Volume 85  ·   Issue 22  ·  2005

Surgery occupies an important position in the treatment of tumor, no matter where the treatment of tumor starts (surgery, radiotherapy, chemotherapy, immunotherapy, etc.), and the surgeon who bears this important responsibility is one of the important factors in the prognosis of patients. When simple surgery is not enough to cure the disease, surgery is also a part of comprehensive treatment; It can be used as a method of palliative treatment of tumor [1]; Sufficient tissue specimens were obtained for clinical analysis and study, which could be used to judge prognosis and guide comprehensive treatment.

During his recent visit to Cleveland Medical Center, President Bush called on every doctor in the United States to use electronic medical records in order to improve the quality of medical care and reduce the cost [1]. In the 2004 State of the Union Address and the 2004 U.S. presidential campaign, President Bush demanded that the medical profession completely abolish the traditional paper medical records within 10 years. Echoing this, the White House set up a special fund of 125 million dollars for the implementation of electronic medical records in the 2006 federal government budget. On the implementation of electronic medical records, the views of government, academia and industry are completely united, which is the first time in American history.

Objective to evaluate the value of Helicobacter pylori (Hp) fecal antigen in the diagnosis of Hp infection. Methods the electronic search was carried out mainly from Chinese Biomedical Literature Database, Chinese Biomedical Journal Literature Database, Chinese Academic Journals Full Text Database and Chinese Scientific and Technological Journals Full Text Database, and then according to % and 93% of published literatures, the diagnosis of Hp infection by Hp fecal antigen is simple, non-invasive and accurate.

Objective to investigate the relationship between preoperative serum soluble CD30 (sCD30) levels and long-term survival of renal transplant recipients and graft. Methods A total of 707 allogeneic kidney transplant recipients with preoperative blood samples from December 1998 to August 2003 were enrolled. The long-term survival and other baseline data of these recipients were retrospectively summarized, and the preoperative serum sCD30 levels were detected with sCD30 enzyme-linked immunosorbent assay (ELISA). Results The 5-year survival rates of low, medium and high sCD30 groups were 84.7%±2.1%, 88.1%±2.9% and 77.7%±3.5%, respectively, and the 5-year functional survival rates were 98.9%±1.1%, 95.1%±1.6% and 85.0%±3.2%. The long-term survival/functional survival of high sCD30 group was significantly lower than that of low and medium sCD30 group (all P<The 5-year survival rates of low, medium and high sCD30 groups were 84.7%±3.9%,92.4%±1.6% and 87.1%±2.7%, respectively. The main causes of death were infection, liver failure and cardiovascular and cerebrovascular accidents, but the acute rejection occurred within 1 month before death in the three groups accounted for 0, 13.0% and 40.9%, respectively. Conclusion The preoperative sCD30 level is related to the immune status of renal transplant recipients, and high sCD30 represents high immune reactivity of recipients, which indicates that the incidence of postoperative acute rejection increases and leads to poor prognosis of renal transplant. Low sCD30 indicates that the body is relatively immunocompromised and at high risk of infection and drug toxicity.

Objective to investigate the localization and expression of vascular endothelial growth factor (VEGF) receptor (Flt-1, KDR) in ectopic and eutopic endometrial tissues of patients with endometriosis (endometriosis for short). Methods the expression rate and intensity of Flt-1, KDR mRNA and protein were detected by immunohistochemistry, Western blot and reverse transcription polymerase chain reaction (RT-PCR). Results Flt-1 and KDR protein were expressed in endometrial glandular cells and mesenchymal cells besides vascular endothelial cells. The positive expression rates of Flt-1 and KDR in endometrial endometrium of patients with endometriosis were 94.3% and 91.4%, respectively, higher than those of ovarian chocolate cyst (74.3% and 77.1%, respectively)<The expression rate of Flt-1 and KDR in eutopic endometrial tissue of non-endometriosis patients (93.8%, 90.6%, P>0.05) was similar to that of non-endometriosis patients (93.8%, 90.6%, P>0.05). The gray values of protein levels were 31±17,36±24, respectively, and the ratios of nucleic acid levels (A) in ovarian chocolate cyst tissues were 1.5±0.9, 1.8±1.0, respectively, and the gray values of protein levels were 17±6,20±11, respectively (P<0.05); The ratio of nucleic acid level (A) in endometrial tissue of control group was 1.9±0.8,2.3±1.3, and the gray value of protein level was 24±18,25±16 (P>0.05). Conclusion VEGF may play a certain biological role through the corresponding receptors on endometrial cells. The expression of Flt-1 and KDR in ectopic endometrium of patients with endometriosis may be related to angiogenesis.

