Volume 87  ·   Issue 27  ·  2007

Looking at the development of life science in the 20th century, the exploration from macroscopic to microscopic, from phenotype to mechanism is its important characteristic. The research of classical structural biology, molecular biology and cell biology based on reductionism has greatly improved people's understanding of the nature of life. After the completion of the Human Genome Project (HGP), life science research has entered the era of "functional genomics" research, and transcriptomics, proteomics and metabolomics have begun to develop rapidly. The research methods of life science are no longer limited to the microscopic split guided by reductionism, but have begun to pay attention to the macroscopic integration research methods. Life science has also sublimated to a higher level where the induction of qualitative phenomena and the exploration of quantitative laws are combined and developed together.

Objective to investigate the causes of lung (lobe) torsion after thoracic surgery. Methods Eight cases of lung (lobe) torsion after thoracic surgery were retrospectively analyzed, including 5 males and 3 females, with an average age of (55 ± 8) years, 4 cases underwent lobectomy (2 cases of left upper lobe and 2 cases of right upper lobe), 2 cases underwent esophageal cancer resection, 1 case of right superior mediastinal giant schwannoma resection and 1 case of descending aorta replacement. Results Among the postoperative torsion of lung lobes, 2 cases were right middle lobe, 1 case of right upper lobe, 3 cases of left upper lobe, 1 case of left lower lobe and 1 case of left whole lung. Two patients underwent pulmonary reduction, and all died. After reoperation, 2 patients were complicated with respiratory failure and 2 patients with atrial fibrillation. The average hospital stay was 24 days (10-56 days). Conclusion The main causes of pulmonary torsion were hilar dissociation and atelectasis after thoracic surgery. It is advisable to take diseased lung resection.

Objective to investigate the clinical effect of repairing soft tissue defects of forearm stump by cutting free skin flap from traumatic severed limbs. Methods This technique was applied to repair the soft tissue defects of forearm stump in 5 cases (4 males and 1 female), aged 22-43 years, with an average of 32 years, 3 cases on the right side and 2 cases on the left side.The area of the flap was 8 cm ×9 cm ~9 cm ×12 cm.Results 1 case developed superficial infection after operation, which gradually healed after changing dressings, and all the flaps survived. All patients were followed up for 1.5-3.5 years, with an average of 2.6 years.The shape of the recipient area and the function of the elbow joint recovered well, and the therapeutic effect was satisfactory.Conclusion Discarded limb skin flap has the advantages of constant vascular anatomy, long vascular pedicle and easy cutting, and this operation can preserve the functional length of the traumatic amputated stump or the function of the elbow joint.

Objective to observe the effects of prefilled 6% hydroxyethyl starch (Wanwen, (R) HES130/0.4) on serum S100B protein level and cerebral oxygen metabolism in open heart patients undergoing cardiopulmonary bypass (CPB), and to investigate whether it has brain protective effect and its possible mechanism.Methods Forty patients who intended to undergo atrial septal defect or ventricular septal defect repair under mild hypothermia and non-stop CPB were randomly divided into Wanwen (HES130/0.4) group and gelatin (succinyl gelatin) group, 20 cases in each group. The prefilled colloid was: Wanwen group, 6% HES130/0.4 20~25 ml/kg; Gelatin group, succinyl gelatin 20~25 ml/kg. The two groups were treated with uniform preoperative medication, anesthesia regimen and cardiopulmonary bypass methods, and 2 ml of central venous blood were collected and centrifuged before (T0), 20 min (T1), immediately after (T2), 60 min (T3) and 24 h (T4), respectively. The serum S100B protein was determined by ELISA, and the blood gas analysis and blood glucose measurement of internal jugular vein and radial artery were taken at the same time at the above time points, and the ratio of cerebral oxygen consumption and cerebral glucose consumption (CMRO2/CMRGLu) was calculated. Results S100B protein in Wanwen group and gelatin group increased at T1, reached peak at T2, and decreased after shutdown. However, S100B protein in Wanwen group was significantly lower than that in gelatin group at T1, T2, and T3 (P<0.01). SjvO2 and CMRO2/CMRGLU increased at T1, decreased at T2, and gradually increased after shutdown (T3, T4). Conclusion S100B protein level in Wanwen group was significantly higher than that in gelatin group at T1, T2, and T3 (P<0.05).

