Volume 90  ·   Issue 32  ·  2010

Objective To explore the clinical effects of alprostadil injection on acute kidney injury (AKI) after cardiac surgical procedures by a prospective randomized controlled trial. Methods A total of 63 AKI-patients after cardiac surgical procedures were randomly divided into the control group (n=31) and the study group (n=32). All patients received routine therapy while patients in the study group were additionally given alprostadil injection (10 μg i. v. once every 12 hours) for 7 days. A 11-year-old patient weighing 29 kg was given half of the conventional dose. During the period of control treatment (7 days), 1patient in the control group and 2 patients in the study group were excluded because of hemodialysis or peritoneal dialysis. Urine volume, urine β-N-acetyglocosamidase, urine α1-microglobulin, urine β2-microglobulin, serum creatinine and blood urea nitrogen were measured before and after the control treatment. And the ICU stay duration and the percentage of dialysis after the control treatment were calculated. Adverse reactions of alprostadil injection were observed simultaneously in the study group.Results After the treatment, urine volume in the study group was obviously more than that in the control group [(65.9±3.1) ml/h vs (58.8±4.5) ml/h, P＜0.05] while urine β-N-acetyglocosamidase, urine α1 -microglobulin, urine β2-microglobulin, serum creatinine and blood urea nitrogen in the study group were obviously lower than those in the control group (all P＜0.05). The ICU stay duration in the study group was obviously less than that in the control group [(12±5)d vs (17±5) d, P ＜0.05]. But there was no significant difference in the percentage of dialysis after the control treatment between two groups (3. 3% vs 6. 7%, P ＞ 0. 05). And no serious adverse reaction was reported in the study group. Conclusion On the basis of routine therapy, alprostadil injection may promote the recovery of renal function in AKI-patients after cardiac surgical procedures.

Objective To determine the feasibility of preservation of intercostobrachial nerve (ICBN) in breast cancer. Methods During June 2004 to June 2006, 99 patients with operable breast cancer receiving an axillary lymph node dissection at our department were analyzed. The extirpated ICBN and ambient tissues were tested by HE staining to observe the pathological changes. Results In 96(96. 97% ) cases with ICBN sacrificing, the nerves were not violated microscopically and the nerve cells remained intact. Of 28 patients with axillary lymphadenectasis, only 3 cases (10.71%) were found to have tumor emboli in the peri-neural vessels. Conclusion The preservation of ICBN is a feasible and safe technique. The operative approach should be advocated. If at all possible, a surgeon should identify ICBN and preserve it.

Objective To determine if human paillomavirus (HPV) infection could be associated with the development of adenocarcinoma of esophagogastric junction (AEG). Methods A total of 106 consecutive AEG patients and 59 consecutive gastric carcinoma patients who accepted surgery at our department between January 2004 and December 2006 were selected. Specimens from tumors and uninvolved mucosa were obtained intra-operatively. Genomic DNA was extracted by the phenol-chloroform-isoamyl alcohol extraction protocol. The HPV infection was determined by PCR using primer set SPF1 and GP6 +.Specificity of the amplified products was confirmed by sequencing. Results The HPV infection rates in AEG and gastric cancer were 10.4% (11/106) and 10.2% (6/59) separately (P=0.966). Conclusion HPV is not a major factor in the carcinogenesis of AEG type Ⅱ , AEG type Ⅲ or stomach.

Objective To evaluate the effect of statin pretreatment on prognosis of octogenarian patients with coronary heart disease with percutaneous coronary intervention(PCI). Methods A total of 90 patients aged at 85 years old and over with coronary heart disease(CAD) undergoing stenting were enrolled.The duration of statin, hospitalization and one-year clinical follow-up outcome including all-cause mortality,major adverse cardiac event (MACE), stroke and other major hemorrhages were collected and analyzed.Results Among these patients, 33 ( 36.7% ) received a statin pre-treatment for at least 2 days and 57(63.3%) did not. Patients on a statin pre-treatment were more likely to have hypertension, hyperlipdemia and a history of myocardial infraction and PCI. The procedure characteristics were similar between two groups. Despite the higher risk profile, the patients on a statin pre-treatment had a lower hospitalization MACE rate(3.0%vs 10.5%, P = 0.05 ). However, at one year, the patients on a statin pre-treatment had a similar MACE rate(6.1% vs 3.8%, P =0.07) as the other group. Conclusion The statin pretreatment in octogenarian CAD patients with PCI may be associated with a reduced hospitalization MACE rate.

