2013年 · 第126卷第23期

Abstract：Background During scanning of the right hypochondrium and right intercostal regions with an ultrasonic transducer,several ultrasonic images of oblique sections are obtained.It is still a challenge for ultrasonography to divide these nonconventional sections into an accurate hepatic segmentation pattern.The aim of this research was to investigate the value of the virtual hepatic segment model (VHSM) in assisting the ultrasonic localization of space-occupying hepatic lesions.Methods VHSM was constructed via 3D reconstruction according to the first Chinese visible human dataset.Preoperative ultrasonography,contrast-enhanced CT scan and VHSM techniques were performed in 100 patients with spaceoccupying focal lesions in the liver parenchyma for segmental localization.The results of these three techniques were compared with the operative findings.Results VHSM was successfully detected on 2D sectional images by 3D reconstruction through surface rendering and volume rendering.The model could simulate ultrasonic directions to conduct a virtual dissection on any section plane,and fine liver segmentation could be displayed in any virtual plane.In 100 patients,there were 112 liver space-occupying focal lesions distributed in 148 liver segmentations.Regarding the positioning accuracies for lesions of different sizes and the lesion segmental distribution accuracies estimated using the three methods mentioned above,ultrasonography exhibited a significantly lower accuracy than VHSM for the segmental localization of lesions (P ＜0.05),and contrast-enhanced CT was not significantly different from ultrasonography plus VHSM (P ＞0.05).Conclusion VHSM increased the accuracy of ultrasonic localization of space-occupying hepatic lesions,particularly in hepatic hypovascular regions。

Abstract：Background Accurate evaluation of coronary artery,aortic valve annulus diameter (AVAD),and cardiac function in patients with aortic valve disease is of great significance for surgical strategy.In this study,we explored the preoperative evaluation of low-dose sequence (MinDose sequence) scan of dual-source CT (DSCT) for those patients.Methods Forty patients suspected for aortic valve disease (the experimental group) underwent MinDose sequence of DSCT to observe coronary artery,AVAD,and left ventricular ejection fraction (LVEF).Another 33 subjects suspected for coronary artery disease (the control group) underwent conventional retrospective electrocardiographically-gated sequence of DSCT.Two-dimensional transthoracic echocardiography (2D-TTE) and four-dimensional transthoracic echocardiography (4D-TTE) were applied in the experimental group to measure AVAD and LVEF and compared with MinDose-DSCT.Results There was a strong correlation between LVEFs measured by 2D-TTE and MinDose-DSCT (r=0.87,P ＜0.01),as well as between 4D-TTE and MinDose-DSCT (r=0.90,P ＜0.01).AVAD measured by MinDose-DSCT was in good agreement with corresponding measurements by 2D-TTE (r=0.90,P ＜0.01).The effective dose in the experimental group was 63.54％ lower than that in the control group.Conclusions MinDose sequence of DSCT with a low radiation dose serving as a one-stop preoperative evaluation makes effective assessment of the coronary artery,AVAD,and LVEF for patients with aortic valve disease。

Abstract：Background Symptoms,endoscopy,and pH monitoring form the basis of diagnosis of gastroesophageal reflux disease (GERD).Their relationship was meaningful for primary care physicians,but still unclear.Our research aimed to compare questionnaire,endoscopy,and pH monitoring and to analyze their correlations.Methods Three hundred patients who underwent the Reflux Disease Questionnaire (RDQ),endoscopy,and esophageal 24-hour pH monitoring from March 2007 to December 2010 in Peking University People's Hospital were enrolled.We analyzed the characteristics of different investigations and their relationships.Results Male (OR for mild reflux esophagitis (RE) =2.433,severe RE =8.386),body mass index (BMI) (OR for mild RE =1.222,severe RE =1.297),and hernia (OR for mild RE =6.059,severe RE =17.547),were found to be the risk factors for RE; age (OR=1.074) was correlated with severe RE.The consistency of questionnaire,endoscopy,and pH monitoring was poor:RDQ did not agree well with pH monitoring (K=0.061),nor with endoscopy (K=0.044); pH monitoring did not agree well with endoscopy (K=0.316).However,the severity of mucosa injury in RE was associated with pathological acid exposure (PAE):reflux episodes of ＞5 minutes (P=0.035),the percentage time pH ＜4 (P=0.017),and the DeMeester score (P=0.016) increased significantly in patients with severe RE.Chest pain had poor relationship with RE or PAE.Conclusions Male,age,BMI,and hernia were probably risk factors for esophagitis.RDQ,endoscopy,and pH monitoring have their own focus and reinforce each other in diagnosis.Of the GERD symptoms,chest pain had negative correlation with RE or PAE。

