Volume 93  ·   Issue 27  ·  2013

Acromegaly (hereinafter referred to as acromegaly) is a chronic progressive endocrine disease with insidious onset, and the course of the disease may be several years or even more than 10 years when the patient sees a doctor. The main cause of large limbs is the excess production of growth hormone (GH) in the body. More than 95% of patients with large limbs are caused by GH-secreting pituitary adenomas. Long-term excessive secretion of GH can lead to excessive hyperplasia of soft tissue, bone and cartilage in the whole body, resulting in facial changes, hypertrophy of hands and feet, thick skin, enlarged viscera, bone and joint lesions, and sleep apnea syndrome. In addition, the incidence of malignant tumors such as pituitary tumor compression symptoms, diabetes, hypertension, cardiovascular and cerebrovascular diseases, respiratory diseases and colon cancer will also increase accordingly. These metabolic disorders and complications seriously affect patients' health and quality of life, resulting in patients' life span shortened. Clinical delays in diagnosis and treatment can significantly increase the incidence of these complications.

To explore the characteristics of both odontoid fractures and adjacent section instability so as to devise proper surgical strategies and achieve better curative effect.

A total of 37 patients (including 26 males and 11 females) with odontoid fractures treated from January 2005 to June 2012 with a mean age of (21- 65) 36 years were analyzed retrospectively.Among 25 cases of simple odontoid fractures, there were typeⅡ (n=20) and low typeⅢ (n=5).There were 12 cases of odontoid fractures with adjacent section instability with C1/2 instability (n=6), C2/3 instability (n=4) and C1/2 and C2/3 instability (n=2).The Frankel scale was used to assess nerve function.There were Grade A (n=1), Grade B (n=2), Grade C (n=3) and Grade D (n=6) at preoperation.Treatment included anterior and/or posterior pedicle screw fixation for reducing fracture and stabilizing upper cervical vertebrae.The Japanese Orthopedic Association (JOA) standards were used to evaluate the therapeutic effect.According to Frankel grade, nerve functional restoration of spinal cord injury was gauged.Fracture healing, bone graft fusion and spinal stability were monitored by radiology or computed tomography.

All patients underwent surgery safely without severe complications.The average follow-up period was 18 (12-48) months.There was significant difference (t=13.464,P=0.000) in JOA score between pre-operation (12.11±2.09) and post-operation (15.36±3.17).And the rate of improvement was 90.8%±11.6% and that of "excellent" or "good" 98%.Degree 1-2 recovery of neural function was achieved in all except for 1 case of Frankel B.All patients were immobilized in a hard collar for 3 months postoperatively.Fusion occurred in all cases within a mean time of (3-6) 4.5 months.Radiology confirmed a proper screw position at postoperation.There were no occurrences of such complications as loosening, displacement or breakage of internal fixations.

Proper surgical approaches may be selected according to the characteristics of both odontoid fractures and adjacent section instability.

To evaluate the efficacies of unilateral versus bilateral pedical screw fixation through the pedicle of fractured vertebra plus short-segment pedicle instrumentation (SSPI) in the treatment of thoracolumbar fractures.

Between June 2008 and September 2010, a total of 46 patients with fractures of thoracolumbar junction, whose scores of load sharing classification (LSC) ranging from 5 to 7, underwent the combined treatment of SSPI and fracture level pedicle screw at our department.They were divided into 2 groups.GroupⅠincluded 25 patients undergoing SSPI plus unilateral pedicle screw fixation through the pedicle of fractured vertebra (5 screws) while GroupⅡincluded 21 patients had SSPI plus bilateral pedicle screw fixation through the pedicle of fractured vertebra (6 screws).The data of anterior body height compression (AVHC), sagittal Cobb′s angle, internal fixation failure, restoration of nervous function, visual analogue score (VAS) and Oswestry disability index (ODI) were analyzed.

The groups were similar with regards to age, gender, LSC, AVHC and sagittal Cobb′s angle preoperatively.Blood loss volume and operative duration were less in the GroupⅠ (109.2±30.68 vs 110.0±32.06 min,t=-0.086, P>0.05 and 376.0±303.1 vs 409.5±361.1 ml, t=-0.342, P>0.05).They were followed up for a minimum period of 12 months.In follow-up period was 17.48±4.14 months in GroupⅠ versus 18.33±4.31 months in GroupⅡ (t=-0.683, P>0.05).All patients with initial partial neurologic deficits improved at the final follow-up.Radiographic parameters and clinical outcomes were similar in both groups.

