Volume 87  ·   Issue 15  ·  2007

Clinical data The patient was a 38-year-old male who went to the emergency department on October 12, 2003 due to paroxysmal epigastric pain for 1 d. He had no nausea, vomiting, chest tightness, shortness of breath and sweating. Routine cardiopulmonary examination showed no abnormalities, right epigastric tenderness +. Abdominal B-ultrasound showed intrahepatic and common bile duct stones. After intramuscular injection of 100 mg of brucinazine hydrochloride and 10 mg of anisodamine, the abdominal pain was relieved. After 10 minutes, he suddenly lost consciousness and sudden respiratory and heart arrest, and was sent to the emergency room.

Objective to summarize the clinicopathological and immunohistochemical characteristics of pulmonary blastoma. Methods the clinicopathological and immunohistochemical characteristics of 4 cases of pulmonary blastoma in our hospital from 1993 to 2004 were retrospectively analyzed. The clinicopathological and immunohistochemical characteristics of 4 cases of pulmonary blastoma were confirmed after surgery. Results 4 cases of pulmonary blastoma treated by surgery were treated for 3~5 cycles of chemotherapy, 1 case underwent radiotherapy, and survived for 5~32 months after surgery. 1 case died of multiple metastases 5 months after surgery, and the longest follow-up was 32 months, and the other 2 cases survived without tumor. All 4 cases in this group were epithelial pulmonary blastoma. Under light microscope, the epithelium showed obvious atypia, and the nuclear division was common, arranged in dense glandular tubular shape, and the mulberry-like structure composed of squamous epithelioid cell mass was observed. Immunohistochemical results showed that CK and TTF-1 were positive, vimentin, EMA, S-100 protein were negative, and Cg-A had scattered positive cells. Conclusion the preoperative diagnosis of pulmonary blastoma is difficult, and it is necessary to be clear after surgery. The histology of epithelial pulmonary blastoma should be compared with that of common adenoid Mulberry-like structures and immunohistochemical staining expressing neuroendocrine markers were useful for identification.

Objective to investigate the correlation between single nucleotide polymorphism (SNP) of tumor necrosis factor-α (TNF-α) gene and the occurrence and development of gastric adenocarcinoma and gastric adenocarcinoma infected by Helicobacter pylori (Hp). Methods the gene microarray technology was used to detect the polymorphism of TNF-α-238G/A and-308G/A in 130 patients with gastric adenocarcinoma and 142 healthy controls. The concentration of Hp-IgG/IgM/IgA antibody in serum was also determined by enzyme-linked immunosorbent assay (ELISA). Results the positive rate of TNF-α genotype and A allele frequency were significantly higher in gastric adenocarcinoma group than in the control group (P<0.01, P<0.01), and significantly higher in Hp-positive gastric adenocarcinoma group than in Hp-negative gastric adenocarcinoma group (P<0.05, P<0.01). There was no correlation between SNP at other sites of TNF-α and gastric adenocarcinoma group or Hp-positive gastric adenocarcinoma group.

Objective to investigate the expression of CD +4CD +25 regulatory T cells in peripheral blood and labial gland tissues of patients with Sjogren's syndrome (SS) Methods the expression of CD +4CD +25 regulatory T cells in peripheral blood and labial gland tissues of 57 patients with SS and 46 healthy controls was detected by flow cytometry. CD4, CD25, CD68 and CD8 were stained by immunohistochemistry. Results the median levels of CD +4 and CD +25 regulatory T cells were 6.9% (2.84%-13.50%) in SS group and 5.77%-15.30% in control group, P<0.001. The levels of CD +4 and CD25 HIGHT cells were 0.001%-1.83% in SS group and 0.13%-2.45% in control group, P<0.001. Immunohistochemistry staining of labial gland showed that CD +4 T cells accounted for the majority of infiltrated lymphocytes in SS group, and there was no expression of CD25 in both groups. Conclusion the lack of CD +4 and CD +25 regulatory T cells in SS patients' labial gland and the decrease of CD4+ CD25+ regulatory T cells in peripheral blood suggest that regulatory T cells play an important role in the pathogenesis of SS.