Objective to investigate the clinical significance of microlymphangiogenesis in early stage of cervical squamous cell carcinoma. Methods 35 cases of cervical squamous cell carcinoma patients with stage Ⅰb and Ⅱa were examined in archived wax sections. The microlymphatic vessels were immunostained with Podoplanin monoclonal antibody, and the lymphatic vessels in and around cancer were quantitatively analyzed by image analysis system. Results (1) Morphological observation showed that the lymphatic vessels in the peritumor were thicker and denser than those in the peritumor. (2) The density of lymphatic vessels in the peritumor of cervical squamous cell carcinoma was (31±10) stripes/mm2, and the density of lymphatic vessels in the peritumor of cervical squamous cell carcinoma was (20±10) stripes/mm2<0.01); The peritumoral relative lymphatic vessel area (LVA) was (0.75±0.40) %, and the intratumoral LVA was (0.19±0.11) % (P<(3) LVD and LVA were (29±7) stripes/mm2, (40±5) stripes/mm2, (0.27±0.10) %, (1.23±0.36) % in patients with pelvic lymph node metastasis, (16±8) stripes/mm2, (28±9) stripes/mm2, (0.16±0.09) %, (0.56±0.20) %, (P<0.01,0.01,<0.05 and P<(4) The peritumoral LVA and intratumoral LVD and LVA of histological grades Ⅰ, Ⅱ and Ⅲ were (0.42±0.10) %, (9±3) strips/mm2, (0.06±0.04) %, respectively; (0.77±0.37) %, (21±8) strips/mm2, (0.21±0.09) %; (0.83±0.46) %, (22±11) strips/mm2, (0.21±0.12) %.P average compared with grade Ⅱ, Ⅲ and Ⅰ<Conclusion the high lymphatic distribution of early cervical squamous cell carcinoma is related to lymph node metastasis.

Objective to determine the genetic phenotype related to the onset of bronchial asthma by detecting umbilical cord blood (hereinafter referred to as umbilical cord blood) of asthmatic mothers and newborns. Methods the umbilical cord blood of 39 asthmatic mothers and 46 normal mothers and newborns were collected, and the values of eosinophils and basophils, the contents of total IgE and interleukin (IL) -4, and the ability of basophils to release mediators in umbilical cord blood were detected. The expression of IL-4 mRNA was observed from purified basophils and T lymphocytes. Results (1) The release rate of basophils in umbilical cord blood increased by 64.10% and 15.22% in asthmatic women with hypertonic mannitol and anti-human IgE as stimulants, respectively, and 17.95% and 2.17% in normal women, respectively<0.005, P<0.025. (2) The expression of IL-4 mRNA was obvious in the two groups of maternal basophils after hyperosmolar stimulation, but the expression of IL-4 mRNA was not obvious in the purified T lymphocytes; There was no significant difference between the two groups in the IL-4 values measured from the supernatant of mononuclear cells isolated from cord blood stimulated by PHA in vitro. (3) There was no significant difference between the two groups in the values of eosinophils, total IgE and IL-4 in cord blood. Conclusion There are qualitative abnormalities in cord blood basophils of asthmatic mothers and newborns, and IL-4 mRNA is obviously expressed, suggesting that it may be a genetic phenotype related to asthma.

