Volume 93  ·   Issue 21  ·  2013

To explore the characteristic, diagnosis and treatment of deep venous thromboembolism (DVT) patients with congenital double inferior vena cava.

Retrospective analyses were conducted for the indications, filter types and efficacies of vena cava filter insertion in 7 hospitalized DVT patients with congenital double inferior vena at our hospital from 2006 to 2012.

All of them had definite indications for vena cava filter insertion.Temporary and permanent vena caval filters were implanted in one subject while retrievable vena caval filters in another five subjects.One retrievable filter was replaced by a permanent filter due to excessive thrombus entrapped in filter.Other temporary or retrievable filters were extracted successfully.All subjects were prescribed postoperatively with oral anticoagulants.The follow-up period was 1-72 months.No recurrent DVT or pulmonary embolism occurred.

The complications of double inferior vena cava in DVT subjects are often misdiagnosed due to its low incidence rate and a lack of clinical manifestations.Fatal pulmonary embolism after implantation may be due to an inappropriate location of filter implant.If implanted in a proper position,satisfactory outcomes ensue.

To explore the roles of short form-36 health survey scale in the evaluation of deep vein thrombosis (DVT) patients.

A total of 179 DV T patients were recruited from Department of Vascular and Thyroid Surgery, First Affiliated Hospital, Xinjiang Medical University from June 2009 to March 2013.They were surveyed with short form-36 health survey scale.Then the feasibility, reliability, validity, responsibility, ceiling effect and floor effect were analyzed.

Feasibility analysis: completion time was (10.4±2.9) min and finishing rate 100%.Reliability analysis: all split-half reliability coefficients and Cronbach′sαwere above 0.8.all internal consistency coefficients were above 0.6.Validity analysis:all Pearson coefficients were above 0.6.Two principal components were extracted by factor analysis and it accounted for 67.011% of total variance.After maximal variance rotation, two common factors were generated.And it was almost the same with the theoretic structural assumption of scale.Responsibility analysis: all score of every degree at posttreatment were higher than at pre-treatment.And it was statistically significant (P<0.01).Ceiling and floor effects:there was remarkable ceiling effect on role physical (RP) and emotional role (RE)(24.81%, 36.62%).Remarkable floor effect on RP was 31.76%.

Short form-36 health survey scale is satisfactory in the evaluation of quality of life among DV T patients.But specific items need further improvement.

To explore the clinical profiles of patients with lower extremity deep venous thrombosis (DV T) complicated with inferior vena cava (IVC) thrombus and summarize their clinical diagnostic and therapeutic experiences.

The clinical characteristics, diagnosis and treatment of 20 hospitalized patients with DV T complicated with inferior vena cava thrombus were analyzed retrospectively.

All of them were of proximal DVT.There were phlegmasia cerulea dolens (n=3), pulmonary embolism (n=3) and completely occlusion of IVC (n=5).Clinical manifestations were severe.Retrievable inferior vena cava filter (IVCF) was implanted for 17 cases.Catheter-directed thrombolysis (CDT) through ipsilateral popliteal vein was applied for 7 cases and systemic thrombolysis therapy for 8 cases.The effective rate of thrombolysis for fresh IVC thrombus was 100%.Among 5 cases with Cockett Syndrome, 3 cases underwent balloon dilatation angioplasty and endovascular stenting of iliac vein.And 17 IVCFs were retrieved successfully within 3 weeks.IVC thrombus disappeared completely in 15 cases.

Systemic or local thrombolysis with protective IVCF is a safe and effective therapy for nonocclusive IVC thrombus in DVT.And CDT is recommended for symptomatic occlusive IVC thrombus.

To explore the clinical value of color Doppler ultrasound in patients with prethrombotic state (PTS).

From October 2011 to November 2012, a total of 201 patients were diagnosed with PTS.There were 95 males and 106 females with an average age of 52 years (range:15-78).They were divided into intervention and observation groups on the basis of drug intervention.And the relevant literatures were reviewed and the images of color Doppler ultrasound before and after treatment compared.

