Volume 96  ·  Issue 09  ·  2016

Skull base surgery involves many disciplines, such as neurosurgery, otolaryngology, oral and maxillofacial surgery, head and neck surgery, ophthalmology, plastic surgery, etc. In the past, traditional disciplines were divided according to human anatomy rather than disease. Due to skull base diseases, such as trauma, tumors, vascular diseases, and congenital developmental abnormalities, many anatomical structures are often involved, such as the junction areas of the brain, eyes, ears, nose, maxillofacial, oral cavity, and neck^[1]It brings obvious limitations to the traditional single-discipline diagnosis and treatment, and it is hoped that various disciplines will integrate and cross, so that patients can have better diagnosis and treatment results, thus promoting the rapid development of multidisciplinary cooperation in skull base surgery, which focuses on surgical treatment.

To study the surface radial dose distribution of different length radioactive biliary stents in different activity of ¹²⁵I seeds by treatment planning system.

After a radioactive biliary stent was positioned in measurement phantom, which were made of solid paraffin and polymethyl methacrylate, a CT scan was performed to get the stent images. The images were then transferred to the treatment planning system for planning. The maximum dose level slice nearest to the center of the stent was selected to calculate the surface radial dose distribution.

The length of the stents (F=3 189.160, P<0.01) and the activity of the¹²⁵I seeds (F= 811.509, P<0.01) can both significantly affect the cumulative radial dose distribution of the radioactive stent. Radial cumulative dose dose (Gy), stent length (cm),¹²⁵I seeds activity (mCi) and distance from the stent surface (cm) meet the regression equation: ln dose =2.565+ 0.208 length+ 1.502 activity-0.738 distance (F=4 929.279, P<0.05).

The choice of suitable activity of radioactive ¹²⁵I should be based on treatment purpose in combination with the length and diameter of lesion and also with reference to the dose table. The measurement results are with smaller uncertainty, which can provide reference for the clinical application of dosimetry.

Acoustic neuroma is a benign tumor mainly originating from Schwann cells in the vestibular nerve sheath of the internal auditory tract^[1,2,3], also known as vestibular schwannoma, accounts for 6% to 9% of intracranial tumors and 80% to 90% of cerebellopontine angle tumors^[4,5]。 Because it is located in the internal auditory canal and cerebellopontine angle area, as the tumor grows, it gradually compresses the surrounding important tissues, which can cause severe symptoms and even threaten the patient's life, so reasonable treatment strategies need to be adopted.

To evaluate the clinical value of Short Form-36 (SF-36) questionnaire and the most commonly used clinical measures in a prospective cohort study of ankylosing spondylitis (AS) patients.

A total of 517 AS patients were collected from the Department of Rheumatology, Chinese PLA General Hospital from August 2013 to September 2015. The Quality of Life (QoL) was assessed by SF-36 questionnaire and compared with the general population. The correlations between QoL and clinical measures of AS, including the Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index (BASMI) et al, were analyzed.

BASDAI and BASFI were significantly correlated with SF-36 scores (r>0.3,P<0.01). Logistic multiple regression analysis showed that BASDAI, BASFI, BASMI and education had close correlation with the baseline global QoL, physical and mental health. Among these clinical measures, BASDAI variation showed the most important influence on the change of global QoL, physical health and mental health (OR=0.235, 0.209, 0.125; P<0.01).

SF-36 can objectively reflect the QoL of patients with AS. Clinical measures such as BASDAI and BASFI show great application value in this prospective cohort study of AS patients.

To explore the clinical value of intraoperative magnetic resonance imaging (iMRI) coregistration combined with position emission tomography/computed tomography (PET/CT) in stereotactic brain biopsy.

Forty nine patients with intracranial lesions were operated by stereotactic biopsy from June 2010 to June 2015 in Tianjin Medical University General Hospital. Seventeen patient's operation was guided by iMRI only (group A), thirty two patients' operation was guided by iMRI and PET/CT (group B). The diagnosis success rate and operation related complications were compared between the two groups.

PET/CT and iMRI were integrated successfully in all cases of group B. Fourteen patients (82.4%) of group A and all 32 patients (100%) of group B had final diagnosis confirmed by histopathological and immunohistochemical observation. The diagnosis success rate of group B was higher than group A (P<0.05). There were 5 patients in total who had postoperative complication, 2 (11.8%) in group A and 3 (9.3%) in group B, but the difference was not statistically significant.

