Volume 87  ·   Issue 35  ·  2007

Ischemia-hypoxia (ischemia/oxygen) injury refers to the cell metabolism caused by the decrease of oxygen supply or the increase of oxygen consumption, and then the changes of cell function and morphology. The process of ischemia and hypoxia is not exactly the same, but both have the basic characteristics of hypoxia. Therefore, the ischemia/oxygen mentioned in this paper generally refers to two kinds of stimulation: ischemia/oxygen often occurs in cardiovascular and cerebrovascular accidents, organ transplantation, fetal intrauterine distress, etc. Therefore, the research on its pathophysiology and its protective measures has attracted the attention of medical workers at home and abroad for a long time. In 1986, Murry et al. [1] first put forward the concept of "preconditioning": after several transient sublethal ischemia/oxygen, a cell or organ experiences severe ischemia/oxygen for a long time, the damage can be significantly reduced.

Perioperative liver function protection is not only to protect the original liver function, but also to avoid or reduce the damage caused by surgery and anesthesia trauma. Therefore, perioperative anesthesia management, operation timing and operation mode determine the patient's condition turnaround and survival. The causes of perioperative liver function damage can be divided into: (1) the patient's primary liver function insufficiency further lesion damage, (2) the patient's liver lesion damage caused by liver operation, and (3) the liver function damage caused by anesthesia treatment.

Objective to investigate the protective effect and possible mechanism of propofol pretreatment on cardiomyocyte apoptosis induced by cardiopulmonary bypass (CPB) in open heart surgery. Methods 40 patients undergoing open heart surgery under elective CPB were randomly divided into two groups (n =20): propofol pretreatment group (group P) and control group (group C). Right atrial tissues were collected before and after CPB for HE staining, mitochondrial ultrastructure was observed under transmission electron microscope, and apoptosis and expression of caspase-9,3 were detected. Results Compared with group C after CPB, group P had higher automatic recovery rate, reduced dosage of dobutamine within 12 h after surgery and shorter stay in ICU (P<0.05); The mitochondrial structure is intact, and the crest and intimal space are still clearly visible; Conclusion Propofol pretreatment can inhibit cardiomyocyte apoptosis induced by cardiopulmonary bypass in open heart surgery, and its mechanism may be related to protecting mitochondria and inhibiting the expression of Caspase-9,3.

Objective to investigate the protective effect of emulsified isoflurane pretreatment on liver ischemia-reperfusion injury in rats, and to prove that this effect is mediated by Kupffer cells.Methods Thirty-two SD rats were randomly divided into fat emulsion control group (group C), Kupffer cell blockade control group (group KC), emulsified isoflurane pretreatment group (group IP) and emulsified isoflurane pretreatment group after Kupffer cell blockade (group IK), 8 rats in each group, and the serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), malondialdehyde (MDA), superoxide dismutase (SOD) and liver histopathological changes in hepatocyte homogenate were observed after liver ischemia for 30min and reperfusion for 2h. Results Compared with group C, the serum ALT and AST contents in IP group were significantly reduced after liver ischemia-reperfusion, the content of MDA in hepatocyte homogenate was decreased, the content of SOD was increased, and the liver histopathological damage was significantly reduced. Compared with group C, there were no significant changes in serum ALT and AST levels, MDA and SOD levels in hepatocyte homogenate, and pathological damage of liver in KC and IK groups after liver ischemia-reperfusion. Conclusion Emulsified isoflurane pretreatment has a protective effect on liver ischemia-reperfusion injury, and this effect is mediated by Kupffer cells.

Objective to study the protective effect of recombinant human erythropoietin (rhEPO) preconditioning on myocardium of ischemia-reperfusion (I-R) rats and discuss the possible mechanism.Methods A total of 156 male Sprague-Dawley rats were used to block the left anterior descending artery for 30 min and then canalize for 3 h in I-R model. The rats were intraperitoneally injected with normal saline or rhEPO 24 h earlier. The contents of myocardial tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay at 1 h and 2 h after reperfusion, respectively; The expression of nuclear factor-κ B (NF-κ B) and activated protein-1 (AP-1) in myocardium was detected by gel electromigration method.Results Single injection of rhEPO (intravenous instillation, 5000 U/kg) 24 h before I-R can significantly reduce the size of myocardial infarction after I-R, improve the ultrastructure of myocardial cells, weaken the level of plasma CK-MB, reduce the infiltration of neutrophils in myocardial tissue, reduce the activation of NF-κ B and AP-1 and the expression of TNF-α and IL-6. Conclusion rhEPO pretreatment has a significant myocardial protective effect, which may be related to the inhibition of the activation of NF-κ B and AP-1 and the downregulation of downstream pro-inflammatory cytokines.

