Volume 92  ·   Issue 25  ·  2012

CSP should be an extremely rare intrauterine ectopic pregnancy, but due to the increasing rate of cesarean section, especially in the past 10 years, its incidence has shown an obvious upward trend. Because of the lack of understanding or insufficient understanding of CSP, the injuries caused to patients due to untimely diagnosis or improper treatment often occur, which has aroused the vigilance and attention of clinicians at present. All levels of women's health care and medical and health institutions have continuously held various lectures to train clinicians about CSP. In fact, the concept of cesarean scar pregnancy was first put forward by foreign scholars Larsen and Solomon in 1978, and one case of CSP was reported, but it did not attract enough attention.

Objective To explore the improvement of surgical procedure in recurrent onychocryptosis and evaluate its efficacy.Methods The meliorated procedure was designed based on the Winograd surgical protocol.A total of 145 cases of recurrent onychocryptosis were reccruited into this retrospective study.The recurrence rate and the difference between recurrent duration and follow-up period were analyzed statistically.Results In this series,onychocryptosis was categorized into type Ⅰ(n =86),type Ⅱ(n =19)and type Ⅲ(n =40)respectively.The average follow-up period was 28.72 ± 9.58 months.No recurrent case was found.The outcomes were significant in both statistical analysis and clinical aspects.Conclusion This modified surgical procedure is effective in the treatment of recurrent onychocryptosis.

Objective To analyze surgical outcome and relevant surgical parameters including resection extent of epileptogenic zone,pathological subtype,brain MRS and MRI results in FCD with intractable epilepsy.Methods We retrospectively analyzed surgical outcomes of 35 patients with intractable epilepsy related to focal cortical dysplasia,accepted surgery in the first affiliated hospital of Fujian Medical University from January 2008 to January 2010,with 12 - 36 months of postoperative follow-up.The relevances between complete resection,pathological subtype,MRS and MRI result and surgical outcome were statistically evaluated.Results 22 patients(66.7％)were Engel class Ⅰ,5 patients(14.3％)were class Ⅱ,6 patients(17.2％)were class Ⅲ,2 patients(5.8％)were class ⅣV.Complete resection of epileptogenic zone(P＜0.05),FCD type Ⅰ(P＜0.05)correlated significantly with favorable surgical outcome.Other factors such as MRI results,abnormal NAA / CHO + Cr ratio on the contralateral side of epileptogenic zone,as well as MRS-accurate lateralization did not influence outcome.Conclusion Overall,the surgical outcome of FCD is favorable.Complete resection,FCD type Ⅰ correlates significantly with favorable surgical outcome.

Objective To evaluate the outcome of CO2 laser treatment as primary therapy for vulvar condylomata acuminate and examine the risk factors and prediction model of single-period CO2 laser treatment.Methods Between March 2009 and December 2010,a multicenter prospective study was conducted at three 3A hospitals of China(Peking Union Medical College Hospital,Zhejiang Women's Health Hospital & Tongji Hospital).All enrolled patients of vulvar condylomata acuminata received CO2 laser vaporization as the primary therapy and had return visits at 1,3 and 6 months individually after treatment.Therapeutic recurrence and side effects were recorded.Logistic regression was used to analyze the associations between demographic or clinical characteristics and the outcome of single-period CO2 laser treatment and a prediction model was established subsequently.The optimal cutoff value of model was evaluated by area under the receiver operating characteristic curve(AUC ROC).Results A total of 160 patients completed a 6-month follow-up with a loss rate of 9.1％(16/176).And 131 patients(82％)were cured after the single-period CO2 laser therapy with a total recovery rate of 94％(150/160).Side effects occurred in 50(31％)patients with a complete self-recovery within 6 months.The most common side effects were local ulceration,pain and edema.No severe side effect was present.Large area of lesion(＞8cm2),vagina involved and unemployment were associated with the failure of single-period treatment while pain symptom was a protective factor of effectiveness.Age,marital status,symptom-free and vaginal involvement were not related with outcome.A prediction model was established as follows:Logit(P0)=-1.511 +1.573X1+1.679X2+3.254X3-1.685X4(X1-X4 representing area of lesion＞8cm2,vaginal involvement,unemployment and pain symptom respectively).The optimal cutoff value of P0 was 0.35 with AUC ROC of 0.816(P＜0.01).The sensitivity,specificity,positive predictive value and negative predictive value of model were 58.6％,91.6％,60.7％ and 90.9％ respectively.Conclusion CO2 laser is effective and safe therapy for vulvar condylomata acuninata.A prediction model has been proposed to predict the outcome of single-period CO2 laser therapy in initially diagnosed patients.It may guide clinical decision-making.

