Volume 90  ·   Issue 24  ·  2010

With the maturity of laparoscopic technique, the application of laparoscopic technique in liver diseases has been gradually recognized and popularized. Existing clinical studies have shown that with the continuous proficiency of laparoscopic operation technique and the shortening of learning curve, the incidence of complications during and after laparoscopic hepatectomy has no obvious difference from that of open operation, and it has the characteristics of less trauma, quick postoperative recovery and less influence on the immune function of patients.

Objective To compare the outcomes between anterior versus conventional approach right hepatectomy for large hepatocellutar carcinoma(HCC).Methods A total of 188 consecutive patients with large HCC(≥5 cm)undergoing right hepatectomy were reviewed retrospectively.Among them,92patients received anterior approach right hepatectomy(anterior group)while the other conventional right hepatectomy(conventional group).Their clinicopathologic data and survivals were compared.Results There were five surgical deaths(2.7%),two in the anterior group and three in the conventional group.The biochemical and tumor pathological data(except for tumor size) of these two groups were comparable.The mean intranperative blood loss,the number of patients with massive hemorrhage(＞3000ml)and the volume of blood transfusion of the anterior group were markedly less than those of conventional group.The 1-,3-year disease-free survival rates of the anterior group were significantly better than those of the conventional group anterior group were also markedly higher than those of conventional group.The Cox regression model indicated that tumor size[P=0.014,odd ratio(OD):1.074] and surgical procedure(P:0.009,OD=0.468) were independent risk factors correlated with disease-free survival.And the surgical procedure(P=0.003,OD=0.369) was the only independent risk factor for postoperative cumulative survival.Conclusion Anterior approach right hepatectomy can significantly decrease intraoperative blood loss.The postoperative survivals of large HCC patients are significantly improved by anterior approach right hepatectomy.

Objective To study the relationship between aflatoxin exposure and the development of primary liver cancer (PLC) in patients with chronic hepatitis. Methods A 21-year longitudinal study was carried out in a large cohort of 515 PLC high-risk individuals with HBV infection in PLC high prevalence region. Results (1) The PLC year-incidence of cohort was 1437. 25/100 000. And it was significantly higher than that of the same natural peoples (184. 53/100,000, P = 0. 000, RR =7.79). There was no significant difference in the incidence of other tumors between these two groups (P =0.576). (2)The PLC patients in the cohort were diagnosed at an average age 1.4 year younger than those in the same natrural peoples and had an average survival of 6. 42 months longer than the latter. (3 ) The PLC year-incidence of those with the exposure to aflatoxin was significantly higher than that of unexposed people (2784. 96/100 000 vs 1251. 02/100 000, P = 0.008, RR =2.23). There was no relationship between the incidence rate of other tumors and the aflatoxin exposure. (4)The PLC year-incidence of aflatoxin-exposing people increased with the rising urine excretion of AFM,. When the urine excretion of AFM, was more than 100 ng during 24 hours, the PLC year-incidence was high as 4 717.82/100 000. The urine excretion of AFM, was also obviously related with the abnormal liver function ( P = 0.035 ). There was no relationship with the positive rate of HBeAg ( P = 0. 812). (5) The PLC year-incidence of those with the exposure to aflatoxin were infected with HBV (2 784. 96/100 000) significantly higher than that of cohort people (P =0. 001) and the same natural peoples ( P = 0. 000, RR = 15. 09). ( 6) It took an average time of 14. 65 years ( median 13.68) from hepatitis occurrence to PLC diagnosis and 7.38 years (median 6.40)from liver cirrhosis to PLC diagnosis.Conclusion HBV infection is a main etiological factor of PLC and the aflatoxin exposure has obvious synergistic effect in the carcinogenesis of PLC.Regular observation in a PLC high-risk cohort is effective for an early diagnosis and treatment.Hepatitis control and aflatoxin de-pollution is effective to inhibit the occurrence of PLC.

