Volume 93  ·   Issue 37  ·  2013

To evaluate the application value of laparoscopic ultrasonography (LUS) in gynecological surgery.

Retrospective analyses were performed for 52 cases undergoing LUS during laparoscopic extirpation/excision of gynecological tumors.Aloka 7.5-MHz laparoscopic probe was used to detect the residual lesions during laparoscopic operations.The findings of LUS were compared with those of preoperative transvaginal ultrasound and postoperative pathohistological examinations.

Preoperative diagnoses were corrected by LUS in 9 cases.And 34 residual lesions located by LUS were successfully removed.

With a high detection rate and diagnostic accuracy rate in the diagnosis of gynecologic disease, LUS can locate invisible lesions during laparoscopic operations and provide guidance for radical tumor removal.It is a safe and valuable assistance for gynecologic surgery.

To explore the effects of pessary use on symptomatic improvement and quality-of-life (QOL) in women with pelvic organ prolapse (POP).

For this prospective cohort study, 79 patients with symptomatic POP were evaluated for pessary insertion between October 2011 and February 2013.After 3 and 6 months of consistent pessary use, quality of life was assessed with the Chinese version of Short-Form 12-Item Health Survey (SF-12) and pelvic floor impact questionnaire short form (PFIQ-7).

Their average age was (66±9) years, average parity (2.4±1.1) and average duration of POP (68±14) months.Among them, 63 (79.7%) continued pessary use at 3 months and 46 (58.2%) at 6 months.The reasons for dropout were inappropriate size, discomfort and urinary retention.Compared with baseline findings, SF-12 and PFIQ-7 demonstrated significant improvement in patient QOL at 3 months and 6 months.

Pessary use results in significant changes of QOL for POP patients.And it is a viable noninvasive treatment for pelvic organ prolapse.

To explore the diagnostic value of T₂-weighted gradient-echo magnetic resonance imaging (MRI) in cerebral microbleeds (CMBs) and its clinical significance.

The distribution of CMBs and follow-up observations were performed by routine T₁WI, T₂WI and T₂-weighted gradient echo sequence in 634 patients clinically suspected for stroke.

In 149 patients, a total of 1140 CMBs occurred predominantly in cortex-subcortical area (n=471, 41.31%), basal ganglia (n=289, 25.35%), thalamus (n=199, 17.45%), brain stem (n=90, 7.89%) and cerebellum (n=91, 7.98%).Among them, 137 patients had various degrees of ischemic brain changes, displayed iso-intensity or hypo-intensity on T₁WI, hyper-intensity on T₂WI and FLAIR in basal ganglia, white matter around sided ventricle and brain stem.There were 23 patients with cerebral infarction and 5 with CMBs after hemorrhagic brain stroke.And 12 of them had new hemorrhagic stroke in 2-6 months.

T₂-weighted gradient echo MRI has obvious advantages in the detection of CMBs.The presence of CMBs suggests a risk of cerebral hemorrhage.

To evaluate the feasibility and efficacy of salvage surgery after local failure of definitive chemoradiotherapy (dCRT) for esophageal carcinomas.

We retrospectively reviewed the esophageal cancer patients underwent salvage surgery (Group A,26 cases) or non-surgical therapy (Group B,11 cases) after local failure of dCRT (cT_1-3N_0-1M₀) between July 2008 and June 2010.

The rate of resection was 84.6% in Group A, R0 was 69.2%.There was no mortality after surgery.The rate of postoperative complications is 53.8%, especially pneumonia 30.8%,anastomosis leakage11.5% and arrhythmia 7.7%.The median survival time is 11.1 months; the 2-year survival rate of Group A was 23.1% in Group A.The non-surgical therapy was given including second-line chemotherapy and esophagus stents; the median survival time is 8.1 months (3.1-15.1) in Group B.The survival rate of Group A was higher than Group B (Kaplan-Meier, P=0.013).

Salvage surgery provides survival benefit for esophageal cancer patients with local persistent or recurrence after primary dCRT, despite of high morbidity.Salvage surgery should be carried out for patients with good physical condition and complete resection is technically possible.

To explore the clinical application value of complete video-assisted thoracoscopic (cVATS) lobectomy in the mini-invasive treatment of lung cancer.