：Objective To examine theevaluative effect of preoperative transvaginal color Doppler sonography (TVCDS) screeningand phasing of endometrial carcinoma. Methods A total of 713jeopardized endometrialcarcinoma patients were screened by TVCDS. The investigators observed the endometriumform, focus location, size and echo, measured the endometrium thickness, judged theregularity and integrity of edge, the integrity of faint echo halos at the interfacebetween endometrium and muscularis and the blood flow inside focus, examined resistanceindex and determined endometrial carcinoma as well as muscularis infiltrating extent.According to the FIGO's phasing scheme in 1988, endometrial carcinoma was divided into Ⅰ , Ⅱ , Ⅲ and Ⅳ phases so as to compare the results of TVCDS in screeningand phasing of endometrial carcinoma with that of operative pathology. Results One hundredcases were diagnosed as endometrial carcinoma. Among which, 96 were proved by surgicalpathology as endometrial carcinoma. The rates of TVCDS screening and phasing coincidencewere 96% (96/100) and 94% (94/100) respectively. Conclusion The application of TVCDS maydiagnose and stage the cases of endometrial carcinoma. It is a valuable tool for selectingtherapeutic regimens and making prognostic evaluations.

Objective To analyze the long-term compliance of oral anticoagulant therapy and the demands of disease management in patient with atrial fibrillation (AF). Methods Inpatients with AF taking warfairn were collected from Department of Internal Medicine from January 1 to December 31,2008.Inpatients from departments of surgery, ophthalmology, otorhinolaryngology, dermatology and pediatrics and those on a previous warfarin therapy were excluded. The data of patient profiles, medical history and anticoagulant treatment were collected from electronic medical record. And the status of anticoagulant treatment one year later and demands of disease management were inquired by telephone. Results A total of 268 AF patients received a telephone survey. Among them, 145 patients (54. 1% ) continued taking warfarin. Gender, age, type of AF, duration of AF and history of ischemic stroke was not significantly associated with the compliance of anticoagulant treatment. The odds ratio was 1.74 ( 95% CI: 0. 67 -4.47), 0. 87 (95% CI: 0. 30 - 2. 53 ), 1.59 ( 95% CI: 0. 35 - 1.09 ), 1.09 ( 95% CI: 0. 61 - 1. 93 ) and 0. 44(95% CI: 0. 12 - 1.60 )respectively. Among patients on warfarin, INR was monitored monthly in 88 patients (60. 7% ) and 70 patients (48. 3% ) had an INR value of 2.0 -3.0. Among 123 withdrawal patients, 88 patients (71.5%) terminated treatment within 6 month. The common reasons included patient ignorance about long-term anticoagulant treatment ( 35.0% ) and switching to aspirin because of a poor effect (24. 4% ). About 80% of patients wished to obtain instructions about INR monitoring and adjustment of drug dosage. Among them, 196/268 patients (73.1%) wished for a regular follow-up. And 176/196 patients (89. 8% ) opted for a telephone follow-up and 150/176 patients (85.2%) wanted to receive monthly instructions. Conclusion The compliance of anticoagulation treatment and the target-meeting proportion of INR value are relative low. And the common reasons of withdrawal are patient ignorance about long-term anticoagulant treatment and switching to aspirin because of a poor effect. Disease management will meet most of AF patients' demands.

