Volume 92  ·   Issue 03  ·  2012

The incidence of Alzheimer's disease (AD) is increasing year by year, and the social burden is increasing day by day. It has become the key research and overcome object of scientific research and clinical work at home and abroad. The clinically diagnosed AD patients are basically in the middle and late stage, and the existing treatments are difficult to achieve satisfactory curative effects. The real hope of AD treatment lies in early recognition and intervention. Mild cognitive impairment (MCI) is a state between normal aging and dementia, and can be divided into amnestic MCI and non-amnestic MCI. Among them, amnestic MCI is the most likely to develop into AD. Therefore, the study and recognition of MCI is helpful to realize early recognition and intervention of AD.

Objective To provide rationales for the prevention and treatment of elderly patients with cognitive disorders through comparing the comorbidities according to different etiologies and severities. Methods Six groups of different cognitive status were selected.There were 438 normal cognitive subjects (NC) from Jing'an community of Shanghai.Five other groups were from the Memory Clinic at our hospital from June 2006 to June 2010.There were subjective memory complaints ( n =443,SMC),mild cognitive impairment (n =540,MCI),vascular cognitive impairment-non dementia (n =119,VCI-ND),Alzheimer's disease (n=337,AD) and vascular dementia (n =54, VaD).All participants finished a battery of neuropsychological tests and completed the survey of such comorbidities as stroke,conscious disturbance,hypertension,diabetes,head injuries and excessive drinking.Results The comorbidity rates of diabetes were 11.4％,9.9％,16.1％,14.2％,12.4％ and 18.5％ in6 groups (NC,SMC,MCI,VCI-ND,AD,VaD) respectively.There were no differences for overall or pairwise chi square tests.The rates of stroke,hypertension and excessive drinking in patients of VCI-ND and VaD were higher than those of SMC,MCI and AD.The comorbidity rates in the VCI-ND and VaD group were 54.6％ vs 62.9％ for stroke; 61.3％ vs 79.6％ for hypertension ; 22.6％ vs 37.0％ for excessive drinking.Whereas in the SMC,MCI and AD groups,the rates were 9.4％,10.9％ and 3.0％ for stroke; 44.9％,47.2％ and 42.1％ for hypertension;18.0％,18.3％ and 15.1％ for excessive drinking.No distinct differences existed for the comorbidity rates among SMC,MCI and AD groups or among different degrees of AD.Conclusion Etiologies rather than severities determine the different rates of comorbidities in the elders with cognitive impairment.

Objective To explore the neuropsychological features of elderly patients with mild cognitive impairment (MCI) susceptible to Alzheimer's disease (AD).Methods A total of 47 patients with MCI diagnosed from June to October 2008 and 21 controls with normal cognition at the same convalescent camp were selected and followed up for two years.Montreal cognitive assessment ( MoCA),mini mental state examination (MMSE) and clock drawing test (CDT) were performed for all subjects at the onset of study and repeated annually.Results At Month 12,the visuospatial skill scores of MCI patients decreased significantly versus those of the control (0.6 ± 0.7 vs 0.1 ± 0.6,P =0.008 ).No one progressed to AD in neither groups.And at Month 24,both visuospatial skill scores(0.9 ± 0.9 vs 0.4 ± 0.9) and attention scores ( 1.0 ± 1.0 vs 0.2 ± 0.8 ) of MCI patients declined significantly versus the control (P =0.021,0.001 ).Among 47 MCI patients,7 progressed to AD.No obvious difference existed in the score of all items between the AD converters and non-converters at baseline.However,the scores of MMSE (27.6 ± 0.8 vs 28.9 ± 1.0),MoCA(24.3 ±3.1 vs 27.9 ± 1.6)and such MoCA subitems as visuospatial skill(3.9 ±0.7 vs 4.5 ± 0.6),language( 1.86 ±0.38 vs 2.65 ±0.53 )and delayed recall(2.1 ± 1.5 vs 3.9 ± 1.0)of the converters were obviously lower than those of the non-converters at Month 12 (P ＜0.05).Furthermore,all other scores of the AD converters,except for designation and abstract,were significantly lower than those of the nonconverters at Month 24( P ＜ 0.05).Conclusion The visuospatial skill,executive function,delayed recall and language function of MCI patients progressing to AD tend to have early impairment and significant changes.It may be useful to predict AD among the MCI patients.

