Volume 93  ·   Issue 39  ·  2013

Intracranial aneurysm is an abnormal bulge caused by local vascular wall damage caused by congenital abnormalities or acquired injuries, and gradually expanding under the action of hemodynamic load and other factors. The prevalence of intracranial aneurysms in the population ranges from 2% to 7%, and it can occur at any age. It is common in 40-60 years old, but there are obvious regional and ethnic differences in the incidence rate^[1,2]。 A transarterial cerebral angiography study suggests that the prevalence of intracranial aneurysms in the Asian population ranges from 2.5% to 3.0%^[3]。 Once an intracranial aneurysm ruptures and bleeds, the fatality and disability rate is extremely high. Among them, 10% ~15% of patients die suddenly before seeking medical attention. The mortality rate of first bleeding is as high as 35%, and the mortality rate of second bleeding is as high as 60% ~80%. Most survivors are disabled^[4]。 Therefore, active intervention for intracranial aneurysms with surgical indications has been widely recognized. There are two main surgical treatments for intracranial aneurysm: craniotomy and clamping and endovascular intervention. Results of the international subarachnoid aneurysm trial (ISAT) published in 2002^[5]It was found that compared with craniotomy and clipping, endovascular interventional therapy can reduce the residual mortality rate and improve the clinical prognosis, thus establishing the position of interventional therapy in the treatment of intracranial aneurysm.

To evaluate the efficacy of laparoscopic conservative surgery plus gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of endometriosis through metaanalysis.

Six randomized controlled clinical trials comparing laparoscopic conservative surgery plus GnRH-a versus placebo or no treatment for endometriosis were retrieved.Meta-analysis was conducted to estimate the efficacy.

A total of 477 patients were included.Among them, 233 patients received laparoscopic conservative surgery plus Gn RH-a while another 244 laparoscopic surgery alone.The results of meta-analysis showed that laparoscopic conservative surgery plus GnRHa could decrease the recurrence of pain symptoms (P<0.05), but it could not increase the pregnancy rate of infertility associated with endometriosis (P>0.05).Furthermore the combined regiment could better improve clinical symptoms than placebo.

Laparoscopic conservative surgery plus GnRH-a could decrease the recurrence of pain symptoms associated with endometriosis, but it failed to increase the pregnancy rate of infertility.

To explore the diagnostic values of breast imaging and reporting data system (BI-RADS) and ultrasonic elastography (UE) for benign and maglinant breast lesions.

A total of 122 breast lesions were studied with BI-RADS and UE scoring to compare the sensitivity and specificity according to the pathologic results.Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of BI-RADS, UE and combination.

Among them, pathological examinations showed that there were 72 benign and 50 malignant cases.Statistically significant differences in specificity existed between BI-RADSlexicon (as≥4) and UE or combination (P<0.05) while sensitivity showed no difference (P>0.05); Statistically significant differences in sensitivity existed between BI-RADS (as≥4B) and UE or combination (P<0.05) while there was no difference in specificity (P>0.05); No statistically significant differences existed between UE or combination.The area under the ROC curve was above 0.7.

Both BI-RADSand UE have a great diagnostic value for breast disease.UE is somewhat superior to BI-RADS.However, the value of combination may be more significant.

To explore the expression and clinical significance of tumor necrosis factor-alpha (TNF-α) and its receptors p55 and p75 in non-specific chronic encephalitis relative intractable epilepsy (NCERE) and non-NCERE.

Immunohistochemical SABC staining was employed to detect the foci of 24 cases of intractable epilepsy (NCERE,n=10; non-NCERE,n=14) and 10 cases of the expression of TNF-αand its receptors p55 and p75 in normal brain tissues (control group) to analyze their clinical significance.

All expressions of the control group were negative.TNF-α and its receptors p55 and p75 were differentially expressed in neuron cytoplasm between NCERE and non-NCERE.No statistical significance existed between NCERE and non-NCERE (P>0.05).There was a positive correlation between the expressions of receptors p55 and p75 (r=0.897, P<0.05).

By binding its receptors and the synergistic effect between receptors p55 and p75, TNF-αis involved in the generation and development of NCERE and non-NCERE.However it appears to have nothing to do with the etiology of epilepsy.

To explore the activation of hypomethylated DNA on plasmacytoid dendritic cells (pDC) in patients with systemic lupus erythematosus (SLE).

Peripheral blood mononuclear cells (PBMC) were isolated from whole blood of SLE patients and healthy controls.The methylation level of DNA and the expression of DNA methyltransferase 1 (DNMT1) mRNA were detected.Flow cytometry was used to detect the expression of CD32 on pDC and the serum concentration of interferon-alpha (IFN-α) measured by enzyme-linked immunosorbent assay (ELISA).

