Volume 92  ·   Issue 31  ·  2012

On July 7, 2012, when the earth was sleeping and people were hoping for the new sun to rise, bad news came. Professor Weng Xinzhi, a master of the domestic scientific circle and the outstanding editor-in-chief of Chinese Journal of Internal Medicine, left us forever. Professor Weng Xinzhi was born in Ningbo, Zhejiang Province on May 10, 1919, and graduated from the Medical College of West China Union University in 1946 with a doctorate in medicine. He is a member of the Communist Party of China, a member of the 7th National Committee of the Chinese People's Political Consultative Conference, an outstanding medical scientist, medical educator, internal medicine and respiratory scientist in China, a senior academician of Chinese Academy of Engineering, and an honorary president of Beijing Chaoyang Hospital.

Stroke has become the main cause of death and disability of adults in China. Its high morbidity, recurrence, disability rate and increasing cost of prevention and treatment have caused huge social and economic burden. Although the overall diagnosis and treatment level of stroke in China is gradually rising, the level of prevention and treatment is uneven from place to place and still has a huge gap with that of developed countries.

Multimodal CT includes plain scan CT, CT angiography (CTA) and CT perfusion imaging (CTP). At present, Beijing Tiantan Hospital conducts one-stop multimodal CT project examination for patients with cerebral hemorrhage (Figure 1), and some research data have been obtained in the aspects of CTA predicting early hematoma enlargement, plain scan CT obtaining "relative volume enlargement ratio" to predict cerebral hernia risk, and CTP-PS (CTP-capillary permeability) to evaluate blood-brain barrier destruction.

In the past 20 years, intracranial atherosclerotic disease (ICAD) has become a fascinating and rapidly developing research field. Although the treatment has made great progress, the clinical recurrence rate of symptomatic ICAD is still high, and most of them occur in the same arterial blood supply area, and nearly half of patients are disabled [1].

white matter hyperintensities (WMHs) are manifested as multiple punctate, patchy or fusion hyperintensities around bilateral lateral ventricles or subcortical white matter on magnetic resonance T2 weighted or fluid attenuation reversal recovery sequence (FLAIR). WMHs, also known as leukoaraiosis, was first proposed by Hachinski et al. [1] in 1987 to describe the abnormal CT manifestations of subcortical white matter, that is, the decrease of white matter density. WMHs is widespread in the elderly population. According to statistics, more than 80% of people aged 60-70 years have WMHs, and almost 100% by 80-90 years old [2]. Therefore, it is often considered as an aging phenomenon and ignored by many doctors.

Objective To explore the relationship between angio-arehitectures ot cerebral arteriovenous malformations (AVM) and hemorrhage.Methods A total of 55 consecutive surgical cases of AVM were collected in August 2010 to May 2011 at Beijing Tiantan Hospital.There were 34 males and 21 females with an average age of 32.5 years ( range:3 - 59).The initial symptoms included bleeding ( n =20),epilepsy ( n =21 ),headache ( n =7 ),neurological dysfunctions ( n =6 ) and others ( n =1 ).The relationship between size,location,type of feeding artery,type of draining vein, complicated venous aneurysm and hemorrhage was analyzed by single factor test.Results The cases of AVM fed by perforators,located in basal ganglia and post-cranial fossa,with small size,exclusively deep drainage and complicated venous aneurysm were more likely to present with hemorrhage.Conclusion The hemorrhage of AVM is significantly correlated with many factors,such as the type of feeding artery,size and location of AVM,the type of draining vein and complicated venous aneurysm.But the number of draining vein is irrelevant.

Objective To investigate the value of 320-slics CT perfusion (CTP) imaging in the study of hepatic hemodynamic characters in ischmic-type biliary lesions (ITBL) after liver transplantation.Methods A total of 11 ITBL patients received 320-slice CT angiography (CTA) and CTP after liver transplantation scheduled at 5 - 10 min away.Four patients underwent liver biopsy While 7 patients with normal liver after transplantation were selected as the control group.The parameters of hepatic artery perfusion (HAP),portal vein perfusion (PVP),total hepatic perfusion (TLP) and hepatic arterial perfusion index (HPI) were measured and compared for all patients.And the blood perfusion characters of liver with ITBL after transplantation were analyzed.Results ( 1 ) In 11 ITBL patients,3 patients had no vascular complications on CTA,1 with simple hepatic artery stenosis (HAS),1 with HAS and arterioportal shunt (APS),2 with HAS and portal vein stenosis/right hepatic vein stenosis (PVS/RHVS),1 with simple APS,2 with simple PVS and 1 with portal vein thrombosis and cavernous transformation of portal vein ( PVT and CTPV).And 4/11 patients underwent liver biopsy,2 in which confirmed mild acute rejection and 2 confirmed biliary obstruction associated with ascending biliary infection.(2) HAP of the ITBL and control groups were (66±38) and (40±8) ml· min-1 · (100 ml)-1,PVP (128±35) and (163±21) ml · min-1 · (100 ml)-1,TLP (194±58) and (203 ±19) ml · min-1 · (100 ml)-1,HPI 34％ ± 14％ and 21％ ± 4％ respectively.The differences in the value of HAP,PVP and HPI between the groups were statistically significant ( P ＜ 0.05 ) excluding TLP.Conclusion Various liver perfusion abnormalities of ITBL may be evaluated objectively by CTP.ITBL might occured when HAP and HPI increased with a decreased of PVP.

