Volume 91  ·   Issue 24  ·  2011

Since the late 1980s, Xinhua Hospital, affiliated to Shanghai Jiaotong University School of Medicine, has focused on the cross-medicine research of combining clinical medicine and preventive medicine, and promoted government health policy and protected children's health with the research results. Our research philosophy is: find problems through clinical practice, answer them by scientific research, and solve them by health policy. After nearly 20 years' efforts, we have made some achievements and accumulated some experience in the prevention and treatment of lead poisoning in children, hearing screening of newborns and sleep research of children.

Objective Foam sclerotherapy of ovarian varicocele is a relatively new and promising treatment option for patients with axial reflux. But its usefulness may be limited by low primary occlusion rates. Here a standard technique for catheter-directed foam sclerotherapy was presented to facilitate a precise delivery of foam to its intended site of action so as to potentially improve the occlusion rates. Methods A selective series of 13 females with ovarian varicocele were treated with foam sclerotherapy through a standard technique for foam delivery from 2008 to 2009. With a mean age 39.4 years, the patients were treated with 1% polidocanol foam through a catheter inserted percutaneously over a guidewire into the trunk of vena ovarica. All successfully treated patients were examined by colour duplex at 1 to 12 months post-procedure. Results Thirteen patients with an insufficiency reflux of vena ovarica were treated with catheter-directed foam sclerotherapy. Primary technical success was achieved in all patients. A dose of polidocanol 1.0% at 4-9 ml was administered. The mean follow-up period was 5.3 months. Pelvic cavity flatulency was totally released in 12 patients and 1 partially released. Two of 5 patients with algopareunia recovered and 3 with perineal region varicosis became relieved. On the follow-up ultrasonic examination, all trunks of vena ovarica became occluded. Conclusion This type of foam sclerotherapy is feasible with a high rate of primary occlusion.

Objective To summarize the preliminary experiences of 13 cases of laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder and evaluate the oncological and functional outcomes of this procedure. Methods From August 2005 through July 2009, 13 patients underwent radical cystectomy and standard lymphadenectomy followed by construction of orthotopic T pouch ileal neobladder via mini-laparostomy for muscular invasive bladder cancer. The data were analyzed according to procedure time, blood loss volume, transfusion volume, number of dissected lymph nodes, peri-operative complications, morphology and function of upper urinary tract and status of urinary continence. Results The mean operating duration was 6 (5-8) hours, estimated volume of blood loss 480 (100-800) ml, transfusion volume 133 (0-400) ml and the number of dissected lymph nodes 16 (8-22). There was no peri-operative mortality. The peri-operative complications were found in 15.4% (2/13) and included urine leak at neobladder-urethra junction managed by drainage (n=1) and urine leak at ureter-neobladder junction repaired (n=1). The complete daytime continence rate was 84.6%(11/13), complete nocturnal continence rate 46.1% (6/13) and <1 pad in 30.8% (4/13). No reflux into afferent limb of neobladder was observed by cystography. Temporary dilation of upper urinary tract was observed in 23.1% (3/13) at Day 45 post-operation and later it disappeared spontaneously. Serum creatinine remained in a normal range in all patients. Within a follow-up of 24 (16-63) months, 7.7% (1/13) died of myocardial infarction at Month 55 post-operation. And 92.3% (12/13) survived without a local relapse or a distal metastasis. Conclusion Within an intermediate follow-up period, the oncological and functional outcomes are encouraging after laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder via mini-laparostomy. The anti-reflux mechanism is effective to preserve the morphology and function of upper urinary tract.