90 patients with non-small cell lung cancer (NSCLC) who had undergone lobectomy were reviewed.According to surgical approach, complete video-assisted thoracoscopic lobectomy group (cVATS,n=47) and videoassisted mini-thoracotomy group (VAMT,n=43) were studied.Numbers of dissected lymph nodes, operation duration,volumes of intraoperative bleeding, duration of postoperative catheter drainage, length of postoperative hospital stay, incidence rates of postoperative complications, postoperative pain scores of patients were compared between the two groups retrospectively.

There were no significant differences in numbers of dissected lymph nodes, operation duration, bleeding during operation, incidence rates of postoperative complication between the two groups (P>0.05).Duration of postoperative catheter drainage and length of postoperative hospital stay of patients in c VATSgroup were shorter than those in VAMT group (P<0.05).Pain scores of patients in c VATS group were lower than those at the same time in VAMT group (P<0.05).

Complete video-assisted thoracoscopic lobectomy is safe and effective surgical strategy for lung cancer patients with advantage of rapid recovery.

To explore the relationship between CNTF gene polymorphism and athletes training adaptation of muscle tissue.

A total of 215 new students without a training history CNTF genotype were recruited from a sports college.During training, the changes in test object biceps muscle belly cross-sectional area, muscle fatigue and muscle damage related biochemical indices were detected.And the impact of gene polymorphism was analyzed on the detection results.

After training, biceps brachii muscle cross-sectional areas showed different degrees of growth and the GG gene type growth was greater than other genotypes (P<0.05).At post-training physical examination, all subjects of muscle fatigue and muscle damage index were higher than those of the control group, but no obvious difference existed between examination groups.In basic training at the end of physical examination, the related indices of each group were higher than those of the control group, but the values of lactic acid, blood urea nitrogen and serum CK value were lower for object type GG than those for the other groups[ (234.7±57.5) vs (84.7±24.7) U, (5.8±0.8) vs (4.3±0.6) mmol/L, (271.5±98.7) vs (59.2±35.6) U] (P<0.05).

During training, muscle cross-sectional area of GG genotype grows more while the serum levels of muscle injury are significantly lower than those of other groups.In summary, GG genotype has better muscle training adaptation than GA and AA.

To explore the clinical and radiological outcomes of Discover artificial cervical disc arthroplasty and the range of motion status on adjacent segments for cervical spondylosis causing radiculopathy or myelopathy.

A total of 18 consecutive patients underwent cervical arthroplasty with the Discover artificial cervical disc at our hospital.Clinical and radiological follow-ups were conducted.Their radiographic parameters of treatment and adjacent segments were evaluated at Month 1, 3, 6, 12, 18 post-operation.And the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) pain score and Odom′s scale were recorded and analyzed.

During followups over an average of 15 months, there was no occurrence of vascular injury,severe complications or prosthesis displacement and loosening.The score of JOA was 7.2±1.8 at preoperation and 16.7±4.5 at postoperation.And the score of VAS was 8.15±1.65 at preoperation and 2.03±1.12 at postoperation.

Discover artificial cervical disc arthroplasty is efficacious and the patients recover quickly.Targeted cervical segments may be stabilized and their physiological ranges of motion preserved.

To explore the efficacy and safety of segmental cut-off bridge and local floating technology for the treatment of ossification of ligamentum flavum (OLF) in throracic spine.

Retrospective study was performed in 98 patients with thoracic OLF who under went operation.There was 56 males and 42 females with an average age of 45.8 (35-73) years.The average duration of onset was 17 (3-51) months.The main clinical symptoms were numbness and paraesthesia (n=90), lower limb weakness and walking trouble (n=46), positive pyramidal tract signs (n=33) and sphincter function obstacle (n=9).OLF was screened and diagnosed by radiology, magnetic resonance imaging (MRI), computed tomography (CT) or CT myelography (CTM).A total of 142 OLF nidus were spotted.The lesions involved single segment (n=32), double segments (n=56), three segments (n=6) and≥four segments (n=4).And the locations were at upper throracic segment (T1-4)(n=34), middle throracic segment (T5-8)(n=23) and lower throracic segment (T9-12)(n=42).The OLF nidus were removed by local floating technology oft windowing at cephalic and caudal ends and a cut-off bridge at both sides of involved segments.Pre- and postoperative Japanese Orthopedic Association (JOA) scores and Epstein grades were recorded to evaluate the outcomes.

