Volume 87  ·   Issue 14  ·  2007

Due to the influence of traditional concepts, actual national conditions and the imperfect system and regulations of organ transplantation donors in China, the number of liver donors is far from meeting the needs of patients waiting for liver transplantation, which seriously restricts the further development of liver transplantation in China.

The eye is an important sensory organ, and most eye diseases will lead to visual organ damage and loss of function. The World Health Organization (WHO) put forward the classification standard of blindness and visual impairment in the 1970s, which stipulated that a person whose best corrected visual acuity with better eyes is less than 0.05 is blind, and whose best corrected visual acuity with better eyes is less than 0.3, but ≥0.05 is low vision.

Objective to evaluate the clinical value of CT-guided 125Ⅰ seed implantation in the treatment of recurrent and extrahepatic metastases of liver cancer after liver transplantation. Methods Eleven patients with recurrent and extrahepatic metastases of liver cancer after liver transplantation underwent 123Ⅰ seed implantation for 33 times, aged 35-68 years, with a median age of 56 years. The total number of lesions in all patients was 45, with an average of 4.09 lesions per person, and the average diameter of the lesions was 2.5 cm. The distribution source was calculated by treatment planning system (TPS) before operation, and 125Ⅰ particles with an activity of 30 MBq were implanted in the tumor lesions under CT guidance during the operation. The particles were implanted in a plane of 0.5-1.0 cm. The matched dose around the tumor (MPD) was 100-150 Gy, and the number of implanted particles in each patient ranged from 10-100. Results 45 lesions, 17 were in complete remission (CR); Partial response (PR) 20; No change (NC) 7; The total effective rate was 82.2%. Pneumothorax occurred in 1 case during operation, and pulmonary compression was less than 30%, which improved after conservative treatment, and 3 cases had a small amount of bleeding during operation; There were 5 cases with blood in sputum and increased body temperature at 1 week after operation, and 2 cases with particle displacement at 2 months follow-up; Conclusion CT-guided 125Ⅰ seed implantation is effective in the treatment of recurrent and metastatic tumors after liver transplantation, with less trauma and less complications.

Objective to evaluate the short-term and long-term survival of liver transplantation patients with acute liver failure and analyze the related factors affecting the efficacy of liver transplantation. Methods The data of 318 liver transplantation patients performed in our hospital from January 2001 to December 2004 were retrospectively analyzed (follow-up until December 2005). According to UNOS liver function classification criteria, the preoperative status of the recipients was evaluated, including 54 cases of acute liver failure (UNOS1 and 2A) and 264 cases of chronic liver cirrhosis (UNOS2B and 3). The incidence of postoperative complications, retransplantation rate, retransplantation cause and death cause were counted. Results The perioperative mortality, postoperative complications and retransplantation rate were 3.7%, 16.7% and 1.1% in the transplantation group with preoperative liver function status of UNOS2B and 3. The 1-year and 3-year survival rates were 91.3% and 86.4%, respectively. The perioperative mortality, postoperative complications and retransplantation rate were 22.6%, 55.6% and 18.5% in the transplantation group with preoperative liver function status of UNOS1 and 2A. The 1-year and 3-year survival rates were 74.1% and 68.5%, respectively. Conclusion The effect of liver transplantation mainly depends on the function of extrahepatic organs and the preoperative liver function status. The short-term and long-term curative effects after liver transplantation were better in patients with chronic liver disease cirrhosis whose preoperative liver function status was UNOS2B and UNOS3, while the perioperative mortality rate of patients with acute liver failure whose preoperative liver function status was UNOS1 and UNOS2a was higher.

