Volume 91  ·   Issue 19  ·  2011

According to the latest survey of death causes of residents in China by the Ministry of Health, cerebrovascular disease has risen to be the first cause of death among urban and rural residents in China [1], and cerebrovascular disease is still the first cause of long-term disability. However, after the occurrence of cerebrovascular disease, there is no particularly effective treatment at present. The endovascular interventional technique developed in recent years has shown great clinical application potential in the prevention and treatment of cerebrovascular disease in the acute phase. In the near future, endovascular interventional technique may become an important means of prevention and treatment of cerebrovascular disease.

Stroke is the third highest mortality rate and the first disability rate among adults in Europe and America, and most of them are ischemic stroke [1]. In China, ischemic stroke is also the most common type of stroke, accounting for 60% ~80% of all strokes [2].<The thrombolytic method of intravenous tissue plasminogen activator injection reported in New England Journal became the first and the only recognized effective method for ischemic stroke [3]. Since then, the application of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in ischemic stroke has been rapidly spread in Europe, America and China [2, 4].

Objective To assess the efficacy and safety of alteplase in acute ischemic stroke for Chinese patients aged 75 years and elder.Methods A total of 32 patients aged 75 years and elder are selected from our departmental database of thrombolytic therapy from January 2005 to December 2008.The primary end points were the proportion of patients with a modified Rankin scale(mRS)score of 0 to 1 at 3 months and the incidence of symptomatic intracranial hemorrhage(sICH)within 36 hours.Results Among them,12 had a mRS of 0 to 1 at 3 month and sICH occurred in 4 patients within 36 hours.The results were similar to those of NINDS(National Institute of Neurological Disorders & Stroke)study.Conclusion An intravenous infusion of rt-PA at 0.6 mg/kg is probably efficacious and safe in the elder Chinese patients with acute ischemic stroke.

Objective To investigate the carotid angioplasty and stenting (CAS).induced hemodynamic depression (HD) and its impact on postprocedural complications so as to identify its risk factors.Methods The incidence,onset time,duration and sevefity of HD were observed in 196 CAS patients.The influences of clinical baseline and vascular angiographic characteristics on HD were recorded and the relationship between HD and postprocedural complications was analyzed.Logistic regression analysis was used to identify the independent risk factors of HD.Results The incidence of HD was 53.1%.Most cases of HD(67.3%)developed within 1-16 hours postprocedural.And 55.8%HD lasted for over 24 hours and became relieved within 3-16 days post-operation.And 78.9% HD patients required medications for the controls of blood pressure and heart rate.Diabetes,hypertension,smoking,plaque involving carotid bulb,ulcerated plaque and calcified plaque were shown to be associated with HD.Further analysis of logistic regression suggested that diabetes and smoking were two protective factors for HD while plaque involving carotid bulb and calcified plaque two independent risk factors for HD.The HD patients were at an increased risk of neurological and cardiopulmonary complications.Conclusion With a high post-CAS incidence after CAS,HD is associated with postprocedural complications.Lesions involving carotid bulb and calcified plaque are two independent risk factors for HD.

Objective To analyze the predictors of Wingspan in-stent restenosis(ISR)for the treatment of symptomatic intracranial arterial stenosis.Methods Between January 2007 and November 2009,42 patients with symptomatic intracranial arterial stenosis registered in Nanjing stroke registry program (NSRP)were treated with Wingspan stent system.Clinical and follow-up results were retrospectively analyzed.They were divided into the non-restenosis and restenosis groups according to their follow-up imaging data.ISR was defined as＞50% stenosis within 5 mm or adjacent to stent or an absolute luminal loss＞20% The analysis of stepwise multivariate Cox regression was performed to evaluate the independent predictive flactors.Results ISR was found in 15 patients(15/42,35.7%) with 16 lesions(16/43,37.2%)at a median follow-up period of 7 months(range:4-23).Diabetes(HR=0.281;95% CI=0.088-0.898;P=0.032)and stent diameter(HR=0.213;95% CI=0.049-0.918;P=0.038)were two independent Dredictors for ISR.Conclusion Diabetes and stent diameter may be two independent predictors for ISR after a treatment of Wingspan system.

