Volume 93  ·   Issue 29  ·  2013

To explore the risk factors of deep vein thrombosis (DVT) in lower extremities.

Retrospective data analyses were performed for a total of 1264 DVT patients at our department from January 2010 to December 2012.

Among them,984 cases (77.85%) were over 40 years old, no overt cause was found for 642 cases (50.79%), 142 cases (11.23%) had a clear history of trauma before onset (without surgery).Among 316 recurrent postoperative cases, there were the surgical histories of orthopedics (n=142, 11.23%), gynecology (n=90, 7.12%), general practice (n=42, 3.32%), vascular (n=23, 1.82%), urological (n=12, 0.94%) and others (n=7, 0.55%).Ten cases (0.79%) occurred after suffering bedridden chronic diseases.And 20 cases (1.58%) were caused by conditions during pregnancy or postpartum period.had Malignant tumors were found in 25 (1.98%) patients.After long-term uses of hormones, 10 patients (0.79%) of rheumatoid arthritis had a recurrence.Owing to varicose veins, 27 patients (2.14%) recurred.Eight patients (0.63%) had a history of drug abuse, 2 cases (0.16%) suffered depression and 62 cases (4.9%) were recurrent.

There are many causative factors of DVT so that prevention is of great importance.We should pay more attention to the prevention and treatment of high-risk DVT patients.

To identify the phenotypic detection and structure analysis of a protein C (PC) missense mutation (Met406Ile) resulting in venous thromboembolism.

Pedigree research was performed for a hereditary PC deficiency pedigree.Chromogenic assay was used for phenotypic diagnosis to detect the AT activity.All 9 exons were amplified by polymerase chain reaction (PCR) and direct sequencing analysis was performed for PCR products.The corresponding mutation sites of family members were detected.Homology modeling was used for reconstructing mutant PC construction.The effects of construction change were analyzed.

The PC activities of proband and 4 family members decreased to different extents by 29.7%, 42.2%,42.4%,67.3% and 70.7% respectively.Among them, the proband and other three family members carried the same mutation (c.1218G>A, Met406Ile) while another family member had a PC polymorphism (rs1799810).Homology modeling showed that VDW′s interaction radius of amino acids decreased after mutation (Met406Ile).In particular, the radius of Gly418:C and Ile406CG2, Gly418:C and Ile406HG23, Leu419:N and Ile406:HG23 decreased to 2.0733å, 1.620 45å and 1.446 52å respectively.Compared with normal PC, the interaction energy of mutant PC rose from -8.504 54 to 1210.04 kal/mol.And the change of VDW interaction energy was significant.

The mechanism of this pedigree is caused by PROC gene missense mutation on exon 9 (c.1218G>A, Met406Ile).The regional amino acids of mutant PC collide with each other and lead to an instability of PC reconstruction.

To explore the outcomes of anticoagulation,systematic thrombolysis and catheter-directed thrombolysis (CDT) in the treatment of lower extremity acute deep venous thrombosis (DVT).

The clinical data of 152 patients with lower extremity acute DVT from January 2005 to December 2009 were analyzed retrospectively.They were divided into single anticoagulation group (A), systematic thrombolysis plus anticoagulation group (B) and CDT plus anticoagulation group (C).Follow-up studies were performed to inquire about patient symptoms, check the status of affected extremities and examine venous patency with venous ultrasonography or anterograde venous radiography.The incidence rate of post-thrombotic syndrome (PTS) was evaluated with the Villalta score while the quality of life with CIVIQ-2 questionnaire.And the post-discharge anticoagulation time and use of compression stockings were analyzed in each group.

(1) The venous patency rate was 69.1%, 70.8%, 85.1% in groups A, B and C respectively.The differences was significant between groups A and C (P<0.05).The differences was insignificant between groups C and B (P>0.05).And the venous patency rate of group C was higher than that of group B.The difference was insignificant between groups A and B (P>0.05).Such remodeling effects as venous valvular destruction and intravenous wall thickening were observed in PTS patients with venous ultrasonography and anterograde venous radiography. (2) The incidence of PTS was 56.8%,54.2%, 38.3% in groups A, Band C.Compared with groups A and B, the difference was significant in group C (P<0.05).The difference was insignificant between groups A and B (P>0.05). (3) CIVIQ-2 score was 20.2±14.4, 20.1±12.5,16.6±11.0 in groups A, B and C.Compared with groups A and B, the difference was insignificant in group C (P>0.05).And it was lower in group C than groups A and B. (4) The differences of average anticoagulant time and compression stocking use were insignificant in 3 groups (P>0.05).

Compared with anticoagulant and systematic thrombolysis, a combination of CDT and anticoagulation may reduce the risk for PTS, alleviate clinical symptoms and improve quality of life.

To explore the short-term outcomes of radiofrequency ablation treatment of bone metastasis.