Objective to observe the expression of heme oxygenase-1 (HO-1) and apoptosis regulatory protein Bcl-2 in the perihemorrhagic cortex neurons after cerebral hemorrhage. Methods the brain tissues of 39 patients who died at different times after cerebral hemorrhage were dissected, and the cerebral cortex tissues from the edge of hemorrhagic foci 1~3 cm outward and the corresponding parts on the opposite side of hemorrhagic foci were collected. The opposite side of hemorrhagic foci was set as the control group. The expression and change of HO-1 and Bcl-2 around hemorrhagic foci at different time points were observed by immunohistochemical technique. The results were statistically analyzed by SPSS 11.5 software. Results (1) The expression of HO-1 in human cerebral hemorrhage was observed 2 hours after the hemorrhage. The number of HO-1 positive cells in perihemorrhagic neurons increased 2~10 hours, reached the peak 17~30 hours, and gradually decreased 120~216 hours after the hemorrhage. The number of HO-1 positive cells in perihemorrhagic neurons increased 240~408 hours after the hemorrhage. The number of Bcl-2 positive cells in peripheral neurons increased at 17~30 h [(6.6±0.5) /high-power field], reached a peak at 36~96 h [(8.9±1.1) /high-power field], and gradually decreased at 240~408 h [(4.7±0.6) /high-power field] (F =29.59, P<0.001). There was no expression of Bcl-2 positive neurons in the control group. (3) There was a certain correlation between HO-1 and Bcl-2 (r =0.66, P<0.001). Conclusion The expression of HO-1 and Bcl-2 in peripheral cortical neurons after cerebral hemorrhage increased, which was involved in the mechanism of brain protection and brain injury after cerebral hemorrhage.

Objective to investigate the expression and correlation of RCAS1 and estrogen receptor subtypes in normal endometrium, hyperplastic endometrium and endometrial carcinoma tissues, and to analyze their role in the development of endometrial carcinoma. Methods Immunohistochemistry and RT-PCR were used to detect the expression of RCAS1 and estrogen receptor α (ER α) and estrogen receptor β (ER β) in 20 normal endometrium tissues, 42 endometrial hyperplasia tissues and 50 endometrial carcinoma tissues. Immunohistochemistry showed that the expression of RCAS1 protein in endometrium of each group was P pattern in normal, simple and complex endometrium, D pattern in 30% (6/20) of dysplastic endometrium and D pattern in endometrial carcinoma. The high expression rates of RCAS1 protein in normal endometrium, simple and complex hyperplasia, dysplastic and endometrial carcinoma were 0% (0/20), 9.1% (2/22), 45.0% (9/20), 68.0% (34/50), respectively. There was significant difference between the groups (P<0.05). The high expression of RCAS1 protein was correlated with the depth of myometrial invasion, vascular invasion and ER α positivity (P<0.05). The results of immunoblotting and RT-PCR were consistent with those of immunohistochemistry. The expression level of RCAS1 mRNA was positively correlated with ER α mRNA, but there was no correlation with ER β mRNA expression. Conclusion The high expression of RCAS1 and the change of expression pattern may be involved in the process of endometrial transformation from benign to malignant, and RCAS1 and ER α expression are related to the development, invasion and metastasis of endometrial cancer.

Objective to investigate whether patients with micro-consciousness preserve a large range of visual neural networks and whether there is visual consciousness, so as to study the possibility of passive stimulation of visual pictures to promote brain function rehabilitation.Methods 10 healthy adult males in the normal control group and 9 patients with micro-consciousness who recovered from severe craniocerebral injury and cerebral hemorrhage in the experimental group; Standardized International Emotional Picture System (IAPS) images were selected from the two groups, and the image data were processed with AFNI software. Results All 10 normal control volunteers were activated with complete visual neural networks such as occipital lobe of primary visual cortex and temporal lobe, spindle gyrus, parietal lobe, orbital gyrus and prefrontal lobe of secondary visual cortex. Two patients in the micro-conscious group activated the visual neural network completely similar to the control group, 3 patients activated the relevant regions of visual neural network partially, and 4 patients did not activate the brain regions completely. Conclusion The visual neural network was feasible, reliable and repeatable by using passive visual stimulation functional magnetic resonance scan of IAPS pictures.

