Volume 85  ·   Issue 34  ·  2005

In 1990, the United States Human Gene Therapy Subcommittee (HGTS) approved the world's first therapeutic gene therapy program (ADA-SCID), and it was successful in clinical practice, which opened a new chapter of gene therapy for human diseases. Since then, although there have been several twists and turns, the interest in gene therapy has not diminished at all. Now gene therapy has expanded from single gene genetic diseases to many diseases including malignant tumors.

Objective to investigate the surgical effect of different surgical approaches to remove medial temporal lobe glioma. Methods 62 patients with medial temporal lobe glioma treated with different surgical approaches were analyzed. Among the 62 cases, 33 cases were localized in the medial temporal lobe structure (type A), 19 cases were located in the anterior medial temporal lobe (type A1), and 14 cases were located in the posterior medial temporal lobe (type A2); The tumor extensively invaded the medial temporal lobe, insula lobe and posterior frontorbital gyrus (type B) in 9 cases; The tumor invaded the temporal pole and lateral temporal horn of the lateral ventricle (type C) in 14 cases; The tumor invaded the brainstem, basal ganglia and thalamus medially in 6 cases (type D). There were three surgical approaches: translateral fissure approach, transtemporal lobe approach and subtemporal approach. Results 25 cases of translateral fissure approach, total tumor resection in 14 cases, near total resection in 6 cases, subtotal resection in 5 cases, aggravation of original visual impairment in 2 cases, transtemporal lobe approach in 23 cases, total tumor resection in 15 cases, near total resection in 5 cases, subtotal resection in 3 cases, aggravation of original visual impairment in 5 cases, new visual impairment in 4 cases, subtemporal approach in 14 cases, total tumor resection in 10 cases, near total resection in 4 cases, no visual impairment in postoperative.Conclusion the translateral fissure and subtemporal approach can reduce the damage to brain tissue and visual radiation, while the lateral approach through superior temporal gyrus and middle temporal gyrus may damage brain tissue and visual radiation.

Objective to investigate the incidence of meniscus injury in knee osteoarthritis (OA) and its significance in diagnosis and treatment. Methods 120 cases of 125 knees underwent arthroscopic arthrodebridement due to the first diagnosis of knee OA. The incidence of meniscal injury, the type of injury and its correlation with the severity of OA were analyzed, and the efficacy of selective joint cavity debridement combined with meniscectomy was evaluated. Results the main symptoms were knee pain, 32 knees (25.6%) had no free body but strangling phenomenon, 22 knees (17.6%) were diagnosed with OA combined with meniscal injury before operation, the average LYSHOLM score was 52 points, 41 knees (32.8%) had medial meniscal injury, 21 knees (16.8%) had lateral meniscal injury, of which 7 knees (5.6%) had medial and lateral injuries. The main types of injuries under microscope were wear (29.0%), brush-like injury at the edge (12.9%), various ruptures (51.6%) and barrel-like tear (1.61%). The degree of injury was positively correlated with the degree of articular cartilage destruction, and the coincidence rate of diagnosis before and after operation was 40.0% (22/55). At 3, 6 and 12 months after operation, the overall satisfaction rates were 89.6% (107/120), 86.4% (104/120) and 83.2% (100/120), respectively. The satisfaction rates of patients with meniscal injury were 94.5% (59/62), 91.0% (56/62) and 87.3% (54/62), respectively. The mean LYSHOLM scores were 77, 74, 71 and 85, 82, 79, respectively.Conclusion Knee OA is often accompanied by meniscal injury, which can aggravate each other.In some patients with OA, conservative treatment is difficult to relieve knee symptoms or delay the course of OA, so arthroscopic debridement has certain diagnostic and therapeutic value.

