2007年 · 第120卷第13期

The surgical procedure of C7 root transfer from the healthy side was first performed successfully on August 26, 1986.1,2 Since then, this procedure has proved one of the major treatments for brachial plexus root avulsions.Nowadays, attitudes of doctors towards this operation have changed from doubt and surprise to deep conviction and acceptance.3,4 The latest progresses in experimental and clinical studies on contralateral C7 root transfer are reviewed in this article。

Abstract：Background After anterior cruciate ligament (ACL) reconstruction, some patients suffered from sensory disturbance around the surgical incision of the leg, This research was aimed to investigate the relationship between the different skin incisions and the injury of the infrapatellar branch of the saphenous nerve (IPBSN) post ACL reconstruction,Methods ACL reconstructions were performed with quadruple hamstring tendon for 60 patients, Sensory disturbance around the skin incision was followed up at an average of 14.5±4.7 months post operation. Among the 60 patients,vertical incision for 35 patients and oblique incision for 25 patients were used for graft taking during ACL reconstruction.The lengths of the incisions were measured. The patients were asked to mark the sensory disturbance zone at follow up time, and then the marked area was measured. The IPBSN of 15 cadaver knees were anatomized. The distance between the IPBSN and the upper edge of the pes anserinus tendon at the middle point of the incision was measured.Independent-samples t-test, chi-square and Mann-Whitney tests were used for statistical analyses.Results The patients'age (P=0.329), the follow-up time (P=0.681), and the incision length (P=0.732) between the two groups had no significant difference. Twenty-three patients (65.7%) in the vertical incision group had IPBSN injury compared with 6 patients (24.0%) in oblique incision group (P=0.002). The average sensory disturbance area in vertical incision group ((48.0±75.3) cm2) was significantly larger (P=0.004) than that in the oblique group ((8.4±19.4) cm2). The anatomy measurement showed the average distance between IPBSN and the upper edge of the pes anserinus tendon was 0.6 cm at the incision.Conclusions Oblique incision with less risk of damage for IPBSN may be better for graft harvesting in ACL reconstruction. As the IPBSN is so near and parallel to the hamstring tendons, damage to the IPBSN is one of the potential complications for graft harvesting, regardless of the incision used. That's why even in the oblique incision group,24% patients also had sensory disturbance complication。

Abstract：Background Total hip arthroplasty (THA) is widely applied for the treatment of end-stage painful hip arthrosis.Traditional THA needed a long incision and caused significant soft tissue trauma. Patients usually required long recovery time after the operation. In this research we aimed to study the feasibility and clinical outcomes of minimally invasive two-incision THA.Methods From February 2004 to March 2005, 27 patients, 12 males and 15 females with a mean age of 71 years (55-76), underwent minimally invasive two-incision THA in our department. The patients included 9 cases of osteoarthritis, 10 cases of osteonecrosis, and 8 cases of femoral neck fracture. The operations were done with VerSys cementless prosthesis and minimally invasive instruments from Zimmer China. Operation time, blood loss, length of incision, postoperative hospital stay, and complications were observed.Results The mean operation time was 90 minutes (80-170 min). The mean blood loss was 260 ml (170-450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average 400 ml). The average length of the anterior incision was 5.0 cm (4.6-6.5 cm) and of the posterior incision 3.7 cm (3.0-4.2 cm). All of the patients were ambulant the day after surgery. Nineteen patients were discharged 5 days post-operatively and 8 patients 7 days post-operatively. The patients were followed for 18 months (13-25 months). One patient was complicated by a proximal femoral fracture intraoperatively. No other complications, including infections, dislocations, and vascular injuries, occurred. The mean Harris score was 94.5 (92-96).Conclusions Two-incision THA has the advantage of being muscle sparing and minimally invasive with less blood loss and rapid recovery. However, this technique is time consuming, technically demanding, and requires fluoroscopy。

