Volume 96  ·  Issue 45  ·  2016

Abdominal aortic aneurysm (AAA) is a kind of vascular surgical disease that seriously endangers patients' lives. Abdominal aortic aneurysm resection and revascularization were once the main measures to treat abdominal aortic aneurysm. In 1997, Academician Wang Zhonghao first successfully treated infrarenal abdominal aortic aneurysm with self-developed stent-type artificial blood vessel in China, thus creating a new era of endovascular repair of abdominal aortic aneurysm (EVAR) in China. In the past 19 years in China, with the progress of endovascular treatment technology and the improvement of endovascular devices, EVAR has become the most commonly used treatment measure for abdominal aortic aneurysm in China. However, what is the current status of endovascular treatment of abdominal aortic aneurysm in various centers in China? What problems still exist, and what countermeasures may we take? Now aiming at these problems from the following aspects to try to analyze and explain.

Endovascular repair of abdominal aortic aneurysm (EVAR) has become the first choice for treatment of abdominal aortic aneurysm due to its advantages such as less trauma, quick recovery, short operation and hospital stay. Abdominal aortic aneurysms involved both unilateral and bilateral iliac arteries in 43% and 11% respectively^[1],Its treatment is difficult, and postoperative complications such as endoleak, iliac branch occlusion and tumor rupture are prone to occur. In order to reduce type IB and type II endoleak, it is necessary to extend the covered stent to the external iliac artery and embolize or occlude the internal iliac artery (ⅡA). However, various clinical complications can occur. With the continuous update of endovascular treatment equipment and technology, various methods for preserving or reconstructing ⅡA have been developed.

Aortic aneurysms and aortic dissections are a class of diseases with extremely high mortality, usually with rupture of the aorta, ischemia of the organs and limbs, which affects life or quality of life, and even in large heart centers, the mortality rate from surgical procedures exceeds 20%. As early as 1964, Dotter put forward the concept of endovascular repair of aneurysms. Twenty-seven years later, Parodi developed the first generation of covered stents. At that time, polytetrafluoroethylene artificial blood vessels were used and fixed on metal stents, and the first case of endovascular repair of abdominal aortic aneurysm (AAA) was successfully completed, thus opening up a new era of endovascular repair of aortic diseases. Because this procedure is less invasive and has fewer complications, endovascular therapy (EVAR) has become the preferred method for the treatment of complex aortic lesions. However, those complex aortic diseases involving important branches (such as carotid artery and visceral artery) have been difficult for vascular surgeons to perform EVAR, mainly reflected in the management of superior aortic arch artery and visceral artery (VA). With the progress of the times and the development of medical material science and technology, the technique of endovascular reconstruction of branched blood vessels makes the application of endovascular grafts break through the anatomical limitations of important branched blood vessels, and turns the complete endovascular treatment of completely complex aortic aneurysm into a reality. This article will briefly describe the current progress in endovascular treatment of diseases involving important branches of the aorta.

Endovascular treatment of abdominal aortic aneurysms (EVAR) began to rise in the 1990s^[1,2]。 In the early stage, the scope of application of EVAR was very limited due to the limitations of the patient's anatomical conditions, age and equipment. Since then, the intraluminal technology has become increasingly mature, and the performance of intraluminal instruments has been continuously improved, so that the intraluminal treatment can be applied to more complex lesions, and the therapeutic effect has been improved.

Alzheimer's disease (AD), as a common chronic degenerative neurological disease in the elderly with cognitive dysfunction and mental behavior disorders as the main clinical features, affects daily life and social function, which brings a heavy burden to the families and society of patients. Although the basic research of AD has made great progress in recent years, clinical trials of new drugs based on the pathophysiology of AD have failed repeatedly. One of the main reasons is that most of the current drug studies are targeted at the dementia stage of AD. However, at this stage, a large number of neurons have undergone degenerative lesions or death, and it is difficult for drug intervention to reverse these lesions and achieve ideal therapeutic effect^[1]。 Therefore, it is generally believed that only early research and intervention for AD can achieve better clinical efficacy^[2]。 In 2011, the diagnostic criteria for AD introduced by the National Institute on Aging and the Alzheimer's Association, namely NIA-AA diagnostic criteria, put forward the concept of "pre-dementia stage" of AD, including clinical asymptomatic phase and mild cognitive dysfunction phase (MCI)^[3]。 The three stages of asymptomatic phase, MCI phase and dementia phase of AD were regarded as continuous pathophysiological processes of the same disease. Although the cognitive function of AD patients in the pre-dementia stage is not significantly impaired and their daily life ability is basically maintained, there are many pathophysiological changes in the brain of patients such as abnormal A β accumulation, abnormal synaptic function and abnormal phosphorylation of tau protein. The risk of MCI transforming into dementia is significantly higher than that of normal people, and about half of MCI patients will eventually develop AD^[4]。 The concept of pre-dementia stage of AD moves the research focus of AD forward and opens a new window for early diagnosis and treatment of AD.