Objective to analyze the changes of external rotation stability of knee joint after rupture and reconstruction of posterolateral structure (PLS). Methods Sixteen intact and fresh lower limb specimens were obtained. The knee joint was maintained at 0 °, 30 °, 60 ° and 90 °, and the external rotation torque of 5 kg·m·s-2 was applied to the distal end of tibia, and the external rotation angle of tibia was measured. The posterior cruciate ligament, popliteofibular ligament (PFL) and popliteal tendon (PT) were severed sequentially, and the external rotation angle of tibia was measured after each ligament or tendon was severed; The posterior cruciate ligament was reconstructed with autologous semitendinosus and gracilis muscle arthroscopy, and the popliteal tendon and popliteofibular ligament were reconstructed with autologous Achilles tendon. The external rotation angle of tibia was measured after each reconstruction. Results the external rotation angle of tibia did not increase after the posterior cruciate ligament was severed alone (flexion 60°: external rotation 14.1° in normal group and 14.57° in PCL severed group; q =0.47; P>0.05); The external rotation angle of the tibia was greater than that of the normal knee joint at 60° and 90° of flexion (60° of flexion: 16.94° of external rotation in PFL section group; q value 2.84, P<0.05); After popliteal tendon resection, the external rotation angle of tibia increased to the maximum in the range of 0° ~90° (flexion 60°: external rotation 28.1°; q =14.01,P<0.05). After posterior cruciate ligament reconstruction alone, the external rotation angle of tibia was still larger than that of normal knee joint (flexion 60°: external rotation 27.67°; q value 0.425,P<0.05); The external rotation angle of tibia after combined reconstruction of posterior cruciate ligament and posterolateral structure is different from that of normal knee joint (flexion 60°: external rotation 14.51°; q =0.412, P<0.05), but the change amplitude does not exceed 1°. Conclusion the injury of posterior cruciate ligament alone has no effect on the external rotation stability of knee joint, but the injury of combined posterolateral structure causes the external rotation instability of knee joint; After popliteal tendon rupture, the knee joint produced excessive external rotation at the maximum angle; The reconstruction of posterior cruciate ligament alone partially restored the excessive external rotation of knee joint after combined injury; Stabilization of external rotation of the knee after combined reconstruction of the posterolateral structure and posterior cruciate ligament.

Objective to explore the technique of total knee arthroplasty for knee valgus by lateral approach.Methods Knee arthroplasty was performed in patients with moderate to severe fixed knee valgus by lateral approach.Intraoperative cutaneous incision of median-lateral knee joint,apple pie-like extension of iliotibial fasciculum,and "Z"-shaped incision of the articular capsule from the lateral patella.Soft tissue balancing was performed by releasing the insertion point of iliotibial fasciculum,lateral collateral ligament of femur and tibia and posterolateral articular capsule. The distal femoral valgus osteotomy was defined as 5° valgus, and the distal femoral rotation angle osteotomy was performed by Whiteside line combined with medial and lateral epicondylar axis positioning.All cases underwent patellar replacement. The articular capsule was sutured at flexion position, and the lateral cuff structure (deep layer) of the articular capsule was sutured with the edge of the medial retinacle (superficial layer). Results 8 cases of 10 patients with knee valgus osteoarthritis underwent total knee arthroplasty by lateral approach.Among them, 1 male with 1 knee and 7 females with 9 knees.The average age was 68.2 years (58~79 years). 7 cases of Krackow type Ⅰ valgus with 9 knees and 1 case of type Ⅱ with 1 knee Two cases of 4 knees were replaced simultaneously with two knee joints, six cases of 6 knees were replaced with one knee joint, 7 cases of 9 knees were treated with domestic posterior stabilization cemented prosthesis (TC-Dynamic, PLUS), and 1 case of 1 knee was treated with imported rotary hinge prosthesis (RT-PLUSTM Solution, PLUS). All patients were completely corrected for valgus deformity after operation, and the average distance of walking independently or assisted by walking frame exceeded 100m at the time of discharge. The range of joint mobility increased from 95.6° (85° ~110°) before operation to 117.1° (100° ~125°) after operation. The range of passive valgus mobility increased from 12.6° (9° ~15°) before operation to 0° after operation. The average FTA angle increased from 27.6° (20° ~40°) before operation to 6.8° (5° ~9°) after operation. The KSS score and functional score increased from 22.7 (9~48) and 26.5 (12~55) before operation to 86.4 (85~95) and 89.1 (80~95) after operation, respectively. The average postoperative follow-up time was 19.6 months (1 month ~51 months). During the follow-up period, the femorotibial angle did not change obviously, and the joint stability was good. Conclusion The lateral approach and "Z" shaped incision of joint capsule can directly release the lateral ligament and soft tissue structure, and effectively relieve the pressure of common peroneal nerve, and solve the problem

