Volume 92  ·   Issue 29  ·  2012

Lower extremity venous ulcer (VU) is the most serious form of chronic venous disease of the lower extremities, and it is also the most difficult type to manage, the most common in the ankle. Although the mechanism of VU is caused by long-term severe venous blood flow stasis and venous hypertension, the actual causes of venous stasis and hypertension are very different from person to person: some are due to venous obstruction, some are due to venous reflux, some are both, and the locations of obstruction or reflux are also different.

Objective To evaluate the clinical application of protein-to-creatinine ratio (P/Cr)in spot urine samples so as to check whether it can replace urine protein excretion in 24 h collections for the diagnosis and screening of preeclampsia.Methods The investigators selected 100 cases of pregnant women with preeclampsia and 36 cases of normal pregnant women examined at Sir Run Run Shaw Hospital over the last two years.The correlations between P/Cr in first morning urine samples and urinary protein excretion in 24 h collections were analyzed.The cutoff values of P/Cr in first morning urine samples for screening preeclampsia of 0.3 g and 5 g in urinary protein excretion in 24 h collections were determined by a receiver operating characteristics (ROC) curve.Results A highly significant correlation existed between P/Cr in first morning urine samples and urinary protein excretion in 24 h collections.By the ROC curve analysis,the P/Cr of 0.34 g /g and 2.08 g/g in first morning urine samples represented the most appropriate threshold for detecting the urinary protein excretion of 0.3 g and 5 g in 24 h collections.Conclusion The P/Cr in spot urine samples can replace urinary protein excretion in 24 h collections.It is a simple and reliable tool of diagnosis and follow-up for preeclampsia.

Objective To explore the potential effects of modified electroconvulsive therapy (MECT) in prefrontal lobe and thalamus in patients with schizophrenia by proton magnetic resonance spectroscopy (1H-MRS).Methods From November 2010 to June 2011,a total of 31 schizophrenics fulfilling the third edition of the Chinese Classification of Mental Disorders (CCMD-Ⅲ) were recruited.And prefrontal lobe and thalamus were evaluated by multi-voxel 1H-MRS before and after 8 sessions of MECT.The subjects were evaluated by the positive and negative syndrome scale (PANSS).And the Nacetylaspartate ( NAA),choline-containing compounds (Cho) and creatine compounds (Cr) were measured and the ratios of NAA/Cr and Cho/Cr determined.Results ( 1 ) In left prefrontal lobe and bilateral thalamus,the NAA/Cr ratio at post-treatment demonstrated higher than that at pre-treatment ( 1.50 ± 0.31 vs1.35±0.30,t=2.07,P＜0.05; 1.53 ±0.31 vs 1.38 ±0.27,t=2.03,P＜0.05; 1.51 ±0.29 vs 1.36 ± 0.26,t =2.14,P ＜ 0.05 ).( 2 ) The major influencing factors of the changes of NAA/Cr in left prefrontal lobe were age of onset,decrease rate of PANSS,baseline PANSS total score and duration of illness.And the major influencing factors for left thalamus were age of onset and duration of illness while a major influencing factor for right thalamus was baseline PANSS total score.Conclusion MECT may modify brain metabolism as measured by 1 H-MRS.The pattern of changes suggests possible neuroprotective effects in schizophrenics.And these effects are correlated with age of onset,duration and severity of illness.

Objective To summarize our own experiences of managing chronic expanding intracerebral hematoma (CEICH) and discuss its diagnosis and treatment.Methods The courses of CEICH,clinical and imaging features,intraoperative findings,pathological examinations and follow-up outcomes were reviewed retrospectively.The relevant literatures were reviewed simultaneously.Results The course of CEICHs ranged from 22 days to 10 years.Twenty-three cases (54.8％ ) were misdiagnosed as cystic gliomas,cystic gliomas,brain cysticercoses,brain abscesses and tumor strokes,etc.The misdiagnostic rate had decreased to 19.0％ since June 1997.Thirty-eight patients underwent surgical operations and 4 had puncture drainage of hematoma.There was no operative death.Thirty-three cases achieved an excellent recovery and 9 cases had varying degrees of nervous dysfunctions.The follow-up period was 1 -21 years.One patient had recurrence after 10 years.Among the cases of multiple CEICH,two lesions underwent no surgical treatment.One increased obviously after 7 years and another disappeared.Conclusion The following five points may be used as the diagnostic criteria of CEICH:( 1 ) intracerebral cystic space-occupying lesions on brain images; (2) circular or circle-like enhancement around lesions; (3)a mixed signal of concentric circular lamellar structures on MRI T1WI; (4) abnormal vascular lesions on CTA,MRA or DSA; (5) clinical signs and symptoms of slow progress of intracranial pressure.CEICHs with clinical symptoms of local mass effect shall be obliterated surgically.The abnormal tissues in cyst wall of hematoma should be resected.Small hematomas ( ＜2 cm) may be followed up.

