Volume 88  ·   Issue 25  ·  2008

Since it was reported in 2005 that JAK2 V617F mutation occurred in chronic myeloproliferative disorder (MPD) [1-3], the discovery of this gene mutation has changed the classification and diagnosis of MPD. In the past, MPD included chronic myeloid leukemia (CML), polycythemia vera (PV), essential thrombocythemia (ET), primary myelofibrosis (PMF), chronic neutrophil leukemia (CNL), chronic eosinophilic leukemia/hypereosinophilic syndrome (CEL/HES) and many other diseases.

Objective To evaluate the therapeutic effect of CT-guided high frequency-induced thermotherapy (HiTT) for intrahepatic cholangiocarcinoma. Methods Seventeen patients of intrahepatic cholangiocarcinoma with 21 lesions underwent comprehensive treatment with HiTT as the principle approach.As to the patients with obstructive jaundice, percutaneous trans-hepatic cholangial drainage (PTCD) or bile duct endoprosthesis placement was performed first to improve the liver function, then HiTT was performed;and patients without obstructive jaundice underwent CT-guided HiTT directly, 1-2 weeks later,chemotherapy was given for 4 -6 courses. Results CT scan 1 week after HiTT showed a short-term achievement rate of 100% ( 17/17), and the single puncture in situ ablation rate was 76.1%( 16/21 ). The average life span in the near future was 13.5 months. The adverse effects included topo-bleeding, pain after procedure, liver function damage, fervescence, etc. All the patients recovered after symptomatic treatment.Conclusion The clinical value of CT-guided HiTT for intrahepatic cholangiocarcinoma is obvious.

Objective To compare the effects of mesh-plug and polypropylene hernia system(PHS) tension-free hernioplasty so as to explore the strategy of treatment for different patients. Methods Eighty patients with inguinal hernia were assigned into 3 equal groups according to the randomization schedule: PHS group and mesh-plug group. The operating time and the outcomes were recorded. Results The operating times of the mesh-plug group was 73.8 minutes significantly longer than that of the PHS group (56.5 minutes, P＜0.05). There was no significant difference in the recovery progress between these 2 groups. The numbers of patients who had sense of foreign body and numbness in the mesh-plug group were significantly greater than those in the PHS group ( both P＜0.05). Conclusions Mesh-plug tension-free hernioplasty is indicated for most inguinal hernia patients owing to the simple operation. More rational in design and more effective in reduction of recurrence, PHS is suitable for thin patients or patients with week or large transversalis fascia defection. And PHS is able to reduce the postoperative discomfort.

Objective To investigate the significance of sympathetic skin response (SSR) in the diagnosis of diabetic small fiber neuropathy. Methods 38 diabetic patients with paraesthesia and 30 healthy controls underwent SSR test on the 4 limbs. The latencies of the initiation and waves N and P of SSR were analyzed. The results of nerve conduction velocities of these patients with paraesthesia were normal. Results The latencies of the initiation and waves N or P in SSR were prolonged in 37 limbs of the 38 patients, and there was no SSR response in 21 limbs. The latencies of the initiation and waves N and P of SSR test in both upper extremity and lower extremities were prolonged significantly in the diabetic patients as compared to the controls (all P＜0. 05). The frequency of abnormality in the latency of SSR was 51% in the lower extremities, and 38% in the upper extremities. The frequency of abnormal latency of SSR in the lower extremities was higher, however, not significantly, than that in the upper extremities (P＞0.05). Twenty-eight of the 38 patients (74%) demonstrated abnormal SSR in at least one limbs. Conclusion SSR can be used to detect the early dysfunction of the small fibers in diabetic peripheral neuropathy, especially in the diabetic patients with normal nerve conduction velocities. SSR test may be a useful and sensitive neuroelectrophysiologic testing for the early diagnosis of diabetic small fiber neuropathy.

