Volume 94  ·   Issue 21  ·  2014

To explore the changes of effective connectivity associated with insula in different nicotine addiction sessions so as to understand its role and function.

A total of 20 smokers received the scans of resting-state functional magnetic resonance imaging in two sessions of different conditions: smoking abstinence followed by smoking satiety. Group ICA was initially adopted to obtain the independent component patterns. And paired t-test of ICA spatial patterns revealed such regions of interest as insula, parahippocampus, precuneus, dorsal anterior cingulate cortex, rostral anterior cingulate cortex, supplementary motor area and ventromedial/dorsolateral prefrontal cortex and effective connectivity from insula to other regions was examined subsequently with GCA.

In smoking abstinence, insula showed increased effective connectivity with dorsolateral prefrontal cortex, ventromedial prefrontal cortex, dorsal anterior cingulate cortex, rostral anterior cingulate cortex, precuneus; while in smoking satiety, there was no significant changes for effective connectivity. Referring to graph theory analysis, the insula was a causal output source in smoking abstinence.

Insula is a signal output node in smoking abstinence, with its interoceptive function monitoring the change of physiological state of body when in smoking abstinence, and then integrating each brain activity to produce subjective consciousness so as to facilitate addiction.

To report a novel surgical technique of laparoscopic extraperitoneal sling suspension for uterine prolapse and evaluate its efficacy.

A total of 21 consecutive patients of symptomatic uterovaginal prolapse with POP-Q (pelvic organ prolapse quantification system) stage ≥2 and aged 59 (42-76) years were enrolled for this procedure between September 2011 and December 2012. In brief, uterus was suspended to anterior abdominal wall fascia using an inelastic nonabsorable mesh extraperitoneally under laparoscopic guidance. The outcomes of interest included total operative duration, estimated blood loss, surgical length of stay POP-Q score change and quality of life questionnaire in pelvic floor distress inventor [PFDI-20] and pelvic floor impact questionnaire [PFIQ-7]. Follow-ups were scheduled at 1, 6 and 12 months and then annually. Comparisons were made between at preoperation and 6 and 12 months. The surgical success was defined as both subjective cure and significant improvement of POP-Q.

This procedure was performed successfully in all patients. The estimated blood loss 10 (10-40) ml, operative duration 30 (25-90) minutes and postoperative hospital stay 1 (1-5) day. There were no major intraoperative or postoperative complications. The median follow-up was 20 (12-26) months. There were significant improvements in POP-Q measurements of Ba and C (P<0.01) and quality-of-life scores (P<0.01) at 6 and 12 months. The subjective cure rate was 100% and surgical success rate at 12 months 100%.

This new sling suspension technique for uterine prolapse is safe, well-tolerated and effective so that it offers a simple alternative of laparoscopic uterine suspension.

To detect cerebral microbleeds by susceptibility weighted imaging and explore the relationship between intracerebral hemorrhage, cerebral microbleeds and risk factors of cerebral vascular disease.

A retrospective analysis was conducted for 70 patients from August 2012 to June 2013 undergoing susceptibility weighted imaging (SWI). The average age was (68±14) years. Their demographic and clinical profiles were recorded. Conventional magnetic resonance imaging (MRI) and SWI images were performed and images analyzed by an experienced radiologist. The occurrence of infarction, hemorrhage and number of microbleeds were recorded. Then regression analysis with SPSS 13.0 was used to define the relationship between the existence of infarction, hemorrhage and the number of microbleeds.

There were 0-65 microbleeds in brains on SWI. There were infarction (n=44) and chronic intracranial hemorrhage (n=7). The binary Logistic regression analysis showed that intracranial hemorrhage was associated with hyperlipidemia (P=0.01). Linear regression analysis showed that the number of microbleeds was related with intracranial hemorrhage (P=0.02).

Evaluation of microbleeds in brain by SWI may help to assess the possibility of intracranial hemorrhage so as to provides rationales for clinical therapeutics.

To explore the microbiological etiology of prosthetic hip infections during two-staged revision and analyze antibiotic susceptibility of bacteria isolated from infected hip arthroplasty specimens so as to provide clinical recommendations for empiric prophylactic and therapeutic antibiotics therapy.

A retrospective review was conducted for hospitalized patients of prothetic hip infections during two-staged revision between January 1, 2007 and December 31, 2013. Suspicious intraoperative tissues were cultured and microbiological data sets and antibiotic susceptibility of bacteria were analyzed.