Objective To discuss an innovative model of blindness prevention targeting the elimination of cataract blindness.Methods The patients aged 50 or above underwent one mature procedure of small incision cataract surgery.It was performed at our class 3A hospital with advanced medical skills,superior medical services and management system.Results A total of 36 681 subjects were examined and 10 090 required operations.And 7624 operations were performed in 5 years.Blindness was eliminated in 99.3％ of those blind surgical patients while 95.0％ of low vision ones improved.The prevalence of surgical complications was 0.8％.Recovery occurred after a proper treatment.Conclusion With a high quality,a high efficiency but a low cost,this innovative model of blindness prevention is reproducible,propagable and suitable for China's conditions and scale-ups.

Objective To explore the effects of transcription factor SOX9 on chondrogenic differentiation potential of human umbilical cord mesenchymal stem cells (hUC-MSCs).Methods hUC-MSCs were harvested from human umbilical cord and their phenotypic characteristics identified by flow cytometry.To confirm their multipotency,hUC-MSCs were induced to differentiate toward adiposity and osteogenesis.After transfection with the packaging lentivirus vectors containing SOX9 in vitro,the expression of green fluorescent protein (GFP) and the efficiency of transfection were detected by fluorescence microscopy.Their cellular proliferation capacity was detected by thiazolyl blue tetrazolium bromide (MTF) assay,hUC-MSCs modified with SOX9 were seeded into monolayer and cultured for 21 days in a defined,serum-free medium supplemented with transforming growth factor (TGF) -β1.The untransduced cells or those transduced with GFP served as the controls.Morphologic changes of hUC-MSCs were observed daily and their chondrogenic differentiation was evaluated by reverse transcription-polymerase chain reaction ( RT-PCR),Western blot,and immunofluorescent staining.And the accumulation of sulfated glycosaminoglycans was detected by Alcian blue staining.Meanwhile,the expressions of collagen Ⅰ,Ⅹ and cell adhesion molecule N-cadherin were assayed.Results The hUC-MSCs isolated from human umbilical cord stromas exhibited fibroblastic morphology and they were positive for CD29 (95.9％),CD44 (96.5％ ),CD90 (98.9％),CD105( 94.3％ ) and negative for hematopoietic stem cells surface markers CD34 ( 3.0％ ) and CD45 (2.6％ ).At Day 21,hUC-MSCs differentiated toward adiposity and osteogenesis.Both oil red O and alkaline phosphatase stains were intensely positive and it confirmed the multilineage potential of hUCMSCs.An intense expression of GFP was observed under flourescence microscope and the transfection efficiency of cells with Lenti-GFP-SOX9 or Lenti-GFP was more than 90％ respectively.SOX9 gene was overexpressed in hUC-MSCs at 48 h post-transduction.The proliferation of hUC-MSCs had no significant effect after the transfection of lentivirus vectors (P ＞ 0.05 ).In vitro high-density monolayer culture of these SOX9transfected hUC-MSCs demonstrated that spontaneous cell aggregation appeared at Day 14 of culturing and subsequently generated large cartilage nodules.However there was no phenomenon of cell aggregation occurring in the cells transducted by Lenti-GFP or untransduced vectors.The expressions of collagen Ⅱ and Aggrecan were higher in SOX9 transducted cells than those in the controls.Alcian blue staining also showed abundant accumulation of sulfated glycosaminoglycans in the SOX9-iuduced cartilage nodules.The expression of collagen Ⅰ had no difference in all groups and collagen Ⅹ was inhibited in SOX9 transduced cells.Ncadherin was strongly up-regulated by SOX9 and might result in cellular aggregation and formation of large cartilage nodules.Conclusion SOX9 may enhance the chondrogenic differentiation potential of human umbilical cord mesenchymal stem cells through cellular aggregation.

