Shanghai Huashan Hospital Research Articles

Low Remnant Cholesterol and In-Hospital Bleeding Risk After Ischemic Stroke or Transient Ischemic Attack.

Bleeding risk brought by intensive lipid-lowering therapy and low low-density lipoprotein cholesterol is concerning, while evidence regarding the relationship between remnant cholesterol and bleeding is frightening. This study aimed to investigate the association between remnant cholesterol at admission and an in-hospital bleeding event after acute ischemic stroke or transient ischemic attack (TIA). A total of 3222 eligible patients admitted to Shanghai Huashan Hospital between 2015 and 2021 with complete lipid data were analyzed. Patients were classified into low (<20.0 mg/dL), moderate (20.0-29.9 mg/dL), and high (≥30 mg/dL) groups by remnant cholesterol. The mean age of patients was 63.0± 13.1 years, including 2301 (71.4%) men and 651 (20.2%) with TIA. The median (interquartile range) of remnant cholesterol was 18.6 (13.5-25.9) mg/dL. After adjustment for confounding variables, patients with low remnant cholesterol had a higher risk of bleeding events (odds ratio, 2.56 [95% CI, 1.12-6.67]) than those with moderate remnant cholesterol. The high remnant cholesterol group was not significantly associated with bleeding risk. Combined assessment of low-density lipoprotein cholesterol and remnant cholesterol further identified patients with the highest risk of bleeding events. Low remnant cholesterol levels were associated with bleeding events during the acute stage of ischemic stroke and TIA. The assessment of remnant cholesterol could inform the bleeding risk during hospitalization both for patients and physicians in clinical practice.

Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery Outcomes.

The management of early gastric cancer (EGC) has witnessed a rise in the utilization of endoscopic submucosal dissection (ESD) as a treatment modality, although prognostic markers are needed to guide management strategies. This study investigates the prognostic implications of lymphovascular invasion (LVI) in ESD-eligible EGC patients, specifically its implications for subsequent radical surgery. A retrospective, multicenter study from two primary hospitals analyzed clinicopathological data from 1369 EGC patients eligible for ESD, who underwent gastrectomy at Shanghai Cancer Center and Huashan Hospital between 2009 and 2018. We evaluated the relationship between LVI and lymph node metastasis (LNM), as well as the influence of LVI on recurrence-free survival (RFS) and overall survival (OS). We found a strong association between LVI and LNM (p < 0.001). Advanced machine learning approaches, including Random Forest, Gradient Boosting Machine, and eXtreme Gradient Boosting, confirmed the pivotal role of LVI in forecasting LNM from both centers. Multivariate analysis identified LVI as an independent negative prognostic factor for both RFS and OS, with hazard ratios of 4.5 (95% CI: 2.4-8.5, p < 0.001) and 4.4 (95% CI: 2.1-8.9, p < 0.001), respectively. LVI is crucial for risk stratification in ESD-eligible EGC patients, underscoring the necessity for radical gastrectomy. Future research should explore the potential incorporation of LVI status into existing TNM staging systems and novel therapeutic strategies.

Analysis of Adverse Reactions of Cosmetics in Chinese Han Population in Recent Five Years.

There are still some gaps in the summary and generalization of cosmetic-related adverse reaction reports. The aim of this study is to summarize and analyze the occurrence of cosmetic adverse reactions in Shanghai Han population by using available survey data. Collection, statistics and analysis of patients with cosmetic adverse reactions in Shanghai Huashan Hospital from 2017 to 2021. Among the 1004 patients, most of them (96.71%) were diagnosed as cosmetic contact dermatitis, which often occurred within 3 days of using cosmetics (51.79%). A total of 260 patients were tested with patch test, but the compliance rate was only 18.08%. Among them, 240 patients underwent additional European standard allergen tests, and positive allergens were detected in 210 cases (87.5%). Univariate analysis revealed that dosage form (emulsion and cream), age (≤25 years) and the allergic ingredients triethanolamine, rose oil, propylene glycol, thiomersal and musk ambrette are associated with the occurrence of cosmetic adverse reactions within seven days. A logit prediction model was also successfully constructed: Logit (P) = 1.710-0.796×1+ 1.185×2 -3.650X3-1.335X4. This study complements the data reported on cosmetic adverse reactions in the Chinese Han population and suggests that in future clinical diagnosis and data collection, emphasis should be placed on patch testing, combining the patch test with cosmetic protoplast with the European standard allergen test to improve the detection rate.