Objective To investigate the expression of apoptosis arrestin PED/PEA-15 and XIAP in hepatocellular carcinoma ( HCC) and explore their relationship with clinicopathological factors of HCC.Methods The mRNA expressions of PED/PEA-15 and XIAP genes were detected by RT-PCR ( reverse transcription-polymerase chain reaction) in resected liver tumor tissues and corresponding adjacent noncancerous tissues from 40 HCC patients and normal liver tissues from 12 patients with benign lesions.Their protein levels were detected by Western blot. Results The mRNA expressions of PED/PEA-15 and XIAP genes and their proteins were significantly higher than those in adjacent tissues and normal tissues (0.636±0.061±0.352±0.068±0.179 ±0. 036;0. 579 ±0.090±0.344 ±0.084±0.184±0.038) (P ＜0. 01). The mRNA levels of PED/PEA-15 and XIAP genes and their protein levels were significantly associated with the pathological grade and clinical stage of HCC (P ＜ 0. 05). However there was not a significant correlation with such clinicopathological features as age, gender, size of tumor, tumor load,metastasis and recurrence (P ＞ 0. 05). Conclusion The expressions of apoptosis arrestin PED/PEA-15 and XIAP are elevated in HCC as compared with adjacent tissues and normal tissues. Thus it may serve as both a reference indicator for biological behaviors of HCC and a new target for gene therapy.

Objective To analyze the clinical and molecular genetic characteristics of one patient with sporadic parathyroid carcinoma(s-PC).Methods The clinical profile,laboratory data and paraffinembedded tissue sample of a s-PC patient were collected at our hospital.Genomic DNA was extracted from the leukocytes of peripheral blood and paraffin-embedded tissue of this patient.All 17 exons of HRPT2 gene including the flanking regions of introns were amplified by PCR.The mutations of HRPT2 gene were analyzed by directly sequencing the amplified DNA fragments.Parafibromin encoded by HRPT2 gene was analyzed by immunohistochemistry.Results The patient was diagnosed as s-PC by the clinical presentations,laboratory examinations and typical pathologic characteristics.HRPT2 germline mutation was identified as a base mutation at codon 222(CGA＞TGA)and caused a nonsense mutation at the codon (R222X) resulting in a truncated protein.Parafibromin was completely lost while comparing the normal parathyroid tissues by immunohistochemistry.Condusion The altered expression of parafibromin caused by HRPT2 gene mutation is one of the molecular mechanisms for explaining the clinical manifestations of this patient.

Objective To perform clinical and genetic pedigree analyses of a Chinese male patient with Gilbert's syndrome and his relatives. Methods Blood sample were collected from the proband and his relatives by liver function test, etiological examination and genetic analysis to exclude other related diseases. The phenobarbital-responsive enhancer module (PBREM) , TATA box and common mutation sites in exons of UGT1A1 gene were amplified by polymerase chain reaction (PCR) and the products screened by direct DNA sequencing. Results c. -3279T ＞ G in PBREM, TA insertion in TATA box and Gly71Arg were observed in this family. A linkage disequilibrium is also noted between c. -3279T ＞ G and TA insertion. In four affected members, three are heterozygotes and one is homozygote. The correlation between genotype and phenotype with a high serum level of unconjugated bilirubin was confirmed. Conclusion c. -3279T ＞ G in PBREM, TA insertion in TATA box and Gly71 Arg are essential for the pathogenesis of Gilbert's syndrome in this Chinese family. Gilbert's syndrome in this family is inherited in an autosomal recessive manner.

Objective To analyze the clinicopathological characteristics of rectal neuroendocrine tumors (NETs) so as to improve their understanding and diagnosis. Methods The data of 62 rectal NETs patients were retrospectively analyzed to summarize their clinical characteristics. They were categorized into 3 types based on the level of histological differentiation. And the relationship of tumor size, histological type and metastases was examined. Results The clinical presentations of rectal NETs were atypical. The main clinical presentation was change in bowel habit (n = 43, 69.4%); Ten cases (16.1%) were asymptomatic. Nine cases were found during routine digital rectal examination. In 57 cases (91.9% ), the distance was within 8cm from anorectal line. All patients had single lesion without the presence of carcinoid syndrome. 25.8% ( 16/62 ) had colonic polyps while 16. 1% ( 10/62 ) synchronous colorectal adenocarcinomas. Except for synchronous colorectal adenocarcinomas (n = 10) , among 52 cases, there were 39 cases with tumor diameter ＜ 1 cm, the main type was type Ⅰ; 7 cases with tumor diameter ＞2 cm, the main types were types Ⅱ and Ⅲ. The metastatic rates in three groups with tumor diameter ＜ 1 cm, 1-2 cm and ＞2 cm were 0, 33.3% and 71.4% respectively. Conclusion The clinical presentations of rectal NETs are non-specific. Most cases are often single lesion without the presence of carcinoid syndrome. The clinical process and prognosis of rectal NETs are closely related to tumor size, histological type, the presence of lymph node metastases and liver metastases. The routine digital rectal examination is the simplest and most effectively way of diagnosing rectal NETs. Colonoscopy is important in diagnosing the synchronous cancers and conducting a follow-up.

