2010年 · 第123卷第16期

Abstract：Background Few reports have evaluated the efficacy of re-operation for relapse after initial surgery for hepatocellular carcinoma (HCC) with bile duct thrombosis (BDT).The aim of this study was to investigate the efficacy of initial surgery and subsequent re-operation for HCC with BDT, and their effects on prognosis.Methods The clinical data of 880 patients with HCC, including 28 patients with BDT, who underwent radical hepatectomy between 1998 and 2008 in our hospital, were reviewed.The effects of BDT and re-operation on prognosis were retrospectively analyzed.Results The 1-, 3- and 5-year survival rates were 89.3%, 46.4% and 21.4%, respectively, in 28 patients with BDT versus 91.4%, 52.9% and 20.9% in 852 patients without BDT (P ＞0.05).Six patients with BDT underwent re-operation after disease relapse, and their survival time was significantly longer than those who did not undergo re-operation (P ＜0.05).Multivariate analysis indicated that portal vein invasion and tumor size were independently associated with tumor relapse and prognosis (P＜0.05).Univariate analysis and multivariate analyses showed that obstructive jaundice was not significantly correlated with tumor relapse or prognosis (P ＞0.05).Conclusions Hepatectomy plus BDT removal is an effective treatment option for HCC with BDT.Obstructive jaundice is not a contraindication for surgery.Re-operation after relapse can provide good outcomes if the cases are appropriately selected。

Abstract：Background ST-segment elevation myocardial infarction (STEMI) in elderly patients presents specific clinical characteristics.The study on percutaneous coronary intervention (PCI) in elderly patients (≥75 years) with STEMI,however, has less been performed.Methods In the present study, 522 consecutive STEMI patients undergoing PCI within 12 hours from symptom onset were investigated, and clinical characteristics and in-hospital and 6-month outcomes of 66 elderly patients (≥75 years,group A) were compared to those of 456 younger patients (＜75 years, group B).Results Compared to younger patients, elderly ones had more females (42.4% vs.17.8%, P ＜0.005), a history of cerebral vascular events (7.6% vs.0.9%, P ＜0.05), higher serum creatinine level ((96.48±31.65) mmol/L vs.(84.87±19.81)mmol/L, P＜0.005) and fewer smokers (28.8% vs.45.4%, P＜0.05).The elderly ones had worse Killip class (Killip I class:69.7% vs.85.7%, P ＜0.05), less drug-eluting stent implantation and lower rates of TIMI flow 3 following PCI (33.3% vs.47.1%, and 84.8% vs.94.7%, P ＜0.05 respectively).Additionally, both in-hospital mortality and myocardial infarction rate were found to be higher in elderly patients (16.7% vs.1.5%, and 7.6% vs.2.6%, P ＜0.05 respectively), which were also observed until 6-month follow-up (9.1% vs.0, and 6.1% vs.0, P ＜0.05 respectively＝.In multivariable Cox regression analysis, serum creatinine level, history of hypertension, left anterior descending coronary artery as infarct-related artery and Killip class were independent predictors of 6-month overall death in elderly patients.Conclusions The clinical characteristics of elderly patients with STEMI after PCI are different from those of younger patients.Although PCI in this population is with a low rate of PCI failure, it is still associated with a worse outcome。

Abstract：Background For patients with severe endometriosis, the spontaneous pregnancy rates have been reported to be near 0 due to extreme distortion of normal pelvic anatomy.Surgery is one of the treatment options; however, if patients failed to conceive after surgery, in vitro fertilization (IVF) is effective.The objective of this retrospective study was to determine the clinical characteristics of IVF/intracytoplasmic sperm injection (ICSI) in patients with stage Ⅲ/Ⅳ endometriosis, and to determine the impact of the interval from surgery to IVF/ICSI on outcome.Methods One hundred and sixty patients who were diagnosed with stage Ⅲ/Ⅳ endometriosis underwent IVF/ICSI cycles between February 2004 and June 2009 were enrolled.The mean interval from surgery to IVF, number of oocytes retrieved, fertilization rate, implantation rate, embryos transferred, and good embryos transferred were compared between two age groups (≤35 years and ＞ 35 years).Results The mean interval from surgery to IVF was (37.9±28.9) months for the group ≤ 35 years of age and (57.6±39.7)months for the group ＞35 years of age.Twenty-five IVF/ICSI cycles (12.8%) were performed during the first year after surgery, and 34.9% IVF/ICSI cycles were performed 2 years after surgery.No significant differences existed between the two groups with respect to the fertilization rate, implantation rate, number of embryos transferred, number of good embryos,clinical pregnancy rates, live birth rates, and cumulative clinical pregnancy rates (P ＞0.05).The probability of cumulative clinical pregnancies was 75%, 50%, and 25% ((29.0±4.8), (61.0±7.6), and (120.0±16.9) months after surgery, respectively).Conclusions For infertile patients with stage Ⅲ/Ⅳ endometriosis, the optimal time to conceive by IVF/ICSI is ＜2 years after surgery; nevertheless, most of the patients took a longer time to conceive。