Postoperative cerebral infarction after revascularization in patients with moyamoya disease: Incidence and risk factors.

Cerebral infarction is the major complication of revascularization surgery in patients with moyamoya disease (MMD), and we analyzed the possible causes of cerebral infarction after revascularization surgery for MMD. MMD patients who were admitted and underwent surgical revascularization at Shanghai Huashan Hospital from January 2019 to December 2021 were retrospectively analyzed. A total of 815 patients and 890 revascularization surgeries (677 first revascularization surgeries and 213 second revascularization surgeries) were included in this study; 453 (50.9%) were performed on the left side and 437 (49.1%) on the right side, with 779 (87.5%) combined procedures and 111 (12.5%) indirect bypasses included. The mean patient age at the time of these procedures was 44.6 ± 11.7 years (range 6-72 years). Postoperative cerebral infarctions were observed in 46 (5.17%) surgeries, among which 31 occurred after left hemisphere revascularization surgeries, with an incidence of 6.84%, and 15 occurred after right hemisphere revascularization surgeries, with an incidence of 3.43%. Of these, 30 (65.2%) occurred in the operated hemispheres, 2 (4.3%) in the contralateral hemisphere and 13 (28.3%) in the bilateral hemisphere. There were 11 cases of massive infarction (23.9%). The incidence of postoperative infarction in patients undergoing the first revascularization was 6% (41/677) and 2.3% (5/213) in the second revascularization surgeries. Initial presentation as infarction (P < 0.001), initial presentation as hemorrhage (P < 0.001), hypertension (P = 0.018), diabetes (P = 0.006), 1st or 2nd surgery and surgical side (P = 0.007) were found to be related to postoperative cerebral infarction. Initial presentation as infarction (OR = 2.934, 95% CI 1.453-5.928, P = 0.003), initial presentation as hemorrhage (OR = 0.149, 95% CI 0.035-0.641, P = 0.011), and 1st or 2nd surgery and surgical side (OR = 1.66, 95% CI 1.106-2.491, P = 0.014) were independently associated with cerebral infarction after revascularization surgeries. In patients with MMD undergoing surgical revascularization, initial presentation as infarction and first revascularization surgery performed on the left hemisphere are independent risk factors for postoperative cerebral infarction, whereas initial presentation as hemorrhage is a protective factor.

Effect of acupuncture with donepezil based on syndrome differentiation on cognitive function in patients with mild-to-moderate Alzheimer’s disease: a study protocol for a multicenter randomized controlled trial

BackgroundThere has been a rapid increase in the worldwide prevalence of Alzheimer’s disease (AD). Previous studies have shown that acupuncture can improve neurological and cognitive function; however, the utility of applying acupuncture in patients with AD remains unclear. This study protocol describes a clinical trial for evaluating the efficacy and safety of acupuncture based on syndrome differentiation with donepezil hydrochloride on cognitive function in patients with AD.Methods/designThis multicenter randomized controlled trial commenced on February 1, 2019, at the Shanghai Longhua Hospital of TCM, Shanghai Huashan Hospital of Fudan University, and Shanghai Mental Health Center, and will conclude on June 30, 2022. The study will recruit 184 patients randomly divided into an acupuncture group or a control group at a 1:1 ratio. All participants will receive donepezil hydrochloride (5 mg/day), and those in the acupuncture group will receive acupuncture based on syndrome differentiation with donepezil for 12 weeks. The primary outcome will be the post-treatment change in the Alzheimer’s Disease Assessment Scale-cognition score at 12 weeks. The secondary outcomes will be the efficacy scores of the Minimum Mental State Examination, Alzheimer’s Disease Cooperative Research Activity-Daily Life, and Quality of Life-Alzheimer’s Disease. All assessments will be performed at baseline, after treatment (week 12), and at follow-up (weeks 24 and 36).DiscussionThis trial may provide high-quality evidence for the efficacy of acupuncture in the treatment of AD. The results of this study will be published in peer-reviewed journals.Trial registrationClinicalTrials.govNCT03810794. Registered on 17 January 2019.

