Volume 94  ·   Issue 39  ·  2014

Inflammatory demyelinating disease of the central nervous system (CNS) refers to a class of immune-mediated demyelination-dominated diseases. The most common are multiple sclerosis (MS) and neuromyelitis optica (NMO). In recent years, it is believed that the incidence of NMO in Asian population is more than that of MS, and both of them are different in pathogenesis, pathological injury and clinical treatment. Therefore, it will be of great significance to master the similarities and differences between the two pathogenesis and clinical treatment and the research progress.

As early as 1870, researchers found that optic neuritis (ON) and spinal cord disease have a co-incidence relationship. In 1894, Devic first proposed the concept of neuromyelitis optica (NMO). NMO is an inflammatory demyelinating disease of the central nervous system (CNS) that selectively involves the optic nerve and spinal cord. It is a disease characterized by severe optic neuritis and long-segment (>3 vertical segments) transverse spinal cord damage, also known as Devic's disease.

To improve the understanding of lumbosacralradiculitis by analyzing the clinical, magnetic resonance imaging (MRI) and neuroeletrophysiological characteristics of disease.

The clinical, MRI and neuroeletrophysiological data of 14 patients diagnosed as lumbosacralradiculitis were retrospectively analyzed.

The predominant age of onset was in the forth decade. Each patient had bilateral or unilateral lower extremity numbness and weakness of variable severity, including muscle atrophy (n=5) and decreased sensation in L4-S1 nerve root territory (n=9). Lower extremity tendon reflexes decreased or became absent in all patients. Urinary and defecation disorders were seen in 3 patients. Lumbosacral MRI showed lumbosacral meninges and nerve root enhancement in 4 patients. Cerebrospinal fluid analysis revealed elevated white blood cell (30×10⁶/L) (n=1) and increased protein content (n=12) (450-1 000 mg/L, n=7; 1 000-2 000 mg/L, n=3; 2 000-3 000 mg/L, n=2). Needle electromyography (EMG) demonstrated neurogenic damage in 13 patients. Motor nerve conduction study showed decreased motor never conduction velocity (MCV) (n=5), decreased compound muscle action potential (CMAP) amplitude (n=12), CMAP absent at right side (n=2) and left side (n=1) among 22 peroneal nerves; decreased MCV (n=6), decreased CMAP amplitude (n=6), CMAP absent at right side (n=2) and left side (n=1) among 23 tibial nerves. F-wave was performed for 11 patients and abnormal in 6 patients, with prolonged latency and reduced occurrence rate in right common peroneal nerve (n=2), left prolonged latency (n=3) and right tibial nerve (n=1) respectively. Bilateral sural nerve conduction study revealed no abnormality.

Diagnosing lumbosacralradiculitis is not easy based on lumbosacral MRI. And neuroelectrophysiological study may provide more valuable information in verifying the location of lesions and judging the damage extent of lumbosacralradiculitis.

To explore the clinical features of neuromyelitis optica (NMO) spectrum disease (NMOSD) with connective tissue disease (CTD).

The clinical features of 184 NMO/NMOSD patients (NMO/NMOSD: 119/184, 64.7%; NMO/NMOSD-CTD: 65/184, 35.3%) from May 2013 to May 2014 were analyzed retrospectively. And the effectiveness of long-term treatment of immunosuppressive drugs in NMOSD was evaluated.

NMO/NMOSD-CTD patients had significantly higher female percentage (93.8% vs 83.2%, P<0.05) and significantly higher percentage of patients with cerebral spinal fluid (CSF)-restricted oligoclonal band (OB)(41.5% vs 21.9%,P<0.05). As compared with NMO/NMOSD-CTD counterparts, NMO/NMOSD patients had significantly higher percentage of non-specific lesions on brain MRI (62.5% vs 35.9%,P<0.01). After >6 months consecutive long-term treatment of immunosuppressive drugs, the relapse rate post-treatment (0.36±0.85) was significantly lower than that pre-treatment (2.91±4.10,P<0.01). And no significant difference existed in expanded disability status scale (EDSS) score between pre-and post-treatment. When using azathioprine (AZA), the percentage of relapse was significantly higher in NMO/NMOSD-CTD patients (50.0%) versus NMO/NMOSD ones (18.5%,P=0.064); When using cyclophosphamide (CTX), there was no such significant difference.