Objective To study the methods and preliminary clinical efficacy of posterior lumbar minimally invasive surgery assisted by 3D-Viewer system under a direct vision and provide rationales for further clinical applications.Methods From September 2008 to September 2009,a total of 84 lumbar degeneraftve disease patients were enrolled and randomly divided into 2 groups(n=42 each).One group was treated operatively by 3D-Viewer system under a direct vision while another treated with conventional operations.The lumbar paraspinal muscle approach was employed.Surgery was assisted by 3D-Viewer system under a direct vision.The operative duration,intra-operative blood loss volume,CK(creatine kinase)levels at Days 1 & 7 post-operation,atrophic rates of cross-sectional areas of bilateral muhifidus muscles on MRI(magnetic resonance imaging)at 12 months post-operation were recorded.At Month 12 post-operation,the themrapeutic efficacy was evaluated by Oswestry disability index(ODI)and the post-operative clinical effects post-operation were statistically different(P＜0.05);there was significant difference in the atrophic rates of cross-sectional areas of bilateral multifidus muscles on MRI and the improvement rates of ODI(P＜0.001);the therapeutic efficacy of the invasivc group was significantly better than that of the group treated with traditional operations(P＜0.05).Conclusion The 3D-Viewer technique reduces the risk of damage. As an ideal minimally invasive procedure,it may achieve satisfactory outcomes for spinal diseases.

Objective To test the reliability,discriminating validity and clinical value of mvositjs disease activity tool in Chinese patients with polymyositis/dermatomyositis(PM/DM).Metllods Fifty-four PM/DM patients(PM,n=18;DM,n=36)at our hospital between January 2009 and June 2010 were enrolled into this prospective study.The disease activity was assessed by the MDAAT(myositis disease activity assessment tool).The reliability and discriminating validity were assessed with test-retest reliability.interrater reliability and t-test analysis.Results The reliability analysis of MDAAT indicated 8 items excellent reliability,the ICC(intraclass correlation coefficient)was 0.72(95%CI:0.57,0.83).0.88(95%CI:0.79,0.93),0.83(95%CI:0.72,0.90),0.62(95%CI:0.42,0.76),0.81(95%CI:0.70,0.89),0.59(95%CI:0.38,0.74),0.85(95%CI:0.75,0.91)and 0.84(95%CI:0.73,0.90) respectively.MDAAT had excellent discrimination validity in all items excent for cardiovascular ones.Conclusion With excellent reliability and discriminating validity,MDAAT may be used to assess the disease activity and therapeutic effects of Chinese PM/DM patients.

objective To investigate the effects of central venous pressure on acute kidney injury (AKI)in septic shock.Methods A total of 86 septic shock patients with PiCCO(pulse indicator continuous cardiac output)monitoring admitted at our department from January 2009 to January 201 1 were retrospectively studied.They were divided into 2 groups based on central venous pressure(CVP)at 24 hs after PiCCO monitoring.There were 41 eases in low CVP group(CVP≤10 mm Hg and 45 cases in high CVP group(CVP＞10 mm Hg).Their hemodynamic data,lactate concentration,ScvO2(centraI venous oxygen saturation).APACHE Ⅱ(acute physiology & chronic health evaluation Ⅱ)score and serum creatinine were obtained at the beginning and 24 hours after PiCCO monitoring.The incidence and mortality of AKI,the outcome of these patients in ICU and at Day 28 post-diagnosis were recorded.Results (1)The incidences of AKI were 51.2%(21/41)and 75.6%(34/45)in low and high CVP groups respectively;(2)Nine cases (22.0%)died in ICU in low CVP group and 20 cases(44.4%)in high CVP group.And 12 cases (29.3%)died within 28 days in low CVP group while 21 cases(46.7%)in high CVP group.Conclusion A high CVP may increase the incidence and morbidity of AKI in septic shock.And an excessively high CVP should be prevented.