PET/CT based metabolic imaging can be automatically integrated with standard MRI guided stereotactic biopsy. Compared with iMRI only, the combined treatment improves diagnosis success rate without increasing complications; it's safe, and has high clinical efficacy.

To evaluate the clinical effects of autologous cytokine-induced killer cell(CIK) on the cumulative survival and reactivation rate of hepatitics B virus(HBV) after radiofrequency ablation(RFA) combined with transcatheter arterial chemoembolization(TACE).

A total of 156 patients with hepatocellular carcinoma treated from June 2006 to September 2012 in Shengli Oilfield Central Hosptial were divided into control group(RFA, TACE) and research group(RFA, TACE, CIK). According to the tumors number, diameter and vascular invasion condition, the patients were divided into another 4 groups: the high and low risk group with tumor ≤5 cm, the high and low risk group with tumor>5 cm.The prognosis of these groups was analyzed. The effects on HBV reactivation rate between antiviral and unantiviral patients were respectively analyzed .

The ratios of the research and control group over 1-, 3-, 5-year were 75.3%(70/93), 58.9%(53/90), 21.5%(20/93)vs 71.4%(45/63), 55.6%(35/63), 22.2%(14/63)(P>0.05), the ratios of the research and control group in the high risk group with tumor≤5 cm were 75.0%(18/24), 58.3%(14/24), 37.5%(9/24)vs 58.8%(10/17), 41.2%(7/17), 23.5%(4/17)(P<0.05). The incidences of HBV reactivation for the research and control group were 6.0% and 24.3%(P<0.05).

Postoperative adjuvant CIK therapy with tumor≤5 cm after RFA combined with TACE is beneficial to the high risk group and decreases the risk of HBV reactivation.

To investigate the clinical efficacy of radiofrequency ablation(RFA)combined with ¹²⁵I seed in patients with multiple nodular hepatocellular carcinoma(HCC).

The clinical data of 47 patients with multiple nodular HCC confirmed clinically or pathologically in the Fifth Affiliated Hospital of Wenzhou Medical University between January 2009 and September 2014 were retrospectively analyzed. All patients were divided into two groups depending on treatment: RFA group(n=29); RFA combined with ¹²⁵I seed group(n=18). Survival time was estimated with the Kaplan-Meier analysis. The survival curve was compared by Log-rank test.

The clinical data and tumor situation of patients between two groups did not show significant differences. The follow-up time ranged from 2 to 55 months. At the end of the study, the median progression-free survival of two groups were 18 months and 11 months, and the differences were statistically significant(P=0.036). The overall survival rates in RFA combined with ¹²⁵I seed group at 1, 2, and 3 years (94.4%, 78.0%, 66.8%, respectively) were higher than those in RFA group (88.5%, 68.6%, 57.1%, respectively). However, the differences between the two groups were not statistically significant(P=0.554).

For multiple nodular HCC, RFA combined with ¹²⁵I seed can prolong progression-free survival, have an advantage in local control rate, and is better than single RFA at short-term curative effect.However, its long-term outcomes should be further explored by a large-sample, multi-center and randomized trial.

To assess the predictive value of the albumin to globulin ratio (AGR) in evaluation of disease severity and prognosis in myasthenia gravis patients.

A total of 135 myasthenia gravis (MG) patients were enrolled between February 2009 and March 2015. The AGR was detected on the first day of hospitalization and ranked from lowest to highest, and the patients were divided into three equal tertiles according to the AGR values, which were T1 (AGR <1.34), T2 (1.34≤AGR≤1.53) and T3 (AGR>1.53). The Kaplan-Meier curve was used to evaluate the prognostic value of AGR. Cox model analysis was used to evaluate the relevant factors. Multivariate Logistic regression analysis was used to find the predictors of myasthenia crisis during hospitalization.

