Volume 85  ·   Issue 47  ·  2005

On September 17, 2004, "Reference News" reprinted an article in the "Guardian" entitled "Experts Question Prostate Cancer Testing". The theme is that prostate specific antigen (PSA) is obsolete for prostate cancer screening. The article quoted is an article by Professor Stamey of Stanford University [1]. In order to understand the background, original intention and what implications it has for us, we later consulted the original article and wrote the following opinions for colleagues' reference.

Objective to compare the safety and efficacy of transurethral plasma bipolar resection (PKRP) and transurethral resection of the prostate (TURP). Methods 400 patients with symptomatic prostatic hyperplasia (BPH) were randomly divided into two groups and underwent PKRP and TURP respectively. Results the prostatic symptom score (IPSS) of 200 patients undergoing PKRP decreased from 27.1 ± 4.5 points before operation to 11.3 ± 3.4 points 6 months after operation (P<0.01), and the maximum urinary flow rate (Qmax) increased from 6.1 ml/s±2.4 ml/s to 18.6 ml/s±3.5 ml/s (P<0.01), and the residual urine volume (RU) decreased from 102.3 ml ± 43.3 ml to 22.6 ml ± 16.3 ml (P<In 200 cases of TURP group, IPSS decreased from 26.9 ± 4.2 points before operation to 10.8 ± 3.6 points 6 months after operation (P<0.01), the maximum urine flow rate increased from 5.7 ml/s±2.4 ml/s to 19.1 ml/s±3.7 ml/s (P<0.01), and the remaining urine (RU) decreased from 102.3 ml ± 43.3 ml to 22.6 ml ± 16.3 ml (P<The mean time of indwelling catheter was 31.5 h in PKRP group and 61.5 h in TURP group, and the difference was statistically significant (P>0.05)<The incidence of postoperative impotence was 14.3% in PKRP group and 15.2% in TURP group (P>0.05). There was no major hemorrhage and transurethral resection of the prostate syndrome (TURS) in PKRP group, and none of them needed blood transfusion. TURS occurred in 5 cases in TURP group, and blood transfusion occurred in 18 cases. Conclusion PKRP can achieve the same therapeutic effect as TURP, with less complications and relatively low price, and the recent effect is satisfactory.

Objective to investigate the surgical treatment of tricuspid valve insufficiency after left ventricular valve replacement. Methods From January 1995 to May 2004, 18 patients with long-term tricuspid valve insufficiency underwent simple tricuspid valve surgery in our hospital. 13 patients underwent mitral valve replacement, 5 patients underwent mitral and aortic valve replacement, and 5 patients underwent tricuspid DeVega valve replacement. At the time of tricuspid valve surgery, the age was 35~65 years old (median 50 years, mean 50.1 years ± 8.1 years), the cardiac function was NYHA Ⅲ ~ Ⅳ, the left ventricular valve function was normal, and the diagnosis was confirmed by echocardiography. Results There were no deaths from thoracotomy, 8 patients underwent tricuspid valve replacement, 10 patients underwent tricuspid valve replacement, 5 patients underwent biological valve and 5 patients underwent mechanical valve. The operative mortality rate was 16.7%, and the follow-up rate was 12~114 months (median 24 months, mean 36.7 ± 31.8 months). The 3-year survival rate was 78.8%. The postoperative symptoms of 12 patients were significantly improved, and the postoperative symptoms of 3 patients were not improved. The cardiac function of NYHA Ⅲ ~ Conclusion Long-term tricuspid valve insufficiency after left heart valve replacement may be related to the late operation timing, unsatisfactory surgical results or the progression of right heart failure. When the symptoms of right heart failure are obvious when severe tricuspid valve insufficiency occurs, surgical treatment should be done as soon as possible to reduce postoperative mortality. Tricuspid valvuloplasty should be the first choice, and the effect of tricuspid valve replacement is acceptable.

