Volume 91  ·   Issue 09  ·  2011

Objective To study the mechanism of sacral plexus injury resulting from zone- Ⅱ sacral fractures by axial compression. Methods Six short-term embalmed pelves were obtained with preserving sacral plexus and resected pubic symphysis. A model of zone- Ⅱ sacral fractures by axial compression was established. Quantitative analysis for fracture displacement was carried out to observe the characteristics and mechanisms of sacral plexus injury. The experimental data were analyzed by SPSS 10.0 statistic software.Results In the sacral fracture model of axial compression, the sacral plexus nerves of L5 and S1 were obviously compressed. The sharp border of fracture segment stabbed the nerves as the distal segment of fractures was displaced to superior-anteriorly. When the displacement exceeded 1 cm, the tension injury of sacral plexus nerves became noticeable, especially at L5, S1 and S2. There was no sacral nerve injury when the distal segment of fractures was displaced posteriorly. Conclusion The mechanisms of sacral plexus injury are complicated. And it probably have close correlations with stability, orientation, extent and duration of fracture displacement.

Objective To evaluate the safety and efficacy of remifentanil-propofol and remifentanilmidazolam analgesia for choledochofiberscopic dilatation of bile duct. Methods 95 patients undergoing choledochofiberscopic dilatation of bile duct were reviewed, 43 of which were dealt with remifentanil-propofol (PR) and 52 with remifentanil-midazolam (MR). After medication, changes of HR, MAP, RR and SPO2were observed. The effects of sedation and analgesia, the instance of amnesia, and side effects were recorded. Results HR in group PR and MR were increase at 10 to 20 min and 20 min respectively after medication. MAP in group PR was increased at 20 min, which were decreased in group MR ( P ＜ 0. 05 ).Compared with group PR, group MR achieved similar analgesia ( P ＞ 0. 05 ), more moderate sedation with modified OAA/S score of 3 -4 (67% vs 28%, P ＜0. 01 ), less memory, less injection pain, and higher satisfaction ( P ＜ 0. 05 ). Conclusion Both remifentanil-propofol and remifentanil-midazolam can provide safe and effective sedation and analgesia for choledochofiberscopic dilatation of bile duct. Remifentanilmidazolam provides more stable hemodynamics, more amnesia, moderate sedation duration and less side effects.

Objective To investigate the effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperative intractable atelectasis. Methods For this prospective study, we recruited 18 patients with pulmonary atelectasis who could not been relieved by bronchoscopic suctioning,closed thoracic drainage, backslap, blowing hall and other routine treatments for over a week. After bronchial intubation, ipsilateral lung was expanded with a constant pressure. And the therapeutic effect was evaluated by chest radiographic examination and auscultation at the following day. Results Collapsed lung tissue were examined in 15 patients (83.3%) after the first treatment and in 2 patients ( 11. 1% ) after twice inflation. And another case failed even after three times treatment. During the procedure, the vital signs of all patients were stable and no complication occurred. Conclusion Constant-pressure expanding of ipsilateral lung during bronchial intubation is a safe and effective treatment for postoperative intractable atelectasis.

Objective To evaluate the diagnostic value of multi-slice CT (MSCT) reconstructions for congenital vascular rings together with tracheal stenosis. Methods 9 cases of children with congenital vascular ring and tracheal stenosis confirmed by surgery were collected in the study, all cases had undergone thin slice CT contrast enhancement, the MSCT data were transmitted to the workstation for multiplanar reconstruction( MPR), volume rendering technique(VRT) and VR transparency resconstruction. With the surgical results as the gold standard, the imaging characteristics of echocardiography (UCG) and MSCT were comparatively analyzed. Results In 9 cases, there were 4 cases of pulmonary artery sling, 3 cases of right aortic arch combination with left aberrant subclavian artery, 1 case of double aortic arch, Ⅰ case of innominate artery compression syndrome. In this group, 5 cases were accompanied with other cardiac malformations (tetralogy of Fallot in 2 cases, double outlet right ventricle with patent ductus arteriosus and ventricular septal defect in 1 case, ventricular septal defect in 1 case, double superior vena cava in 1 case),1 case of tetralogy of Fallot demonstrated many tortuous collateral arteries around aorta. All malformations were well displayed by VRT, MPR. VR transparency resconstruction can stereoscopically display trachea and bronchial compression condition, the main trachea was compressed in 6 cases, the main trachea and left main bronchus was compressed in 2 cases, the main trachea and left main bronchus was compressed in 1 cases,UCG detected all intracardiac malformations, 1 case of pulmonary artery sling was misdiagnosed as patent ductus arteriosus, 8 cases of vascular rings, tracheal and bronchial stenosis were missed. Conclusion MSCT reconstruction technology is a noninvasive, rapid diagnostic method, it can clearly show the congenital vascular rings abnormalities and the degree of tracheal stenosis, it has important significance for clinic treatment.