Expression of Serum PSA, Nesfatin-1, and AMH in Patients with Polycystic Ovary Syndrome.

Insulin resistance and hyperandrogenism are the leading causes of polycystic ovary syndrome (PCOS). Therefore, it has great significance to study the expression levels of PSA, nesfatin-1, and AMH. To provide some reference for clinical diagnosis and treatment of polycystic ovary syndrome (PCOS), the expression levels of PSA, nesfatin-1, and AMH in serum of patients with polycystic ovary syndrome (PCOS) were investigated. The experimental group consisted of 200 patients with polycystic ovary syndrome treated in Shanghai Huashan Hospital from July 2018 to July 2019. The control group consisted of 150 healthy women without pregnancy. The PSA, nesfatin-1, and AMH levels in serum were detected by chemiluminescence immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA). The serum levels of prostate-specific antigen (PSA) and anti-Mullerian hormone (AMH) were 16.53 ± 0.67pg/ml and 10.75 ± 4.02pg/ml in the experimental group (PCOS patients), which were significantly higher than those in the control group (3.27 ± 0.43pg/ml and 5.18 ± 1.84pg/ml, respectively), while the inhibitive factors in the experimental group (1.89 ± 0.99mg/ml) were significantly higher than those in the control group (1.10 ± 0.97mg/ml). There was no significant difference in nesfatin-1. The levels of PSA and nesfatin-1, nesfatin-1, and AMH and the levels of PSA and AMH in patients with polycystic ovary syndrome were positively correlated, and the differences were statistically significant. The levels of PSA, nesfatin-1, and AMH in patients with polycystic ovary syndrome of different ages were different, and the differences were significant and negatively correlated with the age increasing. PSA, nesfatin-1, and AMH levels in patients with polycystic ovary syndrome were significantly different from those in control nonpregnant women. There was a certain correlation between the levels of PSA, nesfatin-1, and AMH, and age. The results have specific clinical reference significance for the diagnosis and treatment of patients with polycystic ovary syndrome.

NCOG-14. REAL-WORLD RETROSPECTIVE ANALYSIS OF TUMOR TREATING FIELDS IN THE TREATMENT OF HIGH-GRADE GLIOMA BASED ON CHINESE POPULATION

Abstract OBJECTIVES Tumor Treating Fields (TTFields) has been approved for the treatment of newly diagnosed and relapsed glioblastoma（GBM）in China in 2020. Only few TTFields data in Asia patients were reported. This retrospective analysis is aimed at investigating the efficacy, safety and the potential relationship with biomarkers of TTFields treatment in the real-world clinical practice of the Chinese glioma population. METHODS High-grade glioma patients who were under TTFields treatment from May 2019 to May 2021 in Shanghai Huashan Hospital were analyzed, including baseline data, efficacy data and incidence of adverse events. RESULTS Eighty-two patients (median age 51.0 [26.0 - 47.0] years) with high-grade glioma were enrolled, including 60 newly diagnosed GBM, 16 recurrent GBM, and 6 WHO grade III gliomas. The median time was 9.9 (4.6-15.7) months for follow-ups, median time for TTFields treatment was 4.3(1.1-20.35) months. The median compliance rate was 90% (40%-97%). For newly diagnosed GBM (n=60) and recurrent GBM (n=16), the 6-month PFS rate were 78.4% (95%CI: 63.9-87.6) and 46.7% (95%CI: 21.2- 67.8) respectively. The 10-month OS rate were 86.3% (95%CI: 69.6- 94.2) and 60.0% (95%CI: 12.6- 88.2) respectively. The 6-month PFS rate in the IDHw/TERTm population was 69.9% (95%CI: 45.9-84.9) and 78.3% (95%CI: 46.5-92.5) in the IDHw/TERTw patients with newly diagnosed GBM. 59(72%) patients had skin-related adverse reactions, and majority are grade 1-2 (grade 1-2, 69.5%; grade 3, 2.5%). CONCLUSIONS This is the 1st retrospective analysis done using TTFields in the treatment of high-grade gliomas in the Chinese population with the largest sample size. From our short follow up, TTFields appears good efficacy among GBM patients. The incidence of skin adverse reactions is higher comparable to published data, but mainly consisted of grade1-2. Long-term efficacy data need to be further followed-up.

