Volume 91  ·   Issue 32  ·  2011

With the continuous development of China's economy, the average life expectancy has gradually increased, and with the change of lifestyle, especially the westernization of eating habits, the incidence of prostate cancer in China has shown an obvious upward trend in recent years [1]. According to statistics, the standardized incidence rate of prostate cancer in men in Shanghai has increased to 9.59/100,000 in 2005, which is nearly 8 times higher than that in 1985, and has become the fifth most common malignant tumor in men. With the gradual development of prostate specific antigen (PSA) screening, more and more prostate cancer can be detected at the early stage, so that they can receive traditional open surgery and minimally invasive laparoscopic or robot-assisted radical prostatectomy, so as to gain the hope of cure.

In the United States, venous thromboembolism (VTE) is the third most common cardiovascular disease after myocardial infarction and stroke, and the mortality rate of acute pulmonary embolism within 3 months is more than that of myocardial infarction, which is more than 15%. In 1971, Miller et al. [1] first reported streptokinase thrombolysis in acute mass pulmonary embolism. In 1990, the first case of acute pulmonary embolism was successfully performed with urokinase [2].

Objective To summarize the clinical outcome and adverse events of estrogen therapy for hormone refractory prostate cancer.Methods A total of 32 patients with hormone refractory prostate cancer received diethylstilbestrol (DES) 2 mg daily at our institute.The data of PSA (prostate-specific antigen)change, time to progression, overall survival rate, disease-specific survival rate and adverse events were collected and analyzed.Results The data of 29 patients were complete.The mean duration of DES dosing was 8.6 ±0.9 months.Among them, 8 (27.5% ) patients achieved a PSA response with a 50% decrement of PSA or more.Seven (24.1% ) patients had a stable level of PSA(50% ＜ PSA ＜ 125% ) while 14 of 29 (48.3% ) maintained a PSA progression with a 25% increment of PSA or more.The overall median time to progression was 4 ( 1 - 12) months.And the median time to progression was 6 (5 - 12) months in the PSA response group.The overall survival rate was 48.3% and disease-specific survival rate 55.2%.The main adverse events were gynecomastia ( 10/29, 34.5% ) and deep vein thrombosis ( 3/29, 10.3% ).Conclusion When used for the treatment of hormone refractory prostate cancer, dethylstilbestrol at a daily dose of 2 mg can achieve a PSA response in 27.5% patients and a PSA stability in 24.1% patients.And the median time to progression is 4 months.Estrogen is efficacious for the patients with hormone refractory prostate cancer.

Objective To observe the influences of erectile dysfunction (ED) by age, prostate size and lower urinary tract symptom ( LUTS ) undergoing two micro ( thulium ) laser resection of prostatetangerine technique (TmLRP-TT).Methods A total of 50 BPH (benign prostatic hyperplasia) patients underwent TmLRP-TT with a 70 W lair power.The patient prostate volume, international prostatic symptomatic score (IPSS), maximal flow rate and international index of erectile function (IIEF-5) were assessed preoperatively.A retrospective assessment was made after surgery and at a 6-month follow-up.They were divided into 2 groups according to prostate volume ≤50 or ＞ 50 ml, age ≤65 yrs or ＞65 yrs, IIEF-5≤20 or ＞ 21 and IPSS ≤27 or ＞ 27 respectively.The postoperative influences of erection by age, prostate size and LUTS were observed.Results Significant differences existed between pre-operation and 6 months post-operation in terms of IPSS ( 25.35 ± 5.6 vs 9.52 ± 3.1, P ＜ 0.01 ) and maximal flow rate (6.51 - 1.21 vs 13.4 ±2.7 ml/s, P ＜0.01 ).There was no difference between pre-operation and 6 monthspost-operation (34 vs 32 cases, X2 = 0.673, P = 0.603 ).The patients with prostate volume ＞ 50 ml group had 9 additional ED cases while those with IPSS ＞ 27 group contained 11 fewer ED cases.There were significant differences between both groups( x2 = 5.255, P = 0.002;x2 = 11.560, P = 0.001 respectively).BPH patients aged over 65 years old were more likely to suffer ED than those under 65 years old ( X2 =5.882, P =0.015).However, there was no significant difference in age in terms of suffering postoperative ED (X2 = 3.125, P = 0.077).Conclusion TmLRP-TT can significantly improve LUTS in BPH patients.The presence of large volume prostate is an independent risk factor for an increased number of ED patients after TmLRP-TT.LUTS is an independent risk factor for ED.And TmLRP-TT may improve the ED patients with severe LUTS.

