Volume 85  ·   Issue 24  ·  2005

The number of liver transplantation cases in China has exceeded 1000 every year. Some units have also set up special liver transplantation groups and liver transplantation wards, and liver transplantation has become more specialized and scaled. The success rate of many liver transplantation centers exceeds 90%, the five-year survival rate is more than 70%, and the transplantation effect is close to the international advanced level.

Primary liver cancer is the second malignant tumor in China, and more than half of the new liver cancer in the world every year is in China [1]. According to incomplete statistics, as of January 2005, there have been more than 5000 cases of liver transplantation in China, of which liver cancer liver transplantation accounts for about 40%. With the increase of liver transplantation number and the accumulation of experience, many liver transplantation centers in China have changed from blindly pursuing the "quantity" of liver transplantation to the direction of "quantity and quality" simultaneously, and the indication of liver transplantation for liver cancer has gradually become the focus of debate.

The development of liver transplantation in China has shown a vigorous development trend. In several large transplantation centers, the perioperative mortality rate of liver transplantation has dropped to below 6%, and the one-year survival rate of recipients after operation has exceeded 90%, showing a very good curative effect. Therefore, many hospitals have actively joined the ranks of liver transplantation.

Objective to investigate the effects of testicular cytomegalovirus (MCMV) infection on sperm acrosome reaction and membrane function in epididymal tail of mice. Methods 48 BALB/c male mice with no history of MCMV infection were randomly selected as the experimental group. The testes were directly inoculated with MCMV, and the mice were sacrificed on the 1st, 2nd, 4th, 6th, 9th and 14th days after infection. The testes were detected by in situ hybridization with digoxin-labeled MCMV M83 mRNA oligonucleotide probe. At the same time, the sperm acrosome reaction and hypotonic swelling function of sperm membrane were detected in mature sperm from epididymal tail. Another 30 male mice in parallel control group (randomly selected by the same method) were inoculated with cell culture medium without MCMV, and the other treatment methods were the same as those in the experimental group. Results In situ hybridization positive signals appeared in the interstitial tissue and/or spermatogenic cells of testes of 48 male mice in experimental group. The sperm acrosome reaction and membrane function of sperm in experimental group were lower than those in experimental group on the 2nd and 4th day after virus inoculation (58%±9%, 56%±9%)<0.05), the hypotonic swelling rate of sperm membrane tail (48%±9%, 38%±8%) was lower than that of the parallel control group (60%±7%, 50%±4%) (P all<Conclusion the testicular MCMV infection model in mice has been established successfully. Acute testicular MCMV infection in mice can lead to a significant decrease of sperm acrosome reaction and membrane function.

Objective to compare the effects of post-treatment with isoflurane and propofol on alveolar capillary barrier function in endotoxemia rats.Methods A total of 96 healthy male SD rats, weighing 250-350 g, were given pentobarbital sodium (C, 20 mg · kg-1 · h-1), isoflurane (I, 0.55%) or propofol (P, 10 mg/kg intravenously, 40 mg · kg-1 · h-1 maintenance) 2 h after intravenous injection of endotoxin (LPS, 4 mg/kg) or equivalent amount of normal saline (NS). They were divided into 6 groups: NS-C, NS-I, NS-P, LPS-C, LPS-I and LPS-P, 16 rats in each group. Mechanical ventilation for 2 h, blood pressure and blood gas analysis were recorded every hour. After the experiment, 8 rats in each group underwent alveolar lavage to measure lung permeability index, wet-to-dry ratio of lung tissue, and observe lung tissue pathology and electron microscopic changes; Evans blue (30 mg/kg) was injected intravenously 30 minutes before the observation time point, and the content of Evans blue in lung tissue was measured after the experiment. Results There was no significant difference in mean arterial pressure and blood gas analysis indexes between NS and LPS groups at each time point. There was no difference in wet-to-dry ratio of lung tissue between the groups; Lung permeability index and Evans blue content were higher in LPS-C group (8.1×10-3 ± 2.4×10-3, absorbance 0.628 ± 0.082) than in NS-C group (3.3×10-3 ± 2.2×10-3, absorbance 0.479 ± 0.154) (P<0.05), LPS-P group (9.1×10-3±2.2×10-3, absorbance 0.664±0.028) was higher than LPS-I group (5.5×10-3±2.0×10-3, absorbance 0.517±0.048) (P<Conclusion Compared with propofol, isoflurane protected the alveolar capillary barrier function and reduced the pulmonary tissue permeability in endotoxemia rats.