Objective To evaluate effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Methods A total of 214 patients with acute myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. All patients were divided into two groups by duration of clopidogrel use; ＜1 year group (n=59) and ≥1 years group (n = 155). Baseline characteristics [age, gender, angiographic characteristics, Killip classification, LVEF (left ventricular ejection fraction) , CK (creatine kinase), CK-MB, CTnI (cardiac troponin-I), hemoglobin levels and history of hypertension, diabetes , hyperlipidemia, obesity and smoking ] of two groups were collected. Clinical follow-up end-point was major adverse cardiac event (MACE) including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was 41.6 ± 16.3 months. MACE occurred in 28 patients. Results Rates of male, infarction site .infarction relative artery, multi-vessel disease, Killip classification (class I) , aspirin use and history of smoking, obesity, hypertension and hyperlipidemia were not different ( P ＞ 0. 05) in duration of clopidogrel use ＜ 1 year group and ≥ 1 years group. Average LVEF, hemoglobin levels and rate of drug-eluting stents were significantly lower in duration of clopidogrel use ＜ 1 year group than that in duration of clopidogrel use ≥1 years group (P ＜0. 0001 ,P ＜0. 0001 ,P=0. 0065). Average CK、CK-MB.CTnI were significantly higher in duration of clopidogrel use ≥ 1 years group than that in duration of clopidogrel use ＜ 1 year group (P ＜ 0. 0001 ). Rate of diabetes and average age were significantly higher in duration of clopidogrel use ＜ 1 year group than that in duration of clopidogrel use ≥1 years group (P =0. 0190, P ＜0. 0001 ). Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use ＜ 1 year group (6.45% vs 30. 51% ,P ＜0. 01). After stopping clopidogrel use, incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use ＜ 1 year group (2. 58% vs 20. 34% , P ＜ 0. 01 ) . Conclusion Primary percutaneous coronary intervention is an effective therapeutic method. Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use ＜ 1 year group. Duration of clopidogrel use may influence clinical outcomes in follow-up period in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

Objective To compare the application of two different definitions of MS (IDF2005 and ATP Ⅲ 2001)in this study population.Accroding to IDF2005.evaluate the impact of body fat content and its distribution for the risk of metabolic syndrome.Methods The sample of 818 subiects maseaure the simple anthropometric parameters including body mass index(BMI),waist circumference,waist-hip ratio (WHR),and so on. Body fat mass and distribution were measured by dual-energy X-ray abosorbtiometry (DEXA).Quatile method is used to analyse the relevance ratio of MS in different value of BF and TF.ROC curve is used in evaluating of tipping point of BF,TF,simple body composition parameters and reliability of diagnosis.The risk of MS were analyzed by logistic regression.Results According to IDF2005,when BF,TF≥P50.the relevance ratio of MS has a remarkable increasing(P＜0.01),its matching BMI is 24 and 23 kg/m2,according to NCEP ATPⅢ2001,when BF、TF≥P75,the relevance ratio of MS has a remarkable increasing,too(P＜0.01),its matching BMI value is 26 kg/m2,BF and TF of MS patients which diagnosed by IDF2005 are lower than ATPⅢ2001(P＜0.05).For each additional level of BF,the odds ratios of MS prevalence were 1.952(male) and 2.644(female);for each additional level of TF,the odds ratios of MS prevalence were 3.276(male) and 3.058(female),BMI,WHR were not into the equation.The AUCROC which used to evaluate the exist of MS by BF and TF is larger than 0.9.and has better performance in sensitivity and specificity than BMI and WHR;the best point of contact of MS in BF is 25%(male),35% (female),in TF is 30%(male),38%(female).Conclusion ATPⅢ standards may have been mi8Sed MS patients with normal high fasting blood glucose value and abdominal obesity.The applicaton of IDF2005 standards was proved better in this populatin.Compared with simple anthropometric parameters,the accmulation of body fat,especially trunk fat even more harmful,to is better to identify the risk of MS in Fuzhou adults population.

