Volume 95  ·  Issue 37  ·  2015

Neutropenia is the main dose-limiting toxicity of cytotoxic chemotherapy drugs in patients with malignant tumors during chemotherapy. The degree and duration of the reduction are related to the increased risk of infection^[1,2]。 febrile neutropenia (FN) is commonly defined as an absolute neutrophil count (ANC) of less than 0.5×10⁹/L, or ANC less than 1.0×10⁹/L and is expected to be less than 0.5×10 within 48 h⁹/L, with a single intraoral temperature ≥38.3 ℃ or ≥38.0 ℃ for more than 1 h, or axillary temperature>38.5 ℃ for more than 1 h^[3]。 Patients with FN may reduce the dose of chemotherapy drugs or delay the treatment, thus reducing the clinical efficacy, and may also develop serious infection or even death. It may also increase the cost of diagnosis and treatment, which in turn leads to an increase in medical expenses.

To investigate the clinical application value of the 3D printing technique in the treatment of basilar invagination and atlantoaxial dislocation.

From January 2013 to September 2013, 10 patients with basilar invagination and atlantoaxial dislocation needing posterior fixation undertook 3D printing modes at the Department of Neurosurgery in PLA General Hospital. The 1∶1 size models were established from skull base to C4 level with different colors between bone structures and vertebral arteries. The simulation of screw insertion was made to investigate the fixation plan and ideal entry point to avoid vertebral artery injury. After obtaining the individual screw insertion data in 3D printing modes, the according surgical operations were performed. The actual clinical results and virtual screw data in 3D printing mode were compared with each other.

The 3D printing modes revealed that all the 10 patients had the dysplasia or occipitalized C1 posterior arch indicating C1 posterior arch screw implantation was not suitable. C1 lateral masses were chosen as the screws entry points. C2 screws were designed individually based on the 3D printing modes as follows: 3 patients with aberrant vertebral artery or narrow C2 pedicle less than 3.5 mm were not suitable for pedicle screw implantation. Among the 3 patients, 1 was fixed with C2 laminar screw, and 1 with C2–3 transarticular screw and 1 with C3 pedicle screw (also combined with congenital C2–3 vertebral fusion). Two patients with narrow C2 pedicle between 3.5 and 4mm were designed to choose pedicle screw fixation after 3D printing mode evaluation. One patient with C1 lateral mass vertically dislocated axis was planned with C1–2 transarticular screw fixation. All the other patients were planned with C2 pedicle screws. All the 10 patients had operation designed as the 3D printing modes schemes. The follow-up ranged from 12 to 18 months and all the patients recovered from the clinical symptoms and the bony fusion attained to 100%.

3D printing mode could provide thorough information of the bony structure abnormalities and route of vertebral artery. It is helpful for setting operation strategy and designing screw entry point and trajectory and avoiding vertebral artery and spinal cord injury and thus deserves generalization.

To investigate the clinical efficacy of cervical anterior internal fixation and bone grafting fusion by comparative analyzing hand dysfunction in Hirayama disease patients using Jebsen–Taylor Test (JTT).

From Feb 2010 to Jan 2014, 20 hirayama disease patients who underwent surgery were enrolled in Department of Orthopaedics, Peking University Third Hospital. JTT were evaluated for the 20 patients before and after surgery. Among them, 9 patients were evaluated before and at three months, one year and more than 2 years after surgery.

All sections of the JTT scale indicated that the patients with CSM exhibited a significant impairment compared with healthy adults. Each scale of JTT was improved after surgery in addition to picking up small objects and placing them in a can and simulated feeding. The whole time were improved from 72.3 s to 60.2 s.

JJT is a valid efficacy evaluation in assessing the impairment of hand and upper extremities of patients with Hirayama disease and the surgery can improve patients' hand function.

To investigate the pulmonary dysfunction patterns in severe spinal deformity and to identify radiological factors affecting the pulmonary function.

From September 2009 to December 2014, a total of 66 patients were involved in this Department of Spine Surgery, The First Affiliated Hospital, Sun Yat–sen University. Preoperative pulmonary function testing (PFTs) and radiographic examination were performed on all of the involved patients. Correlation analysis and subsequent stepwise multiple regression analysis were carried out to assess the associations between radiographic measurements of deformity and the results of pulmonary function testing.