Female patients are more susceptible to have NMO/NMOSD with CTD. NMO/NMOSD-CTD patients tend to have higher percentage of CSF-restricted OB and fewer non-specific lesions on brain MRI. AZA and CTX may effectively reduce relapses in both NMO/NMOSD and NMO/NMOSD-CTD patients. However CTX is superior to AZA for reducing relapses in NMO/NMOSD-CTD patients.

To explore the expression and significance of Beclin 1 and LC3 in peripheral blood mononuclear cells (PBMCs) of patients with multiple sclerosis (MS) and neuromyelitis optica (NMO) before and after treatment during acute and recurrent acute phases.

All outpatients, inpatients and healthy controls were recruited from our hospital from October 2012 to April 2014. During acute phase, PBMCs from patients with multiple sclerosis (MS) and neuromyelitis optica (NMO)(pre and post-treatment) were immediately isolated by Ficoll-Hypaque density gradient centrifugation. And the expressions of Beclin 1 and LC3 were detected by Western blot. And relapsing-remitting MS (RRMS) and relapsing NMO (RNMO) patients were followed up and the expressions of Beclin 1 and LC3 proteins compared during two acute phases.

Compared with normal controls, the expression of Beclin 1 in PBMCs from acute phase of MS and NMO patients decreased while the expression of LC3 increased. During acute phase, the expression of Beclin 1 significantly increased after treatment in MS and NMO patients compared with pre-treatment, but the expression of LC3 significantly decreased. The expression of Beclin1 obviously decreased in RRMS and recurrent RNMO compared with the previous period, but the expression of LC3 significantly increased.

The autophagy level increases in PBMC from MS and NMO patients during acute phase. However it decreases after treatment. However, the autophagy levels significantly increase in RRMS and RNMO. And enhanced autophagy may play its role in the pathogenesis of MS and NMO.

To explore the clinical and imaging features of tumefactive demyelinating lesions (TDL) and glioma.

The brain computed tomography (CT), magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (¹H-MRS) features of 60 pathologically confirmed TDL patients and 65 glioma ones, hospitalized at Navy General Hospital from 2005 to 2013, were reviewed and analyzed.

The mean onset age of glioma was significantly older than that of TDL. The onset symptom was headache for TDL and headache and epilepsy for glioma. The features of lesions on brain CT scan: no hyperdensity in TDL group and 39 with hyperdense lesions in glioma group. Tissue necrosis was more frequently found in lesions of glioma than TDL, especially for higher grade glioma. And increased β and γ-Glx on ¹H-MRS was most frequently found in TDL.

The onset age of glioma is older than TDL. The headache is the top onset symptoms of TDL and epiplesy occurs frequently only in glioma. The hyperdense lesions on CT scan support more the diagnosis of glioma. The lesions with tissue necrosis may be a diagnostic clue for high grade glioma. On ¹H-MRS, increased β and γ-Glx are most frequently found in TDL. Dynamic observation of imaging changes may be more important for facilitating the diagnosis of TDL, especially in conjunctions with imaging characteristics and clinical features.

To evaluate the safety and acceptability of COOK intrauterine balloon stent in uterine for one week after hysteroscopic adhesiolysis.

A total of 79 females with moderate-severe Asherman syndrome undergoing hysteroscopic division of intrauterine adhesion were enrolled from June 2012 to December 2013. They were divided into two groups of intrauterine balloon stent (n=51) and tailed intrauterine contraceptive device (n=28). The sterile swabs were taken from cervical canals for bacterial culture by the same microbiologist. Each patient in balloon group was requested to answer a questionnaire survey on the acceptability of balloon stent.

82.3% of them could tolerate discomforts during balloon placement and 86.3% desired re-ballooning if necessary. Positive microorganism cultures were seen in 17 patients (33.3%) in balloon group versus 8 (28.6%) in intrauterine contraceptive device group. And the positive rate was not different between two groups.

It is relatively safe to maintain the intrauterine balloon stent in uterine for one week. And most patients accept readily the intrauterine balloon stent.

To explore the clinical outcomes of arthroscopic double strand wire fixation anteriorly and posteriorly to anterior cruciate ligament (ACL) for tibial intercondylar eminence fracture.

