Volume 87  ·   Issue 01  ·  2007

In recent years, due to the promotion of the reform of the management system of colleges and universities and the continuous "expansion of enrollment", medical education has developed greatly, but it has also brought many problems. More than 30 medical colleges and universities have been merged into comprehensive universities, which has brought about profound changes in the pattern of medical education in China, and at the same time, a number of comprehensive universities with complete disciplines have been established. From the overall situation and long-term perspective, the merger of medical colleges and universities into comprehensive universities is a major event with profound historical significance for the cause of higher education in China.

Academic journals are the most important media to introduce scientific research achievements to academia and the general public, and journals should also be responsible for the authenticity of scientific research when authors' achievements are published to the public through journals. In recent years, academic journals have quietly formed an "indissolvable bond" with "academic fraud" and "scientific research ethics". Immoral behaviors in the publication of biomedical scientific research papers, such as scientific research design fraud, data fraud, violation of ethics, author's signature, repeated publication, plagiarism, etc. are rarely disclosed [1]. In 1980, the original data of 12 papers published by V. Soman, a diabetologist at Yale University School of Medicine in the United States, was revealed to be missing or forged, and his articles were finally revoked.

Important progress has been made in the treatment of chronic hepatitis B, which is derived from the discovery of interferon and the widespread use of nucleoside (acid) analogues in clinical practice [1]. A large number of chronic hepatitis B virus (HBV) infected patients have benefited from it. The use of antiviral drugs in some patients has improved the quality of life and prolonged the life of HBV infected patients, but also reduced the chance of vertical and horizontal transmission due to the obvious decline of HBV carrier groups. In addition, due to the free vaccination of neonates and children in China, the infection rate of HBV in China has decreased significantly in recent years.

A 47-year-old female was admitted to hospital on April 5, 2006 because of the headache worsening for 10 hours more than 20 days after drilling and drainage of chronic subdural hematoma. She was hospitalized in another hospital because of headache. She was diagnosed as "left frontotemporal subdural hematoma" by brain CT. She was given drilling and drainage, and yellow liquid flowed out of the subdural space during the operation. 21 days later, the patient had headache again, which gradually worsened, so she came to our hospital for treatment. She was admitted to hospital with "recurrence of left frontotemporal chronic subdural hematoma" by brain CT. Physical examination: clear mind, poor spirit, anemic appearance; There were no abnormalities in all cranial nerves, neck resistance, muscle strength and tone of limbs were normal, and the pathological signs were (-).

Objective to investigate the correlation between anti-60 000 SSA (sjogren syndrome Type A, SSA) antibody and anti-52 000 SSA antibody with systemic lupus erythematosus (SLE) and sjogren's syndrome (SS). Methods Western-blot was used to detect the serum of 59 patients with anti-SSA antibody positive, including 44 cases with SLE and 15 cases with primary SS.Results There was no significant difference in the positive rate of anti-60 000 SSA antibody between SLE and primary SS (P>0.05), but there was significant difference between SLE and primary SS with anti-60 000 SSA antibody alone. The positive rate of anti-60 000 SSA antibody alone was 39.47% (15/38) in SLE patients and 6.67% (1/15) in primary SS patients. The positive rate of anti-52000 SSA antibodies was statistically significant between SLE and primary SS (P<0.05). The positive rate of anti-52000 SSA antibodies was 93.33% (14/15) in primary SS patients and 60.53% (23/38) in SLE patients. The positive rate of anti-60 000 and anti-52 000 SSA antibodies was not statistically significant between secondary SS and primary SS. Conclusion Anti-52 000 SSA antibodies were the main patients with primary SS, and the probability of anti-60 000 SSA antibodies alone was very small. The positive rate of anti-52000 SSA antibodies alone may be related to primary SS, but not favorable to the diagnosis of secondary SS.

