Volume 94  ·   Issue 25  ·  2014

To evaluate the left ventricular (LV) myocardial function in coronary atherosclerosis patients with type 2 diabetes mellitus (DM) by two-dimensional speckle tracking echocardiography (2D STE).

A total of 60 patients with a diagnosis of coronary atherosclerosis (<50%) were divided into DM and non-DM groups (n=30 each). And another 30 cases were selected as normal control group. LV regional longitudinal, circumferential and radial peak systolic strain (ε) were measured respectively.

EF showed no difference among 3 groups. However the peak systolic longitudinal strain (ε) in LV basal segments, middle segments and apical segments were significantly lower in DM group than those in non-DM and control groups (P<0.05). The peak systolic circumferential and radial strain parameters showed no significant difference among 3 groups.

The systolic longitudinal myocardial function of LV become compromised before reduced LV global systolic function in coronary atherosclerosis patients with type 2 diabetes mellitus.

To explore the value of computed tomography (CT) imaging in clinical diagnosis and prognostic evaluation of pleural mesothelioma.

The clinical data and CT features were analyzed retrospectively in 12 pathologically confirmed cases of pleural mesothelioma. And 15 relevant papers were reviewed.

The major clinical symptoms included chest pain, stuffiness and cough. The chest CT demonstrated diffusive pleural thickening (n=9), local pleural thickening (n=3), pleural thickening over 1 cm (n=10) and concurrent pleural effusion (n=11).

Chest CT may help to determine the location, shape, extent of pleural lesion and its relation to surrounding tissues. And it provides objective rationales for the clinical diagnosis and prognostic assessment in patients with pleural mesothelioma.

To explore the optimized methods to define and delineate supraclavicular lymph nodal target in postmastectomy radiotherapy for breast cancer patients.

From September 2012 to August 2013, a total of 10 breast cancer patients at Sun Yan-sen University Cancer were selected for mastectomy plus postoperative radiotherapy. The clinical target volume(CTV) of every patient was delineated on CT-slices after computed tomography(CT) simulation by 6 radiation oncologists. Then the coverage discrepancy in anatomic lymphatic drainage subregions was analyzed among both CTVs by different oncologists and CTVs for patients with different clinical characters.

The average volume of SCLN-CTVs was 110±28 cm³. All SCLN, neck-Ⅳ and axilla Ⅲ regions were covered in CTV, none of axillaⅠregion. The covergy rates of nonsurgery-axillaⅡ, Rotter-LN, intraclavicular-LN, neck-Ⅴb, scalenus gap, neck-Ⅲ and surgery-axilla Ⅱregions was 75%, 85%, 73%, 88%, 68%, 10%, 17% , respectively.

SCLN, neck-Ⅳ and axilla Ⅲ regions should be covered according to consensus. However, the opinions of nonsurgery-axillaⅡ, Rotter-LN, intraclavicular-LN, neck-Ⅴb, scalenus gap, neck-Ⅲ and surgery–axilla Ⅱremain divisive.

To explore the surgical techniques and clinical efficacy of sliding osteotomy of lateral femur condyle in severe fixed valgus deformity during total knee arthroplasty (TKA).

A total of 11 consecutive patients (11 knees) undergoing primary TKA for severe valgus deformities were recruited between November 2007 to November 2009. There were 2 males and 9 females with an average age of 67 (58-76) years. The follow-up period was 12-61 months. Primary TKA was performed via a medial parapatellar approach. And conventional osteotomy and soft tissue release were performed. Sliding osteotomy of lateral femur condyle was performed in all cases. Posterior stabilized prosthesis was employed and clinical outcomes were evaluated by the relevant parameters.

The knee society score improved from 51.5±7.8 to 89.9±2.8 and functional score increased from 40.4±7.3 to 84.2±5.9. The tibiofemoral angle changed from a preoperative value of (161.4±4.4)°to a postoperative value of (172.8±1.0)°. Patella dislocation was not reported. And no other complications occurred during the follow-up.

