Volume 90  ·   Issue 44  ·  2010

On September 24th, 2010, the 10th National Annual Conference of Vascular Surgery was held in Nanjing, and the first National Symposium of Vascular Surgery was held in Yantai in 1987, and the annual conference was held every two years until 1993. In less than 30 years, the rapid development of vascular surgery in China has not only the achievements of contemporary young and middle-aged backbones, but also the unremitting efforts of several generations of predecessors. Endovascular technique, a striking symbol of the rapid development of modern vascular surgery, not only leads vascular surgery into a brand-new period, but also expands the scope and area of diagnosis and treatment of vascular diseases. It has become the central content and discussion focus of every academic conference today, and it is also the treatment method that patients with vascular diseases ask and seek when seeking medical treatment.

Objective To explore the perioperative experience of heart valve replacement in Xinjiang area. Methods A total of 913 cases underwent heart valve replacement in moderate hypothermia under cardiopulmonary bypass surgery in Xinjiang area. The clinical characteristic, indications and treatments of the patients were analyzed retrospectively. Results Among all cases, the overall recovery was 868 (95.1% ) cases. And 45 (4.9%) patients died of postoperative complications. The mortality had significant differences between different age groups and different NYHA classification groups. And there was no significant difference between different operation time groups and different cardiothoracic ratio groups.Conclusion Valve replacement surgery is still an effective therapy for valvular diseases in Xinjiang area.Enhancing preoperative care for elders and patients with poor cardiac function can decrease the perioperative complications and mortality rate so as to improve the surgical efficacies.

：Objectiye To providetheoretic rationales for treatment and prevention of staghorn calculi by analyzing stonecomposition and studying the relationship between stone and urinary tract infections.Methods The clinical data of 51 staghorn calculi patients were analyzed retrospectively.The stone compositions were studied by infrared spectrophotometry. Results Six types ofstone compositions were obtained. There were calcium oxalate monohydrate, calcium oxalatedehydrate, carbonate apatite,magnesium ammonium phosphate hexahydrate, uric acid andL-cystine. The majority of stones were of mixed compositions, pure stones were found in 15cases (29. 4% ). Among all stones, calcium oxalate stones were found in 41 cases (80. 4% )and uric stones in 10 cases ( 19. 6% ). Infectious stones were found in 26 cases (51.0%).Urinary tract infections were found in 40 (78.4%) patients and positive urine/stoneculture was detected in 33 ( 64. 7% ) patients. Conclusion With multiple crystallinecompositions and etiological factors, the staghorn calculi are closely correlated withurinary tract infections.

Objective To investigate and analyze the clinical features in patients with histiocytic necrotizing lymphadenitis (HNL). Methods A total of 68 HNL patients at our hospital between the years of 1999 to 2009 were enrolled. The clinical data were collected from the hospital records and the relevant literature was reviewed. Results HNL mainly affected young people with an average age of( 19 ± 13 ) years old and a female-to-male ratio of 1: 1. All patients had lymphadenectasis. And 95.6% patients (65 cases) were feverish and 36. 8% patients ( 25 cases ) had mild hepatosplenomegaly; 25.0% ( 17 cases ) upper respiratory symptoms such as sore throat and cough; 14. 7% (10 cases)skin rash in their history; 51.5% (35 cases) leucopenia; 25.0% ( 17 cases) hepatic dysfunctions; 72. 1% (44/61) elevated erythrocyte sedimentation rate (ESR); 11.1% (6/54) positive antinuclear antibody (ANA). The final diagnosis of HNL was confirmed by pathological examination and immunohistochemical staining of biopsy specimens. And 34 (50. 0% )patients received glucocorticoid for 2 weeks to 3 months. Seven ( 10. 3% ) patients relapsed in which glucocorticoid was effective. Of 6 patients with positive ANA, one case was complicated with systemic lupus erythematosus (SLE) and another case diagnosed with SLE at 2 years after HNL Conclusions The clinical manifestations of HNL lack specificity so that it can be easily misdiagnosed. While the etiology of HNL remains elusive, the histopathological examination of affected lymph nodes has contributed greatly to the final diagnoses of HNL. Glucocorticoid therapy is recommended for treatment. Generally, HNL has an excellent prognosis but it often relapses. It should be noted that HNL may coexist with SLE or evolve ultimately into SLE.