Objective To investigate the effect of a novel analgesic disposable urinary catheter invented by the authors in prevention of restlessness caused by catheter-related bladder discomfort (CRBD)in general anesthesia patients in anesthesia recovery period. Methods Two hundred patients, who underwent general anesthesia for general surgical operation, were divided randomly into 2 equal groups:observation group, undergoing insertion of F16 novel analgesic disposable Foley urinary catheter after inducement of general anesthesia, and control group undergoing insertion of conventional F16 Foley urinary catheter after induction of anesthesia. The rate of restlessness caused by CBRD and the rate of catheter pulling-off were compared. Results The CRBD rate of the observation group was 9%, significantly lower than that of the control group (61%, P＜0.01 ), the rate of CRBD-caused restlessness of the observation group was 0, significantly lower then that of the control group (23%, P＜0.001 ). The extent of CRBD of the observation group was significantly lighter than that of the control group. Conclusion The catheter inserting after the induction of anesthesia is an element related to the restlessness in anesthesia recovery period and other serious postoperative complications.The novel analgesic disposable urinary catheter effectively prevents CRBD-caused restlessness in general anesthesia patients in the anesthesia recovery period.

Objective To investigate the protein expression of RON, a tyrosine kinase receptor,protein in gastric carcinoma and the relationship between its expression and prognosis of cancer. Methods 98 samples of gastric carcinoma obtained from 98 patients, 70 males and 28 females, aged 58 (21-76), 29 specimens of paraneoplastic tissue, and 10 specimens of normal gastric mucosa were examined using immunohistochemical Envision method; 19 samples of gastric carcinoma fresh tissue, paraneoplastic tissue,and paraneoplastic lymph nodes with metastasis obtained from patients during operation underwent Western blotting to detect the protein expression of RON. And 10 specimens of normal gastric mucosa and normal lymph nodes were examined as controls. All cases were followed up for 3-89 months. Results (1) The RON positive rate of the gastric carcinoma tissue was 56.1% (55/98), significantly higher than that of the paraneoplastic tissue (25.6%, 8/29, P＜0.01 ). No RON expression was observed in the normal gastric mucosa. (2)RON expression was positively correlated with the invasive depth of the tumor (P＜0.05 ),perigastric lymph nodes metastasis ( P＜0.05 ), and TNM stage ( P＜0.01 ), but was not correlated with the growing manner of the tumor (Borrmann staging), histopathological grade of the tumor, and distant metastasis ( all P＞0.05 ). (3) RON expression was not related to the survival rate ( P＞0.05 ). (4) The splicing variant of RON was strongly expressed in the fresh gastric carcinoma tissue, corresponding paraneoplastic tissue and perigastric lymph nodes with metastatic carcinoma cell. No expression of the splicing variant of RON was observed in the normal gastric mucosa and normal lymph nodes. Conclusion RON and its splice variant may play an important role in the pathogenesis, progression, and metastasis of gastric carcinoma, and represent potential markers that can be used to evaluate the biological activity of gastric carcinoma.

Objective To investigate the regulation of cyclooxygenase (Cox)-2/2', 3'-cyclic nucleotide3' phosphohydrolase (CNPase) on the oligodendrocyte apoptosis in the pathogenesis of the heroininduced spongiform leucoencephalopathy (HSLE). Methods Samples of frontal lobe, cerebellum, and corpus callosum were obtained from the brains during autopsy of 4 HSLE patients and 5 patients who died of diseases other than cerebral diseases (controls) and underwent light microscopy and electron microscopy.Immunocytochemistry was carried out to detect the expression of myelin basic protein (MBP), caspase-3,COX-2, and CNPase protein. Apoptosis was examined by TUNEL staining. Results Widespread demyelination was seen in the white matter of the frontal lobe, cerebellum, and corpus callosum of the HSLE cases, most severely in cerebellum. In he HSLE group, the levels of caspase-3 and COX-2 expression were significantly higher, and the level of CNPase was significantly lower than those of the control group (all P＜0.05). Conclusion Widespread demyelination in the white matter is a prevailing pathological change of HSLE. Oligodendrocyte apoptosis is one of the causes of HSLE. The upregulation of COX-2 and downregulation of CNPase may contribute to the pathogenesis.