Objective to investigate the molecular mechanism of plasma bilirubin increase after liver ischemia-reperfusion in rats.Methods The experiment was divided into sham operation group (Group A) and 70% of rats with 35 min liver ischemia-reperfusion group (Group B). The study time points were 1 h, 6 h, 1 d, 3 d and 5 d.HE staining to analyze the pathological changes of liver tissues. The bile production rate was calculated, and the changes of bilirubin content in bile and plasma were detected by conventional biochemical methods.The expression of multi-drug resistance associated protein 2 (MRP2) and hepatocytoskeletal connexin root protein in liver tissue were detected by fluorescence quantitative PCR. The localization of MRP2 and root protein on the capillary bile duct membrane of hepatocytes was analyzed by laser confocal method. Results The inflammatory reaction in 70% rats with 35 min liver ischemia-reperfusion model was mild, and there was no hepatocyte necrosis. Compared with group A, the bile production rate and the conjugated bilirubin content in bile were significantly reduced in group B from 1 h to 3 d after reperfusion; Fluorescence quantitative polymerase chain reaction (PCR) showed that the expression of root protein in group B was down-regulated from 6 h to 5 d after reperfusion, especially from 6 h to 1 d after reperfusion, and the significant down-regulation of MRP2 expression only occurred from 6 h to 5 d after reperfusion. Laser confocal analysis showed that the localization of MRP2 in group B on the capillary bile duct membrane was reduced at the loss of root protein expression from 6 h to 5 d after reperfusion. Conclusion The reduced localization of MRP2 on the capillary bile duct membrane caused by the down-regulation of root protein expression may be the molecular mechanism of plasma bilirubin increase after liver ischemia-reperfusion in rats.

Objective to investigate the effects of CD4+ CD25+ regulatory T cells, co-stimulatory pathway blocker CD154 monoclonal antibody and their combination on inhibiting acute rejection of liver transplantation in rats.Methods 48 orthotopic liver transplantation rats (DA → Lewis) were divided into group A: control group; Group B: Lewis rat CD4+ CD25+ cells activated by DA rat splenocytes were reinfused 7 days before operation; Group C: CD154 monoclonal antibody (15 m/kg) was injected intraperitoneally on the 1st and 2nd days after operation; Group D: CD4+ CD25+ cells and CD154 monoclonal antibody were combined. Six recipients were sacrificed in each group at 7 days after operation. The pathological changes of the transplanted liver were observed, and the expression of T cell subsets and cytokines interleukin-2 (IL-2), IL-4, IL-10 and transforming growth factor β 1 (TGF β 1) in the transplanted liver were detected. Spleen lymphocytes were isolated from the donor and the one-way mixed lymphocyte reaction was performed to observe the stimulation index. The survival of the remaining rats was observed. Results the mean survival time of group D (52.00±10.64) d was significantly longer than that of other groups (P<0.01); The number of lymphocyte infiltration (2.47±0.61) ×106 and the percentage of CD8+ cells (14.2±3.0) % in transplanted liver were significantly lower than those in group B and C (P<0.05, P<0.01), while the proportion of CD4+ CD25+ cells (16.4±4.3) % was higher than that in group B and C (P<0.05, P<0.01). The expression of IL-2 mRNA in transplanted liver was the highest in group A and the weakest in group D; IL-4 mRNA was weakly expressed in all groups; The expression of IL-10mRNAB and D groups was high, but not in A and C groups; The expression of TGF β 1 mRNA in groups B and D was significantly stronger than that in groups A and C. The one-way mixed lymphocyte response in group D had the lowest stimulation index (P<0.05). Conclusion CD4+ CD25+ regulatory T cells and CD154 monoclonal antibody, a co-stimulatory pathway blocker, can inhibit the acute rejection of liver transplantation in rats; The combination of CD154 monoclonal antibody significantly enhanced the inhibitory effect of CD4+ CD25+ regulatory T cells on acute rejection.

Methods Methylation-specific polymerase chain reaction was used to detect E-CD, mismatch repair enzyme hMLH1, APC and 6-oxo-methylguanine-DNA methyltransferase (MGMT) in 106 cases of gastric cancer and its adjacent foveal epithelium and 16 cases of chronic gastritis, respectively, and the expression of E-CD in 46 cases of gastric cancer was detected by immunohistochemistry. Results The methylation frequencies were 72.6% (77/106), 44.3% (47/106) and 12.5% (2/16), respectively (P<0.01). The methylation of Laurén diffuse gastric cancer (80.6%, 50/62) was significantly higher than that of intestinal gastric cancer (61.4%, 27/44), and the difference was statistically significant ( Methylation was related to the depth of invasion, pTNM stage and differentiation of gastric cancer (all P<0.05). Among 46 cases of gastric cancer, 22 cases had E-CD gene methylation, and 20 cases (90.9%) showed heterogeneous attenuation or basically disappeared. 24 cases had no E-CD gene methylation, and 9 cases (37.5%) showed heterogeneous attenuation or basically disappeared of E-CD protein expression, and the difference between them was statistically significant (P<0.01). Conclusion the initiation of the region methylation by the above tumor suppressor genes may be an early event in gastric carcinoma.