Abstract：Background Pseudoachondroplasia (PSACH) is an autosomal-dominant osteochondrodysplasia due to mutations in the gene encoding cartilage oligomeric matrix protein (COMP).Clinical diagnosis of PSACH is based primarily on family history, physical examination, and radiographic evaluation.There is evidence that decreased serum COMP concentration may serve as a diagnostic marker in PSACH.Here, we investigated the role of this gene and the serum COMP concentration in Chinese patients with PSACH.Methods A family with three patients and a sporadic case were recruited.Genomic and phenotypic data were recorded.The diagnosis of PSACH was made on the base of clinical evaluation.The genomic DNA was extracted from peripheral blood leukocytes.The 8-19 exons and flanking intron-exon boundary sequences of COMP were amplified by polymerase chain reaction (PCR) and screened for mutation by direct DNA sequencing.Serum COMP concentrations of 4 patients and age-compatible control group of 20 unrelated healthy subjects were analyzed on the basis of an ELISA Kit for human cartilage oligomeric matrix protein.Results A deletion (c.1447-1455del) was identified in exon 13 in the sporadic case.The mean serum COMP concentrations of four patients (3.12±2.28) were significantly lower than those of control group (10.86±2.21, P ＜0.05).There was no overlap in the distribution of serum COMP concentration between PSACH patients and controls.Conclusions Mutations in COMP gene are responsible for the PSACH.Serum COMP concentration may be suggested as an additional diagnostic marker to aid clinical findings in suspected cases of PSACH。

Abstract：Background Polycystic ovary syndrome (PCOS) is considered to be the most common endocrine disorder in women of reproductive age.The involvement of an abnormal menstrual cycle in the etiology of PCOS remains unclear.We aimed to analyze the characteristics of abnormal menstrual cycles and their association with PCOS in community and hospital patient populations.Methods Women with PCOS identified from 2111 permanent female residents in the community of Beijing and 506 outpatients obtained from the reproductive clinic of Peking University Third Hospital were recruited for this study,comprising the PCOS community group and the PCOS hospital group, respectively.Each group was further divided into four subgroups according to the length of menstrual cycles: ＜21 days; 21-34 days; 35-60 days; and ＞60 days.Women in each group were interviewed using a questionnaire to assess factors including age, age of menarche, menstrual cycle history, related family history, and modified Ferriman-Gallwey (mF-G) score.All women received transvaginal ultrasound scan and had fasting blood samples taken for endocrine evaluation.A two-tailed P value of ＜0.05 was considered significant.Results In the community population, the prevalence of abnormal menstrual cycle was 27.19% (574/2111).The prevalence of PCOS in the community was 6.11% (129/2111) according to Rotterdam criteria.In the community group,the most common menstrual cycle length was 35-60 days, whereas for the hospital group, it was ＞60 days.In both the community and hospital groups, the most common phenotype of PCOS was that of Oligo/amenorrhea+PCO+hyperandrogenism (HA) (O+P+H) (P=0.000).With increasing cycle length of 35-60 days to ＞60 days, the percentages of Oligo/amenorrhea+PCO (O+P) and O+P+H were found to significantly decrease in the community group and significantly increase in the hospital group (P=0.000 for each).In the hospital group, as the menstrual cycle length increased from 35-60 days to ＞60 days, the rate of spontaneous abortion increased significantly (P=0.000), meanwhile the rate of poorly-secreted endometrium and abnormal endometrial hyperplasia increased significantly (P=0.000).Conclusions The prevalence of PCOS in the Beijing community of women was 6.11%.Oligo/arnenorrhea was the most common type of abnormal menstrual cycle and may be an indicator for PCOS and endometrial lesions.Gynecologists should seek relevant medical information from women in the community to promptly diagnose PCOS and then follow up patients for potential development of subsequent complications。

Abstract：Background Stathmin was identified as an endometriosis-related protein by comparative proteomics in our previous study.As a microtubule-destablizing factor, stathmin was shown to participate in the relay and integration of diverse intracellular signaling pathways involved in cell proliferation, differentiation, and many other cellular activities.To investigate whether stathmin is involved in the pathogenesis of endometriosis, we examined the expression of stathmin in eutopic endometrium of women with or without endometriosis.Methods Eutopic endometrium samples were collected from thirty-six patients who were diagnosed as endometriosis and the nineteen age-matched patients who were confirmed to be free of endometriosis surgically and histologically.The expression of stathmin mRNA was detected by real-time PCR, and its protein was detected by Western blotting and immunohistochemistry.Results Stathmin was overexpressed in eutopic endometrium of women with endometriosis detected by real-time PCR in mRNA levels and by Western blotting in protein levels, without significant difference between proliferative and 0secretory phase.Immunohistochemistry showed that stathmin protein was localized in both endometrial glandular and stromal cells throughout the menstrual cycle.Conclusions Stathmin is overexpressed in endometrium of patients with endometriosis and may play a role in the pathogenesis of endometriosis。