The mean loss volume of blood was 320 ml and operative duration 155 min.All cases recovered independent activities.The mean follow-up period was 28 (13-48) months.The mean preoperative JOA score was 4.3 (1-8) points and the mean postoperative JOA score 9.7 (5-11) points.The recovery rate was 78.8%.According to Epstein grade, the excellent and good rate was 86.7%.

As a common cause of thoracic spinal cord compression, OLF should be operated as early as possible.Based upon clinical and imaging findings, the application of segmental cut-off bridge and local floating technology is both safe and efficacious in the treatment of OLF in throracic spine.

To explore the relationship between the presence of HPV-16 DNA and the expression Treg surface marker Foxp3⁺, peripheral blood levels of Th17/Treg cell-associated cytokines and explore their roles and significance in cervical cancer progression.

Between January 2012 and October 2012 at Shengjing Hospital of China Medical University, a total of 142 HPV16 positive patients were divided into cervical cancer (CC, n=60), cervical intraepithelial neoplasia (CIN,n=65) and control group (n=17).Cervical liquid-based cytological (LBC) samples were collected to detect E2 and E6 genes of HPV type 16 using multiple real-time polymerase chain reaction (PCR).E2/E6 ratio was used to evaluate the physical status of HPV-16 DNA in host cell genome.The SP immunohistochemical method was used to detect the expressions of FOXP3 in cervical lesions.The concentrations of Th17/Treg cell-associated cytokines were detected by enzymelinked immunosorbent assay (ELISA).

Under the same status of HPV16 DNA in vivo, the levels of Foxp3⁺, transforming growth factor-β (TGF-β) and interleukin-10 (IL-10) were significantly higher than those of the control group (P<0.01) while the levels of interleukin-17 (IL-17) and interleukin-21 (IL-21) were significantly lower than those of the control group (P<0.05).In the same disease, HPV16 DNA integration rate grew with the increases of Foxp3+, TGF-βand IL-10 while IL-17 and IL-21 were opposite.In the different status of HPV16 type DNA, the expression of Foxp3⁺ was closely correlated with Federation International of Gynecology and Obstetrics (FIGO) stage, histological grade and lymphnode metastasis (P<0.05) except for age (P>0.05).

Treg cytokines, HPV16 integration rate and severity of cervical lesions are positively correlated while Th17 cytokines show opposite effects.Th17/Treg cell-associated cytokines may play an important role in the occurrence and development of cervical cancer.

To explore the value of apparent diffusion coefficient (ADC) ratio in the diagnosis of bladder cancer pre-operation by analyzing its differences among different grades of bladder cancer.

A total of 52 cases of bladder cancer were all definitely diagnosed with histological results.Routine examinations of magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) were performed preoperatively on each patient.ADC map was constructed in work station and ADC values of tumor and internal obturator muscle were measured (b=800 s/mm²).Ratio of ADC was calculated with internal obturator muscle as reference site.Then the relationship between ADC ratio and bladder cancer grade was analyzed.

Mean ratio of ADC of all tumors was 0.98±0.35, G1 (1.12±0.21) and G2 (0.67±0.29), the sensitivity and specificity of ADC ratio was 90.2% and 85.3% respectively with an optimal threshold of 0.96.The ratios of ADC of low-grade group were significantly higher than those of high-grade group while the values of non-muscle-invasive group were significantly higher than those of muscle-invasive group.The ratios of ADC of tumor were inversely associated with the malignancy degree of bladder cancer (r=-0.845,P<0.05).

The ratio of ADC of bladder cancer reflects the lesion tissue properties.And its measurement plays an important role in the diagnosis of bladder cancer grading pre-operation.

To compare the pharmacodynamic differences of common carotid artery administration with ear vein administration of propofol and fentanyl in rabbits.

Sixty New Zealand white rabbits were randomly divided into four groups (n=15): PvFv, PvFa, PaFv and PaFa groups.Propofol 30 mg·kg^-1·h^-1 and fentanyl 2μg·kg^-1·h^-1 were administrated via the ear vein or the common carotid artery.The outcomes were recorded, including the time of consciousness loss and recovery, to electrocerebral silence, dose of propofol and fentanyl, mean arterial pressure, heart rate, respiration rate and Sp O₂.