A total of 131 patients met the inclusion criteria. Micro-organisms were isolated in 96 patients. The negative culture rate was 26.7%. Nearly half of primary diseases were of fractures and 31.29% of all infected patients had previous surgery. Gram-positive isolates were the most common genus encountered (n=81, 74.3%), followed by Gram-negative isolates (n=22, 20.2%) and fungal isolates (n=6, 5.5%). Polymicrobial infections accounted for 11.5%. Coagulase-negative staphylococci was the most common causative organism of infection (n=42, 38.5%), followed by Staphylococcus aureus (19.3%). The proportion of isolated methicillin-resistant Staphylococcus was 29.36% for all organisms and 44.4% for Staphylococcus. Gram-negative isolates were dominated by Pseudomonas aeruginosa and Escherichia coli. Fungal isolates were dominated by Candida albicans. Enterococcus was the most common causative organism of polymicrobialinfection. The results of antibiotic susceptibility showed cefazolin and cefuroxime were poorly susceptible to coagulase negative staphylococci (CNS) and methicillin-resistant staphylococcus (MRS). Some third and fourth-generation cephalosporins also had problems of bacterial resistance to Gram-negative isolates. Some antibiotics such as vancomycin, linezolid and rifampin were sensitive to Gram-positive isolates. Some antibiotics such as amikacin piperacillin/tazobactam, cefoperazone/sulbactam, levofloxacinareand carbapenems were sensitive to Gram-negative isolates.

Most infections are caused by staphylococci. The proportion of isolated methicillin-resistant Staphylococcus is high. Empiric antibiotics should include vancomycin for Gram-positive organisms and piperacillin/tazobactam (cefoperazone/sulbactam), levofloxacinare or carbapenems for most Gram-negative bacteria. Antibiotics should be timely adjusted according to the antibiotic susceptibility results.

The correlation between admission Electrocardiogram (ECG) and coronary angiography findings have the responsibility for culprit vessel in predicting the infarct or multivessel disease(MVD) in acute anterior or anterior-inferior ST segment elevation myocardial infarction.

Between 2012 January and 2012 December, in Emergency Department Beijing Anzhen Hospital, Concessive 203 patients were retrospective investigated with the diagnosis of anterior AMI (ASTEMI) with or without ST-segment elevation or ST-segment depression in at least two leads in Ⅱ, Ⅲ, aVF. Patients are categoried in 3 groups by ECG (1) ASTEMI with inferior depressions, (2) ASTEMI with inferior elevations, (3) all ASTEMI according to the ST-segment changes in the inferior region were analyzed by the presence of LAD (SLAD) or multivessles involvement.

The ST-segment depression in aVL and V6 significantly correlated with MVD in ASTEMI patients with whose reciprocal changes in the inferior leads (P=0.004 and P=0.031, respectively). The analyse of all the patients with ASTEMI, the association between the presence of MVD and ST-segment depression in leads aVL, V4, V5 and V6 is significant (P=0.041, P=0.012, P=0.014, P=0.001, respectively).

In the admission ECG, ST-segment depression in anterolateral leads of anterior AMI patients who with reciprocal changes in inferior leads were associated with MVD.

To compare the application of Coopdech bronchial blocker and double lumen bronchial tube during one lung ventilation in children.

Forty children undergoing one lung ventilation for thoracic surgery at Shantou Central Hospital from January 2012 to June 2013, approved by hospital ethics committee, were randomized into Coopdech bronchial blocker group (group A) and double-lumen tube group (group B). Anesthetic management and lung isolation were performed according to a standardized protocol. Two groups of children with the intubation time, intubation success rate, collapse score, the frequency of postoperative hoarseness were recorded. Before and after one lung ventilation in patients of the two groups of PaCO₂, PaO₂ and airway pressure (PAW) changes were recorded.

The intubation time in A was longer than those of group B ((224±72)vs(165±46) s, P<0.05), the success rate of intubation(100% vs 85%,P<0.05), collapse score in A group was higher than in group B(95% vs 75%,P<0.05), Sore throat hoarseness occurred after operation in A group was lower than in B group (10% vs 35%,P<0.05), PaO₂ was higher in group A after one lung ventilation for 30 min ((206±58)vs(148±63) mmHg, P<0.05), PaCO₂ and PAW were lower than group B ((36±4)vs(45±7) mmHg; (21.6±3.2)vs(29.3±5.5) cmH₂O, P<0.05).

The Coodech bronchial blocker provided effective surgical exposure with less throat injuries, higher intubation success rate, lower airway pressure in children during video-assisted thoracoscopic surgery.

To explore the effects of pri ming rocuronium on neuromuscular blockade produced by mivacurium.

