Volume 90  ·   Issue 12  ·  2010

With the establishment and development of system biology and the gradual deepening of the understanding of tumor, the individualized concept of comprehensive treatment of tumor is being accepted by more and more people ~ ([1]). How to carry out individualized treatment for tumor patients and what new role can surgery play in this process besides tumor resection are worthy of serious consideration and exploration.

In recent 10 years, with the publication of international consensus opinions and guidelines on the classification of idiopathic pulmonary fibrosis (IPF), idiopathic interrogative pneumonia (IIP) and interstitial lung disease (ILD) by the American Respiratory Society (ATS) and the European Respiratory Society (ERS) ~ ([1-2]), the extensive development of high-resolution CT (HRCT), bronchoalveolar lavage fluid examination, trans-bronchoscopic lung biopsy and surgical lung biopsy, and the cooperation of pulmonary, radiological and pathological physicians, the diagnostic criteria of ILD represented by IPF have been continuously improved, the diagnostic level of ILD has been obviously improved, and a series of clinical trials with good design and evidence-based medical evidence have been published one after another.

：Objective To study thetherapeutic effects and mechanism of saikosapenin-d (SSd) in mice with bleomycin(BLM)-induced pulmonary fibrosis. Methods According to the random number SSd and SSd + DXMgroups (n=40 each). At 1 hour post-modeling, DXM, SSd and SSd + DXM groups 0. 18 ml) ,DXM+SSd (0. 28 ml) respectively qd until Day 28. BLM group was similarly dosed with normalsaline. In addition, a normal control group (NC group, n = 20) treated likewise. The micewere anesthetized and sacrificed at Days 3, 7, 14, 28 for harvests of serum and lungtissue samples. The conventional histopathological changes of lung tissue were observed.Except for NC group, modeling groups of mice were used to observe the natural survivalrate. Such indices as superoxide dismutase (SOD) and malonaldehyde (MDA) were examinedboth in lung tissue and serum samples. And hydroxyproline (HYP) was tested only in lungtissue. Results SSd could markedly increase the survival rate (80. 0% in SSd and SSd + DXMgroups vs 50. 0% in BLM group, P < 0. 05) and reduce alveolitis and fibrosis in mice.In comparison with BLM group, the levels of HYP of three treatment groups (DXM, SSd andSSd + DXM) in lung tissue was significantly lower (P <0. 05) at Days 14 and 28. Thelevels of MDA both in serum and lung tissue were significantly lower at Days 3, 7 and 14(P < 0. 05). The serum level of SOD was significantly higher at Days 3, 7 and 14 whilethe level of SOD in lung tissue was significantly higher at Days 3 and 7 (P <0. 05, P< 0.01). Conclusions SSd has marked therapeutic effects upon bleomycin-inducedpulmonary fibrosis in mice. And the mechanism may be associated with its anti-lipidperoxidation effect.

Objective To investigate the therapeutic effect of corticosteroids upon idiopathic pulmonary fibrosis (IPF) and the impact of corticosteroids upon survival time. Methods Clinical data of 94 corticosteroid treatment and 32 non-corticosteroid treatment IPF patients during 2000 - 2004 were retrospectively analyzed and their survival rates compared between two groups. The corticosteroid treatment patients were divided into 3 groups: improved, steady and worsened group according to the pulmonary function data. Therapeutic effects and survival rates were compared between these 3 groups. Results In the treatment group, 6 (6. 4%) patients could not be located, 22 (23.4%) patients survived, and 66 (70. 2%) patients died. In the non-corticosteroid treatment group, 1 (3. 1%) patients could not be located, 2 (6. 3%) patients survived and 29 (90. 6%) patients died. No statistically significant difference existed between the two groups (P > 0. 05). Sixty-two corticosteroid treatment patients were followed up for 3 -6 months. Among them, 19 (30. 7%) patients improved, 11 (17. 7%) patients remained steady and 32 (51.6%) patients worsened in pulmonary function. In 19 improved patients, 7 (36. 8%) survived and 12 (63.2%) died. In 11 steady patients, 3 (27.2%) survived and 8 (72.7%) died. In 32 worsened patients, 3 (9. 4%) could not be located, 1 (3. 1%) survived and 28 (87. 5%) died. The survival rate of the improved and steady groups was higher than that of the worsened group (P < 0.01). Conclusions There is some therapeutic effect of corticosteroids in the early alveelitis stage of IPF. The prognosis of the patients with improved and steady pulmonary function parameters during the first 3 -6 months is better than that of worsened patients.

