Volume 93  ·   Issue 41  ·  2013

To explore the diagnostic application of receiver operating characteristic (ROC) curve of P300 amplitude and latency in schizophrenia.

ROC curve of P300 amplitude and latency was plotted from 91 first episode schizophrenia (FES) and 141 normal controls (NC).Youden′s index and distance were calculated in ROC curve to determine the optimal cutoff point of P300 amplitude and latency for schizophrenic diagnosis.Then the subjects were layered by gender and age for improved diagnostic accuracy.

The area under ROC curve for P300 amplitude for predicting schizophrenia was 0.746 (P<0.001), while P300 latency showed poor power in predicting schizophrenia (P=0.373).The optimal cutoff point of P300 amplitude was 5.097μV with a sensitivity of 80.14% and a specificity of 63.74%.After gender and age stratification, Youden′s index was enhanced in all 5 subgroups (from 1.8% to 14.88%) and the sensitivities of corresponding cutoff were enhanced obviously in subgroups of males (25.01%),≤25 years (22.22%) and>40 years (28.80%) patients.

P300 amplitude has certain values in schizophrenic diagnosis.Gender and age stratification may enhance the diagnostic efficiency of ROC curve in the diagnosis of frequent schizophrenia.

To explore the levels of adiponectin (APN), interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in first episode drug naïve schizophrenics and further examine the role of adipocytokines in schizophrenia.

Ninety-six normal weight schizophrenics and 22 overweight/obese ones from First Affiliated Hospital, Zhengzhou University and 60 healthy controls were enrolled.Serum levels of IL-1β, IL-6, TNF-αand APN were measured with enzyme linked immunosorbent assay (ELISA).

Serum levels of IL-1β, IL-6 and TNF-αin normal weight schizophrenics (54±13, 34±12, 48±18) pg/ml and overweight/obese schizophrenics (71±21, 40±12, 53±18) pg/ml were significantly higher than those in the controls (23±16, 16±7, 32±15) pg/ml (P<0.05).Serum levels of IL-1βand IL-6 in overweight/obese schizophrenics were significantly higher than those in normal weight schizophrenics (P<0.05).Serum level of adiponectin in normal weight schizophrenics was significantly higher than that in control group[ (12±4) vs (9±4) pg/ml, P<0.05].

The serum levels of APN, IL-1β, IL-6 and TNF-αincrease in first episode drug na?ve schizophrenics.It suggests that an inflammatory response mediated by adipocytokines.APN may play a pro-inflammatory role in schizophrenia.

To detect the changes of cortical thickness and cortical surface area in untreated patients of first-episode schizophrenia.

Fifty-seven untreated patients of firstepisode schizophrenia (SCZ) hospitalized from September 2009 to March 2012 at Department of Psychiatry, Third Affiliated Hospital, SUN Yat-sen University and 57 healthy controls (HC) recruited by advertising during the same period underwent a high resolution three-dimensional magnetic resonance imaging of brain structures.And cortical-surface based technique was used to analyze the cortical thickness and cortical surface area.The general linear model (GLM) was employed to detect the differences of cortical thickness and cortical surface area between two groups.Results were corrected for multiple comparisons by the Monte Carlo simulation method.

As compared with HC, the cortical thickness of left superior frontal, left caudal middle cingulate, left lateral occipital, right superior frontal, right superior temporal and right fusiform regions in SCZ decreased by 6.0%, 7.2%, 8.2%,5.2%,7.1% and 6.0% respectively.And the largest reductions occurred in left lateral occipital regions.Cortical surface area of each brain regions in SCZ had no significant difference with HC.

Cortical thickness reductions exist in multiple brain regions in schizophrenia.It may be the neuropathological mechanisms of schizophrenia.

To evaluate the cosmetic effect and safety of transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis (PH).

Retrospective studywas conducted for 326 PH cases undergoing transaxillary concealing single incision endoscopic thoracic bilateral sympathectomy during January 2009 and March 2011.

All operations were successfully performed without severe complication and mortality.No conversion into open technique was necessary.The mean unilateral operative duration was 5.8 (5-8) min.It was calculated from the time of skin incision to the application of dressing over wound.The mean follow-up period was 25 (8-38) months.All patients achieved excellent cosmetic effects with undetectable incision.

Transaxillary concealing single incision endoscopic thoracic sympathectomy is a safe and effective procedure for treating primary PH.Incision is undetectable with excellent cosmetic effect.It is worthy of wider popularization.