The median length of hospital stay for each tertile was: for the T1 21 days (15-35.5), T2 18 days (14-27.5), and T3 16 days (12-22.5) (P<0.01), and Kaplan-Meier curves showed significant difference among the three groups. In the univariate model, serum albumin, creatinine, AGR and MGFA clinical classification were related to prognosis of myasthenia gravis. At the multivariate Cox regression analysis, the AGR (P<0.001) and MGFA clinical classification (P<0.001) were independent predictive factors of disease severity and prognosis in myasthenia gravis patients. Respectively, the hazard ratio (HR) were 4.655 (95%CI: 2.355-9.202) and 0.596 (95% CI: 0.492-0.723). Multivariate Logistic regression analysis showed the AGR (P<0.001) and MGFA clinical classification were related to myasthenia crisis.

The AGR may represent a simple, potentially useful predictive biomarker for evaluating the disease severity and prognosis of patients with myasthenia gravis.

To investigate the relationship between sex hormones and metabolic syndrome (MS), as well as its components in elderly men.

1 505 elderly men (≥60 years old, mean age 75.4±9.7 years old) who participated in a routine health screening examination in PLA general hospital from May to June in 2012 were enrolled in this cross-sectional study. Serum lipids, glucose and sex hormones were measured along with body height, weight and blood pressure. Free testosterone (FT) and bioavailable testosterone (BT) were calculated. The correlation of serum sex hormones with the presence of MS and its components were analyzed.

The prevalence of MS was 21.7% (326/1 505) in this study. Elderly men with MS had lower levels of sex hormone-binding globulin (SHBG), total testosterone (TT), FT and BT than those without MS. The levels of SHBG, TT, FT and BT were significantly lower in the overweight/obesity group, hyperglycemia group and dyslipidemia group than those in the respective control groups (P<0.05). Logistic regression analysis showed that the SHBG level was an independent risk factor for MS in elderly men(OR=0.977, 95%CI: 0.964-0.989, P<0.001), while the levels of TT, FT and BT were not associated with MS. The prevalence of MS gradually increased with decreasing of SHBG values (P<0.001). When comparing subjects in the lowest and highest quartile of SHBG, the former group demonstrated a 2.13-fold increase in the odds ratio for MS after adjusting for age, smoking, drinking and other sex hormone indices.

In elderly men, lower SHBG level, not TT, FT or BT may be an independent predictor for the prevalence of MS, in which the mechanism requires further studies.

To analyze the clinical and pathological data and prognosis of IgA nephropathy patients with microalbuminuria and deposition of C3, and to investigate the significance of C3 deposition in IgA nephropathy with microalbuminuria.

The clinical and pathological data of 127 IgA nephropathy patients with microalbuminuria confirmed by renal biopsy in the Jining No.1 People's Hospital from January 2009 to January 2015 and minimum 6-month follow-up was reviewed, and patients were divided into positive group (72 cases, 56.7%)and negative group (55 cases, 43.3%) according to the deposition of C3 in the mesangial area of glomeruli. 24 h urine quantitative protein being more than 1 g, or serum creatinine level becoming abnormal or double by renal biopsy was defined as endpoint of follow-up. Renal survival was calculated by Kaplan-Meier survival analysis.

A total of 127 IgA nephropathy patients with microalbuminuria were followed up successfully, with an average follow-up of (49.6±22.7) months. 24 h urine albumin[(261.3±47.4) vs (238.7±51.9) mg, P=0.011], serum creatinine value[98.0(56.4, 118.6) vs 85.7(51.9, 107.8) μmol/L, P=0.003], uric acid value[(384.0±93.7) vs (360.5±88.4) μmol/L, P=0.043] and serum IgA value[(3.36±1.17) vs (3.12±1.05) g/L, P=0.044] were significantly higher in the C3 positive group than those in the negative group, while the serum complement C3 was significantly lower [(0.70±0.42) vs (0.98±0.49) mg, P=0.047]. Pathological changes [Lee's grade Ⅲ and above Ⅲ: 21(16.5%) vs 11(8.7%),P=0.034], glomerular sclerosis or adhesions [29(22.8%) vs 19(15.0%), P=0.047], renal tubular atrophy or interstitial fibrosis [13(10.2%) vs 8(6.3%), P=0.027] and crescent formation [7(5.5%) vs 2(1.6%), P=0.035] in the complement C3 positive group were more severe than those in the negative group. 38 cases of complement C3 positive group and 14 cases of negative group accomplished the study, and Kaplan-Meier survival analysis showed that there was a significant difference in the median survival time between the two groups [(52.6±8.9) vs (66.1±9.7) months, P=0.019].