Sliding osteotomy of lateral femur condyle is effective for fixed valgus knee deformity during TKA. Improvement of joint function may be achieved significantly with satisfactory clinical outcomes.

To explore the therapeutic effects of Spinal canal reconstruction with autologous spinous process-lamina complex replanted and fixed by titanium sheet and pins after resection of intraspinal tumors.

Among 15 patients with intraspinal tumors at our hospital from July 2011 to December 2013, there were schwannoma (n=11), spinal meningioma (n=1), ependymoma (n=1) and epidermoid cyst (n=2). All resections were performed via a posterior midline approach. And the clinical data were analyzed. The spinous process and lamina complex were resected en bloc by burr drill and reserved with interior sclerotin bitted. Then replantation in situ and fixation by titanium sheet and pins were performed after a resection of intraspinal tumors and skeletal fragment was replanted into bone gaps. Laminoplasty were finished and other procedures were the same as laminectomy. Computed tomography 3-demsional reconstruction, magnetic resonance imaging (MRI) and pathological examination were performed before and after operations. Wound healing, spinal integrity, stability and activity were evaluated. Sagittal diameters of spinal canal lumina in operative area were measured and analyzed statistically.

Fifteen tumors in 15 patients were totally resected while preoperative symptoms improved significantly or disappeared. Incision stitches were removed at days 7-9 post-operation with excellent healing. There was neither cerebrospinal fluid leakage nor local or systemic rejection. During a follow-up period of 3 to 24 months, there was an onset of such subjective discomforts as distraction, contracture and foreign body sensation. No spinal stenosis, collapse or displacement of replanted tissues occurred. Spinal capacities and shapes were plump. There was no collapse and displacement along healed lamina bony. CT and MRI results were satisfactory. No significant difference was found between peri- and post-operative sagittal diameters of spinal canal lumina (P>0.05).

After resection of intraspinal tumors, spinal canal reconstruction with autologous spinous process-lamina complex reduction is both simple, practical and effective for protecting spinal integrity, stability and activity.

To assess the efficacy and safety of lateral supraorbital (LSO) approach for removing sellar tumors.

Between June 2011 and December 2011, 23 patients with neoplastic lesions underwent surgery via a LSO approach. Their clinical manifestations, neuroradiological findings, microsurgical techniques and post-discharge outcomes were analyzed. There were pituitary adenoma (n=11, 48%), tuberculum sellae meningioma (n=6, 26%) and craniopharyngioma (n=6, 26%).

Complete tumor removal was achieved in 21 patients. There was no postoperative onset of cerebrospinal fluid leakage or new visual deficits. One patient had intracranial infection and another developed hematoma. The median Karnofsky score at discharge was 87.4 (0-100). The Glasgow outcome scale at discharge was 4.6 (1-5). Among them, the outcomes were favorable (n=21), severe disability (n=1) and surgical mortality (n=1).

Sellar tumors may be removed via a LSO approach with relatively low morbidity and mortality. And this fast and simple procedure is comparable to more extensive, complex, and time-consuming approaches.

To explore the reliability of the relationship between the tip of greater trochanter and the center of femoral head in restoring leg length discrepancy during hip arthroplasty.

From June 2013 to October 2013, 370 standard anterior-posterior pelvic radiographs were performed. There were 160 males and 210 females with a mean age of 47.6 years. Landmarks were selected by Picture Archiving and Communication Systems (PACS) as follows: the center of femoral head of concentric circles, anatomic axis of proximal femur, the lines perpendicular to anatomic axis of proximal femur through the tip of greater trochanter and the center of femoral head. The distance between two intersected points, i. e. vertical distance between the tip of greater trochanter and the center of femoral head, aka greater trochanter height (GTH), was measured by two orthopedic surgeons respectively. If the tip of greater trochanter was above the center of femoral head, the distance was defined as positive. And the distance was negative if the tip of greater trochanter fell below the center of femoral head. The distance of male and female and that of right and left femurs were compared.