A Qualitative Exploration of Patients' Experiences with Lifestyle Changes After Sleeve Gastrectomy in China.

Sleeve gastrectomy (SG) is the most widely used surgical treatment for severe obesity worldwide. Individuals who have undergone SG usually need to change lifestyle behaviors as a response to the anatomical changes imposed by SG, and patients need to sustain lifestyle changes for long-term surgical success. Little is known about how patients experience and manage lifestyle changes following SG. In China, where SG comprises over 70% of bariatric surgical procedures, there have been no reports addressing this issue. This study aimed to describe individuals' experiences related to lifestyle changes after SG in China. Semi-structured interviews were conducted at the Shanghai Huashan Hospital in China with adults who had undergone SG between 2012 and 2018. Two independent researchers used an interpretive thematic approach to analyze transcripts for themes and sub-themes. Interviews (N = 15) revealed three major themes of participants' experiences with postoperative lifestyle changes: advantages outweigh disadvantages; developing self-management strategies (i.e., adopting new behaviors and developing habits, continuing self-monitoring, focusing on health over weight, staying determined); and experiencing culture-specific difficulties in adherence to follow-up visits and lifestyle recommendations. The data from this study provided a rich description of the postoperative experiences of patients in China. Participants reported that surgical benefits supersede the surgery-related side effects, and participants were able to develop self-management strategies in order to achieve success. However, personal and social barriers, such as the challenges of applying postoperative dietary guidelines into daily practice, may impede patients making and sustaining recommended behavioral changes.

Curative effect of methotrexate combined with teniposide in the treatment of primary central nervous system lymphoma.

The present study aimed to investigate the curative effect of high-dose methotrexate (HD-MTX) combined with teniposide (Vm26) vs. HD-MTX alone in the treatment of primary central nervous system lymphoma (PCNSL), in order to provide data for assisting decisions associated with clinical treatment. Data from 56 patients with PCNSL admitted in Shanghai Huashan Hospital (Shanghai, China) from January 2009 to December 2014 were included into the present study. Clinical data, curative effects and prognosis of patients in these two groups were retrospectively analyzed using SPSS 20 statistical software. In the HD-MTX+Vm26 group, 12 patients (42.85%) achieved complete remission (CR) and 10 patients (35.71%) achieved partial remission (PR), while in the HD-MTX group 7 patients (25%) achieved CR and 11 patients (39.29%) achieved PR (P=0.158). The median progression-free survival (PFS) time was 22 months in the HD-MTX+Vm26 group and 12 months in the HD-MTX group (P=0.019). The median overall survival time was 57 months in the HD-MTX+Vm26 group, and 28 months in the HD-MTX group (P=0.013). Compared with HD-MTX alone, the combined treatment of HD-MTX+Vm26 had an improved curative effect in the treatment of PCNSL, effectively controlled tumor progression in patients, prolonged survival time and improved prognosis. Age was an independent prognostic factor in patients with PCNSL. Patients with an age of ≤60 years exhibited longer PFS compared with patients with an age of >60 years.

Tracking Carbapenem-Producing Klebsiella pneumoniae Outbreak in an Intensive Care Unit by Whole Genome Sequencing.