Objective to investigate the role of Toll-like receptor 4 (TLR4) signaling pathway in cerebral ischemic tolerance induced by hypoxia preconditioning after ventilation arrest. Methods Adult male Wistar rats were randomly divided into 4 groups: (1) Asphyxia cardiac arrest (ACA) group, which suffered 4 minutes of asphyxia cardiac arrest and then resuscitated. (2) Asphyxia preconditioning + asphyxia cardiac arrest (HP + ACA) group, which were given 4 times of 1 min of asphyxia cardiac arrest and resuscitation at an interval of 5 min each time. (3) Asphyxia cardiac arrest and hypoxia preconditioning (HP) group, which received 4 times of asphyxia cardiac arrest and no asphyxia cardiac arrest. (4) Sham operation control group (C), which had no hypoxia preconditioning and no asphyxia cardiac arrest. The mortality of rats 24 h after resuscitation was observed. The neurological function scores at 24, 48 and 72 h after resuscitation were evaluated. The expression of TLR4 mRNA, the activation of NF-κ B and the production of TNF-α and IL-6 in brain tissue were observed at 1, 3, 6, 12, 24, 48 and 72 h after resuscitation. Results The neurological function scores of HP group and HP + ACA group were significantly better than those of ACA group (P<0.05); Compared with group C, the expression of TLR4 mRNA, NF-κ B activity and the production of TNF-α and IL-6 in HP or HP + ACA or ACA groups were significantly increased at different time points (P<0.01), and the magnitude of the increase was increased in turn (HP

Objective to investigate the expression of CD4+ CD25+ regulatory T cells in labial glands of patients with Sjogren's syndrome (SS). Methods CD4, CD25, CD68, CD8 and FOXP3 were stained in serial sections of 31 cases of labial gland paraffin tissues by immunohistochemistry. Results Immunohistochemistry staining showed that CD4+ T cells accounted for the majority of infiltrating lymphocytes in labial glands of 25 patients with SS, and there was no expression of CD25 and FOXP3 in both groups. Conclusion CD4+ CD25+ regulatory T cells were lacking in labial glands of SS patients; Regulatory T cells play an important role in the pathogenesis of SS.

Objective to observe the effect of ulinastatin on perioperative myocardial injury in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods Twenty-four patients with OPCAB were randomized, double-blind and controlled. They were divided into control group (C) and ulinastatin group (W), 12 cases in each group. Group W: Ulinastatin was pumped intravenously at a constant rate of 6000 U/kg after induction of anesthesia, and then continued intravenously at a rate of 1000 U · kg-1 · h-1 until the end of the operation. Group C: The same volume of normal saline was given. The plasma of patients was collected before cutaneous incision (T1), 0.5 h (T2), 2 h (T3), 6 h (T4) and 18 h (T5) after the completion of all coronary artery anastomosis, and the clinical data of patients were recorded. Results The values of cTn Ⅰ in group C and W were significantly higher from 2 h to 18 h postoperatively than before cutaneous incision (P<0.01). The values of cTn Ⅰ in group W were significantly higher from 0.5 h after anastomosis to

Objective to investigate the combined treatment of bilateral temporal lobe epilepsy (BTLE) with stereotactic disruption and subpial transsection. Methods 12 patients with intractable epilepsy were diagnosed with BTLE by clinical symptoms, long-range video electroencephalography (V-EEG), head CT, MRI, magnetic resonance spectroscopy (MRS), positron emission tomography-computed tomography (PET-CT), magnetoencephalography (MEG), neuropsychology, intraoperative cortical electroencephalography (ECoG) and deep electroencephalography (DEEG). Stereotactic amygdala-hippocampal disruption (SAHT) and multiple subpial transsection (MST) were given to the epileptogenic foci in one amygdala-hippocampal complex and one and/or both temporal lobe neocortex, respectively. Results After 6-32 months of follow-up, according to the Engel criteria, there were 5 cases of grade Ⅰ, 3 cases of grade Ⅱ, 3 cases of grade Ⅲ and 1 case of grade Ⅳ. No permanent complications occurred after operation. Conclusion Stereotactic disruption and subpial transsection were used to treat BTLE