To summarize results of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm(AIPA), and to analysis clinical predictors of long term major adverse clinical events(MACE).

Retrospectively collected endovascular treatment for AIPA cases in Peking Union Medical College Hospital within 2000 to 2015. Twenty-nine cases with AIPA treated by endovascular therapy were enrolled in this study. Twenty five cases were male, range from 23 to 67 years old, mean age was (39.3±11.4) years old.Demographic characters, locations of aneurysms, type to auto-immune disease, immuno medical therapy, operation strategy and long term follow-up data were reported. Statistical analysis was made to verify clinical predictors of long-term MACE.

Among the 29 cases, 22 cases with bechet′s disease, 4 cases with Takayasu′s arteritis, 2 cases with systemic lupus erythematosus, 1 cases with polyarteritis nodosa. Eight cases had ruptured or pending ruptured pesudo-aneurysms, the rest 21 cases had dull pain or no overt symptome. Twenty-four cases had infra-renal artery aneurysms, two were para-and supra-renal artery, two were supra-celiac artery, and the rest one had multiple aneurysms involved thoracic and abdominal aorta.All the cases received regular immune medical therapy except the three emergency cases. All the operations were under general anaesthesia. Nineteen cases underwent classical Endovascular aortic aneurysm repair (EVAR), 5 cases underwent fenestration EVAR, the rest 5 cases underwent hybrid procedure. All the 29 operations were successful, without conversion to open surgery. Major peri-operation complication included 3 incision infection, 3 pulmonary infection. No death occurred. All the cases received regular follow-up from 1 to 120 months. There were five recurrence of pseudo-aneurysm, 1 case suffered from iliac limb occlusion. 5 cases received re-intervention procedure. No occlusion of revascularizal visceral artery was found during follow-up. There were 3 deaths during follow-up, with 1 aneurysm related death, the rest died due to other reasons. Single factors logical regressions analysis showed discontinuing immune medicine therapy and age no less than 40 years significantly related long-term MACE(P<0.05). Meanwhile, type of original auto-immune disease, none classical EVAR were not significant related to MACE.

Endovascular therapy is safe and effective for AIPA. Regular peri-operation and long-term immunotherapy is key to success.

To investigate the clinical value of endovascular aneurysm repair(EVAR) using fenestration on table for abdominal aortic aneurysm(AAA) with short proximal neck.

A retrospective analysis of four cases with short proximal neck AAA from Aug. 2015 to May. 2016 of Tianjin Medical University General Hospital treated by EVAR using fenestration on table. Fenestrated stent-grafts were designed according to the preoperative computer tomography angiography(CTA) data. All cases underwent EVAR with the fenestrated stent-grafts on table to revascularize visceral branches.

FEVAR was performed in all of the 4 cases successfully. Device deploying success rate was 100%. No type Ⅰ endoleak was found in all of the 4 cases. Transient renal dysfunction occurred in two cases during 7 post-operative days and improved with the medical treatment. Mean follow-up period was 4.7 months(range, 1-9 months). CTA (3 cases) and ultrasonic imaging(1 case) were performed postoperatively. No endoleak was found around fenestrated stent graft and patency of visceral stent grafts were maintained in all of the 4 cases.

EVAR using fenestration on table for short proximal neck AAA is safe and feasible, which expand the indication of EVAR for AAA, and the long-term safety and outcomes of this technique need to be assessed in the future.

This study was aim to compare the efficacy and safety of percutaneous access and open femoral exposure for endovascular aortic aneurysm repair.

Eligible studies were searched from PubMed, Embase, and Corchrane databases published in English from January 1999 to December 2015. Data extracted from each study were synthesized into overall odds ratios (OR) for technical success rates and complications. The outcomes on technical success rates and complications of both totally percutaneous access and open femoral exposure group were compared.

After a systematic review of English language articles, ten studies including 1 504 patients were eligible for the Meta-analysis. The technical success rates of the percutaneous endovascular aortic aneurysm repair (PEVAR) group was 95.1%, close to that of femoral exposure (FE) group (97.5%). The difference did not show significantly (OR=0.57, 95% CI: 0.31-1.04, P>0.05). However, the incidence of total postoperative complications in PEVAR group was 8%, significantly lower than that in FE group (15.9%) (OR=0.52, 95% CI: 0.37-0.42, P<0.01).