Objective To investigate the correlation factors of ethylenediaminetetraacetic aciddependent pseudothrombocytopenia (EDTA-PTCP) in cancer patients. Methods The potential correlation factors of EDTA-PTCP such as gender, age, case history, tumor types, therapeutic drugs and duration of EDTA-PTCP from cancer patients were analyzed based on the patient records from October 2007 to September 2009 at our cancer center. Results A total of 49 EDTA-PTCP cases from a pool of 55 000 cancer patients were collected. No correlation was found with gender( male 49. 0%, female 51.0% ), concurrent hypertension(20. 4% )/diabetes( 10. 2% ) or cancer types( 1 - 11 cases each type). EDTA-PTCP appeared at pre-therapy ( n = 13 ) and post-therapy ( n = 36). Eleven cases( 30. 6% ) were chemotherapy, 5 cases ( 13.9% ) were radiotherapy plus chemotherapy, 15 case(41.7% )were tumor resection, 5 cases( 13.9% ) were interventional therapy in 36 patients whose EDTA-PTCP appeared post-therapy. The mose frequence use in chemotherapy patients was dexamethasone(87. 5%, 14/16), and in surgery patients was penicillin antibiotics(75.0%, 15/20). And its frequency was once ( n = 18) and more than twice ( n = 31 ). If the subjects were divided into 2 groups of non-treatment plus surgery and chemotherapy plus intervention on the basis of treatment course, there was a significant difference between two groups in proportion of patients whose duration of EDTA-PTCP ≤2 weeks (89. 3% vs 47. 6% ,x2 = 10. 22, P ＜0. 01). Conclusions The incidence of EDTA-PTCP in cancer patients may be associated with therapeutic drugs, but not probably with gender,concurrent hypertension/diabetes, tumor types or therapeutic regimens. Duration of EDTA-PTCP may be associated with the treatment course.

Objective To summarize the epidemiology and risk factors of deep venous thrombosis (DVT) during pregnancy and develop therapeutic strategies. Methods Twenty-nine pregnant women with DVT were admitted into our hospital between 1991 and 2010. And their clinical data were retrospectively reviewed. Results Among all cases, the occurrence (69%, 20/29) of DVT in the first trimester was highest as compared with those in the second and third trimesters. A previous history of DVT was a leading risk factor ( 24%, 7/29 ) . Twenty-four cases ( 82. 8%, 24/29 ) involved left lower extremities.Anticoagulation was the primary therapy. All cases were initially intravenously administrated with unfractioned heparin (UFH) or injected subcutaneously with low-molecule-weight heparin (LMWH).LMWH continued throughtout pregnancy in 7 cases. The fetus had a normal development. Due to financial problems, 11 cases in the first trimester and 2 cases in the second trimester switched to oral warfarin from LMWH after the initial treatment. And warfarin was substituted by LMWH by Week 34. However the fetuses died in 4 cases while the other fetuses were normal. Nine cases in the first trimester decided to terminate pregnancy. Conclusion Treatment decisions during pregnancy carry potential implications for both maternal and fetal health and life. Therefore the DVT strategies during pregnancy differ from those during nonpregnancy. Special cautions should be exercised for the treatment of DVT during pregnancy.

