Volume 92  ·   Issue 19  ·  2012

Breast cancer is the most common malignant tumor in women worldwide, and the incidence rate of breast cancer in large cities such as Shanghai and Beijing and some coastal cities in China has accounted for the first among female malignant tumors. 40% of breast cancer patients in China are postmenopausal women, 70% are positive for hormone receptors, and 30% of these breast cancer patients will eventually relapse and metastasize. Theoretically speaking, metastatic breast cancer (MBC) is an incurable disease, and the purpose of treatment is to prolong the high-quality survival of patients as much as possible [1].

Objective To explore the treatment of greater trochanter fracture after total hip replacement (THR).Methods This series consisted of 3 males and 8 females with fractures of greater trochanter after total or partial hip replacement from 2004 to 2009.The mean age at the time of fracture diagnosis was 69 years old (range:52 -79).Two fractures were seen on radiograph at Day 2 postoperation and 3 found during a regular follow-up within the first 7 months after primary THR.They had no symptoms.Six patients fell and five of them occurred over 2 years after THR.The average migration between trochanter and proximal femur were 12 mm (range:3 -38).Ten cases underwent protected weight bearing for 6 - 12 weeks and avoidance of active abduction until union was complete or there was no pain.Only one case suffered hip dislocation with a 38-mm migration and underwent operative repair of greater trochanter with suture.Hip pain,instability,range of motion and Trendlenburg gait were examined during a regular followup.Evaluations of fracture migration and bone healing were performed from the radiograph of AP and lateral views of hip.Results There was no patient loss.The mean follow-up period was 40 months (range:12 -68).All had nearly normal function and no symptoms at the latest follow-up.For 10 non-operatively treated cases,the fractures remained non-displaced and the Trendlenburg sign was negative at the final visit.Bone healing occurred in 5 patients.Fibrous union occurred in another 6 patients.Conclusion The post-THR fractures of greater trochanter are usually stable and may be treated non-operatively.

Objective To analyze the misdiagnosed cases with benign paroxysmal positional vertigo (BPPV).Methods During October 2010 to January 2011,a total of 287 patients with dizziness visited the Dizziness Clinic at Changzheng Hospital,Second Military Medical University.Forty-eight misdiagnosed cases with BPPV were collected and their clinical data were analyzed.All 48 cases were diagnosed by the DixHallpike or Roll test maneuver.Results ( 1 ) Clinical features:there were 38 females and 10 males with an average age of 54 ± 12 years old( range:31 - 87).Posterior semicircular canal was involved in 75.0％ ( 36/48) whereas the horizontal semicircular and multiple canals in 20.8％ (10/48)and 4.2％ (2/48)respectively.All patients were treated successfully.And 41 cases ( 85.4％ ) were cured on the first visiting day.Recurrences of BPPV occurred in 6 cases during the follow-up.( 2 ) The initial visiting departments consisted of the department of general internal medicine 43.8％ (21/48),department of neurology 27.1％(13/48),department of osteology 18.7％ (9/48),ear,nose & throat (ENT) department 2.1％ (1/48)and other departments 8.3％ (4/48).In addition,68.7％ (33/48) of them frequented the general outpatient clinics during their initial visits and the other 31.3％ (15/48) used the emergency services.(3)The initial diagnoses included vertebrobasilar insufficiency/cerebral circulation insufficiency 27.1％ ( 13/48),cervical spondylosis 27.1％ ( 13/48),cerebral infarction 4.2％ (2/48),Meniere's disease 2.1％ (1/48)and others 10.4％ (5/48); Besides,29.1％ (14/48) of them had no diagnosis. (4) The average clinic visits per patient were 3.4 times (164 visits/48 cases).(5) The most commonly performed tests included brain computed tomography (CT) (28 person-times),cervical magnetic resonance imaging (MRI)( 19 person-times),brain MRI( 18 person-times),cervical radiography ( 18 person-times) and cervical CT (8 person-times).Conclusion In these misdiagnosed cases of BPPV,most of them were middle-aged women.They were most likely to have their first consultations in the departments of general internal medicine and neurology.Therefore these two departments should pay more attention to applying the maneuver of DixHallpike or Roll test so as to reduce the misdiagnosis of BPPV and the waste of healthcare resources.