Objective to detect and analyze the expression of fascin and cytokeratin 14 (CK14) in esophageal squamous cell carcinoma tissues, adjacent normal squamous epithelium and esophageal squamous cell carcinoma cell lines, and to explore the possible role of these two cytoskeletal proteins and related proteins in the development of esophageal squamous cell carcinoma and the application prospect in the diagnosis of esophageal squamous cell carcinoma. Methods 116 esophageal squamous cell carcinoma tissue specimens were collected and tissue microarray was constructed. The expression of fascin and CK14 in esophageal squamous cell carcinoma tissues and adjacent normal squamous epithelium was detected by immunohistochemistry, and the relationship between them and clinicopathological features, prognosis and the relationship between the two proteins was analyzed. The expression of fascin and CK14 in 12 esophageal squamous cell carcinoma cell lines was detected by Western blot method, and the relationship between them and growth and invasion characteristics was analyzed. Results The positive rates of fascin and CK14 were 79.3% and 67.0% respectively. The combined positive rate was as high as 86.2%, and the expression of fasciculin and CK14 was higher in high and medium differentiated squamous cell carcinoma (the positive rate of fasciculin in high, medium and low differentiated squamous cell carcinoma was 87.1%, 83.9%, 62.1%, P =0.054, and the positive rate of CK14 in high, medium and low differentiated squamous cell carcinoma was 87.1%, 76.4%, 27.6%, P<0.01). There was no significant relationship between the expression of fasciculin and CK14 and prognosis (P =0.8980 and P =0.2610). The expression of the two proteins was positively correlated (r =0.487, P<0.01). Fasciculin was highly expressed in most cell lines, but only in TE12 cell line with weak growth and invasion ability, while CK14 was only expressed in KYSE180 cell line. Conclusion The expression of fasciculin and CK14 in esophageal squamous cell carcinoma was up-regulated, which may play an important role in the occurrence and development of esophageal squamous cell carcinoma.

Objective to investigate the difference and clinical significance of acetabular inclination angle after computer-guided and non-guided minimally invasive total hip arthroplasty (MIS-THA). Methods 87 cases with 106 hips were treated with MIS-THA without selection, among which 47 cases with 53 hips were conventional MIS-THA, and 40 cases with 53 hips were treated with computer-guided MIS-THA. In the conventional group, the acetabulum was positioned by conventional methods during operation.The total length of the lower extremities and the orthographic radiographs of both hips were routinely taken before and after operation.The postoperative acetabular inclination angle of the two groups was measured according to the acetabular inclination angle of 30° ~50°,<30°,>50° and the sum of<30° and>50°, respectively.The results showed that the incision length of the navigation group was 7.2~10.5 cm, with an average of 8.9 cm, and the incision length of the conventional group was 7.5~11 cm, with an average of 9.1 cm. The postoperative X-ray film showed that the postoperative acetabular inclination angle of the navigation group was 30° ~54°, with an average of (40.6±5.1) °, only one hip was 54°, and the other 52 hips were in the range of 30° ~50°. The postoperative acetabular inclination angle of the conventional group was 28° ~70°, with an average of (44.2±8.7) °, among which 40 hips were in the range of 30° ~50°,<30° was 3 hips, and>50° was 10 hips. There was a significant difference between the navigation group and the conventional group, t' =2.56, P =0.012 The difference of acetabular inclination angle>50° was statistically significant, x2=8.22, P =0.0042; if the sum of<30° and>50° (marginal value) was compared between the two groups, the difference was statistically significant, x2=11.85, P =0.0006. Conclusion Computer-guided THA is a brand-new technique, which can place acetabular prosthesis more accurately and reduce the variability in MIS-THA.