Objective to introduce the method and curative effect of breast reconstruction with free inferior abdominal artery perforator (DIEP) flap immediately after modified radical mastectomy. Methods From June 2003 to June 2005, 6 patients with stage Ⅰ breast cancer and 2 patients with stage Ⅱ breast cancer were treated with modified radical mastectomy, and the breast reconstruction with DIEP flap immediately after modified radical mastectomy. Results All the flaps survived, 2 patients had minor complications, 1 patient had partial flap congestion and necrosis, and 1 patient had hemorrhage under the flap. All patients were followed up for more than half a year, and no tumor recurrence and metastasis, abdominal wall hernia and abdominal wall bulge were observed. The self-score of the patients with reconstructed breast was 7.75±0.88. Conclusion Free breast reconstruction with DIEP flap is an ideal method for restoring breast shape after modified radical mastectomy.

Objective to analyze the difference of T cell subsets in peripheral blood of chronic hepatitis B patients, hepatitis B virus carriers and normal subjects, and to explore the relationship between the pathogenesis of hepatitis B and the immune function of host cells. Methods The peripheral blood of 29 chronic hepatitis B patients, 25 HBV carriers and 35 healthy blood donors who attended the hepatitis clinic of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from February to July 2004 were collected. The T cell subsets of peripheral blood of chronic hepatitis B patients, HBV carriers and normal controls were detected by flow cytometry, and their differences and clinical significance were analyzed. Results The peripheral blood CD4+ T cell counts of chronic hepatitis B patients, HBV carriers and normal controls were 565 ± 192, 672 ± 148 and 816 ± 259, and CD8+ T cell counts were 491 ± 225, 445 ± 157 and 609 ± 177, respectively Compared with normal controls and HBV carriers, the proportion of CD8+ CD38+ T cells and CD4+ CD45RA-memory/effector T cells in chronic hepatitis B patients was significantly increased, and the proportion and count of CD4+ CD45RA +62L + naive T cells were significantly decreased. Conclusion The imbalance of T lymphocyte subsets and cellular immune dysfunction in chronic hepatitis B patients and HBV carriers may be related to the chronicity of hepatitis B virus infection.

Objective to investigate the protective mechanism of valsartan on cardiac function after myocardial ischemia-reperfusion (I/R) in isolated rats. Methods Forty male SD rats were randomly divided into five groups by Langendorff isolated cardiac perfusion model: the control group was treated with modified Kreb-Henseleit solution (K-H solution continuously perfused for 110 min); I/R group (perfusion with K-H solution was stabilized for 20 min, perfusion was stopped for 30 min, and reperfusion was performed for 60 min); In HOE140 group (K-H solution contained bradykinin β 2 receptor antagonist HOE1401 μ mol/L), valsartan group (K-H solution contained valsartan 1 μ mol/L), valsartan + HOE140 group (K-H solution contained valsartan 1 μ mol/L + HOE140 0.1 μ mol/L), the ischemia-reperfusion process of the latter three groups was the same as that of the I/R group. Left ventricular systolic blood pressure (LVSP), left ventricular pressure increase rate (+ dp/dtmax) were dynamically monitored, and the content of creatine kinase isoenzyme (CK-MB) in cardiac reperfusion effluent was measured. Compared with the control group, LVSP and + dp/dtmax decreased (LVSP 57 mm Hg ± 9 mm Hg vs 107 mm Hg ± 6 mm Hg, + dp/dtmax 679 mm Hg/s ± 177 mm Hg/s vs 1892 mm Hg/s ± 231 mm Hg/s, all P<0.01) The level of myocardial CK-MB increased (210 IU/L ± 48 IU/L vs 27 IU/L ± 7 IU/L, P<0.01). HOE140 alone had no effect on I/R cardiac function, myocardial CK-MB and non-reflow area (P>0.05). Valsartan improved LVSP (85 mm Hg ± 7 mm Hg) and + dp/dtmax (1425 mm Hg/s ± 260 mm Hg/s), Reduce the area of non-reflow area (12.9%±2.5%); Reduced myocardial CK-MB release (103 IU/L ± 24 IU/L, P<0.01 compared with I/R group); Conclusion Bradykinin β 2 receptor antagonist can attenuate the protective effect of valsartan on myocardial ischemia-reperfusion in isolated rats, and the protective mechanism of valsartan on myocardial I/R injury is partly related to the increase of bradykinin release.