Objective To explore the characteristics of cognitive impairment in patients with leukoaraiosis (LA).Methods Forty-six LA patients and 38 age and gender-matched healthy subjects were recruited from the Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University between September 2010 and March 2011.All participants underwent the neuropsychological tests recommended by the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards (NINDS/CSN).The were divided into 3 different groups (mild,moderate and severe) according to the Fazekas scale.The differences of neuropsychological performances were compared among 3 groups.Results The LA patients were associated with comprehensive cognitive function deficits,including MMSE (24.4 ± 3.2 vs 28.3 ± 1.2),MoCA ( 20.4 ± 3.0 vs 26.2 ± 0.8 ),digital span forward (5.7 ± 0.9 vs 6.8 ± 1.0),digital span backward ( 3.5 ± 0.7 vs 4.1 ± 0.7),Stroop-B (69 ±13 vs43 ±5),Stroop-C (141 ±42 vs 65 ± 10),trail making test-A (73 ± 15 vs 31 ±7),trail making test-B ( 126 ± 18 vs 82 ± 6) and digit symbol test ( 25 ± 6 vs 37 ± 5,P ＜ 0.05 ).However,there was no difference in the performance of verbal fluency ( 12.7 ± 2.5 vs 13.4 ± 2.5,P ＞ 0.05 ).Correlation analysis showed that the severity of LA had a negative correlation with the performance of MoCA ( r =-0.601,P =0.002).Conclusions The LA patients are closely correlated with cognitive impairments of attention,memory,executive function and information processing speed.It may be attributed to the frontalsubcortical circuitry dysfunction.

Objective To explore the clinical manifestations of muscular tuberculosis (MT) and analyze its risk factors.Methods Twenty MT patients were recruited from our department during 2000 -2010.There were 9 males and 11 females with an average age of 43.5 years old.And their clinical manifestations were recorded and analyzed.Results All patients had local masses.And 19 patients had the involvement of single muscle and multiple muscles were involved in 1 patient.Gastrocnemius was affected in 9 patients.Nine patients had a previous history of tuberculosis or suffered concurrent tuberculosis of other body parts.Three patients with immune system disease received glucocorticoid therapy.And 11 patients underwent PPD (purified protein derivative) test and only 1 was strongly positive while 10 others were negative.MT was confirmed by pathological examinations in 20 cases.All patients underwent muscle biopsy and received effective chemotherapy.Conclusion As a kind of systemic disease, MT is mainly characterized by painful or painless muscle mass.The patients with a history of tuberculosis,tuberculosis of other body parts and immune system disease are susceptible to MT.Diagnosis is mainly made through biopsy.And chemotherapy is effective.

Objective To discuss the treatment of chronic subdural hematoma by minimally invasive drilling and drainage.Methods The clinical data were collected and analyzed for 118 cases with chronic subdural hematoma at our hospital from May 2003 to August 2011.They underwent minimally invasive drilling and drainage.Results A total of 101 cases( 85.6％ ) were cured and 17 cases ( 14.4％ ) improved.Hematoma recurred in 6 cases (5.08％).Among them,5 cases recurred at Months 1 -2 and 1 case at Month 77 post-operation.Three cases died.The causes included heart failure ( n =1 ),cirrhosis and renal failure ( n =1 ) and sudden cardiac death ( n =1 ).Six recurrent cases were cured by minimally invasive drilling and drainage.And 85 cases received a follow-up period of 1 -80 months.No further recurrence was found for 6 recurrent cases.Conclusion The treatment of chronic subdural hematoma by minimally invasive drilling and drainage is safe,simple and efficacious.

Objective To explore the changes of endometrial tissues after the insertion of levonorgestrel intrauterine system (LNG-IUS).Methods The endometrial tissues were harvested from 21 cases after endometrial polyps resection by hysteroscopy.And the patients received a 1-year follow-up.The immunohistochemical stains for estrogen receptor ( ER),progesterone receptor ( PR),Ki-67,bcl-2 and bax were used for semi-quantitative analyses.The changes of endometrial thickness were monitored and uterine weight was observed with a 3-year follow-up.Results The endometrial thickness and uterine weight declined continuously after the insertion of LNG-IUS.The endometrial thickness decreased from the preoperative level of (9.8 ±1.2) mm to (3.5 ± 1.0) mm while the uterine weight dropped from the preoperative level of (98.8 ±8.6) g to (66.6 ±9.8) g.The expressions of ER,PR and Ki-67 were significantly lower than those of the para-polyps endometrial tissue ( P ＜ 0.05 ).The expressions of bcl-2 and bax were significantly higher than those of the para-polyps endometrial tissue ( P ＜ 0.05 ).Conclusion LNG-IUS may prevent the recurrence of uterine endometrial polyps through its inhibited expressions of ER,PR and Ki-67 and induced endometrial apoptosis.

