Volume 86  ·   Issue 24  ·  2006

Liver cancer is a major disease that threatens human health and is a common malignant tumor. According to statistics, there are about 250,000 new cases of liver cancer every year in the world. The mortality rate of liver cancer in urban residents in China is second only to lung cancer; However, the mortality rate of liver cancer among rural residents ranks first among all kinds of cancers [1]. The etiology is related to hepatitis virus, aflatoxin, environmental pollution and other factors. Unfortunately, the recurrence rate of liver cancer is high, especially the recurrence rate of large liver cancer can reach more than 50%. Therefore, how to improve the cure rate of liver cancer and prolong the life of patients is the key problem in the treatment of primary liver cancer at present [2].

Objective to compare and observe the clinical efficacy of right atrial isthmus ablation alone, pulmonary vein segmental electrical isolation alone and the combination of two ablation methods on typical atrial flutter (atrial flutter) combined with paroxysmal atrial fibrillation (AF). Methods 66 patients with typical atrial flutter combined with paroxysmal atrial fibrillation were treated with right atrial isthmus ablation alone in 30 cases (Group A), pulmonary vein segmental electrical isolation alone in 17 cases (Group B) and the combination of two ablation methods in 19 cases (Group C). The average postoperative clinical follow-up was 30.5 weeks ± 10.4 weeks, and the recurrence rate of arrhythmia and surgical complications were observed. Results The recurrence rate of atrial flutter was significantly lower in group A (13.3%) and group C (10.5%) than that in group B (52.9%) at 12 weeks after operation (all P<0.05), and there was no statistical difference between group A and group C (P>0.05); The recurrence rate of atrial fibrillation in group B (29.4% and 23.5%, respectively) and group C (31.6% and 26.3%, respectively) was significantly lower than that in group A (46.7% and 73.3%, respectively) from 12 to 36 weeks postoperatively (all P<0.05), but the difference between group B and group C was not statistically significant (P>0.05). Conclusion Right atrial isthmus ablation alone is effective for typical atrial flutter combined with paroxysmal atrial fibrillation, but the recurrence rate of atrial fibrillation is higher; Simply pulmonary vein segmental electrical isolation can cure atrial fibrillation radically and control atrial flutter well. Segmental pulmonary vein isolation and right atrial isthmus ablation only reduced the recurrence of early atrial flutter, but long-term follow-up observation did not show its advantage.

Objective to investigate the function and quantity changes of natural killer cells in liver of mice of different age. Methods The killing activity of NK cells in liver and spleen of 2-week-old and 8-week-old mice (CL57BL/6) was measured by 4h 51Cr release assay. The percentage and number of NK cells in the liver and spleen of 2-week-old and 8-week-old mice were determined by flow cytometry, and the expression levels of CD69, Mac-1 and Ly49C/I on the surface of NK cells were determined. The expression intensity of perforin in liver monocytes was determined by RT-PCR. Results the percentage of NK cells in the liver of 2-week-old and 8-week-old mice was approximately the same (11.9%±1.7% vs 9.9%±1.6%, P>0.05), but the number of NK cells per unit mass of liver was significantly higher in 2-week-old mice than in 8-week-old mice [(11.6±2.5) ×105/g vs (3.4±0.8) ×105/g, P<0.05]. The NK cells in the liver of 2-week-old mice had very strong cell killing activity (71.0%±5.5% vs 23.8%±4.4%, P<0.05). The phenotypes of NK cells in the liver of 2-week-old mice were mainly CD69 increased, Mac-1 and Ly49C/I decreased, while the NK cells in the liver of 8-week-old mice were mainly CD69 decreased, and Mac-1 and Ly49C/I increased. Perforin was highly expressed in liver monocytes of 2-week-old mice. Conclusion NK cells in the liver of 2-week-old mice had very strong killing ability and special phenotype, which suggested that the liver of young mice had special