Fifty–seven out of 66 patients had impaired pulmonary dysfunction, and more than half of were ≤59% predicted forced expiratory volume in 1 second (FEV₁). Most of the patients with severe spinal deformity demonstrated a restrictive pattern of pulmonary function. The magnitude of the major curve, the number of involved thoracic vertebrae had significant effect on pulmonary function. While these 2 factors were associated with an increased risk of pulmonary impairment, they explained only 46.2%–55.1% of the observed variability in vital capacity, forced vital capacity, and forced expiratory volume in one second.

Preoperative PFTs are clinically impaired in 86% of patients with severe spinal deformity, and more than half of that were moderate and severe pulmonary dysfunction. The magnitude of the major curve and the number of involved thoracic vertebrae are the main risk factors influencing the pulmonary dysfunction.

To explore the cerebral blood flow (CBF) by three-dimensional arterial spin labeling (3D-ASL) and the standardized uptake value (SUV) of 18F-fluorodeoxyglucose (18F-FDG) in the prefrontal lobe of patients with major depression disorder (MDD), and analyze their correlations with patients' depressive symptoms.

3D-ASL and 18F-FDG positron emission tomography/computed tomography (PET/CT) were performed in 17 MDD patients and 16 healthy controls under the resting state. The depressive symptoms were classified into seven factors using Hamilton depression rating scale. Regional cerebral blood flow (CBF) and standardized uptake value (SUV) were compared between the patients and healthy controls using a two-sample t-test, and the correlation between the CBF and SUV with the patient Hamilton scores was examined using Spearman analysis.

Decreased regional CBF values were present in the bilateral middle and the right superior frontal gyrus in patients, and decreased regional SUVs were observed in the bilateral superior, middle and inferior frontal gyrus. The significant correlation between the CBF and SUV values with the patients' Hamilton scores was mainly observed in the left middle, right middle and the right inferior frontal gyrus.

18F-FDG PET/CT is more sensitive than ASL in identifying the functional abnormalities in the prefrontal lobe. Decreased CBF and SUV in the prefrontal lobe closely correlate with the Hamilton Depression Rating Scale scores. We speculate that the left middle frontal gyrus may be a key responsible functional region in patients with MDD.

The aim of this study is to explore the clinical characteristics, treatment and prognosis of pareneoplastic neurological syndrome (PNS) associated with small cell lung cancer (SCLC) in a single–center cohort.

We retrospectively and consecutively reviewed 34 patients (22 male and 12 female, mean age 55.4 years old) diagnosed as PNS associated with SCLC in our hospital from 2001 to 2014 and investigated the clinical features, related antibodies, treatment and prognosis in this cohort.

In a total of 34 patients, 31(91.4%) presented with neurological symptoms prior to the diagnosis of cancer. Lambert–Eaton syndrome (13/34, 38.2%) was the most common subtype, followed by paraneoplastic sensory neuronopathy (10/34, 29.4%), paraneoplastic cerebellar degeneration (7/34, 20.6%), limbic encephalitis(6/34, 17.6%) and brainstem encephalitis(1/34, 3%). Anti–neuronal antibodies were positive in 9 out of a total of 24 patients (37.5%) who performed the tests. There were 28 (82.4%) patients who received the treatment for the primary tumor. Of them, operation of removing the tumor was performed in 4 patients. 5 patients received treatment of suppression of the immune response to PNS. Significant neurological improvement was found in a patient who received operation combined with immunotherapy after a 3–year follow–up.

The majority of patients with PNS are unknown to have cancer at the time of diagnosis. Early recognition of PNS is helpful to the treatment of the tumor. PNS has diverse presentations, affecting both the central and peripheral nervous system, which makes the diagnosis hard. Operation of removing the tumor and immune suppression may slow the immune response, creating the greatest chance for neurologic improvement or symptom stabilization.

To study the characteristics of auditory ability development in hearing–impaired infants and toddlers under home–based early intervention, and provide the theoretical basis for the development of rehabilitation and assessment strategies.

