Volume 85  ·   Issue 29  ·  2005

After more than 60 years and three generations of efforts, especially in the last 10 years, the surgical development of lung cancer in China has been more rapid. The surgical resection rate has increased obviously, the incidence of postoperative complications and the mortality rate have decreased year by year, and the treatment level has reached the international advanced rank. However, the 5-year survival rate after surgery is still maintained at 30% ~40%. In order to prolong the survival time after surgery, it is still necessary to further improve the surgical treatment level of lung cancer in China.

Biliary tract complications after liver transplantation are still a problem worth exploring in clinical surgery [1-3], and the study of their etiology is leading clinical surgeons to make great progress in biliary tract reconstruction technique.However, the incidence of biliary tract complications is still higher than 10% ~35%, especially the management of biliary tract complications in the middle and late stages is more difficult, and transplantation surgeons need to pay attention to them and put forward new treatment strategies.

Objective to investigate the relationship between anti-inflammatory interleukin-10 (IL-10) gene promoter-1082 A/G polymorphism and microinflammatory status and atherosclerosis (AS) in patients with end-stage renal disease (ESRD). Methods PCR-RFLP was used to detect the distribution of IL-10 gene-1082 A/G polymorphism in 870 patients with end-stage renal disease and 1000 controls, and the related indexes of microinflammatory status and atherosclerosis, and to analyze the mechanism of this gene in protecting patients with end-stage renal disease from microinflammatory status and atherosclerosis. Results Compared with the control group, the levels of CRP, TNF-α, CH50, C3, IL-10 and Alb in the end-stage renal disease group were within the normal range, but still significantly higher than those in the control group.<0.05); There were no significant differences in the distribution of IL-10A/G genotypes and allele frequencies between normal subjects and patients with end-stage renal disease (all P>0.05). The levels of CRP, TNF-α and CH50 in patients with end-stage renal disease with IL-10 A/A genotype were significantly higher than those of G/G and G/A genotype (P<0.05), the levels of IL-10 and Alb were significantly decreased (P<0.01); Serum IL-10 levels were significantly lower in patients with IL-10A/A genotype than in patients with A/G and G/G genotype (P<0.01); The incidence of atherosclerosis in IL-10 gene-1082A/A patients was significantly higher than that in G/G and G/A patients (P<Conclusion IL-10 A/A gene is a predictive factor of microinflammatory state and high incidence of atherosclerosis in patients with end-stage renal disease. In patients with end-stage renal disease, IL-10 G/G gene regulates the "high production" of serum IL-10 and downregulates the inflammatory response, so as to protect them from microinflammation and atherosclerosis.

Objective to investigate the effects of human proximal renal tubular epithelial cell line (HKC) activated by aldosterone (ALDO) on the synthesis of type Ⅰ collagen (ColⅠ) in human renal interstitial fibroblasts (hRIFs). Methods the following experiments were carried out by in vitro cell culture and co-culture techniques. (1) HKC was stimulated by exogenous ALDO at different concentrations and different action time, and the mRNA and protein expression of transforming growth factor-β 1 (TGF-β 1) were detected by reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent (ELISA). (2) HKC was co-stimulated by spironolactone and endothelin-1 (ET-1) at different concentrations and different action time, and the mRNA and protein expression of TGF-β 1 were detected as above. (3) HKC activated by exogenous ALDO was co-cultured with hRIFs (with or without anti-TGF-β 1 antibody in culture medium), and the synthesis of ColⅠ in hRIFs was detected by ELISA. Results (1) The expression of TGF-β 1 was increased by exogenous ALDO in a dose-dependent and time-dependent manner. 1×10<0.05 or 0.01); After 10-7 mol/L ALDO stimulation for different time, the expression of TGF-β 1 was significantly higher than that in the 0 h group (P<(2) The expression of TGF-β 1 in the 10-9 and 10-7 mol/L spironolactone groups was significantly lower than that in the 0 mol/L spironolactone group (P<0.05 or P<0.01). The expression of TGF-β 1 in the 10-9 mol/L ET-1 plus 10-7 mol/L spironolactone and 10-9 mol/L ET-1 alone was significantly different after different time stimulation (P<(3) After 10-7 mol/L ALDO stimulated HKC12 H-activated cells, and then co-cultured with hRIFs for 48 h, the synthesis of ColⅠ by hRIFs increased significantly (P<0.01); 1.0, 2.0 μ g/ml anti-TGF-β 1 antibody partially inhibited this response (P<Conclusion Exogenous ALDO can increase the synthesis of TGF-β 1 by HKC; Endogenous ALDO produced by endothelin stimulated HKC can promote its own synthesis of TGF-β 1; HKC activated by ALDO can promote the synthesis of Col-1 by hRIFs through "messaging" action, which is partially mediated by TGF-β 1.