Objective to investigate the immunotherapeutic effect of anti-L3T4 monoclonal antibody (mAb) on autoimmune cardiomyopathy.Methods Mice were immunized with mitochondrial ADP/ATP carrier peptide to establish an autoimmune cardiomyopathy model (cardiomyopathy group, 6 mice); The mice in the early treatment group (6 mice) were injected with anti-L3T4 monoclonal antibody in the tail vein 1 d before, on the same day and 1 d after peptide immunization; Mice in the intermediate treatment group (6 mice) received anti-L3T4 monoclonal antibody treatment at the third month of peptide immunization; The dynamic changes of serum anti-mitochondrial ADP/ATP carrier antibody were detected by enzyme-linked immunosorbent assay (ELISA), and the expressions of cytokine interferon (IFN) -γ and interleukin-4 (IL-4) in T cells were detected by flow cytometry. The pathological changes of myocardial tissues of mice were observed under light and electron microscope, and the volume fraction of collagen fibers in the tissues was calculated. Results the detection of anti-mitochondrial ADP/ATP carrier antibody in the early treatment group and the control group was negative, and there was no pathological change in myocardial tissue. However, the antibody level of the former group and the cardiomyopathy group were both positive, and the heart showed dilated cardiomyopathy-like changes, but the antibody level of the former decreased transiently, and the cardiomyopathy was slightly milder than that of the latter.The percentage of IFN-γ/IL-4 in T cells in the early treatment group (6.56%±0.21%/2.54%±0.20%) was not statistically significant compared with that in the control group (5.87%±0.19%/2.16%±0.10%); The treatment group (8.91% ± 0.33%/5.15% ± 0.13%) and the cardiomyopathy group (7.85% ± 1.42%/9.45% ± 1.70%) were higher than the control group, and the differences between the two groups were statistically significant compared with the previous two groups. Conclusion Anti-L3T4 monoclonal antibody has a therapeutic effect on mice autoimmune cardiomyopathy induced by mitochondrial ADP/ATP carrier peptide, and the early efficacy is more obvious.

Objective to investigate whether the mobilization of autologous bone marrow stem cells by granulocyte colony stimulating factor (G-CSF) can promote the regeneration of partial liver transplantation and alleviate the liver injury. Methods a 50% partial liver transplantation model (PLTx) of rats (female → male) was established. Posttransplantation mobilization group: 3 h after transplantation, G-CSF injection for 5 d; Unmobilized group: 3 h after transplantation, normal saline was injected subcutaneously for 5 d, and the liver was taken at 1, 3, 5, 7 and 14 d, respectively. CD34 stem cell markers in the transplantation were detected to determine the migration of stem cells into the liver, the mitotic phase of the liver and the incorporation of bromodeoxynucleoside uracil (BrdU) were observed to detect the liver regeneration, and sry + cells were detected to confirm the cell origin. Results After mobilization with G-CSF, the survival rate (90%) of the mobilized group after transplantation was higher than that of the mobilized group before transplantation (60%) and the unmobilized group (50%), and the difference was statistically significant. Compared with the unmobilized group, the liver necrosis foci were less and the mitotic index was higher on the third day after transplantation (30%±5% vs 24%±6%, P<0.05), high BrdU incorporation (42% ± 6% vs 34% ± 4%, P<On the 3rd to 14th day after transplantation, there were more CD34+ lymphocyte-like cells in heaps or scattered distributed in the portal area of the mobilized group after transplantation; On the third day after transplantation, more CD34+ cells were observed in the portal area in the mobilized group before transplantation, and sry positive cells were occasionally observed in the sinus and portal area in each group on the fifth day after transplantation. On the fourteenth day, there were more sry positive cells around the portal area in the two groups mobilized by G-CSF, but less in the non-mobilized group.Conclusion After transplantation, the survival rate of autologous bone marrow stem cells mobilized by G-CSF is high, the transplanted liver regeneration is obvious, and the liver injury is mild.