The clinical data was collected from subjects from 5 provinces between 2012 and 2014 in China. A total of 80 subjects were enrolled and divided into 2 groups with 1 year interval according to chronological age. Initials, finals and disyllable words in Auditory Ability Test were used to assess the auditory development before intervention (0 month) and after intervention (6, 12, 18, 24 months). Data was analyzed by repeated measures analysis of variance.

In 1 age group and 2 age group, the main effect of recovery time and chronological age were significantly different in initials, finals and disyllable (P<0.05). The recognition ability of initials, finals and disyllable words in 1 age group were less than 2 age group at 6– and 12–month after early intervention (P<0.05). After 2 years hearing intervention and rehabilitation, the recognition rates of initials, finals and disyllable words were 88%±11%、90%±11% and 92%±9%, respectively. 18%, 30% and 47%, respectively, hearing–impaired children achieved full score in initials, finals and disyllable words. 70% hearing–impaired children reached more than 90% recognition ability in initials, finals and disyllable words.

The chronological age and recovery time are principle factors for auditory development in hearing–impaired children; 70% hearing–impaired children have reached grade A after 2 years hearing intervention and rehabilitation, and performed well in hearing identification and speech intelligibility.

To compare the differential effects of narrow band imaging (NBI)–assisted holmium laser with transurethral resection on the 1–year recurrence rate of non–muscle invasive bladder cancer (NMIBC), and to evaluate the clinical values of NBI–assisted holmium laser resection for NMIBC (NBI–HoLRBt).

During the period of February 2013 to February 2014, 178 cases of NMIBC were randomly divided into NBI–HoLRBt group and white light imaging (WLI) assisted transurethral resection of bladder tumor (WLI–TURBt) group . In NBI–HoLRBt, all suspicious lesion identified by either WLI or NBI were resected with WLI and in NBI mode for lesion only visible with NBI. At the end of the procedure, a NBI cystoscopic examination was performed to assess the margins of the resection areas and to identify eventual residual lesions. In WLI–TURBt group, only WLI and TURBt were applied. All patients underwent routine follow–up with WLI and NBI cystoscopy supplemented with cytology every 3 month. The recurrence risk of patients with NMIBC subjected to either NBI–HoLRBt or WLI–TURBt was compared at 3 and 12 month.

The 3–month and 1–year recurrence rate was 18.48% (17/92) and 38.04% (35/92) respectively in the WLI–TURBt group, it was 5.81% (5/86) and 18.60% (16/86) in the NBI–HoLRBt group (both P<0.05). In addition, the in situ recurrence rate was less in the NBI–HoLRBt than WLI–TURBt group (2.33% vs 14.13%,P<0.05).

NBI–assisted holmium laser resection of bladder tumor can reduce the 3–month and 1–year recurrence risk of NMIBC and should be considered a valuable clinical therapeutic method for NMIBC.

To investigate the feasibility of parametric color coding of digital subtraction angiography(Syngo iFlow)for hemodynamics assessment in patients with critical limb ischemia in pre-and post-endovascular therapy. To explore the correlation between Syngo iFlow and the conventional techniques.

from January 2013 to December 2014, Clinical data of 21 patients with TASC Ⅱ type B and type C femoropopliteal arteriosclerotic occlusive disease who were treated by percutaneous transluminal angioplasty and/or primary stent implantation in Nanjing first hospital were analyzed retrospectively. Of these patients there were 10 males and 11 females with an average age of (72±6) years (range from 58–85 years). The treatment efficacy was assessed by the variation of a series of clinical symptoms indexes (such as pain score, cold sensation score and intermittent claudication score), ankle braehial index(ABI) and transcutaneous oxygen pressure (TcPO₂). Angiography was performed with the same protocol before and after treatment and parametric color coding of digital subtraction angiography was created by Syngo iFlow software on a dedicated workstation. The time to peak (TTP) of artery and tissue perfusion selected at the same regions of foot and ankle were measured and analyzed to evaluate the improvement of microcirculation and hemodynamics of the ischemic limb. The correlations between Syngo iFlow and the traditional clinical evaluation methods were explored using the Spearman rank correlation test.