Objective To discuss the benefits and complications of the neurosurgical therapy in transorbital intracranial foreign bodies. Methods The clinical data of 28 cases of transorbital intracranial foreign bodies, metallic in 13 cases, vegetal 5 cases, and vitreous, plastic and other kinds in 10 cases, were analyzed retrospectively. Optic nerve injury was found in 13 cases, orbital apex syndrome in 11 cases; CSF rhinorrhea in 13 cases, CSF orbital leak in 3 cases, and hemiplegia in 2 cases. All the patients underwent head CT scan, and orbital horizontal and coronal CT scan. The patients with metallic foreign bodies had DSA exams, and the non-metallic cases had MRA scans. 22 cases had orbital-frontal craniotomy and foreign body resection, and 6 cases had direct foreign body extraction. All the cases received antibiotic and nerve nutritional therapy postoperatively. Result The cases in which the foreign bodies came from the orbital roof into the skull recovered well postoperatively; and the cases in which the foreign bodies came from the superior orbital fissure into the skull showed hemiplegia ( n=2 ) or orbital apex syndrome ( n=6 )postoperatively. Conclusion Transorbital intracranial foreign body should be diagnosed in early stage to avoid missed diagnosis. Omission should be avoided during resection of the foreign body. The relationship between the foreign body and internal carotid artery should be examined carefully before the extraction.Direct extraction of foreign body causes less injury, and patients'condition should be followed up.

Objective To evaluate the clinical effectiveness of transarterial embolization in persistent type Ⅱ endoleak after endovascular aneurysm repair(EVAR). Methods Eligible studies concerning treatment by transarterial embolization in patients with persistent type Ⅱ endoleak after EVAR were identified from electronic database, cross-reference search and pertinent articles. All relevant studies were systematically reviewed and the data were extracted by two independent reviewers. The study endpoints were technical success, clinical success, mortality, and complications. Results A total of 56 studies were selected for comprehensive review. No randomized controlled trials were identified. Seven patient series,comprising 129 type Ⅱ endoleaks, matched the selection criteria. The rate of technical success ranged from 69.7% to 100.0% (95% CI: 78.3% ±7.3%). During the follow-up, the clinical success rate was 100. 0% in three studies using the criterion without increase of the aneurysm diameter by the end of followup ; and in other 3 studies the disappearance rates of type Ⅱ endoleak were 61.5%, 20.0%, and 78.9% respectively. No incidence of serious complications, rupture of aneurysmal sac, and intra-operational death were reported. Conclusion Transarterial embolization is a main option in treating type Ⅱ endoleak without serious complications. Despite the high rate of technical and clinical success of the procedure, long term follow-up and randomized contrast trials are needed to confirm the efficacy.