Objective To evaluate the concordance of human epidermal growth factor receptor 2 ( HER2) gene amplification in invasive breast cancer by the techniques of fluorescence in situ hybridization (FISH) and silver-enhanced in situ hybridization (SISH). Methods A prospective study of 63 invasive breast cancer specimens excised between May 2009 and November 2009 was conducted by automated immunohistochemistry ( IHC) staining and bright field automated SISH. HER2 gene status was also examined by FISH in 43 cases. An evaluation was performed according to the ASCO/CAP guidelines (2007). Results Among 63 breast invasive ductal carcinoma tested by automated SISH, 61 cases were successfully evaluated. Gene amplification was detected in 97% (29/30) HER2 protein expression positive (3 + ) cases and in 18% (2/11) equivocal (2 + ) cases. Two of 11 (18% ) HER2 expression 2 + cases were equivocal for gene amplification. In 43 cases examined by FISH, HER2 gene amplification was detected in 95% (20/21) HER2 expression positive (3 + ) cases and in one equivocal (2 + ) cases. Three of 10 (30% ) expression 2 + cases were equivocal for gene amplification. No gene amplification was detected in expression negative (1 +/0) cases by either SISH or FISH (0/20 and 0/12 respectively). The results of SISH and FISH were identical in 42 cases examined by the above two techniques, including 21 HER2 gene amplification positive, 2 equivocal and 19 negative cases. One case was FISH equivocal and SISH negative. And the overall concordance between FISH and SISH was 98%. Conclusions There is high concordance rate between SISH and FISH results for assessing the HER2 gene amplification status of excised breast cancer specimens.However,SISH has more advantages and it is particularly suited for routine application in surgical pathology.

Objective to investigate the anti-inflammatory ability of recombinant high-density lipoprotein (HDL) combined with apolipoprotein A-I cysteine mutants.Methods the endotoxemia mice model was constructed by lipopolysaccharide induction.Three kinds of cysteine mutants [A-I (S52C), A-I (K107C), A-I (R173C)] and wild-type apolipoprotein A-I combined with dipalmitoylphosphatidylcholine (DPPC) were selected as the intervention group (10 mice in each group), and the lipopolysaccharide group (9 mice) and the normal saline group (5 mice) were used as the controls.The effects of four kinds of recombinant high-density lipoproteins on tumor necrosis factor (TNF) α, interleukin (IL) 1 β and IL-6 after intervention were detected by enzyme-linked immunosorbent assay (ELISA). The lung tissues of each group were detected by pathology. Results 24 hours after injection, the serum TNF-α and IL-1 β in rHDL52 group were significantly lower than that in rHDLwt group

Objective To investigate the effect of oxygen free radicals on intestinal mucosal barrier in traumatic brain injury rats.Methods A total of 64 health male Wistar rats were divided randomly into two groups:traumatic brain injury(TBI)(n=32);Control group with sham operation(n=32).Each group was divided into four subgroups at 6,12,24 and 48 h post-operation(n=8).The levels of malondialdehyde(MDA),superoxide dismutase(SOD) and glutathione(GSH) were measured in intestinal mucosa,mesenteric lymph nodes,liver,spleen,pancreas,lung and kidney tissue.The marked bacilli were counted under a fluorescent microscope.Results The positive rates of bacterial translocation in TBI group were obviously hisher than those of control group(6 h:8.3% vs 2.1%,12 h:25.0% vs 2.1%,24 h:27.1% vs 2.1%.48 h:12.5% vs 0.0%,P＜0.05).The levels of MDA in TBI group were obviously higher than those of control group(6 h:4.9±0.7 vs 2.6±0.3,12 h:6.1±0.8 vs 2.8±0.5,24 h:5.9±0.4 vs 2.6±0.3,48 h:5.3±0.5 vs 2.7±0.4(nmol/mg pro),P＜0.05),and GSH (6 h:287±36 vs 408±53:12 h:192±25 vs 421±46;24 h:160±48 vs 432±35;48 h:241±31 vs 394±51(mg/g pro)P＜0.05).SOD(6 h:19.5±3.3 vs 21.1±1.9;12 h:11.8±2.6 vs 20.7±5.3;24 h:13.3±3.3 vs 20±3.3:48 h:15.1±1.5 vs 21.2±3.2(U/mg pro).P＜0.05)were lower than the control group at the same time point.Conclusions Bacterial translocation occurs obviously in TBI rats.It indicates that oxygen free radicals play important roles in stress-related changes of intestinal mucosal barrier in early stage of traumatic brain injury.