Objective To evaluate the effects of proloading epidural space with epinephrine (1∶200 000) on the incidence of vascular injuries through the insertion of an epidural catheter during cesarean section.Methods Between May 2011 and December 2011,upon obtaining institutional ethics approval and informed consent from the Human Ethics Committee of Nanjing Medical University, 100 laboring women with singleton cephalic presentation at term,ASA (American Society of Anesthesiologists) class Ⅰ - Ⅱ,undergoing caesarean section under continuous epidural analgesia were randomly divided into E and N groups according to a random digit table (n =50 each).After an identification of epidural space,5 ml of normal saline with epinephrine (1∶200 000) was injected into epidural space in group E and 5 ml of normal saline in group N through an epidural needle.The syringe plunger was pressed firmly for 20 seconds to ensure a sufficient diffusion.For both groups,the levels of mean arterial pressure and heart rates were recorded prior to anesthesia (T1),2 min after switching into a supine horizontal position after successful puncture ( T2),the time of fetal delivery ( T3 ) and when surgery was over (T4).The cases with bloody fluid in epidural puncture needle during puncture or epidural catheter during catheter placement,fresh blood in epidural catheter and bloody fluid in caudal end of epidural catheter during extubation were recorded.Results All hemodynamic changes were within the normal ranges.There were no obvious intergroup differences(P ＞ 0.05 ).No significant difference existed in the cases with bloody fluid in epidural needle during catheter insertion (10％ vs 12％ ) or epidural catheter during catheter placement (4％ vs 6％ ),fresh blood in epidural catheter (0％ vs 0％ ) or bloody fluid in caudal end of epidural catheter during extubation (26％ vs 30％ ) between the groups (P ＞ 0.05 ).Conclusion Proloading epidural space with epinephrine ( 1∶200 000) may not lower the incidence of vascular injuries through the insertion of an epidural catheter during cesarean section.

Objective To evaluate the efficacies and medicoeconomic efficiency of therapeutic method for cesarean scar pregnancy (CSP).Methods The pertinent literatures on the treatment of CSP were collected and screened by retrieving some Chinese and English databases,such as PubMed,VIP and Wanfang Data.The weighting means and polled standard deviations of operative duration, operative hemorrhage volume,hysterectomy rate,length of stay,medical fees and the time of serum level of betahuman chorionic gonadotropin (β-HCG) returning to normal were reckoned.Results Among different therapeutic methods of CSP,curettage duration was shortest in the patients with methotrexate ( MTX ) injection; operative hemorrhage volume,hysterectomy rate and length of stay were smallest in those with uterine artery embolization; medical fees was least in those with local MTX injection; the time of serum β-HCG level returning to normal was shortest in those with hysteroscopic and/or laparoscopic operation after MTX injection or uterine artery embolization.Conclusion Curettage after uterine artery embolization offers multiple advantages over therapeutic methods in the treatment of CSP.