Objective To investigate the learning curve of laparoscopic-assisted surgery for rectal cancer by comparing the effects of laparoscopic-assisted rectal surgery at different stages with a literature review. Methods A total of 160 surgical cases of laparoscopic-assisted rectal cancer from May 2007 to December 2009 were reviewed. Different standards were used to divided them into 11 stages (group 1: 15 cases in each) and 8 stages (group 2: 20 cases in each) respectively by operative sequences. The number of revealed lymph nodes, length of distal margin, operating duration, blood loss volume, the incidences of intraoperative and postoperative complications, the rate of conversion into open operation and the length of postoperative hospital stay were analyzed. With the exception of the first stage, all indices in the remainder of 10 stages and 7 stages were analyzed simultaneously. Results There was no significant differences among the 11 stages and 8 stages with the respect to the number of revealed lymph nodes, length of distal margin, blood loss volume, the incidences of intraoperative and postoperative complications, the rate of conversion into open operation and the length of postoperative hospital stay. The average operating duration in the first stage of group 1 was 201.0 min and 193.0 min in the first stage of group 2. And the operating duration in the first stage in the two groups was longer significantly than the remainder of stages in each group (P＜0.001). Conclusion A surgeon may become experienced in laparoscopic-assisted rectal surgery by operating 16-20 patients with rectal cancer.

Objective To explore the clinical features, diagnosis, treatment and prognosis of primary hepatic angiosarcoma (PHA). Methods The clinical data of 7 PHA patients admitted to our hospital from December 2004 to December 2010 were retrospectively analyzed and the relevant literatures reviewed. Results Seven cases (5 males and 2 females) were diagnosed as PHA among 1027 (0.68%) patients with primary hepatic malignant tumors. Their mean age was 43.3 years old (range: 33-74). Four cases were of solitary lesion and three of multiple lesions. No specific clinical features were observed. The PHA lesions were easily misdiagnosed as benign or hepatic metastatic tumors. Contrast enhanced ultrasound (CEUS) showed the lesions with characteristic manifestations. And the positron emission tomography (PET-CT) could confirm the hepatic lesions as malignant tumors. The survival time for two untreated cases was 3 & 5 months, for two cases with liver transplantation (LTx) 3 & 8 months and for two cases treated with surgical resection & targeted therapy was 14 & 19 months respectively. One case was lost to follow-up at 6 months after hepatic resection. Conclusion PHA is a clinically rare and highly malignant tumor with a rapid progression and a poor prognosis. Both CEUS and PET-CT are helpful for its differential and confirmative diagnosis. LTx should be considered as a contraindication for PHA. Hepatic resection has proven to be beneficial for PHA patients with solitary lesion. Surgical resection plus targeted medicines may improve their survival.

Objective To evaluate the occurrence and clinical significance of red blood cell (RBC) allo-antibodies among hospitalized patients in China. Methods The specificity and clinical features of RBC allo-antibodies of hospitalized patients at our hospital from August 2009 to January 2011 were retrospectively analyzed. Results Sixty-four (0.17%) RBC allo-antibodies were episodes of delayed hemolytic transfusion reaction (DHTR). Their antibody frequencies were as follows: anti-E 53.1%(34/64),anti-D 10.9%(7/64),anti-cE 3.1%(2/64),anti-c 1.6%(1/64),anti-M 14.1%(9/64),anti-Mia 10.9%(7/64),anti-Lea 4.7%(3/64),anti-Dia 1.6%(1/64). Antibodies to Rh system were more frequent among transfused patients while antibodies to Lewis system had a male predominance (both P<0.05). Conclusion As the most common and clinically significant RBC allo-antibodies, the antibodies to Rh blood group system, especially anti-E, anti-cE and anti-c, are the main cause of DHTR.

Objective To explore the effects of CD8+CXCR3+T cells on autoimmune hemolytic anemia (AIHA). Methods Twenty-two AIHA patients, including 11 untreated and 11 recovered ones, and 23 normal controls were recruited from July 2010 to November 2010. The percentage of CD8+CXCR3+/CD8+T cells in peripheral blood and the expression of interleukin-10 (IL-10) in CD8+CXCR3+T cells were detected by flow cytometry. Their correlations with the count of CD3+CD4+cells and the percentage of CD5+CD19+ in CD19+ B cells were analyzed. The expression level of CXCR3 mRNA in PBMC was determined by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). Results The percentage of CD8+CXCR3+/CD8+ of untreated AIHA patients was (39.80±19.96)%. And it was lower than that of recovered patients [(58.76±14.22)%,P<0.05] and normal controls [(59.66±12.62)%,P<0.01]. The percentage of IL-10+ T cells in CD8+CXCR3+T cells of untreated patients was (22.98±14.96)% and it was lower than that of normal controls [(38.15±17.03)%,P<0.05]. The expression level of CXCR3 mRNA for untreated AIHA patients was (0.51±0.19) and it was lower than that of normal controls (1.67±1.17,P<0.01). The percentage of CD8+CXCR3+/CD8+T cells had a negative correlation with the count of CD3+CD4+ cells and the percentage of CD5+CD19+/CD19+ B cells (r=-0.571, -0.583,both P<0.05). So did the percentage of IL-10+ T cells in CD8+CXCR3+T cells (r=-0.524, -0.523, both P<0.05). Conclusion The decreased count of CD8+CXCR3+T cells and the lowered level of IL-10 may disturb the immune tolerance and lead to the occurrence of AIHA.