Objective to evaluate the short-term and medium-term results of total arterialized coronary artery bypass grafting using radial artery and internal mammary artery as the only bridges. Methods From January 1999 to January 2005, a total of 123 patients (114 males and 9 females, mean age (51.9 ± 9.4) years) underwent total arterialized coronary artery bypass grafting, with more than two target vessels bridged. The preoperative left ventricular EF value was 30% ~78%, 24 patients (21.1%) had poor ventricular systolic function (EF<50%), 64 patients had a history of old myocardial infarction, 4 patients underwent emergency surgery due to unstable angina pectoris, 36 patients with left main lesion. 74% of patients underwent anastomosis using non-extracorporeal technique, and the average number of anastomoses per patient was 2.6 ± 0.4. Results The early mortality rate was 0.8%. Postoperative complications included transient atrial fibrillation in 7 patients (5.7%), aortic balloon counterpulsation (IABP) in 1 patient due to low cardiac output, Three patients were readmitted within 1 month after operation due to heart failure, recurrent angina pectoris and arrhythmia. Twenty patients (1999-2001) were followed up for 5 years [mean follow-up (62±13) months]. Three patients died during follow-up, all of which were of cardiac causes. One patient underwent secondary coronary artery bypass grafting due to repeated myocardial infarction, and another patient underwent percutaneous intracoronary balloon dilatation (PCI) due to stenosis of the original arterial bridge. Conclusion Total arterialized coronary artery bypass grafting using radial artery and internal mammary artery as bridge material has good short-term effect and low intermediate complications.

Objective to investigate the temporal trend of lung cancer incidence and prognostic factors affecting survival in Shanghai.Methods The death data of malignant tumor patients from 2002 to 2004 obtained from the Shanghai Complete Cause of Death Registry and Reporting System were calculated according to the calculation guidelines of tumor registry of the International Association of Cancer Registry (IACR). The annual percentage of change (APC) from 1972 to 2004 was calculated according to crude rate and standard rate respectively.The multiple factors affecting survival were analyzed by Cox proportional hazard model. The parameters included gender, age, residential area, pathological type, clinical stage and first hospital grade. Results In the 32 years since 1972, the crude incidence rate of lung cancer in the central area of Shanghai increased by 1.723% in men and 2.036% in women, all showing a gradual increasing trend (P<0.01); However, the standardized incidence rate of lung cancer (APC) in men was-0.605%, showing a decreasing trend (P<0.01), while that in women was-0.136%, showing a stable trend (P>0.05). Stage III and IV accounted for the majority of lung cancer patients in Shanghai, accounting for 35.6% and 42.2%, respectively. The 3-year survival rate and median survival time (MST) of female lung cancer in Shanghai were 17.05% and 0.83 years, both of which were higher than those of male (14.01% and 0.77 years) (P<0.01). The survival time analysis of different gender subgroups of lung cancer in each stage showed that the survival time of female was higher than that of male (P<0.05). The results of Cox multivariate analysis showed that gender, age, residential area, pathological type, stage and first-diagnosis hospital grade had an effect on lung cancer survival (P<0.01); Among them, women, young people, living in the city center, squamous cell carcinoma, early stage and high-grade hospital may be beneficial to survival, while men, old people, living in the suburbs, small cell carcinoma, late stage and low-grade hospital may be unfavorable to lung cancer patients.Conclusion The incidence level of lung cancer in Shanghai is gradually close to that in European and American countries.Women, young people, living in the city center, squamous cell carcinoma, early stage and high-grade hospital treatment is beneficial to survival of lung cancer.