Pedical screw fixation through the pedicle of fractured vertebra plus SSPI is an excellent surgical therapeutic choice for patients with a LSC range of 5-7 thoraclumbar fractures.The efficacies of unilateral and bilateral pedicle screw fixation at fracture level are the same.

To compare the medium and long-term outcomes of lateral position onestage plus anteroposterior versus posterior approach with subtotal corpectomy, decompression,and reconstruction of spine in the treatment of thoracolumbar burst fractures.

A total of 47 patients with thoracolumbar burst fractures were divided into 2 groups according to surgical approaches.Group A underwent lateral position one-stage plus anteroposterior approach while group B had posterior approach with subtotal corpectomy, decompression and reconstruction of spine.During a follow-up period of 36-68 months, their clinical and radiological outcomes were retrospectively evaluated.The perioperative volume of blood loss, operative duration, complications, pulmonary functions, Frankel scale and American Spinal Injury Association (ASIA) motor scores were recorded and analyzed.And the heights of anterior edge of vertebral body and Cobb angle were examined for radiological outcomes.

At the latest follow-up, all patients achieved solid fusion with significant neurological improvements.The perioperative volumes of blood loss were less, operative duration was shorter and postoperative pulmonary functions were better in the group B (P<0.05).The ASIA motor score and radiological outcomes were not significantly different at all timepoints between two groups (P<0.05).But the neurological functions of two groups improved by approximately 1.4 Frankel grade (group A) versus 1.41 (group B) at the final follow-up.

Lateral position one-stage plus anteroposterior and posterior approaches with subtotal corpectomy,decompression, and reconstruction of spine are adequate surgical treatments for thoracolumbar burst fractures.But the latter has the major advantages of less perioperative volume of blood loss, fewer complications,shorter operative duration and better pulmonary functions.

To document the magnetic resonance (MR) imaging features of multifocal clear cell renal cell carcinoma (RCC).

The MR findings of 11 cases of pathologically-proved multifocal clear cell RCCs were reviewed retrospectively from January 2008 to December 2010.All patients underwent MR in a 1.5 T or a 3.0 T scanner.The MR features of the lesions were analyzed, with emphasis on the location, the signal intensity on T₂-weighted imaging (T₂WI), in regards to pseudocapsule, lipid component, hemorrhage, cystic degeneration, and enhancement pattern.Meanwhile, from these six aspects, the MR appearance of renal cell carcinomas occurring in the same patient were compared.

24 tumors (mean diameter, 3.1 cm) in the 11 patients (6 men, 5 women; age range, 36-69 years; mean age, 50.6 years) were detected.Multiple lesions in bilateral kidneys were found in 9 patients (9/11), while in unilateral kidney 2 patients (2/11).Hyperintensity on T₂WI were observed in 16 lesions (16/24), while hypointensity 8 lesions (8/24); pseudocapsule was seen in all lesions; hemorrhage in 4 lesions (4/24),lipid component in 12 lesions (12/24) and cystic degeneration in 18 lesions (18/24), persistent enhancement in 22 lesions (22/24) and rapid wash-out pattern in 2 lesions (2/24).All lesions showed moderate or intense enhancement.The MR appearances of lesions in the same patient were identical in 5 cases (5/11), different in 6 cases (6/11).

Multifocal clear cell RCCs occur more commonly in bilateral kidneys simultaneously than in unilateral kidney.The lesions in the same patient can show different MR imaging features, which probably facilitate the preoperative determination.

To examine the correlation between lower extremity artery ultrasound and arteriosclerosis detection indicators, including ankle-brachial index (ABI) and Cardiac Ankle Vascular Index (CAVI).

According to the level of lower extremity arterial disease by ultrasonography, 320 patients were divided into 3 groups (normal group, mild lesions group and severe lesions group).Comparative analysis of the difference of arteriosclerosis detection indicators among the groups, including ABI and CAVI.To analyze the correlation of two test results and explore the risk factors of lower extremity atherosclerotic lesions.

To compare ABI among the three groups, the differences were statistically significant (P<0.05).Lower extremity arterial disease was negatively correlated with ABI and positively correlated with CAVI (P=0.000).Using Logistic regression analysis:age, gender, diabetes, pulse pressure is the impact of lower extremity arterial disease risk factors.