Objective To investigate the relationship between the metastatic lymph node ratio (LNR) and the prognosis of non-small cell lung cancer (NSCLC). Methods A total of 301 patients with N1 and N2 NSCLC undergoing curative pulmonectomy were analyzed retrospectively. There were 103 females and 198 males with a median age of 59 years (range: 31-78). The correlations between LNR and clinicopathological data were analyzed by χ2 test. The effects of LNR on overall survival (OS) and disease free survival (DFS) of patients were analyzed by the methods of univariate Kaplan-Meier and multivatiate Cox proportional hazard model. The risk groups were classified by LNR on the basis of N staging. Results LNR correlated with age, smoking status, pathological type, clinical stage and N stage (P<0.05). And it also correlated with positive lymph nodes, resected lymph nodes and the number of positive lymph node station (P<0.001). Kaplan-Meier survival analysis revealed that LNR influenced significantly the lengths of OS (P<0.001) and DFS (P<0.001). Cox proportional hazard model showed a high LNR was an independent poor prognostic factor for OS (HR=2.507, 95%CI 1.612-3.900, P<0.001) and DFS (HR=1.872, 95%CI 1.182-2.964, P=0.008); and at the same N stage, the low-LNR group was better in OS and DFS than the high-LNR group. After stratification into high-, medium- and low-risk groups, the high- (LNR: >18%, N-status: N2), intermediate- (LNR: >18%, N-status: N1; LNR: <18%, N-status: N2) and low-risk factors (LNR: <18%, N-status: N1) could efficiently predict the outcomes. The 5-year survival rate (32.8% vs 20.7% vs 6.9%), median survival time (MST) (57 vs 30 vs 16 months), 5-year disease-free survival rate (28.1% vs 16.3% vs 5.5%) and disease-free survival time (38 vs 19 vs 10 months) decreased progressively with the rising risk groups (P<0.001). Conclusion LNR may be used to accurately predict the prognosis, guide the treatment of NSCLC and improve its staging.

Objective To evaluate the efficacy and safety of Chinese medicinal shensongyangxin capsules in the treatment of paroxysmal atrial fibrillation. Methods From August 2007 to July 2008, Beijing Chaoyang Hospital coducted a multicenter study, select the eleven hospital's outpatient subjects, aged 18 to 75 years old, male or female, paroxysmal atrial fibrillation (at least one electrocardiogram diagnosis) seizure frequency ≥ 2 times / month, groups: a. Shensongyangxin group, taking shensongyangxin capsule 4 + propafenone analogues 150 mg, 3 times a day; b. Propafenone group, taking propafenone tablets 150 mg + 4 shensongyangxin analogues, 3 times a day; shensongyangxin capsule + propafenone group, taking shensongyangxin capsule 4 + propafenone 150 mg, 3 times a day. The treatment course is 8 weeks, with 3 times of follow-up.Results Total of 349 cases of paroxysmal atrial fibrillation, which 117 cases in shensongyangxin group, 115 cases in propafenone group; 117cases in shensongyangxin + propafenone group.The baseline data analysis showed that there were no significantly difference (P>0.05) among the three groups of atrial fibrillation seizure frequency, vital signs, general condition, medical history, 24-hour ambulatory ECG, 12-lead normal electrocardiogram, cardiac ultrasound and symptoms. The comparioson before and after (8 weeks ) treatment showed that the frequency(from 6 times/m to 2 times/m in each group, P<0.01), number of cases [from 46(43.3%) to 22(20.8%), 43(43.4%) to 25(25.3%), and 40(40.6%) to 31(29.2%), respectively P<0.01] and dutaion time of attack of atrial fibrillation (from 4 h to 0.5 h,4 h to 0.5 h, and 4.25 h to 0.5 h, respectively P<0.01) all decreased in three groups.No significant difference among the three groups comparing the overall effect (62.3%,58.6%, and 58.5%, respectively, P>0.05), while the efficiacy of TCM symptoms in shensongyangxin group(80.2%) was better than that of propafenone group(67.7%)( P<0.05). Safety evaluation showed that adverse reaction rate was 1.8% in shensongyangxin group, and 8.2% and 5.4% in propafenone group and shensongyangxin + propafenone group.Conclusion Shensongyangxin capsules and propafenone have comparable efficacies in the treatment of PAF. The efficacy of TCM symptoms is better than propafenone. Shensongyangxin capsules have an excellent profile of safety.

