Volume 96  ·  Issue 01  ·  2016

The 100th anniversary of the Chinese Medical Journal in 2015. In the past 100 years, this magazine has experienced ups and downs, and through the hard work of generations of sages, the magazine has developed from the initial small 32-format quarterly magazine to a large 16-format weekly magazine with 80 pages per issue since January 2005. The citation frequency and influence factors of the magazine rank among the forefront of domestic comprehensive medical journals. In the past 100 years, Chinese Medical Journal has witnessed the history of the development of medical science in China and recorded a wonderful chapter of medical development; Tens of thousands of papers reflect the changes in the disease spectrum in our country; It also shows the essence of Chinese medicine to the world.

To explore the effect of brain atrophy on the cognition in patients with subcortical ischemic vascular disease (SIVD).

A total of 116 SIVD patients were enrolled from the Department of Neurology, First Affiliated Hospital, Anhui Medical University between September 2013 and December 2014. Lobar atrophy, leukoaraiosis (LA), lacunar infarcts (LI) and vascular risk factors were analyzed in the 116 SIVD patients who were divided into three groups according to the diagnostic criteria: non-cognitive impairment group (SIVD-NCI) , mild cognitive impairment group (SIVD-MCI) and dement group (SIVD-VaD). All patients underwent magnetic resonance imaging (MRI) with a 3.0-T system. The cognitive functions were evaluated by mini-metal state examination (MMSE), the Cambridge cognitive examination-Chinese version (CAMCOG-C), etc. A widely used visual atrophy rating method (0 to 3) was adopted to rate the severity of frontal, parietal and temporal lobe atrophy. The degree of LA and the numbers of LI in 4 brain regions (frontal, parieto-occipital, temporal, and basal ganglia) were evaluated meanwhile.

Firstly, both the SIVD-MCI and SIVD-VaD groups showed significantly higher total scores of atrophy, higher frontal lobe atrophy scores, higher LA scores and larger LI numbers than SIVD-NCI (H=6.138, P=0.013; H=45.845, P=0.000; H=36.818, P=0.000; H=37.46, P=0.000). There were no significant differences in temporal lobe atrophy scores between SIVD-NCI group and SIVD-MCI group. Parietal lobe atrophy scores also showed no differences among the three groups. Secondly, as well as total numbers of LI, total scores of atrophy and LA were negatively correlated with SIVD cognition, especially frontal lobe atrophy scores, parieto-occipital LA scores and basal ganglia LI numbers had a remarkable negative correlation with MMSE scores, CAMCOG-C scores and partial subitems in CAMCOG-C scores (P<0.005). However temporal LI numbers was absence of correlation with MMSE scores, CAMCOG-C scores and subitems in CAMCOG-C scores (P>0.005). Thirdly, education (OR= 0.787, P=0.009), total scores of LA (OR= 1.201, P=0.036) and total numbers of LI (OR= 1.221, P=0.011) remained to be associated with cognition after controlling for sex, age, education, hypertension, diabetes, smoking. While, after adjusting atrophy scores, total scores of LA had no significant association with cognition. Atrophy scores, total numbers of LI and education still showed significant association with cognition, particularly frontal lobe atrophy scores (OR= 16.082, P=0.000), but not temporal and parietal lobe atrophy scores.

Brain atrophy may be a new and independent predictive index of cognitive impairment in SIVD. Further, the effect of brain atrophy, the numbers of LI and degree of LA on cognitive decline is independent and decreases in turn.

To investigate the relationship between the preoperative coronal intervertebral angle changes and postoperative trunk shift (TS) in patients who received congenital scoliosis correction.

The data of 921 patients with congenital scoliosis, who received posterior congenital scoliosis correction and internal fixation, was retrospectively analyzed. Anteroposterior (AP) whole spine standing radiographs and right and left lateral bending radiographs were taken preoperatively, and AP whole spine standing radiographs were obtained postoperatively and at the final follow-up. TS was measured in the coronal plane, and intervertebral angle change was the sum of the absolute values of L4-S1 intervertebral angle changes in the coronal plane, and was determined before surgery, postoperatively, and at final follow-up.

