Volume 95  ·  Issue 25  ·  2015

Treatment is actually a process of intervention according to the condition. The intervention itself can not only have a therapeutic effect on the disease, but also lead to re-injury to the body. In order to highlight the therapeutic effect and reduce the re-injury effect in the intervention process, the intervention must be strictly limited. The accuracy of intervention is mainly determined by the direction, extent and timing of intervention. The treatment of severe cases is often characterized by complicated and concentrated clinical manifestations, hidden intervention sites, drastic intervention degree and rapid changes in disease conditions, which leads to almost strict requirements for severe treatment. The clinical application of hemodynamics can provide a complete interpretation of the precise treatment of severe cases. Severe hemodynamic therapy is a goal-oriented quantitative treatment process based on hemodynamic theory and according to the real-time state and response of the body. Clinical hemodynamics takes the characteristics and regularity of blood and its components in the body as the starting point, and realizes the monitoring of severe cases by discovering and analyzing the mechanism of disease and finding the changes of disease in real time. Through the quantitative grasp of disease changes, the analysis of intervention responsiveness and the regulation of intervention methods, the treatment of severe cases is realized. In severe hemodynamic therapy, the direction of treatment is determined by purpose indicators, and the degree of treatment is defined by target indicators, so as to achieve strict control of the whole intervention process. At the same time, through the real-time judgment of the disease condition, each step in the treatment process is as close to the actual needs of the body as possible. In recent years, the development of hemodynamic theory and clinical operation technology has further enhanced the clinical necessity and feasibility of severe hemodynamic treatment. In the foreseeable time, ten areas of development should be of concern.

To discuss the alterations of brain network efficiency in patients with post-concussion syndrome.

A total of 23 patients from Anhui Provincial Hospital in the period from 2013/6 to 2014/3 who have had the concussion for 3 months were enrolled and 23 volunteers paired in sex, age and education were also enrolled as healthy controls.Comparisons of selective attention of both groups were conducted using Stroop Word-Color Test. The data of resting-state functional magnetic resonance imaging (fMRI) in both groups were collected and the data were dealt with Network Construction which is a part of GRETNA software to obtain the Matrix of brain network. Network analysis was used to obtain Global and Nodal efficiency, then independent t-test was used for statistical analyses of the value of Global and Nodal efficiency.

The difference in Global efficiency of two groups in every threshold value had no statisticalsignificance. Compared with healthy controls, the Nodal efficienciesin patients with post-concussion syndrome weresignificantly different in the brain regionsas below: left orbital middle frontal gyrus, left posterior cingulate, left lingual, left thalamus, left superior temporal gyrus, right anterior cingulate, right posterior cingulate, right supramarginalgyrus.

Compared with healthy controls, there is no significant changes of Globe efficiency in patients with post-concussion syndrome, and the brain function deficits in these patients may be caused by changes of Nodal efficiency in their brain network.

A retrospective study was conducted to analyze the clinical data of patients treated by retractorless surgery and explore the clinical feasibility and practical application of this strategy.

A total of 194 patients undergone retractorless surgery in Beijing Tiantan Hospital from Nov 2013 to Oct 2014 were retrospectively reviewed. Complications related to microsurgical approaches, disease types, neurological function score and intraoperative compression or stretching were analyzed.

Of the 194 cases, there were 127 (65%) patients with cerebrovascular diseases and 67 (35%) patients with intracranial tumors. Sixty patients had anterior circulation aneurysms, of them, 21 aneurysms were accessed through frontal-lateral approaches and 39 reached via pterional approaches. Two patients with posterior inferior cerebellar artery (PICA) aneurysms were treated by far-lateral approaches. Fifteen patients with cerebellopontine angle (CPA) tumors were treated by retrosigmoid approaches. Elven patients with supratentorial tumors were treated by anterior and posterior interhemispheric approaches. Twenty patients with posterior fossa tumors were treated by suboccipital posterior median and paramedian approaches. Two patients with petroclival region lesions were treated by subtemporal approaches. Damage of tissues surrounding the approach occurred in 4 cases (2%). One patient received secondary procedures (0.52%) and 2 patients died after operation (1%). No change of postoperative neurological function was seen in 62.3% of cases, improvement of postoperative neurological function was seen in 29.4% and neurological function deterioration 8.24%.