The clinical and pathological features in IgA nephropathy patients with microalbuminuria and deposition of complement C3 were more severe than those without complement C3 deposition, and the prognosis was not optimistic. Therefore, early and active intervention treatment should be considered for these patients.

To compare the dose difference between pre and post operation of ¹²⁵I seeds implantation guided by 3D print tamplate and investigate the dose accuracy.

From August 2015 to November 2015, a total of 9 patients were selected and underwent 3D print tamplate guided ¹²⁵I seeds implantation in Hebei General Hospital. All patients had been fixed as the position of operation and then performed CT scan. After preplan was designed, the 3D tamplates were printed. The tumors were punctured through needles holes predesigned. Another CT scan was used to confirm the locations of needles and then seeds were implanted into tumor according to preplan. Postplan was performed after the operation. The D90, V90, V100, V150 and seeds number pre and post operation were collected and compared.

The mean D90, V90, V100, V150 and seeds number preoperation was (7 684±3 279)cGy, 93.2%±0.8%, 89.8%±0.9%, 62.8%±4.7% and 58±17 respectively. The mean D90, V90, V100, V150 and seeds number postoperation was (7 531±3 523) cGy, 92.4%±2.0%, 88.0%±2.5%, 61.9%±5.3% and 56±17 respectively. The difference of all data between pre and post operation was not statistically significant (all P> 0.05).

The dose parameters in postplan show no difference compared with preplan. For the fixed tumor, 3D print tamplate guided seeds implantation may become an easy repeated and standard procedure.

To investigate the ability of two non-invasive fibrosis indexes-APRI, i. e. aspartate transaminase (AST) to platelet (PLT) ratio index, and fibrosis index based on the 4 factors (FIB-4)score in predicting ALFD in patients with unresectable primary HCC and underwent TACE.

Clinical data of those patients treated with TACE in Department of Interventional Radiology of the Center from Jan 2010 to Aug 2014 were investigated retrospectively. A total of 366 cases were enrolled after randomized selection, 62 (18.5%) of which developed ALFD after TACE. Child-Pugh score, APRI and FIB-4 score in every case were calculated, receiver operating characteristic (ROC) curve of each model were performed and the predictive abilities of them were assessed by area under the curve (AUC), positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity.

The AUC of Child-Pugh score, APRI and FIB-4 score were 0.783, 0.752 and 0.758 respectively, while the difference had no significance in statistics, indicating that predictive accuracies of them were similar. APRI≤1.15 and FIB-4≤3.08 had better NPV (90.6% and 93.6%) and sensitivity (65.6% and 80.0%) than Child-Pugh score>6 (NPV=85.8%, sensitivity=27.4%), PPV and specificity of them are 35.7%, 32.9%, 89.5% and 73.7%, 64.2%, 99.3% respectively.

Comparing to Child-Pugh score, APRI and FIB-4 score have similar accuracy but better NPV and sensitivity in predicting post-TACE ALFD. Thereafter they are good for selection of low-risk patients for TACE treatment. Candidates with an APRI≤1.15 or a FIB-4≤3.08 or in Child-Pugh a stage are unlikely to develop ALFD thus could receive TACE safely.

To evaluate the worth of solid predictors in acute intracerebral hematoma(ICH) expansions in computer tomography images.

A total of 105 patients with acute ICH in The Second Affiliated Hospital of Soochow University during January 2012 to February 2015 were enrolled. CT plain scan, CTA within 6 hours since the symptoms and CT plain scan recheck within 24 hours were executed. Hematoma location, initial volume of hematoma, shape of hematoma, "spot sign" , UHG speed were analyzed with single factor and binary Logistic regression between the patients with and without hematoma expansion.