Objective To explore the changes of regional cerebral blood flow at the site of anastomosis of superficial temporal artery-middle cerebral artery (STA-MCA) to guide the preventive treatment of symptomatic hyperperfusion.Methods A total of 35 patients with Moyamoya disease were recruited from Beijing Tiantan Hospital.There were 22 males and 13 females with an average age of 29 years (range:5 -55).And there were 10 children.Regional cortical blood flow (rCBF) was measured by Laser Doppler flowmeter (LDF) before,after and at Day 1,2,3,4,5 and 6 postoperation of STA-MCA anastomosis.The probe of LDF was implanted adjacent to the area of anastomosis for 144 hours to record the values of rCBF.Results The baseline LDF values of cortical rCBF near the area of anastomosis were ( 69 ±24) PU before anastomosis,(66 ±74) PU immediately after anastomosis,(123 ±23) PU at the conscious time after anesthesia postoperation,(297 ± 17) PU at Day 1 postoperation.And the LDF values of the following5 days were (302 ±31),(317 ±26),(272 ±46),(363 ±54) and (367 ±24) PU respectively.Conclusion As a safe and effective treatment for Moyamoya disease,STA-MCA anastomosis has great risks for symptomatic hyperperfusion.The highest risk time for hyperperfusion is identified after STA-MCA.

Objective To explore the magnetic resonance imaging (MRI) features of neurofibromatosis type 1 (NF1) with orbital involvement.Methods We retrospectively reviewed the MRI findings of orbital abnormalities in 80 NF1 patients (86 orbits).The diagnosis was confirmed by the updated National Institute of Health (NIH) criteria All of them underwent MRI scans of orbit or brain while 71 patients had contrast enhancement.Results The orbital abnormalities were documented in 80 patients.And 79 cases (85 orbits) had plexiform neurofibroma in orbit and/or adjacent regions.The orbital involvements extended to superficial temporal fossa ( n =61 ),infratemporal fossa ( n =31 ),cavernous sinus ( n =61 )and pterygopalatine fossa (n =51 ).There was mild-to-moderate enhancement in 71 orbits on contrastenhanced MRI examinations.There were localized defects of orbital walls because of sphenoid bone dysplasia of greater wing (n =79),sphenoid bone dysplasia of lesser wing (n =72),augmentation (glaucoma) of eyeballs ( n =32 ) and optic nerve gliomas ( n =5 ).And 53 cases had hyperintense lesions on T2-weighted brain images.Conclusion Orbital involvement is common for NF1.And MRI is a useful tool of evaluating the extent of involvements and other abnormalities in the NF1 patients.

Objective To conduct long-term follow-ups on the efficacies of surgical approaches for intertrochanteric fractures in elder patients.Methods The outcomes of intertrochanteric fractures in 402 elder patients undergoing different surgical procedures during 2005 to 2009 were reviewed.The modified classification of Singh index,detailed surgical contraindications and improved functional scoring system specialized for intertrochanteric fracture were included.Among these,type Ⅰ to Ⅳ had 17 cases (4％),49 cases ( 12％ ),187 cases (72％),48 cases ( 12％ ).The follow-up period was 1 - 5 years.The orthopedic complications,rehabilitation duration and functional scores were reviewed.Results Most patients achieved self-care at 1 month post-operation.The failure rate of internal fixation was 5％ and infection rate 1.9％ in hemiarthroplasty.type Ⅰ to Ⅳ had 70.6％ and 100.0％,85.7％ and 86.7％,85.4％ and 92.0％,72.9％and 87.5％ cases showed excellent or good outcomes at 3 month and 1 year.During a follow-up period of 5 years,there was no occurrence of prothetic loosening or excessive wear of acetabular.Conclusion A rational selection of surgical approaches may markedly reduce the failure rate of internal post-operative fixation and shorten the rehabilitation period.And the long-term follow-up outcomes are satisfactory.