Compared with the retractor surgery, retractorless surgery does not increase the rate of damage of tissues surrounding the approach. With the proficiency in micro-neurosurgery methods, retractorless surgery can reduce the postoperative complications.

To observe the feasibility and safety of carotid angioplasty stenting (CAS) for high-grade extracranial carotid artery stenosis combined with severe tortuosity.

Twenty patients diagnosed with high-grade extracranial carotid artery stenosis combined with severe tortuosity by cerebral angiography, who were in hospital in neurology department of China-Janpan friendship from June 2011 to June 2014. Twelve of these patients were symptomatic. All cases weren't suit for or disagreed with carotid endarterectomy (CEA) to accept CAS. We retrospectively discussed the rates of technical success, the perioperative complications and clinical improvement. During the follow-up for 4 to 40 months we observed the events of cured carotid artery territory stroke and death, and record the plaque hyperplasia in stent, in-stent restenosis, stent deformation or fracture by color doppler ultrasonography or craniocervical CT angiography.

(1) The results of operation: the rate of technical success was 19/20 and the rate of the distal protection device placement was 18/20. One stent and 2 distal protection device were difficult to pass the tortuous access vessels. The kinking was the most common in circuity classification of internal carotid artery. The stenosis was significantly improved after stenting, and the mean degree of stenosis was reduced from (82%±9%) before stenting to (7%±6%) after stenting. Although 5 patients were with perioperative complications, all symptoms disappeared within 1 weeks, and there was no stent related death and disability. There were 4 cases with vascular spasm, one of them was combined with carotid sinus reaction, and anther with transient ischemic attack (TIA) during operation. There was one with ipsilateral carotid territory minor stroke. (2) The results of prognosis and follow up: The clinical symptoms from 12 symptomatic patients were improved significantly on discharge, and the average NIHSS scores on admission were reduced from (4±4) to (2±2) on discharge. One patient experienced ipsilateral carotid territory minor stroke and another patient experienced ipsilateral carotid territory TIA during the follow-up for an average of 19 months, and there were 5 cases with mild plaque hyperplasia in stent and no in-stent restenosis, stent deformation or fracture.

The severe tortuosity of extracranial carotid artery may affect the using of intervention materials and increase the complexity of CAS, but for the patients who disagree with CEA or were with the contraindications to CEA, CAS may be still a relatively safe, effective and alternative treatment.

To investigate the clinical characteristics, short and long term effect of quick repositioning maneuver along the sagittal plane for patients with benign paroxysmal positional vertigo who were induced vertigo in the straight head-hanging test.

The clinical data of 38 patients affected by benign paroxysmal positional vertigo who were induced vertigo in the straight head-hanging test from July 2009 to July 2014 in the Department of Otolaryngology Head and Neck Surgery of Navy General Hospital were retrospectively analyzed.After diagnosis, the patients were underwent quick repositioning maneuver along the sagittal plane.

Of the 38 cases studied, 15 patients (39.5%) were males and 23 patients (60.5%) were females. The age of the patients ranged from 33 to 71 years with a mean of 55±12 years. The median duration between symptoms and diagnosis was 8 days. The total improvement was 33 cases (86.8%) in patients with superior semicircular canal BPPV when they were re-evaluated at 1 week and 32 cases (84.2%) at 3 months time.

Quick repositioning maneuver along the sagittal plane is an effective, easy alternative for treatment of the patients with benign paroxysmal positional vertigo induced vertigo in the straight head-hanging test. It is not necessary to identify the directions of the nystagmus.

To investigate the clinical manifestations and gene mutations on a large spinocerebellar ataxia 3 pedigree, in order to explore the molecular genetical characteristics in this pedigree.

Blood samples from 9 patients and 27 healthy family members in the Department of Neurology of Henan Provincial People's Hospital were collected.The CAG trinucleotide repeats in SCA3 gene in each sample were amplified by polymerase chain reaction (PCR), denaturing polyacrylamide gel electrophoresis and silver staining techniques.The allele fragments were sequenced by biomedical company and the trinucleotide repeats numbers were calculated to identify the genotype.

Nine symptomatic and 9 presymptomatic patients were detected and their CAG repeat numbers were 62-72 and 63-69, respectively.CAG repeat numbers were 12-21 in the other 18 healthy family members.