There were 30 cases with hematoma expansion and 75 cases with no hematoma expansion in 105 patients. In single factor comparisons, hematoma location(χ² =13.125, P<0.05), hematoma shape(χ² =23.987, P<0.05), spot sign(χ² =25.846, P<0.05), UHG speed(χ² =20.328, P<0.05) and the initial hematoma volume(t=-3.183, P<0.05) between the hematoma expansions and the non-hematoma expansions made significant differences. In binary Logistic regression, hematoma shape(irregular (P=0.033) and cleavage(P=0.009)), spot sign(P=0.000) and UHG speed(P=0.040) had significant differences between the two groups. ROC curve areas of hematoma shape, spot sign and UHG speed were 0.776(95%CI 0.682-0.870), 0.740(95%CI 0.625-0.855) and 0.720(95% CI 0.604-0.836). The high specificities of hematoma shape(84%), spot sign (88%)and UHG speed(84%)revealed their great reliabilities with equal sensitivity (60%).

Hematoma shape, spot sign and UHG speed are solid predictors of hematoma expansion among which spot sign has promising specificity, hematoma shape and UHG speed are more convenient to be observed.

To report a new technique of modified percutaneous vertebroplasty (PVP) assisted by preoperative CT-based digital design for osteoporotic vertebral compression fracture (OVCF), and to discuss its preliminary clinical results.

Thoracolumbar spine segment data (Dicom format) were obtained from lamellar CT scanning of seven old female or male with single OVCF. A three-dimensional model of thoracolumbar spine and simulative PVP models (via double transpedicular approach) were built in the Mimics software. With the help of a preoperative transparent marker located at the back midline skin and preoperative digital design by Mimics software, the needle insert point and needle direction in every patient were established. The surgical time, the number of intraoperative radiation perspective, bone cement filling condition in fracture vertebra, intraoperative complications and visual analogue scale (VAS) scores before and after surgery were recorded to evaluate the preliminary clinical results after modified PVP.

The puncture process during PVP was in high accordance with the preoperative digital design by Mimics software in seven cases of single OVCF with the average age of 78 years old. The operation time was only 16.57±2.07 minutes and the intraoperative radiation perspective numbers were less than ten (7.86±1.68) times. The bone cement filling in all fracture vertebras were good and no surgical complications such as spine cord injury and cement leakage were founded. The VAS scores before and after surgery were 8.57±0.53 points and 1.43±0.53 point (P=0.000), respectively.

Percutaneous vertebroplasty (PVP) assisted by preoperative CT-based digital design has high accuracy, which is expected to reduce operation time, intraoperative radiation exposure and the surgical complications related to puncture failure.

Exogenous lipoid pneumonia (ELP) is a rare type of aspiration pneumonia, which is likely to delay diagnosis because of its similar clinical manifestations to many lung diseases^[1]。 There are few reports on exogenous lipid pneumonia caused by paraffin oil at home and abroad. Now, the experience of diagnosis and treatment is summarized in combination with relevant literature.

A 26-year-old male was admitted to hospital on December 22, 2014 due to "right varicocele for more than 7 years and intermittent macroscopic hematuria for half a year". The patient was found to have right varicocele during physical examination on September 3, 2007, without fatigue, macroscopic hematuria, pain and discomfort in the waist, abdomen and groin area. On September 15, 2007, he underwent minimally invasive surgery for right varicocele in Shouguang People's Hospital of Weifang City, after which the patient's condition was stable. On June 12, 2014, there was no obvious cause or trigger for macroscopic hematuria, which was like meat washing water, no fever, low back pain, no urgency, frequent urination, painful urination, no facial edema and edema of both lower limbs, no foamy urine, and the macroscopic hematuria disappeared after about 1 week of rest. On December 7, 2014, the above symptoms reappeared without obvious triggers. He was given symptomatic and supportive treatment such as thrombin in the local hospital, but his condition did not improve. On December 17, 2014, we came to our hospital for routine urine examination + urine red blood cell location showed that the total number of red blood cells was 12.2×10⁹/L, protein + +, white blood cells +, homogeneous red blood cells 90%, granular red blood cells 6%, spore red blood cells 4%, no definite diagnosis, given nephritis rehabilitation tablets, Bailing capsules, caffeic acid, cefixime and other drugs, the condition did not change significantly, and he was admitted to the hospital for further treatment. The patient's past history, personal history, marriage and childbirth history, and family history were not special. Physical examination at admission: body temperature 36.3 ℃, pulse 66 beats/min, breathing 18 beats/min, blood pressure 129/69 mmHg (1 mmHg =0.133 kPa), clear consciousness and good nutrition. There is no pale or yellow stain on the skin and mucosa of the whole body. Unpalpable enlargement of superficial lymph nodes throughout the body. There were no abnormalities in the heart, lung and abdomen. There was no edema in both lower limbs.