Objective to investigate the correlation between the changes of cerebral oxygen saturation and the occurrence of brain complications in patients undergoing aortic aneurysm surgery, and to evaluate the effect of two brain protection methods.Methods Among 30 patients undergoing aortic aneurysm surgery, there were 24 cases of aortic dissection Stanford A, 4 cases of Stanford B, 1 case of ascending aorta and aortic arch aneurysm, 1 case of pseudo-thoracoabdominal aortic aneurysm, and 22 cases of descending aortic arch replacement after deep hypothermic circulatory arrest (DHCA) combined with selective antegrade cerebral perfusion (ASCP) (ASCP group); Eight patients underwent descending thoracic aortic replacement with DHCA alone (DHCA group). Near infrared spectroscopy (NIRS) was used to monitor the continuous cerebral oxygen saturation (TOI) during operation. Results 8 patients had brain complications. The TOI in the complication group and the non-complication group decreased from 77% ± 6% to 52% ± 7%, and the TOI in the ASCP group decreased from 75% ± 6% to 71% ± 7%. There was a significant difference in the degree of TOI decrease between the two groups (P<0.05). Conclusion There was no significant correlation between the mild TOI decrease and the occurrence of brain complications. Compared with DHCA alone, DHCA combined with ASCP has better brain protection effect.

Objective to compare the effects of intraoperative epidural anesthesia combined with general anesthesia, endotracheal intubation or laryngeal mask, total intravenous anesthesia or inhalation anesthesia combined with target-controlled infusion of remifentanil on intraoperative stress response.Methods Sixty patients aged 18-65 years from the Department of Surgery of Peking University First Hospital were selected. Patients who underwent elective gastrointestinal, gallbladder and kidney surgery were randomly divided into 15 patients in the epidural combined general anesthesia tracheal intubation group (EG group), laryngeal mask group (EGL group), remifentanil combined with propofol total intravenous anesthesia group (RP group) and remifentanil combined with inhalation anesthesia group (RI group). Blood pressure, electrocardiogram and pulse oxygen saturation were continuously monitored during operation; End-expiratory partial pressure of carbon dioxide; Plasma epinephrine and norepinephrine, angiotensin Ⅰ and angiotensin Ⅱ, glucagon and blood glucose were measured before, after induction, after incision and after surgery. Results Blood pressure and heart rate in RP group were lower than those in EG group and EGL group at the time of induction, and higher than those in EGL group and RP group at the time of tracheal intubation (P<0.05). The heart rate change was the smallest in RP group at the time of surgical incision, and the heart rate was the fastest in EGL group at the time of extubation. Epinephrine and norepinephrine in each group decreased slightly at the time of induction and intubation, but increased at the end of surgery. Norepinephrine in RP group increased slightly at the time of induction and intubation, and the difference was statistically significant (P<0.05). Glucagon decreased slightly at the time of induction and intubation, and decreased to the lowest after surgery, while glucagon decreased significantly in RP group at the time of surgery. Blood glucose decreased slightly at the time of induction and intubation, and blood glucose increased significantly in all four groups at the time of surgery. Glucagon and blood glucose in EG group and EGL group were significantly higher than those in RP group (P<0.05). Conclusion Different anesthesia methods and However, neither of them could completely block the ascending conduction of nociceptive stimuli, and the effects of stress response on hemodynamic changes and plasma hormone levels were not completely parallel.