Between November 2011 and November 2012, a total of 18 cases were retrospectively reviewed.They underwent resection of bone metastasis with radiofrequency ablation through transforaminal endoscopic spine system.According to the Tomita classification system, the classifications were type 5 (n=8), type 6 (n=4) and type 7 (n=6).There were 8 males and 10 females with a median age of 52.1 (32-76) years.The primary lesions were breast cancer (n=5), carcinoma of prostate (n=3), digestive cancer (n=4), thyroid carcinoma (n=2) and lung cancer (n=4).And two cases had pathologic fracture.

The operative duration was 118 (90-180) min and blood loss volume 30.6 (10-60) ml.All incisions achieved excellent healing.One case of pneumonia recovered with antibiotic.The postoperative visual analogue scale (VAS) scores were 2.4±0.4, 2.6±0.6, 3.0±0.3 and 2.8±0.7.

Radiofrequency ablation through transforaminal endoscopy may be a safe and efficacious option for refractory pain with bone metastasis, especially for those with uncontrolled pain.This procedure is mini-invasive and causes less bleeding.

To analyze the microsurgical treatment regimens of cavernous sinus hemangioma.

The microsurgical experiences were reviewed and analyzed for 17 cases of operatively and pathologically confirmed cavernous sinus cavernous hemangioma at our hospital from January 2008 to January 2012.There were 6 males and 11 females with an average age of 48.5 years.

Among them, there were total (n=14) and subtotal (n=3) resection.And there was no occurrence of postoperative mortality.According to the results of imaging follow-up, total resection cases had no recurrence while subtotal residual tumor was progression-free after radiotherapy.Oculomotor, abducens and trigeminal nerves retained varying degrees of neurological function at 3-6 months postoperation.

Based on the size of tumor and growth direction, appropriate surgical approaches may be selected.And a combination of skilled microsurgical techniques and proper resection may reduce bleeding and facilitate total tumor removal so as to reduce the degree of neurological deficits and improve the long-term postoperative quality-of-life.

To explore the magnetic resonance imaging (MRI) features and diagnostic value of special-site ectopic pregnancy.

The MRI features of special-site ectopic pregnancy on 39 pathologically confirmed cases were retrospectively analyzed.All cases received ultrasonic inspection, MRI plain scan and 11 cases underwent enhanced scan.

In 39 cases, there were 3 cases of interstitial tubal pregnancy (n=3), cornual pregnancy (n=8) and uterine scar pregnancy (n=28).The accuracy rates of location and diagnosis were 94.9% and 82.1% respectively.And they were both higher than the rates of ultrasound.They were classified into two groups by clinical outcomes:pregnancy and miscarriage.In 22 cases of pregnancy, there were sac in sac (n=9) and complete fertilized egg (n=13).In 17 cases of miscarriage, there were irregular honeycomb (n=7), ring (n=6) and mass (n=4).Among 11 enhanced cases, there were significant enhancement (n=4), flake or cord-like enhancement (n=5),a little strengthen on edge (n=1) and no enhancement (n=1).The group had intrauterine decidual tissue hyperplasia (n=22), ovarian cyst (n=8), pelvic fluid (n=6), adenomyosis (n=3), fibroid (n=2), endometriosis in pelvic and abdominal wall scar area (n=1) and mild hydrops in right kidney and ureter (n=1).

The MRI features of special-site ectopic pregnancy are characteristic and important for clinical treatment.

To explore the mortality factors of migrant pregnant women and learn the healthcare utilization status to provide efficient interventions.

A case-control study was conducted in Zhejiang province with a case-control ratio of 1:4.Cases included migrant pregnant women who died.And controls were migrant pregnant women who survived and matched with single birth, age, hospital and gestational weeks.A questionnaire was used to survey social and demographic factors, healthcare status during antenatal or postpartum period and delivery conditions, etc.

Seventy-two cases and 288 controls were recruited.There were significant differences in socio-demographic, antenatal care and obstetric complications between two groups (P<0.05).No prenatal examination was an important factor affecting maternal mortality by multivariate conditional Logistic regression.

Prenatal examination is an important influencing factor of maternal mortality.And improving the ability of utilizing health care system is an efficient method of lowering the migrant maternal mortality.

To explore the effects of statins upon bone mineral density (BMD) and bone metabolic markers in postmenopausal women with hypercholesterolemia.

A prospective study was conducted for 100 women receiving treatment from January 2011 to August 2012 and meeting the inclusion criteria of osteopenia or osteoporosis with hypercholesterolemia postmenopausal.They were randomly divided into treatment group on atorvastatin 10 mg once daily and control group.The parameters of lumbar BMD, bone resorption markers of typeⅠ collagen cross-linked C-telopeptide (CTX), bone synthesis markers procollagen typeⅠ N-terminal peptide (PINP) were compared between two groups after half a year and one year.