ABI and CAVI can be used as reliable indicators for the screening of artery stenosis, occlusion and atherosclerosis, combined with color Doppler ultrasonography can improve the diagnosis rate of lower extremity arterial disease.

To discuss the clinical value of CT-guided ¹²⁵I brachytherapy with retroperitoneal metastatic lymph nodes from primary hepatic carcinoma (PHC).

Twenty patients with retroperitoneal metastatic lymph node recurrence from PHC were percutaneously treated by ¹²⁵I brachytherapy with computed tomographic (CT) guidance.The number, radioactive dose, placed position of radioactive seeds and puncture path were determined by computerized treatment planning system (TPS).The radioactive seeds were implanted when the needles were in right position by CT scan.Radiotherapy verification and quality assessment were performed after treatment by CT scan.Follow-up contrast materialenhanced CT were reviewed.

The local control rate of 3, 6, 10,15 months was 70.0%, 56.3%, 44.4%,25.0% respectively.There were no severe complications such as massive bleeding and radiation injury of normal tissues.

CT-guided ¹²⁵I brachytherapy are effective and may be safely applied to retroperitoneal metastatic lymph nodes from PHC.

To explore the effects of parecoxib sodium analgesia on serum concentrations of neuron-specific enolase (NSE) and S-100β and postoperative cognitive function of elderly patients undergoing acute replacement of femoral head.

After the approval of institutional review board and the provision of informed consent, 80 patients over 70 years old, undergoing acute replacement of femoral head under combined spinal and epidural anesthesia and midazolam sedation at Qingdao Municipal Hospital and Qingdao Hiser Medical Center from January 2011 to May 2012, were randomly assigned into control group (group C,n=40) and parecoxib group (group P,n=40).In group P, parecoxib sodium 20/40 mg (based on weight 50 kg) was administered via an intravenous injection after admission with 12 hours intervals for six times.In group C, morphine 2/4 mg was given initially.Additional morphine 2 mg was given to maintain the pain visual analog scale (VAS) of 3 points or less in both groups.Primary observation indices: (1) postoperative time and additional amount of morphine; (2) rate of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) at 3 days, 1 week,3 months and 6 months postoperation (T₁-T₄); (3) serum levels of NSE and S-100β were measured at the timepoints of before analgesia (t₀), before anesthesia (t₁), end of surgery (t₂) and 6 hours, 24 hours, 48 hours postoperation (t₃-t₅); (4) other serious complications.

Compared with group C, the additional amount of morphine, postoperative time, rate of POD and POCD at T₁-T ₄, the level of NSE at t₂-t₅and S-100β at t₁-t₅were lower in group P (P<0.05).No other serious complications were observed.

Parecoxib sodium analgesia reduces the rate of POD and POCD in elderly patients with neuroprotective effects.

To explore the relationship between chromosome translocation and their phenotypic effect by analyzing the patients with loss pregnancy and avoiding fetuses with chromosomal abnormalities.

A total of 3067 cases with infertility or loss pregnancy were recruited to receive chromosome examination during January 2005 to December 2011 at Center of Prenatal Diagnosis, Peking University People′s Hospital.Retrospective study was used to analyze the chromosome karyotypes and infertility or loss pregnancy.

In 72 cases of patients with chromosome translocation, there were 17 pregnancies with homology translocation in fetus.And the numbers of patients with loss pregnancy and sex apparatus malformations were 40 and 15 respectively.

Chromosome translocation plays an important role in patients with loss pregnancy or infertility.And chromosome examination should be performed to exclude the possibility of chromosome abnormities in patients with obstinate infertility.

To assess the changes in coagulation, thrombosis, anti-coagulation and fibrinolysis during early pregnancy.

A total of 105 gravidas with monocyetic pregnancies between 10 and 12 weeks gestational age at Sun Yat-sen Memorial Hospital, Sun Yat-sen University during April 2005 to June 2009 were recruited for study group and another 82 non-pregnant women as control group.Coagulation parameters, including thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin (PT) and fibrinogen (Fg), were measured.We also tested the prothrombotic state parameters, including prothrombin fragment 1+2 (F1+2), thrombomodulin (TM), thrombin-antithrombin complex (TAT), antithrombin Ⅲ (AT-Ⅲ), GM P140, thromboxane B2 (TXB2), plasminogen activator inhibitor (PAI-2; performed by enzymelinked immunosorbent assay) and D-dimer (D2; tested by latex turbidimetric immunoassay).