Objective to investigate the optimal sedation depth and appropriate EEG bifrequency index (BIS) value of propofol in painless gastroscopy, and to test the operability and practicability of BIS as a control variable in the regulation of propofol infusion process.Methods 160 gastroscopic patients were randomly divided into 4 groups (40 cases in each group) according to the different changes of BIS after propofol injection. When the BIS in group B decreased to 65~74; In group C, BIS decreased to 55-64; The first dose of propofol in group D was stopped when BIS dropped to<55. Blood pressure, heart rate, respiratory rate, SpO2 value, BIS value and success rate of entering the microscope were monitored. Results the first dose of propofol in groups A, B, C and D were: (1.15 ± 0.34) mg/kg; (1.43 ± 0.27) mg/kg; (1.78 ± 0.31) mg/kg; (2.15±0.27) mg/kg, the difference between groups was statistically significant (P<0.05). The successful rate of endoscope entry was 17.5%, 47.5%, 92.5% and 97.5%, respectively. There was no statistically significant difference between C and D, but there was statistically significant difference between the other groups (P<0.05). Heart rate and blood pressure decreased significantly in group D (P<0.05). Conclusion It is safe and effective to monitor the depth of anesthesia and sedation and regulate the dosage of propofol by BIS. The optimal BIS interval for digestive gastroscopy is 55~64.

Objective to investigate the clinicopathological characteristics and prognostic factors of bronchial mucoepidermoid carcinoma. Methods Twenty-one cases of bronchial mucoepidermoid carcinoma admitted from February 1988 to June 2005 were retrospectively analyzed, including 16 males and 5 females, aged 15-72 years, with a median age of 42 years. The first symptoms were mostly cough, shortness of breath, hemoptysis or obstructive pneumonia. All patients underwent fiberoptic bronchoscopy before operation, and the lesions were found. 16 cases were diagnosed as mucoepidermoid carcinoma by biopsy. All patients underwent surgical treatment, including 13 cases of lobectomy, 3 cases of sleeve lobectomy, 4 cases of total pneumonectomy, and 1 case of thoracotomy. Results 21 cases in this group were confirmed as bronchial mucoepidermoid carcinoma by histopathological examination, of which 17 cases were low-grade malignancy and 4 cases were high-grade malignancy. The average follow-up was 68.3 months. All 17 patients with low-grade malignancy (T1-3N0-1M0) survived, including 8 cases with survival time>5 years. Including 1 case with hilar lymph node metastasis and 4 cases with high malignancy (T2-3N0-2M0), the longest survival time was only 13 months.Conclusion Low-grade malignant mucoepidermoid carcinoma can be cured by surgery, but high-grade malignant carcinoma is often prone to distant metastasis, and the prognosis is poor.Tumor stage, malignancy degree and regional lymph node metastasis are closely related to the prognosis.

Objective to determine the imaging changes of intracranial aneurysms after embolization with Matrix coil by follow-up method, and to evaluate the effect of Matrix on preventing recanalization of intracranial aneurysms after embolization and possible influencing factors.Methods 48 patients with intracranial aneurysms who were embolized with Matrix coil underwent cerebral angiography under local anesthesia, and the normal positions, lateral positions and embolization positions were taken routinely. The immediate imaging and follow-up imaging were compared. Results A total of 49 aneurysms in 48 patients were followed up by cerebral angiography, with an average follow-up time of 11.75 months.The rate of complete embolization was 34.7% and 53.1%, the rate of subtotal embolization was 42.9% and 24.5%, and the rate of incomplete embolization was 22.4% and 22.4%, respectively. A total of 14 aneurysms were recanalized, and the recanalization rate was 28.5%, and the severe recanalization rate was 14.3%. Conclusion The imaging of intracranial aneurysms after embolization with Matrix is relatively stable, and the recanalization rate is not higher than that of aneurysms embolized with bare metal coil such as GDC.