Objective To analyze the influence of Bw4 motif carried by HLA-A, B loci on CD4 T cell count and viral load of primary HIV infectors. Methods The technique of SSP-PCR was employed to detect the HLA-A, B allele typing in 95 HIV infectors. And the roles of Bw4 motif carried by HLA-A, B loci on CD4 T cell count and viral load were analyzed. Results ( 1 ) The population frequency of HLA-A, B loci carrying Bw4 motif was respectively 32. 6% (31/95) and 60. 0% (57/95). The population frequency of Bw4/4, Bw4/6, Bw6/6 located on HLA-B was 21.1% (20/95), 38.9% (37/95) and 40.0%(38/95) respectively. (2)Compared with those with CD4 T cell count less than 500/μl, more Bw4 motifs were expressed on HLA-A, B loci of patients with CD4 cell count more than 500/μl (mean rank,56. 7 vs 41.6,U=749. 5, P＜0. 01 ). Moreover, the fewest infectors were those with HLA-A, B carrying 3 Bw4 motifs and CD4 T cell count fewer than 500/μl( 1 case). And secondly were those with HLA-A, B carrying 0 or 3 Bw4 motif and CD4 cell count more than 500/μl (7 cases,x2 = 12. 6, P ＜0. 01 ). (3)The infectors with HLA-A, B loci carrying 3 Bw4 motifs had more CD4 T cell count( median: 65 1/μl)and less viral load (lg median: 3.43 ) than those with HLA-A, B carrying 0 or 1 Bw4 motif(430 and 425/μl,4. 48 and 4. 40).And the difference was significant (all P ＜0. 05 ). However, the CD4 cell count and viral load between the patients with HLA-A, B carrying 2 Bw4 motifs and 3 Bw4 motifs were insignificantly different (P ＞0. 05).(4) Irrespective of Bw4 motif on HLA-A locus, the infectors HLA-B carrying Bw4/4 homozygote had more CD4 cell count (median: 538/μl) and less viral load (lg median: 3.53) than those carrying Bw4/6 heterozygote or Bw6/6 homozygote ( 433/μl and 427 /μl,4. 29 and 4. 48, all P ＜ 0. 05 ) . However,irrespective of Bw4 motif on HLA-B, the CD4 cell count and viral load were insignificantly different between the infectors HLA-A carrying Bw4 motif and non-Bw4 motif. Conclusion Bw4 motifs can increase the CD4 cell count and decrease the viral load of patients with primary HIV infection. Maybe Bw4/4 homozygote on HLA-B plays a role of delaying the disease progression.

：Objective To analyze thehuman leukocyte antigen complex class Ⅰ(-A, -B &-C)and class Ⅱ (-DRB1& -DQB1) linked haplotypes of Guangdong Han nationality and to study the recombinationevents of five classical loci in the inheritance of HLA haplotypes. Methods A total of 939peripheral blood samples were collected from 198 families in Guangdong Han nationality whocame to our center for HLA typing from 2000 August to 2009 December. HLA-( A, B & DRB1) and HLA-( C & DQB1 )alleles were typed by low-resolution polymerase chainreaction-sequence specific oligonucleotide probes (PCR-SSO) and PCR-sequence specificprimers (PCR-SSP) methods respectively. Then the recombination sites were analyzed byfamilial study. The samples of 52 individuals from the families with exchangerecombination were analyzed by the sequence-based typing (SBT) to judge whether therecombination was interallelic or interlocus exchange. Results Among 543 offspringindividuals of 198 families in Guangdong Han nationality, 9 individuals withHLA-A-C-B-DRB1-DQB1 linked haplotypes had a recombination rate of 1. 657%. Among 9 HLAhaplotypes recombined families, 3 of them were found to have a crossover between HLA-A and-Cw loci and 6 of them a crossover between HLA-B and -DRB1 loci. Four of theserecombination events occurred in the most common haplotypes A * 3303-Cw * 0302-B *5801-DRB1 * 0301-DQB1 * 0201of Guangdong Han nationality. Among 9 cases of recombination,5 of them were formed by a crossover between maternal chromosomes and 4 cases a crossoverbetween paternal chromosomes. Three individuals with an exchange between A/Cw loci wereall females. Among 6 cases with an exchange between B/DRB1 loci, 5 of them were males and1 case was female. Conclusion During the inheritance, recombination of HLA linkedhaplotype mainly occured between A /Cw loci and B/DRB1 loci, the recombination is relatedto the haplotype-specificity and sex-specificity.