There was an upward trend of lumbar spine BMD and PINP in the treatment group at half a year and one year compared with the control group.And two groups had significant difference (P<0.05).Although two groups had no significant difference in all parameters at half a year,the values of lumbar spine BMD and PINP were higher in the treatment group at one year than the control group.Two groups had significant difference (P<0.05).

Statins can help maintain or increase bone mass of hypercholesterolemic menopausal women through promoting bone synthesis.

To explore the significance and evaluate the early structural erosion through the expressions of Th17 cells in peripheral blood of patients with rheumatoid arthritis (RA) in clinical remission.

A total of 41 active RA patients without structural erosion were selected.Intracelluar flow cytometric detection of Th17 cells in peripheral blood was performed.And the supernatant level of interleukin (IL) -17A was determined simultaneously in RA patients and control groups at baseline and endpoint of 24-month therapy.The correlations were analyzed between Th17 cells and RA disease activity index DAS28.They were classified into radiographic progression (P, n=10) and radiographic nonprogression groups (NP,n=26) by the Sharp/van der Heijde score (SHS) at the endpoint.The differences of Th17 cells and IL-17A levels wereanalyzed between P (SHS>0.5) and NP groups (SHS≤0.5).

The expression of Th17 cells in active RA patients was significantly higher than that of controls[(1.63±0.45)% vs (0.91±0.26)%, P<0.01].And the results of IL-17A level were similar[1510±280) vs (320±31) ng/L,P<0.05].The expression of Th17 cells was positively correlated with DAS28 score (r=0.87, P<0.01).Thirty-six RA patients were followed up at the endpoint and all of them stayed in clinical remission (DAS28<2.6).The peripheral blood expressions of Th17 cells of P group were significantly higher than those of NP group.At the same time, no differences of IL-17A levels existed between two groups.

Structural erosion still progresses in some RA patients despite an apparent clinic remission.And a high-level peripheral expression of Th17 hints at structural erosion.

To analyze the molecular epidemiological characteristic of HIV-1 B′/C strains prevalent in Beijing.

Plasma samples were collected from 200 newly diagnosed HIV-1 B′/C individuals reported during 2006 to 2010 in Beijing.The gag gene fragments were amplified from RNA template extracted from plasma with reverse transcription (RT) and nested polymerase chain reaction (PCR).And the sequences were analyzed by phylogenetic methods and Entropy analysis.

A total of 159 sequences were successfully amplified from the gag genes of which 147 was CRF07_BC and 12 CRF08_BC.There were 3 main subclusters in CRF07_BC phylogenetic tree and they were named as subcluster IDU-Max (89 sequences), subcluster IDU-Min (22 sequences) and subcluster MSM (34 sequences) based on transmission.No international reference strain was closely related with these three subclusters except for one strain identified in Taiwan.All CRF07_BC recombinant strains were remarkable for their low interpatient diversity in gag genes (3.7%, 3.3% and 2.0% for isolates from IDU-Max, IDU-Min and MSM respectively).When compared with subcluster IDU-Max,there were 32 and 41 significantly different sites of nucleotide polymorphism compositions in subclusers IDU-Min and MSM.

This is the first report of describing the existence of three main epidemic subclusters in CRF07_BC strains prevalent in Beijing.And IDU-Max subcluster is the dominant strain.The CRF07_BC in Beijing are less diverse than other strains and may be derived from a common ancestor.

To assess the feasibility, efficacy and indication of posterior C1-C2 transarticular screw fixation for atlantoaxial instability assisted by intraoperative 3-dimensional fluoroscopybased navigation.

From November 2005 to October 2012,58 patients with atlantoaxial instability underwent posterior C1-C2 transarticular screw fixation assisted by intraoperative 3-dimensional fluoroscopybased navigation.Those with excellent atlantoaxial reduction and no need for decompression underwent percutaneously minimally invasive procedures.Operative duration, blood loss volume, reduction of atlantoaxial joints and postoperative neurovascular complications were recorded.Screw positions were studied by postoperative computed tomography (CT) and divided into 3 categories.The follow-up period was at least 3 months.Local symptoms (assessed by visual analogue scale (VAS) score), neurological conditions (Nurick classification) and bone graft fusion were evaluated.

Among them, the procedure was either open surgery (n=51) or percutaneously minimally invasive surgery (n=7).A total of 111 screws were placed satisfactorily.Five patients underwent only unilateral C1-C2 transarticular screw fixation.No severe complications were encountered.The mean operative duration was 202.2±54.2 minutes and the average volume of blood loss 412.6±281.2 ml.And the values were comparable to those for the traditional fluoroscopy-guided free-hand procedures.No statistical significance existed between open and percutaneously minimally invasive procedures in operative duration, blood loss volume and precision of screw placement.The patients with incompletely reduced C1-C2 dislocation had comparable clinical outcomes with those with complete reduction.After a 3-month follow-up, all of them showed significant improvements of local symptoms.VAS score decreased from 4.5±1.3 preoperatively to 0.7±0.8 postoperatively while the Nurick classification improved from 2.4±1.1 to 0.6±1.0.And bone graft fusion was satisfactory.

