Volume 91  ·   Issue 17  ·  2011

Objective To study the efficacy of porous polyethylene(Medpor)plus titanic mesh sheets in the repair of orbital blowout fractures.Methods A total of 20 patients underwent open sargical reduction with the combined usage of Medpor and titanic mesh.And they were followed up for average period of 14.5 months(range:9-18).Results There is no infection or extrusion of medpor and titanic mesh in follow-up periods.There was no instance of decreased visual acuity at post-operation.And all cases of enophthalmos were corrected.The post-operative protrusion degree of both eyes was almost identical at less than 2 mm.The movement of eye balls was satisfactory in all directions.Diplopia disappeared in 18 cases with a cure rate of 90%.1 case improved and 1 case persisted.Conclusion Medpor plus titanic mesh implant is a safe and effective treatment in the repair of orbital blow out fractures.

Objective To explore the value of low-frequency repetitive nerve stimulationRNSin the diagnosis of myasthenia gravisMG.Methods A total of 436 MG patients admitted during the period of July 2008 and August 2010 and undergoing the repetitive nerve stimulation test were reviewed retrospectivelv.We analyzed the positive rates of RNS in MG patients and compared the abnormalities in different nerves including facial,accessory.axillary and ulnar nerves.Results Among them,73.85% had abnornlal recordings on low-frequency RNS test.The highest abnormality was in facial nerves82.30%,then axillary nerves52.17%and the lowest in ulnar nerves27.64%.The positive rates of RNS in ocular MG were significant lower than those in general MG patients.And there were no significant statistical differences of RNS abnormalrates in types Ⅱ a,Ⅱb,Ⅲ and Ⅳ MG patients with 89.66%,82.56%,91.67%and 83.33%,respectively.In ocular MG,16.34% patients were positive in RNS test under the stimulation of accessory.axillary and ulnar nerves.And 79.50%patients with general MG had two or more nerves with abnormal results.Conclusion The low-frequency RNS test is of great value in the diagnosis of MG.And it shows a higher sensitivity in general MG patients than that in ocular ones.The stimulation of facial and axillary nerves increases the positive rates of RNS in MG patients.

objective To evaluate the short-term prognostic values for the model of end-stage liver disease-sodium(MELD-Na).end-stage liver disease sodium(MELDNa)and their dynamic changes in patients with acute-on-chronic hepatitis B liver failure(ACLF-HBV).Methods A total of 172 patients diagnosed with ACLF-HBV,admitted between January 2007 to February 2009 and hospitalized for over 2 weeks,were retrospectively recruited.The predictive accuracy of MELD-Na,MELDNa and their dynamic change(△)was compared by the method of the area under the receiver operating characteristic curve. Results The 3-month mortality rate was 43.6%.The largest concordance(c)statistic predicting 3-month mortality was MELDNa score after a 2-week treatment(0.790),followed by MELD-Na(0.728)score,△MELDNa(0.713)and AMELD.Na(0.646).The average MELD-Na,MELDNa scores after a 2-week treatment and AMELD-Na,△MELDNa of survival group were 27.7±8.9,25.9±5.0,-2.1±10.0 and -1.9±4.2 while those of dead group 34.6±8.7.31.5±5.0,2.4±10.3 and 2.4±10.3.There was significant difference in MELD-Na.MELDNa,AMELD-Na and △MELDNa between two groups.The 3-month mortality of the MELD-Na scores group<25,25-30,30-35 and>35 were 18.9%,37.8%,57.6% and 65.3% while the MELDNa scores group 14.6%,33.3%,72.5% and 84.2% respectively.There was significant difierence in the 3-month mortality between four groups.The 3-month mortality of the AMELD-Na>0 group was 58.5%while that of the △MELD-Na≤0 group 30%:the 3-month mortality of the △MELDNa>0 group was 61.3% while that of the AMELDNa≤0 group 29.9%.There was significant difference between two groups.Conclusion MELDNa score after a 2-week treatment is a promising and useful predictor for 3-month mortality in ACLF-HBV patients.The predictive value may further improve if in conjunctions with dynamic changes.

