Volume 86  ·   Issue 03  ·  2006

In the early 1980s, when the new technique of interventional nerve radiation began to be developed in China, people's attention focused on how to use this technique to treat hemorrhagic cerebrovascular diseases such as embolization of intracranial aneurysms and cerebral arteriovenous malformations.

Objective to investigate the effect of β-adrenergic agonist (dobutamine) on alveolar fluid clearance in acute lung injury induced by endotoxin. Methods the rat model of acute lung injury was replicated by intravenous injection of endotoxin. Thirty-two clean grade male SD rats were randomly divided into normal control group, acute lung injury group, dobutamine control group and dobutamine treatment group. The expression of α, β, γ sodium channel (rENaC) mRNA in lung tissue was detected by reverse transcription polymerase chain reaction (RT-PCR). Results the expression of α, β-RENAC mRNA in lung tissue of acute lung injury group was significantly lower than that of normal control group (14.0%±1.2% vs 21.0%±3.9%, P<0.05). The expression of α, β-RENAC mRNA in lung tissue of acute lung injury group and dobutamine treatment group was significantly higher than that of normal control group and dobutamine control group (1.40±0.40, 0.70±0.8, 1.38±0.13, 0.71±0.17 vs 1.01±0.14, 0.58±0.12, all P<0.05). The expression of γ-rENaC mRNA in dobutamine treatment group and dobutamine control group was significantly higher than that of acute lung injury group and normal control group (0.90±0.19, 0.97±0.15 vs 0.69±0.10, 0.70±0.32, all P<0.05).

Objective to investigate the inhibitory effect of doxycycline, an anti-infective antibiotic with type IV collagenase inhibitory activity, on bleomycin-induced pulmonary fibrosis in mice. Methods The effect of doxycycline on the secretion of type IV collagenase and the enzyme activity of HT-1080 cells was determined by gelatin zymogram. The pulmonary fibrosis model of mice was replicated by intratracheal perfusion of bleomycin. The content of hydroxyproline in lung tissue was determined by biochemical method. The degree of pulmonary fibrosis in mice was observed and evaluated by histopathology combined with image analysis. Results Doxycycline could inhibit the secretion of type IV collagenase in HT-1080 cells in vitro. 0.1 mg/ml and 0.05 mg/ml doxycycline could significantly inhibit the secretion of MMP-9 and MMP-2 in HT-1080 cells. Doxycycline also inhibited the activity of excreted type IV collagenase. The results of biochemical detection showed that 100 mg/kg doxycycline could significantly reduce the content of hydroxyproline in bleomycin-induced lung of mice, which was 35% of that of bleomycin model group on the 21st day of the experiment. The results of histopathological observation and image analysis further showed that the area ratio of fibrosis, the area ratio of alveolar septum and the nucleated cell count in the left lung lobe of mice in the doxycycline-treated group were significantly less than those in the bleomycin-treated group; The therapeutic effects of the 100 mg/kg doxycycline group and the 3 mg/kg prednisolone acetate group were similar. Conclusion Doxycycline can inhibit the activity of type IV collagenase and inhibit the pulmonary fibrosis induced by bleomycin in mice.