Abstract：Background Aberrantly expressed microRNAs are a hallmark of cancer,and microRNA expression profiling is associated with tumor progression and response to chemotherapy,suggesting their potential application as prognostic and predictive biomarkers.The role of microRNAs in lung cancer remains elusive.It has been recently reported that epidermal growth factor receptor (EGFR) and hepatocyte growth factor receptor (MET) tyrosine kinase can regulate expression of specific microRNAs including miR-30b,miR-30c,miR-221,miR-222,miR-103 and miR-203,and induce tumorigenesis and gefitinib resistance in lung cancers.We intend to study the role of miR-30b and miR-30c expression in predicting response to tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC).Methods We have therefore retrospectively examined expression of miR-30b miR-30c in 41 formalin fixed paraffin embedded tissue samples from NSCLC patients when TKIs were used as first line therapy.Results We found a significant correlation between expression of miR-30b and miR-30c.Furthermore,miR-30b and miR-30c expression correlated with short-term response.Kaplan-Meier analysis further revealed that the expression of miR-30b and miR-30c predicted progression free survival and the overall survival rate in the examined cohort.Conclusion Our study identified miR-30b and miR-30c as useful prognostic predictors in NSCLC patients who underwent first line treatment with TKIs。

Abstract：Background Subjective assessment tools such as visual analog scales (VAS) or pain scores are commonly used to evaluate the intensity of chronic cancer-induced pain.However,their value is limited in some cases.We measured changes in VAS pain scores and salivary a-amylase (sAA) concentrations in cancer patients receiving radiotherapy for bone metastases to ascertain the correlation between these measures.Methods We enrolled 30 patients with bone metastases attending a single institution from June 2010 to March 2011.All patients with cancer-induced bone pain received radiation therapy (RT) at the same dose (30 Gy) and fractionation (3 Gy/ fraction,5 days/week) for palliative pain relief.We assessed heart rate (HR),systolic and diastolic blood pressures (DBP/SBP) and VAS pain scores before (d0) and after five (d5) and ten fractions (d10) of irradiation,sAA and salivary cortisol (SC)concentrations were measured using a portable analyzer and automated chemiluminescence analyzer,respectively.Results Radiotherapy markedly decreased VAS scores from (82.93±9.29) to (31.43±t16.73) mm (P ＜0.001) and sAA concentrations from (109.40±26.38) to (36.03±19.40) U/ml (P ＜0.001).Moreover,there was a significant correlation between these two indices (P ＜0.01,r=0.541).HR decreased by 6.5％ after radiotherapy,but did not correlate with VAS scores (P ＞0.05).SC concentrations and BP did not change significantly during the study (P ＞0.05).Conclusions The significant correlation between sAA concentrations and VAS pain scores identified in these preliminary results suggests that this biomarker may be a valuable,noninvasive and sensitive index for the objective assessment of pain intensity in patients with cancer-induced bone pain。

Abstract：Background Differential diagnosis of isolated calf muscle vein thrombosis (ICMVT) and gastrocnemius hematoma is essential for early identification of deep vein thrombosis (DVT).This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.Methods A retrospective case series of 35 ICMVT (M∶F,21∶14; mean age (64.5±10.6) years) and 23 gastrocnemius hematoma (M∶F,16∶7; mean age (75.4±11.8) years) patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012.Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein,great saphenous vein,calf muscles,skin,and soft tissue were examined.Results ICMVT hypoechoic signals were characterized by long,tube-like masses on longitudinal sections and oval masses on transverse sections,with apparent muscle thrombosis boundaries,distal and proximal venous connections,and,often,lower limb DVT.Gastrocnemius hematoma hypoechoic signals were characterized by large volumes,enhanced posterior hematoma echo,hyperechoic muscle boundaries,no hematoma blood flow,and no DVT,and clear differences in trauma/exercise-and oral anticoagulant-induced hematomas were readily apparent.According to the measurement,the ratio of long diameter/transverse diameter (D/T) in ICMVT patients was about less than 2.0,whereas in gastrocnemius hematoma patients the ratio was more than 2.0.Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas.Partial muscle fibers in the hematoma due to muscle fractures were apparent.Conclusion High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use。