Objective to compare the significance of preoperative suspension traction image (Tr), supine curvature image (SB) and fulcrum curvature image in evaluating the flexibility of adolescent idiopathic scoliosis (AIS) and predicting the corrective effect of surgery. Methods Sixty-eight cases of AIS were selected according to the inclusion/exclusion criteria. All cases were single curvature (PUMC classification was Ia/Ib/Ic). According to the COBB angle size of preoperative orthopaedic X-ray images, they were divided into four groups: moderate thoracic curvature group (19 cases, 40°60°), moderate lumbar curvature group (28 cases, 35°60°). All groups received the same surgical method according to the PUMC classification principle, and all of them used the third generation segmental internal fixation system. The standard method was used to measure the COBB angle size of preoperative orthopaedic image, Tr, SB and fulcrum of standing whole spine and postoperative orthopaedic image. The flexibility of scoliosis of three X-ray methods was calculated and compared with the surgical correction rate. The results were statistically analyzed. Results The flexibility of moderate thoracic curvature group was fulcrum (7 The surgical correction rate was 57%. The flexibility of the moderate lumbar curvature group was SB (79%)>Fulcrum (76%)>Tr (44%). The difference between SB and Fulcrum was not statistically significant, and the surgical correction rate was 86%. The flexibility of the severe lumbar curvature group was Fulcrum (53%)>SB (47%)>Tr (38%). The difference between Fulcrum and SB was not statistically significant, and the surgical correction rate was 67%. Conclusion Fulcrum can better evaluate AIS thoracic curvature but can only predict the flexibility and postoperative correction rate of moderate thoracic curvature. There is no significant difference between Fulcrum and SB in evaluating the flexibility of lumbar curvature.

Objective to investigate the relationship between different grades and anterior-posterior diameters of fetal hydronephrosis and its prognosis, and to put forward a reasonable plan for pregnancy observation and clinical management.Methods 226 pregnant women suspected of fetal hydronephrosis were examined in our obstetric clinic, and the gestational age of ultrasound examination was 20~40 weeks; Two-dimensional ultrasound was used to observe and measure the morphology and size of fetal renal pelvis, the changes of renal calyx and the thickness of renal cortex, and the grading was given. The ultrasound was reviewed regularly and the postpartum outcome was tracked. Results 143 cases of 186 kidneys with grade Ⅰ hydronephrosis were observed. The anteroposterior diameter of renal pelvis was between 0.3 and 1.0 cm, and the prognosis was good. A total of 47 cases of 52 kidneys with grade Ⅱ hydronephrosis, the anteroposterior diameter of the renal pelvis was between 1.1 and 1.8 cm. Most of the remission gradually disappeared after birth, and only a few (about 3.9%) gradually aggravated with the increase of gestational age, which required surgical treatment after birth. A total of 10 cases of 10 kidneys with grade Ⅲ hydronephrosis, the anteroposterior diameter of the renal pelvis was between 1.5 and 3.3 cm, and about 70% of them showed a tendency of aggravation before and after birth, which required surgical treatment. The hydronephrosis above grade Ⅱ requires regular ultrasound examination before and after delivery. It is more appropriate to evaluate fetal hydronephrosis by the combination of anterior and posterior pelvic diameter and grading.

Objective to evaluate the efficiency of population-based maternal serum screening for fetal chromosome abnormalities in middle trimester of pregnancy in Jiangsu Province. Methods A multi-stage sampling method combined with stratified sampling and cluster sampling was used to sample 95 items in townships or streets in southern, central and northern Jiangsu Province. The sampling time was 1 year. All women at 15~20 weeks of pregnancy in the item sites were tested for maternal serum alpha-fetoprotein (AFP) and human chorionic gonadotropin free β subunit (F-β hCG). At the same time, B-ultrasound was used to determine the gestational age. The risk value of fetal chromosome abnormalities was calculated on the basis of weight correction of pregnant women. The high-risk patients were diagnosed on the basis of informed consent. All live births were followed up to 0.5~4 years of age after birth. Results There were 27 313 pregnant women in 95 items in one year, and 26 803 patients participated in prenatal screening, accounting for 98% of the total pregnant women in the same period. The average age of pregnant women was 25.1 years, and 1.7% were ≥35 years old. The maternal serum screening showed that 1244 patients were at high risk of Down syndrome and high risk of Edward syndrome There were 20 fetuses and infants with chromosomal abnormalities, including 9 cases of Down syndrome, 5 cases of Edward syndrome and 6 cases of other chromosomal abnormalities. The detection rate of Down syndrome and Edward syndrome was 56% (5/9) and 80% (4/5) in the combined screening of maternal serum AFP and f-β HCG in the second trimester of pregnancy. Conclusion On the basis of strict quality control, the detection rate of fetal chromosomal abnormalities in the combined screening of maternal serum AFP and f-β HCG in the second trimester of pregnancy is higher, but the good cost-effectiveness ratio of screening is related to the incidence of target birth defects.