Objective Cochlear implantation is the current standard of care in patients with significant sensorineural hearing loss.The purpose of this study was to assess the effects of cochlear implantation on ipsilateral tinnitus.Methods With standard assessment table and standard testing program,48 postlingual hearing-impaired adults aged 18 -62 years(mean age at implantation:35.0)were operated at 5 clinical centers from June 2009 to March 2010.There were 23 males(47.9％)and 25 females (52.1％).We evaluated the pre- and post-implantation degrees of tinnitus,performed free sound field audiometry and scored speech perceptiou during different periods.Secondary analyses were conducted to examine the correlation between the effects of implantation on tinnitus and hearing or speech perception rehabilitation.Results Before implantation,there were 16 cases with ipsilateral tinnitus and 32 cases without tinnitus.After implantation,among 16 cases,the outcomes were recovery(n =6),tinnitus suppression(n =1)and no change in symptoms(n =9).The total effective rate was 43.8％.Among another 32 cases without preoperative tinnitus,2 cases developed tinnitus after implantation.The effects of cochlear implantation on tinnitus were negatively correlated with the course of tinnitus.There was no more correlation with other factors.Conclusion Cochlear implants have significant therapeutic effects on tinnitus in 43.8％ of implant users.Better efficacies are correlated with a shorter course of tinnitus.However,tinnitus suppression using electrical stimulation via cochlear implantation for deafness needs to be further evaluated.

Objective To explore the indications,surgical techniques and prognostic factors of short fusion versus long fusion for elder patients with degenerative lumbar scoliosis.Methods Thirty-eight patients undergoing different kinds of surgical procedures for lumbar spinal scoliosis between June 2005 and October 2010 were recruited for this retrospective study.The mean patient age at surgery was 64.2 years (range:61 -75).The short fusion group included 13 patients and the long fusion group 25 patients.Results There were a variety of treatment methods of degenerative scoliosis based on the symptomatology and radiological measurements of scoliosis and stenosis.Thirty-eight patients were followed up for an average of 37 months.The number of fused levels was 2.8 ±0.7 segments in the short fusion group versus 5.1 ± 1.4 in the long fusion group.The average preoperative Cobb angle was 18.6°(range:12 -27)in the short fusion group versus 33.5°(range:3 -42)in the long fusion group.The correction of Cobb angle averaged 40％ in the short fusion group versus 67％ in the long fusion group.Clinical symptoms and functional tolerance for daily activities improved postoperatively.Radiographic evaluations showed reduced deformity on the frontal and sagittal planes.There were no infections,pseudoarthrosis,instrument-related failures or reoperations.Conclusions Long segment fusion is superior to its short segment counterpart in correcting scoliotic curvature and coronal imbalance and improving rotational subluxation of apical vertebra.Careful perioperative preparation is essential in the treatment of elder patients with lumbar spinal scoliosis.

Objective To evaluate the repair of rotator cuff tear by allogenic cortical bone anchors with the technique of suture bridge.Methods A total of 18 patients with rotator cuff tear were recruited during the period of June 2006 to June 2009.There were 7 males and 11 females with an average age of 45.2 years old(range:34 - 65).The locations included left shoulder(n =11)and right shoulder(n =7).Rotator cuff tear was repaired by allogenic cortical bone anchors with the technique of suture bridge under arthroscopy.The efficacy was evaluated by University of California Los Angeles(UCLA)standard score.Results The average follow-up period was 17.6 months(range:12 -36).The excellent rate of treatment was 100％.All rotator cuff tears were healed.Only 2 cases had minor pain and there was no limitation of joint activity.The bone anchor fully integrated with the subject area at Month 3 post-operation.Conclusion The advantages of repairing rotator cuff tear by allograft cortical bone anchors with the technique of suture bridge includes minimal trauma,a large tendon bone area,firm fixation and a low cost.It is a better approach of repairing rotator cuff tear.