Objective To evaluate the efficacy of adenovirus vector-mediated murine interleukin-10 (mIL-10) gene transfer to rat beta cell-RINm5F cells in vitro and to explore the potential value of gene therapy in type 1 diabetes mellitus. Methods The recombinant adenovirus vector Ad-mIL-10 was constructed and transfected into RINm5F cells (Ad-mIL-10 group). Untransfected RINm5F cells and Ad-eGFP-transfected cells were used as controls. The expression of mIL-10 was examined by RT-PCR and Western blot The levels of IL-10 in supernatant were measured by enzyme-linked immunosorbent assay (ELISA). For a determination of insulin release, the cells were cultured with high glucose ( 16. 7mmol/L) for a 1 -hour co-incubation. Then radioimmunoassay was used to detect the level of insulin in supernatant After induction of IL-1β, the levels of nitric oxide (NO) and nitric oxide synthase ( NOS) were measured, the apoptosis of transfected cells was detected by Hoechst 33258 staining and Fas expression by flow cytometry. Results Both mRNA and protein of Ad-mIL-10 were successfully expressed in RINm5F cells. Expression of mIL-10 gene resulted in significant increases in insulin secretion in response to high glucose. Compared with uninfected control and Ad-eGFP infected group, Ad-mIL-10 infected group had decreased levels of NO and NOS induced by IL-lβ [ NO level ( nmol/106 cells): 52. 9 ± 3. 2 vs 227. 3 ± 26. 4, 235. 1 ±28.6, both P＜0.05; NOS level (U/106 cells): 9. 3 ±1.2 vs 29. 8 ±2.5, 30.5 ±2.8, both P ＜ 0. 05]. Furthermore, Ad-mIL-10 gene transfer led to a profound reduction of Fas-expressing islet cells under the induction of IL-1β. Fas-expressing islet cells in Ad-mIL-10 group were significantly lower than those in uninfected group and Ad-eGFP-transfected group (24. 6% ± 1.0% vs 33. 3% ± 5. 1% , 32. 6% ±1.1%) (P＜0.05).The apoptotic rates of Ad-mIL-10 group were lower in comparison with the other two groups (9.4%±1.1% vs 19.2%±2.2%,20.6%±2.3%,P＜0.05).Conclusions IL-10 gene transfer to islet beta cells may be beneficial in maintaining beta cells function,protecting islet cells from IL-1β-mediated apoptosis and promoting islet cells survival.It is a potential therapy for type 1 diabetes mellitus.

Objective To explore the early changes in serum neutrophil elastase(NE) in rats with burn.blast injury or combined bum-blast injury and its significance.Methors A total of 176 male Spragne Dawley rats were randomly divided into four groups:control(C),burn(BU),blast injury(BL) and burn-blast combined injury(BB).Rats in C group were not injured.Animals in BU group were subjected to 25% TBSA full-thickness burn on back with 94℃ water for 12 seconds;Animals in BL group were inflicted with moderate blast injury with 5g 8701 compressed dynamite stick as the explosion source 75 cm away while left chest facing the explosive source;Rats in BB group were burned immediately after the blot injury similarly as in BL group.During the first 24 h post-injury,animals in BU and BB groups received intraperitoneal bronchoalveolar lavage fluid(BALF),water content of lung tissue and NE content in serum were determined at 0 h(C group),3 h,6 h,12 h,1 d,2 d,3 d,7 d post-injury.Results Protein concentration in BALF,water content of lung tissue and NE content in serum in SD rats of the injured groups were significantly higher than those in C group(P＜0.01 or P＜0.05),peaked within 2 d post-injury,especially at 2 d post-injury(NE content in serum:BU group,319.85±19.50,ng/ml;BL group,467.43±31.64 ng/ml;BB group,626.00±26.38 ng/ml vs.C group,78.53±25.10 ng/ml).Overall,protein concentration in BALF.water content of lung tissue and NE content in serum in BB group were significantly higher than BU and BL groups(P＜0.01 or P＜0.05).Correlation analysis showed that within 3 d post-injury.a significant positive correlation was found between the protein concentration in BALF,water content of lung tissue and NE content in serum(r=0.7910,0.8078,P＜0.05) in BU group.NE content in serum and protein concentration in BALF were significantly positively correlated in BB group(r=0.8672,P＜0.05).Conclusion NE may play an important role in early lung injury of burn or blast injury,especially in combined bum-blast injury.