Objective To evaluate the efficacies of treating intra-calcaneal fractures with bone grafting.Methods From January 2005 to October 2011,a total of 182 calcaneal patients underwent operations for closed fractures.There were 159 males and 23 females with an average age of 41.2 years old.The fractures were of the following types: left calcaneal ( n =68 ),right calcaneal ( n =86) and bilateral (n =28).According to the Sander's classification,there were type Ⅱ ( n =27),type Ⅲ ( n =109 ) and type Ⅳ ( n =46).And they were divided into bone graft ( n =94) and non-bone graft ( n =88 ) groups.All of them underwent a profiled plate fixation via a lateral approach.No external fixation was necessary and early ankle functional exercises started postoperatively.They handled partial weight-bearing at Week 6 and full weight-bearing at Week 12.Their outcomes were assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) while classification comparison affected the prognosis (P ＜0.05).Results The follow-ups of 10 patients were lost at Month 3.And 172 cases were followed up for an average period of 14.2 months (range:9 -16).The average healing duration was 12 weeks (range:6- 15 ).None of follow-up cases had any complication,such as vascular and nerve injury and osteomyelitis.Twentynine cases in the non-bone graft group had articular cave-in after weight bearing.And 21 cases were associated with subtalus arthritis.And in the bone graft group,there was no articular cave-in and only 1 case was associated with subtalus arthritis.The outcomes of bone graft and non-graft groups were as follows:excellent (n =68),good (n=20),fair (n=5) and poor (n=1) vs.excellent (n =44),good (n=26),fair (n =7) and poor (n =9).The rate of excellent and good was 87.9％.And the post-operative AOFAS scores had statistical differences between 2 groups (P ＜ 0.05 ).Conclusion Bone grafting is important for improving the therapeutic efficacies for intra-calcaneal fractures.

Objective To apply an integrated omics analysis so as to discover potential biomarkers for an early diagnosis of osteosarcoma.Methods Gene chip and surface-enhanced laser desorption/ionization-time of flight-mass spectra (SELDI-TOF-MS) were employed to screen the marker genes and serum markers of osteosarcoma respectively.The associations of potential biomarkers from the SELDI data and microarray analysis were further inferred by Link-test to identify stable and specific diagnostic biomarkers.Results A total of 653 pre-biomarkers were found in osteosarcoma cells.And six differentially expressed protein peaks with strong statistical significances were detected by SELDI-TOF-MS in the patient's serum samples.Thirteen potential biomarkers for an early diagnosis of osteosarcoma were screened by Linktest.Conclusion As an effective method of identifying osteosarcoma biomarkers,the integrated omics analysis may serve as a monitoring platform for an early diagnosis of osteosarcoma.

Objective To evaluate the clinical efficacies for open reduction and internal fixation of unstable periarticular fractures of metacarpophalangeal joint (MCP) with the AO miniature plate system.Methods A total of 265 patients ( 172 males and 93 females) with 302 MCP periarticular fractures were retrospectively reviewed.Their mean age was 32.5 years old ( range: 17 - 59 ).The standard internal fixation treatment method was established on the basis of the AO/ASIF Comprehensive Classification of Fractures.A “T” shape plate,double-row-plate or a condylar plate was used for A2,A3,C1,C2 type fractures.Screws alone were used for B type fractures.Active and passive flexion and extension exercises at Day 3 post-operation within the limits of patient pain tolerance.All patients were evaluated regarding the total active motion (TAM) score,average PROM,quick-DASH score,the power of gripping,pinching and Kapandji score.Results The patients were followed up for an average of 4.6 months (range:4-24).Radiological examinations showed that the fracture line disappeared in an average of 8.2 weeks (average:8.2).According to TAM rating criteria,the functions of hands were as follows: excellent (n =113 ),good (n =136) and poor (n =53).The fair rate was 82.8％.The average PROM of MP joint was 82.3° ±4.7° and the average quick-DASH score 17.4.Contrast to the health side,the power of gripping recovered for 94.5％ and pinching for 88.6％.The Kapandji score was 90％.A total of 103 MCP (34.1％ ) completely recovered.Contrasting between the head of metacarpal fracture combined the base of proximal phalangeal fracture and alone the head of metacarpal fracture or the base of proximal phalangeal fracture,the postoperative rates of complications and tendon adhesion were higher.As compared with traditional methods,each of the above parameters had statistic significances ( P ＜ 0.0l ).Conclusion Because of complex anatomic structures,the MCP periarticular fractures have such complications as tendon adhesion,joint stiffness and post-traumatic arthritis,etc.The traditional treatment method is less effective.The AO miniplate and screw system provides rigid and stable fixation so that it is a preferred technique in the treatment of MCP periarticular fractures.