The presence of carbapenem-producing Klebsiella pneumoniae (CP-Kp) is a serious threat to the control of nosocomial infections. Plasmid-mediated horizontal transfer of the resistance gene makes it difficult to control hospital-acquired CP- Kp infections. Nine CP- Kp strains were isolated during an outbreak in the intensive care unit of Shanghai Huashan hospital in east China. We conducted a retrospective study to identify the origin and route of transmission of this CP-Kp outbreak. Whole-genome sequencing (WGS) analysis was performed on 9 clinical isolates obtained from 8 patients, and the results were compared to clinical and epidemiological records. All isolates were ST11 CP-Kp. Single-nucleotide polymorphisms and the presence and structure of plasmids indicated that this CP-Kp outbreak had different origins. These 9 isolates were partitioned into two clades according to genetic distance. Four plasmids, CP002474.1, CP006799.1, CP018455.1, and CP025459.1, were detected among the 9 isolates. The plasmid phylogeny and antibiotic resistance (AR) gene profile results were consistent with the sequencing results. We found that two clades of CP-Kp were responsible for this nosocomial outbreak and demonstrated the transmission route from two index patients. Plasmid carriage and phylogeny are a useful tool for identifying clades involved in disease transmission.

Association of hepatitis B infection with high-risk complications in total joint arthroplasty

BackgroundAn increasing number of patients with hepatitis B virus (HBV) infection are undergoing total joint arthroplasty (TJA) surgery in China. Less attention is provided to the special populations and the purpose of this study is to assess the effect of HBV infection on the prognosis TJAs.MethodsWe retrospectively reviewed patients who underwent elective primary hip and knee arthroplasties in Shanghai Huashan Hospital from 2013 to 2016. Non-hepatitis B cohort was built to match the case cohort to identify whether HBV infection was a risk factor associated with postoperative complications. A total number of 196 patients who underwent primary TJAs were involved in the study, including 49 patients with hepatitis B and 147 non-hepatitis B subjects.ResultsAmong all the patients with TJAs, 5.5% of patients were infected with HBV for the first time. The incidence rate of complications in patients after arthroplasty with hepatitis B infection was significantly higher than that in patients without hepatitis B (10.2% compared to 4.7%, P < 0.01). Surgical related complications (6.1% compared to 3.4%) and general medical complications (4.1% compared to 1.3%) were higher than those in non-B hepatitis group. Compared with non-B hepatitis group, the overall risk of hepatitis B infection increased by 25% (95% CI, 1.04–1.46; p < 0.01). Similar results were obtained for medical and surgical complications. HBV infection presented a 31% increased risk (95% CI, 1.02–1.62; p < 0.01) for medical complication and an 18% increased risk (95% CI, 1.10–1.26; p < 0.01) for surgical complication. No statistical difference was found between the surgical methods and sex. However, a significant difference of C-reactive protein (CRP) level was found between HBV infection group and the matched non-infected group (P < 0.01).ConclusionThis is the first study to investigate the risk of perioperative complications of hepatitis B in Chinese TJAs patients. In consideration of the large population of HBV infection in China, more attention and medical care should be provided to patients with HBV infection who need to undergo TJA operation.

Clinical and Molecular Characteristics of Thalamic Gliomas: Retrospective Report of 26 Cases

Thalamic glioma is a type of midline glioma with poor outcomes. In the present study, we investigated the clinical and molecular features of thalamic gliomas in Chinese patients. The data from 26 patients with thalamic glioma who had undergone surgery at Shanghai Huashan Hospital from January 2011 to August 2015 were retrospectively analyzed. Various clinical and molecular factors were evaluated to explore their effects on prognosis. H3K27M mutation status and its association with relevant molecular factors were also investigated. The mean age of the patients was 38.88 years, and no significant difference was found in sex. The most common initial symptoms were headaches (38.46%; 10 of 26) and motor deficits (30.77%; 8 of 26). The H3K27M mutation was identified in 12 patients, and mutant thalamic glioma showed less frequent O-6-methylguanine DNA methyltransferase (MGMT) promoter methylation compared with the wild-type group (P= 0.015; χ1 test). Multivariate analysis showed that the H3K27M mutation was an independent unfavorable prognostic factor for overall survival. MGMT promoter unmethylation and the TP53 mutation were identified as negative prognostic factors for progression-free survival. Our results revealed the clinical and molecular characteristics of thalamic glioma in China. Our data have shown the absence of MGMT promoter methylation in H3K27M mutant thalamic glioma, validating it as a hallmark of H3K27M mutant gliomas. In addition, H3K27M mutation was identified as the sole unfavorable prognostic factor on overall survival. MGMT promoter unmethylation and TP53 mutation were identified as independent prognostic factors for progression-free survival.