Objective to investigate the changes of cerebral blood flow autoregulation function during carbon dioxide reaction, and to establish a new method for clinical measurement of the lower limit of autoregulation. Methods the blood flow of middle cerebral artery, blood pressure of radial artery and partial pressure of carbon dioxide (ETco2) of exhaled gas at the end of expiration were monitored simultaneously, and the lower limit of autoregulation (LLCA) of cerebral blood flow was measured by critical shut-off pressure (CCP) method. The LLCA of 79 normal healthy volunteers during normal breathing, breath-holding and hyperventilation was observed, and compared with the results of normal breathing. Results the LLCA was 58 mm Hg ± 10 mm Hg (1 mm Hg =0.133 kPa) during normal breathing, and significantly increased to 69 mm Hg ± 15 mm Hg (P<0.05), hyperventilation decreased significantly to 44 mm Hg ± 11 mm Hg (P<Compared with normal breathing, the 95% CI for the difference of LLCA measurement in breath-holding and hyperventilation were 2.70 mm Hg and 2.18 mm Hg, respectively. The change rate of LLCA in breath-holding and hyperventilation was negatively correlated with the change rate of CCP (r = -0.610 5, -0.555 1, both P<At the same time, the change rate of mean blood flow velocity was positively correlated with the change rate of LLCA (r =0.5841,0.7739,both P<Conclusion CCP can be used to determine the lower limit of cerebral blood flow autoregulation accurately and noninvasively. The function of cerebral blood flow autoregulation increases or decreases correspondingly during CO2 reaction, and its mechanism is closely related to the change of cerebral vascular tension.

Objective to investigate the mutation and clinical characteristics of PINK1 gene in autosomal recessive early-onset Parkinsonism type 6 (PARK6). Methods Polymerase chain reaction (PCR), direct DNA sequencing and restriction endonuclease digestion were used to analyze the mutation of PINK1 gene in 11 probands of autosomal recessive early-onset Parkinsonism. Results Two new point mutations of PINK1 gene were detected in two families: C→T at position 938 of exon 4, which caused the encoded amino acid 313 to change from threonine to methionine (T313M); A synonymous mutation (Y454Y) was detected in another family. The clinical characteristics of patients with PINK1 gene mutation include early onset age, slow progression, active tendon reflex, obvious fluctuation of symptoms, relief of symptoms after sleep, good response to low-dose dopa preparation, and no dyskinesia induced by L-dopa. Conclusion PINK1 gene mutation is a common cause of autosomal recessive early onset Parkinsonism; PARK6 family exists in mainland China; PARK6 is clinically heterogeneous.

Objective to investigate the surgical technique of pituitary tumor (PNs) excision by single nostril-sphenoid sinus approach and neuroendoscopic assistance and evaluate its curative effect.Methods 78 consecutive PNs patients admitted to our department from December 2003 to September 2004 were examined by magnetic resonance imaging (MRI) or CT scan, which showed that the tumor in the sellar region compressed the optic nerve and the optic chiasm. All PNs excision by single nostril-sphenoid sinus approach and neuroendoscopic assistance was performed. Results 71 patients (91.0%) had total tumor excision, 5 patients (6.4%) had subtotal resection, and the remaining 2 patients (2.6%) had only partial resection of fibrous tumor. There was no death after operation in this group.67 patients were followed up for an average of 3 months, 64 patients (95.5%) had rapid visual acuity recovery, and the remaining 3 patients (4.5%) also had improvement. 62 cases had visual field defects before operation, 60 cases (96.8%) recovered after operation, and the other 2 cases (3.2%) improved. Conclusion Neuroendoscopic resection of PNs through single nostril-sphenoid sinus approach is an effective minimally invasive surgical method, and endoscopic angle change during operation is helpful to safely and thoroughly resect the tumor.

Objective to investigate the effects of human epidermal growth factor receptor-2 (Her-2/neu) small interfering RNA (siRNA) on the cell cycle and apoptosis mechanism of Her-2/neu overexpressed lung adenocarcinoma cells. Methods Her-2/neu targeted siRNA was used to transfect lung adenocarcinoma calu-3 cells. The levels of Her-2/neu and Cyclin D1 mRNA were determined by reverse transcription-polymerase chain reaction (RT-PCR) before and after transfection. The changes of Her-2/neu protein level and cell cycle were detected by flow cytometry; Detection of Apoptosis in Lung Cancer Cells by Annexin Ⅴ Fluorescein Isobisulfate (FITC) Kit; Determination of Caspase-3 Activity by Fluorescence Spectrophotometry; Enzyme-linked immunosorbent assay (ELISA) was used to detect the level of vascular endothelial growth factor (VEGF) in the supernatant of the culture medium. Results Her-2/neu siRNA could down-regulate the expression of Her-2/neu gene in lung cancer cell line calu-3 at the level of mRNA and protein. After 48 h transfection of Her-2/neu siRNA, the number of cells in G0/G1 phase increased, while the proportion of cells in S phase decreased, and the difference was statistically significant compared with that of non-transfected control group, empty vector group and non-specific siRNA group (F =6.1, P<The level of Cyclin D1 mRNA decreased after Her-2/neu siRNA transfection, and the content of VEGF in the culture supernatant was 176 pg/ml ± 6 pg/ml (F =24.7, P<0.01), and the activity of Caspase-3 was 135% ± 4% (F =8.9, P<0.01), the apoptosis rate was 25.1%±1.2% (F =10.3, P<0.01). Conclusion Chemically synthesized targeted Her-2/neu siRNA can down-regulate the expression of Her-2/neu gene, and then reduce the levels of Cyclin D1 and VEGF, activate the Caspase-3 pathway, thus arresting the cell cycle in G0/G1 phase and inducing apoptosis.