Objective to investigate the expression characteristics and significance of aquaporin 2 (AQP2) in human endometrium at different periods. Methods Immunohistochemistry, Western blot and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect AQP2 in the endometrium of women of reproductive age from different menstrual cycles (23 cases in proliferative stage, 30 cases in early secretory stage and 34 cases in middle secretory stage). Results AQP2 positive staining was mainly distributed in the membrane and cytoplasm of human endometrial cavity epithelium and glandular epithelium cells; Western blot confirmed the expression of AQP2 in human endometrium, and semi-quantitative analysis showed that the relative expression of AQP2 in endometrium was 1.03 ± 0.10, which was significantly lower than that in the early secretion stage (1.33 ± 0.14, P<0.05) and metaphase of secretion (1.63±0.15, P<0.01); Compared with the early and middle stages of secretion, the difference was statistically significant (P<Conclusion AQP2 is expressed in human endometrium, and its expression varies with menstrual cycle, indicating that AQP2 may play a certain role in the fluid balance of uterus under the action of sex hormones.

Objective to investigate the efficacy and safety of adjuvant endocrine therapy in patients with endometrial carcinoma and the influence of progesterone receptor on the effect of endocrine therapy. Methods 171 patients with endometrial carcinoma were selected. The patients were divided into endocrine therapy group (82 cases) and control group (89 cases). The endocrine therapy group was divided into less than 1 year subgroup (27 cases) and more than 1 year subgroup (55 cases) according to the time of medication. Results in the endocrine therapy group and the control group, the number of patients with recurrence/metastasis was 13.4% and 23.6%, respectively, and the number of deaths due to cancer was 12.2% and 20.2%, respectively (P>0.05). The proportion of recurrence/metastasis and death due to cancer in less than 1 year subgroup and more than 1 year subgroup were 25.9% and 7.3%, respectively, and 22.2% and 7.3%, respectively. The proportion of recurrence/metastasis and death due to cancer in more than 1 year subgroup was significantly lower than that in the control group (P =0.012, P =0.036). Multivariate analysis showed that tumor stage, surgical scope, degree of tumor cell differentiation and endocrine therapy time had significant effects on recurrence/metastasis (OR =5.199, OR =0.507, OR =1.796, OR =0.538) and death due to cancer (OR =5.488, OR =0.482, OR =1.516, OR =0.547). In the endocrine therapy group, the recurrence/metastasis of PR positive and PR negative patients was 4.7% and 26.7%, respectively, with statistically significant differences (P =0.034). Conclusion Endocrine therapy can be used as an adjuvant in the comprehensive treatment of endometrial cancer patients, and continuous application for more than one year can improve the prognosis of patients, especially for patients with progesterone receptor positive.

Objective to investigate the infection status and pathogenicity of H. pylori strains containing vacA gene m mixed subtype and iceA gene mixed type in Bai, Naxi and Han nationalities in Yunnan Province. Methods H. pylori strains were isolated and cultured from gastric mucosa of patients with chronic gastritis and peptic ulcer associated with H. pylori. Results the mixed infection rate of 109 H. pylori strains in Yunnan was 32.1%. The detection rate of iceA mixed subtype was significantly higher than that of m mixed subtype of vacA gene (all P<0.05). The mixed infection rate of Bai nationality (67.7%) was higher than that of Naxi nationality (20.0%) and Han nationality (12.1%) (both P<0.001); The mixed infection rate of iceA1+ iceA2 in Bai (61.3%) was significantly higher than that in Naxi (17.8%) and Han (9.1%) (both P<The mixed infection of vacA gene m mixed subtype + iceA mixed genotype in 34 cases of H. pylori mixed infection of Yunnan strain was related to peptic ulcer; Conclusion Mixed infection rates of different countries and regions vary greatly. Mixed infections of H.pylori strains containing vacA gene m mixed subtype and iceA mixed genotype in Yunnan Bai, Naxi and Han nationalities are polymorphic. Mixed infections of vacA gene mixed subtype are more sensitive in Han nationality, and mixed infections of iceA gene mixed subtype are more sensitive in Bai and Naxi nationality. Mixed infections of H.pylori strains containing iceA gene subtype and vacA gene m mixed subtype in Yunnan and vacA gene m subtype in Bai nationality are related to the pathogenicity of H.pylor; Mixed subtypes of iceA gene were used to judge the sensitivity of mixed infection.