objeefive To evaluate the safety profiles of three nevirapine-based theranies for antiretmviral-naive Chinese adults infected with HIV-1(human immunodeficiency virus-1).Methods For this prospective multicentric randomized trial.a total of 198 antiretroviral-naive HIV-1 positive patients were recruited from 13 research centers in China.They were randomly assigned to receive three NVP-based antiretroviral therapies for 52 weeks:Group A,AZT(zidovudine)+DDI(didanosine)+NVP(nevirapifie);Group B,D4T(stavudine)+3TC(lamivudine)+NVP;Group C,AZT+3TC+NVP.Their clinical events and laboratory examinations were monitored at baseline and the end of weeks 4,8,12,24,36 & 52 post-HAART(highly active antiretroviral therapy)to evaluate the occurrence of advelse events(AEs).The chi-square or Fisher's exact test was employed to compare the rates of AEs among three treatment groups.Multivariate logistic regression analyses were used to identify the factors associated with hepatotoxicity.For all tests,P＜0.05 was considered as statistically significant.Results During the 52-week HAART,968 cases of AEs occurred in 188 patients(95.0%).Only 37.4%experienced grade 3/4 AE.And 37 patients withdrew because of HA ART-related AEs (18.7%).The common AEs were hepatotoxicity,bone morrow suppression,gastreintestinal disordels,rash and hyperlipidemia.etc.Most instances of AEs occurred during the early 12 weeks.The total count of AEs for each group had no statistic significant difference(P=0.403).Bone marrow suppression was more strongly associated with an AZT.containing HAART and it was especially prone to gastrointestinal disorders when combined with DDI.The introduction of D4T or DDI led more frequently to peripheral neuropathy and hyperlipidemia.Logistic regression analysis indicated that presence of hepatotoxicity was associated with a higher baseline level of CD4(CD4 count＞250/μl)(OR=2.08,95%CI:1.114-3.882,P=0.021).Conclusion The common reasons of discontinuing HAART are hepatotoxicity,gastrointestinal disorders,bone marrow suppression and rash.The occurrence of AEs should be vigorously monitored especially during the early 3 months of HAART.The HIV/AIDS patients with a CD4 cotmt of＞250/μl shall avoid any NVP-containing regimen.

Objective To observe the effects of neurally adjusted ventilatory assist(NAVA)on subject-ventilator synchrony in rabbits with acute respiratory distress syndrome(ARDS).Methods The rabbit model of ARDS was induced by intratracheal infusion of hydrochloric acid.After sufficient recruitment,the rabbits were randomly divided into 2 groups:pressure support ventilation(PSV)group and NAVA group.The parameters of subject-ventilator synchrony such as ventilation trigger,ventilation switching and delay:tIle trigger delay in the NAVA group were markedly lower than the PsV group at 0,1,2,3 h(P＜0.05);as ventilation time elapsed.the trigger delay changed neither in NAVA nor in PSV group While all neural efforts were trigger,there was no ineffective trigger observed in the NAVA group.(2)Offcycle delay:the off-cycle delay were significantly lower in the PSV group than that in the NAVA group at 0,1,2,3 h(P＜0.05);as the ventiIation time elapsed,the off-cycle delay changed neither in the NAVA group nor in the PSV group(P＞0.05).(3)Magnitude of assist:in the NAVA group.peak EAdi and peak pressure were markedly correlated(determination coefficient 0.86±0.07,P＜0.05).But pressure dellvery during the PSV group was not correlated with EAdi(P＞0.05).Conclusion As compared with PSV,NAVA can improve subject-ventilator synchrony in rabbits with ARDS.