Abstract：Background Pulmonary hypertension (PH) is a set of pathophysiological syndromes characterized by increased pulmonary artery pressure and pulmonary vascular resistance,resulting in increased right ventricular afterload.The left and right ventricles interact through hemodynamics.What impact will PH have on synchronization and function of the left ventricle (LV)? The aim of this study was to evaluate the synchronization of the left ventricular wall motion and left ventricular function in patients with varying degrees of PH using velocity vector imaging (Wl) technology.Methods Sixty patients with chronic PH served as the experimental group,and 20 healthy volunteers served as the control group.According to the different degrees of pulmonary artery systolic pressure,the experimental group was divided into three groups:mild,moderate,and severe PH groups.The time to peak systolic longitudinal velocity (Tvl),the peak systolic longitudinal velocity (Vsl),the peak diastolic longitudinal velocity (Vel),the peak systolic longitudinal strain (SI),and strain rate (SRI) in 18 segments were measured in each group.Results TvI in the control group and each group with PH was reduced from basal to apical segment,and in control group Tvl in various segments of the same wall and in different walls showed no significant difference (P ＞0.05).With increase in pulmonary artery pressure,Tvl values measured showed an increasing trend in groups with PH.In groups with PH,Vsl and Vel of each wall were reduced sequentially from basal to apical segments,showing gradient change; Vsl and Vel values measured showed a decreasing trend with increase in pulmonary artery pressure,in which the differences of Vel values measured in the control group and the mild PH group were statistically significant (P ＜0.01),and the differences between other groups were statistically significant (P ＜0.01).In groups with PH,SI and SRI in basal segment and the middle segment of each wall were decreased; the difference between groups was statistically significant (P ＜0.01).Conclusions Asynchronization of the LV and decreased left ventricular function were present in patients with chronic PH;WI technology can accurately evaluate left ventricular function in patients with PH,and indicators such as Tvl,Vsl,and Vel are valuable。

Abstract：Background Although noninvasive positive pressure ventilation (NPPV) has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respiratory failure after cardiac surgery.Therefore,we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery,and explore the predicting factors of NPPV failure.Methods From September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group (NPPV group) and the conventional treatment group (control group).The between-group differences in the patients' baseline characteristics,re-intubation rate,tracheotomy rate,ventilator associated pneumonia (VAP) incidence,in-hospital mortality,mechanical ventilation time after enrollment (MV time),intensive care unit (ICU) and postoperative hospital stays were compared.The factors that predict NPPV failure were analyzed.Results During the study period,a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded,and 95 of them met the inclusion criteria,which included 59 males and 36 females with a mean age of (61.5±11.2) years.Forty-three patients underwent coronary artery bypass grafting (CABG),23 underwent valve surgery,13 underwent CABG+valve surgery,13 underwent major vascular surgery,and three underwent other surgeries.The NPPV group had 48 patients and the control group had 47 patients.In the NPPV group,the re-intubation rate was 18.8％,tracheotomy rate was 12.5％,VAP incidence was 0,and the in-hospital mortality was 18.8％,significantly lower than in the control group 80.9％,29.8％,17.0％ and 38.3％ respectively,P ＜0.05 or P ＜0.01.The MV time and ICU stay (expressed as the median (P25,P75)) were 18.0 (9.2,35.0) hours and 4.0 (2.0,5.0) days,which were significantly shorter than in the control group,96.0 (26.0,240.0) hours and 6.0 (4.0,9.0) days respectively,P ＜0.05 or P ＜0.01.The postoperative hospital stays of the two groups were similar.The univariate analysis showed that the NPPV success subgroup had more patients with acute lung injury (ALl) (17 vs.0,P=0.038),fewer patients with pneumonia (2 vs.7,P ＜0.001) and lower acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores (16.1±2.8 vs.21.8±3.2,P ＜0.001).Multivariate analysis showed that pneumonia (P=-0.027) and a high APACHE Ⅱ score ＞20 (P=-0.002) were the independent risk factors of NPPV failure.Conclusions We conclude that NPPV can be applied in selected patients with acute respiratory failure after cardiac surgery to reduce the need of re-intubation and improve clinical outcome as compared with conventional treatment.Pneumonia and a high APACHE Ⅱ score ＞20 might be the independent risk factors of NPPV failure in this group of patients。