Objective To explore the therapeutic efficacies of endoscope for fourth ventricular outlet obstruction(FVOO).Methods Endoscopic third ventriculostomy (ETV) was performed for 30 cases.The circumstances of third ventricular floor and basal cistern were observed and recorded intraoperatively.Meanwhile the fourth ventricular exploration and fistulation were performed across enlarged aqueduct.And the velocity and flow rate of aqueduct,fourth ventricular outlet and stoma were evaluated postoperatively with Cine-MR (magnetic resonance).Results Standard ETV was performed successfully in 28 patients.Fourth ventricular exploration ( n =6 ) and outlet membrane fistulation ( n =2 ) were carried out.The mean follow-up period was 2.3 years ( range:0.5 - 4.0).The overall success rate was 78.6％.Conclusion ETV is a viable therapeutic option for FVO0 patients.The therapeutic effects of outlet membrane fistulation require further observations.

Objective To explore the application of prospective ECG-triggering dual-source CT (DSCT) angiography in infants and children with complex congenital heart disease (CHD) compared with transthoracic echocardiography ( TTE ).Methods Eighty-seven patients ( mean age: 28 months,range 3 months to 6 years; male 46; mean weight:1S kg) underwent prospective ECG-triggering DSCT angiography and TTE.Surgery was performed in 54 patients.The overall imaging quality was evaluated on a four-point scale.Inter-observer agreement in subjective image quality grading was assessed by kappa statistics.The accuracy of DSCT angiography and TTE was calculated based on the surgery findings in the 54 patients who were performed with surgery.Results A total of 267 cardiovascular deformities were diagnosed by DSCT angiography,and 231 deformities were diagnosed by TTE.There was a good agreement on overall image quality (kappa =0.78).A total of 173 cardiovascular deformities were confirmed by surgery findings in 54 patients.The accuracy of DSCT angiography and TTE was 97.69％ ( 169/173 ) and 82.08％ ( 142/173 ).The mean effective dose was ( 0.40±0.08 ) mSv.Conclusions Prospective ECG-triggering DSCT angiography with a very low effective radiation dose allows the accurate diagnosis of anomalies in infants and children with complex CHD compared with TTE.It has great value for preoperative assessment of CHD.

Objective To determine the morphological characteristics of myocardial bridge and mural coronary artery ( MB-MCA ) and initially quantify the changes of MB-MCA in diastole and systole phase with multiple-phase reconstruction technique using 256-slice CT angiography (256-slice CTA).Methods We retrospectively collected the coronary artery imaging data of 861 patients undergoing 256-slice CTA with suspected or documented coronary artery disease.The images were reviewed by two independent radiologists,the diagnosis of MB-MCA was confirmed when consistency was obtained.The length,diameter and thickness of MB-MCA in the middle segment of LAD ( LAD2 ) in diastole and systole phase were recorded,and changes of MB-MCA were calculated.Results Among the 861 patients,150 MB-MCA were found in 131 patients (15.2％).99 MB-MCA (66.0％) were located in LAD2,the remaining 51 (34.0％ ) in the other segments of coronary arteries.The average length and thickness of MB was ( 17.6 ±5.7) mm and (2.6 ± 0.7 ) mm,respectively.The average diameter change of MCA in LAD2 from systole phase to diastole phase was ( 1.2 ±0.5) mm,and 41％ of MCA have diameter stenosis more than 50％ in systole phase.Conclusion The changes of MB-MCA from diastole to systole phase could be determined to some extent by 256-slice CTA multiple-phase reconstruction technique.