We fould a large pedigree with the diagnosis of SCA3. The genetic tests of CAG repeat numbers can contribute to clinical diagnose on symptomatic patients and provide informations for presymptomatic patients.

To evaluate therapeutic effectiveness and safety of botulinum toxin type A in the treatment of idiopathic trigeminal neuralgia in patients older than 70 years.

The total 64 patents were involved from neurology clinic and inpatient department from Aug 2008 to Sep 2013. They were divided into two groups according to the age(older than 70 years versus younger than 60 years. The therapeutic dose, safety, effectiveness were compared between two groups. Visual analog scores were employed to measure the degree of pain.

The mean dosage was (88±30) U in the group aged above 70 years old, and (72±33) U in the group aged below 60 years old respectively. There was no significant difference of dosage between the two groups. The average visual analog score of all patients was (7.7±2.2) before the treatment and decreased to (4.4±2.9) one month after the treatment. To be precise, the average visual analog score of the group aged above 70 years old was (8.2±1.9) before and (4.5±3.2) after the treatment, and the visual analog score of the group aged below 60 years old was (7.2±2.4) before and (4.4±2.5) after the treatment. The effect of botulinum toxin type A in the treatment of idiopathic trigeminal neuralgia was considered statistically significant. The D-value of visual analog score in the elderly group was (3.5±3.6), and (2.8±3.5) in the younger group. There was no significant difference in the D-value between the two groups. Five patients had transient minor side effects in the former group and two patients had transient minor side effects in latter group. There was no significant difference in the incidence rate of side effects between the two groups(P>0.05).

Botulinum toxin type A is safe and effective in the treatment of idiopathic trigeminal neuralgia for the patients older than 70 years and the dosages of it are approximate to the patients under 60 years old.

To evaluate the safety and efficacy of suprarenal inferior vena cava (IVC) filter implantation in patients with venous thromboembolism (VTE).

Between May 2006 and December 2014, 28 patients with VTE underwent suprarenal IVC filter implantation, anticoagulant treatment and/or catheter-directed thrombolysis at the affiliated hospital of Xuzhou medical college. Follow up examination with color Doppler ultrasound was taken after treatment to eassess the patency of IVC.

One filter was successfully implanted in suprarenal IVC in each patient intraoperatively. The filter was retrieved in 26 patients after indwelling of 5 to 17 (mean 11±3) days. The filter was permanently indwelled in 2 patients. There were no complications of filter tilt and migration in all cases. Twenty eight patients were followed up for 2 to 104 (mean 34±34) months. None of the 2 patients whose filters were permanently indwelled presented complications of recurrent pulmonary embolism and IVC occlusion due to the filter. Among 26 patients whose filters were retrieved, the IVC was patent.

Suprarenal IVC filter placement is a safe and effective method in the treatment of VTE.

To analyze the outcome of elderly patients with acute kidney injury(AKI) after esophageal cancer operation and the effect of blood purification.

23 patients with AKI, in the department of thoracic surgery in Shanxi Provincial People's Hospital, were analyzed retrospectively after 262 esophageal cancer operations from January 2010 to December 2012. AKI can be classified into three levels, in which, 13 cases for AKI first level, 7 cases for AKI second level and three cases for AKI third level. The possible causes of AKI, disposal and outcomes were analyzed in the research.

Comparing AKI group with un-AKI group after Esophageal cancer operation, diabetes is a high risk factor for AKI in perioperative period. There is no difference in BUN, SCr, average blood amount in the operation and operation duration time between two groups. The rate of low pressure occured in AKI groups is much higher than that of in un-AKI group. 20 patients with AKI have been totally recovered after symptomatic and supportive treatment. Two cases among patients who are AKI third level received timely bedside hemofiltration and were fully recovered. One patient has been dead without hemofiltration treatment.

After the esophageal operations were peroformed, the elderly patients with AKI is mainly related with such factors as age, low blood pressure, diabetes and so on. For such elderly patients, we should monitor the renal function changes closely and eliminate possible causes. Once AKI 3 class occurs, bedside hemofiltration is needed as soon as possible.

To compare the differences in diagnosing breast lesions between gadobenate (Gd-DTPA) and gadopentetate dimeglumine (Gd-BOPTA) in MR dynamic enhancement scanning.