Objective to evaluate the efficacy and safety of Sildenafil in the treatment of pulmonary arterial hypertension. Methods randomized controlled trial (RCT) studies with pulmonary arterial hypertension (PAH) and placebo were searched in the databases PubMed (January 1968 to May 2006), Embase (1980 to 2006) and Chinese Journal Network (January 1994 to May 2006), and the clinical efficacy and safety of Sildenafil were meta-analyzed using RevMan4.2.8 software. Results A total of 10 articles were searched, and the efficacy and safety of 4 RCT studies were evaluated. 328 patients with PAH were enrolled. The quality of the included studies was evaluated according to randomized method, assigned concealment and blinded method. Results One study was grade A, and the rest were grade B. Compared with the placebo group, patients in the Sildenafil treatment group: (1) 6 min walking distance (2) The average increase of exercise time was 221.13 s (95% CI: 146.13-296.14, P<0.01); (3) Pulmonary systolic blood pressure decreased by 11.51 mm Hg (95% CI, 1.41-21.60, P =0.03); (4) The clinical deterioration rate improved significantly, and the combined ratio (OR) was 0.36 (95% CI: 0.16-0.78, P =0.01); (5) There was no statistically significant difference in the incidence of headache and hypotension compared with the placebo group; (6) The application of sildenafil has no obvious effect on the change of libido of patients. Conclusion Sildenafil is safe in short term, and can improve exercise endurance, increase exercise time, reduce pulmonary artery pressure and relieve clinical deterioration of patients with pulmonary arterial hypertension.

Objective to evaluate the efficacy and safety of Yunnan Baiyao Capsule in reducing bleeding during transurethral resection of the prostate (TURP). Methods A multicenter, randomized, double-blind, placebo-controlled clinical study was conducted. Patients who met the inclusion criteria were randomized to receive Yunnan Baiyao Capsule 500 mg or placebo 4 times a day for 3 days. The total amount of intraoperative hemorrhage, hemorrhage index (hemorrhage per unit of resection weight) and hemorrhage intensity (hemorrhage per unit of operation time) were compared between the two groups, and the safety was evaluated. Results Yunnan Baiyao before TURP operation in patients with prostatic hyperplasia could reduce the total amount of intraoperative hemorrhage, hemorrhage index and hemorrhage intensity, among which the total amount of hemorrhage was (147±144) ml and (182±157) ml in the experimental group and the control group, respectively (P<0.05). When the weight of resection gland was ≥20g, the preoperative application of Yunnan Baiyao could significantly reduce the hemorrhage index, hemorrhage intensity and total amount of hemorrhage (P<0.05). The total amount of hemorrhage was (146±116) ml and (220±207) ml in the experimental group and the control group, respectively (2.4±1.8) ml/min and (3.6±3.7) ml/min (P<0.01), and the hemorrhage index was (4.7±4.6) ml/g and (7.1±8.3) ml/g (P<0.05).

Objective to investigate the safety and effectiveness of preoperative precise nerve localization discoscopy (MED) using imaging methods. Methods 87 cases of lumbar disc herniation treated with MED method were retrospectively analyzed. Among them, 54 males and 33 females, 85 cases underwent CTM examination, 11 cases underwent CTD examination, and 2 cases underwent radiculography and closure. The curative effect was observed from the aspects of JOA score, Odom's standard, NAPS, postoperative movement and self-care time, size of surgical incision, operation time and bleeding volume, etc. Results JOA score was (18.2 ± 3.3) before operation, (23.8 ± 4.6) after follow-up, and the improvement rate of JOA was (58.7 ± 4.2) %. According to Odom's standard, 59 cases were excellent, 26 cases were good, 3 cases were acceptable, and 1 case was poor. The excellent and good rate was 95.5%. The NAPS score of low back pain was (1.8 ± 0.4) before operation, and the follow-up score was (1.7 ± 0.3), P =0.607. The postoperative movement time was (2.38 ± 0.21) d, the time of self-care was (12.1 ± 2.2) d, the size of surgical incision was (1.86 ± 0.04) cm, and the operation time was (72.2 ± 12.2) d Conclusion It is a recommended method to accurately locate the responsibility gap and nerve root by using angiography before MED operation, which can significantly reduce the risk of nerve injury during operation, shorten the operation time, reduce the intraoperative bleeding, improve the postoperative curative effect, and make the advantages of microscopic surgery play into full play.