Objective to investigate the expression of c-kit oncogene protein in pulmonary neuroendocrine carcinoma and its clinicopathological significance. Methods the expression of c-kit protein in 90 patients with pulmonary neuroendocrine carcinoma was detected by immunohistochemical SP method and its relationship with clinicopathological indexes and prognosis was analyzed. Results the expression of c-kit protein was localized in the membrane and cytoplasm of cancer cells; The positive rates of c-kit expression were 21.4% (3/14) for carcinoid tumors, 90.0% (18/20) for atypical carcinoid tumors, 38.7% (12/31) for large cell neuroendocrine carcinoma, and 76.0% (19/25) for small cell carcinoma, respectively, with statistically significant differences (P =0.000). The difference was statistically significant (P =0.014). The distribution of c-kit in the gender of patients was 64.8% (46/71) for males and 31.6% (6/19) for females, with statistically significant differences (P =0.017).<43.1% (22/51) of patients with 5 cm and 76.9% (30/39) of patients with ≥5 cm, the difference was statistically significant (P =0.002). The expression of c-kit was 66.1% (47/71) of patients with lymph node metastasis and 26.3% (5/19) of patients without metastasis, the difference was statistically significant (P =0.003). The median survival time of patients with c-kit negative expression cancer was 97 months, and that of patients with c-kit positive cancer was 16 months, the difference was statistically significant (Log Rank =22.85, P =0.000). The expression of c-kit protein was not related to the tumor site (P =1.000) and age (P =0.394). Conclusion c-kit protein plays an important role in the occurrence and evolution of pulmonary neuroendocrine carcinoma, and can be used as a molecular index to monitor the prognosis of patients.

During the development of emergency medicine in the past 30 years, the rescue of critical emergency accidents outside the hospital has become more and more important. Especially in the latter decade of the 20th century, the global disaster situation is severe, so the United Nations designated the last decade of the 20th century as the "International Decade of Disaster Reduction". After entering the 21st century, the situation has not improved. The young Chinese rescue medicine undertakes the heavy responsibility in the medical rescue of national public health emergencies, and at the same time, it must integrate with the international standards and integrate into the global rescue medicine.

In clinic, when we encounter diagnosis and treatment problems, we should follow the steps of evidence-based medicine implementation, that is, put forward a question that can be answered, search for the most reliable and powerful evidence at present, and then evaluate the scientificity, validity and practicality of the obtained evidence. After confirming the scientificity and validity of the evidence, we should also analyze whether the treatment measures in the literature can be applied to my patient. In this respect, we should consider whether the severity of individual clinical patients is similar to that of cases included in the literature, whether the patient's general physical condition and environmental factors are consistent, whether the treatment measures can obtain the same result or better or worse efficacy than the results in the literature if applied to my patient, as well as the availability of treatment measures under the current medical conditions, the feasibility of treatment effect and monitoring adverse drug reactions, the economic affordability of patients, families and countries for this treatment measure and monitoring adverse reactions, Patients' thoughts on treatment, expectations and many other factors. This paper introduces the foreign research progress of the above-mentioned treatment measures in the methodology of bedside implementation.

