Volume 91  ·   Issue 34  ·  2011

The community of respiratory science has made historical contributions to the prevention and treatment of respiratory diseases in China, and made outstanding achievements. In order to further promote the construction of respiratory discipline, we must distinguish the situation clearly, determine the strategy, condense the culture, and strive to create a new situation in the development of the discipline.

Objective To evaluate the safety and efficacy of intraperitoneal anatomical radical nephrectomy (IARN). Methods A retrospective analysis was performed for 60 consecutive patients undergoing IARN at our hospital from March 2007 to December 2009. Various clinical parameters were collected and analyzed statistically. Results Sixty operations were performed successfully. There was neither conversion into open surgery nor blood transfusion. The mean operative tine was (106 ± 23) min, mean intraoperative estimated blood loss ( 112 ± 37 ) ml, mean time of resuming oral intake (2. 1 ± 0. 7) d, mean time to ambulation ( 1.9 ± 1. 1 ) d, mean postoperative analgesics ( pethidine ) dosage ( 65 ± 25 ) mg,average drainage volume 100 ( 50 - 300) ml, mean time of extracting drainage tube ( 3. 6 ± 1.3 ) d and mean postoperative hospital stay (9. 4 ± 2. 1 ) d. Conclusion IARN offers the advantages of distinct anatomical level, shorter operative time, less hemorrhage, less damage, faster postoperative recovery and a lower rate of complications.

Objective To explore the relationship between jugular vein thrombosis and extremity vein thrombosis in cancer patients by vascular color Doppler ultrasound. Methods A total of 79 cases with malignant tumors complicated with venous thrombosis undergoing vascular color Doppler ultrasound were analyzed retrospectively. All cases were divided into the group of jugular vein thrombosis (n =36) and the group of extremity vein thrombosis ( n = 43 ). The thrombotic factors of PT ( prothrombin time), APTT ( activated partial thromboplastin time ), FIB ( fibrinogen ), HCT ( hematocrit ), PLT ( platelet ), PCT (plateletcrit), PDW (platelet distribution width), MPV (mean platelet volume), pathologic type and thrombotic time were compared between two groups. Results Between two groups, significant differences existed in APTT, pathologic types and before or after therapy (P ＜ 0. 05 ). However the other factors were not significant (P ＞ 0. 05 ). Conclusion The clinicians should pay great attention to malignant tumor complicated with venous thromboembolism (VTE). An early diagnosis is essential to prevent pulmonary embolism (PE) and improve patient survival. Vascular color Doppler ultrasound may be used as the first-line examination. Preoperative and postoperative prophylactic anticoagulant therapy can reduce the risk of VTE in patients with high-risk factors.

Objective To assess the efficacy and safety of radiofrequency catheter ablation for verapamil-sensitive ventricular tachycardia ( VT). Methods A total of 18 patients with a diagnosis of verapamil-sensitive VT were enrolled in this study. Radiofrequency catheter ablation was administered after underwent examinations on admission to rule out structural heart disease, the ablation catheter was placed around the left posterior intermediate septum and left anteroseptal in the left ventrieular to searching for the Purkinje potential (P potential). When the Purkinje potential preceded the surface QRS by≥20 ms, it was considered as an ideal target for ablation. Ablation at 25 - 35 W, 60 ℃ was often carried out at the point where the Purkinje potential was earliest. After ablation, perform programmed stimulation to measured the effects. The patients received routine postoperative treatment and care. And the follow-up period was 3 -6 months after discharge. Results 17 patients diagnosed as ventricular raise from left posterior fascicle and 1 patient raise from left anterior fascicle were got to the radiofrequency end point and failed to elicit ventricular tachycardia again. In this patients ,the Purkinje potential advanced to the starting point of QRS 20 ms were recognized as ideal point of radiofrequency. The length as the Purkinje potential advanced to the starting point of QRS are (24. 0 ± 3.5 ) ms. the more length, the less times of radiofrequency. No postoperative complications were noted except for 2 patients who had mild hematoma at the site of puncture. During the follow-up period, 2 patients were found to have relapsed ( recurrence rate = 11.1％ ) and showed transient resistance to verapamil. The remaining patients had no previous history of tachycardia. Conclusion With a low recurrence rate, radiofrequency ablation is a safe and efficacious cure for verapamil-sensitive VT. Despite some efficacies in the treatment of VT.

Objective To explore the clinical and molecular genetic characteristics of a Chinese female patient with partial 17α- hydroxylase/17, 20 lyase deficiency ( 17OHD), a rare type of congenital adrenal hyperplasia. Methods Her clinical features and laboratory data were collected. Genomic DNA was extracted from leukocytes of peripheral blood of her and her mother. All eight exons of CYP17A1 gene,including flanking regions of introns, were amplified by PCR. The mutations of CYP17A1 gene were identified by direct sequencing or cloning and sequencing the amplified DNA fragments. Results The patient presented with hypertension, hypokalemia and irregular menstruation. DNA sequencing results demonstrated a compound heterozygous mutation in CYP17A1 gene. One allele of her had the deletion of phenylalanine (TTC) at either codon 53 or 54 and the other allele contained a base transversion at codon 329 (TAC/AA) and leading to a missense mutation of tyrosine to lysine and the open reading frame shift following this codon to produce a truncated enzyme with 417 amino acids and without activity site. Her mother was a heterozygous carrier of the latter allele. Conclusion The partial 17OHD in this patient is caused by a compound heterozygous mutation in CYP17A1 gene.