The DNA methylation level from SLE patients (1.4±0.6)% was lower than that of controls (1.8±0.7)% (P<0.01).The expression of DNMT1 mRNA significantly decreased in SLE patients (0.06±0.03) versus the controls (0.09±0.02)(P<0.01).The CD32 expression on pDC from SLE patients (29±19)% was higher than that from controls (18.02±7.80)% (P<0.01).The serum level of IFN-αin SLE patients (4.5±6.7) ng/L was significantly higher than that of controls (2.1±2.0) ng/L (P<0.01).The methylation level of DNA in SLE patients was positively correlated with the expression of DNMT1 mRNA (r=0.257, P<0.05) and negatively with the expression of CD32 (r=-0.358, P<0.01) and IFN-α (r=-0.280, P<0.05).

The methylation level of genomic DNA decreases in SLE patients due to the downregulated expression of DNMT1 gene.Hypomethylated DNA may be translocated intracellularly via endocytic receptor (CD32) on pDC.And the activation of pDC is induced to produce IFN-αso as to participate in the onset of SLE.

To explore the effects of left renal vein division (LRVD) on postoperative renal function and examine the overall prognosis in patients undergoing open repair of abdominal aortic aneurysm (AAA).

Retrospective analyses were conducted for the clinical data of AAA patients with open repair at our hospital from January 2000 to December 2011.They were divided into LRVD (n=35) and non-LRVD (n=141) groups.The 30-day mortality, cardiocerebrovascular complications, pulmonary complications, preoperative and postoperative levels of creatinine and glomerular rate filtration (GFR), aortic cross-clamping time, blood loss volume, intensive care duration and dialysis or continuous renal replacement therapy (CRRT) rate were compared between two groups.

A total of 189 AAA repair were performed.And 13 patients with suprarenal clamping were excluded.The LRVD group had a significant higher proportion of ruptured AAA (48.6% vs 27.7%, P<0.01), higher 3-day postoperative creatinine (P<0.01), longer intensive duration (P<0.05) and decreased 3-day postoperative GFR (P<0.01).No significant difference existed in 30-day mortality, incidence of major complications, creatinine or GFR at discharge (P>0.05).

LRVD during open surgery of AAA has no effect on the postoperative mortality and renal function.

To retropspectively evaluate medium and long-term outcomes of conventional fenestration discectomy versus posterior lumbar interbody fusion in lumbar disc herniation with Modic changes.

From January 2002 to January 2007,a total of 486 patients of lumbar disc herniation with Modic changes were analyzed retrospectively.They were divided into fenestration group (n=215) and fusion group (n=271) according to the operative approaches.The scores of Oswestry disability index (ODI) and visual analog scale (VAS) pre-and post-operative 3, 6, 12 month and annually were recorded and analyzed.

All of them had complete records during a mean follow-up period of 88.9 (60-120) months.At the end of the latest follow-up,all symptoms were relieved postoperatively.Significantly difference existed in the improvement rate of back pain VAS between two groups (77.9% vs 68.0%).In the fenestration group, the improvement rate of VAS (back pain) of Modic typeⅡ was better than that of Modic typeⅠ (72.8% vs 64.9%).And the difference was statistically significant.For those with Modic typeⅠ changes, the improvement rate of ODI and VAS (back pain) of the fusion group were better than those of the fenestration group (78.3% vs 70.4% and 77.4% vs 64.9%).And the differences were statistically significant (P<0.05).

The patients with ModicⅠ and Ⅱ changes were recommended to undergo lumbar fusion and undergo fenestration discectomy respectively.

To assess the efficacy and safety of aranidipine versus retard-released felodipine in Chinese patients with mild-to-moderate essential hypertension.

This was a multicenter, randomized, double-blind, placebo and active antihypertensive drug parallel-controlled study.After 2 weeks of placebo run-in period, 315 patients at 6 centers with diastolic blood pressure (DBP) between 95 to 109 mm Hg (1 mm Hg=0.133 kPa) while systolic blood pressure (SBP) below 180 mm Hg were randomized to receive aranidipine 5-20 mg/d (n=126) or retard-released felodipine 5-10 mg/d (n=126) for 12 weeks.Others (n=63) received placebo for 4 weeks.Their blood pressures were evaluated at baseline and the end of Weeks 4, 8 and 12.