Posterior C1-C2 transarticular screw fixation for atlantoaxial instability assisted by intraoperative 3-dimensional fluoroscopy-based navigation is both feasible and safe.Combined with minimally invasive techniques, this procedure may achieve greater precision and minimal invasion.

To analyze the effectiveness and toxicity of intensity-modulated radiotherapy (IMRT) combined with chemotherapy or not for locoregionally advanced nasopharyngeal carcinoma.

A total of 226 patients with locoregionally advanced nasopharyngeal carcinoma were restrospectively reviewed and classified into three groups:67 patients treated by radiotherapy alone (RT group), 82 patients by concurrent chemoradiotherapy (CRT group) and 77 patients by cisplatin+ 5-fluorouracil (PF regimen) combined with CRT (PF+CRT group).All patients using IMRT technique.Outcomes were overall survival, failure patterns, and toxicities.

For the RT, CRT and PF+CRT group, the 5-year overall survival rate was 67.6%, 74% and 71.1% (P=0.664), respectively; progress-free survival rate 66.9%, 72.6% and 75.6% (P=0.410); relapsefree survival rate 82.4%, 86.4% and 86.8% (P=0.447) and distant metastasis-free survival rate 83.8%, 83.8% and 85.8% (P=0.827).Significantly more grade 3-4 acute toxicities happened in patients treated by chemotherapy (P=0.002).

Comparing with IMRT alone, cisplatin-IMRT or PF regimen induction chemotherapy plus cisplatin-IMRT do not significantly improve survival, but increased grade 3-4 acute toxicities.

The aim of this study was to compare the diagnostic value of ¹⁸F-FDG PET/CT with contrast CT for regional lymph node metastasis of colorectal cancer.

Imaging results of 40 patients with colorectal cancer were retrospectively reviewed, and all the patients underwent both abdomen contrast CT and ¹⁸F-FDG PET/CT imaging.Final diagnosis was made by histopathology.

20 colorectal cancer patients were verified with lymph node metastasis while the other 20 patients were absent.Finally, ¹⁸F-FDG PET/CT produced 4 false-positive patients and 3 false-negative patients. ¹⁸F-FDG PET/CT displayed sensitivity 85.0% (17/20), specificity 80.0% (16/ 20), positive predictive value 81.0% (17/21), negative predictive value 84.2% (16/19) and accuracy 82.5% (33/40) in the diagnosis of lymph node metastasis.Contrast CT produced 5 false-positive patients and 8 false-negative patients.Contrast CT had the sensitivity 60.0% (12/20), specificity 75.0% (15/20), positive predictive value 70.6% (12/17), negative predictive value 65.2% (15/23) and accuracy 67.5% (27/40).Sensitivity and specificity of PET/CT was better than of contrast CT, but no statistically significant difference between PET/CT and contrast CT (P=0.478,P=0.893; P=0.344.Fisher′s exact test and Mc Nemar test).

Sensitivity and specificity of PET/CT was better than of contrast CT, but no statistically significant difference.Clinical works also need to select the appropriate inspection methods based on the patient′s situation.

To explore the effect and mechanism of murine marrow stromal cells (MSCs) within cerebrospinal fluid (CSF) on Cu/Zn superoxide dismutase 1 (SOD1) transgenic mice.

A dose of 5×10⁵MSCs was injected into the CSF of SOD1 transgenic mice at the ages of 8, 10 and 12 weeks.Hanging wire test and motor neuron counts were used to assess disease progression of SOD1 mice.To examine the glial activation in murine lumbar spinal cord at 15 weeks of age, the sections were stained with antibody to CD11b and GFAP through immunohistochemistry.In vitro, mRNA expression of neurotrophin of MSCs was analyzed by reverse transcription-polymerase chain reaction (RT-PCR).

Compared with vehicle-treated mice, intrathecally transplanted MSCs enhanced motor performance and decreased motor neuron loss.An intrathecal injection of MSCs inhibited microglial (52±7 vs 38±7; F=69.3,P=0.02) and astrocyte (79±9 vs 63±9;F=40.7, P=0.03) activity in lumbar spinal cord at the age of 15 weeks of age.MSCs cultured in an inflammatory environment expressed a higher mRNA level of neurotrophin (P<0.05).

ACSF administration of MSCs has therapeutic effects on SOD1 mice.And the meditation of MSCs may be achieved through inhibiting neuroinflammation and secreting a variety of trophic factors.