Only 6 tips of greater trochanter were below the center of femoral head, 9 at the same level and 725 above the center of femoral head. And 96.89% of tips of the greater trochanter were at 0-15 mm above the center of femoral head. The difference between male and female (P=0.032) and the difference between right and left sides were statistically significant (P<0.001).

The center of femoral head is not at the same level as the tip of greater trochanter. And the distances of right and left tips of greater trochanter to the ipsilateral center of femoral head are not always at the same level. So it should be cautious to employ the relationship between the tip of greater trochanter and the center of femoral head in restoring leg length discrepancy during hip arthroplasty.

To explore the feasibility, safety and efficacy of treating thoracolumbar disc herniation with transforaminal lumbar intervertebral fusion (TLIF).

From December 2009 to May 2013, 15 consecutive patients with one-level thoracolumbar disc herniation underwent TLIF. There were 9 males and 6 females with an average age of 41.2 (25-72) years. According to the Japanese Orthopedic Association (JOA) criteria and Frankel grading system, it was evaluated for the clinical effects of all patients.

The average operative duration was 140 (115-180) min and mean blood loss volume 329 (100-500) ml. The symptoms improved all greatly over an average follow-up period of 19 (3-44) months. According to the JOA criteria system, the outcomes were excellent (n=9, 60%), good (n=4, 26.6%) and fair (n=2, 13.4%). Based on the Frankel grading system, 2 cases were classified as A (n=2), 2 as B (n=2), 4 as C (n=4) and 7 as D (n=7) preoperatively versus B (n=1), C (n=1), D (n=4) and E (n=9) postoperatively.

The combined approach of TLIF plus posterior laminectomy is anatomically simple, visually distinct, relatively safe, reliable and efficacious in treatment of thoracolumbar disc herniation.

To study the clinical features and gene mutations of EBV-HLH in Chinese children.

Sixteen pediatric patients with Epstein-Barr virus-associated HLH were enrolled the study from May 2011 to September 2012, who were admitted to Capital Institute of Pediatrics. All patients' clinical features were recorded and their nucleotide sequences of all exons and their flanking intronic sequences of perforin (PRF1)gene, protein unc-13 homolog D (UNC13D)gene, two fusion protein genes of syntaxin 11 (STX11)gene, synaptic binding protein 2 (STXBP2) gene, SH2 domain 1A (SH2D1A)gene, and the X-linked inhibitor of apoptosis protein (XIAP) gene were amplified by PCR followed by direct sequencing. Based on HLH gene detection results, all patients divided into the positive and negative gene EBV-HLH subgroups. Statistical analysis was conducted using SPSS 11.5 software.

Seven of sixteen pediatric patients with EBV-HLH were identified with heterozygous, hemizygous, and homozygous mutations in PRF1, UNC13D, STXBP2, and SH2D1A. No significant differences were found on the gender, age, illness duration, EBV load, the positive duration of EBV-DNA, lab results, clinical symptoms, treatment, and the outcome between the HLH gene positive and negative subgroups (P>0.05).

A considerable EBV-HLH pediatric patients have genetic defects, and HLH gene defects may not affect the clinical features and treatment of EBV-HLH pediatric patients.

To explore the related ischemic stroke (IS) risk factors in youth and the importance of sleep quality in young ischemic stroke.

A total of 219 patients aged 18 to 45 years (166 males, 53 females) with an initial onset of ischemic stroke from First Affiliated Hospital, Zhengzhou University and Puyang People's Hospital during June 2011 to February 2013, were recruited as the study cases. Meanwhile 231 patients aged 46 to 80 years (170 males, 61 females) from the same hospitals were selected as the elderly control group. And 149 young persons aged 18 to 45 years undergoing normal physical examinations from the same hospitals were taken as youth control group. For all cases, their ischemic stroke related risk factors and especially the importance of sleep quality were analyzed. Prospective analyses were conducted to re-considerate the related ischemic stroke risk factors in youth.