To explore the suitable lymphadenectomy for squamous cell carcinoma of the lower thoracic esophagus.

From January 2004 to December 2007, 300 patients with lower thoracic esophageal squamous cell carcinoma underwent Ivor-Lewis esophagectomy with 2-field lymphadenectomy in our department.All cases were retrospectively analyzed.143 cases underwent standardlymphadenectomy (standard group), 157 cases underwent total lymphadenectomy (total group).The clinical and pathological characteristics, the status of lymph node metastases, postoperative complications and survival rates were compared between two groups.

There were more lymph nodes dissected (30±10 vs 26±8, P=0.001) and higher respiratory failure rate (16.6% vs 0.7%, P=0.038) in total group than in standard group.The 5-year survival rate was 28.9% and 30.2%, respectively (P=0.936).

The total 2-field lymphadenectomydoesn′t provides better survival benefit for patients with squamous cell carcinoma of the lower thoracic esophagus, instead more complications occurred.For local advanced tumor, 3-field lymphadenectomy and comprehensive treatment should be considered.

To explore the application value of 320-row computed tomography (CT) 4D digital subtraction angiography (DSA) for hepatocellular carcinoma (HCC).

A total of 40 HCC patients received 320-row CT contrast scans.The 4D DSA images were obtained on the basis of baseline data.The normal anatomy and anatomical variations of hepatic artery, tumor supplying arteries, tumor vessels, tumor staining were observed by comparing DSA (n=20).

320-row CT 4D DSA could show 6-7 levels of intrahepatic arterial branch.Normal hepatic artery anatomy was found in 35 cases (87.5%, Michels I type) and variations in 5 cases (12.5%).The diagnose accordance rate was 100% between 4D DSA and DSA in showing the anatomy and variation of hepatic artery.Among them,320-row CT 4D DSA showed tumor staining (n=40), tumor vessels (n=28), tumor supplying arteries (n=26) and two hepatic supplying arteries (n=3).The number of tumor supplying arteries observed by 4D DSA (n=20) was 18 versus 19 by DSA.Compared with DSA, the accurate rate of 4D DSA was 94.7% (18/19) in detecting tumor supplying arteries.

As a noninvasive vascular examination modality, 320-row CT 4D DSA can accurately visualize normal anatomy and variation of hepatic artery, dynamically display tumor staining and reproducibly delineate the three-dimension relationship between tumor and blood vessels.In consistency with DSA in detection blood supply of HCC, 320-row CT 4D DSA provides a rapid, DSA-like and non-invasive alternative.

To explore the clinical characteristics,efficacies and prognosis of primary extradural meningioma (PEM) in head.

A comprehensive literature search from 1976 to 2012 retrieved a total of 212 eligible cases from 89 articles.The clinical data of another 19 cases were pooled from Qilu Hospital, Shandong University between May 1994 and December 2012.Statistical analyses were performed on their demographic features, presenting symptoms and duration, tumor locations and type, imaging features, surgical findings, pathological grade, histological subtype and follow-up outcomes.

PEM in head accounted for 0.8%-1.8% of all meningiomas.The maleto-female ratio was 1∶1.33.Their mean age was 44.9 years with a bimodal distribution of age.The most common presenting symptom was painless, gradually expanding mass.The average duration of symptom was 2.38 years.The skull convexities, paranasal sinuse and middle ear were top three tumor sites.The most common type was typeⅡ.Total, subtotal and partial tumor removal were achieved in 89% (145/163), 5.5% (9/163) and 3.1% (5/163) of cases respectively.There was no perioperative mortality.Among them, 90% (208/231) were benign, 5.6% (13/231) atypical and 3.9% (9/231) malignant.The most common histopathological subtype was meningothelial meningioma.The recurrence and tumor-related mortality occurred in 38 and 14 cases respectively in 170 cases during a mean follow-up period of 3.03 years.

PEM in head has some marked clinical characteristics compared with primary intradural meningiomas.Total tumor removal of all involved tissue plus a reconstruction of tissue defects is the best surgical option for PEM in head.The prognosis is excellent in most cases after complete resection.

To compare the measurements of bone tunnel width with computed tomography (CT) and plain radiography two years after anterior cruciate ligament single-bundle reconstruction.