From January 2009 to February 2012, 12 patients with tibial intercondylar eminence fracture were selected. There were 4 males and 8 females with an average age of 19.5±10 (10-50) years. Time from injury to operation was 4 days to 2 years. All cases belonged to Meyers-Mekeever type Ⅱ and type Ⅲ. Arthroscopic double strand wire compressive fixation was performed anteriorly and posteriorly to ACL. Other measures included postoperative rehabilitation and supports with brace in knee extension when weight-bearing for 4-6 weeks.

The average follow-up period was 15.6 (6-30) months. Final clinical results showed good range of motion and good knee stability. On postoperative radiology, there were good reduction of intercondylar eminence fracture and excellent healing. There was no occurrence of wire rupture. Postoperative IKDC and Lysholm scores were excellent (n=10) and good (n=2). There was no such complication as fragmentation of intercondylar eminence fracture bone, neurovascular injury or infection.

Arthroscopic double strand compressive fixation for tibial intercondylar eminence fracture may be easily performed without injury to ACL substance. The reduction is both stable and reliable. And the clinical outcome is excellent.

To explore the feasibility of virtual noncalcium technique from dual-source computed tomography (DSCT) for the diagnosis of vertebral bone marrow lesions.

A total of 13 patients with acute vertebral bone marrow lesions underwent both DSCT and MRI within 3 days. And the DSCT dual-energy CT data were postprocessed for generating virtual noncalcium images and color-coded maps. Two radiologists analyzed the lesions of bone marrow by magnetic resonance (MR) imaging and virtual noncalcium images on a three-level. MR imaging interpretation served as the reference standard. Consistency check was conducted by using kappa statistics. And then the sensitivity of DSCT dual energy imaging was examined in the diagnosis of acute traumatic bone marrow lesions in spine.

Among them, 13 vertebral body with bone marrow lesions were detected by MRI. The T₂WI fat-suppression irregular high signal and slightly high density shadow under the background in noncalcium images corresponded to corresponding high signal areas on MRI. Interreader agreement was substantial for qualitative grading of DE CT images (κ=0.629). The sensitivity of DSCT dual energy virtual noncalcium images in the diagnosis of acute traumatic bone marrow lesions in spine were 92.3% and 84.6% for observers 1 and 2.

Distinct traumatic bone marrow lesions of spine may be diagnosed with a high sensitivity on virtual noncalcium images reconstructed from DSCT and color-coded maps. And it is worth further explorations.

To determine the imaging characteristics of basilar artery hypoplasia (BAH).

From October 2009 to August 2013, 10 193 magnetic resonance angiogram (MRA) and 31 716 magnetic resonance imaging (MRI) consecutive cases were retrospectively retrieved from our institutional Picture Archiving and Communication System (PACS) database. BAH was defined as a continuous diameter reduction all over artery and a basilar artery diameter ≤2 mm. The same cut-off value was applied for vertebral artery hypoplasia (VAH). We measured the diameters of basilar and vertebral arteries with PACS in all patients according to source imaging and IMP construction of MRA. The carotid arterial computed tomography angiogram (CTA) profiles were reviewed in 50 patients. The fetal-type posterior circle of Willis (FTP) was assessed. The diagnosis of acute cerebral infarction was based on clinical symptoms, signs and a high signal on diffusion-weighted imaging (DWI). Acute cerebral infarction was divided into anterior circulation stroke (ACS) and posterior circulation stroke (PCS).

A total of 210 BAH were identified among 10 193 consecutive patients. BAH was more common in females (56.7%) than males (43.3%) in the patient group. They had a fetal-type of posterior cerebral artery (FTP) (175 bilateral (83.3%), 35 unilateral (16.7%)). 99.5% patients had V4 VAH and 56.0% (28/50) V1-V3 VAH. Among 210 BAH, there are 74 patients (mean age 64 years, average 25-91 years, 44 males) with a diagnosis of acute cerebral infarction (ACI). The males were predominant in ACI (59.5% in males vs 40.5% in females, P=0.021). The frequency of BAH was detected in 74 (2.2%) among 3 294 ACI patients.

As a relatively rare vascular abnormality, BAH has always unilateral or bilateral FTP and V4 VAH.