Hypertension history, high cholesterol, diabetes, smoking and drinking, bad sleep quality, family history of stroke and hyperhomocysteinemia were associated with the onset of young ischemic stroke. The decreasing exposure rates were history of hypertension, smoking, poor sleep quality, hyperlipidemia, alcoholism, hyperhomocysteinemia and a family history of stroke and diabetes. In ischemic stroke young patients, bad sleep quality accounted for 55.7% and ranked third among all risk factors.

The risk factors of young ischemic stroke ranks are different with other studies. As one of the most important factors for youth ischemic stroke, poor sleep quality should not be neglected.

To explore the effects on ischemia-reperfusion injury with different regimens of fluid resuscitation during severe burn shock stage in swines.

A total of 24 Guangxi BA-MA mini-swine were numbered from 1 to 24 and randomly divided by EXCEL 2007 into 4 groups of succinylated gelatin, hydroxyethyl starch (HES 130/0.4), Parkland and allogeneic plasma (n=6 each). Then the burn shock model was established. And fluid resuscitation therapy was applied according to the established regimens of burn shock fluid resuscitation.Blood samples were collected from the animals prior to burn injury and again at intervals of 4, 8, 24 and 48 hours post-injury.The levels of malondialdehyde, superoxide dismutase (SOD), xanthine oxidase (XOD) and total antioxidant capacity (T-AOC) were measured.And the results were analyzed statistically.

Six swines within each group survived the shock stage and the outliers in detection index were eliminated.Then there were 5 swines in each group.The MDA of allogeneic plasma group at intervals of 8 hours was significantly lower than that of succinylated gelatin group, but higher than that of Parkland group [(3.46±0.40) vs (4.55±0.82), (2.59±0.35) μmol/L, both P<0.05]. The level of SOD had statistical difference at 48 hours between the HES 130/0.4 and allogeneic plasma groups ((72.55±5.70) vs (65.42±5.07) U/ml,P<0.05). The level of XOD of the succinylated gelatin group at 4, 8 hour and they increased when compared to pre-burn ((12.00±0.57), (11.28±0.71) vs (9.12±0.51) U/L, bothP<0.01). Statistical significance was observed at 4, 8 hours between succinylated gelatin and allogeneic plasma groups ((10.39±1.24), (9.59±1.17) U/L, bothP<0.01). The T-AOC of HES 130/0.4 group at 8 hours exceed the pre-burn ((2.06±0.43) vs (1.30±0.35) U/ml,P<0.05). The allogeneic plasma group at 4, 8 hours showed increase when compared to pre-burn ((1.55±0.37), (2.59±0.60) vs (1.06±0.13) U/ml, bothP<0.05). The succinylated gelatin group at 8, 48 hours decreased during the corresponding phase of allogeneic plasma group ((1.14±0.26), (0.89±0.20) vs (2.59±0.60), (1.16±0.20) U/ml, bothP<0.05). The comparison at 24, 48 hours between HES 130/0.4 and allogeneic plasma groups ((1.84±0.41), (1.53±0.21) vs (1.13±0.35), (1.16±0.20) U/ml) had statistical difference (bothP<0.01). The Parkland group at intervals of 8 hours was lower than that of allogeneic plasma group ((1.31±0.19) vs (2.59±0.60) U/ml,P<0.01).

HES130/0.4 and allogeneic plasma have comparable the parallel minimum damage effect on ischemia-reperfusion injury during burn shock stage are .

To explore the elution properties of linezolid bone cement so as to guide the clinical application of linezolid bone cement in the treatment of infection after total joint arthroplasty.

The specimens of bone cement (40 g each) were divided into 6 groups depending on mixed different contents with linezolid(5 specimens in each group), group Ⅰ (1.2 g), group Ⅱ (2.4 g), group Ⅲ (3.6 g), group Ⅳ (4.8 g), group Ⅴ (6.0 g) and group Ⅵ (7.2 g). The time-dependent elution of linezolid from bone cement was measured by high performance liquid chromatography (HPLC).