Before treatment, blood flow peak rates of common femoral, popliteal and calf intermuscular veins were (0.16±0.03), (0.14±0.03) and (0.13±0.02) m/s| after treatment, (0.19±0.03), (0.17±0.03) and (0.15±0.01) m/s respectively.The peak flow increased and sluggish flow decreased or disappeared in 152 PS patients.It indicated a relief or an obvious resolution of hypercoagulable state.And the symptom of lower extremity soreness was greatly relieved.Among 49 patients without drug intervention, severe full-lumen storm floating occurred in 12 cases.And 8 of them suffered deep vein thrombosis within 2 weeks.The incidence of thrombus was 66.7%.

Color Doppler ultrasound may detect and assess PTS effectively so as to guide effective interventions.

To analyze the clinical characteristics and surgical outcomes of ruptured cerebellar arteriovenous malformations (AVM).

The clinical data were retrospectively analyzed for 676 brain AVM patients.Among them, 616 cases were treated at Beijing Tiantan Hospital from January 2003 to December 2009 and 32 cases of them were of cerebellar AVM.Another 60 cases of intracranial AVM were managed at Beijing Chaoyang Hospital from January 2003 to December 2011 and there were 8 cases of cerebellar AVM.Microsurgery was performed to remove hematoma and excise AVM.And the postoperative outcomes were evaluated.

Statistics analysis of activities of daily living (ADL) scores for 636 cases of cerebral AVM and 40 cases of cerebellar AVM showed no significant difference.Among 40 cases of cerebellar AVM, hemorrhage occurred first in 35 (87.5%) patients.Postoperative re-examinations of computed tomography revealed the resolution of hematoma and the absence of re-hemorrhage.Digital subtraction angiography (DSA) examinations were performed in 39 cases and no residual nidus was observed.Tonsillar herniation occurred preoperatively in 1 case and DSA was not re-examined.There were balance dysfunction (n=3), dysarthria (n=2) and dystaxia and dysphasia (n=1).The postoperative ADL degrees wereⅠ (n=26),Ⅱ (n=10),Ⅲ (n=3) and Ⅳ (n=1).During a follow-up period of 6 months, no re-hemorrhage occurred and there was no worsening function of central nerve system.

Emergency microsurgery is effective in the treatment of ruptured cerebellar AVM.

To explore the association between estrogen receptorβ (ERβ) gene polymorphisms and hypertension in postmenopausal women.

The relationship of two polymorphisms (rs944050 and rs4986938) with hypertension was examined in 71 postmenopausal women with hypertension and 50 healthy age-matched controls.

In hypertension and control groups, the ERβallelic frequencies of A and G were 0.500, 0.500,0.540, 0.460; 0.077,0.923, 0.170, 0.830 respectively.The genotypic distributions of both polymorphisms stayed within Hardy-Weinberg equilibrium.For polymorphism rs4986938, statistical difference existed between the wildtype genotype and a combination of heterozygous and homozygous variant genotypes (P<0.05).The variant allele A of rs4986938 in ERβ gene decreased the risk of hypertension (OR=0.41, 95% CI 0.18-0.92).

The polymorphism rs4986938 in ERβ gene was associated with an elevated risk of hypertension in Chinese Han postmenopausal women.

To evaluate the feasibility and safety of applying video endoscopic inguinal lymphadenectomy via hypogastric subcutaneous approach (VEIL-H) in the treatment of vulvar carcinoma.

From September 2009 to December 2012, 15 patients with vulvar carcinoma underwent VEIL-H plus radical vulvectomy at many participating hospitals.

All were treated surgically.Two of them underwent laparoscopic pelvic lymphadenectomy (LPL) upon the positive results of parotid operations with frozen section.The mean operative duration of VEIL-H (bilateral groin) were (80.8±2.9) minutes.The mean total volume of blood loss in VEIL was (5.5±0.4) ml, the mean drainage duration (6±2) days and the average postoperative hospitalization (11±4) days.The mean follow-up period was 13.0 months.One patient suffered local recurrence at Month 2 postoperation.

VEIL-H is both feasible and safe in inguinal lymphadenectomy.

To compare the blockage effect of multiple injection axillary brachial plexus blockage between ultrasound guidance alone and ultrasound guidance plus neurostimulation.

Upon the approval of institutional ethical committee, a total of 166 patients underwent hand, forearm and distal arm operations under axillary brachial plexus blockage from January to May in 2011 at Department of Hand Surgery, Beijing Jishuitan Hospital.They were randomly allocated to receive either ultrasound guidance plus nerve stimulation (group US-NS,n=83) or ultrasound guidance alone (group US, n=83) for nerve localization.Ten milliliter ropivacaine 0.5% was administered separately on each nerve.Blockage time, needle frequency, success rate, onset of sensory and motor blocks, procedure-related complications (vascular puncture, acute nerve injury and tourniquet pain, etc.) and patient satisfaction were recorded.