Abstract：Background A number of methods have been used in the treatment of symptomatic and aggressive vertebral hemangioma, but none of them is optimal. Vertebral hemangioma treated with cement vertebroplasty or ethanol injection alone showed relatively good results despite their limitations.Methods Between February 2002 and May 2004, twelve patients with vertebral hemangioma were subjected to combined cement vertebroplasty and ethanol injection, five of them were men and seven women, and aged from 26 to 54 years (mean, 41 years). The following levels of the spine were involved: T9: 1, T10: 3, T12: 2, L1: 1, L2: 2, L3:2 and L4: 1.The clinical results and radiographic records of the patients were assessed after 2 years and 5 months of follow-up.Results The average score of back pain significantly decreased from 6.5 before operation to 1.7 one month after operation. No severe complications occurred during and after operation. During the period of follow-up, symptoms were not deteriorated. At the end of follow-up, neither radiographic sign of aggressive destruction nor collapse of the involved vertebra was observed. Significant improvement in the 12 patients was demonstrated on 7 of 8 SF-36 Health Scale except for mental health.Conclusions Cement vertebroplasty combined with ethanol injection as a safe and effective technique is an alternative to the treatment of patients with vertebral hemangioma。

Abstract：Background Dislocation is the second most common complication of hip replacement surgery, and impact of the prosthesis is believed to be the fundamental reason. The present study employed Solidworks 2003 and MSC-Nastran software to analyze the three dimensional variables in order to investigate how to prevent dislocation following hip replacement surgery.Methods Computed tomography (CT) imaging was used to collect femoral outline data and Solidworks 2003 software was used to construct the cup model with variabilities. Nastran software was used to evaluate dislocation at different prosthesis positions and different geometrical shapes. Three dimensional movement and results from finite element method were analyzed and the values of dislocation resistance index (DRI), range of motion to impingement (ROM-I),range of motion to dislocation (ROM-D) and peak resisting moment (PRM) were determined. Computer simulation was used to evaluate the range of motion of the hip joint at different prosthesis positions.Results Finite element analysis showed: (1) Increasing the ratio of head/neck increased the ROM-I values and moderately increased ROM-D and PRM values. Increasing the head size significantly increased PRM and to some extent ROM-I and ROM-D values, which suggested that there would be a greater likelihood of dislocation. (2) Increasing the anteversion angle increased the ROM-I, ROM-D, PRM, energy required for dislocation (ENERGY-D) and DRI values,which would increase the stability of the joint. (3) As the chamber angle was increased, ROM-I, ROM-D, PRM, Energy-D and DRI values were increased, resulting in improved joint stability. Chamber angles exceeding 55(°-) resulted in increases in ROM-I and ROM-D values, but decreases in PRM, Energy-D, and DRI values, which, in turn, increased the likelihood of dislocation. (4) The cup, which was reduced posteriorly, reduced ROM-I values (2.1-5.3(°-)) and increased the DRI value (0.073). This suggested that the posterior high side had the effect of 10(°-) anteversion angle.Conclusions Increasing the head/neck ratio increases joint stability. Posterior high side reduced the range of motion of the joint but increased joint stability; Increasing the anteversion angle increases DRI values and thus improve joint stability; Increasing the chamber angle increases DRI values and improves joint stability. However, at angles exceeding 55(°-), further increases in the chamber angle result in decreased DRI values and reduce the stability of the joint。

Abstract：Background Obesity is now an epidemic in most parts of the world. In this cross sectional study, we report the most recent data on obesity in Hong Kong Chinese working population and compare the changes over 10 years.Methods Between July 2000 and March 2002, 5882 adult subjects from the working class in Hong Kong were recruited (2716 men (46.2%) and 3166 women (53.8%)). They were randomly selected using computer generated codes according to the distribution of occupational groups. Results of this study were compared with the data collected from a prevalence survey for cardiovascular risk factors in a Hong Kong Chinese working population conducted in 1990 (1513 subjects, 910 men (60.1%) and 603 women (39.9%)).Results Standardized percentages of overweight, obesity, and central obesity, in Hong Kong Chinese working population were 59.7%, 35.0%, 26.7% in men and 32.0%, 21.7%, 26.7% in women. Compared to the data collected in 1990, the percentage of obesity increased by 5% in men and reduced by 6% in women. The percentage of central obesity doubled in men (from 12.2% to 26.7%) but remained stable in women.Conclusions There is a doubling of the percentage of central obesity in Hong Kong Chinese working men over previous decade. Education and proper lifestyle modification program to tackle this social health issue are urgently indicated。