Objective To evaluate the long-term effects of percutaneous transluminal renal angioplasty with stent (PTRAS) on hypertension and renal function in elderly patients with atherosclerotic renal artery stenosis(ARAS). Methods The data of elderly ARAS patients as diagnosed by angiography(stenosis≥70%) were retrospectively collected. PTRAS was performed in 65 patients. The average follow-up period was 30.9 months. Results There were significant decrease in BP(blood pressure, mm Hg, 1 mm Hg=0.133 kPa) (before: 154±24/79±119 vs after: 132±14/69±8; P<0.01) at Day 3 post-PTRAS and the decrease of BP continued until 36 months after PTRAS. The average category of antihypertensive medication also decreased from 2.3±1.1 to 2.1±1.0. The incidence of contrast-induced nephropathy (CIN) was 9.2％. Logistic regression analysis showed that the factors of pre-operative diabetes mellitus, GFR≤30 ml·min-1·1.73 m-2, systolic pressure ≥180 mm Hg and hydration therapy had a significant relationship with the incidence of CIN (P=0.0072;OR=13.51; P=0.0002; OR=519.27; P=0.0134 ; OR=13.16 and P=0.0266; OR=0.10; respectively). Renal function improved in 9.1%-15.8% of patients, stabilized in 67.3%-55.3% and deteriorated in 23.4%-28.9% of patients at Months 12-36 post-PTRAS. Logistic regression analysis showed that the diabetics had a higher risk of deteriorating renal function at month 12 post-PTRAS（P=0.0277; OR=6.32）.The restenosis rate was 13.8%. Conclusion PTRAS is beneficial in the control of blood pressure in elderly ARAS patients within 36 months after operation. The post-PTRAS improvement of renal function in elderly patients is limited.

Objective To compare the safety, efficacy and their impact on stent graft positioning between rapid artificial cardiac pacing induced hypotension and sodium nitroprusside induced hypotension during thoracic endovascular aortic repair( TEVAR). Methods From September 2007 to February 2009,a randomized controlled trial as approved by the Ethics Committee of our hospital was conducted in 197 patients undergoing elective thoracic endovascular aortic repair of thoracic aortic dissection(n=175) or aneurysm(n=22).The patients were randomized into sodium nitroprusside group(n=98) and rapid artificial cardiac pacing group(n=99).During the localization and deployment of stent graft,hypotension was induced by intravenous sodium nitroprusside or rapid artificial cardiac pacing.Hemodynamics, landing precision (deviation from planned placement site), duration of procedure, renal function, neurocognitive function, incidence of endoleaks and paraplegia/hemiplegia were compared. Results Rapid artificial cardiac pacing was conducted without technical difficulty in all 99 patients. The level of hypotension (mm Hg, 1 mm Hg=0.133 kPa) was most pronounced in the rapid artificial cardiac pacing group (47±5 vs 82±7, P=0.003. Once rapid pacing ceased, blood pressure recovered more quickly to the prepacing levels in the rapid artificial cardiac pacing group [(9±2)s vs (481±107)s,P<0.01]. And the duration of procedure was also shorter in the rapid artificial cardiac pacing group [(94±16)min vs (103±24)min, P<0.01]. Moreover, precise positioning and deployment was observed in rapid artificial cardiac pacing group versus to the sodium nitroprusside group(P<0.01).There was no difference in renal function and neurocognitive function before and after the procedure in both groups.There was no difference in the incidences of endoleaks and paraplegia/hemiplegia between different groups(P>0.05). Conclusion As compared with sodium nitroprusside,rapid artificial cardiac pacing is safer in thoracic endovascular aortic repair.It shortens the endovascular procedure and enables more precise positioning and deployment of stent graft.