Objective There are many causative factors for the occurrence of post-prostatectomy incontinence.Objective clinical characteristics, surgical techniques and pelvic floor muscle therapy are the most important ones.The present study was to identify the risk factors associated with urinary incontinence after radical retropubic prostatectomy (RRP).Methods A total of 263 patients were recruited for this multivariate analysis.After a close follow-up, a series of pre-, perl- and post-operative factors were recorded and analyzed.Results Urinary continence after radical prostatectomy was 14.8% at 4 weeks and 94.7% at 16 weeks.The most important recovery interval for urinary continence was 4-16 weeks post-operation.Multivariate analysis revealed that age ( P = 0.015 ), blood transfusion ( P = 0.017 ), previous TURP( transurethral resection of the prostate) ( P = 0.006) and neoadjuvant hormonal therapy ( P = 0.005 ) were the important risk factors for urinary incontinence.Conclusion During RRP, optimized preservation of urethral rhabdosphincter length, nerve sparing and early postoperative functional exercises can improve the recovery of urinary continence.Age, blood transfusion and previous TURP are the independent prognostic factors.Neoadjuvant hormonal therapy may improve urinary continence through increasing the preoperative length of membranous urethra.

Objective To retrospectively analyze the effects of different ventilation modes on pulmonary function during minor operation of general anesthesia with streamlined liner of the pharynx airway (SLIPA) laryngeal mask and assess its safety of spontaneous respiration during general anesthesia.Methods A total of 76 adult patients (aged 28 -44 years old, American Society of Anesthesiologists physical status Ⅰ - Ⅱ ) scheduled for operations were randomly allocated into the mechanical ventilation and spontaneous respiration group ( n = 38 each ).Anesthestic induction was performed intravenously with propofol (2 mg/kg), sulfentanyl (0.5 μg/kg) and cisatracurium besylate (0.3 mg/kg) (in mechanical ventilation group).Anesthesia was maintained by sevoflurane at 0.7 minimum alveolar concentration( MAC), mixture Neostigmine (2 mg) and atropine ( 1 mg) were administered intravenously before the extraction of SLIPA laryngeal mask in order to antagonize the residual effects of muscle relaxation.The parameters including heart rate ( HR), mean blood pressure (MAP) and end-tidal pressure of CO2 ( PETCO2 ), blood gas analysis and the alveolar-arterial oxygen gradient[P(A- a)DO2], respiratory index (RI) and dead volume/tidal volume (VD/VT) were calculated at Different time points.Results No significant differences were found in HR (spontaneous respiration group:76 ±7, 78 ±6, 79 ±7/min;mechanical ventilation group:77 ±6, 80 ±5, 79 ± 6/min), MAP (spontaneous respiration group:91 ± 10, 89 ± 9, 90 ± 9mm Hg;mechanical ventilation group:89 ± 10, 88 ± 9, 92 ± 8) mm Hg at the monitored time points between two groups ( P ＞ 0.05 ).At the time of 30 min and 60 min after insertion, the pH value was significantly lower in spontaneous respiration group (7.351 ±0.028, 7.338 ±0.025) than those in mechanical ventilation group (7.391 ±0.031, 7.389 ±0.032).The values of PaCO2(42 ±4, 46 ±6)mm Hg and PETCO2 (41 ±5, 45 ±3)mm Hg were higher than those in mechanical ventilation group (37 ±3, 35 ±5;37 ±4, 36 ±4)mm Hg (P＜0.05).No significant difference was found in the P( A - a) DO2, RI or VD/VT at the monitored time points between two groups ( P ＞0.05).Conclusion Neither mechanical ventilation mode nor spontaneous respiration ventilation mode has any effect upon pulmonary function by during minor operation of general anesthesia with SLIPA laryngeal mask.Spontaneous respiration can offer a sufficient supply of oxygen but it carries the risk of CO2 accumulation.