The procedure time was shorter in US group than in US-NS group[(3.3±1.5) vs (5.3±2.0) min, P<0.01].The median (range) number of needle frequency of group US was lower than that of group US-NS[(4.3±0.7) vs (5.6±1.4) temps, P<0.01].No intergroup difference existed in success rate.The onset of complete block was shorter in group US-NS than that in group US[(10.6±6.4) vs (12.7±6.9) min, P<0.05].Vascular puncture proportion was higher in group US-NS than group US (16/83 vs 1/83,P<0.01).There was no occurrence of tourniquet pain.Patient acceptance was similar in two groups.

Multiple injection axillary blockage with ultrasound guidance yield similar success rates whether or not combined with nerve stimulation guidance.There appears to be a lower incidence rates of complications for ultrasound guidance alone versus ultrasound guidance plus neurostimulation.

To explore the clinical efficacy of subtalar joint arthrodesis with percutaneous opposite parallel cannulated screws for severe subtalar joint arthritis.

A total of 88 patients with 90 feet underwent subtalar joint fusion under four different incisions from April 2008 to April 2012.There were 56 males and 32 females with a mean age of 43.7 (15-74) years.All of them were evaluated by radiography or computed tomography (CT) scan and assessed by the rating scores of visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS).

Among them,68 cases were followed up for an average of 18.5 (6-48) months.Fusion was confirmed on radiography or CT in 67 cases with a fusion rate of 98.5%.The mean duration of fusion was 13.8 (6-28) weeks, the mean VAS score decreased from 6.00 to 1.03 points (P<0.05) and the mean AOFAS score improved from 57.0 to 80.6 points (P<0.05) with a good-and-excellent rate of 80.8%.

Subtalar joint arthrodesis with percutaneous opposite parallel cannulated screws is recommend for severe subtalar joint arthritis.Such a procedure has a high fusion rate, excellent clinical outcomes and fewer complications.

To determine the prognostic factors and outcomes of Legg-Calvé-Perthes (LCP) disease.

A retrospective review was conducted for a total of 144 LCP patients at Department of Pediatric Orthopedics, Beijing Jishuitan Hospital.Their clinical data, such as age, gender, follow-up duration and radiological characteristics, were collected and assessed with Stulberg classification scheme.

The male-to-female ratio was 8.6:1. Their age of onset was 8.06±2.01 years and follow-up period 5.90±2.29 years.There were Stulberg Ⅰ and Ⅱ (n=52, 36.1%), Ⅲ type (n=57, 39.6%) and Ⅳ and Ⅴ type (n=35,24.3%).Between the low-age (≤8) and highage (>8) groups, the results of lateral pillar classification (A, B, C), modified Catterall staging (A, B) and Stulberg classification had significant differences (P<0.005).Logistic regression analysis showed that age, lateral pillar classification and lateral half dislocation were independent prognostic risk factors.

Age, lateral pillar classification and lateral half dislocation are prognostic factors for LCP.And greater age and higher lateral pillar classification denote a worse outcome.

To investigate the clinical application of multi-slice computed tomography angiography (MSCTA) low-dose scan in pulmonary veins and left atrium and to reduce the radiation dose.

100 middle-sized patients underwent pulmonary veins and left atrium MSCTA were collected and randomly divided into five groups averagely.The tube current were 250 mAs (conventional dose), 200, 150, 100, and 80 mAs (low dose), respectively.The CT scan length (L), volume CT dose index (CTDIvol) and dose length product (DLP) of five groups were recorded automatically,and the effective dose (ED) was measured.The signal to noise ratio (SNR) and the contrast to noise (CNR) of thoracic aorta at the middle level of left atrium were measured to evaluate the image quality objectively.The image quality of pulmonary veins and left atrium MSCTA was evaluated by two experienced radiologists using double-blind method.The results were analyzed by statistics.

(1) The CTDIvol (mGy), DLP (mGycm) and ED decreased evidently with the scan dose reduced, and the difference had statistical significance. (2) The image quality was mainly excellent and good in 100 mAs and the above, and it was mainly good in 80 mAs group.The image quality decreased with mAs reduced.The difference of SNR and CNR within five groups had statistical significance.The satisfaction degree of subjective evaluation on image quality of the five groups was up to 100%.