Objective To assess the efficacy and safety of interventional techniques in the treatment of deep venous thrombosis (DVT) and its complication of acute massive pulmonary thrombosis embolism (PTE).Methods Twenty massive PTE patients received the examinations of Doppler ultrasonography,computed tomography (CT) and venography.After a definite diagnosis,interventional therapy was used for symptomatic controls.The interventional procedures included catheter fragmentation and suction ( n =11 ),catheter-directed thrombolysis ( n =7 ),stent placement ( n =4 ) and inferior vena cava ( IVC ) filter placement (n =11 ).After the above procedures,low doses of urokinase and heparin were prescribed for 1 week.During a follow-up period of 6 -24 months,the findings of CT,radiography and ultrasound were reexamined.Results Interventions were successful.The success rates of fragmentation and sucton and iliac vein stenting were both 100％.No major complications occurred.Pulmonary embolism involved main trunks and branches of lungs.Both arterial blood pressure and oxygen saturation were below normal values.After interventions,the clinical symptoms and angiographic results improved obviously.Conclusion It is safe and effective to apply catheter-directed mechanical fragmentation,suction and thrombolysis in the treatnent of DVT and PTE.IVC filter may be useful for the prevention of PTE.

Objective To explore the diameter of internal carotid artery by arterial phase imaging of multi-slice spiral computed tomography ( CT).Methods A total of 260 routine brain CT scans of the examiner were performed.And the arterial phase images of carotid artery were acquired,observed and measured through a three-dimensional reconstruction workstation.On the diameters of target sections were measured on the multiplanar reconstruction (MPR) images of carotid artery.Two groups were categorized according to gender and 3 groups by age (25 -40 yr,41 -60 yr and 61 -85 yr) for statistical analysis.Results The diameter data of internal carotid artery had statistical significances among genders and 3 age groups (P ＜ 0.05 ).Conclusion The diameter of internal carotid artery may be evaluated by the arterial phase imaging of multi-slice spiral CT so that the reference data can be provided for clinical diagnosis.

Objective To evaluate the value and efficacy of surgical treatment with neuroendoscopy with supported channel for hypertensive intraventricular hemorrhage (HIVH).Methods The clinical data of 32 patients with hypertensive intraventricular hemorrhage were retrospectively analyzed.And they underwent neuroendoscopy with supported channel.Results Computed tomography scans at Day 1 postoperation revealed that the evacuation of intraventricular hematoma was 85.4％ in all patients.The Glasgow coma score (GCS) at Week 1 postoperation was significantly higher than that at preoperation.The postoperative outcomes were intracranial infection ( n =1 ),mortality ( n =1 ) and secondary hemorrhage ( n =3).All patients were followed up for 3 months.According to Glasgow outcome scale ( GOS ),there were excellent recovery (n=17),moderate disability (n =7),severe disability (n =5) and vegetative survival (n=3).Conclusion The surgical treatment of neuroendoscopy with supported channel for HIVH offers great advantages with a low rate of complications and favorable outcomes.

Objective To explore the efficacy and safety of human aspart versus regular human insulin in women with gestational diabetes mellitus (GDM).Methods A total of 80 women with GDM during pregnancy delivered at our hospital divided into 2 groups:Group 1 with human aspart and regular human insulin N while Group 2 with regular human insulin R and N.The levels of glucose were compared before and after 2 h at breakfast,lunch and supper at Day 1,3 and 5.And the outcomes of women and their babies were evaluated.Results No significant difference in general characteristics existed between two groups.Except for breakfast of Day 3,no significant difference was found in terms of the amount of insulin,the time of satisfactory glucose level and delivery time point,etc.There was no significant inter-group difference in the outcomes of pregnant women and their babies.Conclusion The efficacy and safety of human aspart or regular human insulin are comparable for the women with gestational diabetes mellitus.