Objective to investigate the value of serum S100 protein B subtype (S100B) and neuron-specific enolase (NSE) levels in early judgment of brain injury after cardiopulmonary bypass surgery. Methods 48 patients undergoing cardiopulmonary bypass (n =40) and non-cardiopulmonary bypass (n =8) were examined for serum S100B and NSE concentrations before, 24 hours and 48 hours after surgery, and the brain injury index (DQ) was calculated according to the "postoperative neurological status assessment method" at 48 hours after surgery. Results Serum S100B (0.61 μ g/L ± 0.18 μ g/L, 0.37 μ g/L ± 0.12 μ g/L) and NSE (10.14 μ g/L ± 3.87 μ g/L, 5.77 μ g/L ± 2.31 μ g/L) were measured at 24 hours and 48 hours after cardiopulmonary bypass The concentrations of S100B (0.05 μ g/L ± 0.03 μ g/L, 0.04 μ g/L ± 0.03 μ g/L) and NSE (2.91 μ g/L ± 1.56 μ g/L, 2.87 μ g/L ± 1.41 μ g/L) were higher than those before operation (both P<0.01). There was no difference with the preoperative concentrations (0.04 μ g/L ± 0.03 μ g/L, 2.76 μ g/L ± 1.23 μ g/L) (all P>0.05). The levels of serum S100B and NSE at 24 h after cardiopulmonary bypass were correlated with age, cardiopulmonary bypass time and aortic occlusion time (all P<0.05). The levels of serum S100B and NSE were positively correlated with DQ (r =0.739, P<0.01, r =0.371, P<0.05). Conclusion Serum S100B and NSE are both specific indexes to judge brain injury after cardiopulmonary bypass, but the combined detection of serum S100B and NSE has the highest specificity.

Objective to investigate the role of brain structures in exercise preparation and execution.Methods Event-related functional magnetic resonance imaging was used to record the functional activities of the whole brain of 12 right-handed healthy subjects during time-delayed sequence finger movement.The brain activation maps and time signal intensity response curves related to exercise preparation and exercise execution.Results the activation related to exercise preparation mainly concentrated in the anterior part of bilateral premotor region (PMC), bilateral posterior parietal lobe (PPC) and bilateral auxiliary motor region (SMA); The activation areas related to execution are mainly concentrated in the contralateral primary motor area (M1), bilateral auxiliary motor area (SMA), and cerebellar cortex during exercise preparation and execution. The time signal intensity response curve based on single pixel analysis indicates that the above areas are activated to different degrees during exercise preparation and execution, but they have different distribution characteristics in different brain areas. Conclusion the motor-related areas of human brain participate in exercise preparation and execution to different degrees, but the primary motor area close to the primary motor cortex is mainly involved in exercise execution, while the secondary motor cortex which is far away from the primary motor area is more involved in exercise preparation.

Objective to investigate the clinical value of color Doppler ultrasound (CDU) and magnetic resonance angiography (MRA) in the diagnosis of portal vein thrombosis and tumor thrombe.Methods 165 cases of liver transplantation were examined by BUS and MRA before operation.The results were compared with the location and nature of portal vein embolus confirmed by anatomy and postoperative pathology.The sensitivity and specificity of BUS to portal vein occlusion were analyzed, and the accuracy of the diagnosis of portal vein thrombosis or tumor thrombe.Results Pathological anatomy showed that 6 cases of portal vein thrombosis in 77 cases of liver cirrhosis, 7 cases of portal vein thrombosis in 88 cases of liver cancer and 28 cases of tumor thrombe.The total sensitivity and specificity of BUS to portal vein occlusion were 86.5%, 97.4%, and the positive predictive value and negative predictive value were 85.3% and 97.6%, respectively; The total sensitivity and specificity of MRA for portal vein occlusion were 90.5%, 99.3%, and the positive predictive value and the negative predictive value were 95.7% and 98.4%, respectively. However, the accuracy of both MRA for the diagnosis of portal vein blood/tumor thrombus before operation was lower than 70%. Conclusion Both BUS and MRA are non-invasive examinations of portal vein system, each has its own advantages and disadvantages, and both have a certain number of false positive and false negative rates. The sensitivity of MRA is higher than that of BUS, but neither can accurately diagnose the nature of portal vein occlusion, so further clinical research is needed.