Objective To compare the transcatheter arterial chemoembolization(TACE) alone or plus radiofrecluency ablation(RFA)in the treatment of single branch portal vein tumor thrombus (PVTT)in Patients with hepatocellular carcinoma(HCC)so as to evaluate the safety,control rate,prognostic factors and overall survival.Methods From January 2004 to December 2007,50 HCC patients(<5 cm in diameter and 3 parenehymal lesions)with concurrent PVTT were enrolled and treated by TACE alone or TACE plus RFA randomly(TACE,n=25;TACE-RFA,n=25).In TACE group,the intra-hepatic lesions received TACE sequentially with RFA:in TACE-RFA group.PVTT and intra-hepatic lesions were treated with TACE sequentially with RFA separately.Strict follow-uD was conducted by computed tomography and alpha-fetoprotein(AFP) assay.The survival time was analyzed by the Kaplan-Meier method and Cox regression analysis was perfoHned to evaluate the prognostic factors.Results of all 50 HCC patients with single branch PVTT with TACE or RFA,47 patients(TACE,n=24;TACE-RFA,n=23)received all the scheduled proeedures and completed the follow-up.Two patients(8.3%)in TACE group had liver dysfunction versus none in TACE-RFA group,2 patients(8.7%)developed bile duct injury in TACE-RFA group related with the RFA proeedure. The OR (overall response) for PVTT was 54. 2% (complete response (CR) 8. 3%, partial response (PR) 45.8% ) in TACE group while 87. 0% ( CR 60. 9%, PR 26. 1% ) in TACE-RFA group during the follow-up. From the definite diagnosis of HCC, the median survival was 8 months. And the 1-, 2- & 3-year survival rates were 33. 3%, 12. 5%, 8. 3% in TACE group. And 26 months, 65. 2%, 47. 8%, 30. 4% in TACE-RFA group respectively. The difference between two groups was significant. From the definite diagnosis of PVTI, the respective data were 7 months, 12. 5% and 4. 2%, 0 in TACE group versus 22 months, 52. 2%, 34. 8%, and 8.7% in TACE-RFA group with a significant P value. In multivariate analysis, only therapy (TACE or TACE-RFA) showed a protective value ( hazard rate 0. 430 vs 0. 345, P <0. 05 ). Survival was not correlated with age, intra-hepatic tumor status,liver functions and AFP level for all patients. Conclusion RFA is both safe and efficacious to prolong survival in the treatment of single branch PVTT plus TACE in selected HCC patients. It may provide rationales for further studies of evaluating the outcome of RFA plus other therapies in the treatment of HCC with single branch PVTT.

Objective To develop a novel cartilage ECM-derived porous scaffold(cEDPs)and investigate the attachment,proliferation and distribution of bone marrow mesenchymal stem cells(BMSCs) cultured in vitro within the scaffolds.Methods Cartilage microfilaments were prepared after pulverization and gradient centrifugation and prepared into suspension after acellularization treatment.The scaffolds were examined by histological staining,scanning electron microscope(SEM),biochemical and biomechanical analysis.After labeling with PKH26,the canine BMSCs were seeded onto the scaffolds.The attachment,proliferation and differentiafion of cells were observed by inveaed fluorescent microscope and SEM.Results On histology,most extracellular matrices were retained in the scaffold after the removal of cell fragments.Safranin O staining and immunfluorescence examination with collagen Ⅱ antibodies provided positive results.Biochemical analysis showed that the collagen content was(708.2 4±44.7)μg/mg,glycosaminoglycan(254.7 ±25.9)μg/mg and DNA(0.021±0.007)μg/mg.Mechanical testing showed the compression moduli(E)were(1.226±0.288)and(0.052±0.007)MPa ander dry and wet conditions respectively.Inverted fluorescent microscope and SEM showed moderate cell adhesion.chondrocyte-like morphology and matrix synthesis around cells. Conclusion The CEDPS retains most extracellular matrices after a thorough decellularization so as to possess an excellent microstructure with ideal biomechanical characteristics and a good biocompatibility. Thus it is a suitable candidate as an alternative cell-carrier for cartilage tissue engineering. Chondrogenic BMSCs and CEDPS may be used to construct cartilage-like tissue in vitro.