Objective To evaluate the diagnostic value of NT-proBNP in patients with aortic stenosis (AS) , analyze the relation of NT-proBNP to NYHA functional class and echocardiographic findings. Methods Measured the whole venous blood of NT-proBNP with enzyme linked immuno sorbent assay in 40 aortic stenosis patients ( AS group) and 76 normal subjects ( control group). We assessed the diagnostic value of NT-proBNP for aortic stenosis, and related NT-proBNP to clinical NYHA functional class and echocardiographic findings. Results Compared to controls, NT-proBNP levels had significantly higher in patients with aortic stenosis ( P ＜ 0. 01 ). The level of NT-proBNP was gradually and significantly increased with the NYHA functional Ⅱ , Ⅲ and Ⅳclass compared to controls (all P ＜0. 01 ). NT-proBNP was significantly (3.5 times) higher in mild/moderate stenosis group than that in control group(2. 95 ± 0. 48 vs 2.63 ±0. 10, P ＜0. 05), and was significantly (6.0 times) higher in severe stenosis group than that in control group(3.16 ±0. 50 vs 2. 63 ±0. 10,P ＜0. 01 ). LVMI was significantly ( 1.7 times) higher in mild/moderate stenosis group than that in control group( 169 ±51 vs 100 ±22, P ＜0. 01 ), and was significantly (2.1 times) higher in severe stenosis group than that in control group(212 ± 86 vs 100 ± 22, P ＜ 0. 01 ).The NT-proBNP values of 1150 ng/L and 1356 ng/L were determined as the best cutoff values for the diagnosis of patients with mild/moderate ( AUC = 0. 657, P ＜ 0. 05 ) and severe aortic stenosis ( AUC = 0. 848,P ＜0. 01 ), the sensitivity, specificity and accuracy were 61.11% and 77. 30% ,69.74% and 96. 10%,68.09% and 91.80%. Log(NT-proBNP) was significantly positively related with LVEDD, LVMI and mean transvalvular pressure gradient(MTPG) ( all P ＜ 0. 05 ), and negatively related with LVEF ( P = 0. 01 ) in univariate analysis. In multiple regression analyses, NYHA functional class, LVEF and Log(MTPG) was independently associated with NT-proBNP. Conclusion NT-proBNP is valuable for the diagnosis of patients with aortic stenosis. NT-proBNP has correlation with the heart function and severity of the aortic stenosis.

：Objective To study theeffect of pioglitazone, a synthetic peroxisome proliferator-activated receptorγ (PPARγ) agonist, on theRANKL-mediated osteoclastogenesis of osteoclast precursor cells, and to explore thefunction and mechanism of PPARγ in the osteoclastdifferentiation. Methods Pioglitazone treatment of RAW264. 7 murine macrophages werecompared with those of simply cultured control and RANKL-mediated control. Accordingly,the RANKL-mediated cells were cultured with 30 ng/ml RANKL, then induced into significantmultinuclear osteoclast formation. And pioglitazone treated cells were exposed to 10μmol/L pioglitazone during the process of osteoclast differentiation under RANKL.The number of mature osteoclasts was calculated and the mRNA levels of RANK analyzed byreal-time quantitative PCR. Results Pioglitazone significantly inhibitedosteoclastogenesis of osteoclast precursor cells, the number of mature osteoclasts ofpioglitazone treated group was (176± 58 )/cm2 and significantly less than the maturecells of RANKL induced group which number was (322 ±74)/cm2 (P＜0.01);and pioglitazone also significantly inhibited the mRNA expression of RANK, a typicaldifferentiated fator of osteoclast, the number of the mRNA expression of RANK ofpioglitazone treated group was 2.16 ±0.74 and significantly less than the number of RANKLinduced group(4.94 ±0.39,P＜0.01). Conclusion PPARγ agonist inhibited thedifferentitation of RAW264.7 towards osteoclast. It might be due to the suppression ofRANK gene expression in the process of osteoclast differentiation.