Objective to isolate mesenchymal stem cells (MSC) from human placenta and study the immunoregulatory effect of placental MSC in cord blood transplantation. Methods Mononuclear cells (MNC) were isolated from human placental tissue perfusion, adherent cultured, colony screened, surface markers and purity were identified, and multidirectional differentiation potential was identified by adipose and osteogenic induction.The immunosuppressive effect of placental MSC on adult peripheral blood lymphocytes and umbilical cord blood lymphocytes was observed by 3H-TdR incorporation.Different numbers of placental MSC were co-cultured with adult peripheral blood and umbilical cord blood lymphocytes, and phytohemagglutinin (PHA) was added to stimulate lymphocyte proliferation. Results the adherent cells isolated from human placenta had the same cell phenotype and multidirectional differentiation ability as bone marrow MSC, and could significantly inhibit the transformation of adult peripheral blood and umbilical cord blood lymphocytes, and the inhibition effect was positively correlated with the number of MSC. Compared with no MSC, the inhibition rate of adult peripheral blood and umbilical cord blood lymphocytes transformation was 79.97% and 64.06% when MSC was 2×105/well, and 46.83% and 12.19% when MSC was 1.25×104/well, respectively. Conclusion MSC can be successfully isolated from human placenta. Using its immunoregulatory effect on cord blood lymphocytes, MSC can not only be used as a culture medium suitable for cord blood hematopoietic stem/progenitor cells, but also can reduce the long-troubled graft versus host disease (GVHD) problem in cord blood transplantation, and promote the wide application of cord blood transplantation.

Objective to investigate the mechanism of apoptosis induced by Zedoary Zedoary Extract-Elemene and its effect on the expression of Bcl-2 family genes and proteins in rat glioma C6 cell lines. Methods RT-PCR and Western blot were used to detect the apoptosis, proliferation and expression of Bcl-2 family genes and proteins in rat glioma C6 cell lines treated with Elemene at 0, 20, 40, 60, 80 μ g/ml concentrations and the action time was 12, 24, 36, 48, 72 h. Results After 48 h of treatment with Elemene at 20, 40, 60, 80 μ g/ml, the cell count in single field was (536 ± 9), (375 ± 10), (246 ± 9), (112 ± 10), respectively. Compared with the cell count in single field at 0 μ g/ml (625 ± 12), the proliferation inhibition ratio in vitro was statistically significant (F =1292.416, P<The apoptosis rate of C6 cells increased to (27±2) %, (29±4) %, (32±3) %, (35±5) % after treatment with different concentrations of elemene. At the same time, there was a sub-diploid apoptosis peak, that is, Ap peak appeared. Conclusion Down-regulation of Bcl-2/Bcl-x/l gene and protein expression may be the main mechanism of elemene inducing apoptosis and inhibiting the proliferation of C6 cells.

Objective to investigate the effect of breast cancer cells on normal endothelial cells in vitro co-culture system.Methods A conditioned culture medium Z-MCF-7-EC was established for co-culture of breast cancer cell line MCF-7 and normal endothelial cells in vitro; Using normal endothelial cells cultured alone at the same time as the control, the ultrastructure and morphology of endothelial cells co-cultured with breast cancer cell line MCF-7 under Z-MCF-7-EC were observed by transmission electron microscope, and the expression of ESM, IGFBP-3, α V β 3, VE-C and Tie-2-2 genes were analyzed by semi-quantitative RT-PCR with housekeeping gene β 2M as the internal reference, and the angiogenesis was observed by time-shrinkage video technique. The ultrastructure showed enlarged nucleus, enlarged nucleolus, increased nucleoplasmic ratio, loose and deformed endoplasmic reticulum, deepened cell surface window, enlarged intercellular space and decreased cell surface cilium; The semi-quantitative RT-PCR values were up-regulated compared with the control group, and the semi-quantitative values were as follows: ESM/β 2M (0.60 ± 0.28, P<0.01), IGFBP-3/β 2M (0.54 ± 0.30, P<0.05), α v β 3/β 2M (0.58 ± 0.23, P<0.01), VE-C/β 2M (0.51 ± 0.17, P<0.01) and Tie-2-2/β 2M (0.55 ± 0.21, P<Conclusion the endothelial cells after co-culture have obvious tumor-inducing characteristics and angiogenic ability. It is speculated that angiogenesis is promoted by the action of adjacent endothelial cells in the growth of breast cancer in vivo, and the properties and behaviors of neovascularized endothelial cells are different from those of normal endothelial cells.