Objective to observe the effect of enhancing the expression of IP10 in tumor on the distal dissemination and metastasis of breast cancer cell line 4T1. Methods the 4T1 cell line IP10-4T1 was established by electro-transfection. BALB/c mice were divided into IP10-4T1 cell group, 4T1 cell group and 4T1 cell group transfected with pcDNA3 (pcDNA3-4T1). The effect of IP10-4T1 inoculation on the dissemination and metastasis of 4T1 cells was studied by experimental lung metastasis model and in vitro killing experiment. Results the relative content of IP10 mRNA transcription in IP10-4T1 cells was 0.92±0.12 compared with that in untransfected 4T1 cells (0.35±0.12) and pcDNA3-4T1 cells (0.29±0.08). The chemotaxis index of lymphocytes in IP10-4T1 group was 2.77±0.29, which decreased to 1.71±0.20 after treatment with CXCR3 antibody (P<0.05). The experimental lung metastasis results showed that the mice in IP10-4T1 group had significant difference (P<0.01) The number of metastatic nodules formed on the lung surface was less than that in the control group; The number of 4T1 cell clones formed in lung tissue of IP10-4T1 group was 2.6±1.7, which was significantly lower than that of 4T1 group (34.0±6.3) and pcDNA3-4T1 group (33.0±2.3, P<0.05); The lymphocyte killing rate of mice inoculated with IP10-4T1 cells was higher than that of the control group (P<0.05). Conclusion Increasing the expression of IP10 in tumor can enhance the level of cellular immune response and inhibit the dissemination and metastasis of tumor cells through tumor-specific killing effect.

Objective to investigate the clinical characteristics and surgical treatment of surgical related tumors of Castleman disease. Methods The clinical data of 20 patients with surgical related tumors of Castleman disease in Peking Union Medical College Hospital from 1997 to 2004 were analyzed. There were 6 males and 14 females, aged 15-70 years, with an average age of 39 years. The smallest tumor was about 2 cm ×3 cm and the largest was about 10 cm ×9 cm. Distribution of tumors: 6 cases of mediastinal tumor, 2 cases of retroperitoneal tumor, 2 cases of intraperitoneal tumor, 1 case of adrenal region, 6 cases of axillary tumor, neck tumor, posterior ear tumor, and 3 cases of multicenter tumor. Results 19 cases of 20 patients underwent surgical resection or lymph node biopsy. The pathology showed Castleman's disease, and the tumor types were mostly huge lymph node hyperplasia, vascular follicular type and hyaline vascular type. Most of the tumors were benign lesions, and 3 cases were paraneoplastic pemphigus (PNP). Conclusion Castleman's disease is rare in clinic, and manifests as lymph node enlargement of unknown cause. The mass can occur in any part of lymphoid tissue, with mediastinum, neck and axillary as the prevalent sites, and the retroperitoneal adrenal region is rare. Therefore, when the mass of unknown cause is found in clinic, other rare tumors should be considered. Surgical resection of tumor is the first choice.

Objective to investigate the pathogenesis of osteogenesis imperfecta in China by sequencing the type I collagen α 1 chain protein gene (COL1A1 gene). Methods to investigate the clinical characteristics of a family of autosomal dominant osteogenesis imperfecta, and design primers to amplify and sequence the exons of COL1A1 gene from patients and normal persons in the family. At the same time, restriction endonuclease analysis was performed on 50 unrelated healthy controls in the population. The results showed that the mutation of G→A at position 3470 of COL1A1 gene in patients with osteogenesis imperfecta in the family leads to G1157D, but it was not found in non-patients and normal controls in the family. Conclusion The mutation of COL1A1 gene is also one of the causes of osteogenesis imperfecta in Chinese population, and the mutation found is a new pathogenic gene mutation of osteogenesis imperfecta. The mutation of glycine to aspartic acid has important influence on the phenotype of osteogenesis imperfecta.

Objective to summarize the experience of total thoracic and abdominal aortic replacement with four branches of blood vessels under deep hypothermia and segmented circulatory arrest. Methods From August 2003 to May 2005, 38 cases (25 males and 13 females), aged 22-58 (40±9) years and weighing 49-105 (67±19) kg, were performed continuously. There were 4 cases of true thoracoabdominal aortic aneurysm (Crawford type Ⅱ), 24 cases of chronic Stanford type B dissecting tumor, 5 cases of chronic Stanford type A dissecting tumor (all underwent secondary surgery), and 5 cases of Marfan syndrome complicated with chronic Stanford type B dissecting tumor (2 cases underwent secondary surgery). Total thoracoabdominal aortic replacement was performed with four-branch artificial blood vessel through left posterolateral along the rectus abdominis muscle to the pubic symphysis thoracoabdominal symphysis incision, fifth intercostal entry, costal arch severing, and extraperitoneal approach.Results 2 cases died early after surgery (mortality rate 5.26%). 4 cases of neurological complications (coma for more than 3 days) were cured after dehydration and neurotrophic therapy. 2 cases of acute renal failure were cured by hemofiltration therapy. Conclusion Total thoracoabdominal aortic aneurysm resection and artificial blood vessel replacement with four-branch artificial blood vessel and segmented circulatory arrest technique can simplify the surgical method and significantly shorten the ischemic time of brain, spinal cord and vital organs, with good results.