Objective To investigate the potential causes of respiratory failure in patients with interstitial lung disease (ILD) and evaluate the application value of mechanical ventilation (MV) in its treatment. Methods This study included the clinical data of 47 ILD patients (29 males and 18 females) complicating respiratory failure and admitted to respiratory care unit (RICU) for receiving MV at Beijing Chaoyang Hospital from January 1, 1998 to June 30, 2008. The median age was 67 years old. And a retrospective analysis was conducted for clinical characteristics, potential causes of respiratory failure, RICU treatment, prognosis and causes of death, etc. Results The causes of respiratory failure were as follows: respiratory infections (n = 18, 38. 3%), respiratory infection superimposed aggravated ILD (n = 15, 31.9%), pulmonary embolism (n =8, 17.0%), ILD with acute exacerbation (n =5, 10. 6%) and heart failure (n = 1, 2. 1%). And the mortality rates of RICU were 55. 6% (10/18), 73.3% (11/15), 5/8, 4/5 and 1/1 respectively. Upon initial admission into RICU, 31 cases received noninvasive ventilation and 16 cases tracheal intubation. The mortality rates were 54. 8% and 87.5% respectively. And there was statistically significant difference between the groups (X~2 = 5.014, P = 0. 025). In all patients, the RICU mortality rate was 66. 0% (31/47) and the hospital mortality rate 70. 2% (33/47) . Conclusions Respiratory infection, pulmonary embolism and acute exacerbation of ILD are the main common causes of respiratory failure in ILD patients. Noninvasive ventilation therapy is clinically preferable to invasive ventilation for ILD patients with respiratory failure.

Objective To explore the effect of postoperative adjuvant transarterial chemoembolization (TACE) upon early recurrence of hepatocellular carcinoma (HCC) patients after radical resection. Methods Between November 2000 and December 2007, 2591 HCC patients undergoing radical resection were retrospectively recruited. Patients undergoing resection alone were selected as control group while those receiving post-operative adjuvant TACE as intervention group. The patients were further stratified into tumor ≤5 cm with low or high risk factors for residual tumor and tumor > 5 cm with low or high risk factors for residual tumor. A low risk factor for residual tumor was defined as single tumor and without microscopic tumor thrombus while a high risk factor for residual tumor was defined as 2 -3 nodules or with the presence of microscopic tumor thrombus. The effect of adjuvant TACE upon early (≤ 2 years) recurrence was evaluated. Results Recurrent rates of tumor ≤ 5 cm with low or high risk factors for residual tumor and tumor > 5 cm with low or high risk factors for residual tumor at Month 3 post-resection were 1.34%, 3. 17%, 5.33% and 8.43% in the control group versus 4. 14% (P =0. 002), 8. 15% (P= 0. 011), 12. 88% (P = 0. 002) and 14. 29% (P = 0. 045) respectively in the intervention group; recurrence rates at Month 6 post-resection were 4. 63%, 8. 73%, 11.50% and 19.46% in the control group versus 6. 71% (P =0. 133), 13.48% (P =0. 070), 21.02% (P =0. 052) and 23.94% (P =0. 210) respectively in the intervention group. For patients remaining recurrence free within the first 6 months post-resection, there were no significant differences in recurrence rates at Months 9, 12, 18 and 24 post-operation between each intervention group and control group. Conclusion Postoperative adjuvant TACE has no preventive effect upon early recurrence, but may be of benefit to detect residual tumor and early recurrence.