Twenty patients underwent primary anterior cruciate ligament single-bundle reconstruction with hamstring autografts.There were 10 females and 10 males.Tibial and femoral bone tunnel widths were measured with CT and plain radiography at least two years post-operation.The average follow-up period was 26 months (range, 24-31).The tunnel measurements were taken at the widest point of tibial and femoral tunnels on sagittal and coronal CT and plain radiography perpendicularly to the longitudinal axis of tunnels.All data were statistically analyzed.

The tibial tunnel width of one case decreased on CT while all others increased.The average tibial tunnel width on coronal plain radiography was 0.9±0.6 mm (range,0.3-2.2) larger than that on CT.And the average width on sagittal plain radiography was 0.9±0.5 mm (range,0.1-2.1) larger than that on CT. Both were statistically significant.All femoral tunnel widths increased,except in 2 cases.The average femoral tunnel widths on coronal and sagittal plain radiography were both significantly larger than those on CT. And the difference were 0.7±0.6 mm (range,0-1.7) and 0.9±0.7 mm (range, 0.1-2.7) respectively.

Bone tunnel measurements on plain radiography are significantly larger than those on CT after anterior cruciate ligament reconstruction.

To prospectively explore the techniques, feasibility and safety of modified vaginal hysterectomy for large uterus.

A total of 158 patients undergoing hysterectomy at Beijing Hospital from January 2008 to December 2010 were divided into three groups: 12- 16 gestational weeks large uterus for vaginal hysterectomy (n=65, group 1), 12- 16 gestational weeks uterus for abdominal hysterectomy (n=47, group 2) and<10 gestational weeks uterus for vaginal hysterectomy (n=46, group 3).The pattern and techniques of delivery in group 1 was based on the location of fibroids/adenomyoma (in anterior wall, posterior wall, uterine horn or broad ligament, cervix) and the direction of overall shape maximum diameter (direction towards abdomen defined as long type while the direction towards lateral pelvic wall wide type).The completion and safety were observed intraoperatively.The outpatient follow-up period was 1 month.

A total of 158 cases of hysterectomy were performed successfully.The locations of fibroids/adenomyoma included anterior wall (n=17), posterior wall (n=24), unilateral uterine horn (n=6), broad ligament (n=3) and cervix (n=2).in group 1, and there were long (n=6) and wide (n=7) types.They were all successfully delivered through vagina through various techniques.No case was converted into laparotomy.The average largest size (judged by as large as number of gestational weeks) and weight of uterus was group 2 and followed by group 1.But the difference of size and weight between two groups was insignificant (P>0.05).Sorted by mean operative duration, mean amount of bleeding and decrease of hemoglobin, the declining order was the group 2,group 1 and group 3.The amount of bleeding for group 1 was less than that for group 2 (P<0.05).But it was more than group 3 (P>0.05).According to postoperative hospitalization duration, flatus time and indwelling catheter time, no statistical differences existed between groups 1 and 3.But the values of group 1 were significantly better than those of group 2 (P<0.01,<0.05,<0.01).

Vaginal hysterectomy is a safe and effective option for removing enlarged uterus.This pattern of operation can reduce the postoperative hospitalization time, flatus time and indwelling catheter time.

To evaluate the effects of accommodation on lens morphological characters.

From January 2011 to June 2011, magnetic resonance images of eyes were acquired from 30 subjects aged 20 to 24 years during accommodation and at rest.The optimal images were analyzed by Autocad 2010 to obtain the total lens cross-sectional area (CSA) and CSA of anterior and posterior portions of lens, anterior chamber depth, lens thickness, lens diameter, vitreous chamber depth and axial length during accommodation and at rest.Paired-t test was performed.

The anterior curvature radius (mm), posterior curvature radius (mm), CSA of anterior portion (mm²), CSA of posterior portion (mm²), total lens CSA (mm²) was (8.7±0.8), (6.2±0.5), (7.5±2.1), (12.0±2.6), (20±4) during relaxed accommodation; anterior curvature radius (mm), posterior curvature radius (mm), CSA of anterior portion (mm²), CSA of posterior portion (mm²), total lens CSA (mm²) was (7.1±1.3), (5.6±0.5), (14.7±2.9), (12.2±2.1) and (27±4) during accommodation.The total lens CSA (t=-11.556, P<0.01) and CSA of anterior portion (t=-15.653, P<0.01) both increased in accommodative states.The CSA of posterior portion of lens (t=-0.437, P>0.05) under a statistically independent accommodative state.There was significant difference in the anterior chamber depth (t=4.366, P<0.01), lens thickness (t=-5.456, P<0.01) and lens diameter (t=4.597, P<0.01) in accommodative states.There were insignificant differences both in vitreous chamber depth (t=0.428, P>0.05) and axial length (t=0.418, P>0.05) under accommodative states.