Abstract：Background The public vaccination program of hepatitis B virus (HBV) was launched during 1984 in Taiwan, China.However, the long-lasting protective efficacy of HBV vaccination among adolescents older than 15 years of age was seldom recorded.Methods A seroepidemiological survey was conducted among 4575 first-year university students in Taiwan, China during 2000 to 2003, including the serological data of HBV by testing HBV surface antigen (HBsAg), surface antibody (anti-HBs), HBV core antibody (anti-HBc) and demographic information.Results HBsAg carrier rate among male university students born before the initiation of the HBV vaccination program decreased from 12.8% to 4.8% among those born after the vaccination program (P＜0.001, X2 test for linear trend).Similarly, HBsAg carrier rate among female university students born before the initiation of the HBV vaccination program decreased from 8.1% to 2.7% among those born after the vaccination program (P＜0.001, X2 test for linear trend). Both male and female students in eastern Taiwan had the highest HBsAg carrier rate compared with the other places. Using multiple logistic regression analysis, compared with students born after July 1984, the adjusted OR of HBsAg carrier rate decreased from 3.10 for students born before June 1981 to 1.56 for students born from July 1983 to June 1984 (95%CI 1.96-4.91, P＜0.001; 95%C/1.06-2.28, P=0.024; respectively).Conclusions Public vaccination provides long-lasting protection again HBV infection among the university students in Taiwan, China older than 18 years of age. There is a geographic variation of HBV infection among young adults in Taiwan,China。

Abstract：Background Numerous studies have reported a relationship between hepatitis C virus (HCV) genotype and the response to interferon therapy. Despite high sensitivity and specificity, genotyping methods can be performed only on HCV RNA positive samples. Serotyping might be a rapid and cost effective method for determining HCV genotypes,especially in patients with previously undetectable HCV RNA. In this study, an enzyme linked immunosorbent assay (ELISA) method for HCV serotyping with the genotype specific, synthetic peptides derived from HCV nonstructural 5a (NS5A) region was developed.Methods Based on 45 sequences, representing HCV genotypes 1-6 from Genebank, we synthesised 305 overlapping 30-mer peptides within NS5A region at positions 2182-2343 of HCV. All peptides for antigenic reactivity were tested by enzyme immunoassay with 69 human sera with antiHCV positive representing genotype 1-6. Forty hepatitis C patient sera were serotyped using serotype specific, synthetic peptides and genotyped by sequencing analysis.Results The correspondence of amino acids in HCV NS5A region with amino acids in positions 2182-2343 was very low among different genotype peptides. The highly conserved sequences were residues 2182-2211(R1), 2272-2301 (R7)and 2302-2331 (R9): the highly variable 2212-2241 (R3) and 2257-2286 (R6). Using 305 peptides, antigenic regions were located in R3, R7 and R9. Eighteen peptides from highly conserved region representing genotypes 1 to 6 showed broad immunoreactivity with sera containing antibody to all HCV genotypes. Immunoreactivity of the peptides from highly variable region was stronger with similar genotype sera. Twelve unique peptides showed highly, genotype specific,reactivity with types 1 and 3 sera. Type 2 genotype specific peptides had cross reaction with type 3 serum. No type 4, 5 or 6 specific peptides were selected. The serotyping results showed high agreement with sequencing analysis.Conclusions The major antigenic regions in HCV NS5A region were at 2212-2241(R3), 2272-2301(R7) and 2302-2331(R9). Eighteen peptides from highly conserved region show genotype independent, immunoreactivity, useful for antiHCV antibody test. Twelve peptides from highly variable region show genotype 1 and 3 dependent immunoreactivity, useful for determining HCV serotype, especially for patients with previously undetectable HCV RNA。

Abstract：Background Folic acid is very important for embryonic development and dihydrofolate reductase is one of the key enzymes in the process of folic acid performing its biological function. Therefore, the dysfunction of dihydrofolate reductase can inhibit the function of folic acid and finally cause the developmental malformations. In this study, we observed the abnormal cardiac phenotypes in dihydrofolate reductase (DHFR) gene knock-down zebrafish embryos,investigated the effect of DHFR on the expression of heart and neural crest derivatives expressed transcript 2 (HAND2)and explored the possible mechanism of DHFR knock-down inducing zebrafish cardiac malformations.Methods Morpholino oligonucleotides were microinjected into fertilized eggs to knock down the functions of DHFR or HAND2. Full length of HAND2 mRNA which was transcribed in vitro was microinjected into fertilized eggs to overexpress HAND2. The cardiac morphologies, the heart rates and the ventricular shortening fraction were observed and recorded under the microscope at 48 hours post fertilization. Whole-mount in situ hybridization and real-time PCR were performed to detect HAND2 expression.Results DHFR or HAND2 knock-down caused the cardiac malformation in zebrafish. The expression of HAND2 was obviously reduced in DHFR knock-down embryos (P＜0.05). Microinjecting HAND2 mRNA into fertilized eggs can induce HAND2 overexpression. HAND2 overexpression rescued the cardiac malformation phenotypes of DHFR knock-down embryos.Conclusions DHFR plays a crucial role in cardiac development. The down-regulation of HAND2 caused by DHFR knock-down is the possible mechanism of DHFR knock-down inducing the cardiac malformation。