To explore the reorganization of brain cortex on spinal cord injury (SCI) patients with functional magnetic resonance imaging (fMRI) techniques and elucidate its recurring patterns so as to provide theoretic rationales for SCI treatment.

We designed different tasks for 9 SCI patients and 10 normal subjects. The tasks were named block design and it was divided into rest period (R) and stimulating period (S). All subjects underwent fMRI scan while they were performing the tasks.

A significant reorganization occurred on brain cortex of SCI patients after spinal cord injury. This phenomenon changed with elapsing time after spinal cord injury.

Brain cortex undergoes reorganization after spinal cord injury, especially primary sensory and motor cortex.

To explore the clinical characteristics of IgG4-related retroperitoneal fibrosis (RPF) in China.

From December 2010 to September 2013, a total of 107 IgG4-related disease (IgG4-RD) patients were reviewed prospectively. Their clinical, laboratory and histopathological features were summarized. And the treatment responses were analyzed.

Among them, 22 RPF cases were identified. The male-to-female ratio and age were 4.5∶1 and 63±11 years respectively. The follow-up period was 3-28 months. The most common onset symptom was low back pain (55%). Multiple organ involvements were documented in 20 patients (91%), including lymphadenopathy (n=9), aortitis (n=8), sialadenitis (n=7), dacryoadenitis (n=5) and autoimmune pancreatitis (n=4). Allergic histories were reported by10 subjects (46%). Eosinophilia was present in 6 subjects (27%). Serum IgG4 levels were significantly elevated in all subjects. Serum total IgE level was elevated in 12/13 tested subjects. Tissue biopsies of 12 subjects revealed massive lymphocytic infiltration and obvious tissue fibrosis. Immunohistochemical staining showed a massive infiltration of IgG4-positive plasma cell. Glucocorticoid was administrated in all subjects. Most subjects received combined therapy with immunosuppressive agents or tamoxifen.

IgG4-related RPF is a systemic autoimmune disease with favorable responses to the treatments of glucocorticoid and immunosuppressive agents.

To explore the therapeutic effect evaluation of proton magnetic resonance spectroscopy (¹H-MRS) in patients with vascular cognitive impairment no dementia (VCIND) with dioscorea modified pill.

A total of 100 patients with VCIND were randomly assigned into the dioscorea modified pill group (n=50) and the aricept group (n=50). And 50 healthy volunteers were recruited as normal group. Each patient was examined with ¹H-MRS and scored with mini-mental state examination (MMSE) and clinical dementia rating (CDR) scale pre- and post-treatment.

After therapy, the NAA/Cr ratios and the itemized scores of cognitive scale compared with that of pre-therapy had significantly difference (P<0.05) in the dioscorea modified pill group(MMSE(26.5±2.0), CDR(0.14±0.23))vs(MMSE(25.1±2.3), CDR(0.5)). But no difference existed in the aricept group (P>0.05).

¹H-MRS may objectively reflect cognitive dysfunction in VCIND patients. And it has important values in the therapeutic effect evaluation of VCIND with dioscorea modified pill.

To investigate qualitatively and quantitatively the diagnostic performance of 320-slice CT for detection of coronary artery disease with respect to different atherosclerotic plaque characteristics.

A retrospective search was performed for inpatients underwent both coronary CT and further coronary angiography (CAG) from December 1, 2008 to December 31, 2012. The diagnostic performance of 320-slice CTA for detecting significant stenosis (≥50% diameter) with respect to atherosclerotic plaque characteristics were analyzed by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, kappa index (κ), and area under the receiver operating characteristic curve (AUC). Chi-square test was used to evaluate whether there were significant differences of the true-case frequency (true positive + true negative) and false-case frequency (false positive + false negative) among groups. Bland-Altman analysis was used to determine limits of agreement between CTA and CAG.

A total of 454 patients and 6 779 segments were analyzed. Diagnostic accuracy was higher in non-calcified segments; whereas they decreased in the presence of both mild-moderately and heavily calcified plaques. Excellent agreement (κ=0.810) between CT and CAG was observed for non-calcified segments, while good agreement was observed for both mild-moderately (κ=0.701) and heavily calcified segments (κ=0.750). Both mild-moderate (P=0.000) and heavy (P=0.000) calcification decreased the true-case frequency and increased the false-case frequency when compared to non-calcification. There were no significant underestimation or overestimation for non-calcified (P=0.087) and mild-moderately calcified (P=0.704) segments, while there was significant overestimation for heavily calcified segments (P=0.001).