Objective to investigate the effect of carbon dioxide (CO2) pneumoperitoneum laparoscopic surgery on the morphology of human peritoneum. Methods 40 patients with uterine fibroids or simple ovarian cysts (excluding peritoneal inflammation) were randomly performed laparoscopic surgery and laparotomy. The parietal peritoneum was collected at 0, 30, 60, 90 and 120 minutes after surgery, respectively. The morphological changes of peritoneal mesothelial cells were observed by scanning electron microscope (SEM). Results The mesothelial cells in the laparoscopic group showed no obvious changes at 0 minutes after laparotomy, but the cell morphology was normal, and the basement membrane was intact, which remained the same at 60 minutes. The intercellular junctions were occasionally broken at 90 minutes, but slightly obvious at 120 minutes. The mesothelial cells in the laparoscopic group swelled rapidly at 0 minutes after inflation, only mesothelial cells swelled at 30 minutes, and occasionally intercellular spaces were seen. The intercellular junctions of peritoneal mesothelial cells were broken at 60 minutes, and the continuity of the basement membrane was interrupted, so the intercellular spaces were exposed, and the intercellular spaces were more obvious at 90 minutes and 120 minutes. A small number of lymphocytes and macrophages were seen in the intercellular spaces. Conclusion Compared with open laparotomy, C02 pneumoperitoneum laparoscopic surgery The degree of change is related to the inflation time.

Objective to establish a score method for predicting the survival time of patients with end-stage gynecological tumors.Methods the clinical data of 91 patients with end-stage gynecological malignant tumor who were no longer suitable for any anti-tumor therapy and died in hospital were retrospectively analyzed.The median age of 91 patients was 56 years (13~83 years), and the median survival from admission was 27 days (1~240 days). The relationship between 19 clinical and biochemical indexes and survival time was analyzed.The 9 indexes that significantly affected survival time showed by univariate analysis were analyzed by multivariate logistic regression.A regression model including 5 indexes was established by stepwise regression method.The regression coefficients of each index were converted into simple scores and added to obtain the prognostic scores of each patient.According to this scoring method, the patients were divided into two groups.Group A had ≤9.5 scores and Group B had ≥10 scores. Results The univariate analysis showed that the 9 indexes that significantly affected survival time were: dyspnea, Karnofsky functional index (KPS), age, fever, tumor development speed, presence or absence of complications, blood urea nitrogen, creatinine and blood urea nitrogen. The regression equation including dyspnea, KPS, age, fever and blood urea nitrogen was established by multivariate logistic regression. The correct resolution ability of the equation was 83.5%. The average survival time of 37 cases in group A was (65 ± 7) d. The average survival time of 54 patients in group B was (19±2). 83.8% (31/37) of patients survived ≥30 days in group A and 85.2% (46/54) of patients survived ≤29 days in group B. The difference of survival curves between the two groups was statistically significant (P<0.001). Conclusion The scoring method established based on the data of this group is simple and practical, and it is an effective method to predict the survival time of dying patients.

Medical science is an applied science, and its existence and development are determined by its application. Pathology is an important bridge between basic medicine and clinical medicine in medical science. Her task is to study the etiology and pathogenesis of diseases, the morphological and functional changes of diseased organisms, as well as the treatment principles and prognosis judgment of diseases, so it is closely related to clinical medicine.