Objective to evaluate the clinical application value of computer-aided diagnosis (CAD) system with digital mammography. Methods 120 patients with breast cancer were randomly selected with digital mammography, and the sensitivity of radiologists before and after CAD was compared. The characteristics of breast density, mass diameter, calcification diameter, whether it was a burr-like mass, and pathological type of the patients were recorded in detail, and the influence of CAD on the sensitivity of radiologists in diagnosis of breast cancer was discussed. Results The sensitivity of radiologists before and after CAD was 74.2% and 89.2% (χ 2=37.628, P =0.000). Breast density (χ 2=7.352, P =0.007), calcification diameter (χ 2=10.549, P =0.014) and pathological type (χ 2=13.751, P =0.003) have important significance on the influence of CAD on improving the diagnostic sensitivity of radiologists. CAD can significantly reduce the missed diagnosis rate of dense breast lesions, small diameter calcification, intraductal carcinoma and invasive ductal carcinoma; However, the auxiliary diagnosis value of other lesions is limited. The main reasons for radiologists' missed diagnosis are: visual fatigue and attentiveness decrease in the process of reading a large number of films and neglecting some minor lesions (type Ⅰ missed diagnosis); There is no typical malignant mass or calcification (missed diagnosis of type Ⅱ). CAD can effectively avoid missed diagnosis of type Ⅰ, but it is less helpful to missed diagnosis of type Ⅱ. Conclusion CAD system based on digital mammography is helpful to improve the sensitivity of radiologists in diagnosing breast cancer, but it can only be used as a diagnostic assistant for radiologists, but it cannot judge the benign and malignant breast diseases.

Objective to investigate the value of intraoperative real-time ultrasound in the surgical treatment of cerebral arteriovenous malformation (AVM). Methods Thirteen patients with cerebral AVM (12 supratentorial and 1 inferior) underwent microsurgical treatment. Multimodal intraoperative ultrasound scanning was performed before the lesion resection to: (1) locate and describe the boundary of AVM; (2) distinguishing between embolization and perfusion area; (3) To identify the supply artery and the drainage vein. After resection, ultrasonography was repeated to find the residual AVM and compared with the intraoperative and/or postoperative angiographic results. Results All 13 lesions were totally resected under real-time ultrasound navigation. The malformed vascular mass could be accurately located and defined because of the two-color blood flow characteristics. The embolic area was hyperechoic without blood flow signal, and the morphology and hemodynamics of blood supply and drainage vessels were different from those of normal vessels; Conclusion Intraoperative real-time ultrasound can accurately locate and navigate brain AVM, which provides valuable information for operation; And can judge the total resection of brain AVM.

Objective to investigate the relationship between allergic rhinitis and allergic asthma in patients with hay fever in summer and autumn. Methods 1120 patients diagnosed with hay fever in summer and autumn from August 2001 to December 2003 were subjected to inhaled allergen intradermal assay and serum specific IgE detection (UinCAP100 fluorescent enzyme-linked immunoassay). Meanwhile, standard clinical questionnaire survey and study were conducted on the onset age, onset time, clinical symptom characteristics and asthma severity of patients with allergic rhinitis and allergic asthma. Results The mean onset age of pollen-induced allergic rhinitis in summer and autumn was 27.9 years, and the mean onset age of allergic asthma was 32.6 years, the differences between the two were statistically significant (P<0.001); Among all the patients with hay fever in summer and autumn, allergic rhinitis accounted for 97.9% (1096/1120) and simple allergic rhinitis accounted for 45.6% (511/1120); Allergic asthma accounted for 53.8% (602/1120) and simple allergic asthma accounted for 0.9% (10/1120). Among the patients with allergic rhinitis, 53.4% (585/1096) had seasonal allergic asthma; Among the patients with seasonal allergic asthma, 97.2% (585/602) had allergic rhinitis, and 30.8% (183/602) needed emergency treatment. Conclusion the status of allergic rhinitis complicated with asthma should not be ignored in the patients with hay fever in summer and autumn, and pollen is an important cause of asthma in summer and autumn in northern China.