Objective To explore the interacting mechanisms and influences of different chain lengths of fatty acids and the expression of mitochondria long-chain 3 hydroxyacyl CoA dehydrogenase (LCHAD) in trophoblast cells.Methods The serum-free trophoblast cells cultured in vitro were divided into 5 groups to receieve the stimulations of DMEM/F12 medium without FFA (F-FFA),short-chain fatty acids (SC-FFA),medium-chain fatty acids (MC-FFA),long-chain fatty acids (LC-FFA),very long-chain fatty acids (VLC-FFA).The expressions of mRNA and protein of LCHAD in trophoblast cells were detected by real-time polymerase chain reaction (PCR) and Western blot.Results Compared with the F-FFA,SCFFA and MC-FFA groups,the expressions of gene and protein of LCHAD significantly decreased (P ＜0.05) in the LC-FFA group.The expression of gene of LCHAD increased significantly in the VLC-FFA group (P ＜ 0.05).But no difference existed in protein expression between the VLC-FFA group and other three groups (P ＞ 0.05 ).Gene expression of LCHAD had no difference among the F-FFA,SC-FFA,MCFFA groups ( P ＞ 0.05 ).Compared with the LC-FFA group,the expression of gene of LCHAD increased significantly in the VLC-FFA group ( P ＜ 0.05).Conclusion Free fatty acids may affect the expression of mitochondrial β-oxidation enzyme of LCHAD in trophoblast cells.Long-chain fatty acid alters the LCHAD gene protein expression.The correlation between very long chain fatty acids and the gene expression of LCHAD has been detected and their interactions needs further explorations.Short or medium chain fatty acids have no significant effect on the mitochondrial metabolism of fatty acid β-oxidation in trophoblast cells.

Objective To explore the associations between vitamin D receptor (VDR) gene Tru9I polymorphism and myasthenia gravis (MG).Methods A total of 302 MG patients,diagnosed and treated at Affiliated Hospital of Medical College,Qingdao University and Beijing Friendship Hospital from December 2006 to July 2010,were recruited.And 283 normal subjects were selected as the controls.Tru9I polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).The frequencies of genotypes and alleles were compared among different MG subgroups and control group.The relationship between the genotype and susceptibility or severity of MG and immediate efficacies of glucocorticoid were explored.The SPSS17.0 was applied to statistical analysis.Results In the MG patients whose age of onset was above 15 years,the frequency of TT and tt genotypes in females was lower than that of the control group.However the frequency of Tt genotype was higher than that of the control group.And there were significant differences (x2 =8.847,P =0.012 ).The frequency of Tt + tt genotype in females (58/139,41.7％ ) was higher than that of the control group (56/189,29.6％ ).And there were also significant differences (OR =1.70,95％ CI 1.07 - 3.41,x2 =5.169,P =0.023).Although the frequency of t alleles in females ( 61/278,21.9％ ) was higher than that of the control group (65/378,17.2％ ),no significant differences existed ( P ＞ 0.05 ).There were no differences in frequencies of genotypes and alleles between the patients with varying severity and different immediate efficacies of glucocorticoid (P ＞ 0.05).Conclusion VDR gene Tru9I polymorphism may be related to the risk of MG in females aged above 15 years.

Objective To explore the effects of tetramethylpyrazine on the nitric oxide synthase activity and calcium ion concentration in skeletal muscle fiber and decipher the possible mechanisms of antimuscle atrophy function of tetramethylpyrazine in hindlimb unloading rats.Methods Hindlimb unloading (HLU) rats were used as a muscle atrophy model to study the activity of nitric oxide synthase by colorimetry.The concentration of intracellular calcium ion was measured by laser scanning confocal microscope.A total of 18 female rats were randomly divided into 3 groups:control (CON),hindlimb unloading with water ( HLU + W) and hindlimb unloading with tetramethylpyrazine ( HLU + Tmp) ( n =6each).Results ( 1 ) Compared with CON,the activity of nitric oxide synthase decreased by 28％ in HLU + W( P ＜ 0.05) and decreased by 46％ in HLU + Tmp( P ＜ 0.01 ).The activity of nitric oxide synthase less decreased in HLU + Tmp than that in HLU + W,but it was not statistically significant ( P ＞ 0.05 ).(2)Compared with CON,the concentrations of intracellular calcium ion in HLU + W and HLU + Tmp increased by 330％ and 86％ respectively ( P ＜ 0.01 ).Compared with HLU + W,the concentration of intracellular calcium ion decreased by 130％ in HLU + Tmp ( P ＜ 0.01 ).Conclusion The activity of nitric oxide synthase decreases and the concentration of calcium ion increases in hindlimb unloading rats.And tetramethylpyrazine may suppress the calcium ion overloading but not the activity of NOS associated with disuse muscular atrophy.