Ethical approval was granted by the medical ethics committee of our hospital with a reference number of C-2013-018-01. A total of 120 ASA physical status Ⅰ and Ⅱ patients undergoing selective otorhinolaryngologic surgery under general anesthesia signed the form of informed consent. And they were randomly divided by a random number table into 4 groups. After a standardized imidazole-propofol-fentanyl induction, they received a saline placebo injection (GroupⅠ) and a pri ming dose of rocuronium 0.06 mg/kg (GroupⅡ), rocuronium 0.075 mg/kg (Group Ⅲ) and rocuronium 0.1 mg/kg (Group Ⅳ). An intubating dose of mivacurium 0.15 mg/kg was offered 3 minutes later. Anesthesia was maintained with propofol and remifentanyl continuous infusion. Neuromuscular block was monitored with train of four (TOF) stimulation. The onset time, reappearance of T1 (DUR TOFc 1), times of T1 25% and 75% recovery, recovery index and times of TOF25%, 75% and 90% recovery were recorded.

The onset time of mivacurium was significantly shorter and the times of T1 25% and 75% recovery were significantly longer in groups of Ⅱ, Ⅲ and Ⅳ than those in groupⅠ. No significant difference existed in recovery index among 4 groups. The onset time of mivacurium became progressively shorter with the growing pri ming dose of rocurium among three experiment groups. And it was not statistically significant.

Pri ming rocuronium decreases the onset and intubating times of mivacurium without effect on recovery index. No significant difference exists in drug effect among 3 experiment groups.

To evaluate the correlation between synovial tumor necrosis factor receptor-associated factor (TRAF) 6 expression and serum bone metabolism markers in rheumatoid arthritis (RA).

Serum biochemical markers of bone formation (N-terminal propeptide of type I collagen, PINP and N-terminal midfragment of osteocalcin, N-MID. OC) and bone resorption (C-terminal telopeptide of type I collagen, CTX-I) were detected by chemiluminescence in 51 RA patients and 102 age and gender-matched healthy controls from Sun Yat-sen Memorial Hospital during the period of April 2010 to December 2012. Clinical and other serological parameters of reflecting RA activity and severity were collected and correlated with bone metabolism markers. TRAF6 was stained immunohistochemically in synovium from 30 active RA patients and the intensity of TRAF6+ cells was analyzed semiquantitatively. Correlation between synovial TRAF6 expression and serum bone metabolism markers was analyzed.

Serum CTX-I level was significantly higher in RA patients than healthy controls ((0.53±0.33)×10^-3 vs (0.33±0.16)×10^-3 g/L, P<0.01). Serum PINP and N-MID. OC levels of RA patients were correlated negatively with morning stiffness (P<0.05), Health Assessment Questionnaire (HAQ) score (P<0.05) and pain visual analogue scales (VAS) score (P<0.05). Serum PINP level of RA patients correlated positively with gripping power (r=0.296, P<0.05). TRAF6 expression was observed in lining and sublining area of RA synovium and a higher expression of TRAF6 was seen in patients with severe synovitis than those with mild synovitis. Significant correlation was found between synovial TRAF6 expression and serum PINP level (r=0.381, P<0.05), as well as serum N-MID. OC level (r=0.345, P<0.05).

Increased bone resorption and altered skeletal bone metabolism are present in RA. An elevated expression of synovial TRAF6 may be correlated with increased compensatory bone formation. And TRAF6 is probably involved in the pathogenesis of bone metabolism imbalance through modulating synovial inflammation in RA.

To explore the neuroimaging diagnosis and therapeutic efficacy of different surgical methods of gliomatosis cerebri.

26 cases of gliomatosis cerebri at our department between September 2008 and September 2013 were retrospectively analyzed. Preoperative cranial computed tomography (CT), magnetic resonance imaging (MRI) and other multimodal imaging scans were performed. The procedures included stereotactic brain biopsy (n=11) and large craniotomy lobotomy (n=15). Whole brain radiotherapy and/or temozolomide therapy was performed postoperatively according to the malignancy of tumors. Follow-ups were conducted to analyze the survival differences between stereotactic brain biopsy and large craniotomy lobotomy groups.

According to the different features of multimodal imaging, gliomatosis cerebri could be divided into two types: (1) type Ⅰ(n=19) showed a diffuse infiltrating lesion infringing multiple brain lobes or regions with central corpus callosum but without obvious enhancement; (2) type Ⅱ(n=7) appeared as sporadic or tuberous enhancement in addition to the features of type Ⅰ. Pathological diagnosis: pilocytic astrocytoma (n=2), diffuse astrocytoma (n=13), oligodendroglial tumors (n=3), oligoastrocytoma (n=1), anaplastic astrocytoma (n=5) and glioblastoma (n=2). The degree of malignancy was a prognostic factor for postoperative survival in patients with gliomatosis cerebri. The mean survival time (MST) of large craniotomy lobotomy group(23±7) was significantly longer than that of stereotactic brain biopsy group(13±3)(P<0.05).

Gliomatosis cerebri is a primary brain glial tumor with diffuse infiltrative growth but retaining the general structure of central nervous system. Multimodal imaging studies plus pathological examination yield a definitive diagnosis. Comprehensive treatment of operation plus chemo- or radio-therapy can prolong postoperative MST.