Objective to investigate the effect of local sustained-release rapamycin on intimal hyperplasia of vein graft and provide experimental evidence for clinic.Methods 24 healthy rabbits were divided into 4 groups, and the vein graft model was established in the blank control group. Pluronic F-127 control group: 0.5 ml of 20% sustained-release carrier Pluronic F-127 was sprayed locally on the graft vessel; Low dose group: 0.5 ml of 20% Pluronic F-127 carrying rapamycin (50 μ g/cm2) was sprayed locally on the graft vessel; In the high dose group, 0.5 ml of 20% Pluronic F-127 carrying rapamycin (100 μ g/cm2) was sprayed locally on the graft vessel. The degree of intimal hyperplasia and luminal stenosis, the expression of proliferating cell nuclear antigen and the level of apoptosis were observed. Results Compared with the blank control group and the F-127 control group, the intimal hyperplasia was reduced in the low dose group and the high dose group (the intimal thickness was 29 μ m ± 10 μ m, 16 μ m ± 8 μ m, 90 μ m ± 11 μ m, 85 μ m ± 11 μ m, respectively), the degree of restenosis was reduced (the ratio of lumen area/total area was 0.80 ± 0.36, 0.91 ± 0.13, 0.58 ± 0.11, 0.65 ± 0.47, respectively), the proliferation of smooth muscle cells was inhibited (the cell proliferation index was 20% ± 9%, 14% ± 7%, 31% ± 7%, 35% ± 6%, respectively), and the apoptosis level was increased (the apoptosis index was 33% ± 7%, 36% ± 8%, 16% ± 6%, 18% ± 8%, respectively), and the above effects were enhanced with the increase of rapamycin dose.

Objective to investigate whether activation of JAK3 signaling pathway can extend and regulate T lymphoid progenitor cells in vitro and evaluate the feasibility of their directional differentiation.Methods A retroviral vector containing JAK3 gene, MGI-F2JAK3, contained green fluorescent protein (GFP) and two binding sites F36v, which can bind small molecule dimeric compound AP20187, was constructed. The vector was transferred into bone marrow hematopoietic stem cells of mice, and expanded in serum-free medium X-Vivo15 culture system, and divided into four groups: blank control group; AP20187 group; stem cell factor (SCF) group; In the AP20187+ SCF group, immunotyping, directed differentiation and intrathymic injection of the expanded cells were studied by flow cytometry. Results the transduced hematopoietic cells in the AP20187+ SCF group could be expanded in a large number of logarithmic order for a long time, and the cells could reach 1.2×1012 fold ± 0.2×1012 fold after 50 days of expansion. The expanded cells were the earliest T lymphoid progenitor cells with the phenotype of C-kithiCD44+ CD25-TN. The progenitor cell population could be directed to differentiate into Thy1.2 positive T lymphocytes under the conditions of SCF + IL-7+ IL-3 culture, and directed to differentiate into mature T lymphocytes with GFP + CD3+ and GFP + CD4+ double positive in the thymus of mice. Conclusion AP20187 combined with SCF activated JAK3 signal, and the earliest T lymphoid progenitor cells could be largely expanded. The progenitor cells had the function of directed differentiation into mature T lymphocytes. This system is helpful to study the development of T lymphocytes.

Objective to investigate the role of hemagglutinin-like oxidized low density lipoprotein receptor 1 (LOX-1) in p38 mitogen-activated protein kinase (p38MAPK) signaling pathway in human umbilical vein endothelial cells activated by oxidized low density lipoprotein (ox-LDL). Methods Human umbilical vein endothelial cells (HUVEC) were cultured and incubated with different concentrations of ox-LDL. The protein levels of LOX-1 and p38MAPK were detected by Western blot. The mRNA expression of LOX-1 was observed by reverse transcription polymerase chain assay. The endothelial cells were pretreated with LOX-1 specific blocking antibody (JTX92) to detect the protein level of p38MAPK. The effect of ox-LDL on cell viability was observed by tetrazolium blue assay. Results ox-LDL caused changes in the morphology and structure of endothelial cells and inhibited the growth of endothelial cells (P<0.05). ox-LDL upregulated the expression of LOX-1 protein and mRNA in a concentration-dependent manner (all P<0.05), and activated the p38MAPK pathway in a concentration-dependent manner. The expression levels of p-p38MAPK in different concentrations of ox-LDL (25 μ g/ml, 50 μ g/ml, 100 μ g/ml) groups were significantly higher than those in the control group (48±7,79±15,113±14 vs 24±5,P<0.01); The level of p-p38MAPK protein in JTX92+ ox-LDL (100 μ g/ml) group was significantly lower than that in ox-LDL (100 μ g/ml) group (58±13 vs 113±14, P<0.01). Conclusion ox-LDL activates the p38MAPK signaling pathway through LOX-1 pathway, and the upregulation of LOX-1 is an important link in atherosclerosis induced by ox-LDL.