Objective to investigate the changes and related factors of intervertebral angle after anterior orthopedic fusion of simple thoracolumbar/lumbar juvenile idiopathic scoliosis (PUMC Ⅰ b, Ⅰ c). Methods The data of 18 patients with simple thoracolumbar/lumbar juvenile idiopathic scoliosis who underwent anterior orthopedic fusion were retrospectively analyzed, and the parameters such as Cobb angle of crown mounting surface, scoliosis correction rate, number of fusion segments and intervertebral angle were measured and analyzed statistically. The coronal Cobb angle was (44.7±10.2) ° before operation, (6.5±7.5) ° at 1 week after operation, and the average rate of scoliosis correction was 81.2%. The average intervertebral angle was (3.6±3.5) ° before operation, (2.0±4.4) ° at 1 week after operation, and (5.3±5.9) ° at 1 year after operation. The difference between the intervertebral angle before operation and 1 week after operation was statistically significant (P =0.035), and the difference between the intervertebral angle at 1 week after operation and 1 year after operation was statistically significant (P =0.029). The intervertebral angle in group A was (4.1±4.0) ° before operation, (1.2±3.5) ° and (4.0±4.7) ° at 1 week and 1 year after operation, respectively; The intervertebral angle of group B was (2.0±1.8) ° before operation, (4.2±4.5) ° and (7.1±5.1) ° at 1 week and 1 year after operation, respectively. The difference of intervertebral angle between groups A and B in different time periods was statistically significant (P<0.05). Comparing the other parameters between the two groups, the results showed that there were statistically significant differences in preoperative apical vertebral deviation, number of fusion segments and T12~ L1 lordosis (P<0.05). Conclusion The intervertebral angle after anterior orthopedic operation of idiopathic scoliosis was significantly improved compared with that before operation, but the intervertebral angle gradually increased at follow-up; The changes of postoperative intervertebral angle may be related to preoperative vertebral deviation, number of fusion segments, T12~ L1 lordosis and preoperative intervertebral angle. The current consensus is that postoperative intervertebral angle changes cannot be reduced by reducing the scoliosis correction rate and sacrificing the lower lumbar spine motor segment.

Objective to evaluate the clinical effect of anterior and posterior combined decompression and internal fixation in the treatment of cervical spondylotic myelopathy, and summarize the prevention and treatment measures of surgical complications.Methods the clinical effect and complications of 28 cases of cervical spondylotic myelopathy undergoing anterior and posterior combined decompression and internal fixation were retrospectively analyzed.Among them, the patients with good physical condition or clamp type cervical spondylotic myelopathy underwent posterior decompression first, changed posture, and then anterior decompression and fusion internal fixation, 6 cases underwent one-stage anterior and posterior combined operation; Twenty-two patients underwent anterior and posterior staged surgery. After regular follow-up, the clinical effect was evaluated according to JOA score and Odom score, and the effect of cervical fusion was observed by X-ray film. Results All the wounds of the patients healed in one stage, without nervous system injury, and were followed up 24/28, with an average follow-up of 16 months (6-52 months). Most of the patients had further improvement in spinal cord function to varying degrees. The improvement rate of JOA score was 50% at the time of discharge, and the excellent and good rate was 83.3% according to Odom grading evaluation method. The cervical intervertebral fusion was healed 3-6 months after operation, and no failure of internal fixation was found, and no patient needed reoperation for the operated segment. Cerebrospinal fluid leakage occurred in 3 cases after operation, which was cured by conservative treatment. Conclusion Anterior and posterior combined decompression and internal fixation is one of the effective methods for the treatment of severe and multi-segment cervical spondylotic myelopathy. However, the surgical trauma is greater and the internal fixation operation is complicated, so the surgical plan should be carefully designed to prevent complications.

Objective to investigate the prevalence of peripheral arterial occlusive disease (PAD) and its related influencing factors in China.Methods The prevalence of PAD was 19.47% among 1397 patients, of which 18.3% (122/664) were males and 20.4% (150/733) were females. The prevalence of PAD over 70 years of age increased to 31.9%.PAD was significantly positively correlated with age, smoking, systolic blood pressure, course of diabetes mellitus and glycosylated hemoglobin.Conclusion Nearly one fifth of patients over 50 years of age in China suffered from PAD.Age, course of diabetes mellitus, blood glucose level and systolic blood pressure are the risk factors of PAD.ABI and PWV are not only the means of diagnosis of PAD, but also the early warning indicators of cerebrovascular disease (CVD).