Objective To explore the clinical and magnetic resonance imaging(MRI)characteristics and the follow-up outcomes of neurologic complications in children with enterovirus 71-infected hand-foot-mouth disease.Methods The clinical and MRI manifestations and follow-up outcomes in 35 children,at Second Affiliated Hospital,Wenzhou Medical College from August 2008 to November 2010,hospitalized with neurologic complications of enterovirus 71-infected hand-foot-mouth disease were retrospectively analyzed.Results Six children with aseptic meningitis presented the clinical symptoms and signs of meningitis.Five of them showed subdural effusion and ventriculomegaly,or both on MRI.At followups,neurologic sequel could not be found.Among 24 cases with brainstem encephalitis,there were myoclonic jerks and tremor,ataxia,or both(grade Ⅰ disease,n =12),myocloous and cranial-nerve involvement(grade Ⅱ disease,n =4),and cardiopulmonary failure after brain-stem infection(grade Ⅲdisease,n =8).In patients with brainstem encephalitis,lesions were predominantly located at the posterior portions of medulla and pons with hypointensity on T1WI and hyperintensity on T2WI.Cerebellar dentate nucleus,caudate nucleus and lenticular nucleus could also be involved.At follow-ups,the patients with mild symptoms had no neurologic sequel and the lesions within brain stem became small or vanished in most cases.While in the majority of serious patients,neurologic sequel could be found and the lesions located at brain stem became encephalomalacia.Fourteen cases with acute flaccid paralysis presented acute limb myasthenia with tendon reflex and muscular tension decreased.On spinal MRI,the lesions predominantly involved anterior horn regions of spinal cord with hypointensity on T1WI and hyperintensity on T2WI.Most patients improved their muscle strength and most lesions of spinal cord became smaller or vanished during follow-ups.Couclusion MRI is the most effective modality of diagnosis and follow-up for neurologic complications in children with enterovirus 71-infected hand-foot-mouth disease.On MRI,the lesions mainly involve the anterior horn of spinal cord,medulla oblongata and pons.At follow-ups,most patients have no neurologic sequel and the visualized lesions will be absorbed after active treatment.

Objective To evaluate the influences of high-field intraoperative magnetic resonance imaging(iMRI)on the extent of resection(EoR)in low-grade gliomas.Methods Fifty-nine patients with low-grade gliomas underwent microsurgeries under the guidance of high-field iMRI and functional neuronavigation.The rates of gross total removal and EoR were recorded after initial and final iMRI scans and neurological performances were evaluated peri-operatively and at follow-up.Results iMRI and functional neuronavigation were successfully performed in all patients.Initial iMRI found that the rates of gross total removal were misestimated in 21 cases(35.6％).In 17 cases(28.8％),initial iMRI revealed resectable residual tumors and further resection achieved gross total removal in 8 cases(13.6％).iMRI boosted the level of EoR from 90％ + 15％ to 94％ ± 12％(P ＜ 0.001)in all cases and from 78％ ± 17％ to 91％ ±12％ in 17 cases undergoing further tumor resections.At 3-month follow-up,2 cases(3.4％)developed neurological deficits.Conclusion The combination of iMRI and functional neuronavigation helped maximize safe tumor resection in low-grade gliomas.

Objective To explore the secular trends of cesarean delivery and cesarean delivery on maternal request(CDMR)among primiparous women with singleton pregnancy in Southern and Northern China.Methods The Perinatal Healthcare Surveillance System was established in 26 counties/cities of 3 Chinese provinces since 1993.A total of 1 317 774 primiparous women with singleton pregnancy were monitored through the system during the 1993-2010 period.Chi-square tests were performed to assess the linear trends in the prevalence of cesarean delivery and CDMR.Results During the 18-year period,496 054 cesarean deliveries and 129 219 CDMRs were identified.The prevalence rates of cesarean delivery and CDMR were 37.6％ and 10.0％ respectively.CDMR accounted for 26.0％ of all cesarean births.The prevalence of cesarean delivery increased from 29.4％ during the 1993-1995 period to 58.7％ during the 2006-2010 in Southern urban area,from 18.2％ to 58.3％ in Southern rural area and from 4.3％ to 49.5％ in Northern rural area.The prevalence of CDMR increased by 34 folds from 0.6％ during the 1993-1995 period to 21.3％ during the 2006-2010 period in Southern urban area,by 40 folds from 0.6％ to 24.4％ in Southern rural area and by 44 folds from 0.6％ to 27.3％ in Northern rural area.The proportions of CDMR in all cesarean deliveries significantly increased in all three regions.Women aged over 30 years,overweight and well-educated were more likely to experience a cesarean delivery including CDMR.Conclusion The Chinese prevalence rates of cesarean delivery and CDMR increased dramatically during the 1993-2010 period and ranked the highest in the word by 2010.And CDMR became a non-negligible component in all cesarean sections.