Fg (4.00 vs 2.52 g/L), F1+2 (0.66 vs 0.31 nmol/L), TAT (179.95 vs 39.46μg/L), GMP140 (9.42 vs 19.13μg/L), D2 (201.51 vs 125.02μg/L) and PAI-2 (0.047 vs 0.006 g/L) were statistically different between the study and control groups (P<0.01).

The coagulation, fibrinolysis and anti-fibrinolysis functions of healthy pregnant women become enhanced during early pregnancy while anti-coagulation function slightly increases.These four basic functions are balanced at a higher level so that the activation of platelets stays at a lower level.

To compare the detection rates of atherosclerosis by carotid versus lower limb ultrasound in newly diagnosed type 2 diabetics and analyze the relationship between atherosclerosis and cardio-cerebrovascular events.

A total of 148 newly diagnosed type 2 diabetics were recruited.Both carotid and lower extremity atherosclerosis were assessed by Doppler ultrasound.Diabetic atherosclerosis was defined as the presence of either carotid or lower extremity plaques in any of the abovementioned arterial segments.A kappa value was computed to document the agreement between isolated carotid (or lower limb) atherosclerosis and diabetic atherosclerosis.The prevalence of cardio-cerebrovascular events was compared among different distribution types of atherosclerosis.

According to the diagnostic criteria, the prevalence of diabetic atherosclerosis was 66.2% in the newly diagnosed type 2 diabetes.Based on carotid or lower extremity ultrasound, the prevalence of diabetic atherosclerosis was 27.0% and 62.2% respectively in newly diagnosed type 2 diabetes.The kappa values for the agreement between carotid/lower limb atherosclerosis and diabetic atherosclerosis were 0.32/0.91 (95% confidence interval 0.22-0.42 for carotid vs 0.84-0.98 for lower extremity).The combination of carotid and lower extremity arterial atherosclerosis was associated with a significantly increased detection rate of cardiocerebrovascular events (26.5%) versus those with either carotid or lower extremity arterial atherosclerosis (0% and 10.3% respectively).

The combination of carotid and lower extremity ultrasonography can more accurately reflect the atherosclerotic lesions in type 2 diabetes.Due to a higher prevalence of cardio-cerebrovascular events, type 2 diabetics with both carotid and lower extremity atherosclerosis should be managed more aggressively to reduce the risk of cardio-cerebrovascular events.

To study the safety, efficacy and perioperative complications of endovascular therapy in the treatment of subtotal conclusion of internal carotid artery (ICA) in patients.To compare the cerebral embolic load of proximal balloon protection device versus distal filter protection device during the operation.

Review all the operations of stenting for subtotal conclusion of ICA in Xuanwu hospital.New cerebral infarction after stenting was assessed by diffusion-weighted magnetic resonance imaging.Count the number of new ischemic lesions of every patient.

35 patients with subtotal conclusion of ICA received endovascular stenting.Proximal protective device was used for 21 patients.Distal protective device was used for 14 patients.All procedures succeeded.32 patients received the cerebral MRI 1 week before and within 48 hours after the operation.Compared with filter protection (n=14), proximal balloon device (n=18) resulted in a significant reduction in the incidence of new cerebral infarction (6/18 vs 10/14,P=0.03).The number of new cerebral ischemic lesions were significant reduced by proximal balloon device (1/18 vs 4/14,P=0.0006).There were no serious cardiovascular events in 35 patients during the operation and the following up 3 months.3 patients had restenosis which was demonstrated by ultrasound of ICA at 3 months after stenting.

Endovascular stenting may be a safe and valid method for the treatment of subtotal occlusion of ICA.For the stenting of subtotal occlusion of ICA, proximal ballon protection device as compared with filter protection may reduce the embolic load to the brain more effectively.The stenting of subtotal occlusion of ICA still needs the randomized trails to confirm the safety and validity.

To analyze the efficacy and safety of eversion carotid endarterectomy (eCEA) and carotid endarterectomy with patch angioplasty (pCEA) in the treatment of carotid artery stenosis.

The clinical data were collected and analyzed for the patients with carotid artery stenosis undergoing carotid endarterectomy at Department of Vascular Surgery,Peking Union Medical College Hospital from October 2009 to October 2012.According to two different surgical procedures, they were divided into 2 groups of eCEA and pCEA.