(1) None of rabbits appeared breathing to be depressed seriously in group PaFa, while respiratory in the other groups were significantly depressed. (2) The dosage of propofol and fentanyl of group PaFa was significantly less than the other groups (P<0.05). (3) The time of consciousness loss and recovery of group PaFa were shorter than the other three groups.

Compared to drugs infusion via the ear vein,infusion of propol and fentanyl via the common carotid artery is more advantageous in some aspects, such as rapid anesthesia inducation and recovery, smaller dose, and smaller impact on the hemodynamic and respiratory.

To establish a goat model of acute spinal cord compression injury through a modified percutaneous technique with a Foley double-lumen urine catheter and explore the method feasibility and preliminary observation.

Twelve adult male Chongming goats were randomly divided into 3 groups:control (A,n=4),0.5 ml compression (B,n=4) and 1 ml compression (C,n=4).After local anesthesia, all animals received epidural balloon catheter (5Fr) insertion via a percutaneous trans-lumbosacral interlaminar space technique that mimicked the method used in vascular access for angiography.The balloon catheter was advanced under fluoroscopic guidance until its distal tip reached the middle of T6 level.One week later, for groups B and C, the balloon was inflated by half-strength contrast material,0.5 ml and 1 ml, respectively.The balloon was left inflated for 30 min and then deflated.The images of computed tomography (CT) and magnetic resonance (MR) were taken before and after surgical procedures.Quantitative assessment of spine canal occupying rate was accomplished by an off-line software program based on CT results.Motor function was assessed by the modified Tarlov scale.Two animals of each group were sacrificed after a total observation period of 48 h and 72 h respectively.Spinal cords from the injured level were then obtained for pathologic examinations.

All animals underwent successful catheterization occupying 6.8%±0.7% (Group A), 6.7%±0.7% (Group B) and 6.6%±0.6% (Group C) of spine canal respectively.After inflation, the occupying rate of groups B and C achieved 43.4%±2.5% and 88.1%±2.3% respectively.Ventral compression of spinal cord was noted on MR images.Hindlimb movement remained normal after catheter insertion in all groups.All animals in group B and C became paraplegic after inflation.And a positive correlation existed between injection volume and Tarlov score.Pathological findings confirmed neuron atrophy, increased gap around neurons, mild demyelination and vacuolar degeneration both in groups B and C at 48 h after injury.Pathological changes deteriorated at 72 h after injury.

The results of behaviorial evaluation, radiographic images and pathological examination reveal an evidence of acute spinal cord injury.Percutaneous epidural balloon catheter insertion differs from previous techniques by avoiding surgical exposure and associated artifacts, yet it offers injury mechanisms similar to those of human spinal cord injury.As a new means of modeling spinal cord injury in animals, this technique has many potential applications.

To evaluate the efficacy of recombinant human tumor necrosis factor-αreceptorⅡ:IgG fusion protein (RhTNFR:Fc) local injection in collagen-induced arthritis (CIA) of rats.

Twenty-four CIA rats were randomly divided into 3 groups: single therapy (GroupⅠ), multiply therapies (GroupⅡ) and control (GroupⅢ).GroupⅠ received normal saline thrice after a single Rh TNFR:Fc local treatment while GroupsⅡ and Ⅲ had 4 times of Rh TNFR:Fc or normal saline local injection.The severities of right ankle and systemic inflammation were assessed by arthritis index (AI) at baseline and every week after local injection (visits 1, 2, 3 and 4).Serum C reactive protein (CRP) was measured after the last visit.And right ankles were further examined through radiology and pathology.

Local or systemic AI of GroupⅠ were significantly lower than that of baseline at visit 1 (P<0.05), but increased during other visits.And local or systemic AI of GroupⅡ gradually decreased at each follow-up, but AI of GroupⅢ showed no decline.The radiographic scores (5.70±0.67 and 4.90±0.73), histopathological scores (6.00±0.67 and 3.80±0.91) and serum CRP concentration (7.50±0.87 and 3.09±0.76μg/ml) of GroupⅠ and GroupⅡ were lower than those of GroupⅢ (6.60±1.26,7.10±0.7 and 12.15±3.47μg/ml,P<0.05).And all these parameters of GroupⅠ were higher than those of GroupⅡ (P<0.05).

Local injection of Rh TNFR:Fc can effectively alleviate disease activity of CIA and reduce CRP concentration, radiographic and histopathological scores.Multiple therapies show a better efficacy than single injection.