Objective To summarize the clinical experiences of treating deep venous thrombosis (DVT) with retrievable vena cava filter.Methods A total of 180 patients with DVT in unilateral lower extremity were recruited.There were 82 males and 98 females with an average age of 46 years old.After the diagnosis of vascular color Doppler ultrasound, retrievable vena cava filter was implanted through contralateral femoral vein.Simultaneously another 114 patients underwent femoral vein embolectomy.All cases received the post-operative therapies of anticoagulation, thrombolysis and vasodilation.Results The implantation of retrievable vena cava filter was successful in all cases.Among 142 cases of attempted extraction, 116 filters were extracted successfully at Days 12 -24.The success rate was 81.69 %.Filters captured thrombosis in 34 cases (29.31% ).Conclusion As a safe and efficaious method, the implantation of retrievable vena cava filter prevents the occurrence of pulmonary embolism in the patients with DVT in unilateral lower extremity.Its timely extraction may avoid the long-term complications.

Objective To explore an efficacious protocol for the patients with acute promyelocytic leukemia (APL) after a complete remission (CR) by all-trans retinoic acid (ATRA).Methods A total of 32 APL patients with an induction of CR by ATRA at our hospital from January 2000 to October 2007 received conventional standard chemotherapy as a consolidation regimen.Stratified according to age, those under 50 years old received an intermediate dose of cytarabine(IDAra-C) and over 50 years old non-IDAra-C regimen.Maintenance regimen:all patients received ATRA, arsenic trioxide (As2O3) and 6-mercaptopurine (6-MP) + methotrexate (MTX) alternately and sequentially for 3 years.The efficacy and side effects of these chemotherapies were observed.Results The median follow-up was 72 (40 - 124 )months.The 5-year disease-free survival (DFS) rates of under 50 years old and over 50 years old were 94.7% and 92.3% respectively.The difference was statistically insignificant ( P ＞ 0.05 ).One patient relapsed after a consolidation therapy and so did another on a maintenance regimen.Thirty patients achieved a constant CR.And 16 of 30 patients completed chemotherapy beyond 5 years and survived disease-free.The 5-year DFS rate of 32 patients was 93.8 %.Conclusion After the achievement of CR with ATRA, all APL patients have a higher rate of DFS after stratification.The side effects are generally mild.Thus a stratification therapy is both feasible and efficacious.

：Objective To explore thedifferentially expressed proteins of contrast-induced nephropathy through a comparison ofurinary proteome so as to further elucidate the pathogenesis and discover the diseasebiomarker.Methods The urine samples of 12 patients were collected before and aftercoronary angiography.Two dimensional electrophoresis was performed after the urine sampleswere labeled by different dyes.The differences of urine proteome were analyzed by Decydersoftware and the differentially expressed spots identified by mass spectrometry.Results Atotal of 56 differentially expressed spots were detected.Among them, 39 spots wereup-regulated and 17 spots down-regulated.And mannose binding lectin and mannose bindinglectin associated serine protease 2, key proteins in complement body activation, were bothsignificantly up-regulated.Conclusion Urine proteomic study methods are constructed basedon 2D-DIGE and mass spectrometry.The lectin pathway of complement body may be associatedwith contrast-induced acute kidney injury.

Objective To investigate the effects of everolimus ( RAD001 ) or plus panobinostat (LBH589) on the proliferation, apoptosis and drug resistance in chemoresistant acute myeloid leukemic cells.Methods HL-60/ADM cells were treated with RAD001 alone or with LBH589.Proliferation and apoptosis were evaluated by 3-( 4, 5 ) -dimethylthiahiazo ( -z-y1 )-3, 5-di-phenytetrazoliumromide ( MTT )assay, Hoechst33342 and AnnexinV-FTTC/PI stain.The altered expressions of multidrug resistance-associated protein 1 ( MRP1 ) and intercellular adriamycin accumulation were analyzed by flow cytometry.The change in protein level was analyzed by Western blot.Results Effective proliferative inhibition and apoptotic induction in HL60/ADM cells were observed in the treatment of 10 -50 μmol/L RAD001.The maximal effect was shown for the concentration of 30 μmol/L RAD001 at 48 and 72 hours.The inhibition ratio remained unchanged with the adjustment of drug doses (P ＜0.05).Moreover, there was no synergistic effects in the treatment with different concentration of RAD001 and LBH589 (CI ≥ 1.0).A down-regulation of MRP1 (93.9% ±4.2% vs 79.10% ± 3.28% ) and an up-regulation of adriamycin ( 8.53% ± 0.68% vs 15.37% ± 1.46% ) were induced by the treatment with 10 μmol/L RAD001 ( both P ＜ 0.01 ).RAD001 inhibited the p53-dependent expression of MRP1 via an inhibition of phosphoinositide 3-kinase (PI3K)/AKT/mTOR signaling pathway.Conclusion The combined treatment of RAD001 and LBH589 has no synergistically inhibitory effect on HL60/ADM cells.But the sole treatment of RAD001 may inhibit proliferation, induce apoptosis and accumulate intercellular adriamycin through a down-regulated expression of MRP1 in HL60/ADM cells via an inhibition of PI3K/AKT/mTOR signaling pathway.