Objective to explore how to choose the most reasonable surgical method to protect the ovarian function of patients. Methods 103 premenopausal patients with uterine fibroids under 49 years old were divided into 3 groups according to the surgical method: uterine fibroid excision group (group Ⅰ), 33 cases; Subtotal hysterectomy group (group Ⅱ), 30 cases; Serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone were measured before operation in the total hysterectomy group (group Ⅲ). Color Doppler ultrasound was performed on 60 patients with hysterectomy before operation. The maximum systolic blood flow velocity (Vmax), minimum end diastolic blood flow velocity (Vmin), resistance index (RI) and pulsatility index (PI) of ovarian arteries were measured. The patients were followed up at 3 and 6 months after operation, respectively. Results There were no significant differences in FSH, LH, estradiol and progesterone in group Ⅰ regardless of age before and after operation (P>0.05). The levels of estradiol in group Ⅱ and group Ⅲ were significantly different between 6 months after operation and before operation (P>0.05). The levels of estradiol in group Ⅲ over 40 years old were (322 ± 212) pmol/L after operation and (589 ± 458) pmol/L before operation (P<0.01). After hysterectomy, the values of Vmax and Vmin of ovarian arteries decreased, while the resistance index and pulsatility index increased. The values of Vmax and Vmin were (0.24 ± 0.04) m/s and Vmin were (0.05 ± 0.05

Objective to investigate the effect of tumor burden on the differentiation of T1 and T2 in peripheral blood of patients with colorectal cancer and its clinical significance. Methods Peripheral blood of 20 patients with colorectal cancer (17 patients underwent radical resection and 3 patients underwent palliative resection) at the first diagnosis and on the 7th day after removal of tumor burden, and peripheral blood of 20 patients with benign diseases with matched age and sex in the same period were used as controls. T1 and T2 were detected by intracellular factor detection method, and lymphocyte subsets (T, CD4+ T, CD8+ T, B, NK) were detected by flow cytometry. Results T1 and T2 in peripheral blood of patients with colorectal cancer were significantly lower than those in the control group (P =0.006, 0.017); There was no significant change in lymphocyte subsets. T1 increased (P>0.05) and T2 increased significantly (P =0.020) at 7 DT after removing tumor burden. T1 in patients with tumor diameter ≥5 cm and poorly differentiated cancer was lower than that in patients with tumor diameter<5 cm and highly and moderately differentiated cancer, respectively (P =0.064, 0.072); The T1 of patients with lymph node metastasis was significantly lower than that of patients without lymph node metastasis (P =0.033); The T1 of patients with stage Ⅲ + Ⅳ was significantly lower than that of patients with stage Ⅰ + Ⅱ (P =0.033). Conclusion Tumor burden can significantly inhibit the differentiation of T1 and T2 in peripheral blood of patients with colorectal cancer, which is one of the mechanisms leading to low anti-tumor immune function; After removing the tumor burden, T1 and T2 began to rise in a short time, and the immune function was improved to some extent; T1 may be a new prognostic indicator of colorectal cancer.