Objective to investigate the correlation between single nucleotide deletion/insertion (4G/5G) polymorphism in plasma plasminogen activator inhibitor-1 (PAI-1) gene promoter region and the susceptibility and outcome of sepsis. Methods The genotypes of 4G/5G polymorphism in the promoter region of PAI-1 gene were determined by polymerase chain reaction, restriction endonuclease analysis, 16% polyacrylamide gel electrophoresis and ethidium bromide staining in 89 patients with severe postoperative sepsis (sepsis group) and 100 patients without postoperative sepsis (control group). Results the acute physiology and chronic health score Ⅱ score of the patients in sepsis group was 22.5±2.1, and the mortality rate was 51%; The 4G/4G genotype carrying frequency of PAI-1 was 0.44 and 4G allele carrying frequency was 0.65 in the sepsis group and 0.25 and 0.50 in the control group, respectively. The difference between the two groups was statistically significant. In the sepsis group, the 4G/4G genotype carrying frequency was 0.54 in the dead patients and 0.34 in the survivors, and the difference between the two groups was statistically significant. Conclusion The 4G/5G polymorphism in the promoter region of PAI-1 gene is related to the susceptibility and outcome of sepsis, 4G homozygous and 4G allele are early warning indicators of sepsis susceptibility, and 4G homozygous is a high risk genetic marker of sepsis death.

Objective to investigate the effects of different doses of levodopa on the toxicity of paraquat in mice model of Parkinson's disease and the related mechanisms. Methods 72 C57BL mice injected with paraquat for a certain time were injected intraperitoneally with different doses of levodopa. The deposition of paraquat in substantia nigra, the degeneration of dopaminergic neurons and the aggregation of α-synuclein (α-Syn) were observed by immunohistochemistry and Western blot. Results intraperitoneal injection of low-dose levodopa before paraquat injection inhibited paraquat-induced dopaminergic neuron degeneration in substantia nigra and reduced α-Syn aggregation. High-dose levodopa promotes the degeneration of dopaminergic neurons in substantia nigra, and levodopa can depolymerize the already formed fibrous α-Syn. Conclusion Low-dose levodopa competitively inhibits paraquat from entering the central nervous system through the blood-brain barrier, which plays a neuroprotective role; Large doses of L-dopa depolymerized the fibrous α-Syn which had been formed and showed obvious toxic effects.

Objective to investigate the effect of intraventricular injection of EphB2-Fc fusion protein on the activation of endogenous neural stem cells after cerebral cortex infarction. Methods the middle cerebral artery occlusion model (MCAO) was established in stroke-prone renal vascular hypertension rats, and the rats were randomly divided into: (1) sham operation group, (2) cerebral infarction group, (3) infarction + IgG-Fc group, (4) infarction + EphB2-Fc group, 24 rats in each group. On the 4th day after MCAO, the rats in the EphB2-Fc group were injected with 20 μ L of EphB2-Fc fusion protein at a concentration of 200 μ g/ml through the lateral ventricle, and the rats in the IgG-Fc group were injected with equal amount of IgG-Fc at equal concentration. At the first and fourth weeks after MCAO, the brains of rats in each group were sacrificed and collected. The expressions of EphB2 and its mRNA, nestin and polysialic acid-neural cell adhesion molecule (PSA-NCAM) were detected by immunohistochemistry and in situ hybridization at different time points in each group, and the changes of EphB2 and nestin protein in each group were detected by Western blot. Results At one week after MCAO, the expressions of EphB2 and its mRNA in the cerebral cortex and subventricular region of the infarcted side of the cerebral infarction group were lower than those in the sham operation group, and higher in the infarction + EphB2-Fc group than that in the infarction + IgG-Fc group (all P<0.05), there was no significant difference between the cerebral infarction group and the infarction + IgG-Fc group (P>0.05); The expression of nestin and PSA-NCAM in the subventricular region of the infarcted side of the cerebral infarction group was higher than that in the sham operation group, and the expression of nestin and PSA-NCAM in the infarction + EphB2-Fc group was higher than that in the infarction + IgG-Fc group (all P<Four weeks after MCAO, there was no significant difference in the expression levels of EphB2 and its mRNA on the infarct side between the groups (all P>0.05), and the expression levels of nestin and PSA-NCAM on the infarct side of rats with cerebral infarction in each group decreased, but there was no significant difference in the expression levels of nestin between the groups, but the expression level of PSA-NCAM in the cerebral infarction group was still higher than that in the sham operation group.