Objective To explore the clinical significance of squamous cell carcinoma antigen (SCC-Ag) in the diagnosis,treatment and prognosis of cervical squamous cell carcinoma Methods The serum SCC-Ag concentrations were measured for 1195 patients with cervical squamous cell carcinoma,54patients with non-squamous cell type cervical cancer,325 patients with cervical intraepithelial neoplasm and 69 healthy women treated at Gynecology Ward of Shengjing Hospital,China Medical University from August 2008 to October 2010.And the correlations with their clinical pathological features of squamous cell carcinoma were analyzed and the changes in the diagnosis,treatment and prognosis monitored. Results Serum SCC-Ag in patients with cervical squamous cell carcinoma showed a sensitivity of 62.32％ and a specificity of 90.10％ with the optimal cutoff point of diagnosis at 1.45 μg/L.The differences of pretreatment serum SCC-Ag levels were statistically significant in clinical stage,histological differentiation,depth of invasion and lymph node metastasis ( P ＜ 0.01 ).The posttreatment serum SCC-Ag levels of 106 patients undergoing radical surgery and 264 patients on chemotherapy significantly decreased and were significant different with their pretreatment levels ( P ＜ 0.05 ).There was no relationship of serum SCC-Ag levels and human papillomavirus (HPV) opportunistic infection (all P ＞ 0.05 ).The best threshold values of pretreatment serum SCC-Ag concentration for predicting early postoperative cervical lymph node metastasis and prognosis of cervical cancer were 2.15 and 12.1 μg/L respectively.Conclusion As a relatively specific tumor maker for cervical squamous cell carcinoma,squamous cell carcinoma antigen is correlated with clinicopathological features of cervical squamous cell carcinoma.And it has important clinical reference values in the diagnosis,prognosis,follow-up evaluation and treatment monitoring of cervical squamous cell carcinoma.

Objective To compare the outcomes of anterior verus posterior instrumentation under different surgical procedures in the surgical management of thoracolumbar spinal tuberculosis (TB).Methods Between January 2004 and December 2009,241 adult patients with thoracolunbar spinal TB underwent radical debridement and strut grafting plus anterior or posterior instrumentation in single-stage or two-stages.The mean age was 39 years (range:16 -67).The mean follow-up period for 189 patients was 37 months (range:22 -72 ).Among them,157 cases underwent ＞ 3 weeks of chemotherapeutic regimen of isoniazid,rifampin,pyrazinamide and ethamburol and the remaining 32 were operated for neurological impairment after 6 - 18 h with the same chemotherapeutic regimen.Except for 8 patients with skip lesions undergoing hybrid anterioposterior instrumentation,anterior instrumentation was utilized in 74 patients (Group A) and posterior instrumentation in 107 patients (Group B).Results In both groups,local symptoms of all patients were relieved significantly 1 -3 weeks postoperatively.And 10/14 cases (71％) in Group A and 14/19 cases (74％) in Group B with neurological deficits had excellent or good clinical outcomes ( P ＞ 0.05 ).The levels of erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.4 mm/h preoperatively to normal at 8 - 12 weeks postoperatively.Kyphosis degrees were corrected by a mean of 11.5 ° in Group A and 12.6° in Group B ( P ＜ 0.01 ).The correction loss was 6.8 ° in Group A and 6.1° in Group B at the last follow-up ( P ＜0.01 ).Fusion rates of the grafting bone were 92.5％ and 91.8％respectively at the final follow-up ( P ＞ 0.05 ).Severe complications did not occur.Conclusion Either anterior or posterior instrumentation can obtain good results in correction and maintenance of deformity,clearance of foci,decompression of spinal cord and pain relief in the treatment of thoracolumbar spinal TB as long as the surgical indications are properly selected.Posterior instrumentation may be superior to anterior instrumentation in the correction and maintenance of deformity.

Objective To investigate the risk factors of postoperative hemodialysis in patients undergoing off-pump coronary artery bypass grafting (OPCAB).Methods The perioperative data of 2379 consecutive patients undergoing OPCAB from November 2007 to February 2009 were analyzed retrospectively.Patients were divided into dialysis group and non-dialysis group according to their use of hemodialysis therapy or not.Results Fifty-four patients experienced hemodialysis postoperatively.The incidence of hemodialysis was 2.3％,the mortality rate of dialysis group and non-dialysis group was 18.5％ and 0.9％ respectively.Univariate analysis showed that these factors significantly related with the postoperative dialysis:intraoperative ventricular fibrillation,emergent cardiopulmonary bypass,preoperative atrial fibrillation,intraoperative atrial fibrillation,preoperative renal dysfunction,intraoperative high-dose adrenaline usage,ventricular aneurism,combined valvular disease,hypertension,age and numbers of grafting vessels.Multivariate logistic regression showed that intraoperative ventricular fibrillation,intraoperative high-dose adrenaline usage,hypertension,age and the numbers of grafting vessel were the risk factors of postoperative hemodialysis for patients undergoing OPCAB surgery.Conclusion Intraoperative ventricular fibrillation,intraoperative high-dose adrenaline usage,hypertension,age and the numbers of grafting vessels were the independent predictors of postoperative hemodialysis in patients undergoing OPCAB surgery.