Abstract：Background Tissue Doppler imaging (TDI) has provided an objective means to quantify global and regional left ventricular (LV) and right ventricular (RV) function with improved accuracy and greater reproducibility than conventional echocardiography. This study was conducted to assess RV myocardial systolic activation by TDI in subjects with pulmonary arterial hypertension (PAH).Methods A total of 30 patients with PAH and 30 healthy volunteers, all comparable in age and sex, underwent standard Doppler echo and TDI. Using pulsed Doppler echocardiography combined with TDI, the following regional parameters were evaluated in three different myocardial segments (RV basal lateral wall, basal septal, and LV basal lateral) on apical 4-chamber view: systolic (Sm), early- and late-diastolic (Em and Am) peak velocities. RV myocardial systolic activation delay was defined as the difference in time to peak TDI systolic velocities between the RV basal lateral wall and basal septal. In addition, RV end-diastolic and end-systolic areas were measured to calculate RV fractional area change from the same apical 4-chamber view.Results Compared with the control group, patients with PAH showed increased RA and RV end-diastolic diameter (RA:(4.5±1.2)cm vs (3.0±0.8)cm, P＜0.05 and RV: (4.8±1.9)cm vs (3.4±0.5)cm, P＜0.05) and reduced RV fractional area change; (35±14)% vs (56±9)%, P＜0.05. These PAH patients showed lower myocardial peak velocities and a significant activation delay compared with controls (P＜0.05). Moreover, a strong correlation between RV myocardial systolic activation delay and RV fractional area change was shown in patients with pulmonary arterial hypertension (r = -0.82).Conclusions In PAH, RV myocardial systolic activation was markedly delayed, which was directly related to the RV fractional area change. RV myocardial systolic activation delay assessed by TDI could offer a unique approach to predict RV dysfunction。

Abstract：Background It has been confirmed that the concentration of cefepime in cerebrospinal fluid (CSF) could reach the 10% of its concentration in plasma, exceeding the inhibitory concentration to 90% of organisms (MIC90) for common bacteria.However, the blood-brain barrier (BBB) penetration ability of cefepime is still unclear. The aim of this study was to measure the CSF concentration of cefepime in patients after neurosurgical operations, and to determine the penetration of the drug through an incomplete BBB.Methods Eight patients who received ventricular drainage (VD group) and 5 who underwent lumbar puncture drainage (LPD group) were enrolled into this study. Cefepime (2 g) was injected intravenously in 30 minutes after the neurosurgeries. The concentrations of cefepime in the CSF and plasma were measured by high-pressure liquid chromatography (HPLC) at different time points.Results The CSF concentrations of cefepime at different time points in the VD group were significantly higher than those in the LPD group (P＜0.05). In the VD group, the concentration of cefepime in CSF reached the peak ((22.54±14.06)μg/ml) at 1 to 2 hours after the injection, while in the LPD group at 4 hours ((5.61±3.73) μg/ml). In both groups, the peak was higher than the MIC90 of most common bacteria in intensive care unit. The ratio of CSF to plasma cefepime concentrations ranged from 0.30 to 2.14 in the VD group and 0.03 to 1.14 in the LPD group.Conclusion After neurosurgeries, CSF concentration of cefepime can reach a therapeutic level. Thus, the drug could be used to prevent and treat postoperative intracranial infection。