Prevalence and associated physical symptoms of depressive and anxiety symptoms in neurology outpatient clinic

The co-occurrence of depressive and anxiety symptoms in a variety of neurological conditions are widely common and disabling. Furthermore, it could persist for a long time and interfere in the...

Small intestinal bacterial overgrowth and low-grade systemic inflammation in 50 patients with irritable bowel syndrome

Objective To investigate the incidence of small intestinal bacterial overgrowth (SIBO) and systemic low-grade inflammation in patients with irritable bowel syndrome (IBS). Methods From June to October in 2017, 50 cases of IBS patients who met Rome Ⅳ criteria were consecutively collected at Outpatient Department of Gastroenterology of Shanghai Huashan Hospital. The incidence of SIBO was detected by hydrogen lactulose breath test (LBT) and methane LBT. The incidence of systemic low-grade inflammation in IBS patients was determined by fractional exhaled nitric oxide(FeNO) breath test. Chi-square test was used for statistical analysis. Results Among 50 IBS patients, the positive rate of FeNO was 70%(35/50), and the number of FeNO positive cases in diarrhea-predominant (n=28), constipation-predominant (n=14) and mix-type (n=8) IBS paitents was 18, 11 and six, respectively, and the difference was not statistically significant among three groups (χ2=1.020, P=0.600). The incidence rate of SIBO was 60% (30/50), with 20 cases (40%) being only positive for hydrogen LBT, seven cases (14%) being methane LBT, and three cases (6%) being both positive. The numbers of hydrogen LBT and methane LBT in diarrhea-predominant, constipation-predominant, and mix-type IBS patents were 17, three, three and two, six, two, respectively. There were statistically significant differences in positive rates of hydrogen LBT and methane LBT among three groups (χ2=6.076 and 6.392, both P<0.05). The positive rate of FeNO in IBS patients with SIBO was higher than that of IBS patients without SIBO (90%, 27/30 vs. 40%, 8/20), and the difference was statistically significant (χ2=14.286, P<0.01). Conclusions Combination of hydrogen LBT and methane LBT has a higher detection rate of SIBO than traditional single hydrogen LBT. There is a correlation between SIBO and systemic low-grade inflammation in IBS patients. Key words: Irritable bowel syndrome; Small intestinal bacterial overgrowth; Lactulose breath test; Systemic low-grade inflammation

A Study of the Effects of Organizational Support on Organizational Learning based on Knowledge Management

Being in the era of the knowledge-based economy, knowledge would replace land, labor, capital, and equipment to become the primary production factor. An enterprise could create competitive advantages for the organization merely by constant knowledge accumulation and acquisition. Competitive advantages in the medical industry come from the efficacy of knowledge application that the execution of knowledge management is a pursued goal of medical institutions. Nurses in a hospital are like employees in an enterprise, and doctors are the senior supervisors in the organization. Supervisors in medical units must have the employees understand the attention from the hospitals so as to have nurses devote themselves to executing the organizational objectives. Aiming at hospitals in Shanghai, physicians and medical personnel in Shanghai Huashan Hospital were distributed with 420 copies of a questionnaire. A total 352 valid copies were retrieved, with the retrieval rate at 84%. The research results conclude significantly positive effects of organizational support of knowledge management, knowledge management of organizational learning, and organizational support of organizational learning. Some suggestions are proposed at the end, expecting to assist the domestic medical industry in establishing market advantages.

Clinical analysis of elderly patients with osteoporotic hip fractures

Clinical data of 448 patients aged ≥60 years with osteoporotic hip fractures admitted in Shanghai Huashan Hospital between January 2010 and December 2014 were retrospectively analyzed. Among 448 cases, there were 143 males and 305 females; 196 cases aged 80-89 years (43.8%) and 137 cases aged 70-79 years (30.6%); 304 cases of femoral neck fracture (67.9%) and 144 cases of intertrochanteric femoral fracture (32.1%); the fractures caused by fall in 328 cases (73.2%) and comorbidity with hypertension and diabetes mellitus in 415 cases (92.6%). Two hundred and sixty eight patients were followed up for 2 years, among whom re-fractures occurred in 17 cases. The study indicates that health education is important for prevention of osteoporotic fractures in elderly people. Key words: Osteoporosis fractures; Hip fracture; Elderly