Gastroesophageal reflux disease includes hiatal hernia, reflux esophagitis, Barrett's esophagus and digestive esophageal stricture and short esophagus, which are serious complications in the later stage of gastroesophageal reflux disease. In western countries, gastroesophageal reflux disease is a common disease [1], which not only causes severe pain to patients, but also is considered as the main risk factor of esophageal adenocarcinoma [2]. Therefore, the research on gastroesophageal reflux disease has become a focus of upper gastrointestinal diseases in western countries. There are a large number of patients with gastroesophageal reflux disease in China, and the incidence rate of gastroesophageal reflux disease is increasing year by year. However, compared with their counterparts in western countries, many doctors in China, including thoracic surgeons, have far less knowledge of gastroesophageal reflux disease, especially the position and role of surgery in the treatment of gastroesophageal reflux disease have not been paid enough attention.

1. Clinical data The patient was a 58-year-old female who was admitted to the cardiac surgery ward of Beijing Anzhen Hospital on March 30, 2004 due to intermittent attacks of chest pain and chest tightness aggravated for 2 weeks for 8 years. The patient was admitted to our hospital with a recurrence of ascending aorta and arch dissection aneurysm after type Ⅱ aortic dissection, formation of aortic valve neoplasm, abdominal aortic dissection, and hypertension. Eight years ago, the patient developed severe chest pain and chest tightness, radiating to the back, accompanied by a blood pressure increase of 180/100 mm Hg (1 mm Hg =0.133 kPa). The diagnosis was confirmed by chest magnetic resonance imaging (MRI): type Ⅱ aortic dissection.

The patient was a 50-year-old male. Two years ago, a cyst in his right kidney, about 70 mm in size, was found in physical examination. Recently, the cyst enlarged, and he was hospitalized for diagnosis and treatment. Since the onset of the disease, he had no low back pain, no macroscopic hematuria, denied that he had genetic diseases at home, and had no history of hemodialysis. The patient had good development and nutrition, heart and lungs (-), flat abdomen, unpalpable kidneys, and no snap pain in the kidney area.

Wnt signal transduction pathway plays a role in the occurrence and development of many kinds of tumors, and lymphoid enhancing factor (LEF) -1 is a key factor, which plays an important function.In this study, immunohistochemistry and in situ hybridization were used to detect the expression and clinicopathological characteristics of LEF-1 protein and mRNA in malignant melanoma, and to explore the role and significance of LEF-1 in the occurrence and development of melanoma.

In order to explore the value of Trp-p8 in the diagnosis of prostate carcinoma, we examined the expression of Trp-p8 mRNA and protein in normal prostate, benign hyperplastic prostate and prostate carcinoma tissues by molecular biology and analyzed its clinical significance.

The mutual recognition of human leukocyte antigen (HLA) -DR molecule, antigen peptide and T cell receptor (TCR) and the formation of three molecule complexes are the initial links in the pathogenesis of rheumatoid arthritis (RA) [1]. Many laboratories inhibit the formation of three molecule complexes and hinder the pathogenesis of RA in the upstream of the immune response in the pathological process of RA, thus achieving the purpose of RA immunotherapy [2, 3]. However, the immunotherapy preparations such as antibodies and peptides used need to be administered continuously because of their short half-life and easy hydrolysis, and these treatments do not fundamentally block the formation of three molecule complexes [4].

A 52-year-old female was admitted to the hospital in 1991 for 6 months of continuous decrease in visual acuity. Pituitary tumor was found by magnetic resonance examination (no aneurysm was found). Most of the transsphenoidal pituitary tumor was resected, and the sellar area was treated with linear accelerator (50 Gy radiation dose each time) three times after operation. On 20 September 2004, she suffered from sudden headache. MRI showed suspicious right internal carotid aneurysm; Digital subtraction angiography showed right internal carotid aneurysm, which improved after conservative treatment.

Diet and lifestyle changes can significantly reduce the incidence of type 2 diabetes. It has been reported that there is a significant negative correlation between dairy intake and insulin resistance syndrome in young obese people, but what is the relationship between dairy intake and type 2 diabetes? Choi et al. of Massachusetts General Hospital showed that men who consumed more dairy products had a lower risk of developing type 2 diabetes, and the results were published in Archive of Internal Medicine (Arch Intern Med, 2005, 165:997-1003), May 9, 2005.