Objective to investigate the relationship between matrix metalloproteinase family (MMP) -2, 3, 9, extracellular matrix (ECM) fibronectin (FN) and tendinprotein (TN-C) and myocardial remodeling and cardiac function impairment in patients with heart failure. Methods Thirty-nine patients with congestive heart failure (CHF) underwent mitral valve replacement due to mitral insufficiency heart disease and 38 normal controls (8 of them were from organ donors) were selected. The serum levels of MMP-2, 3, 9 and their inhibitor-1 (TIMP-1) were detected by enzyme-linked immunosorbent assay (ELISA), the pathological changes of myocardial tissue were detected by light microscope, the expression of MMP-2, 3, 9 and TIMP-1 proteins in myocardial tissue was detected by immunoprecipitation, and the distribution of FN and TN-C in extracellular matrix in myocardial tissue was detected by immunofluorescence. Results The myocardial tissue of CHF patients caused by valvular disease showed typical pathological changes of myocardial remodeling. The plasma levels of MMP-2, 3, 9 and TIMP-1 in normal control group were 213 μ g/L ± 23 The ratio of MMP-2,3,9 and TN-C protein expression absorbance (A) (A/β-actin) in myocardial tissues was 1.01±0.02, 1.45±0.04, 0.68±0.03, 0 in the normal control group, respectively, and the CHF group was 1.13±0.01, 1.69±0.05, 1.32±0.05, 1.69±0.05), 3.32±0.02, 1.98±0.06, 1.73±0.07, 1.89±0.06) and IV (6.29±0.05, 2.36±0.4, 1.99±0.09, 3.36±0.40), respectively, and the difference was statistically significant compared with the normal control group (P<0.05 or 0.01). On the contrary, the expression ratios of TIMP-1 and FN protein (A/β-actin) in myocardial tissue were 2.10±0.12 and 2.01±0.02 in the normal group, respectively, and the CHF group was 1.58±0.16 and 1.13±0.01, 0.79±0.06 and 0.70±0.02, and 2.10±0.12 and 0.42±0.05, respectively (P<0.05 or 0.01). Conclusion The increase of MMP-2, 3 and 9 expression and the decrease of TIMP-1 in patients with heart failure were involved in the pathological process of myocardial remodeling, and the cardiac function was further deteriorated by changing the extracellular matrix of myocardium.

Objective to investigate the distribution of glucose metabolism and analyze the characteristics of angiography in 553 patients with suspected coronary artery disease. The physical parameters and blood biochemical indexes of 553 patients with suspected coronary artery disease were measured, and coronary artery angiography was performed. The distribution of glucose metabolism was evaluated by 1999 WHO diagnostic criteria for diabetes mellitus. The results of angiography were quantitatively evaluated by the criteria of coronary artery stenosis prescribed by American Heart Association and Gensini scoring system. The patients were divided into groups according to the angiography results and glucose metabolism status. Results The average age of the subjects was 60 years old (60.1±9.7), 277 patients (50.1%) had normal glucose tolerance, 276 patients (49.9%) had abnormal glucose metabolism, including 127 patients (23.0%) with impaired glucose regulation, 61 patients (11.0%) with newly diagnosed diabetes mellitus, and 88 patients (15.9%) with known diabetes mellitus. The incidence of multi-vessel lesions and Gensini score in the diabetic group were higher than those in the non-diabetic group (56.4% and 34.5%, P<0.05) The incidence of multi-vessel disease and the degree of coronary artery stenosis were higher in diabetic patients than in non-diabetic patients.