Objective To investigate the effects of estrogen 17β-estradiol on β-amyloid protein 25-35 ( Aβ25-35 ) -induced neurotoxity and possible mechanism thereof. Methods Primary cortical neurons were obtained from the brain of a SD rat and cultured and treated with Aβ25-35 and 17β-estradiol. I order to investigate the possible mechanism of antagonism of estrogen against the neurotoxicity of Aβ25-35, Akt-Ⅰ, a specific Akt inhibitor and ICI-182780, an inhibitor of estrogen receptor were added before the addition of estrogen. The Aβ25-35 induced cell viability and lactate dehydrogenase (LDH) release into the cell media was detected with spectrophotometer. Western blotting was used to detect the level of phosphorylated Akt, a cellprotecting factor, and level of nonphosphorylated Akt in different conditions. Results 20μmol/L Aβ25-35 decreased the cell viability of the rat cortical neurons to 40.4% ( P＜0.01 ) as compared with the control group and the cell viability of the group with the addition of 17β-estradiol was 84.2%, significantly higher than that of the Aβ25-35 group (P＜0.01 ). The LDH secretion level of the Aβ25-35 was 172.5% as high as that of the control group (P＜0.01 ), while that of the 17β-estradiol preincubation group was only 118.5% that of the control group ( P＜0. 01 ). Both Akt inhibitor and estrogen receptor antagonist partially antagonized estrogen's protective effects against Aβ25-35 in cell viability. Aβ25-35 decreased the phosphorylated Akt level to 69.5%(P＜0.01 ), while estrogen 17β-estradiol pretreatment antagonized this effect to 94.7% (P＜0.01 ), and the addition of Akt inhibitor partially blocked the estrogen's rescue effect (75.4% , P＜0. 05 ). Estrogen treatment alone increased Akt phosphorylation, but this phosphorylation could be partially blocked by the estrogen receptor antagonist, the latter alone had no effect on Akt phosphorylation. Under all circumstances, the amount of nonphosphorylated Akt didn't change significantly. Conclusion The estrogen 17β-estradiol partially alleviates the Aβ25-35-induced neurotoxity and Akt activation may be involved in estrogen's neuroprotective effect. Estrogen receptor may play a role in estrogen induced Akt activation.

Objective To obtain differentially expressed genes related to human glioma using cDNA microarray and to characterization of one novel full-length gene. Method Four samples of human glioma samples, 1 fetal brain tissue sample, and 2 normal brain tissue samples were used to extract the total RNA,and the mRNA was used to make probes. After hybridization and washing procedure, the products of hybridization were scanned using computer system. One gene, named 436F11 clone, was subsequently analyzed by Northern blotting, bioinformatics, and protein expression. Result Fifteen differentially expressed new genes related to human glioma were obtained through four times of hybridization and scanning.Northern blotting confirmed that over-expression of 436F11 gene in the normal human brain tissue and lowexpression in the human glioma tissues. The analysis of BLASTn and BLASTx showed that the clone of 436F11 was a novel full-length gene coding 78 amino acids of protein with a theoretical relative molecular weight of 8648 and an isoelectric point of 4.69 and that it was 60% identical to mouse PKIβ amino acid, so it was called human PKIβ gene. After it was transfected into Escherichia. coli, higher-expressed protein of PKIβ was obtained which yielded a major clear band on an SDS-PAGE gel after purification. The products obtained from amino acid sequencing and molecular weight detection were exactly the same as the products performed by bioinformatic analysis. Conclusion cDNA microarray technology can be successfully applied to identify differentially expressed genes. PKIβ may be a novel full-length gene related to human glioma and may provide a new way to gene therapy of glioma.

Objective To test our hypothesis whether a group of flavonoids (FE) derived from herbal Epimedium exerted its prevention of estrogen-deficiency-induced osteoporosis mainly through an enhancement in intestinal calcium absorption. Methods Forty-five 12-month-old female Wistar rats were randomly assigned into one sham-operated group and four ovariectomy (OVX) subgroups, i.e. OVX with vehicle (OVX group), OVX with FE (FE group), OVX with calcium supplement (CS group), and OVX with FE and CS. Daily oral administration of FE (10 mg·kg-1·d-1) and/or CS (56 mg·kg-1·d-1)started on day 4 after OVX for 12 weeks. Before sacrificing the animals, urine and serum samples were collected for assaying indicators for intestinal calcium absorption, regulator of calcium homeostasis and markers for bone turnover. Then, the left proximal femur was dissected for the primary-end-point index(failure force) , and the second-end-point indexes (pQCT-calculated densitometry, geometry and micro-CT-quantified 3-D trabecula mictroarchitecture), as well as pQCT-defined cross-sectional envelope. Results FE prevented OVX-induced deterioration in failure force as well as the second-end-point indexes with no increase in uterus weight. CS had no prevention effect on OVX-induced reduction in failure force. Two-way factorial interaction analysis between FE and CS showed that the un-enhanced suppression of parathyroid hormone for calcium homeostasis provided no link between the enhanced intestinal calcium absorption and the enhanced inhibition of bone resorption in the present study. Furthermore, discrepancy between the enhanced intestinal calcium absorption and the un-enhanced primary / second-end-point indexes as well as anabolic effect was also found by the interaction analysis. Conclusion Independent of intestinal calcium absorption,FE inhibited bone resorption, stimulated bone formation and accordingly prevented osteoporosis without hyperplastic effect on uterus in the OVX rat model.