Objective To detect the expression levels of interferons IFNα,IFNβ and IFNγ in the peripheral blood and muscle of patients witll idiopathic inflammatory myopathies(IIM)so as to analyze their relationships with organ manifestations.Methods The serum levels of IFNα,IFNβ,IFNγ and anti-Jo- 1 antibody were measured with EUSA(enzyme-linked immunosorbent assay).And the method of SYBR green dye based real-time quantitative PCR(polymerase chain reaction)was used to compare the expression levels of IFNα,IFNβ,interferon ot receptor 1(IFNαR1),signal transducer and activator of transcription 1 (STAT1)in the IIM patients and normal controls.Results The serum levels of IFNα(50.2±21.0)nG/L and IFNβ(10.7±5.4)nG/L in IIM patients were significantly higher than those in normal controls(18.6± 3.6)ng/L,(3.9±0.8)ng/L(P<0.01).And the serum levels of IFNα(55.7±21.9)ng/L and IFNβ (11.3±2.3)ng/L in DM patients were significantly hisher than those in PM patients(26.1±8.2)ng/L,(6.2±3.5)ng/L(P<0.05).The serum levels of IFNα and IFNβ correlated with the presence of skin rash (P<0.05).And their serum concentrations correlated positively with erythrocyte sedimentation rate(r= 0.442,P=0.000:r=0.562.P=0.000)and C-reactive protein(r=0.348,P=0.004;r=0.432,P=0.005)respectively.The serum levels of IFNα and IFNβ decreased significantly after treatment in 12 PM/DM(pelymyositis/dermatomyositis)patients(P<0.01).The mRNA expression levels of IFNα,IFNβ,IFNαR1 and STAT1 in PM/DM patients were higher than those in normal controls(P<O.05).Conclusion The expression levels of IFNα and IFNβ in PM/DM patients are significantly higher than those in normal controls.And the increments had correlations with disease activity and severity.STAT1 has been implicated in signal transduction of IFNα and IFNβ in the muscles of PM/DM patients.

Objective To explore the correlation between Chinese myasthenia gravis(MG)patients from Guangdong province and the polymorphism of HLA immunogene.Methods The genotypes of HLA-A,B and DRB1 alleles in 104 MG patients and 121 healthy blood donors were detected by PCR-SBT (ploymerase chain reaction-sequencing-based typing).Results (1) There were 15 alleles at A locus,32 at B locus and 23 at DRB1 locus in MG group.(2)The frequency of HLA-A*02:07(P=0.000,RR=3.715),-B*46:01(P=0.000,RR=5.698),.DRB1*04:03(P=0.033,RP=6.312),-DRB1*09:01(P=0.000,RR=5.884)in MG patients was higher than that in healthy controls.(3)There were positive associations of HLA-DRB1*09:01(P=0.000.RR:1.349)with juvenile-onset ocular MG.Conclusion There is susceptibility association of HLA-A*02:07,-B*46:01.-DRB1*04:03,-DRB1*09:01 with Chinese MG patients from Guangdong province.There is a close genetic and immunological correlation between HLA alleles and the pathogenesis of MG.It has directional significance in the race and region iucideuce study,clinical classification,differential diagnosis,treatment and prognosis of MG.

A 19-year-old male developed macroscopic hematuria after strenuous exercise half a month ago, which was soy sauce-colored. It was painless whole-course hematuria with frequent urination, with an interval of 2~3h. He visited the urology department of our hospital on July 6, 2010. Abdominal CT scan showed a cyst in the posterior bladder rectal space (Figure 1), with a size of 4.2cm ×5.5cm ×5.9cm (anterior and posterior × left and right × upper and lower), which was considered to be derived from the seminal vesicle gland. Absence of left kidney.