All patients (21 limbs) underwent successful endovaseular therapy. The mean pain score, cold sensation score , intermittent claudication score, ABI and TcPO₂ before treatment were(0.48±0.68), (2.71±0.72), (2.86±0.85), ABI(0.33±0.07), TcPO₂(26.83±3.41)mmHg. While 1 week after treatment all above indicators were (2.57±0.93), (0.33±0.48), (0.90±0.54), (0.69±0.11), TcPO₂(53.75±3.60)mmHg respectively. There were significant statistical differences between pre- and post-treatment(P<0.05=. The pre- and post-operative TTP of artery and tissue perfusion were (14.07±1.77) vs (10.43±2.05)s, (18.75±2.72) vs (15.38±2.78)s. For assessment of hemodynamic changes during and after treatment, parametric color coding of digital subtraction angiography(Syngo iFlow) was assumed to show the limb blood flow and perfusion were improved and the differences were statistically significant. The Spearman rank correlation test showed the TTP of artery was positively correlated with ABI, TcPO₂(r=0.65, 0.73, P<0.05=, the TTP of tissue perfusion was also positively correlated with ABI, TcPO₂(r=0.60, 0.60, P<0.05=.

Parametric color coding of digital subtraction angiography(Syngo iFlow) is a real-time, sensitive and quantitative tool that might provide additional support in the hemodynamics evaluation of endovascular treatment for patients with lower extremity peripheral arterial occlusion disease.

To discuss the best noise index combined with ASIR weighting selection in low–dose chest scanning based on BMI.

200 patients collected from May to December 2014 underwent non–contrast chest CT examinations, they were randomly assigned into standard dose group(Group A, NI15 combined with 30%ASIR)and low–dose groups(Group B, NI25 combined with 40%ASIR, Group C, NI30 combined with 50%ASIR, Group D, NI35 combined with 60%ASIR), 50 cases in each group; the patients were assigned into three groups based on BMI(kg/m²): BMI<18.5; 18.5≤BMI≤25; BMI>25.Signal–to–nosie ratio(SNR), contrast–to noise ratio(CNR), CT dose index volume(CTDIvol), dose–length product(DLP), effective dose(ED)and subjective scoring between the standard and low–dose groups were compared and analyzed statistically.Differences of SNR, CNR, CTDIvol, DLP and ED among groups were determined withANOVA analysis and the consistency of diagnosis with Kappa test.

SNR, CTDIvol, DLP and ED reduced with the increase of nosie index, the differences among the groups were statistically significant (P<0.05).Kappa value of the two reviewers were 0.888.Subjective scoring of four groups were all above 3 points in BMI<18.5 kg/m² group; subjective scoring of ABC groups were all above 3 points in 18.5 kg/m²≤BMI≤25 kg/m² group and subjective scoring of AB groups were all above 3 points in BMI>25 kg/m² group.

NI35 combined with 60%ASIR in BMI<18.5 kg/m² group; NI30 combined with 50%ASIR in 18.5 kg/m²≤BMI≤25 kg/m² group; NI25 combined with 40%ASIR in 18.5 kg/m²≤BMI≤25 kg/m² group were the best parameters combination which both can significantly reduce the radiation dose and ensure the image quality.

The present study sought to investigate the predictors of successful dilatation and curettage (D&C) in treatment of cesarean scar pregnancy (CSP).

Retrospective analysis was conducted in 84 CSP patients undergoing D&C from January 2013 to December 2014. Failure was defined as D&C followed by transcatheter uterine arterial embolization due to uncontrolled hemorrhage. Sub-stratification of success group as residue group or non-residue group was performed according to the residues at the site of cesarean scar after D&C. The univariate logistic regression and linear regression were used to assess the predictors of the failure and residues. ROC curve was used to assess the cut-off values of the predictors.