A total of 38 patients with a mean age of 16.42±8.36 years old and a mean follow-up of 12.4 months (range, 6 to 36 months) were included. A median negative correlation were found between TS at the final follow-up and total variance of bending (r=-0.51, P=0.001). Groups were defined by two methods: coronal intervertebral angle changes ≥10° or <10°, and final follow-up TS < 20 mm or ≥ 20 mm. TS at the final follow-up was significantly greater in the <10° group than the ≥10° group (32.45 vs 12.44 mm, P=0.001), and coronal intervertebral angle changes was significantly greater in the TS < 20 mm group than the ≥ 20 mm group (14.2° vs 6°, P=0.001).

Postoperative TS which will not compensate spontaneously can be predicted by measurement of the preoperative intervertebral interspace angle in the congenital scoliosis lumbosacral region.

To compare the clinical effects among three kinds of treatments (external fixation, plate fixation, and non-operation) of 1/3 displaced midshaft clavicular fractures in adults.

Retrospective analysis was conducted on 306 patients with clavicular fractures in Trauma Orthopedic Department in Jishuitan Hospital from March 2010 to May 2013, and 89 of these patients met the inclusive criteria.Among them, there were 29 cases of external fixation (Group A), 30 cases of plate fixation (Group B), and 30 cases of non-operation with the clavicle sling in Outpatient and Emergency Department (Group C). The average follow-up period was 32 months.The results were evaluated from four perspectives, respectively, follow-up period, Constant Shoulder Score (CSS), Disability of the Arm Shoulder and Hand Score (DASH), and imaging.There was no significant difference in demography, severity of injuries, mechanism of injury, and fracture type among the patients in the three groups.

Among 29 cases of external fixation, 25 cases were successfully followed up, 4 were lost.60 cases of plate fixationand non-operation were all successfully followed up.Based on the pairwise comparison of CSS and DASH among the three groups, there was no significant difference between external fixation [(94.0±6.4), (15.2±3.4)Score] and plate fixation[(92.9±8.4), (15.7±3.5)Score] (bothP>0.05). Mean values of CSS and DASH of non-operation group [(86.0±3.6), (18.0±3.6)Score] were lower than those of the former two groups (P<0.001). The healing time of 3 kinds of treatments were as follows: external fixation 10.4±2.32 weeks; plate fixation 12.1±2.5 weeks; and non-operation 15.7±2.2 weeks.In terms of their complications, for the external fixation group, there was 1 case of nonunion (4%); and 3 cases of angulation deformity in the 12^th week, whose external fixations were maintained till their unions in the 16^th week.Shortening and displacement did not appear in any cases.In the plate fixation group, there was 1 case of nonunion (3%) and no malunion in this group.The biggest complications of plate fixation were implants stimulus and to remove the plate in the second operation, accounting for 60%.In the non-operation group, there were 3 cases of nonunion (10%), and 12 cases of malunion (40%) including 10 cases without symptoms and 2 cases with symptoms.The satisfaction rates for the appearance of shoulder after these 3 kinds of treatments among the patients were 96%, 93% and 77%, respectively.

(1) In treating 1/3 displaced midshaft clavicular fractures in adults, external fixation and plate fixation are overall better than non-operation.And there is no significant difference in curative effects between the two. (2) Both external fixation and plate fixation have its advantages and disadvantages.The choice of treatment must be based on the clinical type of the fracture and the communication with patients.

To evaluate the clinical value of swallow tail appearance in detecting the patient with Parkinson's disease at 3.0 T MRI.

A total of 42 patients with clinical diagnosis of Parkinson's disease(PD) and 27 age-matched normal controls underwent the brain MR examination with conventional and E-SWAN sequences. Patients were divided into 4 groups based on Hoehn-Yahr stage and 2 groups according the treatment condition (treated, untreated). Substantia nigra (SN) was selected as region of interest (ROI) and observed the swallow tail appearance on magnitude imagines of E-SWAN sequence. Nonparametric test was used for comparison between patients groups and normal controls. There was statistically difference if theP value was lower than 0.05.