Objective to investigate the inhibitory effect of interferon α (IFN-α) on HCV replicon in vitro by using the hepatitis C virus (HCV) replicon cell model, and to explore the expression level of IFN-α signaling and activating transcription molecule (STAT) and interferon-stimulating gene (ISGs) that mediates the antiviral effect of IFN-α. Methods HCV replicon RNA was synthesized by HCV replicon plasmid as template in vitro, and the RNA was transfected into Huh7 hepatoma cells and screened by G418 to establish HCV replicon cell lines; HCV replicon cells were treated with different doses (0-5000 IU/ml) of IFN-α for 72 h or 1000 IU/ml of IFN-α for different times (0, 24, 48, 72, 96 h). HCV RNA was detected by semi-quantitative RT-PCR and real-time quantitative PCR simultaneously, and the expression level of HCV NS5A protein was detected by Western blot to investigate the inhibitory effect of IFN-α on HCV replicon. Results IFN-α significantly inhibited HCV RNA replication, and 10 IU/ml and 25 IU/ml of IFN-α decreased HCV RNA by about 68% and 75% respectively compared with control cells without IFN-α treatment; IFN-α 1000 IU/ml for 24 h or 96 h resulted in a 75% and 88% reduction of HCV RNA compared with the control group, respectively. Similarly, IFN-α also significantly inhibited the synthesis of HCV NS5A protein, indicating that the anti-HCV effect of IFN-α was dose-and time-dependent; The antiviral ISGs (PKR, 2'5'OAS, G1P3, ISG20 and ISGF3 γ) in HCV replicon cells showed obvious IFN-inducible expression. Conclusion IFN-α can significantly inhibit the replication of HCV RNA, and its inhibitory effect is related to the dose and time of IFN-α. ISGs such as PKR, 2'5'OAS, G1P3, ISG20 and ISGF3 γ may mediate the anti-HCV effect of IFN-α.

Objective to investigate the effect of resting pressure on proliferation and apoptosis of vascular smooth muscle cells. Methods Embryonic rat vascular smooth muscle cell line A10 cells were cultured under normal atmospheric pressure, 80, 100, 200 mm Hg and other resting pressures, respectively; The cell survival rate was measured by MTT assay, and the cell cycle and apoptosis rate of the samples were measured by flow cytometry. Results Under low pressure (100 mmHg), the survival rate of A10 cells increased and the cells proliferated. The percentage of A10 cells in G0/G1 phase decreased significantly, the proliferation index (PI) increased significantly, and the apoptosis rate was not different from that of normal. Under the pressure of 200 mm Hg, the survival rate decreased, the percentage of A10 cells in G0/G1 phase increased significantly, the cell proliferation was inhibited, and the apoptosis rate also increased significantly. Conclusion Lower pressure can promote the proliferation of vascular smooth muscle cells, while too high pressure can induce apoptosis.