：Objective To study theprotective effects and mechanisms of erythromycin on human bronchial epithelial (HBE)cells damaged by interleukin-4.Methods The growth curve of HBE cells was recorded byMTT.The cells were divided into the following groups:control (incubation for 24, 48h);IL-4 (0.01 mg/L, incubation for 24, 48 h );erythromycin intervention group 1 (4 mg/Lerythromycin co-incubation for 24, 48 h after adding IL-4) and erythromycin interventiongroup 2 (40 mg/L erythromycin co-incubation for 24, 48 h after adding IL-4).The mitoticcycle of HBE cell was determined by flow cytometry and its apoptosis examined by Hoechstdyeing.Results The viability of HBE cells was significantly enhanced after a 24/48-hourtreatment of erythromycin as compared with IL-4 group (P ＜ 0.05, P ＜ 0.01 ).In erythromycinintervention group 1, the cell ratios of G0/G1 and S phases were (55.9 ±2.5)% and (34.7±3.4)% respectively while the rate of cell apoptosis was (9.5 ± 0.9)%.There weresignificant differences as compared with IL-4 group ( P ＜ 0.05 ).In erythromycin intervention group 2, the cell ratios of G0/G1 and Sphases were (55.1 ±0.5)% and (36.2 ±2.7)% respectively while the rate of cell apoptosiswas (4.0 ± 0.6)%.There were significant differences as compared with IL-4 group (P＜0.05).ConclusionErythromycin has protective effects on HBE cells damaged by IL-4.The mechanism is probablythrough influencing the mitotic cycle and inhibiting the apoptosis.

Objective To explore the in vitro anti-tumor effects of zoledronic acid on cell proliferation and invasion in human nasopharyngeal carcinoma cell line HNE1.Methods The cytotoxic effects of zoledronic acid on HNE1 cells were detected by MTT assay, invasion of HNE1 cells by Transwell assay, secretion of (vascular endothelial growth factor)VEGF by (enzyme-linked immunosorbent assay)ELISA and the activities of MMP ( matrix metalloproteinase)2 and MMP9 by gelatine zymography.And the expressions of mRNA and proteins of MMP2, MMP9 and VEGF were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot respectively.Results After a treatment of zoledronic acid at 2.5, 5, 10, 20 and 40 mol/L for 48 h or 72 h, the highest inhibition rate of proliferation at approximately 50% was observed in the 40 mol/L group after 72 h.The inhibitory effect was not in a dose/time-dependent manner.After a 24-hour treatment of zoledronic acid at different concentrations (0, 10, 20 and 40 mol/L), the numbers of membrane-invading cells were 75.8 ±2.6, 54.8 ±5.4, 44.6 ±6.4and 38.6 ± 8.2 respectively (all P ＜ 0.01 ).Gelatinase zymography demonstrated that the activities of MMP2 and MMP9 were inhibited significantly only in cells treated at 0 μmol/L.After a 24-hour exposure to zoledronic acid at O, 10, 20 and 40 μmol/L, the concentrations of VEGF in supernatant were (5264 ± 89 ), (4626 ± 30), (4155 ±40) and ( 1908 ± 171 ) g/L respectively (all P ＜0.01 ).The expressions of mRNA and protein of MMP2, MMP9 and VEGF were down-regulated.Conclusion Zoledronic acid can inhibit the in vitro proliferation and invasion of HNE1 cell through suppressing the secretion of VEGF, the activities of MMP2 and MMP9 and the expressions of VEGF, MMP2 and MMP9.