Objective to observe the expression characteristics of type Ⅰ and Ⅱ collagen and transforming growth factor-β 1 (TGF-β 1) in the articular processes of 9 patients with idiopathic scoliosis (IS) and 10 patients with congenital scoliosis (CS) were collected and stained by hematoxylin-eosin (HE) staining and immunohistochemical method. The results of immunohistochemical staining were processed by image analysis system.Results the expression of type Ⅰ collagen in the concave articular processes of the apical vertebrae of IS and CS were 193±64 vs 151±45 and 199±86 vs 179±78 (P<The expression of TGF-β 1 in the concave side of IS and CS vertebrae was 145±43 vs 112±50 and 120±61 vs 89±32, respectively (P<0.05), the concave side of the lower end of IS IS higher than the convex side; Among the three groups of IS apical vertebra, upper vertebra and lower vertebra, the convex side of IS apical vertebra IS higher than that of upper vertebra, and the concave side of CS apical vertebra IS higher than that of end vertebra; IS apical vertebrae IS higher than CS. Conclusion the articular cartilage of the apical articular processes in patients with scoliosis showed signs of degeneration, and the expression of type Ⅰ and Ⅱ collagen and TGF-β 1 in the concave articular processes of IS and CS and the expression of apical vertebrae increased. Abnormal compressive stress may play a very important role.

Objective to observe the outcome of donor intraosseous cells during bone defect repair with different diameter bone grafts. Methods 174 inbred DA rats (58 male rats) were used as donors; 116 female rats were randomly divided into massive bone group, granular bone group and blank control group. The model of radial bone defect was established. The ilium bone of male rats was taken as the donor bone, and bone fragments with a diameter of 2 mm and granular bone with a diameter of 0.3~0.5 mm were made and implanted into the bone defect respectively. The samples were collected at 1, 4 days and 1, 2, 4, 6 and 10 weeks after operation, respectively. The expression of Y chromosome sex determining gene (Sry) in the recipient bone tissue was observed by polymerase chain reaction technique, and the histological changes of each group were observed. Results the expression of Sry decreased gradually in the early stage of transplantation, disappeared at 1 week, reappeared after 4 weeks, and increased gradually with time; The expression of Sry in granular bone group decreased gradually with time, but the expression of Sry was observed in all time periods. At the same time point, more osteocytes survived in granular bone than in massive bone, and its osteogenic effect was better than that in massive bone. Conclusion Donor bone cells are involved in bone defect repair with different diameter bone grafts, but more bone cells survive in granular bone. These bone cells participate in all stages of bone defect repair, and can accelerate bone defect repair, which provides a new and effective method for bone defect repair and spinal fusion in clinic.

With the progress of society, the implementation of health system reform and the acceleration of China's entry into the World Trade Organization (WTO), the medical market is facing fierce competition and challenges. How to dialectically view the opportunities and challenges brought to the pharmacy work in the new period is particularly important. Patient-centered and people-oriented will undoubtedly become the management elements under the new situation.

A 25-year-old female from Taicang, Jiangsu Province, was admitted to the hospital on March 12, 2004 due to "fever for 7 days, shortness of breath and chest tightness for 5 days". The patient gave birth to a 37-week-old girl at 2 a.m. 7 days before admission. At 16 p.m., she developed fever, body temperature 38℃, mild cough, a little white foamy sputum, occasionally bright red blood streaks, no other accompanying symptoms and no lochia. There was no improvement after treatment with ceftriaxone, ribavirin and aminopyrine in the local hospital.