Abstract：Background The choice for the surgical approach of interdigital neuroma in the foot is controversial.Plantar approach can leave a painful scar on weight bearing area; hence, some prefer dorsal approach.The aim of the current study was to measure the outcome of interdigital (Morton's) neurectomy performed by a single surgeon using dorsal and plantar approaches.Methods A retrospective review of the patient records of one orthopaedic foot and ankle surgeon identified thirty-six patients (42 feet) who had been treated operatively for a primary, persistently painful interdigital neuroma.The mean follow-up was 18 months.Pain, weight bearing, wound problems and rehabilitation period were studied.Results The duration to full weight bearing, return to work, driving and recreational activities were at least one week shorter in the dorsal group.The overall satisfaction for surgery was rated as excellent or good in 85% of the thirty six patients.Scar problems were more troublesome and common in the plantar group.There was residual numbness noticed in twenty feet, the pattern of numbness was quite variable and it was bothersome in only seven feet.There was one recurrence in the plantar group.Conclusions Resection of a symptomatic interdigital neuroma through a dorsal or a plantar approach can result in a good outcome.Dorsal approach, however, is associated with better rehabilitation and less scar problems。

Abstract：Background Despite its widespread use in the management of HIV-related cytomegalovirus (CMV) infection, there have been surprisingly few reports of the use of valganciclovir (VGC) in the post-allotransplant setting.So far, no multi-center, non-crossover trial data have been available with the use of this drug as the primary pre-emptive.The present study evaluated the efficacy and safety of VGC for preemptive therapy of CMV infection after allogeneic hematopoietic stem cell transplantation (HSCT).Methods From January to April 2007, VGC was adopted in eleven centers in mainland China for pre-emptive therapy of CMV infection in consecutive patients undergoing allogeneic HSCT.Allogeneic HSCT recipients were followed weekly via CMV pp65 antigenemia assay or real-time quantitative polymerase chain reaction (PCR) for detection of CMV-DNA.Patients with a positive assay were treated with VGC, 900 mg P.O.twice a day for 14 days followed by 900 mg P.O.once a day for 14 days after a negative result or the CMV-DNA load was lower.Results A total of 54 patients (15 siblings, 28 mismatched related donors, 11 unrelated donors) had a positive assay treated with oral VGC.The seroconversion rate was 89% (48/54) as confirmed by a negative assay; six patients failed oral VGC.No significant toxicity was encountered.No case of CMV disease was diagnosed in the responding patients with a median follow-up of 5.3 months after the drug administration.Conclusion Pre-emptive therapy of CMV viraemia with oral VGC is safe and effective in allogeneic HSCT。

Abstract：Background The virtual reality (VR) system can provide the neurosurgeon to intuitively interact with and manipulate the three dimensional (3-D) image similarly to manipulate a real object.it was seldom reported that the system was used in diagnosis and treatment of cerebral aneurysms.This study aimed to investigate the application of VR system in diagnosis and therapeutic planning of cerebral aneurysms.Methods A total of 24 cases of cerebral aneurysms were enrolled in this study from 2006 to 2008, which diagnosed by 3-D digital subtraction angiography (3D-DSA) or VR-based computed tomography angiographies (CTA).The VR system and 3D-DSA system were used to observe and measure aneurysms and the adjacent vessels.The data of observation and measurements were compared between VR image and 3D-DSA image.All the patients underwent surgical plan and simulated neurosurgical procedures in the VR system.Results There were 28 aneurysms detected in VR system and 3D-DSA system.The VR system generated clear and vivid 3-D virtual images which clearly displayed the location and size of the aneurysms and their precise anatomical spatial relations to the parent arteries and skull.The location, size and shape of the aneurysms and their anatomical relationship with the adjacent vessels were similar between 3-D virtual image and 3D-DSA, but the spatial relationship between aneurysms and skull only been displayed by VR system.This VR system also could simulate simple surgical procedures and surgical environments.Conclusions The VR system can provide a highly effective way to provide precise imaging details as same as 3D-DSA system and assist the diagnosis of cerebral aneurysms with virtual 3-D data based on CTA.It significantly enhances the chosen therapeutic strategy of cerebral aneurysms。