Objective To explore the mechanisms of focal adhesion kinase (FAK) in the proliferation of human pulmonary artery smooth muscle cells (HPASMCs) under hypoxia.Methods Cultured HPASMCs were passively transfected with FAK oligonucleotides (ODNS) and under normoxia or hypoxia condition.They were divided into four groups:normoxia without fibronectin ( FN), normoxia with FN, hypoxia without FN, hypoxia with FN in vitro respectively.Cytoplasmic FAK, Grb2 and paxillin were observed simultaneously by immunoprecipitation and Western blot.In addition, the expressions of cytoplasmic FAK, Grb2 and paxillin were detected by immunocytochemical staining.Results Immunoprecipitation and Western blot demonstrated that cytoplasmic expressions of FAK, Grb2 and paxillin in HPASMCs increased in hypoxia with FN from 43.4 ± 1.4, 69.7 ± 1.9, 59.3 ± 1.6 to 35.7 ± 1.2, 48.7±1.3, 33.2±1.8 at 1.5 h (all P＜0.05), from41.3±1.3, 71.3 ±1.5, 59.4 ±1.8 to41.3±1.3, 50.2 ± 1.7, 38.9 ± 1.9 at 24 h respectively ( P ＜ 0.01, P ＜ 0.05, P ＜ 0.05).Immunocytochemistry staining showed that the cytoplasmic expressions of FAK, Grb2 and paxillin were enhanced in hypoxia with FN versus normoxia with FN.There were significant differences.Conclusion Hypoxia can induce the activation of cytoplasmic FAK, Grb2 and paxillin so as to regulate the migration, survival and proliferation of HPASMCs.

Objective Although earlier studies have shown that the transplantation of mesenchymal stem cells (MSCs) might improve cardiac functions after myocardial infraction, its role on vascular restenosis after percutaneous coronary intervention (PCI) remains controversial.The aim of this study was to investigate the effects of MSCs on the restenosis of injured artery following balloon angioplasty in a rabbit model with both myocardial infarction reperfusion and atherosclerotic stenosis cardotid artery by balloon injury.Methods After the animal model was established for myocardial infraction reperfusion and atherosclerotic stenosis cardotid artery by balloon injury, the rabbits received an intravenous transplantation of MSCs.And an equal volume of phosphate buffered solution was administered for the control group.The animal vascular tissue and myocardium tissue were excised at different time points post-transplantation and used to detect the homing of MSCs and the expressions of playlet-endothelial cell adhesion molecule-1 (CD31) and proliferating cell nuclear antigen (PCNA) by immunohistochemical staining.Four weeks later, vascular restenosis was analyzed by angiography of bilateral carotid arteries and the vascular tissues were used for histological studies.Results At one week post-transplantation, the 4', 6-diamidino-2-phenylindole (DAPI)-labeled MSCs could be detected in myocardial infarction and injured intima.And the intimal expression of CD31 was observed at 2 weeks in the MSCs transplantation group.Yet the expression of PCNA was significantly lower in the MSCs transplantation group than that in the control group (50.5% ± 3.6% vs 23.4% ±2.8%, P ＜0.05).At 4 week post-transplantation, the neointimal area of injured vessels and the vascular restenosis were significantly lower in the MSCs transplantation group than those in the control group (0.092±0.009 vs0.189 ±0.007, P＜0.05;41.7 ±3.7 vs 61.3 ±1.6, P＜0.05).Furthermore the MSCs transplantation group demonstrated improved cardiac functions, reduced myocardial infarct size (21.7% ±2.2% vs 34.3% ± 1.8%, P ＜ 0.05) and significantly increased capillary density around infarction foci (33.6% ±2.1% vs 20.8% ±2.6%, P ＜0.05 ) versus the control group.Conclusion The transplantation of MSCs plays significant roles in cardiac repairing in terms of improved cardiac functions, accelerated repair of injured vessels, suppression of neointimal hyperplasia and reduced restenosis of injured vessels.