Objective to evaluate the safety and efficacy of donor peripheral blood hematopoietic stem cell transfusion (GPBSCI) after platelet implantation failure after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods The clinical data of 15 patients who underwent allo-HSCT in the Institute of Hematology of Peking University from April 2003 to June 2006 were analyzed retrospectively. Results The median age of 15 patients was 33 years old (14-48 years old), 9 males and 6 females, all of which were acute and chronic leukemia patients. The average number of mononuclear cells (MNC) in bone marrow transfusion was (4.21±1.91) ×108/kg, (1.50-7.46) ×108/kg, (3.27±1.40) ×108/kg, (1.13-5.90) ×108/kg, and (2.13±1.69) ×106/kg All patients received granulocyte transplantation, 8 patients were treated with GPBSCI due to primary platelet transplantation failure, and the remaining 8 patients were treated with GPBSCI due to secondary platelet transplantation failure.The median time of retransfusion was +113 d (43-384d) after transplantation.The average MNC count of retransfusion was (3.09±1.54) ×108/kg [(1.35-5.99) ×108/kg]. Only 1 patient showed acute graft versus host disease (aGVHD) after retransfusion. Three cases were significantly effective, 6 cases were effective, 1 case was progressive, and 6 cases were ineffective. The effective rate was 56.3%. Two retransfusions within 100 d after transplantation were more effective. Conclusion For patients with allo-HSCT who failed platelet transplantation, two retransfusions of donor peripheral blood hematopoietic stem cells showed little related adverse reactions, which can play a certain effect on promoting hematopoietic recovery of recipients.

Objective to investigate the relationship between ankle-brachial index (ABI) and all-cause and cardiovascular disease (CVD) mortality in men with multiple risk of arteriosclerosis. Methods A total of 1941 male patients aged 36-96 years with multiple risk factors of arteriosclerosis were enrolled in multiple internal medicine inpatients. Baseline characteristics were investigated and followed up for 13 months to observe the incidence of endpoint events. Results All-cause mortality (15.4% vs 7.7%) and CVD mortality (5.1% vs 1.8%) in peripheral arterial disease (PAD) group were higher than those in normal group, and the differences were statistically significant (P<0.001). The all-cause mortality (17.6%, 15.2%, 10.1% and 7.3%) and CVD mortality (14.7%, 4.4%, 2.9% and 1.6%) in severe PAD group, mild to moderate PAD group, borderline group and normal control group were statistically significant (P<0.001). The survival of all-cause death and CVD death in PAD group was significantly lower than that in normal group. Conclusion ABI is an independent risk factor for all-cause death and CVD death, and the lower ABI, the higher the CVD mortality rate.