Objective to study the dose-effect relationship between ultraviolet radiation and pterygium onset. Methods 95 pterygium patients in Yacheng area of Sanya City, Hainan Province were selected as pterygium group. 95 volunteers were paired 1:1 according to the same age, gender, nationality and whether they wear glasses and hats as normal controls. The two groups were divided into three stages according to age: young, middle-aged and old-aged. The individual UV exposure time was calculated by asking the accumulated outdoor activity time of the subjects in detail and filling in a questionnaire. As the UV exposure amount, the relationship between UV exposure time and pterygium onset in the two groups was compared and analyzed. Results The relationship between UV exposure time and pterygium onset in the young group (35 637 h +13 587 h or 26 188 h +17 423 h; t =3.352, P =0.006) and the middle-aged group (73 412 h +23 082 h or 63368 h +25 091 h; t =2.322, P =0.024) The UV exposure time of patients with pterygium was significantly higher than that of the control group, but the UV exposure time between the elderly pterygium group (106 816 h +37 423 h or 106 748 h +43 111 h) and the control group was not statistically significant (t =0.008, P =0.994); The length of pterygium was positively correlated with UV exposure time (r =0.361, P<0.05), and the length of pterygium increased with age. Conclusion There is a dose-effect relationship between UV radiation and the pathogenesis of pterygium.

Objective to analyze the epidemiological characteristics and laboratory results of 654 cases of fungal keratitis, so as to improve the clinical diagnosis and treatment efficacy of fungal keratitis. Methods The demographic characteristics, disease risk factors, seasonal changes, clinical characteristics, laboratory results and treatment strategies of hospitalized patients with fungal keratitis from January 1999 to December 2004 were retrospectively analyzed. Results The proportion of fungal keratitis patients was the highest (61.9%). Corneal injury (51.4%), especially plant-based injury (25.7%) was the most common risk factor. The incidence of fungal keratitis was higher in autumn and winter than in spring and summer, and showed an increasing trend year by year. The positive rate of direct microscopic examination by potassium hydroxide wet film was 88.7%. Among the isolated fungi, Fusarium genus was the most common (73.3%). 604 patients (92.4%) underwent surgical intervention, including penetrating keratoplasty (399 cases) (66.0%), 177 cases (29.3%) of lamellar keratoplasty. Conclusion Fusarium is the most important pathogen in fungal keratitis. Direct microscopic examination with potassium hydroxide wet film is worthy of further promotion because of its quickness, simplicity and high specificity. Keratoplasty is still the most effective method for treating severe fungal keratitis, and it is recommended to implement it early.

Objective to investigate the prevalence and distribution of type 2 diabetes mellitus and abnormal glucose regulation (IGR) among community residents in Shanghai. Methods A multi-stage cluster random sampling method was used to investigate the prevalence of type 2 diabetes mellitus, impaired glucose tolerance (IGT) and impaired fasting blood glucose (IFG) among urban and rural residents in Shanghai. Results The prevalence of type 2 diabetes mellitus, impaired glucose tolerance (IGT) and impaired fasting blood glucose (IFG) were 8.6% (1000/11589), 6.9% (802/11 589) and 1.0% (120/11 589), respectively (the standardized rate was 6.2%, 5.1% and 0.8%). The prevalence of type 2 diabetes mellitus among overweight and obese people was 11.5% (454/3946) and 16.3% (207/1273), the prevalence of IGT was 8.9% (352/3946) and 12.0% (153/1273), the prevalence of IFG was 1.4% (57/3946) and 2.3% (29/1273), which were significantly higher than those of normal body mass index (5.3% (337/6364), 4.6% (294/6364) and 0.5% (34/6364), respectively) (all P<0.01). The prevalence rates of type 2 diabetes mellitus, IGT and IFG in women were 8.4% (588/6968), 7.3% (506/6968) and 1.0% (73/6968), respectively. The prevalence rates of type 2 diabetes mellitus, IGT and IFG in urban areas were 11.2% (730/6500), 6.4% (419/6500) and 1.2% (77/6500), respectively (standardized rates were 6.5%, 4.9% and 0.8%, respectively). The prevalence rates of type 2 diabetes mellitus, IGT and IFG in rural areas were 5.3% (270/5089), 7.5% (383/5089) and 0.8% (43/5089), respectively (standardized rates were 3.8%, 5.4% and 0.7%, respectively). The prevalence rates of type 2 diabetes mellitus and IGT in urban and rural areas were statistically significant (P<0.05), but the prevalence rate of IFG was not statistically significant (P =0.073). The proportion of newly diagnosed type 2 diabetes mellitus was 47.6%, among which 69.3% (187/270) in rural areas were significantly higher than that in urban areas [39.6% (289/730)]