The swallow tail appearance lost was significantly correlated with Parkinson's disease (P=0.000). The swallow tail appearance lost was not correlated with the usage of drugs(P=0.833) and Hoehn-Yahr stage(P=0.189). The sensitivity of diagnosis of PD by using the swallow tail disappearance was 95.5% (42/44), the specificity was 83.3% (25/30), the accuracy was 90.5%(67/74).

Assessing the substantia nigra on E-SWAN for the typical swallow tail appearance has potential to become a new and easy applicable 3.0 T MRI diagnostic tool for PD, however, it was meaningless for prognosis and staging.

To explore the prevention strategies for surgical complications of sphenoid wing meningiomas.

A total of 76 cases of sphenoid wing meningiomas were included from The People's Hospital of Henan Province from 2011 to 2014. Based on the preoperative imaging data, the patients were divided into 28 cases of lateral type, 16 cases of middle type and 32 cases of medial type. According to the different characteristics of different types of sphenoid wing meningiomas, appropriate preoperative, intraoperative and postoperative measures to prevent complications were carried out.

A total of 2 cases of facial nerve injury occurred in 28 cases with lateral type; 1 case of intraoperative subarachnoid hemorrhage and brain swelling occurred in 16 cases with middle type; 3 cases of oculomotor nerve damage, 1 case of optic nerve injury and 4 cases of vascular injury occurred in 32 cases with the medial type. The total incidence of complications was 14.5% (11/76).

Detailed preoperative planning according to the characteristics of different types of sphenoid wing meningiomas, intraoperative use of microsurgery and Cavitron Ultrasonic Surgical Aspirator (CUSA), following the principle of in situ removal, controlling the extent of resection of tumor adhering to cavernous sinus and the great vessels, the severe surgery complications of sphenoid wing meningiomas can be reduced.

To detect the expression of renal M-type phospholipase A2 receptor (PLA2R) in patients with idiopathic membranous nephropathy (IMN), and to explore the relationship between renal PLA2R and the curative effect of immunotherapy.

A total of 56 patients who were diagnosed as IMN from January 2012 to June 2014 in the department of nephrology in First People's Hospital, Shanghai Jiaotong University, were included in this study. The expression of renal PLA2R was detected by immumofluorescence assay. The IMN patients were treated with corticosteroids and cyclophosphamide, and the relationship between renal PLA2R and the curative effect of immunotherapy was observed.

The ratio of PLA2R related IMN (renal PLA2R-positive) patients was 71.4%(40/56). The recovery conditions in proteinuria and serum albumin were better in the non-PLA2R related IMN group since 6 months after the treatment (P<0.05). The overall response rate in PLA2R related IMN group was 58.3%, 62.5% and 62.5% after 6, 9, 12 months, respectively. However, the overall response rate in non-PLA2R related IMN group almost reached 100% after treatment for 6 months. Compared with PLA2R related IMN group, the time which patients reached complete remission was significantly shorter in the non-PLA2R related IMN group [(5.4±3.5) vs (10.5±1.6) months,P<0.05].

Detection of renal PLA2R can be helpful to diagnose IMN. Non-PLA2R related IMN patients usually have a better curative effect of immunotherapy and a shorter time to onset of efficacy.

To explore the clinical characteristics of IgA nephropathy (IgAN) with severe chronic periodontitis and aggressive periodontitis.

A total of 436 hospitalized patients who underwent renal needle biopsy in the department of nephrology of China-Japan Friendship Hospital from November 2013 to December 2014 were recruited in the study and blindly had periodontal examination. The patients were divided into IgAN group and non-IgAN group according to the renal pathology. The patients with IgAN were further categorized as non-periodontitis, chronic periodontitis and aggressive peridontitis group by Haas classification. The chronic periodontitis group was continually divided into mild, moderate and severe periodontitis group. The levels of interleukin (IL)-1β and IL-6 in gingival crevicular fluid were analyzed by enzyme-linked immunosorbent assays.