Objeclive To create far-red fluorescence protein reporter gene mKate2 lentivirus.label human liver cancer cell line HepG2 with lentivirus and explore the feasibility of in vitro fluorescence imaging of labeled tumor cells so as to provide experimental rationales for in vivo fluorescence tumor imaging.Methods mKate2 gene was amplified from pmKate2-N plasmid.Then the fragment was inserted into the lentivirus expression vector pLenti6.3/V5-DEST.The expression plasmids pLenti6.3-mKate2 and the packaging plasmids were cotransfected into 293T cells.The biological titer of lentivirus was determined.HepG2 cells were infected with mKate2 lentivirus at a MOI(virus multiplicitv of infeetion)of 6 for 96 hours.The infection efficiency was assayed through fluorescence microscope and fluorescent-activated cell scanning(FACS).And 2×106 mKate2-HepG2 cells were collected for fluorescence imaging through an optical imaging system.And the optimal imaging parameters were determined.Results DNA sequencing analysis confirmed that mKate2 gene sequence was correct and there was no mutation or deletion.The biological titer of produced mKate2 lentivims was 1.6×106 TU/ml.At 96 hours after mKate2 lentivirus infection,fluorescence microscope showed that mKate2 was expressed in a large percentage of cells.FACS assay showed that the mKate2 positive rate was 93.8%±0.4%.Excitation light 530±15 nm and emission light 710±28 nm were the optimal imaging parameters for mKate2-HepG2 cells.Conclusion Lentivirus can mediate efficiently the mKate2 reporter gene labeling of human liver cancer cell line HepG2.The mKate2-labeled HepG2 cells can be detected through in vitro fluorescence imaging.Further tracing studies of in vivo tumor fluorescence imaging age technically feasible.

Objective To explore the effects of curcumin on the expression of high mobility group box 1(HMGB1)and apoptotic neurons in hippocampus after global cerebral ischemia/reperfu8ion in SD rats.Methods A total of 192 male SD rats were randomly divided into 4 groups:sham group(SH),ischemia-reperfusion group(IR),cureumin group(Cur)and solvent control group(SC).Bilateral vertebrate arteries were electroeauterized and bilateral comlnon carotid arteries libemted in 3 ischemic groups.Isasteric curcumin solutions(200 mg=/kg)or menstruum were injected intraperitoneally at 1 hour preischemia in Cur and SC groups.The rats in each group were ligated for 15 minutes and then decapitated at slides.Apoptotic neurons were detected in CA1 region by TUNEL(terminal deoxynueleotidyl transferasemediated dUTP-biotin nick end labeling).Western blot was used to make a semi-deternination of HMGB1 expression.Results At each time point,tlle number of apoptotic neurons was much more in IR and SC groups than that in SH group(P＜0.05).And the number of apoptotie neurons at 1,3,5,7 d postreperfusion was only 41%,57%,65%and 70%in Cur group respectively(P＜0.05).The exPressional level of HMGB1 in IR and SC groups was significantly lower at 1d post-reperfusion(0.685±0.050:0.695±0.053 vs 0.977±0.063,P＜0.05).And it was significantly higher at 3,5,7 d post-reperfusion in IR and SC groups than that in SH groups(1.360±0.045/1.353±0.045;1.342±0.046/1.338±0.047;1.319±0.052/1.322 ±0.035 vs 0.992±0.031;0.978±0.090;0.992±0.075,P<0.05).The level at 1 d post-reperfusion(0. 842±0. 063)in Cur group was significantly higher than that in IR and SC groups but lower than that in SH group. And it was lower at 3, 5, 7 d post-reperfusion (1. 125 ± 0. 023, 1. 098 ±0. 073, 1. 087 ± 0. 089) than those in IR and SC groups (P＜0. 05). There was no significant difference of HMGB1 expression level between IR and SC groups. Conclusion The expression level of HMGB1 in hippocampus is significantly reduced at 1 d post-reperfusion. Then it significantly increases and a high level is maintained until 7 d after global cerebral ischemia/reperfusion. Cureumin can reduce hippocampal neuronal apoptosis and injury. Such an effect may be due to an inhibition of the synthesis and release of HMGB1.