The guideline for clinical diagnosis and treatment (guideline) is a principle to regulate and guide the diagnosis and treatment of diseases, which is formulated by authoritative academic institutions and is applicable in a country or more. It has certain binding force, so it must be treated carefully and formulated and published scientifically in accordance with the principle of evidence-based medicine.

Objective to investigate the surgical management of liver tumors invading inferior vena cava, so as to improve the resection and surgical safety. Methods The clinical data of 29 cases of liver malignant tumors invading inferior vena cava from January 1996 to September 2005 were retrospectively analyzed, including tumor size, location, stage, surgical mode and prognosis, etc. Results The surgical methods of 29 cases of liver tumors invading inferior vena cava included partial resection and repair of inferior vena cava, and 4 cases of liver cancer resection and tumor thrombus removal of inferior vena cava, all of which were successful without surgical complications. Conclusion B-mode ultrasound, CT and magnetic resonance (MRI) are indispensable examinations before surgery. MRI can clarify the compression, invasion, displacement and occlusion of inferior vena cava. Radical resection of liver tumors invading inferior vena cava can be performed selectively. Partial resection and repair of inferior vena cava wall is safe, effective and feasible, and can greatly improve the resection rate of tumor.

Objective to investigate the effect of rapamycin (RPM), a novel immunosuppressant with antitumor properties, on the growth and metastasis of hepatocellular carcinoma cells. Methods The effects of RPM (10 ng/ml), cyclosporine (CsA) (100 ng/ml) and their combination on apoptosis and cell cycle of human hepatocellular carcinoma cell line MHCC97H were detected by flow cytometry. The expressions of vascular endothelial growth factor (VEGF) mRNA, basic fibroblast growth factor (bFGF) mRNA, hypoxia-inducible factor-1 α (HIF-1 α) mRNA and transforming growth factor b (TGFb) after RPM treatment were detected by real-time quantitative polymerase chain reaction (PCR). The changes of VEGF protein levels in the supernatant of MHCC97H culture medium were detected by ELISA. 28 nude mice with high metastatic human liver cancer model LCI-D20 were randomly divided into CsA (25 mg/kg) group, RPM (2 mg/kg) group, CsA + RPM group and control group (normal saline), 7 mice in each group; To investigate the effects of immunosuppressive agents on tumor growth and spontaneous lung metastasis. Results In vitro, RPM inhibited the proliferation of MHCC97H cells and arrested the cells in G0/G1 phase, but did not promote apoptosis. RPM downregulated the gene expression of HIF-1 α and VEGF and the expression of VEGF protein in the supernatant of MHCC97H medium (890.3 pg/ml ± 25.1 pg/ml vs 1583.7 pg/ml ± 17.3 pg/ml, P =0.000). CsA had no effect on cell cycle and proliferation. In vivo, RPM and CsA + RPM inhibited the growth of LCI-D20 model tumors (0.76 g ± 0.38 g vs 2.09 g ± 0.75 g, P =0.001; 0.40 g ± 0.22 g vs 2.09 g ± 0.75 g, P =0.000) The number of spontaneous lung metastases in the CsA group was more than that in the control group (6±2 vs 4±1, P =0.046). Conclusion RPM can significantly inhibit the growth and metastasis of hepatocellular carcinoma cells, and the immunosuppression regimen based on RPM may have clinical application prospect in liver transplantation of hepatocellular carcinoma.