PEVAR is associated with a similar technical success rate and lower complication incidence rate comparing with FE. Therefore, it could be as a preferred approach of endovascular aortic aneurysm repair.

To discuss the association between ultrasound screening frequency and total mortality in patients with HCC before diagnosing HCC, and explore the optimal ultrasound screening frequency for HCC high-risk groups.

Retrospectively collected clinical data of 615 cases of liver cirrhosis who developed to HCC from January 1, 2010 to December 31, 2015. Before diagnosing HCC, all patients were divided into five groups according to ultrasound screening frequency: 0-6, 7-12, 13-24, 25-36 months and not screened within 3 years (never screened). The chance to receive curative therapy, 5-year cumulative mortalities and independent factors of mortality in patients with HCC were analyzed.

Chances to receive curative therapy among the 0-6, 7-12, 13-24, 25-36 months and never screened groups were 38.2%, 27.2%, 25.4%, 23.8% and 19.7%, respectively (P<0.05). The 5-year overall mortality rates were 76.4%, 77.7%, 79.3%, 82.5% and 84.6%, respectively. Compared with 0-6 months, the adjustedOR of mortality for the other groups were 1.112, 1.235, 1.305 and 1.451, respectively (all P<0.05). Multivariate analysis showed that ultrasound screening frequency, curative treatment and Child-Pugh (class A/B) were the factors to affect long-term survival in patients with HCC (allP<0.05).

For HCC high-risk groups, optimal ultrasound screening frequency is within 6 months, and high-frequency ultrasound screening can increase the chance of receiving curative treatment, reduce total mortality, and improve overall survival.

To analyze features and the related factors of myoclonus of 47 patients with probable or possible Creutzfeldt-Jakob disease (CJD).

All patients diagnosed with"suspected CJD" and hospitalized in Xuanwu Hospital from January 2013 to November 2015 were included, and their clinical information and myoclonus features were analyzed. Age, clinical, course and manifestation, EEG, MRI, CSF14-3-3 features between myoclonus positive group and negative group were compared, and the correlation between myoclonus features and these factors was analyzed using Spearman correlation analyses.

(1) Occurrence rate of extrapyramidal symptoms (P=0.028), visual impairment (P=0.025) and dyssomnia (P=0.004) were higher in myoclonus positive group, the differences were significant. Spearman correlation analysis showed that myoclonus was related to extrapyramidal symptoms (P=0.024), visual impairment (P=0.030) and dyssomnia (P=0.001). (2) EEG features showed no significant difference between myoclonus positive and negative group. The 17 myoclonus positive patients were divided into three subgroups, typical EEG change group 52.94%(9/17), atypical EEG change group 23.53%(4/17) and no EEG change group 23.53%(4/17). Difference of myoclonus and other clinical manifestations were not significant among the three subgroups(P>0.05); correlation analysis also found no statistically significant correlation between myoclonus and EEG (P=0.201).

Myoclonus often occurs after the damage of locomotor system (including pyramidal tract, extracorticospinal tract and cerebellum) among CJD patients, and it is related to extrapyramidal symptoms , visual impairment and dyssomnia . There is undefined correlation between myoclonus and periodic sharp wave complexes (PSWC) in EEG.

To study and the value of morning plasma adrenocorticotropic hormone (ACTH) and urinary free cortisol (24 h UFC) within 3 days after operation in patients with Cushing′s disease in predicting the long-term outcome.

The clinical data of 140 patients with Cushing′s disease who were treated in Department of Neurosurgery of PUMCH from 2012 to 2014 were analyzed retrospectively.The univariate analysis, multivariate Logistic analysis, ROC curve analysis and other statistical methods were used to study the predicting value of morning plasma ACTH and 24 h UFC in 3 days post operation.

Univariate analysis showed that in the two groups of the early remission and no remission, there was significant statistical difference between the preoperative ACTH, preoperative 24 h UFC, postoperative ACTH and postoperative 24 h UFC (P<0.05, <0.01, <0.01). Logistic analysis showed that ACTH and 24 h UFC after operation of two groups had significant difference (P<0.01, <0.05). ROC curve analysis showed that postoperative cutoff values of ACTH and 24 h UFC were 4.11 pmol/L (18.7 pg/ml) and 281.42 nmol (102 μg)/24 h. ROC analysis was performed to evaluate the predicting performance of postoperative ACTH, resulting in an area under the curve (AUC) of 0.917 (95%CI: 0.858-0.957, P<0.01). In comparison, 24 h UFC had an AUC of 0.814 (95%CI: 0.739-0.875, P<0.01). The predicting value of ACTH is significantly better than that of 24 h UFC (P=0.005).