Objective to investigate the chromosomal variation characteristics and clinicopathological significance of chromosome and microsatellite stable (MACS) colorectal cancer (CRC). Methods DNA ploidy, microsatellite instability analysis and immunohistochemistry were used to detect the expression of DNA mismatch repair proteins (hMSH2 and hMLH1) in 156 CRC patients, and to screen and confirm MACS CRC. Comparative genomic hybridization (CGH) was used to detect the chromosome variation of MACS CRC, and the correlation was analyzed by combining the clinical pathological data of the patients. Results Among 156 CRC patients, 41 (26%) were both diploid/near diploid DNA tumors and showed stable DNA microsatellite sequences, and all showed normal expression of hMSH1 and hMSH2 proteins, confirming that they were MACS CRC. The results of CGH detection showed that the overall average number of chromosome variation (amplification and deletion) in 41 MACS CRC patients was 9.6. The loci with chromosome DNA amplification frequency ≥10% appeared in the following order: 20 q (68%), 13 q (56%), 7 q (49%), 13 p (39%), 20 p (37%), 8 q (30%), 1 q (22%), 11 q (15%), 16 q (12%), 2 p, 4 q and 10 q (10%); The loci with chromosomal DNA deletion frequency ≥10% were: 18Q (63%), 8P (51%), 17P (37%), 1P (30%), 3P (26%), 4P, 13Q and 14 (15%), 21Q and Xp (10%); In Dukes'C/D stage CRC, 79% and 82% tumors showed chromosome 20 q amplification and 18 q deletion, respectively, and the mutation rate was significantly higher than that of Dukes'A/B stage CRC (46%,P =0.038; 21%, P =0.0009). Conclusion The frequency of chromosome variation in MACS CRC was close to that of chromosome unstable (CI) type CRC, but higher than that of microsatellite unstable (MSI) type CRC; High frequency deletion of chromosome 8p may be a relatively unique molecular event for MACS CRC different from CI and MSI CRC; Chromosome 20 q amplification and 18 q deletion are the most frequent chromosome variants in MACS CRC, and they are closely related to the malignant clinical phenotype of this type of CRC, and may play a very important role in its malignant progression.

Objective to construct an RNA interfering expression vector targeting mammalian rapamycin target protein (mTOR) gene, and to investigate its effect on the proliferation activity of vascular smooth muscle cells (VSMC) cultured in vitro and the intimal hyperplasia of rat autograft veins. Methods the short hairpin loop RNA (shRNA) sequence and control sequence targeting rat mTOR gene were designed and synthesized, and the retroviral vector pLXIN was inserted into the packaging cells to obtain recombinant viral vector. The expression of mTOR and its downstream substrates 4E-BP1 and p70s6k were detected by Northern hybridization and immunoprotein blotting, the proliferation cycle of VSMC was detected by flow cytometry, and the proliferation activity of VSMC was detected by MTT assay. 54 rats were randomly divided into transgenic group, control group and blank control group. The samples were collected at 7 days, 14 days and 28 days after operation. The expression of mTOR was detected by conventional HE staining, immunohistochemical staining, immunoprotein blotting, and the apoptosis of VSMC was detected by TUNEL assay The expression of p70s6k downstream of mTOR pathway was decreased, while the expression of 4E-BP1 was significantly increased; The process of division and proliferation of infected VSMC was blocked, and more cells stopped in G0/G1 phase; Local infection of transplanted blood vessels can significantly reduce the expression of mTOR gene mRNA and protein products (all P<0.01), the degree of intimal hyperplasia is significantly reduced compared with other groups (P<0.01), and the number of apoptotic cells is increased (P<0.01). Conclusion RNA interference expression vector targeting mTOR gene is successfully constructed. Silencing mTOR gene expression can inhibit the division, differentiation and proliferation of VSMC, reduce intimal hyperplasia and increase apoptosis of VSMC.

Objective to observe the distribution and cell localization of p38 α and p38 β in the lumbar spinal cord of rats with bone cancer pain model, and to explore their mechanism of action in bone cancer pain. Methods Twenty female SD rats were randomly divided into two groups, 10 rats in each group: Group A (control group): 3 μ L Hanks solution was injected into the bone marrow cavity of the left upper tibia; Group B (model group): 3 μ L of MADB-106 rat breast cancer cells (4.8×103/μ L) were injected into the bone marrow cavity of the left upper tibia. The threshold changes of mechanical pain and radiation heat pain in each group were observed every other day before and 14 days after operation. On the 14th day, the L4~6 segments of spinal cord of rats were taken, and the distribution changes and cell localization of p38 α and p38 β immunoreactive products in the lumbar spinal cord of bone cancer pain model rats were observed by immunohistochemical ABC method and fluorescence double labeling method. Compared with group A, the threshold of paw retraction in the first 6 days after operation in group B was statistically significant (P<0.05). On the 14th day after surgery, compared with the threshold of paw retraction and radiation heat pain in group A, the difference in group B was statistically significant (P<0.05). The immunoreactive absorbance values of p38 α and p38 β in the dorsal horn of the affected lumbar spinal cord in group B were significantly higher than those in group A, and the difference between the two groups was statistically significant (both P<0.05). Fluorescence double labeling showed that p38 α was co-expressed with neuron-specific nucleoprotein marker NeuN, and p38 β was co-expressed with microglia marker OX-42 in the dorsal horn of the affected lumbar spinal cord. Conclusion Spinal cord p38 α and p38 β are involved in the occurrence and development of bone cancer pain. P38 α is mainly expressed in spinal cord neurons, while p38 β is expressed in spinal cord microglia.