Great qualitative and quantitative diagnostic performances of 320-slice CT were observed in non-calcified coronary segments. However, qualitative diagnostic performance decreased in both mild-moderately and heavily calcified segments, and quantitative overestimation were observed in heavily calcified segments.

To explore the risk factors and prognosis of hypotension in postoperative sedation patients.

A total of 175 patients with postoperative sedation at our department from May 2013 to March 2014 were retrospectively reviewed. Patients with age <18 years, cardiac surgery, pheochromocytoma surgery, hemorrhagic shock, septic shock or cardiogenic shock were excluded. APACHE Ⅱ, dosage and duration of sedative drug, mean arterial pressure at baseline and after sedation, central venous pressure, fluid balance, dosage and duration of norepinephrine, endotracheal intubation time and length of intensive care unit (ICU) stay were recorded.

Blood pressures decreased significantly after administration of sedation (77.2±11.2 vs 82.6±9.3 mmHg, P=0.000). Compared to those with lower disease severity (APACHEⅡ≤10), the patients with APACHEⅡ.>10 required higher norepinephrine dosage and longer time of infusion. A longer time of norepinephrine infusion was needed for patients with coronary heart disease. Patients undergoing thoracic, abdominal or pelvic surgery, or those with hepatic dysfunction had a higher norepinephrine dosage. Decrement of blood pressure and norepinephrine duration were independent risk factors of endotracheal intubation time. And dosage and duration of norepinephrine were independent risk factors of ICU time.

Disease severity, past history of heart disease, surgical site and liver function are risk factors of hypotension in postoperative sedation patients. It is important to pay attention to dosage and administrative route of sedative drug. Norepinephrine duration after sedation is an independent risk factor of endotracheal intubation time and ICU time.

The child was a girl, 29 days after birth. Admission due to abdominal mass found on prenatal B-ultrasound. The child is the first birth, full-term birth, there is no asphyxia after birth, no vomiting after feeding, and the fetus has been discharged. Immediately after birth, he came to the Second Affiliated Hospital of Wenzhou Medical University for diagnosis and treatment. Physical examination: body temperature 37 ℃, heart rate 128 beats/min, breathing 36 beats/min, body weight 4.2 kg. The anterior fontanel was 2.0 cm ×1.0 cm, flat and soft, with clear respiratory sounds in both lungs and heart (–). Abdominal distension was slightly obvious, no gastrointestinal shape and peristaltic wave, no tenderness and rebound pain, and mobile voiced sound (–). Blood routine: white blood cells 6.86×10⁹/L, red blood cells 4.31×10¹²/L, platelets 479×10⁹/L. After admission, feeding and defecation were normal. Abdominal B-ultrasound showed (Figure 1): A cystic fluid dark area with a size of about 7.5 cm ×5.1 cm ×6.4 cm in the abdominal cavity, with clear boundaries, good sound transmission, and pressure and displacement of the surrounding intestine, was diagnosed as a cystic mass in the abdominal cavity. Abdominal CT showed (Figure 2): A large cystic-solid mass occupied in the left abdominal cavity of about 6.5 cm ×4.6 cm with clear boundaries, and a high-density shadow of about 2.0 cm ×1.4 cm was seen behind it. It was diagnosed as a huge cystic-solid mass occupied in the abdominal cavity with cystic mass occupied with bleeding? MRI showed (Figure 3，Figure 4): The size of the left lower abdomen is about 4.3 cm ×6.3 cm ×7.5 cm, the huge cystic occupies the space, the border is clear, and the signal is high on both T1WI and T2WI. The fluid-fluid level is seen in the lesion, and the patchy hemorrhage is seen in the posterior part of the lesion. The diagnosis was a large occupation of the left abdominal cavity, and cystic teratoma was considered first. An exploratory laparotomy was performed, and a cystic solid mass was found in the abdominal cavity during the operation. There were no abnormalities in the liver, spleen, stomach, omentum and large and small intestines. A cystic mass was seen in the middle and lower abdomen, about 8 cm ×7 cm ×6 cm in size, with thin wall. 80 ml of cystic fluid coffee solution was withdrawn, and the mass was pulled out. The left ovary where the cyst originated was seen. Careful observation found that the cystic pedicle was twisted 360° clockwise and was necrotic, so pedicle resection was given. Postoperative pathological diagnosis: ovarian cyst with pedicle torsion.