Objective To analyze the misdiagnosis of bilateral iridocorneal endothelial (ICE) syndrome and the possible reasons.Methods The patients seen from January 1998 to December 2011 at Beijing Tongren Hospital,misdiagnosed as bilateral ICE syndrome,were analyzed retrospectively.And a literature search was performed with a Wanfang computerized database website for the case studies of bilateral ICE syndrome.The history,clinical profiles and the findings of corneal,iris and anterior chamber examinations were analyzed.The clinical manifestations of patients with ICE syndrome were also compared with those of Axenfeld-Rieger syndrome,posterior polymorphous dystrophy (PPMD) and chronic iritis for differential diagnosis.Results Ten patients were diagnosed as bilateral ICE syndrome.However,among them,5 patients were diagnosed as Axenfeld-Rieger syndrome,2 patients as PPMD,3 as chronic iritis and none as bilateral ICE syndrome.There were 9 Chinese reports of bilateral ICE syndrome in a total of 18 patients.Analysis showed that Axenfeld-Rieger syndrome needed to be ruled out in 10 patients,PPMD could not be ruled out in 2 patients while diagnosis could not be made in 6 patients for a lack of proof.Conclusion Despite the reporting of bilateral cases,ICE syndrome is usually unilateral.With specific micrographic features for a definite diagnosis of ICE syndrome,ICE cells may become an important feature differentiating from Axenfeld-Rieger syndrome,PPMD and chronic iritis.

Objective To prepare injectable chitosan/β-glyceral phosphate disodium/collagen scaffold and observe its effects upon the growth and differentiation of myoblasts.Methods After the preparations,2 wt％ chitosan ? solution,50 wt％ β-glyceral phosphate disodium (GP) solution and 2 mg/ml collagen ( Co ) solution were mixed on ice according to a volume ratio of 5 ∶ 1 ∶ 6 to yield a thermosensitive injectable scaffold.To assess the cytotoxicity of scaffold,the extraction fluids of different concentrations were added into the myoblast culture.Then relative growth rate (RGR) was calculated.The growth and differentiation state of myoblasts in routine culture or gel-coated plates were compared.Myoblasts were encapsulated in C/GP/Co solution before gelation to perform a 3-dimensional culture and then observed dynanically.Results No cytotoxicity was demonstrated.No significant difference of proliferation index was demonstrated (P ＞ 0.05 ) but fusion index and size of myotube increased significantly ( P ＜ 0.05 ).Thriving viability and proliferation were verified by the observations of laser confocal scanning microscope and scanning electron microscope.Conclusion C/GP/Co scaffold is a promising carrier for the culture and transplantation of myoblasts.

Objective To employ the classical Wnt/β-catenin signaling pathway interference to explore the effects on the functional changes of eutopic endometrium stromal cells and the differences between endometriosis in a murine model.Methods Two out of three mouse groups received an injection of either Wnt/β-catenin signaling pathway activator or blocker.Later the endometrial tissue samples were obtained to develop endometrial stromal cell cultures for the detection of cell invasion ability via Boyden chamber invasion assay and Western blot (WB).Then the methods of WB and Immunohistochemical staining (IHC)were used to examine the factors of eutopic endometrium.And an endometriosis model was established to investigate the factors of signaling pathway via quantitative polymerase chain reaction ( QPCR ) and IHC.Results According to WB test,the level of β-catenin,GSK-3β and APC in the activation group were significantly higher than in the inhibition group( P ＜ 0.01 ).In Boyden chamber invasion assay,the number of cells on membranes in the trial group was significantly higher than the control group [ (113 ± 12) vs (64 ± 13) ].The expressions of VEGF and MMP-9 in the endometrial stromal cells culture from Boyden chamber assay analyzed via WB were ranked from highest to lowest respectively as activation group (vs control group was 35.6％ and 27.4％ higher),control group and inhibition group (vs control group was 12.3％ and 30.4％ lower).Furthermore,the endometrial E-cadherin and VEGF examined via IHC respectively showed a positive expression in inhibitor group and strong positive expression in activation group.QPCR showed the level of Wnt3,Wnt7,GSK3β,Lef and E-cadherin in the activation group was higher than those in the inhibition group ( P ＜ 0.05 ).Conclusion The intervention of WNT signaling pathway in vivo cause the changes of eutopic endometrial invasion and adhesion function,and further affect the development of endometriosis.Wnt/β-catenin signaling pathway may promote the eutopic endometrial cell proliferation and improve the ability of eutopic endometrial implantation, invasion,metastasis and angiogenesis.