Objective to investigate the relationship between survivin and acquired drug resistance of human lung cancer multidrug resistant strain H460/cDDP. Methods RT-PCR and Western blot were used to detect the expression of survivin in drug resistant strain H460/cDDP and sensitive strain H460. The expression of survivin was inhibited by liposome-mediated transfection of small interfering RNA (siRNA) against survivin into drug-resistant strain H460/cDDP; The cytotoxic effects of cisplatin (DDP) and paclitaxel (Taxol) on drug-resistant strain H460/cDDP were detected by tetramethylazo salt assay (MTT). Results the expression of survivin mRNA and protein in drug-resistant strain H460/cDDP were higher than that in susceptible strain H460. The inhibition rate of survivin protein was 92.3% 72 h after survivin siRNA transfection. The IC50 of drug-resistant strain H460/cDDP and susceptible strain H460 on DDP were (6.3±0.6) mg/L and (0.8±0.1) mg/L, respectively, and the IC50 of Taxol were (12.7±1.2) mg/L and (1.5±0.3) mg/L, respectively. The IC50 of H460/cDDP to DDP and Taxol were (4.0±0.9) mg/L (P =0.002) and (8.1±1.7) mg/L (P =0.003) respectively after survivin siRNA. Conclusion The high expression of survivin is related to the acquired drug resistance of H460/cDDP, and survivin may be an effective target for reversing drug resistance in lung cancer.

Objective to investigate the feasibility of co-culture of chondrocytes and bone marrow stromal cells (BMSC) to form mature cartilage tissue in vitro.Methods Porcine BMSC were cultured and expanded in vitro.After transfection with green fluorescent protein (EGFP) gene, they were mixed with porcine articular chondrocytes at a ratio of 1:1, and inoculated with polyhydroxyacetic acid/polylactic acid (PGA/PLA) scaffold at a final concentration of 5.0×107/ml as co-culture group.Pure chondrocytes and BMSC with the same final concentration were inoculated with PGA/PLA as positive control group and negative control group.The samples of each group were cultured in vitro for 2 weeks and then implanted subcutaneously in nude mice. After 8 weeks, the samples were collected. The new cartilage tissue was comprehensively evaluated by gross observation, laser confocal microscopy, glycosaminoglycan content determination, biomechanics, histology and immunohistochemistry methods.Results the cells in each group adhered well to the material. After 8 weeks of in vivo implantation, the samples of co-culture group and positive control group were maintained as before implantation Histology showed the formation of continuous cartilage lacunae-like structures in both groups, and immunohistochemistry showed a large amount of type Ⅱ collagen deposition. The quantitative results showed that the glycosaminoglycan content and elastic modulus of the co-cultured group reached more than 80% of the cartilage tissue constructed by chondrocytes. Confocal microscopy showed that EGFP-labeled cells formed cartilage lacunae. The volume of the negative control group was significantly smaller than that before implantation, and there was no formation of cartilage-like tissue in histology and immunohistochemistry. Conclusion The complex constructed by co-cultured chondrocytes and BMSC can continue to form mature cartilage tissue after implantation, which indicates that chondrocytes can still maintain the induction effect on BMSC after implantation.

Objective to investigate the effects of intraparenchymal injection, fluid volume and drug on spinal nerve function in normal rats and the safe injection amount for gene therapy of spinal cord injury. Methods 96 healthy adult SD rats were randomly divided into 12 groups by (4×3) factorial experiment design. Each group was injected with 2, 4, 6 and 10 μ l of NS or virus buffer or Ad-LacZ (1×109 pfu/ml) at the level of T13 vertebral body according to the grouping. Six adult healthy SD rats were taken as surgical control group. Only laminodecompression was performed without microinjection. The hindlimb motor function of each group was examined by BBB score at different times after surgery. The rats were sacrificed at 1, 2 and 4 weeks after surgery, and the effective tissue retention rate was determined by pathological analysis. The expression of recombinant adenovirus in spinal cord was observed by X-gal staining in the sections of each group of Ad-LacZ. Results The degree of nerve function and tissue damage increased with the increase of injection volume, and the difference between different injection volumes was statistically significant (P =0.000). Compared with different injection drugs, the degree of injury in Ad-LacZ group was more serious than that in NS group and virus buffer group, and the difference was statistically significant (P =0.044). The difference between NS group and virus buffer group was not statistically significant (P =1.000). The transfection of gray matter neurons and glial cells in each group of Ad-LacZ with different fluid volume could be completed, and the number of positive cells decreased at 4 weeks after surgery. Conclusion Microinjection in spinal cord parenchyma itself can cause tissue damage and neurological dysfunction. For normal rat spinal cord, 4 μ l of recombinant adenovirus is a relatively safe injection amount; 6 μ L is the critical injection volume, which should be controlled carefully.