Objective to investigate the role of α-secretase in the mechanism of cognitive impairment after cerebral ischemia. Methods 48 old Wistar rats were randomly divided into hypoperfusion group and sham operation group. Each group was subdivided into 4 subgroups at 1, 2, 4 and 16 weeks after operation. Study of learning and memory ability in rats by Y maze; The expression of α-secretase ADAM17 mRNA in rat hippocampus was detected by fluorescence quantitative PCR; The activity of α-secretase in hippocampus was detected by direct fluorescence assay. Results the results of Y-maze test were significantly decreased in the hypoperfusion group at 2, 4 and 16 weeks postoperatively. The expression of α-secretase ADAM17 mRNA in the hypoperfusion group at 2, 4 and 16 weeks postoperatively (the ratio to the reference substance was 0.78±0.03, 0.78±0.02 and 0.54±0.03, respectively) was significantly lower than that in the sham operation group (1.12±0.05, 0.99±0.04 and 1.01±0.04, respectively), and the differences were statistically significant (all P<0.01); The activity of α-secretase in the hypoperfusion group was significantly decreased at 1, 2, 4 and 16 weeks after operation (fluorescence values were 33 880 ± 1086, 37 496 ± 817, 32 295 ± 864 and 30 069 ± 1111, respectively), and the difference was statistically significant compared with that in the sham operation group (39 497 ± 838, 39 802 ± 1052, 40 137 ± 776 and 39 894 ± 1076, respectively) (all P<0.01). Conclusion Chronic cerebral hypoperfusion downregulated the expression of α-secretase ADAM17 mRNA and inhibited the activity of α-secretase in hippocampus, which may increase the amount of APP, the substrate of α-secretase, indirectly activate the β-secretase pathway of APP metabolism, and finally increase the production of A β in the brain, thus impairing the learning and memory ability of rats.

Objective to observe the effects of follicle stimulating hormone (FSH) on the proliferation, apoptosis, migration and invasion of ovarian cancer cell lines SKOV-3 and ES-2. Methods FSH was applied to 1×105 or 2.5×106 SKOV-3 cells and 6×104 or 1.5×106 ES-2 cells at different concentrations (10, 20, 40, 80, 160 mU/ml), respectively. FSH 0 mU/ml was used as the control group. The appropriate time of FSH was 48 h for SKOV-3 cells and 24 h for ES-2 cells, respectively. Apoptosis and cell cycle; Activity of Matrix Metalloproteinase 2 (MMP-2) in Cell Culture Supernatant; Changes of MMP-2 protein and mRNA expression in SKOV-3 and ES-2 cells; Results (1) With the increase of FSH concentration, the proliferation activity of SKOV-3 cells increased, and the differences were statistically significant compared with the control group (all P<0.01). (2) With the increase of FSH concentration, the apoptosis rate of SKOV-3 cells decreased, which were 0.94% ± 0.06%, 0.71% ± 0.03%, 0.22% ± 0.02%, 0.32% ± 0.02% and 0.55% ± 0.05%, respectively, and the differences were statistically significant compared with the control group (1.30% ± 0.10%) (all P<0.01). (3) With the concentration of FSH at 40 mU/ml, the percentage of SKOV-3 cells in G0/G1 phase decreased gradually, and the percentage of S phase increased gradually, and the differences were statistically significant compared with the control group (all P<0.05). (4) FSH could increase the content of MMP-2 mRNA and MMP-2 protein in cytoplasm of SKOV-3 cells and the activity of MMP-2 in cell culture supernatant. (5) Invasion experiment: SKOV-3 cells plus FSH group and control group penetrated the basement membrane The scratch experiment also showed that FSH increased the migration ability of SKOV-3 cells, and the performance of FSH on ES-2 cells was basically the same as that of SKOV-3 cells. Conclusion FSH can promote the proliferation, migration and invasion of SKOV-3 and ES-2 cells, and inhibit the apoptosis of ovarian cancer cells.