Objective To study the effects of carbon tetrachloride (CCl_4)/ethanol induction upon experimental liver fibrosis and hepatic carcinogenesis of HBV transgenic mice. Methods The wild-type mice, p21-HBx transgenic mice with integration of p21 locus by HBx gene and p21-HBsAg transgenic mice with integration of p21 locus by HBsAg gene were induced separately by CCl_4/ethanol twice weekly for 20 weeks. The investigators observed the development of liver fibrosis and hepatic carcinogenesis in three groups and detected the gene expressions of HBx and HBsAg by RT-PCR. Results The expression of HBx or HBsAg mRNA existed in both control and induced transgenic mice, but in none of wild-type mice. Comparing with wild-type mice, p21 genes was not expressed in livers of transgenic mice. After induction by CCl_4/ethanol, the fibrotic degrees of liver were not significantly different among wild-type mice, p21-HBx transgenic mice and p21-HBsAg transgenic mice, as well as between male and female mice. Reversely, the p21-HBsAg) were higher than that of wild-type mice. And the incidence rate of hepatic carcinogenesis in males was also markedly higher than that in females. Induction by CCl_4/ethanol markedly promoted and accelerated hepatic carcinogenesis in transgenic mice. Conclusions Integration of HBsAg and HBx genes into the murine p21 locus can significantly promote the progression of hepatic carcinogenesis, but failed to promote the progression of liver fibrosis. The male mouse is more likely to develop experimental hepatocellular carcinoma than the female mouse. Experimental hepatocellular carcinoma induced by CCl_4/ ethanol in p21-HBx and p21-HBsAg transgenic mice is a feasible animal model.

Objective To explore whether or not HBx protein can induce epithelial-mesenchymal transition (EMT) in liver cancer cell SMMC-7721. Methods A recombinant adenovirus vector containing HBx gene was constructed and introduced into SMMC-7721 cell. The morphological changes were observed. The expression changes of epithelial and mesenchymal markers were investigated by RT-PCR, Western blot and immunohistochemistry. Invasive and metastatic capacity of transfected SMMC-7721 cell was evaluated through transwell migration assay. Results The recombinant adenovirus vector containing HBx gene was constructed and transfected successfully into SMMC-7721 cell. At Day 7 post-transfection, the transfected SMMC-7721 cell underwent the morphological change from a classic epithelial morphology to a spindle-like shape. In addition, the HBx protein significantly increased the expressions of N-cadherin, vimentin and fibronectin, but decreased the expressions of E-cadherin and α-catenin in SMMC-7721 cell. The cellular invasion assay indicated that transfection of HBx drastically enhanced the invasive potential of SMMC-7721 celL Conclusion HBx protein may induce EMT and enhance the invasive potential of SMMC-7721 cell.

Objective To investigate the in vitro anti-cancer effects of ouabin combined Na~+/K~+-ATPase α1 siRNA upon HepG2 cells and its molecular mechanism. Methods The Na~+/K~+ -ATPase α1 subunit expressions of human hepatoma tissue, normal liver tissue and human hepatoma cell lines (HepG2, SMC7721 and Bel7402) were determined. The cells received different treatments (0. 03 μmol/L siRNA, 0. 1 μmol/L ouabain and combination). The proliferation of HepG2 was observed by CCK-8 assay. The activity of Na~+/K~+-ATPase was measured. The HepG2 cell cycle distribution was detected by flow cytometry. The mRNA and protein levels of Na~+/K~+-ATPase α1 subunit, MAPK1, CyclinA, CDK2, PCNA and P21WAF1 were detected by quantitative RT-PCR and Western blot. Results The gray value Na~+/K~+ -ATPase α1 subunit in hepatoma tissue was 174. 74 ± 16. 77 and 65.31 ± 7. 88 respectively in normal liver tissue. The Na~+/K~+ -ATPase α1 subunit expression of hepatoma tissue was significantly higherthan normal liver tissue(P < 0. 05). The Na~+/K~+ -ATPase α1 subunit expression level of HepG2 was higher than that in SMMC-7721 and Bel-7402 cells. The CCK-8 experiments demonstrated that siRNA, ouabain and combination could inhibit the HepG2 proliferation, and the combination group was different from the ouabain or siRNA group (P < 0. 05). The 24, 48 and 72 h inhibitory rates of 0. 03 μmol/L siRNA, 0. 1 μmol/L ouabain and combination group were (17.4%, 20. 3%, 24. 3%), (37. 5%, 44. 3%, 51.2%) and (52. 3% ,70. 2% ,88. 2%) respectively. The activity of Na~+/K~+ -ATPase decreased in siRNA, ouabain and combination group. The S phase proportion of ouabain and combination group increased from 24. 2% to 66. 5% and 75. 2% respectively. The 0. 1 μmol/L ouabain and combination group could down-regulate the expression of Na~+/K~+-ATPsae α1, MAPK1, CyclinA, CDK2, PCNA and up-regulate the expression of P21WAF1 in HepG2 cell. Conclusion The Na~+/K~+ -ATPase α1 siRNA combined ouabain inhibits the proliferation of HepG2 cells by decreasing the expression of MAPK1 and induces the cell cycle S arrest by decreasing the production of CyclinA/CDK2/PCNA complex and increasing the expression of P21~(WAF1).