Characteristics of cerebral glucose metabolism on 18F-FDG PET imaging in patients with Parkinson′s disease

Objective To validate the reproducibility of abnormal cerebral metabolic characteristics in PD patients from different medical centers using 18F-FDG PET imaging. Methods A total of 108 subjects who were referred for resting-state brain 18F-FDG PET imaging were retrospectively reviewed. Thirty-three PD patients (15 males, 18 females, age: 38-79 years) and 33 age-matched healthy controls (15 males, 18 females, age: 40-77 years) underwent evaluation at Shanghai Huashan Hospital Affiliated to Fudan University. Seventeen PD patients (10 males, 7 females, age: 44-74 years) and 17 age-matched healthy controls (6 males, 11 females, age: 42-67 years) underwent evaluation at the First Affiliated Hospital of Sun Yat-sen University. SPM was used to investigate the cerebral metabolic characteristics of the patients with two-sample t test. Statistically significant voxels were obtained by using familywise error rate (FWE; P<0.05). Two sets of PD patients with abnormal glucose metabolism of brain regions were obtained and the cerebral metabolic characteristics were compared. Results Regarding the PD patients from Shanghai Huashan Hospital, the features of cerebral glucose metabolism by SPM analysis were demonstrated as follows: increased metabolism was found in the region of pons, cerebellum, thalamus, putamen and pallidum, while decreased metabolism was displayed in the region of parietal lobe and occipital lobe. The increased regions referred to 8 110 voxels and decreased regions referred to 2 810 voxels (P<0.05). The similar metabolic pattern was found in PD patients from the First Affiliated Hospital of Sun Yat-sen University. The increased metabolism was shown in the regions of pons, cerebellum, thalamus, putamen and pallidum, and referred to 15 573 voxels. The metabolism-decreased regions included parietal lobe, occipital lobe and frontal lobe, and referred to 3 945 voxels (P<0.05). Conclusions 18F-FDG PET/CT imaging results demonstrate similar metabolic pattern in PD patients from different medical centers, in whom the metabolism-increased regions are found in the pons, cerebellum, thalamus and pallidum and decreased regions were demonstrated in the parietal lobe and occipital lobe. The reproducibility from 18F-FDG PET/CT imaging provides reliable evidence for the multi-center study in the differential diagnosis of PD. Key words: Parkinson disease; Brain; Metabolism; Positron-emission tomography; Deoxyglucose

The surgical management of giant intracranial vestibular schwannoma via retrosigmoid approach: a retrospective review of 657 cases

To discuss the surgical technique and common complications from the microsurgical treatment of giant intracranial vestibular schwannoma via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications. Surgical outcomes and complications were evaluated in a consecutive series of 657 unilateral giant vestibular schwannomas treated in Shanghai Huashan Hospital via suboccipital retrosigmoid approach from 1999 to 2014. According to the international classification of vestibular schwannoma, giant tumor means tumor's size over 4 cm in diameter. Clinical status and complications were assessed postoperatively within 14 days and at follow-ups (range, 6-191 months; mean, 59.6 months). Follow-up data were available for 566 of the 657 patients (86.1%). The most frequent clinical symptoms were hearing loss in different levels (100%), deafness (36.4%), facial numbness (68.8%). Total tumor resection was achieved in 556 patients (84.6%), subtotal resection in 99 patients (15.1%), and partial resection in 2 patients (0.3%). The common postoperative complications included new deafness (49.6%), intracranial infection (7.6%), low cranial nerve defect (7.5%) and pneumonia (6.2%). The facial nerve was preserved anatomically in 589 cases (89.6%) after operation, and the functional valuation of facial nerve according to postoperative House-Brackmann showed 216 patients (32.9%) in grade Ⅰ-Ⅱ, 308 cases (46.9%) in grade Ⅲ, 133 patients (20.2%) in grade Ⅳ-Ⅵ. Long-term followed-up results showed 428 patients (75.6%) in grade Ⅰ-Ⅲ one year after surgical treatment. Many of these complications are avoidable. Surgical experiences and the clinical anatomy of the approach, accompany with using intraoperative nerve monitoring, preoperatively study the individual imaging and clinical data and multidisciplinary cooperation are the key points to avoid the complications of giant intracranial vestibular schwannoma via suboccipital retrosigmoid approach.