Early morning 24 h UFC and ACTH within 3 days after operation both showed considerable accuracy in predicting the long-term outcome of Cushing′s disease, and the significance of ACTH was even greater than that of 24 h UFC.

To study the clinical manifestations and detection method for imported patients of Zika virus disease.

The records of symptoms, signs and laboratory results were collected and analyzed. The specimen of blood, saliva and urine from patients were collected.

Two of ten patients had mild fever. The visible cutaneous maculopapular rash of the trunk and extremities was observed in all patients. Seven patients were observed congestive conjunctivitis and only one patient gave an account of itching. No patient had symptoms of myalgia or arthralgia. The laboratory results of patients were normal except two patients had mild leucopenia and another one had thrombocytosis. The Zika virus RNA was detected in urine samples for a longest period. The detection rates of Zika virus RNA from the samples of blood, saliva and urine that collected in seventh day after disease onset were 0, 5, 8 cases, respectively.

Epidemiology history, maculopapular rash, congestive conjunctivitis and Zika virus RNA being detected in urine can be considered as the important clinical criterion for making a definite diagnosis as Zika virus disease.

To compare the clinical outcomes among three kinds of transforaminal interbody fusion technique in the treatment of single segment lumbar degenerative disease.

From October 2012 to November 2014, a total of 67 cases of lumbar degenerative disease of single segment underwent surgical intervention were retrospectively analyzed, including 19 cases by mis- transforaminal lumbar interbody fusion(TLIF), 25 cases by mini-open TLIF and 23 cases by open TLIF.Blood loss, surgical time, fluoroscopy time and hospital costs were recorded.Pre- and postoperative back pain was assessed with visual analogue scale (VAS), and lumbar function was evaluated with Oswestry disability index (ODI).

mis-TLIF group need more surgical time, fluoroscopy time and more hospital costs when compared to mini-open TLIF group and open TLIF group (P<0.05), but no significant difference between mini-open TLIF group and open TLIF group (P>0.05). mis-TLIF group tended to lose less blood than mini-open TLIF group(P<0.05), and mini-open TLIF group lose less blood than open TLIF group (P<0.05). There is no significant difference of the change of ODI among three groups (P>0.05). mis-TLIF group and mini-open TLIF group was superior to open TLIF group in VAS of the second day postoperative [(3.2±1.6) scale, (3.4±1.5) scale vs(5.8±1.4)scale](P<0.05).

mis-TLIF, mini-open TLIF and open TLIF can all get satisfactory clinical outcomes in the treatment of single segment lumbar degenerative disease.mis-TLIF and mini-open TLIF was superior to open TLIF in blood loss, early postoperative recovery.Compared with mis-TLIF, mini-open TLIF reduce the fluoroscopy time and hospital costs, and also has a shorter learning curve.

To explored the clinical effects of different methods of the proximal fusion for long segmental lumbar vertebrae fusion in treatment of degenerative lumbar scoliosis(DLS).

From January 2007 to March 2014 fifty-five cases of DLS treated by the posterior proximal fusion of long segmental lumbar vertebrae fusion were analyzed in Department of Orthopaedics, Shanghai general Hospital of Nanjing Medical University (35)HuaiAn The First Hospital Affiliated to Nanjing Medical University(20). According to various upper instrumented vertebra(UIV) the patients were divided into Group A(upper horizontal vertebra, UHV, n=17), Group B (upper natural vertebra, UNV n=18 ), and Group C(upper end vertebra, UEV, n=20). The VAS, ODI, spinal balance parameters and postoperative complications in each group were assessed.

Except for 1 case death of serious lung infection in early postoperative, 54 cases were received 2-4 years follow-up. No statistical differences in improvements and fusion rates were found among 3 groups (P>0.05). The improvements of the coronal Cobb′s angle in the A group were significantly more than the C group (75.8%±12.8%, 69.6%±11.8%, 63.4%±15.3%,P<0.05). The incidences of early postoperative complications in A group were the highest, next in B group, and lowest C group (52.9%, 22.0%, 15.0%,P<0.05). The incidences of proximal ASD in the C group were significantly more than the A group (12.5%, 22.2%, 50.0%,P=0.045).