Objective To explore the aberrant formation of excitatory and inhibitory circuit rearrangements of hippoeampus in temporal lobe epilepsy.Methods Pilocarpine-induced animal model was established.At around Day 60 post-modeling,retrograde tracer fluorogold(FG)was injected in vivo into CA1 and CA3 areas of hippocampus by stereotaxic apparatus.Immunohistochemistry of FG was used to observe the aberrant excitatory circuit rearrangements.Double immunofluorescence with NPY(neuropeptide Y)and FG was performed to observe the aberrant inhibitory circuit rearrangements.Results After an iniection of FG into CA1 area.the FG-labeled pyramidal cells could be observed distantly from the zone of dye soread in CA1 area.CA3 area and subiculm.And the FG-labeled non-principal neurons could be seen in stratum oriens of CA1 and hilus in experimental group.Double immunofluorescence revealed that the FG-labeled NPY interneurons were located distantly from the zone of dye spread in CA1 area.CA3 area and hilus in experimental rats.When injection was administered in CA3 area.the FG-labeled pyramidal cells were visible in the whole CA3 area and hilus in both groups.Some pyramidal cells were present in CA1 in experimental group.Also some FG-labeled non-principle cells were foand in hilus and distantly from the zone of dve spread in CA1 area,And the FG-labeled NPY neurons could be seen in hilus in experimental rats.Conclusion Aberrant excitatory and inhibitory synaptic reconstruction exist in hippocampus in chronic phase of temporal lobe epilepsy,including excitatory synaptic connections among pyramidal cells in CA1 area.pyramidal cells between CAl and subiculum and pyramidal cells between CA1 and CA3,inhibitory synaptie connections among dendritie intemeurons in CA1 area,CA3 to CA1,hilus to CA1 and hilus to CA3area,These circuit arrangements may play an important role in the pathogenesis of epilepsy.

The patient was a 30-year-old male who came to the emergency department of Peking Union Medical College Hospital on November 17, 2009 due to swelling of the right lower limb for 6 days, swelling of both lower limbs with dry cough, coughing up blood and holding up breath for 1 day. The patient developed concave edema of the right lower limb with gastrocnemius pain without obvious trigger 6 days ago, without fever, dry cough and coughing up blood. Blood routine examination in the local hospital: white blood cells: 13.5×109/L, neutral classification: 56%, lymphoid classification: 18.8%, red blood cells: 4.3×1012/L, hemoglobin: 133 g/L, platelets: 178×109/L. Color ultrasound of both lower limbs showed that the femoral vein and deep femoral vein of the right lower limb were thrombotic, and the deep vein of the left lower limb was patent. Anticoagulant therapy with enoxaparin (0.6 ml subcutaneous injection every 12 h) was started immediately.

A 46-year-old woman was admitted to the General Hospital of the People's Liberation Army for more than 2 months due to fever and lymph node enlargement. The patient was admitted to the General Hospital of the People's Liberation Army for 1 week due to liver and spleen enlargement. There was no abdominal pain, diarrhea, frequent urination, urgency and other symptoms, which were not treated. The body temperature returned to normal in the morning of the second day, and the fever resumed in the evening of the same day. There was a slight chill before the fever, and the body temperature reached the highest 39.6℃. During this period, there was pain in the right upper abdomen, radiating to the back. In addition, there was obvious fatigue, anorexia, nausea, and vomiting the stomach contents once. CT examination was performed in the local hospital, and multiple lymph nodes in the abdominal cavity were found (Figure 1A), and he was hospitalized for diagnosis and treatment.