Objective To investigate the potential effect of uremic medium on cell proliferation and apoptosis of aortic endothelial cell (AEC), two key processes in the development of atherosclerosis, in rabbit culture. And to understand the effects of uremic medium on the activation of nuclear factor-kappa B (NF-κB) pathway and cytokines expression of AEC. Methods Rabbit AEC were cultured with growth media supplemented with pooled sera from normal rabbits or those with chronic renal failure. The 80%confiuent AEC were incubated for 24 h with media supplemented with pools of control or uremic sera. Cell proliferation was assessed by a MTT assay and cell cycle detected by flow cytometry. Hoechst33342 assay and flow cytometry were used to investigate the apoptotic effect of uremic medium in AEC. The expression of mRNA and protein levels for NF-κB, IκBα were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot. NF-κB P65 nuclear translocation was analyzed by immunofluorescence. The activity of NF-κB was measured by electrophoretic mobility shift assay (EMSA). Concentrations of TNF-α and IL-6 in culture supernatants were evaluated by ELISA, and the expression of protein for TNF-α in cell lysates by Western blot. Results Uremic medium induced proliferation in the lower concentration range of 3%-10% while promoted apotosis in the higher concentrations (＞10%). Uremic serum increased NF-κB mRNA (0.35 ±0.05 vs 0.26 ±0.02, P＜0.01) and protein (1.67 ±0.15 vs 0.41 ±0.05, P＜0.01)expression, decreased IκBα mRNA (0.13 ±0.03vs 0.24 ±0.04, P＜0.01) and protein (0.29 ±0.06 vs 0.65 ±0.08, P＜0.01 ) expression. Uremic serum enabled NF-κB p65 nuclear translocation and increased NF-κB DNA binding activity. An increased secretion of cytokines IL-6 and TNF-α. in AEC was observed after a treatment of 10% uremic sera in a time dependent manner. The expression of TNF-α in AEC exposed to 10% uremic sera also increased significantly (0.37 ± 0.04 vs 0.14 ± 0.03, P＜0.01). Conclusion Uremic medium induces the activation of AEC. A lower level of uremic medium accelerates the proliferation of AEC while a higher level induces the apotosis of AEC. The increased proliferation may be related to a higher NF-κB activity and the expression of inflammation cytokines. Although the enhanced atherosclerosis can not be explained on the basis of an apoptotic process, the proliferative status can contribute to intimal proliferation, an earlier step in the development of atherosclerosis.

Objective To investigate the apoptosis-inducing effect of peroxisome proliferator-activated receptor γ (PPARγ) agonist ciglitazone (CGZ)on leukemic HL-60 cells and its mechanisms of action. Methods HL-60 cells in vitro culture medium were subject to different concentrations of CGZ (10-50 μmol/L) for 24, 48 and 72 h. MTT assay was used to detect the cell inhibitory rate and agarose gel electrophoresis to observe DNA fragmentation. Flow cytometry (FCM) and Annexin V/PI staining were used to detect CGZ and/or GW9662 ( PPARγ antagonist)-induced cell apoptosis. The expression of PPARγ was examined by RT-PCR and Western bloting. The caspase-3 and protein levels in mitogen-activated protein kinase signaling pathways (MAPKs, p-P38, p-ERK and p-JNK) were also detected. Results CGZ (over 30 μmol/L) could inhibit the growth of HL-60 cells in both time- and dose-dependent manner. After treatment for 72 h, the cell growth inhibitory rate in 50 μmol/L CGZ (84% ± 11% ) treated cells was found more higher than that in both 40 μmol/L and 30 μmol/L CGZ treated cells (72% ± 13% ,59% ± 13% ,P ＜0.01 ) and a typical DNA ladder was also observed by agarose gel electrophoresis. The expression of PPARγ was gradually up-regulated by CGZ treatment and could be down-regulated partially by PPARγ antagonist GW9662. The results also revealed that CGZ-induced cell apoptosis(49.7% ,72 h)could not be inhibited thoroughly by GW9662 ( 36. 2%, control: 3.2% ). It indicated that the CGZ-induced cell apoptosis was partially PPARγ-independent. Western bloting showed a cleavage of caspase-3 zymogen protein and upregulation of p-P38 protein. Thus it indicated that the activations of caspase-3 and P38 MAPK were involved in CGZ-induced cell apoptosis. Conclusion CGZ inhibits cell growth by induction of cell apoptosis in HL-60 cells via PPARγ dependent and independent signaling pathways. The activations of caspase-3 and P38MAPK may be one of the important mechanisms in CGZ in treated HL-60 cells.