Relationship between plasma coagulation factor VII and progressive hemorrhagic injury in patients with isolated traumatic brain injury

Objective To measure the early changes of plasma coagulation factor Ⅶ (FⅦ) in patients with traumatic brain injury (TBI) and analyze the association between FⅦ and progressive hemorrhagic injury (PHI) so as to provide evidences for treatment of PHI. Methods The study enrolled 112 patients with moderate or severe isolated TBI, aged ≥16 years, who were admitted to the neurotrauma center at Shanghai Huashan Hospital from August 2010 through June 2014. Peripheral blood samples were collected at admission, 24 hours and 48 hours after admission to determine the parameters of international normalized ratio (INR), activated partial thromboplastin time (APTT), platelet count (PLT), D-dimer, fibrinogen (FIB) and FⅦ activity. Follow-up head CT was performed every 24 hours. PHI was defined as when follow-up CT noted any increase in size or number of hemorrhagic lesions. Results Plasma level of FⅦ in patients who developed PHI were significantly lower than those without PHI [0 hour: (77.79 ± 22.82)% vs (100.32±30.39)%; 24 hours: (95.25±28.20)% vs (113.52±21.66)%; 48 hours: (93.02±21.34)% vs (107.69±20.26)%, P 0.05). Logistic regression analysis identified decreases in FⅦ level and platelet count as independent risk factors for the presence of PHI (P<0.05). Conclusion At early stage after TBI, the decreased FⅦ activity and the low platelet level are closely associated with PHI, indicating their importance in guiding treatment of PHI. Key words: Craniocerebral trauma; Intracranial hemorrhages; Coagulation factor Ⅶ; Blood coagulation function

Efficacy analysis of diagnosis and treatment of Cushing's disease with a multidisciplinary team

Objective To analyze the efficacy and experiences of the diagnosis and treatment of Cushing's disease with a multidisciplinary team. Methods Forty-five patients with Cushing's syndrome treated under the MDT diagnosis and treatment process mode at Shanghai Huashan Hospital, Fudan University from January to December 2013 were analyzed retrospectively. Among the 45 patients, 22 underwent bilateral inferior petrosal sinus blood sampling, and 40 were diagnosed as Cushing's syndrome. Macroadenomas, microadenomas, and MRI negative were 8, 26, and 6, respectively, 3 of them were invasive. Thirty-two patients were newly diagnosed, 8 relapsed or did not relieve after the first treatment.Their diagnosis, management, efficacy, and room for improvement were summarized. Results Thirty-three patients with Cushing's disease received neurosurgery, 32 had transnasal surgery and 1 underwent craniotomy. There was significant difference in the lowest values of serum cortisol at 1 week before and after surgery (869±361 and 60±41 nmol/L respectively; P<0.01). Twenty-two patients had early remission, and 25 had overall remission (76%) at 3 months after surgery; the remission proportions of macroadenoma, microadenoma, MRI negative, and invasive pituitary adenoma were 6/6, 14/18, 3/6, and 2/3, respectively. Of the patients who relapsed or did not relieve after treatment, 6 were reoperated, and 4 were relieved. Of the 27 patients with adrenocorticotropic hormone (ACTH) tumor and 6 with hyperplasia or glandular tissue, 25 and 0 were relieved. Of the 8 patients who were not relieved after surgery, 2 were enrolled into the new drug research of pasireotide, 3 were treated with gamma knife, 1 began to be treated with metyrapone, 1 was waiting for reoperation, and 1 was lost to follow-up. Seven patients had surgical complications. Conclusions The factors affecting surgical treatment of Cushing's disease include the pituitary imaging and pathological features, etc. Under the MDT mode, the diagnosis and treatment help patients to timely choose the optimal treatment regimen. Key words: Cushing disease; Petrosal sinus sampling; Multidisciplinary team