Epilepsy is one of the common chronic neurological diseases. Studies have found that 37% ~70% of patients with epilepsy have neuropsychiatric disorders [1-3], such as depression, anxiety and attention deficit/hyperactivity disorder (ADHD) [4-5], among which ADHD may be closely related to epilepsy in children and adolescents. Attention deficit/hyperactivity disorder refers to a psychopathological disorder characterized by inattention, hyperactivity and impulsive behavior that do not correspond to the developmental degree (age). Studies have shown that the incidence of ADHD in children with epilepsy is significantly higher than that in ordinary children. However, so far, the pathophysiological mechanism of ADHD in children with epilepsy is still unclear, and the clinical seizures of epilepsy, EEG epileptoid discharge, the relationship between anti-epileptic drugs (AEDs) and ADHD and whether the treatment of ADHD (methylphenidate) will aggravate epileptic seizures are still uncertain. Therefore, the above contents are reviewed with reference to some literatures in recent years.

Restenosis and occlusion have always been one of the important problems affecting the long-term effect of endovascular therapy. Since the advent of nickel-titanium alloy stents, it has been reported in the literature that among in-stent restenosis (ISR) appearing 12 months after stent placement, restenosis with stenosis degree less than 50% only accounts for 54% ~68% of all ISRs, which is not satisfactory. Compared with elastic arteries such as iliac artery, the middle-term patency rate of percutaneous transluminal angioplasty (PTA) of femoropopliteal artery is lower, and the restenosis rate of one year after operation is 40% ~60% [1-3]. The one-year restenosis rate of extensive superficial femoral artery disease over 10 cm is more than 70%. The long-term patency rate is too low, so that endovascular therapy cannot completely replace surgical bypass surgery for most patients with claudication or severe limb ischemia caused by superior genicular artery occlusion.

depression is a common mood disorder, with significant and persistent low mood as its main clinical characteristics, and the low mood is not commensurate with its situation. The clinical manifestations are gloom, sadness, slow response to pleasant or unpleasant events, decreased motivation, loss of interest and/or happiness, decreased attention, hesitation or hesitation, loss of self-confidence or self-esteem, sense of worthlessness, self-blame without reason, or inappropriate guilt, helplessness, pessimism, hopelessness, wanting to die and suicidal ideas; Some cases had obvious anxiety and motor agitation; In severe cases, psychotic symptoms such as hallucinations and delusions may occur. What should arouse the attention of non-psychiatrists is that patients with depression have a large amount of physical discomfort, which may be consulted in various clinical departments. The possible physical discomfort of patients with depression can be summarized as follows: (1) Changes in basic functions: insomnia and (or) excessive sleep, decrease or increase in appetite and weight, and decrease in sexual desire; (2) Changes in energy: fatigue, feeling of weakness, decreased energy and lack of vitality; (3) Physical sensation: chronic pain, cold sensation, burning sensation, heavy limb, any other vague and indistinguishable discomfort sensation; (4) Visceral symptoms: gastrointestinal complaints, cardiovascular complaints, and other vague complaints of body functions.

The patient, a 73-year-old female, was admitted to Taihe Hospital affiliated to Hubei Medical College in November 2010 due to sudden lower limb weakness for 3h and dyspnea for more than 2h. Admission status: 3h ago, she suffered from sudden lower limb weakness, inability to move, no limb pain, urinary incontinence, no limb twitching and disturbance of consciousness. 2h ago, she suffered from sudden dyspnea, breathing with her mouth open and sitting in an upright position; Accompanied by chest tightness, sweating, damp and cold skin, no cough and sputum, no chest pain. Six months ago, he was treated in our hospital for coronary heart disease, old inferior wall myocardial infarction, atrial fibrillation, heart failure, and grade IV cardiac function; He denied the history of hypertension, diabetes, hepatitis and tuberculosis, surgery and trauma, and drug allergy. Physical examination: clear consciousness, breathing with open mouth, damp and cold skin of both lower limbs, pale complexion, shallow and fast breathing, slightly cyanotic lips, bilateral pupils of equal size and round, about 3 mm in diameter, light reflection, no abnormalities in cranial nerve examination. Both lungs were covered with dry and wet rales. The left heart boundary was large, the apical beat point was located in the anterior axillary line of the sixth intercostal on the left margin of the sternum, the heart rate was 140 beats/min, the heart rhythm was absolutely irregular, the first heart sound was of varying intensity, and no murmur was heard. The abdomen was flat and soft, no abnormalities were heard in the auscultation area of abdominal aorta, and the intestinal sounds were normal.