Objective To explore the correlation between imaging features of solid-pseudopapillary tumor of pancreas (SPTP) and their pathological findings.Methods Analyze the imaging of 19patients (female 15,male 4,median age 25 years) who underwent surgery for SPTP,and divide their into solidpredominance type, solid-cyst type and cyst-predominance type to compare with their pathological specimens.All patients plain and enhanced CT examination and plain and enhanced MR examination.Results (1) 2 cases of solid-predominance type (11％),13 cases solid-cyst type (68％),4 cases of cystpredominance type(21％ ).Cyst are located in the surrounding area of solid-predominance type; Solid and cyst are mixed in cyst-solid type; cyst-predominance type arc thick-walled cystic tumors with nodules.(2) 12 cases (63％)show obvious signs of haemorrhage and 4 cases (21％) had calcification on CT; All cases (100％) which on MR can be seen signs of haemorrhage.(3)Pathological findings demonstrate SPTP have two ingredients: solid and cystic.However, the two ingredients occupy different ratio in different types.Haemorrhage are seen in all of tumors.Conclusion As a sort of neoplasm which preferentially arising in SPTP occur in pancreas of young women,its different types of imaging features related to their pathological findings.

Objective To conduct a systematic review to compare the early efficacies of minimally invasive surgery (MIS) versus conventional approaches in TKA (total knee arthroplasty). Methods Randomized controlled trials ( RCTs) and clinical controlled trials ( CCTs) were retrieved from the databases of MEDLINE ( 1996.6 - 2010.12), EMBASE ( 1996.6 - 2010.12), PubMed ( 1996 - 2010.12) and Cochrane Library ( Issue 2,2012).Journal of Orthopedics ( from establishment to December 2010) and Orthopedic Journal of China ( from establishment to December 2010) were manually searched.Both RCTs and CCTs were included.The data were extracted by two reviewers with designed extraction form RevMan 4.2.8 software for data analysis.The criteria were as follows: (1) operative duration and reduced blood loss; (2) VAS ( visual analog scale) score; (3) faster recovery of ROM ( range of movement); (4) quadriceps muscle strength; (5)component positioning malalignement; (6) tibiofemoral angle; (7) rate of complications.Results A total of 18 RCTs were included.Compared with the standard TKA procedure,the MIS group had a longer operative duration ( WMD ( weighted mean difference) 14.16,95％ CI ( confidence interval) ( 12.61,15.71)) ; reduced blood loss ( WMD 8.31,95％ CI( 6.16,10.46)) ; lower VAS score at Days 3 -5 post-operation ( WMD 4.99,95 ％ CI(4.19,5.78)) ; better Mean Knee Society scores at Week 6 post-operation ( WMD 4.99,95％ CI ( 4.19, 5.78 )), improvement in ROM occurred more rapidly at Month 3 post-TKA ( WMD 14.59,95％ CI( 8.39,20.80)). Although the differences were not statistically significant,tibiofemoral angle was more precise in the standard group and the rate of component malalignment occurred more frequently in the MIS group ( WMD 0.20,95％ CI( - 0.12,0.52)) ( RR 1.57,95％ CI(0.88,2.83)).Conclusion MIS leads to a faster recovery than conventional surgery with a shorter operative duration,a reduced blood loss,a lower VAS score and a faster recovery of ROM and quadriceps muscle strength.However,the rates of component malalignment and complications occur more frequently in the MIS group.Potential benefits in long-term survival rate and functional improvement require further investigations.

Ovarian pain is the disease with the highest mortality among gynecological malignant tumors. In recent years, its incidence is increasing year by year and getting younger. Because the ovary is located deep in the pelvic cavity, there are no specific symptoms and signs in the early stage, 70% of patients are advanced at the time of diagnosis. The texture of the cancer is brittle, the blood supply is abundant, and the invasion area is wide, which makes the operation more difficult and risky. The treatment of patients with advanced ovarian cancer is aimed at controlling recurrence, prolonging survival and improving the quality of life of patients. The key to achieving this goal is to implement ideal tumor cytoreductive surgery and remove the lesions visible to the naked eye as much as possible. When patients with advanced ovarian cancer have multiple or even multiple organ metastases in the pelvic and abdominal cavity, surgery is still an important treatment link as long as the state permits [1-2]. The treatment experience of two patients with advanced ovarian cancer treated by multidisciplinary combined surgery in the Department of Obstetrics and Gynecology of the Second Hospital of Jilin University is reported as follows.