Objective to study the difference of ultrastructure, marker expression and permeability of microvascular endothelial cells between optic nerve blood optic nerve barrier and blood brain barrier in rats.Methods Twenty male SD rats were taken from anterior sieve plate area, posterior sieve plate area, intraorbital segment, intraductal segment, intracranial segment and prefrontal cortex respectively.The ultrastructure of microvascular endothelial cells in 10 rats was observed by electron microscope; The expression of endothelial barrier antigen (EBA) and the extravasation of fibrinogen around microvascular were detected by immunohistochemistry.Results Electron microscopy showed that the microvascular endothelial cells in all segments of optic nerve and prefrontal cortex were tightly connected, and the microvascular endothelial cells were photographed at 30 000 times. The number of plasma membrane vesicles in 3 square grids was randomly numbered by 5 mm transparent square mesh overlapping on the photographs, and finally the number of plasma membrane vesicles per μ m2 of intimal membrane was converted into the number of plasma membrane vesicles per μ m2 of intimal membrane. The number of plasma membrane vesicles in the presieve area was (108.0±12.0), which was more than that in prefrontal cortex [plasma membrane vesicles (31.8±2.9)], and the difference was statistically significant (P<0.05); However, there were no significant differences in plasma membrane vesicles (30.4±2.8), posterior sieve plate (30.3±3.0), intraorbital segment (31.3±3.8), intraductal segment (28.9±2.0) and intracranial segment (30.1±2.1) of endothelial cells in prefrontal cortex compared with those in prefrontal cortex (all P>0.05). Immunohistochemistry showed that the expression of EBA in microvascular endothelial cells in anterior sieve plate was negative, and the perivascular fibrinogen was positive; Conclusion the microvascular endothelial cells in the prefrontal cortex are different in ultrastructure, marker expression and permeability from the prefrontal cortex, so they do not have blood-brain barrier properties, while the sieve plates, the posterior sieve plates, the intraorbital segment, the intracanal segment and the intracranial segment are similar to the prefrontal cortex, so they have blood-brain barrier properties.

Objective to observe the effect of the dry powder solution of Shensong Yangxin Capsule on the membrane sodium channel current (INa) and L-type calcium channel current (ICa, L) of single guinea pig ventricular myocytes. Methods The dry powder of Shensong Yangxin Capsule was prepared with calcium extract into different concentrations (1%, 0.5%, 0.25%). Single ventricular myocytes were isolated by enzymatic hydrolysis, and the current was recorded by whole cell patch clamp recording technique.Results When the drug concentration was 0.5%, the peak current density of INa was reduced from (27.2 ± 5.4) pA/pF to (14.9 ± 2.8) pA/pF, and the average inhibition rate was 44.8% ± 7.7% (n =5, P<0.05); The inhibition rates of the peak current density of ICa, L were 50.7%±5.6%,44.8%±6.5% and 19.2%±1.1% at the concentrations of 1%,0.5%and 0.25%, respectively (n =5,P<0.05). The current density-voltage curves of INa, ICa, L could be shifted up by the drugs, but the activation, peak and reversal potentials were not changed. Conclusion the dry powder solution extracted from Shensong Yangxin Capsule has a blocking effect on INa, ICa, L, which may be part of the pharmacological mechanism of its anti-arrhythmia and myocardial protection.

Objective to establish an animal model of Tbx2 gene suppressing congenital heart disease in zebrafish and to study the effect of Tbx2 gene on cardiac development.Methods Tbx2 gene suppressed cardiac development in embryos was observed by microinjection of morpholine ring oligonucleotide, and the role of Tbx2 in cardiac development was further elucidated by whole embryo in situ hybridization technique. Results 27.2% (163/600) of 600 zebrafish embryos suppressed by Tbx2 gene died at 8 h after fertilization, and mild, moderate and severe cardiac developmental abnormalities occurred at 24-96 h, the proportions of which were 21.3% (128/600), 32.8% (197/600) and 18.7% (112/600), respectively. Cardiac defects included ventricular dysplasia, atrial dilation, atrioventricular abnormalities, slow heart rate, arrhythmia, blood reflux, etc. The results of whole embryo in situ hybridization showed abnormal expression of versican gene, a specific molecular marker in atrioventricular region. Morpholine loop oligonucleotide gene repression is a good method to study gene function. Tbx2 gene plays an important role in atrioventricular specific differentiation and atrioventricular duct formation.