The release rate of linezolid bone cement samples was positively correlated with the concentration of antibiotics. And he release rate increased with the rising concentrations. The release of all groups dropped dramatically at Day 1. And as of Day 2 there was a slow release at a very low level. The elution of all groups persisted through 7 weeks.The analysis of variance between groups showed significant differences in release rates. And further examination by q test revealed that the release of group of 3.6-7.2 g was significantly higher than other groups.

The drainage tube should be clamped at Day 1 post-operation so that there is a full release of high concentration of linezolid. Adding 3.6 g linezolid to 40 g cement may provide better cost-effective outcomes.

To determine the pregnancy outcomes related with maternal age in China.

A total of 110 450 cases were selected and divided into 6 age groups at intervals of 5 years. The clinical data were collected from 39 hospitals in mainland China. All deliveries were after 28 weeks of completed gestation in 2011. The unadjusted binary-logistic regression was employed for statistics.

The mean age of all pregnant women was 28±5 at the time of delivery. The advanced age groups (35-39 yr and ≥40 yr) had higher risks than the 25-29 age group for pregestational diabetes [odds ratio (OR), 2.2 and 3.8], chronic hypertension (OR, 4.6 and 6.5), leiomyoma (OR, 4.2 and 5.8), gestational diabetes (OR, 2.6 and 3.5), preeclampsia (OR, 2.5 and 3.6), postpartum hemorrhage (OR, 1.5 and 1.7), premature delivery (OR, 1.8 and 2.4), placenta previa (OR, 2.7 and 4.0), placental abruption (OR, 1.4 and 2.5), cesarean delivery (OR, 2.1 and 2.5), macrosomia (OR, 1.2 and 1.2), low birth weight neonates (OR, 1.6 and 2.3) and perinatal mortality (OR, 1.6 and 3.7). The adolescent group had higher risks than the 25-29 age group for anemia (OR, 1.4), preeclampsia (OR, 1.6), preterm birth (OR, 2.1), low birth weight neonates (OR, 2.3) and perinatal mortality (OR, 3.6).

Maternal and neonatal risks are higher during both the adolescent and advanced maternal ages. And the age group of 20-30 years has the lowest risk for pregnancy and delivery.

Epidemiological studies have shown that decreased high-density lipoprotein cholesterol (HDL-C) levels are independent predictors of coronary heart disease, and that increased HDL-C levels are inversely correlated with the incidence of cardiovascular disease, even in patients with LDL-C levels below 1.82 mmol/L, high HDL-C levels remain protective against coronary heart disease. Therefore, HDL is another target in the field of anti-atherosclerosis research. Increasing HDL level may provide a new treatment for the prevention and treatment of coronary heart disease. At present, HDL is believed to mediate reverse cholesterol transportation (RCT), which transports cholesterol from atherosclerotic plaques in peripheral blood vessels to the liver for excretion, thereby reducing the deposition of lipids in blood vessel walls, improving endothelial function, antioxidant, anti-inflammatory and other effects to exert anti-artherosclerosis (AS) effects.

Occult hepatitis B virus infection (OBI) refers to a negative serum hepatitis B virus surface antigen (HBsAg) and a positive DNA test for hepatitis B virus (HBV) in serum and/or liver tissue. In 2008, the European Association of Liver Diseases (EASL) convened a meeting of the OBI Working Group, which defined OBI as "serum HBsAg negative but HBV DNA positive in liver tissue, and recommended a margin of serum HBV DNA of<200 IU/ml "^[1]。 Therefore, the two main characteristics of OBI are HBsAg negativity and low levels of viral replication. However, liver biopsy should not be carried out extensively, and detection of the virus in the serum is very difficult (even with the most sensitive detection techniques), while positive hepatitis B virus core antibody (anti-HBc) ± positive hepatitis B virus surface antibody (anti-HBs) in OBI is common. Therefore, the accepted belief is that anti-HBc positive individuals are potential OBI (pOBI). It should be noted that about 7% to 20% of OBI were negative for all viral serological indicators^[2]。