Objective to investigate whether proteasome function defects can induce apoptosis of dopaminergic cells and its possible mechanism.Methods Rat pheochromocytoma PC12 cell line was treated with highly selective proteasome inhibitor lactacystin (0, 1 μ mol/L, 5 μ mol/L or 10 μ mol/L) for 24 h, and the changes of cell viability were detected by tetramethylazolazole blue (MTT) colorimetry.After 24 h treatment with 10 μ mol/L lactacystin, the nuclear morphological changes of apoptotic cells were observed by Hoechst fluorescence staining, and the percentage of apoptosis was determined by flow cytometry.The dynamic changes of cysteine protease 3 activated fragment in PC12 cells were detected by Western blot at 0, 24 or 48 h treatment with 10 μ mol/L lactacystin. Results After 24 h treatment with 5 μ mol/L or 10 μ mol/L lactacystin, the viability of PC12 cells (87%±6% and 26%±6%) was significantly lower than that in the control group (P<0.05). Hoechst fluorescence staining showed that some cells showed apoptotic nuclear morphological changes after 24 h treatment with 10 μ mol/L lactacystin; Flow cytometry confirmed that 31.4%±4.0% of PC12 cells had apoptosis, and the difference was statistically significant compared with the control group (7.5%±0.8%) (P<0.01). Western blot showed that only a very small amount of cysteine proteolytic enzyme 3 activated fragment was expressed in control cells; Conclusion lactacystin, a proteasome inhibitor, can induce apoptosis of dopaminergic PC12 cells, and the activation of cysteine protease 3 protease may be involved in the apoptosis of PC12 cells induced by lactacystin. Functional defects in proteasomes may play an important role in the pathogenesis of Parkinson's disease.

Objective to isolate and purify bone marrow mesenchymal stem cells (MSCs) from patients with chronic myeloid leukemia (CML), and to identify the functions and characteristics of MSCs. Methods MSCs from bone marrow of CML patients were obtained, and MSCs from monoclonal sources were obtained by limiting dilution method, and cultured and expanded in low serum medium; Flow cytometry was used to detect the immunophenotype and cell cycle of MSC; The differentiation of MSC into adipose, bone and nerve cells was detected by oil red O staining, Von Kossa staining and Western blot. The ultrastructure of MSC in bone marrow of CML patients was examined by electron microscope; The tumorigenicity of CML-derived MSCs was determined by soft agar culture and inoculation in nude mice. Results MSCs could differentiate into bone, adipose and nerve cells under the corresponding induction conditions. CML-derived MSCs were spindle-shaped under inverted microscope, and expressed CD29, CD44 and CD105, while CD11b, CD31, CD34, CD45 and HLA-DR were negative. The BCR/ABL fusion gene of CML-derived MSCs was negative, and did not have tumorigenicity in vivo and in vitro. Conclusion MSCs with multidirectional differentiation ability existed in the bone marrow of CML patients, and this cell population did not have tumorigenicity in vitro and in vivo, and showed the biological characteristics of normal MSCs.

Objective to evaluate the efficacy of first metatarsophalangeal joint replacement with Swanson double-stem silicone artificial hinge prosthesis.Methods 10 cases of 13 joints were performed with Swanson double-stem silicone artificial hinge prosthesis.Among them, 8 cases of elderly osteoarthritis hallux valgus with 10 feet, 1 case of rheumatoid arthritis with 2 feet and 1 case of traumatic arthritis.Results All cases were followed up from 12 months to 38 months, with an average of 25 months.Eight patients obtained completely satisfactory results, and one patient was partially satisfactory.The unsatisfactory patient was caused by severe bone hyperplasia caused by pain at the osteotomy surface of the metatarsophalangeal joint 3 years after joint replacement, and 2 cases had obvious osteolysis around the silicone prosthesis, but there were no symptoms and no special treatment. Conclusion The first metatarsophalangeal joint replacement with Swanson double-stem silicone prosthesis can preserve the joint mobility and the length of the pathway toe, thus maintaining the normal walking function of the forefoot, It is an effective method to reconstruct the metatarsophalangeal joint by achieving the ideal effect of eliminating the pain, improving the function and correcting the deformity of the metatarsophalangeal joint.