According to the World Health Organization (WHO), the proportion of adverse drug reactions in hospitalized patients is 10% ~20% in the world, and 5% of them die from serious adverse drug reactions. In China, the patients with adverse drug reactions account for 10% ~30% of the hospitalized patients. Every year, 5 million patients are admitted to hospital due to adverse drug reactions, and about 190,000 people die from adverse drug reactions every year. In the treatment of diseases, there are many drugs with different curative effects and different side effects for different people. The dominant side effects are easily paid attention to by doctors, but the hidden damage to liver, kidney and other organs caused by drug side effects are easily ignored by doctors and patients.

Adenomyosis is a diffuse or localized lesion caused by periodic hemorrhage of endometrial glands and interstitial ectopic human myometrium under the influence of hormones, and proliferation of muscle fibers and connective tissues. It is a common gynecological disease with an unknown incidence rate. Some literatures report that the incidence rate is 10% ~65% [1-2]. Adenomyosis tends to occur in women of childbearing age, especially in women aged 30~50 years. At present, its treatment methods mainly include drug therapy, surgical therapy and interpersonal therapy. Drug and surgical therapy are conventional treatment methods for adenomyosis, and the technology is mature. Interventional therapy is a new technology developed in recent years with remarkable curative effect, but it has not been widely used in clinical practice. The methods, clinical effects and side effects of various treatment techniques are summarized as follows.

Case 1: A 39-year-old female was admitted to Peking Union Medical College Hospital on March 17, 2010 due to her hands turning white and purple when exposed to cold for 13 years, vomiting and abdominal distension for 12 years, and aggravated for 1 year. The patient began to have her hands turning white and purple when exposed to cold 13 years ago. Twelve years ago, she began to eat intermittently with nausea, vomiting and abdominal distension, without abdominal pain, diarrhea and constipation. Four years ago, gastroscopy showed reflux esophagitis, and pathology showed chronic active inflammation of esophageal mucosa with granulation tissue formation. No abnormalities were found in colonoscopy. The symptoms were relieved after treatment with prednisone 50 mg, once/d, and mesalazine enteric-coated tablets 1.0 g, four times/d.

The patient, a 40-year-old female, was admitted to Shaoxing County Central Hospital on December 3, 2008. Because of lower abdominal distension and pain for 4 days, accompanied by nausea and vomiting, she took ofloxacin tablets for enteritis, but the pain was not relieved. After going to a primary hospital, B-ultrasound examination showed mixed mass in the left adnexal area and pelvic effusion. The urine pregnancy test was negative, and her menstruation was regular. The last menstruation was on November 15, 2008, considering the possibility of "corpus luteum rupture", and she was transferred to Shaoxing County Central Hospital. B-ultrasound review showed pelvic mass 69 mm ×46 mm and pelvic effusion. Laboratory examination: AKP 213 U/L, CA125 102 U/mol.

Hypertension is a complex dysfunctional disease, and it is difficult to achieve the standard of blood pressure control, especially when administered with single drugs. However, the British guidelines do not recommend other drugs for combined blood pressure reduction except that beta blockers can be used for combined blood pressure reduction. Combined blood pressure reduction is used for early hypertension treatment, which can reduce the risk of continued blood pressure increase by short-term rapid blood pressure reduction, and can benefit from long-term blood pressure control. The VALUE study (a long-term study of valsartan against hypertension) confirmed that valsartan and amlodipine can reduce blood pressure by 3.8/2.2mm Hg (1 mm Hg =0.133 kPa) after 3 months of combined treatment.

There is currently no cure for Parkinson's disease. Previous studies have shown that users of nonsteroidal anti-inflammatory drugs (NSAIDs) have a reduced risk of developing Parkinson's disease, but most have shown no difference between ibuprofen and other non-aspirin NSAIDs. A new study by researchers at the Harvard School of Public Health (HSPH) shows that adults who regularly take ibuprofen have a 1/3 lower risk of developing Parkinson's disease than those who do not take it. This study was published in Neurology (Neurology,2011,76:863-869) on March 8, 2011.