Objective to investigate the changes of platelet active factor (PAF) in liver and blood circulation and its effect on portal hypertension during liver cirrhosis. Methods CCl4 was injected intraperitoneally for 8 weeks (0.15 ml/kg, twice/week) to induce liver cirrhosis in rats, and the levels of PAF in liver and circulation were detected by rapid 3H-PAF liquid scintillation. Analysis of PAF binding capacity in liver tissue by receptor saturation binding assay; The effects of exogenous PAF and its antagonist BN52021 on portal pressure and systemic arterial pressure were monitored. Results Compared with the control group, the levels of intrahepatic PAF, hepatic output PAF and intrahepatic raw PAF in cirrhosis were significantly increased, 4.0 ng/g ± 0.4 ng/g vs 2.7 ng/g ± 0.5 ng/g, respectively (P<0.01), 6.3 ng/ml ± 0.6 ng/ml vs 3.4 ng/ml ± 0.6 ng/ml (P<0.01), 1.0 ng/ml ± 0.6 ng/ml vs-0.3 ng/ml ± 0.5 ng/ml (P<0.01); The PAF binding capacity Bmax of liver tissue was significantly increased (2.8±0.21) fmol/μ g membrane protein vs (0.9±0.06) fmol/μ g membrane protein, P<The difference in receptor affinity Kd was not statistically significant (8.0 nmol/L ± 1.3 nmol/L vs 5.8 nmol/L ± 1.0 nmol/L, P>0.05). The basal portal pulse pressure increased in the cirrhosis group (12.2 mm Hg ± 0.7 mm Hg vs 5.3 mm Hg ± 0.6 mm Hg, P<0.01), systemic arterial pressure decreased (82 mm Hg±10 mm Hg vs 114 mm Hg±9 mm Hg,P<After injection of PAF (1 μ g/kg) into the portal vein, the portal pulse pressure in the cirrhosis group increased by 32% (12.1 mm Hg ± 0.6 mm Hg vs 16.0 mm Hg ± 0.7 mm Hg, P<0.01), the increase was approximately that of the control group 227% (4.1 mm Hg ± 1.0 mm Hg vs 1.8 mm Hg ± 0.3 mm Hg, P<0.01), while systemic arterial pressure decreased in both groups (from 82 mm Hg ± 10 mm Hg to 48 mm Hg ± 4 mm Hg in cirrhosis group, P<0.01; the control group decreased from 114 mm Hg ± 9 mm Hg to 52 mm Hg ± 4 mm Hg, P<The portal pressure of BN52021 (5 mg/kg) decreased by 16% (14.6 mm Hg ± 1.6 mm Hg vs 12.3 mm Hg ± 0.8 mm Hg, P<Conclusion A significant increase in liver synthesis of PAF in cirrhosis is an important source of elevation of circulating blood PAF, and up-regulation of liver hemodynamics affects the formation of portal hypertension, and its effect can be partially reversed by its antagonist BN52021.

Objective to construct fusion cells from CD14+ mononuclear cells in peripheral blood of healthy volunteers and hepatoma cell line HCCLM3 cells, and to observe and evaluate the function of these fusion cells in vitro. Methods CD14+ cells were isolated from HLA-A2 positive healthy human peripheral blood, cultured in complete dendritic cell medium for 48 h and promoted maturation to obtain mature dendritic cells (called FastDC). Dendritic cells and hepatoma cell line HCCLM3 cells were fused with 50% polyethylene glycol and 10% dimethyl sulfoxide as fusion agents. After successful fusion, the fusion cells stimulated the proliferation of autologous T cells and the specific killing of CD8+ T cells, and compared with dendritic cells group, HCCLM3 group and dendritic cells and HCCLM3 mixed groups. Results The fusion cells constructed from dendritic cells cultured for 48 h and hepatoma cell line HCCLM3 cells could effectively stimulate the proliferation response of autologous T cells, and the level of IFN-γ secreted by activated CD8+ T cells (3 d Conclusion the fusion of dendritic cells obtained from peripheral blood CD14+ cells cultured for 48 h and hepatoma cell line HCCLM3 cells can effectively induce the immune response to specifically kill HCCLM3 cells in vitro.

