis by their spine surgeons were invited for a follow-up review. The points of analysis were complications, revisions and reasons of surgery failure. Results The mean follow-up period was 56. 3 months. Of 25 patients, 20 (80%) required additional surgery for a total of 25 reoperations. Three patients in need of additional surgery underwent another operation at a remote spinal segment. And 17 patients had the reoperations because of segmental instability at the operated or adjacent levels. Conclusion The PD patients undergoing spine surgery have a high reoperation rate associated with technical complications. They should be appropriately counseled regarding an increased risk of operative complications. A closely follow-up is essential.

Objective To explore the surgical indications and efficacy of lateral approaches in the removal of brainstem cavernous malformations retrospectively. Methods From July 1999 to June 2008, 10cases of brainstem cavernous malformations were removed via lateral approaches. Four of them had reached the lateral pial surface and 6 were covered by parenchyma or glial tissue. Three lesions were located dorsal to the cranial nerve roots and 4 lesions rostral to the facial nerve root. All 7 lesions were removed via the retrosigmoidal approach. Far lateral approach was used for 2 cases with the lesions ventral or caudal to the posterior cranial nerves. Subtemporal approach was adopted in 1 patient with the lesion ventral and rostral to the trigeminal nerve. The preoperative visual reality technique, in combination with intraoperative neuronavigation, was employed in the recent 3 cases to select a safe entry point on the surface of brainstem and a surgical corridor so as to maintain minimal damage to the surrounding fiber tracts and cranial nerve nuclei. Results Total lesion removal was achieved in all patients. Four cases of associated venous malformation were all preserved. The mean NIHSS score was 1.1 after a mean post-operative follow-up of 41months. Eight patients improved, 1 worsened and 1 remained unchanged versus the preoperative state.Conclusion Lateral approaches are recommended for lesions reaching the lateral glial surface or accessible via the lateral safe entry zone approaches.

Objective To study the impact of two human glioma tissue resistance genes MGMT and ERCC2 on the temozolomide-based treatment of malignant gliomas and detect the relationship of their expressions. Methods A total of 58 malignant glioma patients aged 19 -68 years old receiving a chemotherapy of temozolomide were followed up and classified as non-sensitive group (n = 30) and sensitive group (n = 28). Immunohistochemistry was employed to detect the expression rates of MGMT and ERCC2.And the correlation between the expressions of two genes was analyzed by immunohistochemistry and RT-PCR (reverse transcription-polymerase chain reaction). Results The expression rates of MGMT and ERCC2were 10. 71% and 3.57% in the sensitive group and 63.33% and 56. 67% in the non-sensitive group. It had an obvious correlation with the expressions of MEGT and ERCC2 through an analysis of immunohistochemistry and RT-PCR (both P ＜0. 01 ). Conclusion The expressions of MGMT and ERCC2in the sensitive group are markedly lower than those in the non-sensitive group. The expression of two genes may be related to tumor prognosis. Maybe these two genes have an intrinsic link between their expressions.Both participate in the repair of cellular DNA damage and the formation of tumor drug resistance. And the prognosis has obvious relevance.

Objective To explore the biomechanical effects on adjacent vertebra of thoracolumbar osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP) with cement leakage into the disc by using finite element analysis. Methods T10-L2 segment data were obtained from computed tomography (CT) scans of an elder female with single T12 OVCF undergoing a cement leakage into the T1 2-L1 disc after PKP. A three-dimensional finite element Model of thoracolumbar spine (T10-L2)was built in the Mimics and the ABAQUS software. The stress on annulus fiber, nucleus pulposus, endplate and facet joints under axial pressure (0. 3, 1.0, 4. 0 MPa) were analyzed. Results The 3D finite element after percutancous kyphoplasty (PKP) with cement leakage into the disc may be strongly related with the changes of biomechanical effects on adjacent vertebras of thoracolumbar OVCF. Models of thoracolumbar OVCF before and after PVP with a cement leakage into the T12-L1 disc were successfully established. The stresses increased with a rising axial pressure in the model of cement leakage into the disc after PVP, the stress augmentation scope on adjacent end plates ( T11 low plate & L1 top plate) and intervertebral disc (T11-12 & T12-L1 ) increased. The maximal Von Mises stress on adjacent vertebras (T11 & L1 ) increased while but the maximal Von Mises stress on end vertebras (T10 & L2) decreased. Conclusion Postoperative adjacent vertebral fracture.