Objective to investigate the effect of HLA-DRB1-conjugated influenza virus hemagglutinin (HA) 308-317 allosteric peptide on the activation of peripheral blood T cells in patients with rheumatoid arthritis (RA). Methods Twenty-seven HLA-DRB1-positive RA patients were isolated from peripheral blood mononuclear cells by density gradient centrifugation. The effects of HA308-317 allosteric peptide on T cell activation mediated by CII263-272 or HA308-317 polypeptide were also observed. Results the positive rates of T cell proliferation stimulated by allosteric peptide were 7.4% (APL1), 3.7% (APL2) and 3.7% (APL3), respectively, which were significantly lower than those of CII263-272 and HA308-317 prototypes (62.2% and 52.9%), and the stimulation indexes of the three allosteric peptides were also significantly lower than those of prototype peptides (all P<The levels of IL-2, gamma interferon secretion and CD69 expression were also decreased (P<Compared with the control group with CII263-272 or HA308-317 prototype peptide alone, the stimulation index of T cell proliferation with HA308-317 allosteric peptide was significantly decreased (P<Conclusion Substitution of T cell receptor contact residues in HA308-317 polypeptide produces weak or non-T cell stimulating peptides, which may effectively inhibit the T cell immune response of RA.

Objective to investigate the role and mechanism of heme oxidase-1 (HO-1) in liver xenotransplantation. Methods A guinea pig-to-rat liver transplantation model was used. The experimental animals were divided into 3 groups, 10 pairs of rats in each group. The donors in group B were injected intraperitoneally with HO-1 inducer cobalt protoporphyrin (CoPP) 24 h before operation, and the donors in group C were injected with CoPP at the same time as HO-1 inhibitor zinc protoporphyrin (ZnPP). The recipients in each group received cobra venom factor (CVF). The mRNA and protein expression of HO-1 were observed by RT-PCR and western blot, respectively. The activation of transcription factor (NF) -κ B in transplanted liver nucleus was detected by gel electrophoresis mobility change method (EMSA), and the expression of E-selectin was observed by immunohistochemistry to evaluate the inhibitory effect of HO-1 on endothelial cell activation. The survival time of recipient mice in each group was compared. Results No hyperacute rejection occurred in each group. There was significant difference between group B and (0.112±0.039) group A (0.211±0.030) and group C (0.283±0.075) (P<0.05). Compared with other groups, the swelling of transplanted liver endothelial cells was reduced, the number of infiltrating cells was reduced, the liver function was improved, and the survival time of recipient mice was significantly prolonged. The difference between group B (15.5 h ± 3.8 h) and group A (7.3 h ± 2.1 h) was statistically significant (P<0.01). This protective effect can be cancelled by concomitant administration of the HO-1 inhibitor ZnPP; The difference between group B and group C (6.7 h ± 2.9 h) was statistically significant (P<Conclusion HO-1 inhibits the activation of endothelial cells and delays the occurrence of xenograft liver rejection.

Objective to investigate the diagnosis and treatment of early hepatic artery thrombosis after liver transplantation. Methods A total of 220 cases of liver transplantation were performed in Zhongshan Hospital affiliated to Fudan University from April 2001 to November 2004. Hepatic arterial blood flow was monitored regularly by color Doppler ultrasound after transplantation, and hepatic arteriography was performed in those suspected of hepatic arterial thrombosis (HAT). All cases diagnosed with HAT were treated with continuous urokinase thrombolysis through intrahepatic arterial catheter. Results the incidence of HAT in this group was 2.7% (6/220). Six cases of HAT occurred from 2 to 19 days after transplantation (median 5.5 days), and the hepatic arteries were recanalized after thrombolysis therapy. One case died of pulmonary infection 2 months after operation, the other case died of multiple organ failure 2 months after the second liver transplantation due to thrombolysis failure. The other 4 cases have been healthy and survived until now, the shortest is 3 months, the longest is 22 months. Conclusion CDI examination is very important for the early diagnosis of HAT. Continuous thrombolytic therapy with urokinase through intrahepatic arterial catheter is effective, and it can be the first choice for HAT after liver transplantation.