A total of 248 patients received a follow-up.Among 274 cases of endarterectomy,101 cases of eCEA and 173 cases of pCEA were performed.No significant difference (P>0.05) existed between two groups in gender,age, risk factors, stenotic degree of carotid artery or ratio of bilateral lesions.The ratio of shunt (15.8%) and antibiotics (26.7%) application, the duration of operation (88±20) min,intraoperative blood loss (45±16) ml and the length of stay (16±4) days in the group eCEA were significantly lower than those of group pCEA (P<0.05).There was no significant difference (P>0.05) between two groups in the ratio of complications, surgery-related mortality, restenosis and ipsilateral stroke.

Both surgical procedures are both safe and effective in the treatment of carotid artery stenosis.However eCEA offers potential advantages.The choice of a particular surgical procedure depends on the surgeon experience and specific circumstances of carotid artery lesions.

To evaluate the short and middle-term efficacies of endovascular repair for isolated iliac artery aneurysms (IIAAs).

Retrospective analyses were performed for the clinical and follow-up data of 27 patients undergoing endovascular repair at Department of Vascular Surgery, Affiliated Zhongshan Hospital, Fudan University from January 2008 to December 2012.For asymptomatic aneurysms, repair criterion was a diameter over 3 cm while under 3 cm for symptomatic aneurysms.

There were 19 asymptomatic and 8 symptomatic cases.And 25 selective and 2 emergent operations were performed.The interventions included endovascular stent grafts (n=17), coil embolization (n=1), both stent grafts and coils (n=7) and hybrid operations (n=2).Technical success was achieved in all cases.No delayed healing or infection of inguinal access sites occurred.In-stent thrombosis could be observed in 2 cases.Buttock claudication was observed in one case.Sexual dysfunction occurred in three cases.Endoleaks were confirmed by intraoperative digital subtraction angiography in three cases.There was no occurrence of colorectal ischemia or postoperative aneurysmal rupture.Patients were followed up for a mean period of 33±18 months.One patient died of recurrent renal cell carcinoma.

Endovascular repair of isolated iliac artery aneurysms provides good short and middle-term patency.It may become a first-choice for treating isolated iliac artery aneurysms in the future.

To explore the potential value of up-regulator of cell proliferation (URGCP) as a biomarker for predicting the prognosis of hepatocellular carcinoma (HCC).

The expression of URGCP was analyzed in 15 HCC cell lines and in 10 pairs of HCC and adjacent tissues with reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.The expression of URGCP in 278 paraffin-embedded, archived clinical HCC samples was analyzed by immunohistochemistry (IHC) and statistic analysis conducted to examine the relationship of prognosis and URGCP expression.

IHC analysis revealed a high expression of URGCP in all HCC cell lines and in 122/278 (43.8%) paraffinembedded archived HCCspecimens.The expression level of URGCP was significantly correlated with clinical staging and poor patient survival of HCC in the study cohort and in various clinical subgroups, but not correlated with HCC patient age, tumor size, tumor number or alpha-fetoprotein level.

URGCP plays an important role in promoting the proliferation and tumorigenesis of HCC and may represent a novel prognostic biomarker and therapeutic target for the disease.

To explore the effects of pericytes on the leakage of rat corneal neovascularization (CNV).

CNV was induced by micropocket assay in rats.Two eyes of the same rat were divided randomly into experimental and control groups.The experimental group received the VEGF+anti-PDGF-B pellet while the control group the VEGF+PBS pellet.Corneal samples were excised at Day 5 postoperation.CNV leakage was measured by Evans blue method.Pericyte coverage index (MPI) was applied to quantify the pericyte coverage through double immunofluorescent stain of frozen sections of corneas with CD31 as endothelial andα-smooth muscle actin (α-SMA) as pericyte marker.Corneal weight was measured.

In the control group, MPI was 56.5%, cornea weight (7.36±0.56) mg and CNV permeability rate (0.24±0.07) μg·ml^-1·mm^-2.In the experimental group, MPI was 11.3%, cornea weight (8.96±1.09) mg and CNV permeability rate (0.68±0.36) μg·ml^-1·mm^-2.The intergroup difference was statistically significant (P_MPI<0.01, P_{permeability rate}=0.01, P_weight=0.01).

Pericytes inhibit the leakage of rat CNV.Such findings may guide the clinical management of hyperpermeability.