Continuous collection patients because of breast lesions from General Hospital of Lanzhou Command PLA in August 2012 to December 2014. Fifty-three women with breast lesions detected by clinical touch or by X-ray mammography and ultrasound examination were included. The patients were randomly injected with equivalent dose of Gd-BOPTA or Gd-DTPA. Two dynamic enhanced scanning were performed on the 3.0 T MR scanner separated by 48 to 72 hours and eight phases were collected 25 seconds after the injection. Analysis was done double-blinded to find out the lesions, make differential diagnosis, and to compare with the histopathology.

Among the 87 lesions diagnosed by postoperative pathological detection, more lesions were detected by Gd-BOPTA than by Gd-DTPA, 83/87(95.4%) vs 69/87 (79.3%)(P<0.01), respectively, the difference is statistically significant.In the detection of malignant lesions, the sensitivity was 96.3% and 76.3%, and the specificity was 78.1% and 68.7%, for Gd-BOPTA and Gd-DTPA, respectively.

Gd-BOPTA was better for the detection of breast lesions and differential diagnosis of benign and malignant lesions than Gd-DTPA. Especially, Gd-BOPTA is obviously better than Gd-DTPA in detection of breast nodules, and the lesions with weak strengthening effect or located inconspicuously.

To discuss the diagnostic value of Crohn's disease activity with multi-slice CT enterography.

MSCTE examination data of 88 cases of CD patients by clinical, endoscopy, pathology confirmed in Sir Run Run Shaw Hospital from January 2013 to June 2014 were analysed. According to the Harvey-Bradshaw index, all of CD patients were divided into the active phase group and remission phase group. Imaging findings of two groups were compared. To explore the relationship between MSCTE findings and CRP/ESR of CD patients.

The wall thickness(8.2±2.6)mm and enhancement degree(112±16)HU in active phase group were higher than the wall thickness(5.4±1.6)mm and enhancement degree(93±17)HU in the remission phase group(P<0.01). The incidences of intestinal wall stratification enhancement, comb sign, swollen lymph nodes, phlegmon, intestinal fistula, intestinal stenosis in active phase group (88.5%, 72.1%, 77%, 45.9%, 26.2%, 65.6%) were significantly higher than those in remission phase group (29.6%, 18.5%, 25.9%, 0, 3.7%, 37%)(P<0.05). The incidences of intestinal wall homogeneous enhancement in remission phase group(70.4%) were higher than those in active phase group(11.5%)(P<0.01). There was no significant difference in the incidences of abscesse in two groups (P>0.05). CRP was correlated with the wall thickness and enhancement degree, abnornlal mesentery vascularity, lymph node enlargement, phlegmon, intestinal fistula (r>0.2,P<0.05). ESR was correlated with the wall enhancement degree, abnormal mesentery vascularity, lymph node enlargement and phlegmon (r>0.2,P<0.05).

CT enterography can adequately demonstrate mural abnormalities and assess the presence of extramural complications, which are helpful in evaluating the activity of Crohn's disease.

To explore the roles of proliferative lesions of mesangial cell and reactive oxygen species (ROS) in the pathogenetic progress of lupus nephritis fibrosis.

Control mice C57BL/6 and model mice NZBWF1 were selected. Kidney tissues were collected for hematoxylin and eosin (HE) and Masson staining at Week 8, 12 and 16. The proliferation of glomerular cells was assessed by BrdU incorporation light microscopy. And the expression of NOX4 protein was detected by Western blot.

HE and Masson staining showed that model mice began to develop interstitial fibrosis and worsened at Weeks 12 and 16. The numbers of mesangial cell increased at Week 8 and became prominent at Weeks 12 and 16. The expression of NOX4 protein increased with the progression of lupus nephritis fibrosis.

Glomerular mesangial cell and ROS play an role in the pathogenetic progress of lupus nephritis fibrosis.

To investigate the effects of hydrogen-rich saline on cardiomyocyte autophagy during myocardial ischemia-reperfusion in aged rats.