Objective To investigate the integrated effects of adipocytes on rat beta-cells, differentiated 3T3L1 adipocytes and rat islet cells co-culture system was established. Methods There were two groups; control group ( SD rat islet cells) and co-culture group (islet cells and 3T3L1 adipocytes co-culture system). Islet cells were obtained for determination of (1) insulin secretion and insulin content; (2) mRNA expressions of GLUT2, GCK and Kir6. 2; (3) protein expressions of IR-β, IRS-1 and their tyrosine phosphorylation leveL Results (1) At low glucose, insulin secretion of co-culture group increased compared with that of control group (0.79±0.35) ng·h-1 · ml-1 islet vs (0.38±0.09 ) ng · h-1 · ml-1 · islet, P = 0. 028 . At high glucose, insulin secretion of those two groups was almost at the same level (P =0.760). Compared with control group (2. 84 ±0.92) , stimulation index (SI, insulin release at high glucose/ low glucose) of co-culture system decreased to (1. 57 ±0. 61, P =0.04). And the insulin content of the both groups was almost at the same level (P=0.102). (2) The mRNA of GCK, GLUT2 and Kir6. 2 in co-culture group downregulated to (0. 27 ±0. 11, P = 0. 01) , (0. 34 ±0. 24, P = 0. 009) and (0.41 ± 0. 09, P = 0. 003) compared with control group (mRNA = 1). ( 3) The protein levels of IR-β, IRS-1 and their tyrosine phosphorylation decreased in co-culture system. Conclusions 3T3L1 adipocytes are involved in beta-cell dysfunction, which may facilitate the development of type 2 diabetes. The effects may be mediated by multiple pathways, which include downregulation of GSIS related gene expressions and suppression of islet cell insulin signaling.

Objective To investigate the mechanism of telomere shortening through 8-methoxypsoralen(8-MOP)and subsequent ultraviolet A(UVA)irradiation-induced photoaging model in human dermal fibroblasts(HDFs).Methotis Photoaging model was established by 8-MOP+UVA in skin HDFs.Flow cytometer.enzyme eytochemistry,immunofluorescence,Westem blot and Real-time PCR were employed.Results The percentage of G1 blockage of 8-MOP+UVA group were higher than that of control group at 24、48、72 h and 7 d(61.4%±1.5% vs 32.8%±1.5%.69.5%±2.2% vs 44.9% ±2.3%.88.2%±1.6% vs 59.8%±1.4%,90.7%±2.5% vs 68.5%±2.6%.all P＜0.01).The expression of SA-β-Gal of 8-MOP+UVA group were higher than that of control group at 24、48、72 h and 7 d(34.87%±0.59% vs 7.11%±0.78%,59.38%±0.46% vs 10.57%±0.47%.72.46%±0.98% vs 11.67%±0.87%,94.33%±0.13% vs 12.04%±0.12%,all P＜0.01).8-MOP+UVA treatment could significantly aggravate the oxidative DNA damages,the percentage of 8-oxo-dG positive cell of 8-MOP+UVA group(95.78%±0.14%)were significantly higher than that of control group(7.69%±0.09%,P＜0.01),8-MOP group(9.76%±0.11%,P＜0.01)and UVA group(35.29%±0.14%,P＜0.05).8-MOP+UVA treatment could accelerate the telomere shortening.the relative length of telomere of 8-MOP +UVA group were 2.57±0.05 lower than that of control group(6.63±0.12.P＜0.01).The levels of P53,P21WAF-1 and P16INK-4a of 8-MOP+UVA group were higher than that of control group(3.00±0.88 vs 0.54±0.10,2.50±0.51 vs 0.42±0.06,2.21±0.34 vs 0.38±0.05,all P＜0.01).Conclusion 8-MOP+UVA-induced photoaging of HDFs can be mediated though the regulation of telomere and subsequent P53-dependent signaling pathways.

The patient was a male, born in 1985. He was admitted to our hospital in September 2009 with "darkening of skin color for 11 years, fatigue, frequent urination and loss of sexual desire for 1 year". In 1998, his skin color turned dark all over his body without inducement, with more obvious pigmentation in areola, gums, dorsal side of finger joints and scrotum. There was no fatigue, nausea and vomiting, and no diagnosis and treatment was made.

From ancient times to present, doctors and patients are face-to-face, and they are close to each other. However, if the diagnosis of difficult diseases is unclear and the treatment plan is difficult to determine, the doctor will be helpless, and the patient will travel thousands of miles to seek a better doctor.