Objective To investigate clinicopathological characteristics of male breast cancer patients and women breast cancer patients, compare disease-free survival and overall survival in a group of matched men and women with breast cancer. Methods The clinical data and survival status of 45 cases operable male breast cancer treated in our hospital from 1982. 9 to 2006. 12 were collected. Each man with breast cancer recorded in the database was matched with two women. Matching was done based on age, year of diagnosis, stage and pathology. SPSS16. 0 software was used for statistic treatment. Chi-square test was used for the comparison of frequency data between groups. Kaplan-Meier method was applied to analyze survivals. And Log-Rank was used to compare curves between groups. Statistical significance was considered at P ＜ 0. 05. Results The 45 male breast cancer patients were matched with 90 female patients. The median age at diagnosis was 59 (26 ～ 75 ) years for men and 57 (22 ～ 76) years for women. The median follow-up was 61(5 ～262) months for men and 71 (29 ～283) months for women. Mass location, receptor status, chemotherapy and hormonal therapy were statistically significant between male BC and female BC groups. About male BC patients, monofactorial analysis showed tumor size, lymph node state and TNM stage were prognostic factors. The 5-year disease-free survival of male BC and women BC were respectively 62. 3% and 78. 8%, 10-year DFS were 35.3% and 45.3% ;The 5-year overall survival of male BC and female BC were respectively 70. 5% and 82. 5% ,10-year OS were 42. 8% and 62. 4%. Conclusions After the matching of age, year of diagnosis, stage and pathology, the prognosis for men with breast carcinoma is significantly poor comparing with women. We should play more emphasization on early diagnosis and early therapy, and think highly of chemotherapy and hormonal therapy to improve the prognosis of male BC patients.

Objective To compare the safety and efficacy of Doppler-guided hemorrhoidal artery ligation and operative procedures for prolapse and hemorrhoids. Methods Ninty-two cases with a diagnosis of hemorrhoids from June 1, 2006 to June 1, 2008 at our hospital were collected and divided into the observation group (A, n = 40 ) and the control group (B, n = 52 ). They received Doppler-guided hemorrhoidal artery ligation and operative procedures for prolapse and hemorrhoids respectively. The efficacy of two groups was compared with regards to efficacy, operative duration, postoperative pain score,postoperative analgesic use, postoperative complications, hospitalization duration, recovery time, total treatment expenditure, patient satisfaction and 1-year follow-up. Results After treatment, two groups demonstrated similar profiles of efficacy, operative duration, patient satisfaction and the relapsing rate at 1 year. Group A was obviously better than Group B. with regards to recovery time, hospitalization duration and total treatment expenditure. Furthermore the incidence of such complications as postoperative pain, urinary retention, anal bulge, hemorrhage, perianal infections, anal edema and anal fissure was lower. Conclusion Doppler-guided hemorrhoidal artery ligation has many advantages, such as safety, effectiveness, less trauma, a quick recovery, less treatment expenditure and a lower incidence of complications. Thus it is worthy of a wider popularization. However, its long-term effect remains to be seen.

Objective To evaluate the therapeutic efficacy of duodenum-preserving pancreatic head resection (DPPHR) for severe chronic pancreatitis (CP). Methods From February 2004 to March 2010,duodenum-preserving resection of pancreatic head was performed in 21 patients with severe CP. A "modified-DPPHR" was carried out in 14 patients of them and a "Frey's DPPHR" in the other 7 patients.The values of fasting plasma blood (FPB), oral glucose tolerance test ( OGTT), body weight ( BW), visual analogue pain intensity scale ( VAS score) and the quality of life indices were evaluated before and 6th month after surgery. Results There was no hospital mortality. The complications from adjacent organs were resolved definitively. Pancreatic fistula was the major and the most frequent morbidity occurring in 23. 8% of the patients. After operation 85.7% of the patients were completely pain-free and 14. 3% had continuing abdominal pain. The VAS score decreased more after surgery comparing with before and there was a significant difference (81.1 ±5.6 vs 7. 8 ±3.6, P ＜0. 05). The value of FPB in post-operative patients was similar to that in pre-operative ones and there was no significant difference [ (5.3 ±0. 4) mmol/L vs (5.4 ±0. 4) mmol/L, P ＞ 0. 05 ]. The value of 2 h-OGGT in post-operative patients was also similar to that in preoperative ones and it did not differ significantly [ (8.0 ± 0. 6) mmol/L vs (7. 9 ± 0. 6) mmol/L, P ＞ 0. 05 ].After operation 77.8% of patients gained more than 5% of their pre-operative body weight with a mean increment of (4. 8 ± 0. 7) kg (58.8 ± 1.8 vs 53.9 ± 2. 0, P ＜ 0. 05). A significant rise of the overall quality of life index was observed after surgery (78. 1 ± 7. 3 vs 61.0 ± 6. 2, P ＜ 0. 05 ). Conclusion DPPHR is both safe and effective with regard to pain relief, a definitive control of complications affecting adjacent organs and an improvement of overall quality of life. It leads to no further deterioration of pancreatic functions