On the premise that the image quality confirmed to the clinical diagnosis, the low dose scan in pulmonary veins and left atrium SCTA can obviously reduce radiation dose, and it had important clinical significance.

To explore the imaging findings of non-contrast CT scan, enhancement and H RCT of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma.

All the patients with pathologically proven pulmonary MALT lymphoma underwent non-contrast CT scan, of which 7 underwent CT enhancement and 9 had HRCT.CT features of 16 patients were retrospectively reviewed.

Major CT signs of 16 cases were consolidations, nodules and masses, of which 11 had two or more signs and 5 had only one.Together with them, normal or dilated air bronchograms were seen in 13 cases, ground-glass opacity (GGO) in 10, interstitial changes and cysts in respective 5, partial atelectasis and mediastinal and hilar lymphoadenopathy in respective 4, pleural effusion in 2 and MALT lymphoma of tracheobronchial tree in 1. Multiple lesions were found in 12 cases and solitary lesion in 4 cases.Consolidations, greater tubercles and masses mostly had a peribronchovascular distribution.Micronodules occurred in a perilymphatic distribution, of which 8 accompanied other signs.On CT enhancement scans, greater tubercles in the trachea had mild enhancement| most of the consolidations and masses had obvious enhancement, while greater tubercles mostly mild enhancement.CT angiogram sign was found in 3 cases.

Most cases with pulmonary MALT lymphoma have consolidations, greater tubercles and masses with normal or dilated air bronchograms which have a peribronchovascular distribution, together with GGO and micronodules in a perilymphatic distribution| the distinctive manifestations are obvious enhancement with CT angiogram sign.Minority cases have interstitial changes, cysts, partial atelectasis, mediastinal and hilar lymphoadenopathy, pleural effusion and MALT lymphoma of tracheobronchial tree.

To explore the values of total ultrasonic scores of conventional ultrasound and ultrasound elastography in the diagnosis of thyroid nodular lesions.

A total of 347 thyroid nodules proved by fine-needle aspiration cytology (FNAC) and surgery underwent preoperative conventional ultrasound and ultrasound elastography.The features on gray scale,color Doppler flow imaging (CDFI) and elastogram were documented and total ultrasonic scores recorded.

Among 347 nodules, 184 nodules were benign and 163 malignant.Significant differences of total ultrasonic scores were found between thyroid carcinoma and benign nodular lesions including the parameters of nodular shape, edge, echoes, sound attenuation, psammous calcifications, internal blood flow and ultrasound elastography score.The higher the total ultrasonic scores, the more possibility of thyroid carcinoma was.By the analysis of receiver operating characteristic curve, the sensitivity, specificity and accuracy of distinguishing thyroid carcinoma from benign nodular lesions was 84.0%, 89.6% and 84.9% if the cut-off value of total ultrasonic scores was over 4.

For the differential diagnosis of benign and malignant thyroid lesions, the total ultrasonic scores of conventional ultrasound and ultrasound elastography can offer greater values.

To explore the characteristics of time-based prospective memory (TBPM) and event-based prospective memory (EBPM) in patients with severe traumatic brain injury (TBI) during recovery stage.

A total of 20 patients with severe TBI were recruited along with another 20 age, gender and education-matched healthy volunteers.The Chinese version of Cambridge Prospective Memory Test was used to assess the TBPM and EBPM characteristics.The TBPM score, EBPM score, time monitoring frequency, cue finding frequency, and whether or not the participants choose to take notes were recorded and compared between patients and controls.

The TBPM and EBPM scores (9.05±3.59, 11.35±2.25 respectively) of TBI patients were lower than that of controls (14.95±2.09, 16.45±1.54, respectively)(P<0.05).Compared with the controls, time monitoring frequency of the patients[times] was less (1 (1, 2) vs 4 (3, 5.25) times)(P<0.05); cue discovery frequency also less (2 (2,3) vs 5 (4.25, 5) times).And there were fewer note-taking subjects in TBI group (P<0.05).

With deficits in both the time- and eventbased prospective memory, the TBI patients have difficulty of finding time or event cue during interference and auxiliary memory strategy is rarely utilized to realize the prospective memory tasks.