UHV, UNV and UEV had similar clinical outcomes for treatment of degenerative lumbar scoliosis in short term. Correction of the coronal deformity of UHV was superior to UEV. UEV was beneficial to reduce early complications, but more likely to happen proximal adjacent segment degeneration in the long run.

The association between endometrial stimulation and the intrauterine insemination outcome remains to be a controversial issue, for there being all kinds of conflicting data in the existing literatures. We conducted a Meta-analysis case to verify the relations between endometrial stimulation and intrauterine insemination (IUI).

The articles had been searched in the following online databases: MEDLINE, CNKI, VIP, Wan Fang, EMBASE and the Cochrane Library. All of the statistics quoted for our studies have been published in English or Chinese from Jan, 2000 to May, 2016. Among the 6 studies included in this Meta-analysis, all of them used a case - control design. All the 6 studies evaluated a total of 1349 participants, including 734 cases of endometrial injury.

The results of the Meta-analysis showed that patients with endometrial stimulation were more likely to receive clinical pregnancy than those who did not. Compared with the control group, the clinical pregnancy rate of experiment group was higher (RR=0.88, 95% CI: 0.82-0.95, P=0.001), while the differences between their abortion rate (RR=0.72, 95% CI: 0.37-1.4, P=0.33) and multiple pregnancies rate (RR=0.78, 95% CI: 0.3-2.01, P=0.60) were insignificant.

Endometrial stimulation could help increase the pregnancy rate in IUI cycles, while the abortion rate and multiple pregnancies rate would not be raised.

Case 1 male, 14 years old, developed inability to lift the left upper arm and weakness of flexing the elbow of the left upper limb without obvious trigger 3 months ago, which lasted for about 1 week and gradually relieved. Three days ago, the above symptoms were aggravated again when the left upper limb elbow support was used to operate the mobile phone, with numbness in the left upper limb and no pain. Family history denied. When he went to Qilu Hospital of Shandong University (Qingdao), the muscle strength examination showed that the left deltoid muscle was grade 3, the biceps brachii was grade 4, and the triceps brachii was grade 4. The muscle strength of the rest of the limbs was normal. Symmetric (+ +) tendon reflexes in the extremities. Sensory examination was normal, with pathological signs and high arch (-). Nerve conduction examination of left limb in external hospital at 3 months of onset (Table 1，Table 2) suggesting demyelinating sensorimotor polyperipheral neuropathy with damage to the ulnar nerve at the elbow; Electromyography suggested that the muscles innervated by C5-C7 could be seen with self-visible active denervation and re-innervation, and the damage to the superior and middle trunks of the brachial plexus was considered. Prednisone 30 mg was administered orally once daily for 2 weeks, subsequently reduced by 5 mg every week. Four months after the onset of the disease, the left upper limb function of the patients was basically restored to normal.

The formation of the mammalian cerebral cortex is a complex, dynamic process of change, including neuronal formation, proliferation, differentiation, migration, and synapse formation. However, the development of human brain cortex is more long and complicated. In this process, both genetic and environmental changes can affect the development of the cortex^[1]。 cortical dysplasia (CD) was first discovered in 1867. Virchow studied a 44-year-old male patient and found that there was local aggregation and expansion of cells in the cerebral cortex. He called this phenomenon ectopia. The most representative cortical dysplasia is the local cortical dysplasia common in childhood epilepsy surgery, in addition to microcephaly, multiple cerebellar gyrus, schizophrenia, etc^[2]。

In recent years, stem cell transplantation has a good application prospect in tumor, trauma, degenerative diseases and other fields, and it is a hot spot in medical research. However, because traditional imaging technology cannot provide effective information on biological behavior after cell transplantation, it cannot be used as an objective basis to evaluate the effect of cell therapy, which limits the popularization of stem cell therapy in clinical practice to some extent. With the development of molecular imaging, molecular imaging technologies such as bioluminescence imaging, fluorescence imaging, radionuclide imaging and magnetic resonance imaging (MRI) can visually express complex physiological and pathological processes in the form of images from the cellular level, which provides the feasibility for stem cell tracing in vivo. Biological autoluminescence imaging and fluorescence imaging techniques have low tissue penetration power, and are currently only used in animal experiments^[1]。 Compared with radionuclide imaging, MRI has the advantages of no ionizing radiation, lower examination cost and better spatial resolution^[2], attracting more and more attention. Among them, superparamagnetic iron oxide (SPIO) as MRI probe has good biocompatibility and MRI signal sensitivity, and has been widely used in the research of stem cell tracing. Based on this, the research status of SPIO in stem cell tracing will be reviewed.