Objective To compare the difference of clinicopathological characteristics between colorectal signet-ring cell carcinoma and mucinous adenocarcinoma. Methods The clinicopathological and survival data of 65 patients with colorectal signet-ring carcinoma and 166 with mucinous adenocarcinoma were retrospectively analyzed. Results Such clinical characteristics as gender, goss anatomical classification,preoperative carcinoembryonic antigen level and hepatic metastasis or not had no significant difference between two groups ( P ＞ 0. 05 ) while the difference of such characteristics as age, location of tumor,vascular tumor embolus, N stage, T stage, AJCC stage, preoperative obstruction and the ratio of radical resection between them was significant (P ＜ 0. 05 ). The overall 3, 5-year survival of the whole group was 56. 7% and 31.6% respectively. The 3, 5-year survival and median survival time (MST) in the signet-ring cell carcinoma and the mucinous adenocarcinoma groups were 33. 1 %, 14. 8%, 24. 0 months and 64. 1%,36. 6%, 41.5 months respectively. The pathological type of signet-ring cell carcinoma was an independent risk factor of survival in the whole group. Conclusion Compared to colorectal mucinous adenocarcinoma,signet-ring cell carcinoma has a higher degree of malignancy and the patients have a worse survival.

Objective To investigate the activation of TLR4/NF-κB signaling pathway and the level of inflammation in volunteers with varying degrees of metabolic disorders and the effect of intervention by TLR4 monoclonal antibody. Methods THP-1 cell line was cultured with 10% serum of volunteers with various degrees of metabolic disorders(each 10 cases) for 24,48 h. TLR4 and NF-κB p65 phosphorylation protein were measured by Western blot. TLR4 mRNA was measured by RT-PCR. The expression of IL-1 β and TNF-α were detected by ELISA. Results The TLR4 mRNA and protein, the level of NF-κB p65 phosphorylation protein in THP-1 cell line and IL-1β and TNF-α expression in culture supernatant in normal, simple obesity, obesity with hyperglycemia, obesity with hyperlipidemia, obesity with three metabolic disorders groups had statistical significance( P ＜ 0. 05 ). The TLR4 mRNA and protein, the level of NF-κB p65 phosphorylation protein and the IL-1β and TNF-α expression in obesity with three metabolic disorders group were higher than those in other group, and those were time-dependent ( P ＜0. 05 ). TNF-α expression in normal, simple obesity, obesity with hyperglycemia, obesity with hyperlipidemia, obesity with three metabolic disorders group at 48 h were (222 ± 32), (246 ± 52 ), ( 322 ± 32 ), ( 322 ± 34) and (490 ±83) ng/L, respectively, IL-1β(ng/L)were (94 ± 19), ( 133 ± 19), ( 174 ±22), ( 180 ±30), (279 ±38) (P ＜0. 05). Conclusions The activation of TLR4/NF-κB signaling pathway on THP-1 cell line which is cultured by serum with various degrees of metabolic disorders is different, with the increasing of severity of metabolic disorders, TLR4/NF-κB signaling pathway activation levels also incr.