To evaluate the effects of age, gender, tibial anterior laxity and time from surgery to follow-up on patellofemoral articular cartilage status after anterior cruciate ligament reconstruction by second-look arthroscopy.

A total of 102 patients undergoing arthroscopic anterior cruciate ligament reconstruction received second-look arthroscopy at least one year after operation. There were 71 males and 31 females with an average age of 27.1 (16-41) years. The average time from primary operation to second-look arthroscopy was 23 (12-51) months. Arthroscopic evaluations of patella and trochlea cartilage status for all patients were performed at initial anterior cruciate ligament reconstruction and second-look arthroscopy. The effects of age, gender, tibial anterior laxity and time from surgery to follow-up on patellofemoral articular cartilage status were retrospectively examined.

Patellofemoral articular cartilage degeneration continued to aggravate after anterior cruciate ligament reconstruction. There was no significant gender difference in patella and trochlear cartilage status. The patellar cartilage of patients under 30 years was worse than that of patients aged 30 years and above. Even though there was no significant difference. However, no significant inter-group difference existed in trochlear cartilage damage. With regard to KT-2000 side-to-side differences (0-3 mm vs >3 mm), no significant difference existed in patella and trochlear cartilage status. No significant difference was also found in the status of patella and trochlear cartilage between patients with body mass index under 24 kg/m ² and patients 24 kg/m² and higher. The patellar cartilage of patients within 24 months after operation was significantly worse than that of patients 24 months and longer. However it did not apply to trochlear cartilage.

The degeneration of patellofemoral articular cartilage worsens after anterior cruciate ligament reconstruction. And significantly more severe lesions are found in patellar cartilage of patients within 24 months after operation.

To observe the changes of proliferation and angiogenesis of residual tumor in rabbit lung after radiofrequency ablation (RFA).

The model of VX2 tumor in rabbit lung was established by injection of tissue block suspension. 64 New Zealand White rabbits bearing VX2 tumor were assigned randomly to the control group (n=10) and the RFA group (n=48). During the RFA procedure, residual tumors were achieved by controlling the range of electrode expanding, output power and treatment time. At several points of time, Ki-67 labeling index (Ki-67LI) and microvessel density (MVD) of the residual tumors were calculated by immunohistochemical detection.

Ki-67LI of the control group was 45.3%±2.1%. Ki-67LI of the RFA group at the first, 3 and 5 day were 56.4%±3.4%, 60.1%±4.1% and 59.8%±2.4% respectively, significantly higher than that of the control group; however, at the seventh, 9, 14 and 21 day, they were 45.4%±2.0%, 46.2%±3.4%, 45.1%±4.4% and 47.8%±3.9% respectively, no significant difference compared with the control group. The control group MVD was 28.9±2.9. MVD of the RFA group at third, 5 and 7 day were 36.8±2.6, 55.6±4.8 and 51.5±2.8 respectively, significantly higher than that of the control group; however, at the first, 9, 14 and 21 day were 27±2.8, 29.2±3.2, 30±2.8 and 28.8±3.1 respectively, no significant difference compared with the control group.

The proliferation and angiogenesis of pulmonary residual tumor exhibit a transient increase phenomenon after RFA.

Functional gastrointestinal disease (FGID) is a group of functional diseases with gastrointestinal symptoms as the main clinical manifestation without organic changes, which can involve the whole gastrointestinal tract. At present, the Rome III standard is widely used to classify FGID in adults and 28 diseases in 6 categories, and FGID in children is divided into 2 categories and 17 diseases^[1]Among them, functional dyspepsia (FD) and irritable bowel syndrome (IBS) are the most common. Gastrointestinal motility modulators are widely used in FGID overlap therapy.

Patient 1, female, 68 years old. He was admitted to the hospital on 30 August 2010 due to weakness of his right upper limb for 1 week. Physical examination: blood pressure 118/80 mmHg (1 mmHg =0.133 kPa), clear mind, heart rate 85 beats/min, absolutely irregular heart rhythm, and variable intensity of the first heart sound. The muscle strength of the right upper limb was grade III, and the pathological reflex was negative. Cranial CT: Multiple intracranial space occupation with hemorrhage, metastasis possible. PET-CT: Mass occupation in the left atrium, clear boundary, slightly higher wall density, no abnormal increase in FDG uptake, considering left atrial myxoma; Multiple nodular slightly high-density shadows in the cranium, considering multiple hemorrhagic cerebral infarction. Electrocardiogram: atrial fibrillation. Later, the atrial tumor was removed by surgery, and it was confirmed by pathology as atrial myxoma. After operation, the patient's condition was stable, and the symptoms of limb weakness gradually improved (Figure 1)。