In order to explore the interventional therapy of complex intracranial aneurysms and the indications of stent-assisted coil embolization, we treated 18 cases of complex intracranial aneurysms that could not be treated with conventional simple microcoil embolization, and all of them achieved good results. The related problems are analyzed and discussed as follows.

A 47-year-old female farmer was admitted to hospital for "repeated wheezing and cough with chest tightness for 10 years, aggravated for 1 week". One week ago, she developed chills and fever without inducement, and her body temperature was as high as 39℃. She was treated with cefalomycin and other drugs in the local hospital, and her body temperature dropped, but still persisted at about 38℃, especially in the afternoon. She had no night sweats, cough and expectoration, with wheezing and chest tightness.

Shakespeare in his novels<"The more you worry, the worse the outcome," wrote Troilos and Cressida. "However, panic can also be dangerous before a large epidemic occurs. The Nov. 19, 2005 issue of Lancet (Lancet, 2005, 366: 1751) reported that much of the anti-avian flu campaign was indirectly triggered by panic, some of which stemmed from the government's blockade of information.

Objective to investigate the technique and efficacy of transarterial embolization with low concentration of n-butyl cyanoacrylate (NBCA) in the treatment of dural arteriovenous fistula. Methods Eighteen patients with different parts of dural arteriovenous fistula were treated with low concentration (10% ~20%) of n-butyl cyanoacrylate (NBCA) through the supply artery. Among the 18 patients, 12 patients had dural arteriovenous fistula in the cavernous sinus area and 6 patients had apical dural arteriovenous fistula. The key operation method of this technique was to inject low concentration of NBCA into the venous end to occlude it and reflux into other supply arteries. Results 17 of the 18 patients achieved anatomical cure after embolization, and the clinical symptoms disappeared after operation. The other one had one degree of symptom improvement after embolization with dural arteriovenous fistula in the cavernous sinus area, and the symptom worsened after 2 days. After reexamination and angiography, the vein was not completely occluded, and the reflux vein changed, and the symptoms improved obviously after 10 days of neck compression. Conclusion Transarterial embolization with low concentration of NBCA is a good choice for some cases, which is characterized by low cost, rapid and satisfactory curative effect.

Objective to investigate the feasibility of embolization of cerebral arteriovenous malformations (AVM) by using methyl methacrylate and 2-hydroxyethyl methacrylate copolymer. Methods iohexol was added to the copolymer solution to embolize the AVM model in vitro and the skull base microvascular network (RMB) of 7 domestic pigs. After the operation, the microcatheter was examined and the inner wall of the microcatheter was observed. The embolization stability of the copolymer on domestic pig RMB was re-examined by angiography. The histocompatibility and embolization stability of the copolymer were investigated by histological examination. Results Nine in vitro AVM models were co-embolized with copolymer solution. The copolymer dispersed uniformly between glass beads and could effectively stop the water flow through the microcatheter. There was no copolymer adhesion to the inner wall of the microcatheter. The embolization of 9 RMB from 7 domestic pigs with copolymer was satisfactory. Except for the first one animal that died due to too fast injection of copolymer solution during embolization, the other 6 animals survived well. A total of 4 animals were re-examined and no vascular recanalization was found after embolization. The copolymer could diffuse into the vascular lumen with a diameter of 80~150 μ m in the blood vessel. Neutrophil aggregation was observed in the vascular lumen 2 days after embolization, suggesting mild inflammatory reaction. Except for mild inflammatory changes in and around the vascular lumen, The tissue samples at 2 and 6 months after embolization showed hyperplasia of connective tissue and mild to moderate chronic inflammatory reaction, and foreign body giant cell reaction was observed in RMB vessel wall and its surrounding tissues.Conclusion As a non-adhesive liquid embolic material, the copolymer has low viscosity, easy to pass through microcatheter, good biocompatibility and stable embolization effect, and can be used for the embolization of cerebral AVM.