Objective To study the expression of non-coding RNA HULC in different rumor cell lines and its effects on the expression of neighboring genes. Methods The expression levels of HULC were detected in different tumor cell lines. And the neighboring genes of HULC were searched by bioinformatics.Then its effects on the neighboring genes were examined by real-time polymerase chain reaction (PCR).Results The expression levels of HULC RNA were detected in the 293T, EC9706, KYSE150, HCT116,SMMC-7721, HepG2, H446 and H1299 cell lines. Non-coding RNA HULC was specifically highly upregulated in hepatocarcinoma cell line HepG2. Little coding genes existed around HULC gene ( ＜ 1000 bp) and the nearest coding gene was SLC35B3 at 200 000 bp away from the location of HULC gene. The SMMC-7721 cell line had a low endogenous expression of HULC gene. In comparison with SMMC-7721 cell line, the expression of SLC35B3 gene in HepG2 cell line was higher [ (0. 477 ± 0. 040) % vs (0. 129 ± 0. 004) %, P ＜0. 01 ]. The exogenous expression of HULC had little effects on SLC35B3 gene. But knocking down the expression of HULC gene by siRNA attenuated the expression of SLC35B3 [ siA (0. 283 ± 0. 007 )%, siB (0.387±0.015)%,control(0.477 ±0.042)%]. Conclusion The specifically up-regulated non-coding gene HULC in HepG2 cell line has some effects on the expression of its neighboring gene SLC35B3.

A 5-year-old and 7-month-old child went to the Department of Endocrinology of Peking Union Medical College Hospital on October 8, 2007 due to enlargement of penis and accelerated height growth for one year.The child showed obvious enlargement of penis and increased erection frequency, accompanied by accelerated height growth, about 12 cm/year.The pubic hair growth and deepening of voice appeared in the past 8 months. No spermatorrhea, headache, polydipsia, polyuria and limb mobility impairment.He denied taking nutritional supplements and exogenous sex hormones.He went to another hospital in April 2007. Physical examination in another hospital showed that he was 124 cm tall (average height of the same age and sex +2.2 SD), weighed 30 kg, no milk caffeina spots and obvious pigmentation on the skin, initial appearance of Adam's apple, moderate voice change, no beard growth, left/right testis =4 ml/4 ml, medium texture; Tanner stage: bilateral breast B1, pubic hair P3, penis length 6 cm.

MicroRNA (miRNA) is an endogenous non-coding RNA, which can express original miRNA transcripts (pri-miRNA). Larger primiRNA is processed into single-stranded miRNA precursors by an endonuclease III (Drosha) and cofactor Pasha (containing a double-stranded RNA binding region). Subsequently, the single-stranded miRNA precursor with hairpin structure is cleaved into about 22 nt miRNA by double-stranded RNA specific endonuclease (Dicer) in the cytoplasm. One single strand of the mature miRNA binds to RNA-induced silencing complex (RISC) to form RISC complex.

p53 gene is one of the tumor-related genes widely and deeply researched. It has been established that wild-type p53 gene is a tumor suppressor gene, and its inactivation plays an important role in tumor formation. The abnormal forms of p53 gene mainly include gene mutation, deletion, single nucleotide polymorphism, murine double microbody abnormality, etc. It is closely related to the pathogenesis and prognosis of B cell non-Hodgkin lymphoma (B-NHL) and the corresponding therapeutic strategies.

Hypertension is already one of the main disease burdens in the world. At present, the incidence of hypertension in the world is about 26%. With the aging of the population, the incidence of hypertension will exceed 29% by 2025. With the research progress of antihypertensive drugs, the cardiovascular mortality associated with hypertension has decreased year by year since 1994. According to the clinical trial conclusion, antihypertensive can reduce the incidence of stroke by 35% ~40%, the incidence of myocardial infarction by 20% ~25%, and the incidence of heart failure by more than 50%.