Objective to investigate the changes of chromosomes in chemoresistant ovarian cancer tissues, and to find or locate the genes closely related to chemoresistance of ovarian cancer, so as to further study the mechanism of its drug resistance.Methods Comparative genomic hybridization technique was used to analyze the genomic imbalance, i.e. DNA loss or amplification, in the chemoresistant group (6 serous ovarian carcinoma, 3 mucinous ovarian carcinoma, 2 endometrioid ovarian carcinoma and 1 clear cell carcinoma, 12 cases) and the chemosensitive group (5 serous ovarian carcinoma, 3 mucinous ovarian carcinoma, 2 endometrioid ovarian carcinoma and 2 clear cell carcinoma, 12 cases). Results The most common sites with increased chromosomal DNA copy number in chemoresistant tissues were 3q,8q,20q,11q,17q,2p,1q; The common DNA copy number deletion sites were 9p,5q,10q,3p.The increase of 17q was 66.7% in the drug resistant group and 16.7% in the sensitive group; The increase of 1q was 66.7% in the drug resistant group and 16.7% in the sensitive group; The loss of 3p was 50.0% in the drug-resistant group and 8.3% in the sensitive group, and it was more obvious in the tissues of chemoresistant patients. Conclusion The most obvious changes of chromosome genome in the tissues of drug-resistant ovarian cancer were the increase of 17q, 1q and the loss of 3p. These sites may have oncogenes and tumor suppressor genes closely related to chemoresistance of ovarian cancer.

Objective to investigate the changes of cell apoptosis and expression of caspase-12 in rats with progressive spinal cord compression injury and their relationship.Methods 120 healthy adult Wistar rats were randomly selected and divided into two groups: 60 rats in the operation group and 10 rats in the control group at each time point, according to the self-designed method as spinal cord compression model; The apoptosis and expression of caspase-12 after spinal cord compression were observed at 1, 3, 7, 14, 21 and 28 days after surgery. Results Apoptosis occurred in nerve cells in each compression group, and the incidence of apoptosis was 12.5%±2.3%, 13.0%±3.6%, 17.2%±4.3%, 29.4%±4.4%, 36.1%±6.5% and 2.3%±7.9% at 1, 3, 7, 14, 21 and 28 days, respectively, with the increase of caspase-12 expression, and the difference between the groups was statistically significant at 14, 21 and 28 days (all P<0.05).

Objective to detect the expression of hexokinase-Ⅱ gene (HK-Ⅱ) in human colon cancer cells, and to investigate the therapeutic effect and mechanism of inhibiting HK-Ⅱ on colon carcinoma. Methods the expression of HK-Ⅱ gene in four human colon cancer cells was detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot. Under the induction of HK-Ⅱ inhibitor (3-BrPA), the proliferation and chemosensitivity of colon cancer cells were observed by MTT assay. Apoptotic DNA fragments were analyzed by agarose gel electrophoresis; Determination of caspase-3 Activity by Substrate Colorimetry; The mitochondrial membrane potential was detected by flow cytometry and UV spectrophotometer, respectively ( △ Results HK-Ⅱ gene was obviously expressed in four kinds of human colon cancer cells. Inhibition of HK-Ⅱ (3-BrPA) could significantly control the proliferation and induce apoptosis of colon cancer cells. After 48 h with 300 μ mol/L 3-BrPA stimulated LOVO, HCT-116, HT-29 and SW480 cells, the cell proliferation inhibition rates were 83.7%±2.0%, 83.4%±4.1%, 89.7%±3.7% and 80.6%±0.9%, respectively. The proliferation inhibition rate of low-dose L-OHP (0.5, 1.0 μ g/ml) increased from 19.2%±6.1% and 32.2%±2.2% to 48.4%±3.2% and 60.5%±4.6% respectively (P<0.01). The activity of caspase-3 in LOVO cells induced by 50, 100, 150 μ mol/L 3-BrPA for 24 h was 1.13±0.11, 1.60±0.20 and 3.03±0.11 respectively (P =0.000). After 20 min of mitochondria induced by 3-BrPA, the degree of PTP opening in LOVO cells was 40.0%±3.5%, while that in the control group (CaCl2) was 37.4%±2.3%, the difference was not statistically significant (P =0.348). After 1, 3, 5 h stimulated by 100 μ mol/L 3-BrPA, △ The decrease rate of ψ m was 12.7%, 15.4% and 26.8%, respectively. Conclusion HK-Ⅱ gene is expected to be an effective therapeutic target for colon cancer.