During accommodation, the anterior chamber depth decreases, lens thickness increases and diameter of lens decreases while anterior portions and total lens CSA increase.There are insignificant changes in posterior portions of lens CSA, vitreous chamber depth and axial length.The accommodative changes in CSA indicate that the anterior portion of lens may be related with the properties of anterior capsule and lens material, the position of zonular attachments and the location of fetal nucleus.Helmholtz theory is supported.

To explore the causes for delirium of elderly patients after hip fracture operation.

A total of 68 cases of delirium were selected from 458 patients aged over 65 years undergoing hip fracture operation via spinal anesthesia from 2009 to 2011.There were 26 males and 42 females with an average age of 72.9 (66-98) years.Their clinical features, such as gender, operative duration, blood loss volume, saturation of arterial oxygen, were observed.After single factor risk analysis, multiple factor analysis was performed by binary Logistic regression.

Delirium occurred at certain timepoints during the first postoperative days.The incidence of delirium was 14.9%.The Logistic stepwise regression analysis showed that significant differences existed between delirium and non-delirium in age (P=0.042), operative duration (P=0.042), blood loss volume (P=0.027), hypoxemia (P=0.019) and preoperative comorbidity (P=0.029).

The independent risk factors for postoperative delirium include age,operative duration, blood loss volume, preoperative comorbidity and hypoxemia.

To evaluate the effect of our prophylaxis job against awareness during general anesthesia and identify the effective methods.To analyze the risk factors of awareness.

Patients who received general anesthesia requiring muscle relaxants were interviewed postoperatively.The cases with explicit recall (ER) were identified as the cases of awareness.The results of the patients were compared with a historical group of 2025 cases in a previous study.

16 patients in the later group (6305 cases), 0.25%, had ER as compared with 1.38% in the earlier group (P<0.05).8330 patients were included in a Logistic analysis and factors associated with awareness were: TIVA technique (OR=6.671), O₂/N₂O-based anesthesia>30 min (OR=8.791), obvious intraoperative blood pressure fluctuation (OR=9.995), midazolam as a premedication (OR=0.060),anesthetic gas monitoring (OR=0.441).

Attentiveness on the knowledge of awareness and improvement in anesthetic management and monitoring were associated with a significantly reduced incidence of awareness as compared with a historical control population.

To analyze the blood picture changes of the ward nurses who nurse the patients received ¹²⁵I seeds implantation.

32 ward nurses who nurse the patients for ¹²⁵I seeds implantation were involved in the experimental group, the control group included 32 ward nurses from the medical oncology never exposed to ¹²⁵Iseeds.The WBC count, hemoglobin concentration and platelet counts from the two groups were analyzed statistically, respectively.30 patients received ¹²⁵I seeds implantation were selected randomly andγ-ray dose from the unshielded group and lead rubber cloth covering group was detected at a distance of 0, 15, 30, 50, 100 cm from patient body surface and at different angles.

No significant statistical difference was found between the two groups of WBC count, hemoglobin concentration and platelet count (7.1±1.7 vs 6.8±2.0,132±11 vs 136±11,236±57 vs 242±61).The measured radiation dose was close to the natural background dose (10.2-10.8μSv/h) at a distance of 50 cm from the body surface[(12.7±4.3) μSv/h] and the same as after 0.125 mm lead equivalent (Pb) rubber cloth shield protection[(11.2±3.1) μSv/h].

Interstitial ¹²⁵I seed implantation is safe on the blood picture of the ward nurses after taking appropriate protective measures.

To explore the relationship between multi-differentiation potential of monoclonal immortalized human mesenchymal stem cells (hMSC-TERT) in vivo and their cluster of differentiation antigens (CD).

Monoclonal hMSC-TERT were isolated using limiting dilution.Direct immunofluorescence staining flow cytometry was used to detect the cluster of differentiation antigens (CD44, CD45, CD105) of these cell lines.Their adipocytic, osteogenic, neuronal differentiation potential in vitro were determined by Oil Red O staining, Von Kossa staining and immuocytochemistry for tubulin-βⅢ antibody.Then hMSC-TERTs were transplanted subcutaneously into severe combined immunodeficiency (SCID) mice.The cell grafts were removed and analyzed by immunohistochemistry for pathologic tissue markers for multi-differentiation potential of hMSC-TERT cells in vivo.