Abstract：Background Clinical features of anterior cruciate ligament (ACL) injury are important for its prevention,diagnosis and treatment.However,few studies have reported such data,especially in China.The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.Methods Between 1993 and 2007,a total of 4355 ACL deficient inpatients (612 athletes and 3743 non-athletes) were registered.Data were collected using a special database system.And the distributions of characteristics in different groups were compared and analyzed statistically.Results All subjects were confirmed with ACL tear during surgery.Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group (56.05％ vs.24.95％,P＜0.001).This study also found that sports trauma was the main cause of ACL tears.Soccer,basketball,judo,wrestling and track and field were the five most responsible activities for athletes.The average injury time for athletes was significantly shorter than that for non-athletes (413.3 days vs.717.5 days,P＜0.001).Three thousand nine hundred and eight cases were ordered ACL reconstruction (76.04％ single-bundle,18.30％ double-bundle).Three hundred and forty-five patients (7.92％)were combined with other ligaments injuries,2667 (61.24％) were found with various grades of cartilage lesions,and 3377 (77.54％) were found with meniscal injury.Conclusions Sports trauma was the main cause of ACL tears in China,and reconstruction had become the principal surgical choice.In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury,patienttailored ACL reconstruction should be suggested at the right moment。

Abstract：Background Although Multi-planar reconstruction (MPR) has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very useful to clinical operation,especially for patients with type B aortic dissection.It helps the surgeon to locate accurately with more information about aortic dissection,so that the safety and effectiveness of operation can be improved.This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection,a spin angle of the coronal plane,and a tilt angle of the sagittal plane in treatment of type B aortic dissection.Methods The conventional and the MPR approaches were compared on positioning the aortic arch for surgery.A group of 40 patients (group A) and another group of 42 patients (group B) was sampled.About the comparison of baseline characteristics,a fourfold table X2 test was conducted on gender,and two independent samples t-test was applied to age between group A and group B.Spin as well as tilt angles for group A were obtained from the patients using both approaches,and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group.Stent graft placement of group B was based on the conventional approach.Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement.They were also compared with a fourfold table X2 test.Results Gender difference was not found between group A and group B (X2=0.80,P ＞0.05),and age difference was not statistically significant (F=2.55,homogeneity of variance,t=-1.46,P ＞0.05).A significant difference was found between the conventional and the MPR approaches for spin angle (t=9.17) as well as tilt angle (t=-2.07),P ＜0.05.Percentage of proximal distributed markers (5.0％) of group A was significantly lower than that of group B (42.9％),X2=15.92,P ＜0.05;and incidence of complications (5.0％) of group A was also significant lower than that of group B (21.4％),X2=4.76,P ＜0.05.Conclusions Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA.It is feasible in endovascular treatment of type B aortic dissection,and can effectively and safely guide surgical operations。

Abstract：Background Interleukin-13 (IL-13) has been implicated to be responsible for recruitment of inflammatory cells from the blood to the lung,regulation of matrix metalloproteinase and induction of mucin production and secretion in chronic obstructive pulmonary disease (COPD).We determined plasma IL-13 levels in patients with COPD and investigated its association with common polymorphisms of IL-13 gene in a case-control study.Methods We genotyped 160 cases and 175 control subjects in a local hospital using Mass-ArrayTM Technology Platform then tested the association of four SNPs in IL-13 (rs1295685,rs1800925,rs1881457,rs20541) with COPD,and then determined plasma IL-13 levels in patients with COPD and controls.Results Association was found between IL-13 gene SNPs (rs20541 and rs1800925) and an increased risk of COPD.By linkage disequilibrium (LD) analysis,two blocks (rs1881457 and rs1800925; rs20541 and rs1295685) were found.The risk of COPD was found associated with the IL-13 gene polymorphism among southern Chinese Han population.Plasma IL-13 level was increased in COPD patients compared with controls.Conclusions The polymorphism of the IL-13 gene is associated with an increased risk of COPD in southern Chinese Han population.Plasma IL-13 levels were found elevated in patients with COPD。