One hundred and fifty healthy male Sprague Dawley rats, 18 months old, weighing 400-540 g were selected.The rats were then randomly divided into 5 groups(n=30): Normal control group(group Ⅰ); Sham operation group(group Ⅱ); Myocardial ischemia-reperfusion group (group Ⅲ); Hydrogen-rich saline group(group Ⅳ); Normal saline group(group Ⅴ) .No any processing in group Ⅰ. In group Ⅱ, the anterior descending branch was only exposed but not ligated. Myocardial I/R was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 12 h and 24 h of reperfusion with Bimbaum. Hydrogen-rich saline 1 ml/100 g were injected intraperitoneally 5 min before reperfusion in group Ⅳ.Normal saline 1 ml/100 g were injected intraperitoneally 5 min before reperfusion in group Ⅴ.The rats were sacrificed at 12 h and 24 h of reperfusion and hearts were removed .The pathological changes of myocardial tissue were detected by HE staining.The rate of cardiomyocyte autophagy were detected by the MDC fluorescent dye and flow cytometry instrument .The expression of AMPK, mTOR, Beclin1, LC3 in myocardial tissue was investigated by Western blot.

Compared with groups Ⅰ and Ⅱ, the rate of cardiomyocyte autophagy, the expression of AMPK, mTOR, Beclin1, LC3 in myocardial tissue were significantly increased at 12 h, 24 h in groups Ⅲ, ⅣandⅤ(F=23.45, 26.65, 25.58; F=23.16, 25.15, 27.85; F=21.04, 24.83, 27.43; F=22.15, 25.79, 29.05; F=22.58, 27.25, 28.46), P<0.05. Compared with group Ⅲ and Ⅴ, the rate of cardiomyocyte autophagy, the expression of AMPK, mTOR, Beclin1, LC3 were significantly decreased at 12 h, 24 h in group Ⅳ(F=21.29, 24.71; F=22.37, 25.84; F=20.48, 22.38; F=21.76, 28.43; F=22.54, 27.21), P<0.05.

Hydrogen-rich saline can attenuate myocardial reperfusion injury through inhibiting cardiomyocyte autophagy.The mechanism may be associated with decreasing the expression of AMPK, mTOR, Beclin1, LC3 in myocardial tissue.

To clarify the association of stillbirth with the maternal Body Mass Index(BMI).

We performed a comprehensive search from PubMed and EMbase to identify studies pertaining to the association between stillbirth and BMI. The statistical software, STATA (version 12.0) was applied to investigate heterogeneity among individual studies and summarize the studies.

Our analysis included a total of 17 articles that examined the effect of overweight on the risk of stillbirth. The association between overweight and the risk of stillbirth was statistically significant (OR 1.30, 95%CI: 1.26-1.35); 25 articles that examined the effect of obesity on the risk of stillbirth. The association between obesity and the risk of stillbirth was statistically significant (OR 1.71, 95% CI 1.66-1.76).

Overweight and obesity can increase the risk of stillbirth.

The patient was a 57-year-old male. Radiation pain in the left lower limb for more than 4 years, which has aggravated in the last 4 months and was admitted to Beijing Hospital. More than 4 years ago, the patient had left lower limb pain without obvious trigger, and the pain had no obvious temporal change, and there was no obvious way to relieve it. Physical examination: the ankle reflex of the left leg is weaker than that of the right leg, the pain in the tibial side of the left leg is more sensitive than that in the fibular side, spinous process tenderness (+), paravertebral percussion pain (+), Babinski (-), Chaddock (-). On March 12, 2010, CT (plain scan plus enhancement) in an outside hospital considered the possibility of left psoas major schwannoma. On April 26, 2010, plain MRI scan in Beijing Hospital showed the left side nodule of the lumbar 2 vertebral body.₁The nodules on WI and lipid pressure images showed high and low signal (FIG. 1A，FIG. 1B), T₂High and low mixed signals were shown on WI and lipid pressure images, and patchy hyperintensity shadows were seen in the surrounding soft tissues (FIG. 2A，Figure 2B), with non-uniform mild enhancement after enhancement scan (FIG. 3A，FIG. 3B), the edges are underfinished. Surgical findings: The space between the multifidus muscle and the longissimus pectoralis muscle was separated, and the lumbar 2 transverse processes were disconnected and drawn laterally, revealing the tumor capsule, which was gray-white, tough in texture, with clear boundaries, and abundant tumor bleeding. Pathological findings: (L2 paravertebral space occupied) there was hemorrhage and a large amount of hemosiderin deposition, and a large number of plasma cells and lymphocytes were seen locally (FIG. 4A，FIG. 4B)。 Pathological diagnosis: epithelioid hemangioendothelioma. Immunohistochemistry: VM (+ +), S-100 (-), Desmin (-), CD34 (+), Bcl-2 (-), ALK (-), Ki-67 (1% +), Actin Ping (+).