To explore the relationship between chemokine axis CXCL12-CXCR4 and the pathogenesy and severity of epithelial ovarian cancer.

SKO V3 transfected with plasmid, SKOV3 transfected with vector and SKOV3 were cultured in vitro.Methyl thiazolyl tetrazolium (MTT) was used to analyze the effects of different concentrations of CXCL12 on the proliferation, migration and invasion of three cell lines and examine the inhibition of neutralizing CXCR4 antibody or antagonist A MD3100.And the load and weight of acquired tumor were determined at different concentrations of CXCL12.

CXCL12 could promote the proliferation, migration and invasion of SKOV3/CXCR4 cells in a dose-dependent fashion (P<0.05).The effect on CXCL12 tumorigenesis could be inhibited by neutralizing CXCR4 antibody or antagonist AMD3100 (P<0.05).Significant differences existed in the mean survival time, load and weight of metastatic tumors among the three nude mice.

A close correlation exists between hemokine axis CXCL12-CXCR4 and the pathogenesis, metastasis of epithelial ovarian cancer.The above axis may be an important pathogenic factor of epithelial ovarian cancer.And the antibody of CXCL12-CXCR4 is probably effective in its management.

To explore whether neonatal endotoxin challenge alters reproductive hormone secretion in adult female rats.

Rats were intraperitoneally injected with lipopolysaccharide (LPS) or normal saline at postnatal days 3 and 5.At Week 12, the animals underwent bilateral oophorectomy and were exposed to LPS or saline.The secretion levels of luteinizing hormone (LH) and estradiol were measured.

The LPS injection in adult neonatal saline rats caused the suppressed secretion of LH and estradiol.However, the decreased secretion of both LH and estradiol were much more apparent in adult neonatal LPS-treated rats.

The neonatal LPS challenge alters the secretions of LH and estradiol during adulthood.And the mechanism may be mediated by epigenetic programming of hypothalamic-pituitary-gonadal axis.

To observe the effects of neural stem cells (NSC) plus self-assembly isoleucine-lysine-valine-alanine-valine (IKVAV) nanofiber gel transplantation on the promotion of function recovery of spinal cord injury (SCI) in rats.

A total of 230 SD rats were randomized into gel, NSC, NSC plus self-assembly IKVAV nanofiber gel transplantation, normal saline and sham-operation groups.Function repair was evaluated by bundle branch block (BBB) score, immunofluorescence and Western blot respectively at Day 1, 3, 5, 7, 14, 28, 56 and 92 postoperation.

There were statistically significant differences among bundle branch block (BBB) scores of different treatment groups (P<0.01).Moreover, statistical significance existed between each treatment group and combined transplantation group (P=0.000).The expression of glial fibrillary acidic protein in combined transplantation group (rats with spinal injury) was lower than that in other treatment groups (except for sham operation) and the expression of NF-200 in this group was higher than that in other treatment groups (except for sham operation).Significant differences existed in the expressions of brain-derived neurotrophic factor and nerve growth factor between combined transplantation and other treatment groups (P<0.01).

Transplantation with IKVAV nanofiber gel, NSC and NSC plus self-assembly IKVAV nanofiber gel may promote the repair of SCI in rats.But the method of NSC plus self-assembly IKVAV nanofiber gel is more effective.

To explore the altered expressions of Che-1 in rat brain cortex and relative biological functions after traumatic brain injury.

According to a random number table, a total of 64 male Sprague-Dawley rats were divided into normal, sham and trauma group.Then the trauma group was further divided into 6 phase sub-groups (12 h, 1 d,3 d, 5 d, 7 d, 14 d)(n=8 each).The craniocerebral injury (CCI) model was established to induce brain trauma at different timepoints.The examinations of Western blot and immunohistochemistry were performed to detect the expressions and diffusion changes of Che-1.Meanwhile the method of terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) was employed to examine neuronal apoptosis.Additionally, the association of Che-1 with p53, active-caspase-3 and GAP43 was tested with Western blot and immunofluorescent staining.

Compared with the normal and sham groups, the expression of Che-1 peaked at Day 3 post-injury (0.817±0.022, P<0.05) and it was related with neuronal apoptosis.Moreover, the altered expressions of p53, GAP43 and active-caspase-3 were associated with the level of Che-1.

The expression of Che-1 is elevated after brain trauma and may be involved in neuronal apoptosis and axonal regeneration through p53.