Objective to evaluate the effect of stent reconstruction on renal function in patients with ischemic nephropathy. Methods 27 patients with severe atherosclerotic renal artery stenosis accompanied by renal insufficiency underwent renal artery stenting (PTRAS) and were followed up for 6~48 months to observe the effect of operation on renal function. Results PTRAS was successful in 27 patients. After 6, 12, 24 and 36 months of follow-up, serum creatinine was 155 μ mol/L ± 31 μ mol/L before operation and 145 μ mol/L ± 22 μ mmol/L, 143 μ mol/L ± 22 μ mol/L, 145 μ mol/L ± 24 μ mol/L, 140 μ mol/L ± 11 μ mol/L after operation, respectively. Conclusion Renal artery stenting is beneficial to renal function in patients with ischemic nephropathy, but there are many surgical complications, and the long-term efficacy needs further investigation.

Objective to evaluate the efficacy of emergency percutaneous coronary intervention (PCI) in elderly diabetic patients with acute myocardial infarction (AMI) during hospitalization. Methods 556 elderly patients (≥60 years old) with AMI from December 1995 to April 2005 were divided into diabetic group (DM group, 127 cases) and non-diabetic group (ND group, 429 cases). Emergency PCI was performed within 24 hours of onset. The clinical and coronary angiographic features, success rate of PCI and postoperative complication rate of the two groups were compared. Results the percentages of anterior wall AMI, non-ST segment elevation AMI, Killip grade Ⅲ ~ Ⅳ and IABP placement in DM group were significantly higher than those in ND group (P<0.05); 59.1% of infarction-related vessels in DM group were anterior descending artery, which was significantly higher than that in ND group (45.0%, P<0.05); The rate of three-vessel lesions in DM group was 77.2%, which was significantly higher than that in ND group (60.8%, P<0.01). There were no significant differences between the two groups in the immediate success rate of PCI, the incidence of non-reflow during operation, the incidence of complications after PCI during hospitalization and the mortality rate. Conclusion Emergency PCI can obtain good short-term efficacy in the treatment of elderly diabetic AMI patients.

Objective to establish a hospital-based high-risk assessment and screening program for pancreatic carcinoma. Methods A case-control study was conducted. 136 patients with pancreatic carcinoma were selected as the case group and 191 patients with benign digestive diseases were selected as the control group. All patients were investigated by epidemiological questionnaire, and the risk factors and symptoms related to pancreatic carcinoma were selected for multivariate Logistic analysis. The weight scores of each variable were calculated to establish a high-risk score model. At the same time, the diagnostic value of diagnostic markers (serum CA19-9, CA242, K-ras and p53 mutation detection in feces) and imaging examination (CT and B-mode ultrasound) were evaluated, and the screening program was established based on this model. Results According to this high-risk score model, the average score of the two groups was 49.6 points [95% confidence interval (CI): 45.6~53.7] in the case group, which was higher than that of the control group [21.6 points (95% CI: 19.3~23.9), P<The diagnostic sensitivity and specificity were 87.0% (94/108) and 68.1% (130/191), respectively. The diagnostic sensitivity was increased by 100% by combining tumor marker detection and imaging examination. The first step of screening was K-ras mutation in stool, blood CA19-9 and CT, and the second step was invasive examination such as endoscopic ultrasound. Conclusion The newly established high-risk score model for pancreatic cancer is simple and easy, and if high-risk patients are found, they can be diagnosed immediately according to screening protocol, which may help to improve the early diagnosis and treatment of pancreatic cancer.

Objective to investigate the effects of Duffy antigen chemokine receptor (DARC) on tumorigenicity and lung metastasis of human breast cancer cell lines and its mechanism.Methods MDA-MB-435 lung hypermetastatic cell line (MDA-MB-435HM-DARC) with DARC overexpression was established to observe the changes of cell biological behavior in vitro, and the concentrations of DARC ligands CXCL8 (IL-8) and CCL2 (MCP-1, JE) in culture supernatant were detected. The human breast cancer BALB/c orthotopic transplantation model was established in nude mice. The tumor growth curve and intrapulmonary metastasis were observed, and the changes of DARC, JE, CD34, matrix metalloproteinase-9 (MMP-9) in the tumor were detected, and the correlation analysis was performed. Results the proliferation and invasiveness of MDA-MB-435HM-DARC in vitro were not significantly changed, but the concentrations of CXCL8 and CCL2 in the culture supernatant were significantly reduced. In vivo experiments showed that the growth of MDA-MB-435HM-DARC transplantation tumor was delayed and the volume decreased, the number of intrapulmonary metastasis decreased, the level of CCL2 protein, the microvessel density (MVD) in the tumor decreased, and the production of MMP-9 decreased.