The prevalence of periodontitis in the study was 88.3% (385/436). The prevalence of chronic periodontitis and aggressive periodontitis were higher in patients with IgAN than those with non-IgAN (P<0.05). Degree of chronic periodontitis was correlated with pathologic grading of IgAN (r=0.48, P<0.001). Compared with IgAN patients with other types of periodontitis, those with severe chronic and aggressive periodontitis had more severe pathology, more frequent recurrent gross hematuria, higher levels of 24 h proteinuria, serum triglyceride and uric acid, higher periodontal probing depth and clinical attatchment level, as well as higer levels of IL-1β and IL-6, but had lower creatinine clearance rate (allP<0.05).

The prevalence of severe chronic and aggressive periodontitis was higher in patients with IgAN. Chronic periodontitis is correlated with the onset and development of IgAN. Patients with IgAN have worse condition with the aggravation of periodontitis.

To determine whether intramural administration of rapamycin (RPM)-loaded polylactic-polyglycolic acid (PLGA) nanoparticles (NPs) can reduce intimal thickening and affect the mRNA expressions of matrix metalloproteinase (MMP)-2, tissue inhibitor of metalloproteinase (TIMP)-2 and p27^kipl in a coronary injury-stenosis model of minipigs.

Twenty eight minipigs were randomly separated into four groups: saline group (n=7), blank PLGA NPs group (5.0 mg/ml)(n=7), RPM group (1.0 mg/ml)(n=7), and RPM-PLGA NPs(5.0 mg/ml)group (n=7), respectively. Different treatments were intracoronary locally delivered via a Dispatch™ catheter for 10 minutes. Serial angiography was performed pre-and post-modeling 30 days and the percent stenosis degree was assessed. Hematoxylin-Eosin (HE) staining, Weigert's resorcin fuchsin staining and picric acid-sirius red staining were used for morphometric analysis. Immunohistochemistry was performed to assess the levels of proliferating cell nuclear antigen (PCNA), MMP-2, and TIMP-2 at early and late time points, respectively. The expression of p27^kip1 mRNA was detected by in situ hybridization staining.

Data from 21 minipigs had been collected at the end of the experiment with 6, 4, 5, and 6 from the former mentioned 4 groups, respectively. For the instant injury index, there was no significant difference among the four groups. The percent stenosis degree of RPM-PLGA NPs group was significantly lower than that of the other three groups respectively (all P< 0.05). The neointima area, net external elastic lamina area to external elastic laminal area ratio, and proliferative index of RPM-PLGA NPs group were significantly less than those of the other three groups, with all theP values less than 0.05. The mean value of integral optical density of p27^kip1mRNA expression of RPM-PLGA group was 0.35±0.06, higher than that of blank PLGA NPs group (0.12±0.05, P< 0.01), saline group (0.16 ±0.03,P< 0.05), and RPM group (0.15 ±0.03,P< 0.05), respectively. The MMP-2/TIMP-2 ratio and the positive expression index of PCNA in RPM-PLGA group were lower than that of the other groups (P< 0.05).

Locally delivered rapamycin-loaded PLGA NPs significantly reduces MMP-2/TIMP-2 ratio and PCNA expression, increases p27^kip1 mRNA expression and significantly relieves percent stenosis degree and shows excellent acute procedural results in the minipig interventional coronary artery oversized balloon injury model. The results from minipig model further support that this approach could be a potential clinical procedure for vascular proliferative disease.

To evaluate the effect and safety of using thermo-sensitive Matrigel as artificial ascites on minimizing thermal injury to the nearby structures in a rat model of radiofrequency (RF) ablation of the liver.

In this research, the morphological characterization of Matrigel was observed at different temperatures in vitro. In vivo study was conducted by using 42 SD rats in Matrigel, Saline and control groups of 14 rats each. Artificial ascites with 10 ml of Matrigel or saline was produced under ultrasound guidance before RF in the experimental groups. Using a 0.7 cm exposed 17 G RF electrode for 5 minutes (90±2) ℃, 41 hepatic ablations was performed abutting the diaphragm, abdominal wall and stomach. The 41 rats were sacrificed at 24 h, and necropsy was performed.Gross and histopathologic examinations were performed to compare the frequency and extent of thermal injury to the nearby organs.The animal status was followed up to achieve long term safety evaluation of Matrigel.