Objective To explore the scan protocol of second generation dual source computed tomography (CT) for CT pulmonary angiogram (CTPA) in patients with suspected pulmonary embolism and determine the proper volume of contrast medium.Methods A total of 120 patients undergoing CTPA were recruited.All examinations were performed on a second generation dual source CT.The scan delay was determined with the test bolus technique.Four contrast volume protocols were designed,namely groups A,B,C and D respectively (n =30 each).For CTPA scan of groups A,B,C and D,35,40,45 and 50 ml contrast medium were injected at an injection rate of 4 ml/s,followed by a saline chaser of 55,50,45 and 40 ml respectively.Attenuation profiles of different vascular segments ( subclavian vein,vena cava,left atrium,pulmonary trunk,S1 artery,S10 artery) were measured to evaluate the timing techniques.The image quality and artifact of iodine map were analyzed by two radiologists for comparisons.Results The percentage of pulmonary arteries exceeding optimal attenuation ( ＞ 200 HU) showed that groups of B,C and D were higher than group A (93％ - 100％ vs 80％ -90％ ).The image quality of group A was lower than the others (P ＜ 0.05) while the other groups showed no significant difference.The artifacts of iodine map of group A were much fewer than the others (P ＜ 0.05 ) and group D was much more than the other groups (P＜0.05).Groups B and C had a score of 4.13 and 3.67 respectively without significant difference (P=0.091).Conclusion With the aids of test bolus technique and proper injection protocol (40 ml contrast medium followed by 50 ml saline),the high quality image and low volume of iodine can be realized with second generation dual source CT for CTPA.

Objective To explore the possible diagnostic values of serum surfactant protein-A (SP-A) and surfactant protein-D (SP-D) for interstitial lung diseases (ILD) in patients with polymyositis or dermatomyositis (PM/DM).Methods Serum MCP-1 concentrations were measured by enzyme-linked immunosorbent assay (ELISA) in 100 adult PM/DM patients,20 patients with pulmonary infection and 42 healthy controls.And the association with their clinical features and serum levels of SP-A and SP-D was analyzed.Results The serum levels of SP-A and SP-D in the PM/DM patients with ILD were both significantly higher than those without ILD and healthy controls (all P ＜ 0.01 ) while there were no significance differences with those with infectious lung diseases (P ＞ 0.05 ).The sensitivity of serum abnormal levels of SP-A,SP-D and combination of SP-A and SP-D for ILD in PM/DM patients were 66.1％,64.3％ and 80.0％ and the specificity 72.7％,72.7％ and 70.2％ respectively.The serum levels of SP-A were positively correlated with serum ferritin and C-reactive protein (CRP) and negatively with percent carbon monoxide diffusing capacity ( DLCO％ ) ( r =- 0.474,P ＜ 0.05 ),VC％ ( r =- 0.404,P ＜ 0.05) while the serum levels of SP-D were negatively correlated with circulating CD3 + T cells ( r =- 0.244,P ＜ 0.05 ) and CD4 + T cells ( r =- 0.277,P ＜ 0.05 ) in PM/DM patients.Furthermore,SP-A was an independent risk factor for death of ILD in PM/DM ( OR 1.032,95 ％ CI 1.006 - 1.059,P ＜ 0.05 ).Conclusion SP-A and SP-D may be potential useful serum markers for the diagnosis of ILD in PM/DM patients.And the combined detection of SP-A and SP-D offers a higher sensitivity than either marker alone.As a risk factor,serum SP-A can predict the prognosis of PM/DM patients with ILD.

Objective To explore the effects of all trans retinoic acid (ATRA) on the cell proliferation and expression alterations of beta-protein 1 (BP1) in human breast cancer cells lines of MDA-MB-468 and MCF-7.Method The proliferation changes were detected by thiazolyl blue tetrazolium bromide (MTT) after the treatment of ATRA.At the dose of 10 -5 mol/L ATRA,the expression of BP1 was measured by reverse transcription-polymerase chain reaction (RT-PCR) and immunochemistry.Results After the treatment of ATRA,the proliferation of cells and the expression of BP1 decreased.Optical density ratio (ODR) of each group decreased from 0.85 ±0.01,0.71 ±0.01 to 0.75 ±0.02,0.72 ±0.06 at 24 h,0.55 ± 0.01,0.52 ± 0.05 at 48 h and 0.34 ± 0.02,0.48 ± 0.03 at 72 h.Significant differences existed among different time groups ( P ＜ 0.01 ).The mean optical density ( MOD ) of each group decreased from 0.509 ±0.081,0.826 ± 0.015 to 0.509 ± 0.081,0.826 ± 0.015 at 24 h,0.270 ± 0.022,0.641 ± 0.041at 48 h and 0.145 ±0.019 and 0.206 ±0.179 at 72 h.Significant differences existed among different time groups(P ＜ 0.01 ).Conclusion ATRA can inhibit the proliferation and the expression of BP1 in breast cancer cells.And BP1 gene may become a therapeutic target for the ATRA-mediated inhibited growth of breast cancer cells.