Objective to investigate the standard and efficacy of comprehensive treatment of non-small cell lung carcinoma (NSCLC). Methods 812 cases of stage Ⅲa non-small cell lung carcinoma (NSCLC) resected by surgery from 1991 to the end of 1999 were analyzed. At the same time, 326 cases of comprehensive treatment were compared with 486 cases of simple surgery. Results The 5-year survival rate of the whole group was 16.4%, including 23.5% in the comprehensive treatment group and 10.2% in the simple surgery group. The 5-year survival rate of squamous cell carcinoma and adenocarcinoma was 15.2% and 9.9% in the operation group alone. The results showed that the survival rate of the comprehensive treatment group was higher than that of the operation group alone. Conclusion Multidisciplinary comprehensive treatment should be the standard treatment for middle and advanced NSCLC, and different treatment combinations should be selected according to different TNM and pathological types.

Objective to compare the clinical value of positron emission computed tomography (PET) and CT imaging in determining the presence or absence of mediastinal lymph node metastasis in patients with resectable non-small cell lung cancer (NSCLC). Methods 68 patients with resectable non-small cell lung cancer were routinely performed PET and CT chest imaging before surgery to determine the presence or absence of mediastinal lymph node metastasis. Mediastinal lymph node dissection or standard video mediastinoscopic lymph node biopsy were performed within 1 month to obtain mediastinal lymph node pathological specimens. The resected mediastinal lymph node was stained with conventional paraffin section HE and PCNA/Ki67 immunohistochemical staining. The pathological examination results were compared with the imaging CT examination before surgery. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CT imaging in the diagnosis of mediastinal lymph nodes were 76.9% (40/52), 50% (8/16), 70.6% (48/68), 83.3% (40/48) and 40% (8/20), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET imaging in the diagnosis of mediastinal lymph nodes were 92.3% (48/52), 87.5% (14/16), 91.2% (62/68), 96% (48/50) and 77.7% (14/18), respectively. The sensitivity of CT + PET was 98% (51/52). Conclusion PET is significantly superior to CT in the diagnosis of mediastinal lymph node metastasis in NSCLC, and CT + PET can improve the sensitivity of mediastinal lymph node examination in NSCLC.

Objective to evaluate the anti-tumor effect of recombinant mutant human TRAIL (rmhTRAIL). Methods NCI-H460 xenograft tumor model was used to observe the inhibitory effect of rmhTRAIL on tumor growth in nude mice by intraperitoneal injection of different doses (divided into 5 groups). In addition, the apoptosis-inducing effect of rmhTRAIL on tumor cells in nude mice in vitro and in vivo was observed by TUNEL staining and gel electrophoresis of DNA fragments. Results The relative tumor volume (RTV) of rmhTRAIL (5 mg/kg) and high dose (15 mg/kg) groups was 3.19 ± 2.05 and 1.47 ± 0.77, respectively, which was significantly lower than that of control group (8.48 ± 5.87 (P<0.05, and P<0.01); The relative tumor value increment rate (T/C%) was 37.6% and 17.3%, respectively. The tumor weights in the medium and high dose groups were 1.09 g ± 0.55 g and 0.31 g ± 0.09 g, respectively, which were significantly less than those in the control group (2.78 g ± 0.77 g) (P<A large number of apoptotic cells with positive TUNEL staining appeared in both tumor tissues treated with rmhTRAIL and tumor cells cultured in vitro, and the DNA extracts of rmhTRAIL treated tumor cells showed a typical DNA ladder with apoptotic characteristics on agarose gel electrophoresis. Conclusion rmhTRAIL has a significant anti-tumor effect in vivo and in vitro, and its main mechanism is that it causes apoptosis of tumor cells.