D&C under ultrasound guidance succeeded in 75 patients (89.3%) and 36 patients had residues at the site of cesarean scar among them (48%), 9 patients failed in D&C (10.7%). High Serum human chorionic-gonadotropin (hCG), small gestation sac (GS), thin cesarean scar myometrium thickness (CSM) and low peritrophoblastic flow resistance index (RI) were risk factors of D&C failure in treatment of CSP. That serum hCG >97 006 U/L was prime predictor of failure (predictive value 100%, 95%CI 94.9%–100%). High success ratio was observed in patients with serum hCG <58 076 U/L, GS ≤19 mm, CSM >2.7 mm, and RI >0.25. And days of menopause ≤41 d, GS ≤15 mm, CSM >3.7 mm, RI >0.4 and serum hCG <3 935 U/L were predictors of complete success of D&C. The postponed restoration of menstruation was observed in patients with residues, which did not induce amenorrhea and disappeared in 1–3 months after procedures.

Early diagnosis and treatment is associated with successful D&C in treatment of CSP. HCG, GS, CSM and RI are valuable in predicting the prognosis of D&C in treatment of CSP.

To evaluate the effect of Ixabepilone on quiescent or hypoxic cells response to ionizing radiation.

NCI–H460 and A549, two human NSCLC cell lines, were employed in this experiment. Quiescent cells (QC) or hypoxic cells (HC) were induced as mentioned previously and untreated cells as control. A colony forming assay was applied to compare cellular radio–sensitivity with or without Ixabepilone. Flow cytometry and Western blot analysis were used to detect cell cycle distribution and apoptosis.

Along with an increased population of G₁ cell (NCI–H46 P=0.001 3; A549 P=0.006), both HC and QC were exhibited radio–resistance compared to untreated cells (survival fraction: NCI–H460 P=0.003; A549 P=0.000 1). Moreover, it was found that Ixabepilone, which induced apoptosis in both IR–treated or untreated NSCLC cells, significantly enhanced cells death under hypoxia(decrease of survival fraction: NCI–H460 P=0.000 2; A549 P<0.01).

The existence of quiescent or hypoxic cells in solid tumors poses a critical therapeutic problem since they were resistant to IR. Ixabepilone, which induces apoptosis in NSCLC, showed great radio–sensitization effect on hypoxic cells. Following work will focus on whether Ixabepilone could increase hypoxic tumor cells radio–sensitivity in vivo, which could provide useful data for the application of Ixabepilone in clinical practice.

To explorec Histocompatibility of nano-hydroxyapatite/poly-co-glycolic acid tissue engineering bone modified by mesenchymal stem cells with vascular endothelial frowth factor transinfected.

Rat bone marrow mesenchymal stem cells(BMSCs) was separated, using BMSCs as target cells, and then vascular endothelial growth factor(VEGF)gene was transfected.Composite bone marrow mesenchymal stem cells and cells transfected with nano-hydroxyapatite(HA)/polylactic-co-glycolic acid(PLGA). The composition of cell and scaffold was observed.

The blank plasmid transfection was 39.1%, 40.1% in VEGF group.The cell adhesion and growth was found on the scaffold pore wall after 5 days, and the number of adherent cells in the nano-HA/PLGA composite scaffold material basically had no significant difference in both.

Although the nano-HA/PLGA scaffold material is still not fully meet the requirements of the matrix material for bone tissue engineering, but good biocompatibility, structure is its rich microporous satisfaction in material mechanics, toughening, enhanced obviously. Composition scaffold with BMSCs transfected by VEGF plasmid, the ability of angiogenesis is promoted.