Matrigel was in liquid formation at 0-4 ℃, but was not moving in vials at temperature 37 ℃ in 1 min, presenting gel formation.In vivo experiment, the artificial fluid thickness of Matrigel in site was significant larger than that of saline group, especially at 5 min of ablation ((8.1±1.1) mm vs (2.4±0.8)mm, P<0.01). Thermal injury to the nearby structures was found in 12 of 13 cases in control group, 8 of 14 cases (P=0.037) in saline group, and 1 of 14 cases (P<0.01) in Matrigel group. The sizes of the ablation zone of the liver did not differ among the three groups. There was no difference in the incidence of operation related complications among the three groups. There was no significant difference in body weight and health related parameters between Matrigel and saline group during 60 days of follow up.

Using thermo-sensitive Matrigel as artificial ascites may be a safe and useful technique and help to further reduce the frequency and severity of collateral thermal injury to the nearby structures compare to conventional saline, during RF ablation of subcapsular hepatic tumors.

To investigate the incidence and influencing factors of term small for gestational age infants (SGA ) in China.

This study is a multicenter study. Data were collected from Chinese Neonatal Network with term infants, born from May 1st 2010 to February 28th 2014, from 83 nationwide hospitals.

A total of 170 565 neonates were recorded from 83 nationwide hospitals; 144 659 cases were term newborn, and 3 543 neonates were found to be term SGA. The incidence of term SGA was 2.45%. In term SGA, the girl's incidence (2.88%, 1 985/69 003) was higher than boy (2.05%, 1 531/74 707),P<0.001. Furthermore, the incidence ofin vitro fertilization (IVF) and artificial fertilization of term SGA was 9.12% (66/724), which was higher than the natural conception (2.42%, 3 465/143 283), P<0.001. The incidence of term SGA in multiple births (30.37%, 741/2 440) was higher than that of single birth (1.97%, 2 787/141 366),P<0.001. The incidence of SGA with maternal age <18 years old was 4.86% (27/556) and was 3.20% (307/9 592) with maternal age > 35 years old, meanwhile both were higher than that with maternal age as 18-35 years old (2.39%, 3 197/133 662). The incidence of SGA with maternal occupation as farmers was 4.67% (854/18 284), which was significantly higher than other professions. The incidence of SGA with maternal education as illiterate and elementary education was 8.65% (187/2 162), 5.17% (397/7 678), respectively, both were significantly higher than those with mother graduated from university (1.72%, 853/49 692). Moreover, the geographical distribution of the main residence of the term SGA mothers showed Northeast Area (1.54%, 30/1 946)and East Area (2.21%, 1 267/57 334) had lower incidence of term SGA than those of Central South Area (2.71%, 493/18 223) and Southwest Area (3.67%, 876/23 852).

The incidence of term SGA was 2.45% in this study, which was influenced significantly by gender, IVF, multiple births, maternal factors (age, maternal occupation, level of education) and geographical distribution. This multicenter study with large data, to a certain extent, reflected status of the incidence and influencing factors of term SGA in China, which will help prevent and treat term SGA.

To systematically evaluate the security of hormone replacement therapy (HRT) among postoperative patients with endometrial carcinoma (EC).

A systematic review and Meta-analysis of studies on security of HRT among EC patients after operation was done by Revman 5.2 software. Studies were mainly searched from the CENTRAL, Medline, Embase, Ovid, Wanfang, CNKI databases.

A total of 7 studies with 2 038 stageⅠand stageⅡ endometrial carcinoma patients were included. The quality of 6 studies included were medium, and 1 study was high. The endometrial carcinoma patients on HRT did not have a statistically increased incidence in the EC recurrence (RR=0.69, 95%CI (0.42-1.15), P=0.16) and cancer-induced death (RR=0.55, 95%CI (0.25-1.21), P=0.14). Subgroup analysis for the start of HRT within 6 months from time of surgery group and only estrogen replacement therapy group found no statistical different in the risk of the EC recurrence and cancer-induced death, compared with control group. No statistically increased risk of the EC recurrence was observed for estrogen plus progestin replacement therapy group.