Objective to investigate the preparation method of CEA-targeted chimeric anchored T cells, and to detect their activation function and induce the killing activity of CEA-positive gastric cancer cells. Methods Peripheral blood mononuclear cells (PBMC) were isolated, and then CD8+ T cells were isolated by immunomagnetic beads. The expression of CD69 was detected by flow cytometry to detect the activation function of chimeric anchored T cells; Chimeric anchored T cells were co-cultured with gastric cancer cells HGC-27 and SGC-7901, and the expression of annexin V in the latter was detected, and the apoptotic effects of chimeric anchored T cells on gastric cancer cells were analyzed. Results After the prepared chimeric anchored T cells were cultured for 12 h and 24 h, the expression rates of activation signal CD69 were 40.5%±3.4% and 48.3%±2.8%, respectively, which proved that chimeric anchored T cells had activation function. The apoptotic rates of HGC-27 and SGC-7901 cells co-cultured with chimeric anchored T cells were 47.8%±4.2% and 18.7%±2.8%, respectively, with statistical significance (P<0.05). Conclusion CEA-targeted chimeric anchored T cells can specifically recognize CEA-positive gastric cancer cells and promote the apoptosis of the latter, which will provide a promising way for the clinical diagnosis and treatment of gastric cancer.

Objective to observe the effect of 6-hydroxydopamine (6-OHDA) on the phosphorylation of STAT1 and STAT3 in SH-SY5Y cells, and to investigate the role of STAT in the neurotoxicity mechanism of 6-OHDA. Methods SH-SY5Y cells were treated with different concentrations of 6-OHDA to prepare cell injury models. The cell survival rate was detected by 3H-labeled thymine (3H-TdR) incorporation assay and thiazole blue (MTT) assay. The changes of STAT1 and STAT3 phosphorylation levels were detected by Western blot. Results 6-OHDA decreased the survival rate and STAT3 phosphorylation level of SH-SY5Y cells in a concentration-and time-dependent manner, but had no effect on STAT1 phosphorylation level. The cell survival rate of 50-400 μ mol/L 6-OHDA treated for 24 hours decreased to 8.1%-81.9% of that of the control group. The phosphorylation level of STAT3 decreased significantly by 100 μ mol/L 6-OHDA treated for 0.5-48 hours, and the relative density of bands was 0.747 ± 0.011-0.238 ± 0.007.50-200 μ mol/L

Methods Fifty male Sprague-Dawley rats were divided into 5 groups: A, B, C, D and E. After the sciatic nerve was severed in groups A, B and C, the proximal end of the rats was kept intact and the distal sciatic nerve was sleeved with a chitin cannula with a gap of 2 mm in group A. The common peroneal nerve bundle in the sciatic nerve was ligated and severed at 5 mm proximal end and the tibial nerve bundle was sleeved with the distal sciatic nerve in group B. The tibial nerve bundle in the sciatic nerve was ligated and severed at 5 mm proximal end and the common peroneal nerve bundle was sleeved with the distal sciatic nerve in group C. The tibial nerve was cut 5 mm distal to the bifurcation in D and E groups; In group D, 2/3 of the proximal fibers were ligated and severed, and the remaining nerve fibers were connected with the distal tibial nerve by chitin cannula. In group E, all the proximal fibers were connected with the distal tibial nerve by chitin cannula. After 1, 2, 4 and 12 weeks, the samples were collected for histological and electrophysiological studies respectively. Results Statistical analysis was performed by SPSS software. Results After 12 weeks, electrophysiological examination showed that the area under the maximum amplitude induced by each group was smaller in groups B and C than in group A (both P<0.05), and in group D was smaller than in group E (P<0.05). The sensory nerve conduction velocity was similar between groups A and B and C, and between groups D and E. The number of myelinated nerve fibers stained with osmic acid was larger at the distal end than the proximal end in each group: the distal end increased by 34.4% in group A, 39.6% in group B, 80.4% in group C, 101.1% in group D and 48.9% in group E (P<0.05). Conclusion After peripheral nerve bridging, the number of nerve fibers in the distal end was significantly larger than that in the proximal end, and there was amplification of the number of nerve fibers; The amplification effect of homologous nerve bridging is greater than that of non-homologous nerve. Clinically, it is possible to repair distal thick nerve with thinner nerve.