Objective To evaluate the effect of nanophase Ti6Al4V substrates on the osseointergration in vivo.Method Novel nanophase Ti6Al4V substrates were prepared according to the severe plastic deformation principle.Eighteen New Zealand white rabbits were randomly divided into 3 equal groups with their trochanters of femur exposed and implanted with titanium substrate with common snrface (Ti group),nanophase Ti6A14V substrate(nano-Ti group),and hydroxyapatite-coated substrate(HA group) respectively.Four,8,and 12 weeks later X-ray films were taken on 6 rabbits from each group,tetracycline and calcein were injected intramuscularly,and one day later the rabbits were sacrificed.The histological changes of the tissue surrounding the implant including the bone kinesics parameter were evaluated:the bone-implant interfaces were examined with scanning electron microscope(SEM) and transmission electron microscope (TEM) respectively.Result Radiographic examinations showed that the bone recovery around the implant in the nano-Ti group was earlier compared to that in the Ti group.Histological examination suggested that the interface osseointegration rates 4,8,and 12 weeks later of the nano-Ti groups were all significantly higher than those of the Ti group(all P<0.01).Strong tetracycline labeling and caleein labeling were observed around the implants in the nano-Ti group,indicating the active form action of new bone.The rates of bone mineralization and deposition 4,8,and 12 weeks later of the nano-Ti group were higher than those of the Ti group.SEM and TEM examinations showed greater degradation of the surface and much more grains in cells in the HA group as compared to those in the nano-Ti group.The bone mineralization and osseointegration rates 4 weeks later of the HA group were significantly higher than those of the nan0-Ti group(both P<0.05),however,there were no significant differences in the bone mineralization and osseointegration rates 8 weeks later between these 2 groups.The bone mineralization and osseointegration rates 12 weeks later of the nano-Ti group were even higher than those of the HA group.Conciusion The novel nanophase Ti6A14V substrates improves the bone.implant osseointegration without significant grains of degradation in vivo,suggesting that the novel substrates and nano technology should be further considered for the orthopedic implant applications.