Objective To establish the neocortex-striatum-substantia nigra brain slices of rats and observe the medium spiny neurons of striatum under a visible condition so as to explore their electrophysiological characteristics. Methods The brain slices containing the neocortex-striatum-substantia nigra were prepared from SD rats of postnatal 7 - 10 days. With infrared differential interference contrast (IR-DIC) microscope and patch clamp amplifier whole-cell recording technique, the medium spiny neurons were located in striatum and their spontaneous electrical activity was recorded in the current clamp mode. By infusing the step current, we observed the variation of membrane potentials. Results There were three types of conditions in the 92 medium spiny neurons successfully recorded. Among them, 14 were in persistent down state without action potential firing; 61 displayed persistnet down state accompanied with interval temporal depolarizing to the threshold potential with action potential firing; and the remaining 17 showed persistent down state with the interval emergent up state. There was no statistical significance in the difference of mean resting and threshold potentials in three neuronal types ( P > 0. 05 ). When the neurons

Objective To establish the model of cultivating and identifying fibroblast from human endometriosis(HEFC)in vitro.Methods The tissues of human endometriotic cysts of ovary were digested by collagenases Ⅰ, Ⅱ and Ⅳ The resulting cells were purified by centrifugation and differential adhesion.HEFC was identified by observing the morphologic changes under an inverted microscope and the expressions of vimentin,α-SMA(α-smooth muscle actin)and keratin were detected by immunocytochemistry.Results Immunohistochemical staining of vimentin Was positive.α-SMA rarely positive and keratin completely negative in cultured fibroblasts.HEFC grew as a confluent monolayer of short fat fusiform,triangular,starshaped and polygonal fiber-like cells.Furthermore HEFC could be well sub-cultured.Conclusion Acquired fibroblast can be cultured in vitro stably.It iS quite important to Study the specificities of HEFC.Sufficient and reliable target cells may be obtained for studying the mechanisms of fibrosis and adhesion in endometriosis at the molecular level.

Objective To investigate the effects of acupuncture pre-conditioning on apoptosis in hippocampal neurons following ischemia-reperfusion injury in aged rats. Methods A total of 120 senile male Wistar rats aged 19-21 months (corresponding to 60-year-old human being) weighting 550-710 g were randomly divided into 4 groups (n = 30 each). Cerebral ischemie group: 4-vessel-block was conducted for 4 minutes to establish cerebral ischemie models; Acupuncture pre-eonditioning group: electroacupuneture was applied at acupoint Baihui ( GV20 ) with a frequency of 15 Hz and 2 mA for 30 minutes once daily for 5 days. Then the rats received 4-vessel-block for 4 minutes; Sham-operation group: 4 vessels were exposed; Sham-acupuncture group: only eleetroaeupuncture for 5 days without operation. The rats were sacrificed at the end of predetermined duration of reperfusion 12 h, 1, 2, 3 and 7 d respectively. The brains were immediately harvested and hippocampal CA1 region was isolated for ( 1 ) light and electron microscopic examinations of hippoeampal neurons; (2) detection of apoptotic neurons (TUNEL) ; (3) determination of easpase-3 protein expression with SABC (streptavidin-biotin-poroxidase complex) immuno-histoehemieal technique. Results There were apoptotic neurons in all groups. The numbers of apoptotic neurons and positive neurons of caspase-3 significantly increased in the acupuncture pre-conditioning and cerebral isehemic groups versus the sham-acupuncture and sham-operation groups ( P < 0. O1 ). And the numbers of apoptotic neurons and positive neurons of caspase-3 significantly decreased in the acupuncture preconditioning group versus the cerebral ischemic group (P < 0.01 ). Conclusion Acupuncture preconditioning can decrease the neuronal apoptosis after ischemia-reperfusion injury through a lowered expression of caspase-3 protein in senile rats.