A 31-year-old female, pregnant with 5 deliveries and 1 flow 4, was pregnant with a uterine horn on April 27, 2013 due to irregular vaginal bleeding for 15 days? Treatment in the First People's Hospital of Qingdao Economic and Technological Development Zone. The patient usually had regular menstruation, 3~5/30 days. The last menstruation was on January 7, 2013. The patient had an induced abortion in Juye County People's Hospital of Shandong Province on March 6, 2013. No villus tissue was found during the operation, and the scraped tissue was sent to pathology for examination. The pathological results showed that villus tissue was seen in the scraped tissue. The postoperative vaginal bleeding was clean for 7 days, and there was no follow-up. About 1 month after surgery (about the beginning of April) intercourse once. The patient developed irregular vaginal bleeding on April 12, 2013. He thought that menstrual cramps began, but no diagnosis and treatment were performed. The amount of vaginal bleeding was about twice that of menstrual flow, and it was inexhaustible. On April 26 of the same year, the blood progesterone was 1.37 μ g/L and human chorionic gonadotropin (hCG) was 14 435 U/L in the First People's Hospital of Qingdao Economic and Technological Development Zone, Shandong Province. B-ultrasound examination showed that the uterine body size was about 5.1 cm ×6.3 m ×4.7 cm, the endometrium thickness was about 0.9 cm, and a strong echo mass of 2.1 cm ×1.4 cm was seen at the right uterine corner, and a cystoid echo of 0.7 cm ×0.5 cm was seen inside. No abnormal masses were observed in bilateral adnexal areas. Outpatient to horn pregnancy? Admitted to hospital for treatment. Admission physical examination: vital signs stable, gynecological examination: vulva married multipartum type, dark red blood in vagina, cervical third degree erosion, no lifting pain and swaying pain, uterine body posterior position, slightly larger, no tenderness, bilateral adnexal area no palpable mass, no tenderness. In order to confirm the diagnosis after admission, painless curettage and curettage was performed on the same day. No villus was found in the scraped tissue during the operation. The scraped tissue was sent to pathological examination. The next day, the blood hCG was re-examined at 13 956 IU/L, which was not significantly lower than that before curettage and curettage. Pathological examination showed that no villus tissue was found in the tissue submitted for examination. Vaginal color ultrasound examination was performed again: heterogeneous echo mass was seen at the right corner of the uterus, and interstitial pregnancy of the fallopian tube was considered. Laparoscopic diagnosis and treatment were performed on April 28 of the same year. Intraoperative findings: pelvic hemorrhage about 50 ml, no abnormalities in the appearance of bilateral fallopian tubes and ovaries, slightly larger uterus, slightly protruding right posterior wall of uterus, with an extent of about 3 cm ×3 cm (Figure 1), the assistance of a B-ultrasound doctor was asked during the operation. Under the B-ultrasound, a 0.5 cm ×0.5 cm cystic echo was seen between the muscle walls of the right posterior wall of the uterus. Intraoperative diagnosis: intramural pregnancy. During the operation, under the guidance of B-ultrasound, the muscular layer of the right posterior wall of the uterus was transversely cut with unipolar, which was about 3 cm long. After the muscular layer was cut, the villous tissue protruded (Figure 2), the villus tissue was clamped out with vascular forceps, and the ectopic lesion cavity was not communicated with the uterine cavity (Figure 3)。 1 – 0 absorbable thread continuous suture of uterine muscle wall molding. hCG 1 017 U/L was re-examined on 4 days after operation, and he was cured and discharged on 5 days after operation. hCG decreased to normal at 2 weeks after surgery.