Objective To systematically review the efficacy and safety of beclomethosone nasal spray in the treatment of chronic adenoid hypertrophy in children. Methods We computerized searches of the Cochrane Central Register of ControUed Trials (CENTRAL) (issue1,009), MEDLINE (1950 to August 2008) ,EMbase (1984 to August 2008), CNKI (1994 to September 2008), and VIP (1989 to August 2008), WANFANG DATA, Annual Review-s and Elsevier Science. Also the reference lists of all papers were identified for further trials. All searches were initially performed in May 2007 and updated in April 2009. Randomized controlled trials (RCT) and quasi-RCTs were identified and analyzed according to the Cochrane Handbook for Systematic Reviews of Interventions. Results Three RCT were included. Meta-analysis was not performed due to heterogeneity and the data were summarized in a narrative formal The trials showed that higher doses of beclomethasone (336 μg/d, 400 μg/d) might improve the nasal obstruction symptoms and reduce adenoid size in children with adenoid hypertrophy. Conclusions Higher and subsequently half doses of beclomethasone (336 g/d, 400 g/d) can improve the nasal obstruction symptoms in children with adenoid hypertrophy. The improvement appears to be associated with a reduction of adenoid size. Beacuse of a lack of the RCT, further studies are required to support the use of beclomethasone as a first-line approach for these children.

Objective To develop the evaluation tool for the risk level of abnormal glucose metabolism morbidity in the middle-aged and elder populations. Methods By the stratified cluster sampling method, a survey was conducted in middle-aged and elder populations aged 40 -70 years old in urban and rural areas of Chengdu during April-November 2008. The parameters included blood pressure, fasting blood glucose, blood glucose after oral administration of 75 g glucose, blood lipid, blood uric acid, height, body weight and waistline, etc. A total of 5205 valid copies of questionnaires were obtained. A discriminant analysis and a multifactorial logistic regression analysis were conducted. The quantitative scoring system was established and the ROC analysis conducted to screen the boundary point of the quantitative scoring system. The discriminant performance of simple scoring model was conducted in 336 subjects for physical examination. Results The accuracies of discriminant analysis in male and female models were 79. 04% and 81.35% respectively. The simple male scoring mode included the following eight parameters: age, physical work intensity, parental history of diabetes mellitus, sibling's history of diabetes mellitus, BMI index, existing abdominal obesity and history of hypertension. The simple female scoring mode included the following eight parameters: age, physical work intensity, physical training, parental history of diabetes meUitus, sibling' s history of diabetes mellitus, BMI index, existing abdominal obesity, history of hypertension, number of parturition and history of gestational diabetes mellitus. The ROC AUCs were 0. 701 and 0. 728 in male and female models respectively. During applications in other populations, the sensitivity and specificity of the male model were 86. 86% and 65. 12% while those of female model 88. 89% and 72. 97% respectively. Conclusions The newly developed evaluation tool for the risk level of abnormal glucose metabolism morbidity in middle-aged and elder populations is both simple and practical. With an excellent practicability; it may be used to screen abnormal glucose metabolism in middle-aged and elder populations.