Abstract：Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample the enlarged mediastinal lymph nodes which are unreachable by conventional bronchoscopy.It is a relatively simple and safe method to see beyond the bronchial tree.We describe and discuss its initial application and our experience.Methods From July 2009 to December 2009, 52 patients with undiagnosed enlarged mediastinal lymph nodes were accessed with EBUS-TBNA in the People's Liberation Army General Hospital.Conventional bronchoscopy was performed before EBUS-TBNA, and patients with endobronchial lesions were excluded from this study.Smears fixed in 95% alcohol and histological specimens fixed in formalin were sent to Department of Pathology.Results EBUS-TBNA was diagnostic in 33 (63%) patients, with diagnosis of lung cancer in 23 patients (14 patients of small cell lung cancer, eight patients with adenocarcinoma, and one patient of squamous carcinoma).Four patients, who had negative EBUS-TBNA results, were later diagnosed with malignancy at thoracotomy.One patient with negative EBUS-TBNA results died of cancer cachexia.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of neoplastic disease were 85%, 100%, 100%, and 50% respectively.Among the 16sarcoidosis patients, who were diagnosed by a combination of the clinical and radiological information as well as pathological results obtained by EBUS-TBNA, nine of them had granulomas and benign lymphoid cells detected by EBUS-TBNA.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of sarcoidosis were 56%, 100%, 100%, and 13%, respectively.Five patients with no definite diagnosis from EBUS-TNBA examination are under close follow-up.Conclusions EBUS-TBNA can provide a safe and effective method to sample mediastinal leisions suspected of malignancy.It also adds pathological information needed to make the diagnosis of sarcoidosis。

Abstract：Background Spinocerebellar ataxia type 7 (SCA7) is known as an autosomal dominant cerebellar ataxia; patients with genetically confirmed diagnoses of SCA7 have increased rapidly in recent years.However, SCA7 is a rare subtype of SCA, and most data available about SCA7 are those of white people.The aim of the present study was to systematically review the prevalence and clinical and genetic aspects of SCA7 patients in East Asian population.Methods A search for publications on SCA7 was performed by using the "PubMed" database with the published language limited in English.Publications mainly focusing on the prevalence of SCA7 in patients with SCA and the clinical and genetic features of SCA7 patients were fully reviewed and analyzed.Results The prevalence of SCA7 in SCA patients ranged from 0 to 7.7%, which was similar to those reported previously.The clinical manifestations were typically present at the 30's of its victims (median, 29 years; interquartile range (IQR),19.5-36.5 years), and the symptoms appeared 15 years ((15.17±4.22) years) earlier on average in the offspring than in the parents.Gait ataxia and visual impairment were both found in all patients of whom the clinical features were described.Mutant SCA7 alleles contained 40-100 CAG repeats, with a median of 47 repeats (IQR, 44.5-50.0); and the offspring had 13 more repeats on average compared with their parents (12.62±19.03).A strong negative correlation was found between CAG repeat size and the onset age of patients (r=-0.739, P=0.000).In addition, no significant difference was found in CAG repeat sizes between patients with visual impairment as the initial symptom and those with gait disturbance as their initial symptom (P=0.476).Conclusions The prevalence of SCA7 in SCA patients, the age at onset and CAG repeats of SCA7 patients in East Asia are consistent with those of white people.However, larger population study is needed to assess the correlation between the CAG repeat size and initial symptoms of SCA7 patients in East Asia。

Lymphatic complications leading to retention,accumulation or drainage of peritoneal fluid are frequently encountered following extended or superextended lymphadenectomy for gastric cancer.1 The vast majority of these drainages usually subsides spontaneously, but in some instances they can persist for long period of time causing significant morbidity.However, the classification, the terminology and the diagnostic criteria for these complications are confusingly used in the English literature causing misunderstandings and difficulties in the interpretation of the published results。

It has been demonstrated that pulmonary veins (PV)play an important role in the initiation and perpetuation of paroxysmal atrial fibrillation (PAF).1-5 Therefore, PV isolation has become the cornerstone for catheter ablation in the majority of these AF patients.3-5 In addition, ectopic foci in the non-PVs areas, such as superior vena cava(SVC), inferior vena cava (IVC), coronary sinus (CS),ligament of Marshall, have also participated in the initiation of PAF.The ostium isolation or local ablation for these structures was feasible and safe for PAF therapy.6-9 In this report, we describe a young PAF patient with anomalous right superior PV (RSPV) inserting into the SVC-right atrium (RA) junction who underwent successful isolation of all PVs and SVC for PAF guided with the CARTO-Merge technique。

To the editor: Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with complex genetic inheritance.l In recent years, genome-wide association studies (GWAS) had further provided novel insights into the genetics background of SLE by identifying multiple susceptibility genes in different ethnic populations。