To explore the relationship between bore diameter of porous hydroxyapatite (HA) scaffolds and the adhesion, proliferation and metabolism of osteoblasts by 3D cultivation.

MC3T3-E1 cell suspension was separately dropped axially through different bore diameter scaffolds (Group A: 150 μm, Group B: 300 μm) to confirm initial seeding. Then scaffolds were transferred into a perfusion bioreactor of 5% CO ₂ at 37 ℃for 5 days with an average flow of 3.4 ml/min. After perfusion cultivation, cell proliferation between different groups of scaffolds was determined by methyl thiazolyl tetrazolium (MTT) assay and cell metabolic activities were determined by glucose consumption. Lastly cell adhesion and proliferation were observed directly by scanning electronic microscope (SEM).

The results of MTT assay showed that the optical density/mass ratios were 1.31±0.26 in group A and 1.51±0.43 in group B. There was no significant difference (t test, P=0.36). Glucose consumption in group A was significantly lower than that in group B [(162.38±33.09) vs (217.97±27.91) μmol/L, P=0.01]. The adhesion, proliferation, pseudopodia and extracellular matrix of osteoblasts in internal part of scaffolds after perfusion cultivation were observed by SEM.

With excellent biocompatibility, porous HA scaffolds are available for fabricating tissue engineering bones. There is no effect of bore diameter on the proliferation of osteoblasts. But it affects the metabolic activity of osteoblasts. So bore diameter may be increased within a feasible range on the premise of mechanical properties.

The hypothesis that "cell phone induces brain tumor" has become a target of much controversy for several decades and is still a matter of debate even now. We aim to make a systematic review and meta-analysis based on published studies on glioma to identify current evidences for evaluating mobile phones and glioma risk, especially on long-term use of mobile phones.

The study was conducted according to the Cochrane systematic review methods and reported according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement according to a prospective research protocol accessed via http: //www.crd.york.ac.uk/prospero. The software RevMan 5 was used for statistic analysis. Latency and lateralization were used for the examining the dose-response relationship.

Overall evidence suggested the increased risk of glioma among long-term ipsilateral users of mobile phone with an odds ratio (OR) of 1.46[1.12,1.92]based on meta-analysis. Especially, for low-grade glioma, long-term use yielded an OR value of 2.27[1.81,2.85].

The evidence is currently insufficient on this issue, especially on long-term use of mobile phone. Neither a definite answer nor a clear explanation may be offered for the relationship. And larger prospective trials are warranted.

The characteristic lumbar lordosis and continuous curvature of the spine, the extension of the hip and knee joints, the changes of the arch and muscle dynamic system, which form the characteristic shape and position relationship of the spine and pelvis^[1]。 Evolution from stable quadruped supports to human bipedal mechanisms with smaller supporting surfaces, balance must be maintained to conserve energy conforms to power science^[2]。 The center of gravity and the line of gravity (GL) of the human body are the result of the interaction between the ground and the chains of the trunk, pelvis and lower limbs. When normal people stand quietly on the force measuring platform, GL is projected on the support surface between the two feet including the soles of the two feet, and GL is projected on the full-length lateral X-ray film of the spine, generally passing through the center of the femoral head slightly behind and the sacrum slightly forward^[3,4]。 The sagittal balance of the spine and pelvis has an important influence on spinal diseases. For the convenience of measurement, the full-length X-ray of the spine in standing position is generally measured to evaluate the sagittal balance^[5]。

Rheumatoid arthritis (RA) is a chronic, destructive, autoimmune disease characterized by synovial inflammation and joint destruction, and may also have systemic manifestations such as fatigue, anemia, and osteoporosis. Currently, there are a variety of cytokines involved in the pathogenesis of RA, among which interleukin (IL) – 6 plays a key role.