Velcade, also known as bortezomib, formerly known as PS-341, is the first and currently the only proteasome inhibitor approved to enter the clinic. This is a class of new drugs with completely different mechanisms of action, and has good clinical application prospects for many kinds of tumors. Related research won the Nobel Prize in Chemistry in 2004.

Eosinophilic bronchitis (EB) is a disease first defined by Gibson et al. in 1989. It is characterized by chronic dry cough or morning cough with a little sticky sputum, sputum eosinophils>3% (0.03), normal pulmonary function, no evidence of airway hyperresponsiveness, and normal peak flow rate variability. It is an important cause of chronic cough, accounting for about 10% ~20% of chronic cough. After inhaling glucocorticoid, the cough is relieved in a short time, and the sputum eosinophils are decreased, but the long-term effect is still uncertain. Although EB as an independent clinical disease has not been recognized so far, its relationship with asthma and chronic obstructive pulmonary disease (COPD) and its natural outcome have aroused great interest. In May 2005, Berry et al.<The results of their 7-year follow-up observations were reported in Clin Exp Allergy, 2005, 35: 598-601.

Two Randomized controlled studies have shown that elective transvascular Endovascular abdominal aortic Aneurysm repair surgery (Endovascular surgery for short) has better results than open surgery within one month. It has been reported that in these two studies, The mortality rate of inpatients undergoing open surgery was 4.6% and 6%, respectively, while that of Endovascular surgery was 1.6% and 1.2%, respectively. However, whether this survival advantage of Endovascular surgery can be sustained is still controversial. The results of uncontrolled clinical studies show that Endovascular surgery has no advantage over time. To answer this question, The Dutch Randomized Endovascular Aneurysm Management (DREAM) trial conducted a multicenter Randomized controlled clinical study, The results of which were published on June 9, 2005<New England Journal of Medicine (N Engl J Med, 2005, 352:2398-2405).

A 59-year-old female had intermittent fever for 1 month, accompanied by severe headache for 1 day. One month before admission, the patient had irregular fever without inducement, body temperature fluctuated between 37.5 and 38.5℃, accompanied by fatigue and loss of appetite. After anti-inflammatory treatment, she still had intermittent fever, and persistent severe headache for 1 day before admission. Physical examination at admission: body temperature 37.9℃, pulse 90 beats/min, blood pressure 120/80 mm Hg (1 mm Hg =0.133 kPa), clear consciousness, mild anemia appearance, no bleeding spots on skin and mucosa, clear breathing sounds in both lungs, slightly enlarged heart boundary to the left, heart rate 90 beats/min, uniform rhythm, systolic murmur of grade 3/6 in the auscultation area of mitral valve, rough and extensive conduction, flat and soft abdomen, no tenderness. Neurological examination: cervical resistance (+), Klinker's sign (+), Bruin's sign (-), no positive signs in cranial nerve examination, bilateral sensory symmetry, normal muscle tone of limbs, muscle strength grade IV, symmetric physiological reflex, but no pathological reflex.

multidrug resistance (MDR) is one of the main causes of leukemia chemotherapy failure, and has become the main obstacle to leukemia chemotherapy and long-term disease-free survival of leukemia patients. Its mechanism is complex and involves many factors. There have been many reports on the research of multidrug resistance-associated protein gene (MRP) [1-3]. MRP family has been confirmed to have seven members MRP1~ MRP7 [4]. Among them, there are many studies on MRP1. MRP2 is used to transport glutathione (GSH) conjugates and chemotherapeutic drugs, such as cisplatin, etoposide and vincristine; The role of MRP3 is to pump out methotrexate and etoposide instead of GSH. There are few reports on the expression of MRP2 and MRP3 in acute leukemia and their relationship with MDR. The expression of MRP2 and MRP3 in acute leukemia patients is reported as follows.

Streptococcus mutans (S. mutans) is the main cariogenic bacteria, and cell surface protein antigen PAc and glucosyltransferas (GTFs) are its main virulence factors.Guo Jihua et al. constructed a targeted caries-prevention DNA vaccine pGJA-P guided by cytotoxic T lymphocyte-associated antigen 4 against Streptococcus mutans PAc and GTF, which greatly improved the caries-prevention effect [1,2].