The 35-year-old male was admitted to the Department of Endocrinology and Metabolism of the Sixth Affiliated People's Hospital of Shanghai Jiaotong University on September 3, 2014 due to "repeated lower limb soreness after exertion for more than 10 years". More than 10 years ago, he was prone to pain in both lower limbs after fatigue, mainly in ankle and knee joints. He had taken radiographs to suggest "osteoporosis". After taking calcium carbonate D intermittently for 5 years, he still had repeated pain and discomfort in both lower limbs, which was aggravated after fatigue. In June 2013, he suffered a fracture of his right tibia after accidentally falling, and his symptoms improved after 3 months of braking. In March 2014, I fell again due to weakness in my right lower limb. I did not fracture my bone, but my activities were limited. After 3 months of braking, I could get out of bed and do moderate activities, so I could take care of myself. The film showed "obvious osteoporosis", and he went to the osteoporosis department of our hospital in August 2014, and the bone density measurement showed "severe osteoporosis"; MRI scan of right tibia and fibula showed abnormal bone signal in the upper segment of right tibia, considering the resorption change of old hematoma. MRI of the head showed no abnormalities; X-ray radiographs showed mild osteoporosis of skull bones and trabecular sparsity of pelvic bones. Electrolytes: calcium 2.36 mmol/L (normal reference value: 2.08-2.60 mmol/L), phosphorus 1.18 mmol/L (normal reference value: 0.80-1.60 mmol/L). The erythrocyte sedimentation rate was 9 mm/1 h (normal reference value: 0-38 mm/1 h), and the total 25-hydroxyvitamin D was 57.7 nmol/L (<50 nmol/L insufficient,>50 nmol/L sufficient), parathyroid hormone (PTH) 30.0 ng/L (normal reference value: 15.0-65.0 ng/L), and the diagnosis of "severe osteoporosis". Calcitriol 0.25 μ g twice a day and calcium carbonate D 0.6 g once a day were given orally. The juvenile physique is acceptable, and there is no obvious abnormality in growth and development compared with that of peers. However, since childhood, my sense of smell is slow, and I can't distinguish between irritating smells such as vinegar, ethanol and perfume. Secondary sexual characteristics began to appear at the age of 15, with Adam's apple and beard. She married at the age of 26, and her sexual life was poor after marriage. She had a daughter three years ago, and was conceived by "in vitro fertilization" technology. Parents who are not intimate married and have no similar diseases in their families.

Panic disorder (PD) is an acute anxiety disorder characterized by recurrent panic episodes, accompanied by severe impairment of social function, with an annual prevalence of up to 1.8%^[1]。 Regarding the pathogenesis of PD, it is currently believed that panic attacks come from abnormal fear networks in the amygdala as the core and in the hippocampus, thalamus, hypothalamus, gray matter around the aqueduct of the midbrain, and spot coerulea^[2]。 In recent years, with the rapid development of brain imaging, especially magnetic resonance imaging, a large number of new discoveries have been made in the study of brain structure and function of PD, which provides new evidence for elucidating the neuroanatomical mechanism of PD.

Polycystic ovary syndrome (PCOS) is a highly heterogeneous disease caused by multiple factors. The main characteristics include chronic thin ovulatory or anovulatory infertility, hyperandrogenemia, insulin resistance (IR) and/or hyperisletemia. It is the main cause of anovulatory infertility, which seriously affects women's quality of life and physical and mental health^[1]。 The research progress of PCOS metabolic abnormalities is summarized as follows.

Mitochondrial complex I [nicotinamide adenine dinucleotide (NADH): ubiquinone oxidoreductase], as the first and largest enzyme in the oxidative phosphorylation (OXPHOS) system, is crucial in human energy metabolism and supply. Oxidative phosphorylation is the process of breaking down organic nutrients and converting them into adenosine triphosphate (ATP) products. Complex I dysfunction can lead to complex I deficiency, which is the most common biochemical deficiency of the OXPHOS system. OXPHOS disorder is estimated to occur in 1 out of every 5 000 newborns, with complex I deficiency accounting for 25% to 35%^[1]。