CD105+ cell was 84.68% positive in hMSC-TERT-C19 while<5% in other monoclonal cell lines.The positive rate of cytokeratin in grafts formed by h MSCTERT-C19 cell line in SCID mice was much higher than the others (P<0.01).

The positive CD105 of monoclonal hMSC-TERTs may be directly correlated with its epithelial differentiation potential.

To investigate the feasibility of training anesthesiologists with hemodynamic models of miniature pigs.

Eight miniature experimental pigs were chosen; ECG, SpO₂, PetCO₂, ABP, CVP, SV, SVV and PAP were monitored after anesthesia.The research was divided into two parts.Part one: the blood of pig was taken from its artery, air was injected into its body throught jugular vein,15% KCl and 0.75% bupivacaine were given by peripheral vein respectively.The resuscitation would not be implemented unless the monitoring data changes were significantly and were recorded.Trainees looked on only during that time.Part two: Trainees were trained for placement of Swan-Ganz catheter after the sheath had been success-fully intubated into pig′s right jugular vein.Trainees were trained for placement of femoral artery guided by ultrasound.Scores related to trainees′performance were written down.

(1) Monitoring data (ABP, SV, SVV, CVP, PetCO₂, PAP, SpO₂, ECG) changes were significantly (P<0.05 or P<0.01), which indicated that the models had been successfully established.The evaluation scale displays:81.3% of trainees thought this research improved their under-tanding of hemodynamic changes; 78.2% thought that it helped them know how to deal with these circumstances; 71.9% thought this training was meaningful. (2) It was improved for students′skill to place Swan-Ganz catheter (P<0.05), whereas the skill for placement of artery catheter by ultrasound was not significantly improved (P>0.05).

It was feasible to use a hemodynamic model of miniature pigs as an assisted teaching method to improve resident anesthesiologists′ability to understand and cope with clinical hemodynamic changes.

investigation the impact factor of timeliness lag about cataract patient of operation.

Through Opportunistic Screening, from January 2007 to January 2012, we extracted people aged 50 or above and carried out the cataract screening in 10 towns of Wenzhou region of Zhejiang province.People extracted was checked by slit lamp microscope and ophthalmoscope directly,and the people who are suit for operation were brought to a first-rate of level three eye hospital and operated by MSICS.At the same time we have made questionnaire about five aspect including basic situation,economic status, basic life status, health and medical status and health needs for the operator and this questionnaire involves twenty-three relevant indexes about the timeliness, these factors of timeliness for patients seeing a doctor are judged.

36 681 people are checked for five years and 10 326 people (10 326 eyes) are suitable for surgery.Through analyzing sixteen relevant indexes about the timeliness,there are ten indexes which have Statistical Significance including in transportation, the distance for nearest medical aid post, care knowledge, population of family, income of family, respondents degree, the highest degree of family members type of work, structure of building, government subsidies.The first reason that the people can′t be operated in time are economic difficulties, next are older and making children trouble for seven factors of no operation in time.The people for this three reason is more than 75% for not seeing a doctor in time.

The key work of blindness prevention and treatment is the cataract surgery for our country.Eye doctors pay attention to new surgical technique,at the same time we should promote MSICS which is technique of low cost and have good effect of the operation.

To explore the local prevalence of rheumatoid arthritis (RA) among the middle-aged and elderly population.

A total of 8610 residents were recruited for a two-stage cluster sampling survey through a questionnaire of RA according to 2010 ACR/EULAR classification criteria.Physical examinations and blood tests were performed.

The responding rate was 96.10%.Joint score 0, 1, 2, 3, 5 was detected in 13.62%, 7.57%, 2.79%,1.87% and 0.23% of subjects.The prevalence of joint score 0, 1, 2, 3, 5 was 13.62%, 7.57%, 2.79%, 1.87% and 0.23%.The rate was 17.48% and 14.27% for elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP),6.62%,1.96% and 5.48%,1.55% for low titer and high titer rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) positive antibody.And 63 RA cases were confirmed.The crude prevalence was 0.76% and 0.71% for standardized prevalence.Compared to males, females had a higher prevalence of RA (1.02% vs 0.39%, P<0.01).In the population, the awareness rate was 74.60%, cure rate 71.43% and control rate 18.57% respectively.

The local prevalence of RA in elderly females is higher than that in males.And the treatment and awareness rates are also low.