Objective to analyze the clinical outcome of biliary complications (BC) in the context of early hepatic arterial malsupply (HAI) after liver transplantation. Methods From February 1999 to February 2004, 240 cases of orthotopic liver transplantation were performed in our unit. Modified microsurgical anastomosis technique was used to reconstruct the hepatic artery and biliary tract during the operation, and the hemodynamics of hepatic artery and the integrity of biliary tree were monitored dynamically after the operation. The effects of early HAI on the occurrence and prognosis of biliary tract complications after liver transplantation were retrospectively studied. Results Biliary tract complications occurred in 32 cases (13.3%), of which 11 cases (4.6%) had HAI early after transplantation (HAI group) and 21 cases (8.7%) had no HAI early after transplantation (non-HAI group). Emergency thrombectomy was successfully performed in 3 patients with HAT, and 2 patients with HAS received short-term anticoagulant therapy. 7 cases of biliary tract stricture and 4 cases of bile leakage occurred in HAI group, 6 cases underwent endoscopic and/or radiation interventional therapy, 4 cases underwent anastomotic repair and biliary drainage, and 1 case underwent drug therapy. 8 patients died, and 3 cases were cured. The preoperative serum total bilirubin level of patients in HAI group was significantly higher than that in non-HAI group (373 μ mol/L ± 94 μ mol/L vs 111 μ mol/L ± 45 μ mol/L, P =0.008). The 1-year and 3-year survival rates of patients in HAI group were 54.6% and 16.4%, respectively, and those in non-HAI group were 66.3% and 61.2%, and the difference between the two groups was statistically significant (P =0.042). Conclusion The prognosis of patients with biliary tract complications with HAI early after liver transplantation is poor; Dynamic monitoring of color Doppler ultrasound should be strengthened early after transplantation to restore normal blood flow of hepatic artery as soon as possible; Once biliary complications occur in patients with early HAI background, interventional therapy or transfer to surgery should be performed in time and the necessity of retransplantation should be considered.

The patient was admitted to hospital on 11 March 2004 due to intermittent chest tightness and shortness of breath aggravated for more than 3 years with episodic syncope for 2 months. More than 3 years ago, the patient had chest tightness and shortness of breath during activity without obvious inducement, the degree was not serious, accompanied by dizziness and fatigue, which could be relieved after rest for more than 10 minutes. After that, the activity endurance gradually decreased, and oliguria, abdominal distension and inability to lie down at night induced by respiratory tract infection gradually appeared. 　　

With the wide application of prenatal ultrasonography and the improvement of diagnostic technology, people have increased their understanding of fetal hydronephrosis. However, how much influence this renal change will have on the fetus, and what measures of examination, diagnosis and treatment should be taken are still urgent problems to be solved in ultrasonography, obstetrics and pediatric urology [1]. The current research status of prenatal diagnosis and postpartum clinical outcome of fetal hydronephrosis is summarized as follows.

Whole brain digital subtraction angiography (DSA) has been regarded as the gold standard for preoperative diagnosis of intracranial aneurysm for a long time. However, as an invasive examination, DSA not only takes a long time, but also may cause complications such as intracranial embolus detachment and cerebral vasospasm, and cause permanent neurological deficits in 0.5% of patients. Once these complications occur, they not only make the injury of aneurysm patients worse, but also may further increase the difficulty of operation.

Fish oil is very effective in increasing heart rate variability (HRV), and the results of this study have been published in Chest, 2005, 127: 1102-1107. The level of omega-3 fatty acids, the main component of fish oil, is directly related to the reduction of sudden cardiac death rate, but its cardiovascular protection mechanism is not well understood. The possible mechanism is that it can improve cardiac autonomy by increasing HRV and thus reduce the risk of arrhythmia. 58 elderly non-hospitalized patients who needed care were randomly divided into two groups, one group took fish oil capsules with higher content of omega-3 fatty acids (2 g/d) every day, and the other group took plant-derived omega-3 fatty acids (α-linolenic acid, 2 g/d) with lower content.

The 12th Asia Pacific Orthopaedic Association Spine Operating Course and the first interactive Spine surgery demonstration and Spine disease symposium in China were held in Beijing from April 7 to 10, 2005.

Our comparative genomic hybridization studies have found that there is significant chromosome imbalance in both primary and lymph node metastases of nasopharyngeal carcinoma [1]. In this study, 16p, which has a high chromosome deletion rate, was used as the research object to construct its loss of heterozygosity (LOH) map, which provides a basis for further localization and cloning of tumor suppressor genes associated with nasopharyngeal carcinoma metastasis.

It was found that apoptosis is the main factor of cell reduction in degenerative intervertebral disc tissue, and intervertebral disc degeneration is related to apoptosis and stromal metabolism disorder caused by apoptosis [1]. The expression of Fas and FasL was found in intervertebral disc tissue of patients with lumbar intervertebral disc herniation [2], but the related functions were not studied in depth. In this study, reverse transcription PCR (RT-PCR) and immunoblotting were used to detect the expression of Fas and FasL genes in degenerative lumbar intervertebral disc tissue, and the apoptosis of intervertebral disc cells was induced by anti-Fas antibody, so as to understand the role of Fas system in lumbar intervertebral disc degeneration.

In recent years, there have been reports abroad about open heart surgery in pregnant women under cardiopulmonary bypass (CPB) [1]. So far, the relevant reports in China are still rare. Three cases of heart valve replacement in pregnant women were successfully performed under CPB in our hospital, and the reports are as follows.