Association analysis is more and more used in the mapping of disease-related genes, and its key is to select appropriate normal control groups, because there are differences between case groups and control groups, which will lead to false positive results. Recently, people have analyzed whether there are significant differences in the distribution of some genetic markers not related to disease between the two groups to determine the degree of stratification between samples, so as to identify the authenticity of disease association results. ancestry informative markers (AIMs), also called population-specific markers, are genetic loci with large differences in alleles in different populations [1]. Some foreign groups have screened many such markers, but most of them reflect the differences between African-American, European-American and Native-American populations [1, 2]. We selected five AIMs according to the literature, analyzed their distribution between familial febrile convulsion group (FC) and normal control group, explored the matching between the two groups, and compared with the distribution of AIMs in other populations, To find out whether these markers can reflect the specificity of the Chinese population composition.

Stroke is one of the most important complications after coronary artery bypass grafting (CABG), which has a great impact on the prognosis of patients. Some people have summarized 33 kinds of risk factors for stroke after CABG, and high carotid stenosis is one of the important risk factors. In order to prevent this fatal complication, it is very important to fully understand the correlation between carotid stenosis (CAS) and stroke after CABG.

A 49-year-old male was diagnosed with "sigmoid colon cancer" by colonoscopy on October 10, 2004 due to "left lower abdominal pain for half a year and blood in stool for 3 months". No metastasis was found in other parts by B-ultrasound and CT. Carcinoembryonic antigen (CEA) was 59 ng/ml (normal value 0.0-5.0 ng/ml) and CA199 199 U/ml (normal value 0-27 U/ml). He underwent radical left hemicolectomy in the Department of Surgery of Zhongshan Hospital of Fudan University on October 20, 2004. The postoperative pathology was: sigmoid colon protuberance tubular adenocarcinoma grade II, partially with signet ring cells, the mass was 4 cm ×5 cm, invading the whole thickness and surrounding adipose tissue, and there was no cancer involvement in both margins. 14 mesenteric lymph nodes and 18 paratenteric lymph nodes were found, but no cancer metastasis was found. After operation, the patient recovered well. When the doctor and the patient talked about postoperative chemotherapy, the patient had many questions.

All 4 patients were male, aged 32-50 years, with an average of 44.2 years, and all had a history of accidentally eating fish bone or chicken bone. The time from onset to consultation was 20-78 hours, with an average of 49 hours, and all were accompanied by chest tightness, shortness of breath and fever. 2 cases were complicated with left side hydropneumothorax and 2 cases were complicated with right side hydropneumothorax. 1 case underwent closed left thoracic drainage, and the esophageal residue was drained after operation, and the esophageal residue was drained from the drainage tube by oral methylene blue.

The local recurrence rate of hepatocellular carcinoma after radiofrequency coagulation was reported to range from 2% to 60%. Most authors believe that tumor volume is an important risk factor for local recurrence. However, due to the limited number of reported cases and short follow-up time, it is impossible to make a meaningful multivariate analysis of other risk factors affecting recurrence, such as tumor pathology, tumor location and treatment approach.

The 2005 National Symposium on Hip Joint and Peripheral Neurosurgery and the 3rd Seminar on Repair and Reconstruction of Femoral Head Avascular Necrosis were held in Dalian from July 22 to 25, 2005. Lu Shibi, Wang Guozhao, Yu Mingzhe and other famous experts and scholars at home and abroad were invited to attend the conference and give special lectures.

The migration of tumor cells and endothelial cells to extracellular matrix and basement membrane requires the participation of a series of proteolytic enzymes [1]. Urokinase-type plasminogen activator (uPA), as a serine protease, can degrade basement membrane and extracellular matrix components after binding to its receptor, thus promoting tumor invasion, metastasis and angiogenesis [2]. In this study, the expression of uPA, urokinase-type plasminogen activator receptor (uPAR) and vascular endothelial growth factor (VEGF) in gastric cancer tissues was observed by in situ hybridization and immunohistochemistry, and the relationship between them and angiogenesis, invasion, metastasis and prognosis of gastric cancer was investigated.

Since July 1999, 82 patients underwent minimally invasive direct CABG (MIDCAB) by ministernotomy (MIST) in our hospital. The experience is presented below.