Objective to investigate the effect of upright posture on the susceptibility of scoliosis and the progression of scoliosis curve under asymmetric stress.Methods the experiment was divided into two-legged rats group, four-legged rats group and two-legged rats sham operation control group.The characteristics of human upright posture were simulated by relying on two-legged rats. The posterior median incision of the interscapular region was used to tie the left rib root high (T2-3 or T3-4) and low (T10-11 or T11-12) with No. 4 silk thread along the space between the erector spinal muscle and the trunk muscle, which caused asymmetric stress and simulated primary thoracic curvature. X-ray spinal radiographs were taken at 1, 2, 3, 4, 6 and 8 weeks after operation to dynamically observe the difference of scoliosis outcome and progression trend between two-legged rats and four-legged rats. Results the initial thoracic curvature or single thoracolumbar curvature convex to the right was caused by operation in two-legged rats and four-legged rats. All asymmetric tethers were loosened due to rib fracture or osteolysis and resorption at the tethering point at 1 to 4 weeks after operation. All scoliosis disappeared and the spinal curve returned to normal at 1 to 4 weeks after the tethering was loosened However, with the extension of asymmetric tethering time, the progression rate of scoliosis increased significantly, and irreducible scoliosis appeared after tethering lasted for 3~4 weeks.The progression pattern of scoliosis in bipedal rats showed diverse characteristics, including stable single thoracic curvature, progressive single thoracolumbar curvature and progressive double curvature, and the scoliosis morphology was similar to that of human idiopathic scoliosis.There was no scoliosis in bipedal rats under blank operation. Upright posture changes the progression rule of scoliosis, leads to the variety of scoliosis morphology changes during the progression of primary thoracic curvature, and induces the curve compensation phenomenon of scoliosis.

tissue engineering is a new discipline that combines cell biology and material science to construct tissues or organs in vitro or in vivo. A small number of seed cells are expanded in vitro and planted on natural or synthetic extracellular matrix. After a period of culture, they are transplanted into the body. Finally, tissues or organs with normal structure and function are formed, so as to replace the diseased and defective tissues and organs and reconstruct anatomical and physiological functions [1-2].

In 1906, Dutch scholars and American scholars described an arrhythmia called atrial fibrillation. After that, with the development of electrocardiogram, people realized that atrial fibrillation is one of the most common persistent tachyarrhythmias in clinic.

The American Heart Association (AHA) 2006 annual scientific conference was held in Chicago on November 12-15, 2006. The theme of this conference was to promote the intersection and integration of cardiovascular related disciplines. About 30,000 delegates from all over the world attended the conference, and presented and exchanged 4200 original research papers including cardiovascular epidemiology, basic and clinical research, as well as colorful speeches, lectures, invited presentations and special discussions, etc. The "meeting-within-a-meeting" communication mode proposed by AHA continued to flourish in this conference.

1. Family report Proband A, male, born in January 1949. In April 1996 (47 years old), he was diagnosed with rectal cancer due to increased frequency of stool and blood in the stool, and underwent radical rectal cancer resection (Dixon procedure). Postoperative pathology showed moderately differentiated adenocarcinoma of the rectum. In May 1998 (49 years old), he was diagnosed with gastric cardia cancer due to abdominal pain and abdominal distension, and underwent radical gastrectomy, and postoperative pathology showed poorly differentiated adenocarcinoma of the gastric cardia. In April 2006 (57 years old), he was diagnosed with cecal cancer due to abdominal pain and blood in the stool, and underwent right hemicolectomy, and postoperative pathology showed moderately differentiated adenocarcinoma of the cecum.