A 52-year-old male was admitted to the hospital on November 8, 2004 due to "intermittent hemoptysis for more than 1 year, aggravated for 1 week, and slurred speech for 5 days". The patient had cough and sputum with hemoptysis after catching cold since July 2003, which was fresh sputum, about 100 ml/d. The local hospital diagnosed "bronchiectasis". After 15 days of treatment, the symptoms improved and he was discharged from the hospital.

Systemic autoimmune diseases, usually called connective tissue diseases, are mostly chronic, recurrent and progressively aggravated, and the etiology is unknown. It is generally believed that genetic and environmental factors cause immune disorders of the body, and the production of multiple autoantibodies in the body is one of the main pathogenesis mechanisms.

All along, the treatment of acute asthma attacks can be roughly summarized as sufficient arterial oxygen saturation by oxygen supply, repeated use of short-acting inhaled bronchodilators to relieve airflow obstruction, and early use of systemic corticosteroids to prevent future recurrence.

A 71-year-old male was admitted to the hospital on April 24, 2006, mainly because of "chest pain during activity for more than 1 year, aggravated for 1 month". He had a history of hypertension for more than 2 years, and arterial stenosis of both lower limbs and occlusion of left anterior tibial artery for 1 year were found. Electrocardiogram: sinus rhythm, no obvious ST-T changes were found. Echocardiogram (April 27, 2006): left ventricular end-diastolic diameter 46 mm, left ventricular end-systolic diameter 27 mm, ventricular septal thickness 10.6 mm, motion amplitude 8 mm, ejection fraction 65%.

The child, a 12-year-old male, was admitted to hospital for 3 months due to progressive dizziness. The child began to feel dizziness 3 months ago, which gradually worsened. There were no symptoms such as convulsions, vomiting, fever and diplopia. There was no history of familial genetic diseases. Physical examination: intelligence was the same as the child of the same age, consciousness was clear, both pupils were 0.25 cm, equal size, light reflex was sensitive, the optic papilla was not edema, red macules distributed along the bridge of the nose on the face and a 5 cm ×4 cm sebaceous cyst in the occipital region, negative meningeal irritation sign, and the muscle strength and muscle tone of the limbs were normal.

The patient, male, 8 months old, was gradually found to be larger than that of the same age after birth and had poor response. CT examination was performed in the local hospital, and intracranial space-occupying lesions with hydrocephalus were diagnosed (Figure 1). He was transferred to Tianjin Children's Hospital and admitted to the hospital for physical examination: he was clear, his response was slightly poor, the anterior fontanel was patent, the tension was slightly higher, and no obvious neurological dysfunction was found. No abnormalities were found on chest X-ray and echocardiography before operation.

A 27-year-old male patient had a chest CT examination of "right spontaneous pneumothorax" 4 years ago, which showed several cystic-like low-density areas in both lungs. Two years ago, it was found that the cystic-like lesions were increased and larger than before, and the bronchial vascular bundle was thickened in the left lower lung. One year ago, the cystic-like lesions were significantly increased, with small nodules scattered in both lungs and honeycomb changes in the right middle lobe. Six months ago, CT scan showed that both lungs were covered with cystic-like lesions with a diameter of 1.0~3.5 cm and nodular lesions scattered in 0.5~1.5 cm, especially in the lower lungs (Figure 1,2). The patient had a history of dry mouth, several keratitis attacks and purpura in both lower limbs.