Objective to investigate and summarize the new technique of Neuroform self-expanding stent combined with coil in the treatment of intracranial wide-neck aneurysms, and to evaluate the compliance and effectiveness of Neuroform self-expanding stent combined with coil in the treatment of intracranial wide-neck aneurysms. Methods The efficacy of 30 patients with intracranial wide-neck aneurysms treated with Neuroform self-expanding stent combined with coil was retrospectively analyzed. The mean aneurysm size of 30 patients was 9.5 mm. The Neuroform stent assembly was pushed under the guidance of micro-guide wire, and the stent was released across the neck of the aneurysm. Among the 30 patients, 21 cases (70%) were completely embolized, 9 cases (30%) were mostly embolized, 2 cases were stent displacement and 1 case was thromboembolized. 29 cases were followed up after operation, and only 1 case had permanent hemiparesis. Twenty-one cases with residual aneurysms were treated by digital subtraction angiography 6-12 months after surgery. Among them, 4 cases were completely embolized for the second time. Conclusion The new stent-assisted coil embolization technique improves the short-term efficacy of intracranial wide-neck aneurysms, but the long-term efficacy needs to be confirmed by clinical and angiographic follow-up results.

From June 2001 to May 2005, 12 cases of penetrating aortic ulcer were treated by stent-type artificial vessel intervention in the Department of Cardiac Surgery of Beijing Anzhen Hospital. The summary is as follows. 　　

The main function of intravenous thrombolysis after acute cerebral infarction is to recanalize the blood flow and improve the defective neurological function. transcranial Doppler (TCD), as a non-invasive method of cerebral blood flow detection, can dynamically observe the changes of blood flow of major intracranial arteries before and after thrombolysis in patients with acute cerebral infarction.

Povidone (PVP) has been widely used in cosmetic surgery, food industry and other fields because of its special adhesion [1]. In recent 6 years, PVP has been used as solvent in our hospital to prevent the recurrence of bladder cancer by intracavitary perfusion of doxorubicin, and the curative effect is remarkable [2]. This experiment studied the pathological and cellular immune characteristics of recurrent bladder cancer after perfusion, aiming to explore its mechanism of action.

migraine is a common vascular headache, which is mainly divided into migraine with aura (MA) and migraine without aura (MO). The etiology of migraine is not very clear at present. Family and twin studies have confirmed that genetic factors play an important role in the pathogenesis of migraine, but the specific pathogenic genes have not been found yet [1].

Anuolfia is classified into conductive, sensorineural and mixed. Conductive anolfia is the most common in clinic because of the lesions of nasal cavity and sinus affecting the airflow to the olfactory area, but its etiology and diagnosis are clear, and its treatment and prognosis are good. Sensorineural anolfia has always been a difficult point in clinical research.

pulmonary artery embolism is rare, and the embolic sources causing pulmonary artery embolism are thrombus, tumor and foreign body [1]. It is reported in the literature that the surgical treatment of pulmonary artery embolism is mainly chronic thromboembolic pulmonary hypertension (CTEPH) with pulmonary thromboendarterectomy (PTE) [2].

Keyhole surgery is a surgical technique to treat deep lesions in the body through small incisions on the body surface. The supraorbital keyhole approach was developed from the infrafrontal approach. Authors at home and abroad have used this approach to treat anterior and posterior circulation aneurysms, sellar region and ventral brainstem tumors [1]. From January 2001 to January 2005, 35 patients with sellar region tumors were treated by supraorbital keyhole approach assisted by neuroendoscopy in the Department of Neurosurgery of the Second Affiliated Hospital of Zhejiang University School of Medicine, with satisfactory results.

survivin, a new member of the apoptosis inhibitor protein family, is abundantly expressed in embryonic tissues and most human malignant tumor tissues, but not in differentiated and adjacent tissues [1, 2].