Objective To examine the current ambulance transport rates and ascertain factors associated with use of emergency medical service (EMS) in patients with acute myocardial infarction (AMI) in Beijing. Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours of onset of symptoms. Data were collected by structured interviews and medical records review within 1 week after admission. Patients were categorized into the EMS group and the serf-transport group according to their modes of transport to the initial hospital. Data were analyzed by descriptive statistics, univariate and multivariate logistic analysis. Results Of the 789 patients with STEMI, only 260 (33.0%) arrived at the initial hospital by EMS, while the remaining 529 (77.0%) relied on self-transport Multivariate logistic analysis showed that age ≥ 65 years (OR: 1. 530, 95% CI: 1. 050 - 2. 230, P = 0. 027), higher education level (OR: 2. 032, 95% CI: 1. 257 - 3. 284, P = 0. 004), history of coronary artery disease (OR: 0. 474, 95% CI: 1. 049 - 2. 458, P = 0. 029), unbearable symptoms (OR: 0.592, 95%CI:1.090-2.520, P=0. 008), anxiety (OR: 0.760, 95%CI:1.238 -3.695, P= 0.006) and attribution of symptoms to cardiac origin (OR: 0.402, 95% CI: 1.020 -2. 171, P=0.041) were independent predictors of EMS use. However, presence of pre-infarction angina significantly decreased the likelihood of using EMS (OR: 0. 626, 95 % CI: 0. 431 - 0. 907, P = 0. 013). Conclusions Only one-third of patients with STEMI arrived at the hospital by EMS in Beijing. Demographics, history of coronary artery disease, symptoms characteristics and cognitive factors of patients were associated with the EMS use.

Objective To assess the outcome of stented elephant trunk surgery for chronic Debakey Ⅰ aortic dissection in Marfan syndrome and hypertension patients by CT. Methods Between 2003 and 2008, 54 patients underwent the modified stented elephant trunk procedure and total arch replacement for chronic Debakey Ⅰ aortic dissection. Twenty-two patients were made a diagnosis of Marfan syndrome and the other 32 patients of hypertension. Aortic evolvement was evaluated with CT angiography by calculating the diameter ratios between the stent graft/true lumen and the aorta at the same level. Results CT study one year after discharge showed no difference in the diameter ratios of the stent and aorta at the carina level between groups (0. 84±0. 16 vs 0. 80 ±0. 23, P =0. 472), but had significant difference before and after surgery (0. 29 ± 0. 16 vs 0. 72 ±0. 21, P≤ 0. 001). And significant difference occurred at the different periods after discharge (0.72±0.21 vs 0.81±0.20, 0.81±0.20 vs 0.77±0.20, P≤0.001). The residual false lumen in the proximal descending aorta reached complete thrombosis in 59% of Marfan and 78% of hypertension. Conclusion The modified stented elephant trunk technique is effective for closing the false lumen in the proximal descending aorta of chronic Debakey Ⅰ aortic dissection in Marfan syndrome and hypertension patients.

Objective To investigate the effects of the proteasome inhibitor MG-132 upnon NF-κB and the expression of intercellular adhesion molecule-1 (ICAM-1) in cerulein-induced acute pancreatitis (AP) in mice. Methods Forty-five BalB/c mice were randomly allocated into nine groups: control 3, 6, 12 h group (n = 5) ; AP 3, 6, 12 h group (n = 5) and MG-132 3, 6, 12 h group (n = 5). AP group was induced by an ip injection of 100 μg/kg cerulein six times with a 1 h interval. Control group received physiological saline likewise. MG-132 group was injected ip with 10 mg/kg MG-132 at 30 min before induction of AP. The levels of serum amylase and soluble ICAM-1 (sICAM-1) were tested. The pathological changes of pancreas were observed. The expression of NF-κB proteins was examined by immunohistochemistry and the expression of ICAM-1 mRNA analyzed by reverse transcription-polymerase chain reaction (RT-PCR). Results In MG-132 group, the levels of serum amylase (U/L) and sICAM-1 (pg/ml) markedly decreased in comparison with AP group (1629 ± 59, 1794 ± 123, 2910 ± 152 vs 1282 ±61, 1525±103, 1809±117, 133±10, 157±10, 217±43 vs 106±6, 135±4, 163±19, P<0.05 or P <0. 01) ; the scores of pathological changes decreased in pancreas (5.7 ± 1.0, 7. 1 ± 1.2, 9. 6 ± 2. 1 vs 3.2 ± 1.0, 5. 3 ± 1.0, 6. 9 ± 0. 8, P < 0. 05 or P < 0. 01) ; the expression of NF-κB protein (3.8 ± 1.1, 4.6±1.2, 6.7±0.4 vs 1.9±0.6, 3. 1 ± 1.0, 4.7 ± 1.0, P <0.05 or P <0.01) were significantly lowered than those in AP group. ICAM-1 mRNA also decreased more than those in AP group (0. 3±0. 1, 1.0±0.2,1.2±1.0 vs 0.3±0.2,1.8±0.2,2.1±0.2, P<0.05 or P<0.01). Conclusions The pmteasome inhibitor MG-132 can obviously improve the outcome of acute pancreatis. And the mechanism may be related to the down-regulated expression of cytokines, including adhesion molecules, through the suppression of NF-κB activation.