Objective to investigate the expression characteristics of placental growth factor (PlGF) and pigment epithelium-derived factor (PEDF) in NSCLC and their relationship with tumor neovascularization, and to investigate the significance of these two factors in judging the prognosis of NSCLC patients. Methods The expression levels of PlGF and PEDF in 81 NSCLC patients were detected by hypersensitive peroxidase immunohistochemistry, and the microvessel density (MVD) was statistically analyzed by CD31 staining. Results The positive rates of PlGF and PEDF in 81 NSCLC patients were 43.2% (35 cases) and 53.1% (43 cases), respectively. The positive expression of PlGF was correlated with high MVD; The positive expression of PEDF was associated with low value MVD; The expression of PlGF and PEDF is negatively correlated. Both univariate and multivariate analysis suggest that PlGF is an independent prognostic index of NSCLC. Conclusion Both PlGF and PEDF can be expressed in NSCLC tissues, and they have antagonistic effects on the process of angiogenesis. Compared with PEDF, PlGF has a greater role in the development of NSCLC and predicting the prognosis of patients.

A 67-year-old male was admitted to the hospital on December 13, 2004 due to nasal discharge and purulent discharge for 4 months, fever, eye swelling and purulent discharge for 2 months. In August 2004, the patient had nasal congestion, yellow purulent discharge and severe discharge at night without obvious trigger, no obvious headache, fever, cough, sore throat or macroscopic hematuria, but no diagnosis and treatment. On October 9, 2004, he developed fever after being exposed to cold, body temperature 38℃, accompanied by chills, occasional nausea, vomiting of stomach contents, purulent discharge, without headache, limb movement disorder, abdominal pain, diarrhea, frequent urination, urgency and pain in urination.

AIDS has become one of the major infectious diseases that threatens human health. At present, the total number of HIV (human immunodeficiency virus) infected people in the world has reached 69 million, and 27 million have died.

Video assisted thoracoscopic surgery (VATS) is the development of thoracic surgery to minimally invasive surgery. Since 1980s, VATS has been mainly used in the diagnosis and treatment of lung tumor biopsy, pleural effusion, pulmonary bullae and other diseases. With the skillful mastery of surgical technique and the improvement of various endoscopic instruments, many thoracic surgeons have been able to complete VATS lobectomy. From April 2003 to September 2004, we treated 39 cases of peripheral non-small cell lung cancer with VATS, and achieved satisfactory clinical results.

The World Health Organization, the Food and Agriculture Organization, the World Organization for Animal Health and the World Bank jointly hosted a partnership meeting on avian influenza and human pandemic influenza in Geneva, Switzerland, from 7 to 9 November 2005, identifying key components of a global action plan to control avian influenza in animals while limiting the threat of human influenza pandemics.

The patient was a 33-year-old female who was hospitalized with hepatosplenomegaly due to gingival bleeding, dizziness and upper abdominal fullness after eating in December 2001. Peripheral blood leukocytes were 3.8×109/L, N 71.2%, L 22.5% and M 6.3%, red blood cells 4.45×1012/L, hemoglobin 135 g/L and platelets 54×109/L.

A 24-year-old male who suffered from headache and unsteady walking for 20 days was admitted to hospital on June 12, 2001. The patient had a larger head than ordinary children when he was young and could not walk in a straight line.

In recent years, tumor diagnosis has developed rapidly on the basis of absorbing the latest achievements of modern science and technology. At present, tumor diagnosis has developed into three branches, namely, clinical diagnosis, imaging diagnosis and experimental diagnosis. In the aspect of experimental diagnosis, a new branch of tumor diagnosis, namely experimental diagnosis, has been formed by integrating the achievements of tumor diagnosis in laboratory medicine, pathology, cytology, immunology and molecular biology.

ischmia-reperfusion (I/R) injury during free island flap transplantation often leads to partial or total necrosis of the flap.

Infection is the primary complication of hematological malignant diseases, especially in the state of neutrophil deficiency after high dose chemotherapy. The incidence of various bacterial infections and the high rate of drug resistance have seriously affected the prognosis of leukemia [1]. How to choose effective antibiotics for empirical treatment has attracted widespread attention. This study aims to provide valuable experience for the rational choice of antibiotics for chemotherapy complicated with infection by observing the efficacy of cefepime (Maspin) in the treatment of neutropenia with fever in patients with hematological malignant diseases.

To be able to win the Golden Pen Award at the 90th anniversary celebration of the founding of Chinese medical journal and rank first in the citation frequency of Chinese medical journal authors, first of all, I would like to thank the editors, reviewers and all the specific workers of Chinese medical journal.