Objective To explore the effects of sevoflurane postconditioning on ischemic/reperfused myocardial apoptosis.Methods Isolated perfused rat hearts were randomly assigned into 3 groups:shamoperation ( sham), ischemia/reperfusion (I/R) and sevoflurane postconditioning (SPC).Except for the sham group, the hearts were subjected to 40 min global myocardial ischemia and 120 min reperfusion.Left ventricular systolic pressure (LVSP), left ventricular developed pressure (LVDP), left ventricular enddiastolic pressure ( LVEDP), maximum increase rate of LVDP ( + dp/dt), maximum decrease rate of LVDP ( - dp/dt), heart rate (HR) and coronary flow (CF) were measured at baseline, R (reperfusion) 30 min, R60 min, R90 ain and R120 min.Creatine kinase (CK) and lactate dehydrogenase (LDH) were measured at 5 min and 10 min post-reperfusion.Infarct size was determined by triphenyltetrazolium chloride staining at the end of reperfusion.The expressions of Bcl-2 and Bax were determined by Western blot.Results The values of LVSP, LVDP, ± dp/dt and CF were higher while that of LVEDP was lower in the SPC group than the I/R group at all time points of reperfusion ( P ＜ 0.05 ).The releases of CK and LDH and infarct size were significantly reduced in the SPC group versus the I/R group (22.2% ±2.8% vs L/R:44.9% ±6.6%, P ＜0.05).The expression of Bcl-2 increased significantly while that of Bax decreased in the SPC group verus the I/R group.Conclusion Sevoflurane postconditioning may improve myocardial functions, reduce infarct size and attenuate myocardial apoptosis.And the modulated expression of apoptotic proteins plays an important role in sevoflurane-induced myocardial protection.

The patient was a 56-year-old male. He was admitted to the hospital on October 28, 2010 due to hypertension for 3 years, abdominal pain and abdominal distension for 25 days. The patient developed hypertension 3 years ago, and the highest blood pressure was 220/110 mm Hg (1 mm Hg =0.133 kPa). The patient developed persistent abdominal pain during the front defecation for 25 days, accompanied by abdominal distension and sweating. There was no nausea and vomiting, no diarrhea and melena. He went to the local community hospital and was suspected of "acute gastroenteritis", but intravenous antibiotics were ineffective. More than 10 hours later, he went to the county hospital. The blood pressure was 221/104 mm Hg, there was tenderness in the upper abdomen, no rebound pain and muscle tension, and the intestinal sounds were weakened.

primary pulmonary vascular tumors are rare in clinic, and their pathological changes are most common in poorly differentiated and highly lethal sarcomas, among which primary pulmonary arterial sarcoma (PAS) accounts for the vast majority, and pulmonary vein sarcoma is very rare. Because of its rarity, PAS is often misdiagnosed as chronic pulmonary thromboembolism. PAS is slightly more female than male, and the onset age reported in the literature is 13-86 years old, and most of them are middle-aged patients [1].

The carboxy-terminal PDZ ligand of neuronal nitric oxide synthase (nNOS) (a conserved sequence consisting of 80 to 100 amino acid residues, which can be used for the interconnection of proteins, is the abbreviated binding ligand of postsynaptic density protein 95 (PSD95), Drosophila tumor suppressor (DlgA), and zo-1) (CAPON) was first discovered by Jaffrey et al. in rat brain tissue [1]. Later, people found the expression of this protein in human brain and mouse heart, pancreas, skeletal muscle and other tissues [2-5], among which the content of CAPON is the most abundant in brain tissue.

Objective To establish a multiplex PCR point mutation screening technique for the genotyping of CYP2C19.Methods Deoxyinosine multiplex-polymerase chain reaction (PCR) primers (DMPs) were designed to detect simultaneously CYP2C19 * 1, * 2, * 3 alleles in one PCR tube.Results The above technique could detect the genotypes of CYP2C19 * 1, CYP2C19 * 2 and CYP2C19 * 3 successfully.And the results were completely consistent with those of DNA sequencing.Conclusion A novel screening technique of multiplex PCR point mutation is successfully established.With the advantages of high specificity, convenient handling, fast completion and low cost, it provides a reasonable and reliable detection method for basic researches and personalized medicine.