Objective to investigate the characteristics of microsatellite variation of plasma circulating DNA in patients with hepatocellular carcinoma (HCC) and its consistency with tumor tissues. Methods Three highly polymorphic microsatellite markers on chromosome 8p were selected to detect heterozygous deletion (LOH) and microsatellite instability (MSI) in plasma and tissue samples of 62 patients with hepatocellular carcinoma. Results Among the three microsatellite loci combined, 33 plasma samples of 39 tissue samples with LOH had the same changes at the corresponding loci, with a consistency of 84.6%; Among the 19 MSI-positive tissue specimens, the same MSI was detected in 14 cases in the corresponding plasma, with a consistency of 73.7%; The positive rate of LOH (58.1%, 36/62) in plasma DNA was significantly higher than MSI (29.0%, 18/62) in 62 cases of HCC (P<0.01); The positive rate of MSI in HCC tissue and plasma DNA at D8S277 locus was significantly higher than that in the other two loci (P<0.05). Conclusion HCC plasma circulating DNA has a high agreement with microsatellite variation of tumor tissue, and plasma circulating DNA can be used to reflect microsatellite variation of tumor tissue; LOH mode plays an important role in the occurrence and development of HCC, followed by MSI; D8S277 is a detection site sensitive to MSI in HCC.

granulocyte macrophage colony stimulating factor (GM-CSF) is a multifunctional growth factor. Previous studies have shown that GM-CSF can stimulate the proliferation, differentiation and maturation of hematopoietic progenitor cells and transfer from bone marrow to the periphery, and can induce the differentiation and proliferation of many kinds of cells. GM-CSF has been used as an important treatment for severe infection with immunocompromised or radiotherapy or chemotherapy patients with leukodeficiency. Recent studies have shown that GM-CSF plays an important role in wound healing of skin tissue.

The patient was a 32-year-old female. After induced abortion, she had irregular vaginal bleeding for 19 days and increased for 2 days. Her last menstruation was on November 20, 2005. After menopause for 49 days, she underwent painless induced abortion in the local area on January 9, 2006. The local doctor told her that she had scraped "villi" and was hospitalized for 3 days due to massive bleeding during the operation (specific treatment unknown). After induced abortion, there was a small amount of vaginal bleeding. On the evening of January 26, massive vaginal bleeding occurred, and the local B-ultrasound revealed irregular fluid dark area in the uterus.

Avian influenza is another serious respiratory infectious disease prevalent worldwide after SARS, which brings great threat to human health and economic development. The World Health Organization reported 97 (55%) deaths of 176 patients on March 10, 2006. It has been found that many viruses isolated from human have hereditary resistance to adamantane, and resistance to oseltamivir has also been reported. Although human-to-human transmission is still rare, it is urgent to develop a vaccine against influenza A (H5N1) virus. The New England Journal of Medicine published on March 30, 2006 (N Eng J Med, 2006, 354: 1343-1351) reported the results of safety and immunogenicity tests of influenza H5N1 vaccine in the United States.

Marfan syndrome (MFS) is a congenital defect of mesenchymal tissue described by Marfan in 1896. It is caused by the mutation of FBN1 gene encoding fibrillin-1. There has been evidence that MFS is involved in the increase of transforming growth factor-β (TGF-β) signaling, and the use of TGF-β neutralizing antibody can reduce atrioventricular valve myxoma in mice with FBN1 gene mutation.

Intrahepatic bile duct stones are rare in Europe and America, but very common in Asia. It is considered as an endemic disease in the Far East. It causes great harm to the health of patients, especially the rural people in East Asia. Because of the difficulties in etiological classification and disease classification, it is impossible to form a universally accepted treatment standard [1]. At present, the treatment of intrahepatic bile duct stones includes both surgical methods (including choledocholithotomy, sphincteroplasty, choleenterostomy and hepatectomy) and non-surgical methods (including choledochoscopic lithotomy, transhepatic bile duct dilation lithotomy, hydraulic lithotripsy, extracorporeal shock wave lithotripsy and drug therapy).

Cord blood transplantation is often accompanied by increased risk factors such as delayed hematopoiesis and infection [1]. Cytokine-mediated expansion in vitro is expected to solve this problem. However, in order to effectively expand cord blood hematopoietic cells and maintain or increase the implantation potential of expanded cord blood hematopoietic cells in vitro expansion, it is closely related to the selection of starting cells and the combination of cytokines. In this study, the effects of different cytokine combinations on the expansion of cord blood mononuclear cells were investigated.