Objective To investigate the effects of ginsenoside-Rg1 on the apoptosis induced by beta amyloid (Aβ) and mechanism thereof so as to search an approach to prevent and treat Alzheimer' s disease. Methods (1) Chinese hamster ovarian tumor cells of the line CHO unable to produce endogenous Aβ were cultured and randomly divided into 3 group: control group, Aβ25-35 group treated with Aβ25-35, and ginsenoside-Rg1 and Aβ25-35 group treated with ginsenoside-Rg1 of the concentrations of 10, 12.5, 25, 50,and 100 μmol/L respectively for 12 h and then treated with Aβ25-35. MTT method was used to dete4ct the survival rate of the CHO cells. (2) Chinese hamster ovarian tumor CHO cells transfected with mutant PSIM146L gene and wild type APP751 gene (mutant PSM146L/APP751 cells) stably producing excessive Aβ1-42 and wild type PSI cells were randomly divided into groups added with ginsenoside-Rg1 of the concentration of 25 μmol/L and groups without ginsenoside-Rg1. Annexin V-FITC/PI apoptosis kit and TUNEL kit were used to detect the apoptotic cells. Immunofluorescence staining was used to detect the protein expression levels of and caspase-3 that mediates the cell apoptosis induced by Aβ. Western blotting was used to detect the protein expression of caspase-3. Results Ginsenoside-Rg1 25, 5, and 100 μmol/L dose-dependently increased the cytoactivity level of the CHO cells ( all P＜0.05 ) compared with that of the untreated cells. Annexin V-FIFC/PI test and TUNEL showed that the number of apoptotic cells of the mutant PSM146L cells was significantly higher than that off the wild type PSI cells ( P＜0.05 ), and the number of apoptotic cells of the mutant PSM146L cells treated with ginsenoside-Rg1 was significantly lower than that of the un-treated cells (P＜0.05 ), Immunofluorescence staining showed that the expression site of Aβ was consistent with that of caspase-3, the protein expression levels of Aβ42 and caspase-3 of the PS1M146L/APP751 CHO cells treated with 25 μmol/L ginsenoside-Rg1 were both significantly lower than those of the untreated PS1M146L/APP751 CHO cells (P＜0.05 ). Western blotting showed that the active caspase-3 protein expression level of the PSIM146L cells was significantly higher than hat of the wild type PSI cells(P＜0.05 ) and the caspase-3 protein expression level of the PS1M146L/APP751 CHO cells treated with 25 μmol/L ginsenoside-Rg1 was significantly lower than that of the untreated PS1M146L/APP751 CHO cells(P＜0.05). Conclusion Ginsenoside-Rg1 prevents cells from apoptosis through inhibiting the production of Aβ42 and decreasing the expression of the active caspase-3.

Stress urinary incontinence (SUI) is a common disease in women, especially middle-aged and elderly women, which seriously affects the quality of life of patients. 90% of stress urinary incontinence is anatomical stress urinary incontinence, that is, involuntary urination when abdominal pressure increases caused by high movement of the urethra. In 1994, DeLancey [1] put forward a new mechanism of stress urinary incontinence-"hammock" hypothesis, which believes that the closure of urethra is accomplished by the contraction of the anterior part of the pubococcygeal muscle to form a "hammock". Under normal circumstances, when abdominal pressure increases, the pubococcygeal muscle contracts, causing the "hammock" to act to close the urethra, and then the urethral closure pressure increases to maintain urine self-control under increased abdominal pressure.

A 50-year-old female was admitted to our hospital for more than 2 months due to swelling of the left lower limb. In July 2005, the patient underwent ultrasound Doppler revealed low deep venous blood flow rate of the left lower limb due to swelling of the left lower limb. After oral administration of Maizhiling, there was no obvious relief after subcutaneous injection of low molecular weight heparin for 1 week. Reexamination of B-ultrasound showed that the left common iliac vein and external iliac vein were thrombotic, and partially recanalized.

Abstract A 33-year-old female was admitted to the hospital on March 1, 2007 because of "abdominal mass found for 4 months". About 4 months ago, the patient found "abdominal mass" during physical examination, without obvious low back pain, abdominal pain, abdominal distension, fever, dizziness, chest tightness, palpitations, shortness of breath, nausea, vomiting, diarrhea, frequent urination, urgency, painful urination, and macroscopic hematuria.

total knee arthroplastic (TKA) is often accompanied by massive blood loss due to the exposure of cancellous bone and medullary cavity and soft tissue release caused by multiple osteotomies and drilling, anticoagulation therapy and joint function exercises after operation. The complications caused by massive blood loss not only affect the rehabilitation of the whole body and limb function after operation, but also may infect blood-borne diseases due to allogeneic blood transfusion. Therefore, how to reduce the blood loss and the risk of exposure to allogeneic blood in total knee arthroplastic (TKA) is increasingly paid attention to.

The 4th National Pediatric Anesthesia Conference sponsored by Anesthesiology Branch of Chinese Medical Association, Tianjin Medical Association and Tianjin Anesthesiology Society was held in Binhai New Area, Tianjin from May 9th to 11th, 2008.