Objective To explore the effects of ferric ion on the differentiation from both RAW264.7 and bone marrow macrophages to osteoclast in vitro and bone resorption in vivo.Methods In the presence of 50 ng/ml receptor activator of nuclear factor kappa-B ligand (RANKL),RAW264.7 was treated with ferric ammonium citrate (FAC).The formation of osteoclast was observed by staining of tartrateresistant acid phosphatase (TRAP) and the TRAP positive cell counted.The expression levels of TRAP,cathepsin-K,nuclear factor of activated T cells c1 ( NFATc1 ) and ( receptor activator of NF-κB) RANK were measured by reverse transcription-polymerase chain reaction (RT-PCR).The control and iron overload groups were established by the intraperitoneal injection of normal saline and FAC.In vivo imaging system was employed to determine the bone density of femoral midportion and the fourth lumbar vertebra.After that,the bone marrow cells of femurs were used for osteoclast culture.The serum levels of ferritin, TRAP-5b,RANKL,osteoprotegerin (OPG) and C-terminal cross-linking telopeptide (CTX) were measured by enzyme-linked immunosorbent assay (ELISA).Results Ferric ion could stimulate the formation of TRAP positive cells in a dose-dependent manner.The expression levels of TRAP,cathepsin-K and NFATc1 in the FAC treated group were significantly higher those of the control group ( P ＜ 0.05 ) while the expression of RANK showed no statistical difference among these groups ( P =0.967 ).The bone marrow density of femoral midportion and the fourth lumbar vertebra of the iron-overload group decreased significantly versus the control group.The concentrations of ferritin,TRAP-5b,RANKL and CTX of the iron overload group were markedly higher than those of the control group ( P ＜ 0.05 ).Moreover,the concentration of ferritin showed a positive correlation with TRAP-5b and CTX respectively in the iron-overload group ( r =0.65,r =0.76,P ＜ 0.05).But no significant differences existed in the concentration of OPG for two groups (P ＞ 0.05).Conclusion Ferric ion may enhance the differentiation of osteoclast in vitro as well as bone resorption in vivo.

Objective To examine whether the isoflurane-induced spatial memory changes is associated with AD pathogenesis of tau protein phosphorylation.Methods We exposed 18-month-old male Sprague-Dawley rats to 1.4％ isoflurane for 2 hours (anesthesia group,n=31 ).Spatial memory was measured with the Morris water maze before and 2 days after anesthesia.Behavioral testing of the training group ( n =20),without anesthetics,was performed currently with the anesthesia group.The control group (n =10) received no anesthesia or behavioral testing.We calculated the average escape latency of every training day for each rat.We divided the anesthesia group into an isoflurane-induced severe memory impairment group (SIG) and a no severe memory impairment group (NSIG) according to whether prolonged escape latency of each day after anesthesia was more than 1.96 SD of mean escape latency for the training group.Following behavioral testing,total tau protein ( T-Tau ),p-Tau-Thr231 ( pT231 ),p-Tau-Ser396 (pS396),glycogen synthase kinase 3β (GSK-3β) and protein phophatase 2A (PP2A) were quantified by Western blot.Results Six rats had severe post-anesthesia impairments.The expressions of T-Tau,pT231,pS396,GSK-3β and PP2A in the SIG exhibited no differences as compared with the NSIG,training and control groups.Conclusion Tau protein phosphorylation in hippocampus may be irrelevant for isofluraneinduced spatial memory impairment in senile rats.

Objective To explore the differential expressions of microRNA (miRNA) between young and senescent endothelial cells.Methods Young and senescent aorta endothelial cells (EC) were isolated and cultured in young and old male C57BL/6J mice.Immunostaining of Ⅷ factor was performed to identify the endothelial cells.The method of diphenyl tetrazolium bromide (MTT) was employed to compare the cell growth.Microarray was used to detect the differential expression of microRNA between young and senescent endothelial cells and the microarray results were confirmed by real-time polymerase chain reaction (PCR).The expression of endothelial nitric oxide synthase (eNOS) was detected by Western blot.Results Primarily cultured endothelial cells were confirmed by the Ⅷ immunostaining factor.Senescent ECs grew more rapidly than young ECs in lower serum ex vivo.Excluding gender difference,miR-135a,miR-182,miR-96,miR-31,miR-126-3p and miR-362-5p were up-regulated over 2 folds in young ECs,and miR-335-3p and miR-335-5p up-regulated over 2 folds in senescent ECs by miRNA microarray and RT-PCR.The up-regulation of miR335-3p in old ECs and the up-regulation of miR-135a,miR-96 in the young ECs might contribute to a lower expression of eNOS in senescent ECs.Conclusion The expression of miRNAs changes with advancing age and may result in differential expressions of downstream genes.