Studies have shown that about 50% of DNA sequences in human genome can be transcribed into RNA, but 98% of RNA cannot be translated into protein [1]. The large amount of non-coding RNA produced during the transcription process was once considered useless "junk" [2]. However, since RNA interference was discovered in 1998 [3], more and more attention has been paid to the regulation of gene expression mediated by non-coding small RNA (ncRNA). Up to now, there is no clear definition of non-coding small RNA.

With the continuous development of biotechnology, the universality and importance of circulating tumor cell (CTC) phenomenon have gradually been paid attention to in the clinical practice of tumor. Now it has become one of the excellent evaluation indexes of survival time and survival rate of breast cancer patients, and it can also promote and accelerate the development of clinical chemotherapy drugs and the invention of tumor vaccines.

Vitamin D is a group of fat-soluble steroid derivatives, which can not only regulate the balance of calcium and phosphorus in organisms, maintain bone homeostasis, but also have many functions such as anti-tumor, regulating immunity, preventing and treating metabolic syndrome.

According to statistics, there are about 645 000 new cases of head and neck cancer every year in the world, which has become the sixth highest incidence cancer in the world. Most of the patients are diagnosed as advanced and accompanied by secondary tumors.

Condylar fracture is one of the most common types of mandibular fracture. If condylar fracture is not treated in time or improperly, a series of complications will occur. Children may have developmental deformity of the jaw, some patients may have malocclusion and limited opening of the mouth, and the most serious complication is temporomandibular joint ankylosis.

A 36-year-old male was found to have cystic mass in the upper abdomen during physical examination half a month ago. He was not accompanied by heartburn, pantothenic acid, belching, vomiting, hematemesis, melena, fever and upper abdominal discomfort. He was admitted to hospital without emergency. Since the onset of the disease, his diet, sleep, urine and stool were normal. He denied the history of hepatitis, tuberculosis and diabetes. He denied the history of trauma and abdominal surgery. He denied the history of long-term epidemic area and contact with epidemic water. He denied the familial and hereditary history. Physical examination: body temperature: 36.6 ℃, heart rate: 84 beats/min, breathing: 19 beats/min, blood pressure: 140/70mmHg (1 mm Hg =0.133 kPa).

A 57-year-old female was admitted to hospital for the first time on January 2, 2008 due to headache, anorexia, fatigue for 1 month, polydipsia and polyuria with fever for 2 weeks. Before admission, the patient developed headache, anorexia, nausea, polydipsia and polyuria with fever, drinking water and urine volume exceeded 6 L daily, body temperature 38-39℃, no cough, sputum, abdominal pain, diarrhea, urgency, pain in urination, no visual acuity and visual field changes.

A 35-year-old female was admitted to the hospital on April 10, 2008 due to intermittent abdominal pain for 1 1/2 years, aggravated with fever for 3 months. The patient developed persistent dull pain in the right lower abdomen without obvious trigger in August 2006. On abdominal and pelvic CT, the patient showed splenomegaly, dilation of the right renal pelvis, calyx and hydroureterus, considering external pressure lesions, atrophy of the right kidney; multiple enlarged lymph nodes in the pelvic cavity ". Renal blood flow diagram showed that the right kidney had poor blood perfusion, serious impairment of function, and poor drainage of the right upper urinary tract". After 3 months of treatment with traditional Chinese medicine, the abdominal pain was relieved.