Objective To observe the expression of eyclin-dependent kinase 5(Cdk5),p35,tau protein and the activity of Cdk5 in rat hippoeampus during pentylenetetrazole(PTZ)kindling process and their correlation with mossy fiber sprouting(MFS)so as to investigate the role of Cdk5/p35 in epileptogenesis.Methods A total of 240 healthy male SD rats were divided randomly into normal controls and pentylenetetrazole(PTZ)treatment groups.The epileptic models were established by injection of PTZ intraperitoneally.At Day 3,Weeks 1,2,4 & 6 after a daily injection of PTZ,Timm staining was scored in the CA3 region and dentate gyrus.At the same time,the mRNA and protein of Cdk5 and p35,total tau protein and its phosphorylation at set202 and Cdk5 activity were analyzed in the hilus and stratum granulosum of dentate gyms and the CA 1,CA3 regions of hippocampus.The methods of in situ hybridization,immunohistochemistry,Western blot and immuno-precipitation and liquid scintillation counter were employed respectively.Results Prominent MFS was observed in area CA3 rather than the inner molecular layer in PTZ-treated rats.And the degree of MFS progressed with the development of behavioral kindled seizures.The expressions of Cdk5/p35 mRNA and protein,tau protein and its phosphorylation at Set202 significantly increased from Day 3 to Week 4 in the PTZ treatment group.It was in accordance with the progression of MFS in area CA3.Conclusion CdkS/p35 and its substrate tau protein may be involed in M FS.Undeerstanding the molecular mechanisms of MFS may lead to therapeutic interventions for limiting epileptogenesis.

Objective To investigate the multi-differentiation potential and VEGF secretory volume of monoclonal immortalized human mesenchymal stem cells(hMSC-TERT)and to determine the relationship between them.Methods Monoelonal hMSC-TERT were isolated using limiting dilution.The growth curves of them were detected by method of MTT.ELISA was used to detect the concentration of VEGF in the supernatant of those mnoclonal hMSC-TERT.Their adipocytic,osteogenic,neuronal differentiation potential in vitro were determined by Oil Red O staining,Van Kossa staining and immuocytochemistry for Tubulin-βⅢ antibody.Those Monoclonal hMSC-TERT were transplanted into the subcutaneously of severe combined immunodeficiency(SCID) mices.The grafts of those cells were removed and analyzed by immunohistochemistry for pathologic tissue markers to discover the multi-differentiation potential of those mnoclonal hMSC-TERT in vivo.Results There was statistically significant difieFence between different mnoelonal hMSC-TERT in multidifferentiation potential and the decreased concentration of VEGF in the supernatant of those mnoconal hMSC-TERT from the 3 rd day to the 5th day.The positive rates of CK in grafts formed by those monoelonal hMSC-TERT in SCID mices were direct correlation with the decreased concentration of VEGF in the supernatant of those cells.Conclusion The secretory capability of VEGF of those monoclonal hMSC-TERT may direct correlation with the epithelial differentiation potential of those cells.