There is no statistical difference in the recurrence rate and cancer-induced death rate of EC whether the early stage postoperative patients used HRT or not.

Pituitary growth hormone (GH) adenoma causes excessive growth of soft tissue and hypertrophy of internal organs due to excessive secretion of GH, resulting in cardiovascular, metabolic and respiratory complications, which seriously affect the quality of life of patients^[1]。 Surgery is the preferred treatment. Because part of the tumor grows to the cavernous sinus, surrounds the internal carotid artery or the tumor is a huge adenoma, it is difficult to remove the tumor completely by surgery. The overall biochemical remission rate of surgery is about 60%^[1]。 Some patients cannot achieve effective biochemical control even through surgery, drugs and radiotherapy^[1]。 This study retrospectively summarizes the experience of 2 cases of pituitary refractory pituitary growth hormone adenomas in preoperative drug therapy, biochemical control and clinical symptom relief after surgical tumor reduction combined with drug therapy, which are reported below.

In 2013, the author wrote an article "IgG4-related diseases and unnamed diseases from 'non-infectious non-tumoral inflammation'", and put forward a new idea of diagnosis and treatment of difficult immune diseases such as "non-infectious non-tumoral inflammation", which triggered readers to deepen their understanding of rheumatology and immunology diseases, clinical understanding of immune inflammation, and challenges to difficult inflammatory diseases and even unnamed diseases. Clinically, many diseases are indeed related to inflammation, such as infectious inflammation, tumor inflammation, immune inflammation and physical and chemical damage inflammation. In these difficult cases, pathological examination or clinical features show "inflammation", but no specific cause can be found, and it is difficult to make a specific diagnosis. In this regard, if we grasp the pathological feature of "inflammation" and carry out screening, identification and treatment, we can often get a successful shortcut.

With the development of vascular imaging technology, the detection rate of unruptured intracranial aneurysms (UIAs) has increased significantly. UIAs refers to aneurysms that have no history of ruptured bleeding or are not directly related to bleeding, including asymptomatic aneurysms found accidentally, unruptured aneurysms among multiple aneurysms, etc.^[1]。 Once detected, the problem for clinicians is to assess the risk of rupture and develop individualized management strategies. Currently, the management protocol of UIAs includes: conservative observation and surgical intervention. However, most UIAs have no positive clinical symptoms, so the risk of aneurysm rupture and the advantages and disadvantages of surgery should be carefully weighed when making decisions.

Acute respiratory distress syndrome (ARDS) is a common syndrome in the Department of Critical Care Medicine (ICU). This type of patient can benefit from mechanical ventilation, but if used incorrectly, it can also lead to ventilator-related lung injury (VILI) and increase the mortality rate. VILI not only aggravates lung lesions, but also causes a systemic inflammatory response that leads to involvement of extrapulmonary organs^[1]。 Ventilation mode, ventilation time, tension (pressure and volume) produced by ventilation, and the cause, time, degree of lesion and underlying disease of lung injury were all related to VILI^[2]。 Studies have demonstrated that a protective pulmonary ventilation strategy with low tidal volume/low plateau pressure and appropriate positive end-expiratory pressure (PEEP) can reduce the incidence of VILI and improve survival in patients with ARDS^[3,4,5]。 However, other research results in recent years have also raised questions about existing protective lung ventilation strategies.

Following the successful application of positron emission tomography/computed tomography (PET/CT) in clinical practice, the research and development of positron emission tomography/magnetic resonance imaging (PET/MRI) has become increasingly hot. As a new multimodal imaging device, PET/MRI realizes the real-time fusion of anatomical structure and functional/metabolic/biochemical images. Compared with CT, MRI has higher soft tissue resolution, can provide image information such as function and metabolism through special sequences, and MRI has no ionizing radiation. It is especially suitable for children, pregnant women and patients who need repeated imaging examinations^[1]。 It is foreseeable that PET/MRI will show important value and unique superiority in the assessment of various pathophysiological states. This paper briefly introduces the recent progress of PET/MRI and its clinical application in recent years.