A 22-year-old male was admitted to Xuanwu Hospital for the first time on July 31, 2014, mainly due to intermittent fever and headache for 2 weeks and trance for 7 days. On July 17, 2014, the patient developed fever without obvious trigger. The body temperature was measured at about 38℃, accompanied by headache. The headache was whole brain distension and pain, which was tolerable. There was no abdominal pain, diarrhea, cough or expectoration. The body temperature returned to normal after oral antibiotic treatment (details unknown), and the headache also improved slightly. Jul 24, 2014 · Sudden trance at work, lack of memory of what is happening around me, want to speak expressively but can't speak, and occasionally understand simple instructions. Visit the local hospital immediately, check lumbar puncture, CSF pressure 300 mmH₂O (1 mmH₂O =0.0098 kPa), White blood cells 372×10⁶/L, monocytes 0.2, multinucleated cells 0.8, glucose 1.1 mmol/L, protein 8.06 g/L, chloride 108 mmol/L, acyclovir 0.5 g intravenous drip, once/18 h antiviral, ceftriaxone 2 g intravenous drip, once/d anti-inflammatory, mannitol 125 ml intravenous drip, once/8 h intracranial pressure lowering, the patient's consciousness gradually improved after 3 days, and he could communicate and cooperate with physical examination, but the remaining memory loss and slow response. Later, he went to the 309 Hospital of the People's Liberation Army. The tuberculin (PPD) test result was negative for the exception of "tuberculous meningoencephalitis", and the lumbar puncture was re-examined: pressure 220 mmH₂O, white blood cells 239×10⁶/L, monocytes 0.92, multinucleated cells 0.08, glucose 2.15 mmol/L, protein 1.99 g/L, chloride 107 mmol/L, adenosine deaminase (ADA): 38.3 U/L, tuberculosis antibody negative, mixed lymphocyte culture negative, Mycobacterium tuberculosis test negative, tuberculosis infection was not considered, and anti-viral and anti-inflammatory treatment was continued. On July 31, 2014, he went to Xuanwu Hospital and was admitted to Shennei Group 11.

A 74-year-old female was admitted to the Department of Neurology, Institute of Field Surgery, Third Affiliated Hospital, Third Military Medical University in March 2014 due to recurrent dizziness, unstable walking, leftward tilt and blurred vision. Past History: Hypertension; Diabetes free. Family history is not special. Parents have died. No history of drug allergy. No history of head trauma. Admission physical examination: heart rate 81 beats/min, breathing 20 beats/min, blood pressure 142/85 mmHg (1 mmHg =0.133 kPa), clear consciousness, quick thinking, clear speech, cranial nerve (–), muscle strength of limbs grade 5, symmetric tendon reflex of limbs; Accurate finger nose, flexible rotation, Romberg sign (–), no abnormality in acupuncture pain examination, bilateral pathological sign (–). Preliminary diagnosis: (1) posterior circulation ischemic attack; (2) Grade 3 hypertension, high risk. The patient was scheduled to undergo head and neck CT angiography (CTA) examination.

As an important component of small veseel disease (SVD), leukoaraiosis (LA), also known as white matter lesions (WMLs) or white matter hyperintensities (WMHs), refers to spotty or patchy changes in periventricular or subcortical white matter caused by various causes, showing low density on CT and low density on MRI-T₁The weighted image shows an isosignal or a low signal, T₂High signal changes are present on weighted images and fluid-attenuated inversion recovery images (FLAIR^[1]。 It is currently believed that LA is one of the major imaging changes causing vascular cognitive impairment (VCI)^[2]However, the mechanism of its occurrence is still unclear, and it is also a hot topic of current research. In this paper, the neural mechanism of LA occurrence will be expounded from several aspects, such as chronic ischemia/hypoperfusion theory, blood-brain barrier disruption theory, endothelial dysfunction theory, inflammatory response theory, genetic theory and venous abnormality theory, so as to provide some theoretical basis for clinical diagnosis and treatment.

Heart failure (heart failure) has the characteristics of high morbidity, high mortality and high cost. Data from the United States show that central failure has exceeded 5.1 million people over the age of 20, and 825,000 new heart failure and 58,000 deaths among people over the age of 45 each year, costing $30.7 billion^[1]。 The American Heart Association (AHA) predicts that the incidence of heart failure will increase by 46% from 2012 to 2030, and more than 8 million people over the age of 18 will suffer from central failure^[2]。 With the change of lifestyle, the aging of the population and the increasing incidence of heart failure causes such as myocardial infarction, China is also facing the huge burden brought by heart failure. At present, there are 4.2 million patients with heart failure in China, and the incidence of central failure in people aged 35-74 is 0.9%^[3]。 Heart failure has now become an important burden of chronic diseases worldwide.

Human glioma is the most common intracranial tumor, derived from glial cells of brain tissue^[1,2]。 Identification of glioma-related genes will provide new ideas for glioma treatment^[3,4,5,6]CXCR4 has been shown to play an important role in the development of gliomas. The mechanisms of action of CXCR4 receptors in glioma survival, migration, invasion, proliferation, angiogenesis and immunomodulation are reviewed below.