Objective To explore the pmtective effect of breviscapine on human hepatocytes(L-02)under hypoxia/re-oxygenation(H/R)and elucidate its possible mechanism.Methods A in vitro model of H/R was employed to mimic H/R injury of graft organ.L-02 cells were randomly divided into 3 groups:control,H/R and breviscapine treatment(pre-treated with breviscapine and H/R).After a 10 h hypoxic culturing under 1％ O2,94％ N2 and 5％ CO2,L-02 cells received oxygen for 1,2,4,8,16 and 24 h respectively.MICA mRNA and protein levels were detected by quantitative real-time polymerase chain reaction(PCR)and Western blot.And the activity of natural killer(NK)cell cytotoxicity for L-02 was measured by lactate dehydrogenase(LDH)release assay.After blocking I/R treatment with NKG2D antibody,the activity of NK cell cytotoxicity for L-02 was detected.Results After 10 h hypoxia,MICA mRNA and protein levels significantly increased from 1 h,stayed up-regulated until 8 h and then went back to normal level after reoxygenation versus the control group.The activity of NK cell cytotoxicity for L-02 under the treatment of H/R increased markedly from 1 h post-reoxygenation and stayed up-regulated from 1 h to 8 h versus the control group.After hypoxia,L-02 cells were blocked with NKG2D antibody and the NK cell cytotoxicity for L-02 significantly decreased versus the L/R group.The administration of breviscapine significantly lowered the mRNA and protein levels of MICA in L-02 under I/R and then significantly decreased the NK cell cytotoxicity.Conclusion The process of I/R may mediate the NK cell cytotoxicity activity toward to L-02 by inducing a strong increase of MICA at mRNA and protein levels in L-02 cells.And the dministration of Breviscapine significantly reduces the NK cell cytotoxicity for L-02 under I/R through the down-regulated expression of MICA.

Objective To explore the expression of α5 subunit of extrasynaptic GABAA receptor in insular electrical kindled rats and analyze its significance.Methods A total of 96 male Sprague-Dawley rats were divided randomly into kindled,sham-operated and control groups(n =32).And each group was further divided into 2 sub-groups at different time points.Kindled group:insular electrical kindled via chronic electrical stimulation; Sham-operated group:electrode implantation without electrical stimulation;Control group:no operation at all.The number of hippocampal neurons was detected by Nissl staining; the mRNA of α5 subunit of hippocampus by quantitative-polymerase chain reaction(q-PCR); the expression of α5 subunit of hippocampus by immunohistochemistry.Results No significant difference existed in the number of hippocampal neurons between epileptic and normal rats(P＞0.05).The mRNA levels of α5 subunit of hippocampus in the sham-operated and control groups were much higher than that of the kindled group at Day 1 and 7 post-sacrificing(P＜0.01).And the hippocampal expressions of α5 subunit were much more in the sham-operated and control groups than that of the kindled group at Day 1 and 7 post sacrificing(P＜0.01).Conclusion The hippocampal expression of α5 subunit decreases markedly in insular epilepsy.And α5 subunit may play an important role in the occurrence and development of insular epilepsy.

At present, the evaluation of treatment response of depression is still subjective, and there is a lack of objective biological indexes [1]. There are studies using EEG signals to observe the changes of EEG in rhythm, amplitude and power with antidepressant treatment [2-3]. However, these studies mainly focus on EEG, and the results are influenced by scalp, skull and extracerebral tissues, with many influencing factors, poor spatial localization accuracy and poor repeatability of the results. However, magnetoencephalography (MEG) can detect brain electromagnetic activity in real time without invasion, and the data acquisition is more reliable. At present, there are few studies on neuropathological mechanism of depression patients [4-5]. In this study, MEG technology was used to observe the energy changes of various frequency waves in young and middle-aged patients with major depression before and after treatment compared with healthy people, in order to provide experimental basis for finding evaluation indexes for depression treatment.

The patient was an 82-year-old male with asymptomatic infrarenal abdominal aortic aneurysm found by physical examination and ultrasound. The maximum diameter of the aneurysm was 7.5 cm by CT arterial reconstruction (CTA). On September 25, 2010, he underwent endovascular repair of abdominal aortic aneurysm (EVAR) under general anesthesia in the Department of Vascular Surgery of Peking Union Medical College Hospital. He was complicated with chronic renal insufficiency before operation, with serum creatinine 141 μ mol/L and endogenous serum creatinine clearance 34.7ml/min. The EVAR operation was successful, and the abdominal aortic stent graft system (Endurant, USA) was selected. After stent implantation, the angiography showed that there was no endoleak and the aneurysm isolation was satisfactory. The intraoperative vital signs were stable, and the total intraoperative bleeding volume was about 400 ml.