Objective to investigate the molecular mechanism of AT deficiency induced by mutation of antithrombin (AT) gene T98I and A404T. Methods AT wild-type and mutant expression plasmids (ATwt, AT T98I, AT A404T) were constructed and transiently transfected into COS-7 cells or CHO cells, and the expression assay, pulse-tracking assay and immunofluorescence staining were performed. The changes of AT mRNA expression in transfected cells were detected by fluorescence real-time PCR (RT-PCR); Results AT T98I was not secreted from the transfected cells but was gradually degraded in the cells, while AT A404T was only partially secreted from the cells and most of it was not secreted and gradually degraded in the cells. RT-PCR showed that compared with wild-type AT mRNA, the mutant AT mRNA did not decrease. Pulse-tracking test showed that the secretion of these two AT mutants was impaired, but did not aggregate in the cells but degraded. Protein degradation inhibition experiment showed that the mutant AT T98I was degraded in the cells by proteosome enzyme pathway. Fluorescence staining of transfected cells showed that the intracellular fluorescence intensity of CHO transfected with AT T98I plasmid was significantly weakened and there was no obvious perinuclear aggregation, while the intracellular fluorescence of CHO transfected with AT A404T plasmid was weakened and dispersed in the cytoplasm and perinuclear aggregation was mildly observed. Conclusion Secretion disorder and intracellular degradation are the molecular pathological mechanisms of AT deficiency caused by mutation of AT genes T98I and A404T.

Objective to investigate the effects of continuous activation of extracellular signal-regulated kinase-mitogen protein kinase signaling pathway (ERK-MAPK) by wild type RAF and MEK on the proliferation and cell cycle-related genes of human colon cancer cells. Methods Human colon cancer cell line SW1116 was cultured, liposome-mediated transfection of RAF and MEK genes and empty plasmid, and the positive clones of G418 were screened. The cell cycle was analyzed by flow cytometry, the cell morphological changes were observed under light microscope, the cell viability was detected by tetramethylazolazole blue (MTT) assay, the cell proliferation was detected by growth curve and soft agar colony formation, and the transcription levels of p21WAF1, p16INK4A and oncogene c-myc were detected by real-time quantitative PCR. Results The cell lines stably expressing RAF or MEK were established. High expression of RAF or MEK significantly reduced the percentage of cells in G0/G1 phase, promoted the cell cycle from G1 to S phase, increased the percentage of cells in S phase of DNA synthesis, increased cell viability and proliferation by 3~4 times, and the cell division and proliferation were vigorous. Conclusion the activation of ERK-MAPK signaling pathway can down-regulate the expression of cell cycle-related genes p21WAF1 and p16INK4A, and up-regulate the expression of c-myc, decrease the G0 phase, accelerate the transformation of G1/S phase, and promote cell proliferation.

A 57-year-old female was admitted to the Second Xiangya Hospital of Central South University on May 11, 2004 due to recurrent subcutaneous hematoma of the limbs for 14 years. The patient developed subcutaneous hematoma of the left lower limb in July 1990 without obvious inducement. The hematoma gradually increased, about the size of a fist, swollen, with obvious local fluctuation, accompanied by pain, and resolved spontaneously after a few days.

A 6-year-old male, Han nationality, whose father is from Jiangsu and whose mother is from Hebei, was born with white skin, white hair with light yellow, white eyebrows and eyelashes, gray iris and photophobia. He came to genetic consultation in October 2005 and asked for albinism classification and diagnosis.

A 67-year-old female was admitted to our hospital on April 7, 2005 due to the discovery of swollen lymph nodes in the neck and axilla for more than 3 months. The examination found that there were lymph nodes in the neck, axilla, groin, mediastinum, hepatic hilum and retroperitoneum, and pleural effusion on both sides. Two lymph node biopsies showed non-Hodgkin's lymphoma (NHL), diffuse large B-cell type, stage IV.

A 30-year-old woman suffered from nasal congestion and headache for half a year, which worsened for more than 1 month. In September 2004, she started to suffer from nasal congestion and pain from the temple to the right side of the tooth, which worsened gradually. In December 2004, she underwent nasal septum correction and double maxillary sinus and ethmoid sinus opening in a local hospital.

Percutaneous coronary intervention (PCI) can be used to treat MB patients successfully [1], but coronary artery rupture after stent implantation is rarely reported.

Nosocomial infection is a common complication in hospitalized patients, which not only consumes medical resources, but also affects the prognosis of patients. The incidence of nosocomial infection in patients undergoing cardiac surgery is over 20% due to the decrease of resistance. With more and more elderly patients undergoing cardiac surgery, the incidence of nosocomial infection after surgery is on the rise.

More and more studies have shown that some rare undifferentiated cell populations play an important role in the formation and growth of tumor cells. Recognition and confirmation of tumor-origin cells and oncogenes in colorectal cancer has become a hot research topic at present.