Abstract：Background Acute kidney injury (AKI) has been recognized as a major healthcare problem affecting millions of patients worldwide.However,epidemiologic data concerning AKI in China are still lacking.The objectives of this study were to characterize AKI defined by RIFLE criteria,assess the association with hospital mortality,and evaluate the impact of AKI in the context of other risk factors.Methods This prospective multicenter observational study enrolled 3,063 consecutive patients from 1 July 2009 to 31 August 2009 in 22 ICUs across mainland China.We excluded patients who were admitted for less than 24 hours (n=1623),younger than 18 years (n=127),receiving chronic hemodialysis (n=29),receiving renal transplantation (n=1) and unknown reasons (n=28).There were 1255 patients in the final analysis.AKI was diagnosed and classified according to RIFLE criteria.Results There were 396 patients (31.6％) who had AKI,with RIFLE maximum class R,I,and F in 126 (10.0％),91 (7.3％),and 179 (14.3％) patients,respectively.Renal function deteriorated in 206 patients (16.4％).In comparison with non AKI patients,patients in the risk class on ICU admission were more likely to progress to the injury class (odds ratio (OR) 3.564,95％ confidence interval (CI) 1.706-7.443,P =0.001],while patients in the risk class (OR 5.215,95％ CI 2.798-9.719,P ＜0.001) and injury class (OR 13.316,95％ CI 7.507-23.622,P ＜0.001) had a significantly higher probability of deteriorating into failure class.The adjusted hazard ratios for 90-day mortality were 1.884 for the risk group,3.401 for the injury group,and 5.306 for the failure group.Conclusions The prevalence of AKI was high among critically ill patients in Chinese ICUs.In comparison with non-AKI patients,patients with RIFLE class R or class I on ICU admission were more susceptibility to progression to class I or class F.The RIFLE criteria were robust and correlated well with clinical deterioration and mortality。

Abstract：Background Influenza A (H7Ng) virus infections were first observed in China in March 2013.This type virus can cause severe illness and deaths,the situation raises many urgent questions and global public health concerns.Our purpose was to investigate bedside chest radiography findings for patients with novel influenza A (H7Ng) virus infections and the followup appearances after short-time treatment.Methods Eight hospitalized patients infected with the novel influenza A (H7Ng) virus were included in our study.All of the patients underwent bedside chest radiography after admission,and all had follow-up bedside chest radiography during their first ten days,using AXIOM Aristos MX and/or AMX-Ⅳ portable X-ray units.The exposure dose was generally 90 kV and 5 mAs,and was slightly adjusted according to the weight of the patients.The initial radiography data were evaluated for radiological patterns (ground glass opacity,consolidation,and reticulation),distribution type (focal,multifocal,and diffuse),lung zones involved,and appearance at follow-up while the patients underwent therapy.Results All patients presented with bilateral multiple lung involvement.Two patients had bilateral diffuse lesions,three patients had unilateral diffuse lesions of the right lobe with multifocal lesions of the left lobe,and the remaining three had bilateral multifocal lung lesions.The lesions were present throughout bilateral lung zones in three patients,the whole right lung zone in three patients with additional involvement in the left middle and/or lower lung zone(s),both lower and middle lung zones in one patient,and the right middle and lower in combination with the left lower lung zones in one patient.The most common abnormal radiographic patterns were ground glass opacity (8/8),and consolidation (8/8).In three cases examined by CT we also found the pattern of reticulation in combination with CT images.Four patients had bilateral and four had unilateral pleural effusion.After a short period of treatment the pneumonia in one patient had significantly improved and three cases demonstrated disease progression.In four cases the severity of the pneumonia fluctuated.Conclusions In patients with influenza A (H7N9) virus infection,the distribution of the lung lesions are extensive,and the disease usually involves both lung zones.The most common imaging findings are a mixture of ground glass opacity and consolidation.Pleural effusion is common.Most cases have a poor short-time treatment response,and seem to have either rapid progressive radiographic deterioration or fluctuating radiographic changes.Chest radiography is helpful for evaluating patients with severe clinical symptoms and for follow-up evaluation。

Abstract：Background The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome (SVCS).The aim of this study is to report our experience in the diagnosis of SVCS by endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA).Methods The data of 520 patients who underwent EBUS-TBNA from September 2009 to May 2012 at our institution were reviewed.Of these,there were 14 males and 6 females (mean age of 59.1 years) with SVCS who received EBUS-TBNA that were included in the analysis.Results The mean short axis diameter of the paratracheal lesions was (3.32±1.79) cm (range,1.69 to 9.50 cm) and 6 cases also had subcarinal lymph node enlargement with a mean short axis diameter of (2.14±0.49) cm (range,1.73 to 3.01 cm).An average of 4.3 punctures was performed per lesion.Malignancy was confirmed in 16 cases (10 small cell carcinomas,4 adenocarcinomas,1 squamous cell carcinoma and 1 Hodgkin lymphoma).In two patients,pathological examination of tissue revealed no evidence of malignancy and for 13 to 24 months of follow-up.One patient from whom adequate tissue was not obtained refused further surgical biopsy since he had undergone endovascular stenting of the SVC.One patient in whom a diagnosis was not obtained by EBUS-TBNA underwent thoracoscopic biopsy and the final diagnosis was B cell non-Hodgkin's lymphoma.The diagnosis accuracy of EBUS-TBNA in SVCS was 18/20 patients.Conclusion EBUS-TBNA is a highly effective and safe procedure for the diagnosis of SVCS。