Objective To study the histological effects of different temperatures and durations of radiofrequency on the trigeminal ganglions in rabbits. Methods Trigeminal ganglions of 80 rabbits were treated by R-2000B RF thermocoagulation at 60, 70, 80 ℃ respectively and the thermal electrode of 50 mm long and 0.4 mm in diameter. The treaded trigeminal ganglions were removed for HE (hematoxylin & eosin) dying at Days 1, 7, 14 and 28. And the expressions of neurofilament protein (NF200), acetylcholinesterase (ACHE) and muscarinic receptors (M-receptor) were observed after an immunohistochemical detection of HE positive samples. Results The positive manifestations of HE were degeneration of trigeminal ganglionic cells, the distribution of nerve fibers and a loss of myelinic membrane. The positive features of immunohistochemistry were as follows: NF200: dark yellow-brown particles within cytoplasm of ganglionic cells and nerve fibers cells; ACHE: deep yellow-brown particles within cytoplasm of ganglion cells and nerve fibers cells; M-receptor: yellow-brown particles within cytoplasm of ganglionic cells and nerve fibers cells. The expressions of NF200, ACHE and M-receptor increased while the temperature and radio frequency time remained constant. There was no significant difference between the expression rates of NF200, ACHE, M receptor at the same temperature for 1 and 3 minutes (P＞0.05). When treated for the same time, the expressions of NF200, ACHE and M receptor decreased more significantly at 70 ℃ versus 60 ℃ (P<0.05). However, there was no significant difference between 70 ℃ and 80 ℃ (P＞0.05). Conclusion 70 ℃ may be a suitable temperature at which radiofrequency causes the greatest harm to trigeminal ganglions so that nerve activity decreases significantly.

Objective To compare the effects of gabapentin on high-voltage-activated calcium (HVA) current in dorsal root ganglion (DRG) neurons in normal and nerve-injured rats and understand the reasons of their differences. Methods Pathogen-free male SD rats(weight 180-220 mg)aged 4-6 weeks were used. The animals were anesthetized with intraperitoneal pentobarbital sodium 50 mg/kg. L5 spinal nerve was ligated between DRG and sciatic nerve and cut distal to the ligature. The animals were decapitated at Day 14 post-operation. L5 (SNL-L5 group) and L4 DRGs (SNL-L4 group) were respectively isolated and the ganglionic neurons enzymatically dissociated. The control group of rats was not operated. The lumbar DRG neurons of normal rats were treated similarly. The HVA-Ca2+ current was recorded by the technique of whole cell patch clamp. Results Compared with the SNL-L4 group [(16.0±1.9)%, (26.9±2.0)%, (27.4±2.3)%] and the control group, gabapentin inhibited the peak calcium current highlier at 10, 100 and 300 μmol/L in the SNL-L5 group [(18.5±1.7)%, (32.0±2.6)%, (32.7±2.8)%] (P<0.05). The steady-state inactivation curves shifted to more hyperpolarized potentials in the SNL-L5 group. The N-type relative contribution to the gabapentin-sensitive HVA-Ca2+ current was markedly elevated in the SNL-L5 group compared with that in other two groups (P<0.05). Conclusion Gabapentin enhances the inhibition of HVA-Ca2+ current in injured DRG neurons following spinal nerve ligation in rats. The alteration in the activation of electrophysiological properties and the increase of N-type relative contribution to the total HVA-Ca2+ current may be involved in the mechanism.