Objective To analyze the difference of virulence-related protein concerned with type Ⅲ secretion system (T3SS) in Pseudomonas aeruginosa during the changes of antibiotic sensitivity and interpret the clinical patient data to explore the relationship between the changes in resistance and variance of virulence. Methods The isolates of Pseudomonas aeruginosa was isolated from the respiratory tract of a same patient with an altered sensitivity of antibiotics. It turned out to be one clone. The homolog of isolates was determined by ERIC-PCR. The Kirby-Bauer antibiotic testing was employed to detect the sensitivity of antibiotics of isolates. PCR was used to detect the gene of T3SS and virulence of isolates and two-dimensional gel electrophoresis to compare the whole-cell proteins. The mass spectrometry was employed to analyze a variety of protein spots. The relevant information was retrieved from protein databases. Clinical record was collected to study the relationship of clinical features, bacteria resistance and virulence-asseciated protein. Results One subject was diagnosed with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pneumonia. Psendomonas aeruginosa was isolated from his respiratory tract three times in one year. Sensitivity spectrum of isolates were as follows: sensitivity, multi-drug resistant (MDR) and pan-drug resistance (PDR). Virulence gene was exo U +/exo S -. Twenty-one differentially expressed proteins were revealed by two-dimensional gel electrophoresis in three isolates. The functions of 11 proteins were definite. Only 9 proteins were associated with basal bacterial metabolism. Disulfide oxidoreductase A (DsbA) corresponded to the variation of virulence and sensitivity spectrum. Clinical record revealed that the severe lung infection was caused by the PDR strain and the patient died within one month. Conclusions The sensitivity spectrum and virulence of Pseudomonas aerug/nosa may undergo changes when there is an alteration of eco-environment during colonization and infection over a long period of time. DsbA plays a key role in the variety of virulence.

A 45-year-old male was admitted to the Department of Hematology of Nanfang Hospital of Southern Medical University on December 28, 2006 due to intermittent fever, cough and shortness of breath with lung shadows for more than one year.

Rheumatoid arthritis (RA) is a systemic autoimmune disease with chronic and symmetric polyarthritis as the main clinical manifestation, which mainly invades the synovial joint. It can also involve the respiratory system, cardiovascular system, skin, eye, nervous system and other extraarticular systems.

The patient was a 70-year-old male who came to the clinic on August 13, 2009 due to the discovery of left upper calyx tumor for 1 year and bladder tumor for 1 week. He had no previous family history of hereditary diseases and urinary tract infection. The patient was found to have multiple soft tissue density shadows in the left renal calyx on physical examination (CT) in September 2008. The CT value of plain scan was 40 HU, and the CT value of enhanced scan was 55 HU. The filling defect was found on delayed scan, and the lesion extent involved most of the middle and upper calyx and the left renal pelvis.

Standardized questionnaire survey showed that the prevalence of asthma has been increasing in recent 30 years. The increase of asthma prevalence may be related to factors such as environmental influence, decrease of physical activity, diet and obesity, exposure to allergens, etc.

In the past decades, disease surveillance and epidemiological studies have shown an increasing global prevalence of asthma, which is characterized by reversible airflow restriction and airway hyperresponsiveness, and wheezing is the most common symptom of asthma.

In 2009, the new influenza A (H1N1) virus has a potential fatal risk in children.45% of the hospitalized patients are under 18 years old, which may be related to the lack of immunity against this virus in children.Epidemiological experience from other vaccines suggests that two doses of vaccine in children and adults can meet the licensing criteria of the Center for Biological Products Evaluation and Research (CBER).