Objective To study the prognosis of fibroid after ultrasound-guidance percutaneous microwave ablation (PMAUF). Methods From Mar. 2007 to Jul. 2010 forty uterine fibroids in forty patients with symptoms which were diagnosed in our hospital accepted PMAUF. One day after treatment blood supply within the fibroid was evaluated, by enhanced MRI. The size of fibroid was measured by ultrasonograpy in one year with 3 months interval ,the monthly menstrual of patient was followed and the mass discharge through vagina were collected for pathological examination. Results Among the 40 fibroid nodules, 22 are intramural fibroids, 15 subserosal fibroids and 3 submucosal fibroids. The baseline mean diameter of the fibroids ranged from (3.7 to 9.0 ) cm, with an average of ( 6. 4 ± 1.5 ) cm. The mean volume ranged from ( 14.6 - 341.1 ) cm3, with an average of ( 140. 1 ± 87.4 ) cm3. Three months after treatment, the anechoic zone was observed within the ablated nodules and disappeared in six to seven months. the echo of ablated zone keep higher than the surrounding tissue, whereas the size of fibroid shrank significantly. Meat tissue was discharged from vagina in 8 patients (2 cases of submucosal fibroids, 6 cases intramural fibroids) in the period of menstrual in 1 - 8 months after ablation. The largest dimension of the discharge was 2. 1 cm. Pathological examination confirmed the discharges as necrotic fibroid. The patients with subserosal fibroid had no discharge of necrotic tissue. The fibroid shrink rate was higher in the patients with vaginal discharges than that without vaginal discharges ( P ＜ 0. 01 ). Conclusions After PMAUF necrotic tissue of submucosal and intramural fibroids can be discharged through vagina, liquefaction in the center of subserosal and intramural fibroids may occur and be absorbed gradually, that may be the main reasons for fibroids reduced significantly or disappearance.

Objective To summarize the characteristics of the pathological anatomy and blood supply model of massive tuberculum sellae meningiomas (MTSM) and explore its corresponding microneurosurgical strategies. Methods The clinical data of 16 MTSM patients were reviewed retrospectively. From January 1998 to January 2010, according to their unique pathological anatomy and blood supply model, all patients underwent microneurosurgical removal with induced hypotension through tumor corridor by the bi-subfrontal anterior longitudinal fission ( n = 14), right frontolateral approach ( n =1 ) and pterional approach (n = 1 ). There were 5 males and 11 females with a mean age of 48. 5 years old ( range: 26 - 65 ). But the mean follow-up period was 74. 9 months ( range: 4 - 132) in 2/4 cases. Results Among all cases, the mean tumor diameter was 58.9 mm ( range: 51.1 - 76. 2 mm). Simpson grade Ⅰ, Ⅱ ,Ⅲ, Ⅳ removal of MTSMs were accomplished in 3, 9, 3 and 1 case respectively. One case died within 4postoperative days. Visual acuity improved in 10 patients, remained unchanged in 2 and deteriorated in 2.Transient postoperative diabetes insipidus occurred in 9 cases. Conclusion It is critical to understand the unique characteristics of pathological anatomy and blood supply model of MTSM so as to adopt proper microneurosurgical strategies to remove it in situ.

Objective To investigate polysomnographic determinants of excessive daytime sleepiness (EDS) and potential relationship in Chinese patients with obstructive sleep apnea-hypopnea syndrome (OSAS). Methods A total of 410 patients with obstructive sleep apnea-hypopnea syndrome were analyzed retrospectively who were obtained in Sleep medicine center of West China hospital from January to April in 2010. All of the patients with an apnea-hypopnea index (AHI) greater than 5 h-1 were evaluated using the Epworth Sleepiness Scale (ESS) and sleep disorders questionnaire. The patients who ESS score was more than 10 were defined as EDS; otherwise, the other was considered to without EDS. Results A total of 176 patients with EDS( ESS: 15 ± 3 ) and 234 without EDS ( ESS: 6 ± 3 ) were studied. Patients with EDS were slightly higher BMI (28 ±4 vs 26 ±4) and shorter REM sleep latency (99 ±65 vs 125 ±81 ) than patients without EDS. Furthermore, there were significant difference in awake SaO2, AHI, minimum SaO2,oxygen desaturation index and arousal index between EDS group were No-EDS group ( P ＜ 0. 001 ). There was a significant difference in waking SaO2 of severe OSAS between both groups. Conclusion Long-term chronic hypoxia already exists in severe OSAS patients with prominent sleepiness. Waking SaO2 may play a role as a predictor in evaluation and diagnosis in patients with OSAS.

Objective To observe and assess the cognitive changes of mild cognitive impairment (MCI) in the elderly. Methods A cohort study design was conducted among 47 patients with MCI and 21 control selected from the same convalescent camp, Montreal cognitive assessment ( MoCA ), mini mental state examination (MMSE)and clock drawing test (CDT) were performed to all subjects at the onset of study and 12 months later. Results The score of MMSE, CDT, MoCA and its subitems including visuospatial skill and delayed recall of MCI group were lower than the baseline afer12 months, with significantly decline in the score of MoCA( P= 0. 041 )and delay recall (P = 0. 003 ). There was no obvious difference in the score of control between the baseline and that afer12 months. Conclusion The decline of delayed recall occurred early and significantly, which may be a predictor in the conversion of mild cognitive impairment to dementia.