Abstract：Background Large and giant medial sphenoid wing meningiomas that are located deeply in the skull base where they are closely bounded by cavernous sinus,optic nerve,and internal carotid artery make the gross resection hard to achieve.Also,this kind of meningiomas is often accompanied by a series of severe complications.Therefore,it was regarded as a formidable challenge to even the most experienced neurosurgeons.This study aimed to investigate the clinical features and management experience of patients with large and giant medial sphenoid wing meningiomas.Methods In this study,53 patients (33 female and 20 male,mean age of 47.5 years) with large and giant medial sphenoid wing meningiomas were treated surgically between April 2004 to March 2012,with their clinical features analyzed,management experience collected,and treatment results investigated retrospectively.Results In this study,gross total resection (Simpson Ⅰ and Ⅱ) was applied in 44 patients (83％).Fifty-three patients had accepted the routine computed tomography scan and magnetic resonance imaging scan as postoperative neuroradiological evaluation.Their performance showed surgical complications of vascular lesions and helped us evaluate patients' conditions,respectively.Meanwhile,the drugs resisting cerebral angiospasm,such as Nimodipine,were infused in every postoperative patient through vein as routine.As a result,11 patients (21％) were found to have secondary injury of cranial nerves Ⅱ,Ⅲ,and Ⅳ,and nine patients got recovered during the long-term observing follow-up period.Temporary surgical complications of vascular lesions occurred after surgery,such as cerebral angiospasm,ischemia,and edema;24 patients (45％) appeared to have infarction and dyskinesia of limbs.Overall,visual ability was improved in 41 patients (77％).No patient died during the process.Conclusions Microsurgical treatment may be the most effective method for the large and giant medial sphenoid wing meningiomas.The surgical strategy should focus on survival and postoperative living quality。

Abstract：Background Combination paclitaxel and carboplatin is currently a first-line regimen for ovarian cancer.However,many patients develop tumor recurrence or drug resistance to this regimen.The study aims to investigate the effectiveness and safety of an oxaliplatin + epirubicin + ifosfamide regimen for the treatment of recurrent and drug-resistant epithelial ovarian cancer.Methods A retrospective analysis of 73 patients with recurrent and drug-resistant ovarian cancer was performed; 38 cases of them received oxaliplatin + epirubicin + ifosfamide regimens (lAP group),35 patients received non-oxaliplatinbased chemotherapy regimens (control group).The therapeutic effects and side effects of the oxaliplatin + epirubicin + ifosfamide regimen were analyzed and summarized.Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare progression-free and overall survival between the two groups.Results Of the 38 patients in the lAP group,14 patients (36.84％) achieved complete remission,12 (31.58％) achieved partial remission,2 (5.26％) achieved stable disease and 10 (26.32％) developed progressive disease.The overall effective rate (complete or partial remission) of the lAP regime was 68.42％.While,of the 35 patients in the control group,12 patients (34.29％) achieved complete remission,3 (8.57％) achieved partial remission,5 (14.29％) achieved stable disease and 15 (42.86％) developed progressive disease.The overall effective rate was 42.86％,which was lower than that in the lAP group (P=0.035,X2=4.836).Progression-free survival was 9.5 months (0-64 months) in the lAP group vs.3 months (0-74 months) in the non-oxaliplatin group (P=0.014 by Kaplan-Meier survival curves; HR=-2.260; 95％C/1.117-4.573; P=0.023 by Cox proportional hazards regression).Median overall survival was 46 months (9-124 months)in the lAP group vs.35 months (9-108 months) in non-oxaliplatin group (P=0.018 by Kaplan-Meier survival curves;HR=2.272; 95％CI 1.123-4.598; P=0.022 by Cox proportional hazards regression).In lAP group,15.79％ (6/38)of the patients suffered grade Ⅲ-Ⅳ bone marrow arrest.The main non-hematological side effects of the lAP regimen included nausea and vomiting (21.05％,8/38),peripheral neurotoxicity (15.79％,6/38) and hepatic or renal lesions (2.63％,1/38).The main side effects of the two chemotherapy regimens showed no statistical difference.Conclusion The oxaliplatin-based lAP regimen is potentially effective for salvage chemotherapy in patients with recurrent and drug-resistant ovarian cancer,with a better therapeutic effect and tolerable side effects。