Objective To explore the effects of chemokine-like factor 1 ( CKLF1 ) on the growth and apoptosis of human vascular smooth muscle cell and understand its mechanism for the induction of cell apoptosis.Methods After the transfection of human vascular smooth muscle cell with CKLF1,CCK8 assay was used to observe the growth of cell.The cell cycle and apoptosis was assessed by flow cytometry (FCM).And the mRNA and protein expressions of Bcl-2,Bax and Caspase-3 were detected by real-time polymerase chain reaction (PCR) and Western blot respectively.Results At 24,48 and 72 h,the growth proliferation ( 15.8％ ± 3.4％,25.5％ ± 9.8％ and 37.2％ ± 3.3％,P ＜ 0.05) and inhibited apoptosis (5.5％ ±1.3％,7.6％ ± 0.7％ and 11.4％ ± 5.5％,P ＜ 0.05 ) of vascular smooth muscle cell were detected.CKLF1 also down-regulated the level of mRNA expression of Bax (0.96 ± 0.14,0.61 ± 0.15 and 0.37 ±0.05),protein expression of Caspase-3 (1.94 ±0.30,1.09 ±0.17 and 0.73 ±0.09) and elevated the mRNA expression of Bcl-2 ( 1.59 ± 0.18,2.05 ± 0.51 and 2.96 ± 0.27 ).Conclusion CKLF1 can induce proliferation and inhibit apoptosis of human vascular smooth muscle cell through the down-regulation of Bax and Caspase-3 and the up-regulation of Bcl-2 expression.

The diagnosis of multiple sclerosis (MS) seems simple, and the diagnosis is determined according to the clinical symptoms, neuroimaging examination and laboratory testing criteria established in relevant guidelines. In fact, there are many diseases with similar manifestations to MS, so many clinicians may misdiagnose other diseases (such as non-specific white matter lesions, minor stroke, migraine, etc.) as MS.

Primary liver cancer (PLC) is one of the most common malignant tumors in clinic, and its global incidence rate is increasing year by year. In 2008, the incidence number has exceeded 748,000/year, ranking fifth among malignant tumors; The number of deaths is nearly 695,000/year, ranking second among tumor-related deaths.

Thrombolysis is one of the therapeutic methods for thrombotic diseases. However, in the past, thrombolytic drugs have short half-life, need to be used repeatedly or continuously, which caused bleeding complications by excessive dosage, and their sustained-release preparations have emerged as the times require. The ideal sustained-release preparations of thrombolytic drugs have the dual functions of sustained-release drugs and targeting. The drugs are slowly released and have long half-life, which improves thrombolytic efficiency, reduces drug dosage and reduces toxic and side effects.

adjacent segment disease (ASD) is a long-term complication after fusion surgery, which is a new clinical symptom caused by the degeneration of movable vertebral segments adjacent to the fusion site [1-2]. ASD is commonly called "adjacent spondylosis", which mainly occurs in the first segment adjacent to the fusion site, sometimes in the second segment adjacent to the upper segment or the lower segment adjacent to the fusion site.

A 75-year-old female was admitted to the Department of Rheumatology and Immunology of the First Affiliated Hospital of Sun Yat-sen University on August 2, 2011 with hemorrhagic cystitis (HC) due to painless macroscopic hematuria with blood clots for 2 weeks. The patient was diagnosed with systemic sclerosis in April 2004 due to skin swelling of limbs with dysphagia.

The patient was a 33-year-old female, an accountant. She was admitted to hospital on October 21, 2011 due to "intermittent headache for more than 1 year, aggravated with memory loss for more than 10 days". In the past year, the patient had pulsatile pain in the left frontotemporal region after every menstruation, accompanied by nausea, sweating, tiredness and inattention. The headache was significantly aggravated after activity, and the pain could be relieved after sleep, lasting for about 2~3 days each time, and the symptoms were repeated. It was effective to take non-steroidal drugs.