Objective To establish a guinea pig model of acute and postinfectious cough caused by respiratory syncytial virus (RSV) infection and investigate the role of neurogenic inflammation in its pathogenesis. Methods Fifty guinea pigs were randomly divided into control group and four groups of Days 6, 12, 28 and 42 after RSV inoculation (n=10 each). The RSV suspension was inoculated by intranasal instillation. Buxco system was used to assess the cough reflex sensitivity (CRS) to inhaled capsaicin. Airway inflammation was determined by bronchoalveolar lavage fluid(BALF)cytology and lung histopathology. RSV antigen and nucleic acid were detected by immunofluorescence and real-time fluorescence quantitative PCR (polymerase chain reaction). After modeling, the content of substance P in homogenate of lung tissue was detected by ELISA (enzyme-linked immunosorbent assay) kit. The level of neurokinins receptor 1 (NK1) mRNA in lung tissue was detected by real-time PCR. The expression of substance P protein in lung tissue was detected by immunohistochemistry. The correlation analyses between CRS and the levels of substance P and NK1 mRNA were performed respectively. Results The viral antigen expression could be found in lung tissue of RSV infected guinea pigs. The concentration of RSV RNA content showed a gradually decreasing trend with infection time until 42 days at very low titers. The CRS values were (8.0±1.2), (8.7±2.0), (7.6±1.4) and (6.7±1.2) cough counts at Days 6, 12, 28 and 42 respectively. Compared with (2.5±0.5) cough counts of control group, the CRS to capsaicin increased significantly in all animals with PIV3 inoculation (all P<0.05) and peaked at Day 12 (P<0.01). BALF cytology and lung tissue pathology showed airway inflammation during the acute stage of infection without pneumonia. All the contents of substance P in lung tissue homogenates increased markedly in infected groups. The immunohistochemical results of substance P in lung tissue of infected groups showed a distinct brown-yellow positive expression. In addition to Group Day 6, the NK1 mRNA contents of lung tissue in all other infection groups became elevated significantly. The correlation analysis showed a positive correlation between CRS and the levels of substance P and NK1 mRNA (all P<0.05). Conclusion A guinea pig model for cough of RSV infection has been successfully established. The elevated releases of substance P and its receptor may cause neurogenic inflammation. And airway neurogenic inflammation may play a decisive role in the heightened CRS and postinfectious cough induced by RSV.

Mitochondria are organelles with double membrane structure in the cytoplasm of eukaryotic cells. The functions of mitochondria include generating reactive oxygen species (ROS), participating in apoptosis, participating in the metabolism and oxidation of nutrients including fat and pyruvate, etc. [1]. A group of multisystem diseases caused by the defect of mitochondrial metabolic enzymes caused by genetic defects in mitochondria, which lead to the impairment of ATP synthesis and insufficient energy production, are called mitochondrial diseases, also called mitochondrial cell diseases. Among them, those involved mainly in skeletal muscle are called mitochondrial myopathy, and those involved in central nervous system are called mitochondrial encephalomyopathy.

Acute coronary syndrome is caused by coronary artery spasm, which causes instability, rupture and thrombosis of atheromatous plaque, which can lead to unstable angina pectoris, myocardial infarction or sudden death. Many cardiovascular drugs, such as antiplatelet drugs, anticoagulants, statins and beta blockers, have large individual differences in effective therapeutic doses. Age, sex, race, liver and kidney function, etc. affect drug dosage, plasma drug concentration and efficacy, but these external factors can only partially explain the differences between individuals in drug response. Research data show that 20% ~95% of individual differences are attributed to genetic polymorphism [1].

A 62-year-old male, weighing 72 kg, was admitted to the hospital with "more than 3 years after tracheotomy, 24 days after tracheal granulectomy, and 3 days of shortness of breath". He had a history of chronic bronchitis and emphysema for more than 10 years. He underwent emergency tracheotomy in another hospital due to dyspnea. After that, he underwent multiple granulation hyperplasia, tracheal stenosis, and difficulty in extubation, so the tracheal cannula was replaced. In March and July 2008, he underwent holmium laser tracheal granulectomy twice, which improved significantly but relapsed soon. This time, he was diagnosed with "low tracheal stenosis and tracheal granuloma formation" before operation, and planned to undergo holmium laser endotracheal granulectomy and stent implantation under cardiopulmonary shunt (CPB).