Objective To evaluate the clinical characteristics of pelvic lymph node metastases in patients with early-stage cervical carcinoma. Methods The clinical, pathologic and follow-up data of patients with cervical carcinoma treated at our hospital from June 2006 to May 2008 were collected and analyzed retrospectively. The relevant literature was reviewed. Results The median age at diagnosis was (45.6 +3. 8) years old. Among these patients, 587 patients ( 92. 3% ) were of squamous cell cervical carcinoma while 49 patients ( 7. 7% ) cervical adenocarcinoma. But the differences of pelvic lymph node metastases were not significant ( P ＞ 0. 05 ). The overall prevalence of lymph node metastasis was 10. 9%(69/636). The rate of pelvic lymph node metastases became significantly high up from the clinical stage Ⅰb1.When the pelvic nodes were positive,the obturator group was involved in 69 cases (69/120). Conclusion There is an increased rate of pelvic lymph node metastasis in the patient groups of clinical stage Ⅰb1- Ⅱ. And the obturator group is predominantly involved. Thus a routine pelvic lymphadenectomy is essential.

Objective To study the expression of nociceptin in adenomyosis tissue and understand its relationship with the severity of dysmenorrhea. Methods The myometrial specimens were collected from 55 patients undergoing hysterectomy at our hospital during December 2007 and June 2008. Their mean age was 41 -52 years old. There were 34 adenomyosis patients in case group and 21 other patients in control group. Immunohistochemical staining was employed to detect nociceptin in eutopic endometrium and ectopic endometrial tissues in case group and normal endometrium and myometrial tissues in control group. Results The expression of nociceptin was significantly higher in the eutopic endometrial tissue ( 7. 1 ± 1.7 ) of case group than those in endometrial(2.7±2.0 ) and myometrial tissues of control group ( P ＜ 0.05 ); The expression of nociceptin was higher in the eutopic endometrial tissue (7.4±1.5) of dysmenorrhea group than that of non-dysmenorrhea group ( 5.0 ± 1.2 ) in case group ( P ＜ 0.05 ); The expression of nociceptin in eutopic endometrium and myometrium was the highest in severe dysmenorrhea group ( 8.4 ±1.3 ). And the non-dysmenorrhea and mild dysmenorrheal groups had no significant differences [(5.0 ± 1.2 ) vs (6.8 ± 1.4)]. And it decreased gradually in moderate dysmenorrhea, mild dysmenorrhea and nondysmenorrhea groups. Conclusion A high expression of nociceptin in adenomyosis may be one of the casual factors of dysmenorrhea. The severity of dysmenorrhea is positively correlated with the expression of nociceptin in eutopic endometrial tissue in case group ( r = 0.515, P = 0.034) and ectopic endometrium tissue. And the endometrial expression of nociceptin may be monitored dynamically to track the development of adenomyosis.

The researchers developed a long-lasting anti-cocaine immunity in mice by inoculating them with a safe vaccine that combines the cold virus with cocaine-like particles. The research was funded by the National Institute on Drug Abuse and the results were published online in Molecular Therapy on January 4, 2011.