relaxin is a polypeptide hormone that can relax pelvic ligaments originally extracted from pig serum by Hisaw et al., hence the name "relaxin". Relaxin plays an important role in human reproductive system and non-reproductive system. As a reproductive hormone, relaxin promotes endometrial decidualization in early pregnancy, assists embryo implantation and placental growth; Dilate peripheral blood vessels in the middle and late trimester of pregnancy, improve placental blood flow supply, and inhibit the contraction of uterine muscles during pregnancy to facilitate the maintenance of pregnancy; Relaxation of pelvic connective tissue at term pregnancy to facilitate delivery. Relaxin also works on other systems in the body. The physiological role of relaxin in the reproductive system and its relationship with disease are reviewed as follows.

cerebral amyloid angiopathy (CAA) is a neurodegenerative disease characterized by the deposition of amyloid β (A β) in intracranial microvessels. In recent years, some studies have found that some patients with intracranial vascular A β deposition also have vascular inflammation, which is now commonly called cerebral amyloid angiopathy related inflammation (CAA-I). CAA-Ⅰ often manifests as acute or subacute cognitive decline, headache, epilepsy or focal neurological deficit, and responds well to immunosuppressive therapy^[1]At present, it is rarely reported in China. This article focuses on a systematic review of clinical manifestations, pathological characteristics, diagnosis and treatment of CAA-Ⅰ, aiming at improving clinicians' understanding of CAA-Ⅰ and reducing misdiagnosis or misdiagnosis.

With the continuous improvement of arthroscopic instruments and the gradual proficiency of doctors' operation techniques, arthroscopic repair of rotator cuff injury has been widely used. Although arthroscopic repair of rotator cuff injury significantly reduces pain and improves shoulder function, previous studies have shown that the postoperative rotator cuff re-tearing rate is still around 11% to 29%^[1,2]。 Therefore, how to reduce the postoperative re-tear rate is still a serious problem faced by sports injury doctors. Platelet-rich plasma (PRP) has attracted the attention of many researchers because it contains a large number of growth factors that promote tissue repair, including platelet-like growth factor (PDGF), transforming growth factor (TGF), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF) and epithelial growth factor (EGF). According to the different preparation methods of PRP and the content of white blood cells and fibrin, PRP can be divided into many types. At present, the more accepted Dohan classification method^[3,4]PRP was divided into the following four categories: pure PRP (pure P-PRP), leukocyte-rich platelet plasma (L-PRP), pure platelet-rich fibrin (P-PRF) and leukocyte-rich platelet fibrin (L-PRF). PRP has been widely used in damage repair of various tissues^[5,6,7]。 Theoretically, PRP can promote the repair of rotator cuff injury. In recent years, a lot of researches have been carried out in the world on PRP repair of rotator cuff injury. Now, the latest basic, clinical and evidence-based medical evidence of PRP repair of rotator cuff injury in recent years are reviewed.

With the improvement of medical technology, electrosurgical equipment, laser knife, ultrasonic scalpel and other tools are widely used in surgery, which makes modern medical work more convenient and effective, and also brings new health risk factors to medical staff, and surgical smoke is one of them. Operating room smoke refers to gaseous substances generated during surgery, also known as aerosols, burning smoke, diathermic plumes, etc. It is the destruction, ablation, and decomposition of tissue causing its fine particles to suspend in the air when using electrosurgical equipment (ESU), laser knife, high-frequency electrosurgical knife, or ultrasonic scalpel^[1]。 It is an air pollutant, and medical staff are exposed to harmful smoke for a long time due to work reasons, which is a serious threat to their health. According to the Occupational Safety and Health Administration (OSHA), up to 500,000 healthcare workers in the United States are exposed to operating room smoke each year, including surgeons, anesthesiologists, nurses and other staff. In order to improve the awareness of the hazards of surgical smoke and strengthen the protection against it, we investigated the situation of the awareness of surgical smoke and put forward suggestions for protection.