Objective To evaluate the accuracy of keratometric value derived from one zone of Orbscan Ⅱ mean power map after Laser in situ keratomileusis (LASIK) in combination with Holladay IOL Consultant software to calculate the intraocular lens (IOL) power. Methods A two-part study was conducted at a referral practice. Part 1 was a prospective study of 118 eyes undergoing LASIK. The changes in Orbscan Ⅱ mean power maps at four central zones ( 1.5, 2. 0, 2. 5 and 3.0 mm) were compared with the cornea power calculated from pre-LASIK data to determine the optimum Orbscan Ⅱ correlation zone. In Part 2, the power of optimum measured by Orbscan Ⅱ after LASIK was applied to IOL calculations for 62 eyes undergoing LASIK. And the results were compared with the IOL power calculated by the pre-LASIK data.Results ( 1 ) An analysis at the Orbscan Ⅱ 1.5 mm measurement zone demonstrated an underestimation of net cornea power after LASIK while the 3.0 mm zones demonstrated an overestimation. The 2.0 mm and 2.5mm zones best approximated the net cornea power calculated from pre-LASIK data; (2)The cornea power at 2. 5 mm from Orbscan Ⅱ was selected for IOL calculations in combination with Holladay IOL Consultant software Holladay Ⅱ and HofferQ formula. The refractive error calculated by Holladay Ⅱ and HofferQ formula were (0. 47 ± 0. 75 ) D and (0. 52 ± 0. 83 ) D versus the IOL power calculated by clinical history method. The refractive errors of two formula within ± 0. 50 D were 48.4% and 43.5% and within ± 1.0 D 80. 6% and 74. 2%. Conclusions The cornea power from 2. 5 mm Orbscan Ⅱ zone after LASIK in combination with Holladay Ⅱ or HofferQ formula can accurately predict the IOL power for cataract surgery.

Objective To study the feasibility of applying autogenous pulmonary tissue flap with alloy stent to correct the defects of trachea and esophagus. Methods Twenty-four dogs were divided into tracheal and esophageal groups. Bronchus was ligated to prepare a pulmonary flap. And a defect of 3 -4 cm long and 1/2-2/3 perimeter was made in tracheal or esophageal wall. Pulmonary arteries and veins were protected. Then the pulmonary gas was emitted to create a pulmonary tissue flap. The defect was repaired with a pulmonary flap with a self-expanded stent inside. The gross appearance, histological appearance, CT and barium X-ray films were observed at Weeks 2, 4, 6 and 8 post-operation. Results Eighteen experimental dogs survived over 2 weeks. Anatomotic leak was the main cause of death. Two dogs died of perforation of ulcer in esophageal group. Reliable cicatrisation was observed between the pulmonary tissue flap and damage area. A quick growth of new tracheal and esophageal epithelium was observed from periphery area to central area. During the first 2 weeks, a little epithelization was observed at free edge of anastomosis equivalent to 1 - 2 layers of new epithelial cells. At weeks 4-6 post-operation, the internal surface of defect was covered with 3 - 5 layers of epithelial cells. At Weeks 8-10 post-operation, the luminal surface was covered with 6 - 8 layers of stratified epithelial cells. More ulcers could be observed on the surface of pulmonary tissue flap in esophageal group. In pulmonary flap, massive fibrous tissue proliferated and fibroblasts were active, but no necrosis occurred. CT and barium X-ray showed no obstruction in anastomotic stoma. Conclusion With an excellent compatibility with epithelial cells of trachea and esophagus, the autogenous pulmonary tissue flap can support the mucosal crawl in the defect of trachea and esophagus. When combined with alloy stent, it may be a choice procedure for reconstructing the defect of trachea and esophagus.

In recent years, the incidence of liver cancer in the world has increased obviously, and it is estimated that more than 1 million new cases are added in the world every year. The mortality rate of liver cancer is the third after gastric cancer and esophageal cancer. In addition, hepatitis B virus infection and other problems have not been effectively controlled, and the incidence of liver cancer is still on the rise. Searching for convenient and effective methods to prevent and treat liver cancer has become the focus of current cancer research. Surgical resection is still the first choice for the treatment of liver cancer nowadays, but with the progress of technology, many non-surgical treatment methods such as non-waterless sperm injection, radiofrequency ablation and transcatheter hepatic artery chemoembolization are attracting people's attention [1]. In order to further improve the targeting of liver cancer treatment, increase the local drug concentration and reduce the toxic and side effects of drugs, drug-loaded nanoparticles are developing rapidly as a new treatment method. Drug-loaded nanoparticles are controlled at the scale of 1~1000nm by physical and chemical technology. Under this nanometer scale, due to the effect of surface effect and small volume effect, The molecular properties have changed greatly, as the surface area increases, the selective adsorption capacity of the molecule is significantly enhanced, and the colloidal stability of the particle is significantly improved. By coupling the drug to this kind of specially modified nanoparticles, the drug can be targeted transport, local high concentration slow release, and the specific curative effect can be improved and the toxic and side effects can be minimized [2-3]. In recent years, drug-loaded nanoparticles technology has become a hot spot in the research of targeted therapy of liver cancer because of its many advantages.