The patient, a 30-year-old woman, was admitted to our hospital on April 29, 2010 due to repeated pus and blood in stool for 7 years, intermittent fever with pain in both lower limbs for 2 years. The patient developed diarrhea and pus and blood in stool without trigger 7 years ago, about 10 times/d, each time with a dose of about 10 ml. Multiple colonoscopies in other hospitals showed diffuse congestive edema and erosion of the whole colon, needle-tip ulcer, and crypt abscess was found in colon mucosal biopsy. She was treated with prednisone 50 mg once a day and sulfasalazine 3 g once a day. The dose of prednisone was gradually reduced to 5~10 mg once a day, and the symptoms could be controlled. She stooled 1~2 times a day, which was yellow shaped stool, but there was still no trigger for recurrence and aggravation 1~2 times a year, lasting about 1 week.

A 67-year-old female was admitted to the hospital on August 5, 2009. No obvious abnormalities were found in clinical laboratory examination. CT examination after admission showed that the cystic low-density shadow on the right side of the pericardium was observed on plain scan, with uniform internal density, thick wall and calcification (Figure 1A). After enhanced scan, the lesion wall was obviously strengthened, but there was no enhancement, and the lesion invaded the ventricular wall and protruded into the right ventricular cavity (Figure 1B, 1C).

Objective To identify the differential microRNA expression profiles of acquired radioresistant esophageal cell line established by fractionated ionizing radiation (FIR) versus parental cell line. Methods MicroRNA microarray was employed for detection. Bioinformatic software tools were used to predict the target genes of identified microRNAs. For an understanding of miRNA functions, the GO analysis of abundantly differentially expressed targets of miRNAs was performed by GeneOntology Browser. Results Compared with parental cell line, 10 microRNAs (hsa-miR-1539, bsa-miR-1237, hsa-miR-92b, etc. ) were up-regulated over 2-fold and 25 microRNAs (hsa-miR-185, hsa-miR-18b, hsa-miR-17, etc. ) downregulated in KYSE-150R. Eighteen miRNAs had their target genes, 10 of them had the potential to individually target up to 200 mRNAs. Hsa-let-7a, bsa-miR-185, hsa-miR-141, hsa-miR-92b, hsa-miR-22 and hsa-miR-301a were known as important genes associated with radioresistance. Conclusion These results confirm the involvement of miRNA in radiation resistance. It may potentially help to explain the mechanisms of gene regulation in cellular response to radioresistance.

Objective To study the registration method based on structured light scanning for navigation assisted spinal surgery and assess its accuracy so as to construct a registration system for the navigation assisted spinal surgery using structured light scanning. Methods Both the computed tomographic (CT) dataset and the structured light scanning images of thoracic vertebra were obtained. The preregistration and multi-segment iterative closest point (ICP) algorithm were used for the registration of CT images and structured light images. Four segmentations were selected from the surface of thoracic vertebra and placed into different combinations. The accuracy for each combination was studied. Noise and perturbation were exerted to structured light and registration accuracy was studied. And calf vertebra was used for further verification. Results A combination of pre-registration and multi-segment iterative closest point (ICP) algorithm was competent for the registration of CT scanning data and the structured light scanning data. The registration error was less than 1 mm when two and more segments were selected for registration combination. The registration error was less than 1 mm when noise was exerted. Conclusion With a high accuracy and a perturbation resistance, a combination of pre-registration and multi-segment registration algorithm based on structured light scanning is competent for the registration of CT scanning data and structured light scanning data.

osteofascial compartment syndrome (OCS) is a series of early symptoms and signs caused by acute progressive ischemic necrosis of the muscles and nerves in the osteofascial compartment formed by bone, interosseous membrane, intermuscular septum and deep fascia, which may occur in any part of the limb.

Pathological anatomy has played a very important role in the establishment and development of modern medicine. In the establishment and development of modern medical pathological anatomy, the contribution of our country to modern medicine is not commensurate with the proportion of its population. One of the important reasons is that cultural customs and psychology hinder the development of pathological anatomy in China.