Objective to investigate whether transforming growth factor (TGF) β 1 can induce the transformation of alveolar type Ⅱ epithelial cells into mesenchymal cells (EMT) in vitro, and whether Smad7 gene transfection can prevent this transformation and the related signal transduction mechanism.Methods Smad7 gene was transfected into rat alveolar type Ⅱ epithelium (RLE-6TN) by liposome method; Real-time fluorescence PCR and Western blot were used to detect the expression changes of epithelial cell markers (E-cadherin, CK19), mesenchymal cell markers (FN, Vimentin and α-SMA) and Smad signaling pathway-related proteins before and after transfection. The morphological changes of alveolar epithelial cells induced by TGF β 1 were observed by phase contrast microscopy, and the ultrastructural changes were observed by transmission electron microscopy. Results Smad7 was successfully transfected into RLE-6TN; Before transfection, under the action of TGF β 1, the expression of RLE-6TN mesenchymal markers was up-regulated at mRNA and protein levels, while the expression of epithelial markers was down-regulated; After transfection, the interstitial markers were down-regulated while the epithelial markers were up-regulated; The expression of p-Smad2/3 in RLE-6TN was up-regulated under the action of TGF β 1 before transfection, but its expression did not change significantly after transfection; Morphologically, TGF β 1 can induce EMT in alveolar epithelium, and Smad7 transfection can prevent EMT; In ultrastructure, TGF β 1 can induce the degeneration and swelling of lamellar bodies characteristic of alveolar epithelium, and eventually disappear completely with the prolongation of time. Conclusion TGF β 1 can induce the transformation of alveolar type Ⅱ epithelium into mesenchymal cells in vitro, and its mechanism is partly related to Smad signal transduction pathway, and Smad7 transfection can prevent this transformation to some extent.

We introduced the second generation posterior microendoscopic discectomy (MED), and adopted the "double fenestration" surgical approach of posterior median longitudinal incision to treat central disc herniation complicated with nerve root canal or lateral recess stenosis, with good curative effect, which is reported as follows.

The human spine is connected by 23 intervertebral discs. From the cervical vertebra to the lumbar vertebra, the intervertebral discs account for about 20% ~30% of the length of the spine [1], which can make the spine mobile and buffer the stress in all directions.

The treatment guidelines for bronchial asthma recommend regular use of inhaled hormones in patients with mild persistent bronchial asthma. Although long-term use of low-dose inhaled hormones has little side effects, due to concerns and long course of treatment, the treatment compliance of these patients is very poor.

A 57-year-old male was admitted to the hospital on February 1, 2005. He had no fever, fatigue and weight loss since the onset of the disease. Previously, he underwent thyroid adenoma removal in 1989. He smoked for 20 years, 40 cigarettes/d. Physical examination: no positive findings.

A 56-year-old male was admitted to the hospital on October 8, 2005 due to intermittent swelling and pain of the lower limbs for 6 years, intermittent fever for 2.5 years, and high fever for 7 days. In June 1999, the patient developed swelling and pain on the gastrocnemius side of the right lower limb without obvious trigger, and alternating redness and swelling of both lower limbs. The symptoms could be alleviated by 3~5 days of antibiotics every time, and occasionally fever, body temperature 37.0~38.0 ℃, no rash, joint swelling and pain, and no concave edema of both lower limbs. In September 2001, he was diagnosed as vasculitis in another hospital, and was given prednisone 30 mg once a day. After one month, the dose was reduced to 30 mg once every other day, and he was maintained until March 2004. In April 2003, he developed fever without trigger, and his body temperature fluctuated between 38.0~39.0 ℃.