The main injury mechanism of posterior condylar fracture of the tibial plateau is axial violence in the flexion position of the knee joint, which often manifests as split of the medial condyle, collapse of the lateral condyle, avulsion of the anterior cruciate ligament (ACL) tibial insertion or avulsion fracture of the ACL insertion of the intercondylar spine of the tibia. Such fractures often need to be reduced and fixed under direct vision through posterior approach to restore the smoothness and mechanical stability of the articular surface. There are difficulties in exposing the articular surface and simultaneously managing the ACL injury during surgery. This study reviewed the data of patients with posterior condylar fracture of the tibial plateau treated by arthroscopy to explore the treatment methods and clinical efficacy of this fracture.

Stroke is an important cause of disability and death in adults worldwide. Epidemiological investigation shows that there are about 2 million new stroke patients in China every year, and 1.5 million die from stroke, of which more than half are ischemic stroke [1]. Carotid artery stenosis is an important cause of ischemic stroke, and about 1/4 of ischemic strokes are related to carotid artery stenosis [2]. Therefore, strengthening and standardizing the treatment of carotid artery stenosis has become an important and effective way to prevent stroke.

Anxiety and depression are common psychological problems in general hospitals. Most patients with anxiety and depression have been seen in general hospitals and other medical institutions with physical discomfort symptoms. Due to the lack of training and experience in diagnosing and treating psychological disorders, clinical physicians in various departments cannot identify and deal with patients with anxiety and depression with physical symptoms as the main complaint, which often leads to missed diagnosis and misdiagnosis, delayed treatment opportunity and waste of medical resources.

Intravenous tissue plasminogen activator (tPA) is the only effective treatment for acute stroke. However, intravenous thrombolysis with tissue plasminogen activator increases the risk of spontaneous intracranial hemorrhage (sICH) (2.4% ~8.8% of patients after thrombolysis). Experience shows that the risk of sICH after intravenous thrombolysis is higher in warfarin users.

There are about 22 million new stroke patients every year, and the burden of acute stroke patients on society is obvious.In Europe, recombinant tissue plasminogen activator (rt-PA) is strictly indicated for thrombolytic therapy after acute stroke: age<80 years, onset time<3h. However, according to some previous reports and meta-analysis, it seems that patients aged>80 years and the onset time of thrombolysis>3h can also benefit from this. Therefore, the 3rd International Stroke Trial (IST-3) collaborative group included some thrombolytic patients aged>80 years with onset time<6h. The results were Published Online May 23, 2012 in Lancet.

A 75-year-old male was admitted to the Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical College, Jiangsu Province on December 12, 2009 due to progressive dyspnea 7 months after total laryngectomy. The patient underwent total laryngectomy and bilateral functional lymph node dissection 7 months ago for laryngeal cancer (T4N1M0). After operation, the patient underwent cervical tracheostomy and fistula, and an indwelling tracheal metal cannula was placed to maintain ventilation.

Case 1: A male, 26 years old, weighing 57 kg, went to our hospital for "25 years of diagnosis of hemophilia A and 2 months of right thigh pain". The patient underwent "open reduction and intramedullary nailing fixation of right femoral shaft fracture" in an external hospital 2 years ago for "right femoral shaft fracture", and the wound healed well after operation. The diagnosis of admission was "right femoral supracondylar fracture, right knee hemophilia arthritis and hemophilia A", and it was planned to undergo "open reduction of right femoral supracondylar fracture, allogeneic bone grafting and absorbable screw internal fixation". Preoperatively, FⅧ:C was 7.1%, and there was no coagulation factor VIII (Factor VIII, FVIII) antibody. FVIII preparation was replaced 100% on the day of operation, 80% on the first 3 days after operation, and 60% on the 4th to 7th days after operation.

A 30-year-old female underwent laparoscopic bilateral salpingostomy due to primary infertility and hydrosalpinx in 2007, without contraception and pregnancy after operation. In July 2010, she underwent super-ovulation induction and in vitro fertilization treatment due to tubal infertility, and two frozen-thawed embryos were transplanted for the first time on October 13, 2010. 30 days after transplantation, routine B-ultrasound examination revealed a live fetus in normal intrauterine position, with a gestational sac size of about 4.2cm ×1.2cm and a buttock length of 0.9cm. With a live fetus in the left uterine horn, the size of the gestational sac was about 3.0 cm ×3.0 cm, the length of the parietal gluteal was 1.1cm, and the lateral muscle wall of the gestational sac became thinner and the thickness was about 0.17 cm; No free fluid was observed in the pelvic and abdominal cavities.