Abstract：Background Fanconi anemia is a severe congenital disorder associated with mutations in a cluster of genes responsible for DNA repair.Arriving at an accurate and timely diagnosis can be difficult in cases of Fanconi anemia with atypical clinical features.It is very important to increase the rate of accurate diagnosis for such cases in a clinical setting.The purpose of this study is to explore the clinical diagnosis of Fanconi anemia in children with atypical clinical features.Methods Six cases of Fanconi anemia with atypical clinical features were enrolled in the study,and their clinical features were recorded,their FANCA gene transcription was assessed by RT-PCR,and FANCA mutations and the ubiquitination of FANCD2 protein were analyzed using DNA sequencing and western blotting respectively.Results All six cases showed atypical clinical features including no apparent deformities,lack of response to immune therapy,and progressively increasing bone marrow failure.They also have significantly increased fetal hemoglobin,negative mitomycin-induced fracture test results,and carry a FANCA gene missense mutation.Single protein ubiquitination of FANCD2 was not observed in those patients.Conclusion The combination of clinical features,FANCA pathogenic gene mutation genotype and the absence of FANCD2 protein ubiquitination are helpful in the accurate and timely diagnosis of Fanconi anemia in children。

Abstract：Background Graves' ophthalmopathy/orbitopathy (GO) patients often suffer ocular surface damages and tear fluid proteins play a significant role in maintaining healthy ocular surfaces,while changes in tear protein components reflect the changes ocular surface abnormalities.In this study proteomics techniques were used to investigate tear protein compositions in GO patients.Methods We carried out a case-control study by comparing tear fluid contents of GO patients with that of healthy subjects.In the first step the tears were subjected to SDS-PAGE electrophoresis and then single protein bands were analyzed by to in-gel trypsin digestion and nano-flow liquid mass spectrometry (LC-MS/MS) using a MS software.Results In tear samples of GO subjects,the protein fractions of inflammation-related protein immunoglobulin kappa chain C region (IgKC) and serum albumin were essentially reduced,whereas a novel isoform of complement component 3 (C3),which we detected in control subjects,was completely absent in the GO patients' tears.Conclusions Reduced protein concentrations of particularly IgKC and complement C3 as well as albumin in the tears of GO patients may contribute to changes in their ocular surfaces via diminished reactive oxygen species (ROS) depletion and adaptive immune responses.The completely absent of C3 in the GO patients' tears,may imply that an important inflammatory signaling pathway is affected,which needs further investigation。

Abstract：Background Glaucoma filtering surgery (GFS) is the most common procedure performed in the treatment of glaucoma.Although antiscarring agents help prevent postsurgical scarring and improve glaucoma surgical outcomes,they may be associated with an increased incidence of severe and potentially blinding complications.Poly(DL-lactide-co-glycolide) (PDLLA/GA) is a bioresorbable polymer,which can be prepared with a large range of physical,mechanical,and biological properties and has been widely used in medicine,including as an absorbable suture and a drug carrier and especially as a scaffold in tissue engineering.This study aimed to evaluate the effect of PDLLA/GA on scar formation after glaucoma filtration surgery (GFS).Methods Forty-eight New Zealand white rabbits were divided into two groups randomly and GFS was performed on the right eye of each.PDLLA/GA membranes were put under the sclera flap for evaluation.GFS with no membrane inserted served as control.Clinical evaluations of intraocular pressure (lOP) and the presence of a filtration bleb were performed at intervals (3 days,1,2,4,8,12,20,and 24 weeks) postoperatively.At each time point,three eyes per group were excised to observe histological changes such as inflammation and scar formation and the expression of collagen type Ⅳ,proliferating cell nuclear antigen (PCNA),matrix metalloproteinase-9 (MMP-9),and tissue inhibitor of metalloproteinase-1 (TIMP-1).The expression of connective tissue growth factor (CTGF) mRNA was determined by reverse transcription-polymerase chain reaction.Results The lower lOP level and an effective bleb were maintained for a long time after GFS in the PDLLA/GA group.The histological analysis showed less inflammation and scar formation,weaker expression of collagen type Ⅳ and PCNA,more intense MMP-9 and TIMP-1,slightly elevated ratio of MMP-9 and TIMP-1,and a smaller increase in CTGF mRNA postoperatively in the PDLLA/GA group but less than the control group (P ＜0.05).Conclusion PDLLA/GA membranes may be promising for preventing fibrosis after GFS。