After a 12-week treatment,SBP decreased from 148.8±10.7 mm Hg to (132.8±11.2) mm Hg while DBP dropped from (98.4±2.8) mm Hg to (83.9±7.5) mm Hg.There were significant differences with the baseline values (P<0.0001).After a 4-week treatment, the reductions of SBP in aranidipine and retard-released felodipine groups were (12.1±11.0) mm Hg and (12.2±11.2) mm Hg while the reductions of DBP in two groups (11.8±6.9) mm Hg and (12.1±7.9) mm Hg respectively.The reductions of SBP and DBP in two groups were (2.3±8.4) mm Hg and (4.0±5.1) mm Hg and they were significantly superior to that in placebo group (P<0.0001).But no significant difference existed between aranidipine and retard-released felodipine groups.Also no significant differences were found between these two antihypertensive therapy groups at the end of Weeks 4,8 and 12 in the reduction of blood pressure, total response rate and blood pressure control rate.But 20 mg daily aranidipine was significantly superior to 10 mg daily retard-released felodipine in the control rates of SBP and DBP.Adverse events occurred at 24.22% and 29.92% in aranidipine and retard-released felodipine groups respectively (P=0.305).

Administration of aranidipine 5-20 mg/d can effectively control blood pressure and is not inferior to retard-released felodipine 5-10 mg/d.The efficacy of 20 mg/d aranidipine is superior to that of retard-released felodipine 5-10 mg/d.And the effectiveness and safety of aranidipine are similar to those of retard-released felodipine.

To observe the topically hemostatic effects of batroxobin (BX) in different concentrations on the carotid arteries adventitia removal rabbit.

18 rabbits were removed vascular adventitia by collagenase digestion and mechanical dissection, causing capillary hemorrhage.Then all of them were randomly divided into 6 groups: blank control, negative control group, 0.5, 1, 2 and 4 kU/L (U/ml) BX group.The hemostatic time and bleeding volume were observed to compare the hemostatic effect of each group.Haematoxylin-eosin, Masson staining and immunohistochemistry were performed to assure adventitia removed.

It was feasible to remove vascular adventitia with collagenase digestion and mechanical dissection.The hemostatic time and bleeding volume were significantly different (P<0.05) from 0.5 U/ml BX group[ (97±20) s, (0.102±0.013) g/cm²] of the negative control group[ (143±33) s, (0.130±0.023) g/cm²].With the increase of BX concentration, there was a significant difference (P<0.05) between 2 U/ml BX group (32±13,0.056±0.015) and 1 U/ml BX group (32±13,0.056±0.015), but there was no statistical significance (P>0.05) between 2 U/ml BX group and 4 U/ml BX group (28±14,0.053±0.012).Thus, the best topical hemostatic concentration of BX was 2 U/ml.

The topical hemostatic effect of batroxobin is reliable in small area of blood oozing.

To observe the effects of bone marrow concentrate (BMC) -PGA scaffolds for bone marrow stimulation enhancement and repairing rabbit articular cartilage.

A rabbit model of articular cartilage defect was established for BMC-PGA stent implantation.After 8 weeks, the experimental animals were sacrificed.And the methods of hematoxylin and eosin stain, toluidine blue stain and immunohistochemistry were used to evaluate the effects of bone marrow stimulation enhancement and rabbit cartilage defect repairing.

Visible new cartilage formation was evident after implantation.As compared with other groups, the repairing effect was better.

The implantation of BMC-PGA scaffolds is both simple and effective in the repair of articular cartilage.

Aim to determine the effect of different dose of 6% 130/0.4 hydroxyethyl starch on coagulation function in rats model with severe sepsis by cecal ligation and puncture (CLP).

80 male SD rats were selected and randomly divided into the sham groups and the CLP groups, every group was divided into 4 small Groups again: before recovery (H₀), 7.5 ml/kg group (H₁), 15 ml/kg group (H₂) and 30 ml/kg group (H₃), n=10; The CLP groups were established by cecal ligation and perforation (CLP), the sham groups were the same as the CLP groups except for CLP, MAP was monitored for all rats during the experiment.After 4 hours by CLP, Procedure fluid resuscitation which received 6% hydroxyethyl starch 130/0.4 by respectively 7.5 ml/kg, 15 ml/kg, 30 ml/kg were started at a rate of 10 ml·kg_-1·h^-1, the sham groups were the same dose 6% hydroxyethyl starch 130/0.4 at the same time.All rats were taken for arterial blood harvest at 4 h after fluid infusion for arterial blood gases, blood routine examination, conventional coagulation function and thrombelastography (TEG).

Compared with the sham groups, PO₂in the CLP groups was not significantly different.pH, PCO₂and MAP were significantly lower than the sham groups, Lac was significantly higher than the sham groups (P<0.05).APTT and PT were significantly higher than the sham groups (P<0.05), D-Dime and FIB were not significant different (P>0.05), R and K were significantly shorter than the sham groups, MA was significantly higher than the sham groups (P<0.05), α and CI were higher than the sham groups, but the difference was not statistically significant (P>0.05).Within CLP group, compared with H ₀, R, K, α, MA and CI after fluid resuscitation were not significant different.

Low-dose (less than 30 ml/kg) 6% hydroxyethyl starch 130/0.4 in early fluid resuscitation have less effect on coagulation function in rats with severe sepsis.