Objective to observe the effect of hypertonic fluid on the expression of aquaporin 1 (AQP1) in pleural mesothelial cells.Methods Wistar rat pleural mesothelial cells were cultured in vitro.After identification, the cells were randomly divided into control group and hypertonic group.The control group was cultured with D-MEM/F-12 culture medium, and the hypertonic group was cultured with hypertonic culture medium containing different concentrations of NaCl. The fraction of 100 mmol/L NaCl was 6, 12, 18 and 24 h. The expression of AQP1 in the cells was detected by Western blot and RT-PCR.Results After 24 h treatment with hypertonic culture medium containing 25, 50, 75, 100 and 150 mmol/L NaCl, the expression of AQP1 protein (A value) was 24.0±1.8, 27.8±2.4, 31.7±2.5, 89.7±6.2 and 107.7±9.3, respectively, which were higher than those in the control group (10.8±1.5) (t value was 16.1, 17.1, 20.2, 35.1 and 29.0, respectively, all P<0.01); The expression levels of AQP1 were 42.1±2.6, 78.9±3.6, 109.6±7.6 and 123.4±8.6 respectively after 6, 12, 18 and 24 h of culture in 100 mmol/L NaCl hypertonic solution, all of which were higher than those in the control group (12.9±1.9) (t values were 25.7, 45.5, 34.8 and 35.3 respectively, all P<0.01). Conclusion the hypertonic solution can up-regulate the expression of AQP1 in pleural mesothelial cells, and AQP1 may be involved in the transport of pleural effusion.

Clinically, local lymph nodes play a key role in the diagnosis, staging and treatment of tumors.Malignant tumors of epithelial origin often have local lymph node metastasis, which is often very important to analyze the prognosis of such patients. Although the phenomenon of tumor metastasis through lymphatic vessels has been discovered 200 years ago, its exact mechanism is still not completely understood. In recent years, many studies on tumor pathophysiology [1-2], specific lymphatic endothelial cell (LEC) markers [3] and lymphatic endothelial cell factors [4] have focused on the mechanism of tumor lymphangiogenesis [4-12] and lymphatic metastasis of tumor cells [9-10].

Faced with a series of public health emergencies, such as Streptococcus suis infection in Sichuan, vaccine incident in Si County, Anhui Province, water pollution incident in Songhua River, avian influenza epidemic, SARS, etc., insufficient government investment, poor command system, inaccessible information network and imperfect disease control system often become the influencing factors that experts comment on [1]. However, few people mention the education and training of emergency personnel, and few people put forward scientific and rational suggestions for the training of emergency personnel.

In recent years, some large-scale prospective studies have found that obesity is associated with pancreatic Cancer, but the relationship between nutritional status, especially nutrients that play a role in DNA methylation, and pancreatic Cancer is still unclear. Recently, an article published in June in the American journal Cancer Research reported a study on the association between plasma folate, vitamin B6, vitamin B12 and homocysteine and pancreatic Cancer risk (Cancer Research, 2007, 67: 5553-5560).

A 62-year-old male was admitted to the hospital on November 10, 2006 due to "choking and coughing during drinking water for half a year, aggravated by one week". In the past six months, the patient mainly showed unexplained choking and coughing during drinking water, but no choking and coughing after eating solid food. Upper gastrointestinal angiography showed that there was an abnormal channel about 2.4 cm long between the middle esophagus and the right lower lobe bronchus, and the contrast medium entered the lower esophagus and the right lower lobe bronchus at the same time (Figure 1). Electronic gastroscopy showed a localized depression of 0.8 cm ×0.7 cm in the posterior wall of the esophagus 30 cm away from the incisors.