Background Human group O red blood cells have great benefit in specialized transfusion areas such as armed conflict and natural calamity. The group B antigen differs structurally from group O antigen only by the addition of one terminal α-linked galactose residue. In this study we aimed to remove the terminal galactose from group B red blood cell to get group O red blood cell.Methods α-galactosidase cDNA was cloned by RT-PCR from Catimor coffee beans grown on Hainan Island of China.The vector for α-galactosidase cDNA expression was constructed and transferred into Pichia pastoris cells by electroporation. The transgenic cells were cloned by fermentation and the recombinant α-galactosidase was purified by ion exchange chromatography. After studying the biochemical characters of α-galactosidase, we have used it in converting human erythrocytes from group B to group O.Results The purity of recombinant α-galactosidase was higher than 96%, which was thought to be suitable for the use of blood conversion. Enzymatically converted human group O red blood cells (ECHORBC) exhibited membrane integrity,metabolic integrity, normal cell deformation and morphology. There were no coagulation between ECHORBC and any group of human blood. The ECHORBC will keep normal structure and function for a period of 21 days at 4℃ in monoammoniumphosphate nutrient solution. Experiments with Rhesus monkeys and gibbons showed that transfusion of enzymatically converted erythrocytes was safe.Conclusion ECHORBC can be easily obtained from group B red blood cell by α-galactosidase digestion. This study suggests that ECHORBC could be transfused to patients safely and efficiently.

Abstract：Objective The results of studies on association between -148C/T polymorphism in promoter region of β-fibrinogen gene and susceptibility to cerebral infarction in Chinese population are controversial. In this study, we summarize the results of published works in this field by a meta-analysis.Data sources Genetic association studies evaluating the β-fibrinogen gene -148C/T polymorphisms and cerebral infarction involving Chinese population published before December 2005 were collected from PubMed, EMBASE and CNKI.Study selection Case control studies involving unrelated, Han subjects aged from 18 to 80 years, and the internationally recognized diagnostic standard of cerebral infarction and genotype frequencies in control group consistent with Hardy-Weinberg equilibrium were used. Publication bias was tested by funnel plot and the odds ratios of all studies were combined dependent on the result of heterogeneity test among the individual studies. The software Review Manager (Version 4.2) was used for meta-analysis.Results Eleven studies including 1223 patients and 1433 controls met the selection criteria. There was no heterogeneity among the odds ratios (ORs) of individual studies (x2=17.82, P=0.06). The combined OR of susceptibility to cerebral infarction in -148T allele carriers compared to the wild homozygote was 1.32 (95%C/1.12 to 1.55, P=0.0008).In the patients with cerebral infarction, the average plasma fibrinogen level of allele T carrier was 0.42 g/L (95%CI 0.29 to 0.54, P＜0.001), higher than that of -148C/C homozygous ones.Conclusions β-fibrinogen gene -148C/T polymorphism might contribute to susceptibility to cerebral infarction in Han Chinese. To reach a definitive conclusion, further gene to gene and gene to environment interactions studies on β-fibrinogen polymorphisms and cerebral infarction with large sample size are required。

Podocytes in renal glomerulus express unusual intermediate filament proteins (IFs) for visceral epithelial cells. IFs cytoskeleton is mainly composed of vimentin, nestin and desmin. Tissue injury is often accompanied by changes in gene expression of IFs.1 Enhanced desmin staining in podocytes are observed in a variety of rat experimental models of podocyte injury including puromycin aminonucleoside (PAN)nephrosis.2-4 It has not been elucidated whether expression of vimentin and nestin is up-regulated in podocyte injury. To further gain insight into expression of IFs in podocytes, we investigated the time course of vimentin, nestin and desmin in PAN nephrosis。

Multiple toes transplantation is an effective method for restoring the prehension of the hands.1-5 Generally, the thumb, index and middle finger are reconstructed by transferring a free big toe skin-nail flap with the second and third toes from a same foot. The great saphenous vein, superficial veins on the dorsum of the foot, the dorsalis pedis artery, and the first dorsal metatarsal artery are resected to be used as the donor pedicle. The arterial pedicle is freed up to the dorsal digital artery of the big and second toes. Both the second and third toes are supplied by the dorsal digital artery of the second toe on the tibial side. By using unilateral toe donation to reconstruct a digitless hand, we can preserve the normal form and function of the contralateral foot.However, because of the small length of the digital arteries between the big and second toes, the first web space is limited. Here we present our experiences on two cases of hand reconstruction with unilateral three toes transplantation. Good function and motion range of the thumb were achieved in both the patients。