To evaluate the metastasis and survival of an intra-arterial infusion of 3-bromopyruvate (3-BrPA) on hepatic VX2 tumor in rabbits.

VX2 tumor was implanted in left lateral lobe of liver of 18 white New Zealand rabbits.The animals were randomized into 3 groups (n=6 each) and underwent an intra-arterial infusion of phosphate-buffered saline or 3-BrPA via hepatic artery at 14 days post-implantation.At 28 days post-implantation, 3 rabbits in each group were sacrificed.The abdomen of these rabbits was opened and inspected for metastases.Then the survival of the remaining rabbits was observed.

At 28 days post-implantation,in PBS group, there were intrahepatic metastasis and abdominal cavity dissemination (n=3), renal metastases (n=2) and lung metastases (n=2); in early 3-BrPA infusion group, intrahepatic metastasis (n=2), abdominal cavity dissemination (n=1) and lung metastases (n=1); in late 3-BrPA infusion group, intrahepatic metastasis (n=1) and lung metastases (n=1).The survival of the remaining animals was observed.Rabbits in early 3-BrPA infusion group survived significantly longer than those in PBS group[(27±5) vs (17±3) days,P=0.041]; rabbits in late 3-BrPA infusion group[ (42±6) days] survived significantly longer than those in early 3-BrPA infusion group (P=0.007).

An intra-arterial infusion of 3-BrPA could reduce metastasis and prolong survival in rabbits with hepatic VX2 tumor.The earlier the infusion, the better the outcome.

To explore the recurring patterns of migration and distribution of transplanted bone marrow stromal cells (BMSCs) in rat model with hepatic fibrosis and the feasibility of magnetic resonance (MR) tracing.

BMSCs labeled with 5-bromodeoxyuridine (Brdu) and superpara-magnetic iron oxide (SPIO) were transplanted into rat model with hepatic fibrosis via portal vein.MR scan was performed at Hour 2, Day 3, Day 7 and Week 2 post-transplantation to analyze the hepatic features of MR signal intensity and pathohistology of BMSCs.

Multiple hypo-intense lesions appeared in hepatic hilar region at Hour 2 and became smaller with the elapsing time.Hemosiderin and Brdu immunohistochemical stains showed that positive cells were found in portal vein of hepatic porta at Hour 2, small branches of portal vein, sinus hepaticus and around central veins of hepatic lobules at Day 3 and liver parenchyma (esp.in area of lesion) at Day 7 and Week 2.Some of transplanted BMSCs were tightly connected with liver cell to form liver cell cord.The signal intensity changes of MRI corresponded to histological findings at different timepoints.

The transplanted BMSCs are gradually scattered in whole liver (esp.in lesion area) so that it may help to repair hepatic lesions.And the recurring patterns of MR signal intensity changes reflected the condition of distribution,immigration and differentiation of transplanted cells.

To explore the changes of magnetic resonance imaging (MRI) and computed tomography (CT) after transplantation of VX2 carcinoma into lumbar vertebrae of rabbits under CT guidance and examine its relationship with the onset of paralysis.

A total of 52 rabbits were randomly divided into 4 groups.Under CT guidance, pieces of VX2 carcinoma were transplanted into the first or second lumbar vertebra in Groups A, B and C (n=14 each) while sham operation was performed in Group D (n=10).The anticipated endpoints of group A was natural death or Day 50 post-operation, group B Day 3 after onset of paralysis,group C Day 14 post-transplantation and group D natural death or Day 50 post-operation.CT and MR scans were performed at an interval of 7 days and hind limb functions monitored daily post-operation until endpoints.Pathohistological examinations of vertebras were performed at endpoints.

All lumbar vertebras were successfully transplanted under CT guidance.Thirty-two rabbits with spinal tumor and 9 surviving rabbits in the control group were monitored until endpoints.Abnormal signals on target vertebras appeared on MRI in all 41 rabbits at Day 7 post-operation while positive CT findings were absent.No abnormal MRI/CT findings were found in 9 control rabbits from Day 14 post-operation to the end of study.Significant differences (P<0.001) existed between the rates of tumor visualization with 65.6% (21/32) on MR and 3.1% (1/32) on CT at Day 14, 100% (21/21) on MR and 42.9% (9/21) on CT at Day 21.The rates of tumor visualization were 100% on both MR and CT from Day 28 to endpoints.The average survival time of Group A was significantly shorter than Group D (40±4 vs 50 days, P<0.01).The onset time of paralysis time in Group A (22±5 days) had no significant difference with Group B (22±5 days)(P=0.952).

A rabbit model of spinal metastasis is established with high rates of success and reproducibility.Vertebral tumor may be located earlier on MR than CT after transplantation of VX2 carcinoma.The examinations of MRI and CT after Day 7 post-operation are controversial.The survival time of rabbits with paralysis caused by spinal tumor is significantly shortened.