Abstract：Background IgA nephropathy (IgAN) is the most common primary glomerular disease.Transforming growth factor β1 (TGFβ1) plays an important role in pathogenesis of IgAN.Associations between the polymorphisms of TGFβ1 gene and the risk of IgAN remained inconsistent.A meta-analysis was conducted to investigate the association between polymorphisms in the TGFβ1 gene and IgAN susceptibility.Methods Databases including Pubmed,EMBASE,ISI,et al.were searched to find relevant studies.Odds ratios (ORs)with 95％ confidence intervals (CIs) were used to evaluate the strength of associations.Results Ten studies involving 1770 cases and 1953 controls were included.Significant association between C509T polymorphism and IgAN risk was observed (OR 1.42,95％ CI 1.12-1.81,P=0.0004; I2=0％) in Caucasians by the overdominant model (CT vs.CC + TT),but no significant association was found (P=0.200) in Asians by the dominant model (CC + CT vs.TT).Significant association between T869C polymorphism and IgAN susceptibility was found (OR 1.21,95％ CI 1.02-1.44,P=0.030) in overall populations by the dominant model (TT + TC vs.CC).Subgroup analysis found T allele of T869C polymorphism was associated with IgAN susceptibility in Caucasians (P=0.030),but not in Asians (P=0.290).Conclusion Both heterozygotes of C509T polymorphism and T allele of T869C polymorphism in TGFβ1 were associated with the risk of IgAN in Caucasians,but not in Asians。

Abstract：Objective To review the updated research on direct antiviral agents (DAAs)-including regimens for hepatitis C virus (HCV),and focus on "difficult-to-treat" HCV-infected patients.Data sources The literature concerning DAAs and hepatitis C cited in this review was collected from PubMed and Google Scholar databases published in English up to July 2013.Study selection Data from published articles regarding HCV and DAAs in clinical trials and in clinical use were identified and reviewed.Results It was recognized that some "difficult-to-treat" patients would still exist,even though stronger treatments using such as DAAs,including telaprevir and boceprevir,which lead to higher sustained virological response rates,are available.Such patients include those with advanced fibrosis/cirrhosis,elderly persons,children,HCV-human immunodeficiency virus co-infected patients,HCV-infected recipients,and so on.Conclusions Certain "difficult-to-treat" patients would still exist,even though stronger treatment is available.Although evidence from clinical trials is still lacking,interferon-sparing regimens could have stronger effects for eradicating HCV in such cases。

Endometriosis,characterized by endometrial-like tissue outside the uterus,is a frequently occurred benign gynecologic disease that afflicts mainly women of reproductive age,with a prevalence of 6％ to 10％.Endometriosis can be subdivided into ovarian,peritoneal and deep infiltrating types,with the deep infiltrating endometriotic lesions closely related with pain symptoms.1 Though a rare clinical occurrence,endometriosis does affect 2％-5％ women in their postmenopausal years,with many of the cases reported having been under hormone replacement therapy (HRT).With the ovaries being its most common sites,postmenopausal endometriosis poses a 1％ risk of malignant transformation,as well as an increased risk of ovarian cancer.2 Usually with abdominal or pelvic mass the only clinical finding before surgery,almost all cases reported were diagnosed retrospectively by pathologic examinations。

For localized prostate cancer,radiation therapy (RT) is commonly used.However,in the first five years of RT,10％-20％ of localized prostate cancer patients,and 30％-50％ of the locally advanced prostate cancer patients will progress to biochemical recurrence.In the past,only few these patients considered salvage radical prostatectomy (SRP) as their primary selection due to the significant morbidity.With the improvement of surgical techniques and radiation technology,morbidity of SRP had decreased significantly in recent studies.We reported our experience of SRP at Shanghai Changhai Hospital from April 2005 to July 2011。

To the editor:Up to now there was no case reported on whether splenectomy influenced relapse of chronic myelogenous leukemia (CML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Here we report a relapsed CML patient after alIo-HSCT and splenectomy. This patient is a 52-year-old man who initially presented with CML in chronic phase in 2002.At diagnosis he underwent alloHSCT from his HLA-identical brother.The conditioning regimen was the busulfan and cyclophosphamide (BU-CY2) and then he received cyclosporine and methotrexate for graft-versus-host disease (GVHD) prophylaxis.Because of pancytopenia,the patient received splenectomy and then had a rapid hematopoeitic recovery without evidence of Ph-positive chromosomes.Molecular studies also proved to be a complete donor chimerism (CDC) for him。