The patient was a 19-year-old female, Han nationality, unmarried. She was admitted to the Department of Rheumatology of PLA General Hospital on October 10, 2009 due to alternating swelling and pain in both knees for more than 4 years, waist discomfort for 2 years, and hip pain with aggravation for more than 2 months. The patient developed swelling and pain in the right knee joint after falling on a bicycle in 2005. A small amount of pale yellow fluid was extracted from the right knee joint in the local hospital. According to "synovitis", she was treated with analgesics and "synovitis granules" (details unknown) for 2 months, and the swelling and pain in the right knee joint basically disappeared. Since then, alternating swelling and pain in both knee joints occurred every year due to knee twisting or long-term weight bearing, including standing and walking, which lasted for about 1 month each time, and there was no formal diagnosis and treatment.

Drug allergic reaction refers to the adverse reaction of patients with specific constitution after using certain drugs. It is a common problem in clinical practice. If not paid enough attention to it, it not only affects the treatment of diseases, causes complications, but even threatens life. 65% ~75% of Stevensjohnson syndrome (SJS) and toxic epidermal necrolysis (TEN) with high mortality rate are caused by drugs. Recent studies have shown that cytotoxic T lymphocytes mediated by human leukocyte antigen (HLA) restriction pathway can initiate special immune reactions such as SJS/TEN, and their pathological mechanism is closely related to HLA alleles [1].

At present, drug-induced liver injury (DILI) has attracted more and more attention. In the United States, DILI is the leading cause of acute liver failure, and its incidence rate is at least 10~15 per 100 000 people per year. Insufficient understanding of DILI often leads to difficulty in diagnosis, and its diagnosis mainly relies on exclusion methods at present. In order to deeply study the pathogenesis of DILI, the drug-induced liver injury Research Network (DILIN) is exploring standardized methods for diagnosing and evaluating liver injury caused by suspected drugs. The National Institutes of Health (NIH) working group has provided a framework diagram for diagnosing DILI including clinical characteristics, with the goal of improving the safety of patients by reducing the exposure of high-risk potential hepatotoxic drugs. Due to the lack of objective biochemical markers, the study of its pathogenesis is more and more difficult and important. This paper will introduce the research progress of DILI pathogenesis in recent years.

A 61-year-old female was admitted to the hospital due to "progressive difficulty walking of both lower limbs for 3 months". The patient developed low back pain in January 2008, and began to develop weakness with numbness of both lower limbs in June, difficulty walking, and the symptoms gradually worsened. She was admitted to the neurology department on September 16. The admission diagnosis was: spinal cord lesion with incomplete paralysis. On September 16, she was admitted to the neurology department. Physical examination showed that both lower limbs had increased muscle tone, tendon hyperreflex, positive bilateral Babinski sign, decreased vibration and position sensation of both lower limbs, uncooperative heel, knee and tibia test, bilateral ankle adduction, involuntary twitching of both feet, and needed to be helped to walk. Subacute combined degeneration of the spinal cord was preliminarily considered. B-ultrasound showed cholecystitis with multiple gallbladder stones, multiple left kidney stones, and no obvious abnormalities in liver, pancreas, spleen and right kidney.

Waardenburg syndrome (WS) [1] is a rare autosomal genetic disease involving eyes, ears, skin, hair, bones and digestive tract. Three cases found by the author in the community screening work in Changchun City are shared with colleagues. Case 1, male, 19 years old, Han nationality. He has been deaf in both ears since childhood, and his right eye is heterochromatic. He was delivered naturally at full term, with no similar medical history in his family, his parents are not close relatives, and his mother has no history of rubella or medication during pregnancy. Physical examination: There is no pigmentation in the skin of the whole body, normal head and neck, no white hair on the forehead, thick and messy eyebrows, no connected eyebrows, no deformity in the ear, normal lungs, normal heart, normal abdomen, normal spine and limbs, and no positive signs in the nervous system.

Clinically, there are several indexes to evaluate the efficacy of depression. In the past, the commonly used one is "response", which refers to the patient's depression scale score dropping by 50% or more. The commonly used depression scales are Hamilton depression scale (HAMD) and Montgomery depression scale (MARDS). Among them, Hamilton depression scale has 17-item and 24-item versions, and the most commonly used one is 17-item version (HAMD17). In addition, self-rating depression scales, such as Zhuang's self-rating depression scale (SDS), are also used. However, the concept of "effective" has many defects. For example, the HAMD17 score of a depressed patient before medication was 36 points, but after several weeks of treatment, the score dropped to 18 points, reaching the "effective" standard, but the patient was still in an obvious state of depression, social function impairment and suicide risk.