Objective To investigate the role of brain-derived neurotrophic factor(BDNF)in pain facilitation and spinal mechanisms in the rat model of bone cancer pain.Methods The bone cancer pain model was developed by inoculated Walker 256 mammary gland carcinoma cells into the tibia medullary cavity.Sixty SD female rats were divided into 5 groups(n=12 each)randomly;group Ⅰ:contrrol group (sham operation);group Ⅱ;model group;group Ⅲ:control group+anti-BDNF intrathecal(i.t.);group Ⅳ:modeI group+control IgG i.t.;group Ⅴ:model group+anti-BDNF i.t..Anti-BDNF or control IgG was injected i.t. during 7 to 9th day.Von-Frey threshold was measured one day before operation and every 2 days after operation.On the 9th day after threshold tested,rats were sacrificed after i.t. injection of either antiBDNF or control IgG,the lumbar 4-6 spinal cord was removed.The expression of the spihal BDNF and the phosphorylation of extracellular signal-regulated protein kinase1/2(p-ERK1/2)were detected by immunohistochemistry assay and Western-Blot.Co-expression pattern of BDNF and p-ERK1/2 were determined by double-labeling immunofluorescence.Results We demonstrated the coexistence of BDNF and p-ERK1/2 in the spinal cord of rats. From the 7 to 9th day after operation,von-Frey threshold in groups Ⅱ and Ⅳ was significantly lower than that in group Ⅰ and group Ⅴ(P<0.01),group Ⅴ was remarklv higher than that in group Ⅳ(P<0.01).'The spinal BDNF and p-ERK1/2 expression in group Ⅱ or Ⅳ were significantly increased compared with that in group Ⅰ or Ⅴ(P<0.01),intrathceal anti-BDNF was significantly suppressed BDNF and P-ERK1/2 expression(P<0.01).Conclusion BDNF and p-ERK1/2 was coexistence in the spinal cord of rats,and it maybe involved in the bone cancer pain.

Objective To assess the changes about numbers and immune functions of splenic DC (dendritic cell)after a combined therapy of cryoablation and GM-CSF(granulocyte maerophage-colony stimulating factor)for prostate cancer.Methods Murine model of prostate cancer was established.And the tumor-bearing mice were divided into 4 groups:control group(Group A),GM-CSF treatment(Group B),eryoablatiou treatment(Group C)and a combined therapy of cryoablation and GM-CSF(Group D).Spleens were sampled before and 7,14.21 days after treatment.Immunohistochemistry of DC was performed.And splenic lymphocytes were isolated and their activated percents analyzed by flow cytometry.The tumor-specific cytolytic activity of cytotoxic T lymphocyte(CTL)was measured by LDH(lactate dehydrogenase)assay.And the lung metastasis rates were calculated.Results At Day 7 post-treatment,the number of DC per high-power field was 26.4±1.1,36.6±2.1,25.8±1.3 and 58.2±1.9(P<0.05);the activated percent of DC 13.60%±1.67%,9.50%±0.21%.14.40%±1.14%and 32.80%±2.39%(P<0.05);cytolytic activity of CIL against prostate cancer cells 7.76%±0.11%,8.10%±0.92%.9.38%±0.45%and 41.68%±0.82% in Groups A,B and C respectively(P<0.05).At Day 21 posttreatment,the rate of lung metastasis was 5/5,4/5,4/5 and 1/5 respectively.Conclusion A combined therapy of cryoablation and GM-CSF may increase the number and activated percent of DC in spleen.enhance the tumor-specific immune responses and decrease lung metastasis rate.

A 49-year-old male was admitted to Peking Union Medical College Hospital on December 17, 2009 due to mandibular mass for 1 1/2 years and enlargement of parotid and lacrimal glands for 7 months. In April 2008, the patient developed bilateral mandibular mass without inducement, about the size of a walnut, with medium mass and no tenderness. The mass gradually increased. In December of the same year, bilateral submandibular gland and tumor resection were performed in an external hospital. Postoperative pathology: bilateral submandibular gland chronic sclerosing submandibular adenitis.

Stress hyperglycemia is often associated with critically ill patients in ICU, and a significant increase in blood glucose is an independent risk factor for death in critically ill patients. The mortality rate of patients with stress hyperglycemia in critically ill patients is even higher than that of patients with previous history of diabetes [1].

Lower extremity varicose veins is a common clinical disease with high incidence. A large number of clinical case series and randomized controlled clinical trials have been published with unquestionable evidence to support that foam sclerotherapy is one of the exact methods for the treatment of lower extremity varicose veins [1-5], and its effect is comparable to that of surgery [1-2,4]. 　　 　　

Acetaminophen, or paracetamol, can effectively relieve pain and fever, and is a commonly used medicine for antipyretic and analgesic, treating cold, joint pain, neuralgia and other diseases, but its side effects can not be ignored, especially liver injury.