Objective To explore the effects of anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope for the emergency treatment of uveitic acute angle closure glaucoma (ACG). Methods In early stage, 14 uveitc acute ACG patients received anterior chamber paracentesis plus pupillary block relief while another 10 uveitc acute ACG patients underwent laser peripheral iridectomy (LPI). The intraocular pressure ( IOP), degree of Tyndall, degree of pupillary block and severe adverse events were recorded at each observation timepoint. Results The IOP values for the paracentesis plus pupillary block relief group were (9.2 ±2.1) mm Hg, (12.4 ±3.7) mm Hg and (14.1 ±2.6) mm Hg at 1,48 h and 10 d vs (24.5 ± 7.1 ) mm Hg, (22.2 ± 8.6) mm Hg and ( 19.3 ± 9.3) mm Hg respectively for the LPI group. The inflammatory reaction of anterior chamber was more relieved in the paracentesis plus pupillary block relief group at Day 10. Pupillary block was observed in 1 (1/14) patient from the paracentesis plus pupillaxy block relief group and 6 (6/10) patients from the LPI group at Day 10. Mild hemorrhage at pupillary margin was observed in 2 cases from the paracentesis plus pupillary block relief group. Both were self-absorbed within 10 days. Conclusion Anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope is the safe and effective emergency treatment for uveitic acute ACG.And it may offer a basis for further therapy.

Objective To explore the relationship between smoking and bladder cancer in China. Methods A multicenter case-control study was conducted from September 2005 to June 2008. A total of 432 bladder cancer patients, matched with 392 control cases, received a questionnaire including the type of exposure ( active vs. passive smoking), the age of beginning and/or quitting smoking, smoking amount and time and depth of smoke inhalation. Results Both active smoking and passive smoking increased the incidence of bladder cancer ( P ＜ 0. 05 ). Bladder cancer risk increased 1. 89 times in active smokers and 1.88 times in passive smokers compared to non-smokers ( P ＜ 0. 05). Smoke amount and time were significantly correlated with bladder cancer risk ( P ＜ 0. 05). But the age of beginning smoking did not affect the bladder cancer risk ( P ＞ 0. 05 ). Inhaling smoke into mouth or throat was also a risk factor for bladder cancer (P ＜ 0.05 ). Conclusion There is a strong association between smoking and bladder cancer. Active and passive smoking, smoke amount and time, and the depth of smoke inhalation are risk factors for bladder cancer. The best way of preventing bladder cancer is never smoking.

Objective To determine the incidence of BK virus associated nephropathy(BKVAN) in renal-transplantation recipients, observe its histological features. Methods A total of 137 renal allograft biopsy specimens collected at our hospital during December 1999 to January 2008 were analyzed by routine histologic examination, immunohistochemistry and transmission electron microscopy (TEM) to screen for BKV. The case records of involved recipients were accessed to know their clinical manifestations, diagnostic characteristic and treatment regimens at that time. And the 1-, 3-year graft survival rate were analyzed by Kaplan-Meier analysis. Results A total of 16 renal biopsy specimens ( 11.7％ ) were positive for BKV.Viral particales on the size of 35 -40 nm were seen in the tubular epithelial cells of 3 biopsy specimens and 7 urinary sediment samples. The numbers of BKVAN recipients suffering acute rejection, using ALG/ATG/OKT3 and using FK506 + MMF immunosuppressive protocol were 7, 7 and 10 respectively. In 14 cases of BKVAN, there was an elevated level of serum creatine concentrations. Four cases lost their grafts after using a large dose of immunosuppressives. And renal functions improved by a reduction of immunosuppression or a replacement of FK506 with CsA in 8 cases. And graft functions deteriorated or had already failed in the remaining 4 cases whose immunosuppressive protocol were not changed. The 1-, 3-year graft survival rates were 81.3％ and 54. 2％ in BKVAN recipients respectively. Conclusion The diagnosis of BKVAN should be considered in recipients when their graft functions are deteriorating, especially for those with the accompanied risk factors. The morphological hallmarks of BKVAN are similar to those of acute rejection.The differentiation may be made by either immunohistochemistry or TEM. A proper modification of maintenance immunosuppression is effective in slowing down the progression of BKVAN.

Objective To explore the expressions of SARI (suppressor of AP-1, regulated by IFN)and connective tissue growth factor/cysteine-rich 61/nephroblastoma-1 ( CCN1 ) and clarify their influences on the occurrence, development and prognosis of colorectal carcinoma (CRC). Methods Real-time PCR (polymerase chain reaction) was used to confirm the expressions of SARI and CCN1 at the mRNA level in 32 fresh tissue samples. And the expressions of Caco-2, HT-29 and Lovo were also detected by RT-PCR (reverse transcription-PCR) in cell lines. Tissue specimens were obtained from 116 cases of CRC and the expressions of SARI and CCN1 for each specimen detected by immunohistochemistry. The correlations between the expressions of SARI and CCN1 proteins were summarized. The relationships between the expression levels of SARI and CCN1 and their clinical features in primary CRC were analyzed respectively.The effects of expression levels of SARI and CCNI proteins on the prognosis were also assessed in 116 CRC cases. Results The expressions of SARI and CCN1 at the mRNA level in fresh cancerous tissues and cell lines decreased and became up-regulated respectively. The positive rate of SARI protein expression was 76. 7％ and 28.4％ in cancerous and noncancerous tissues respectively ( P ＜ 0. 05 ). The positive rate of CCN1 protein expression was 26. 7％ and 74. 1％ in cancerous and noncancerous tissues respectively (P ＜0. 05 ). A negative correlation was observed between the expressions of SARI and CCNI (r = -0. 24, P ＜0. 05 ). The negative expression of SARI correlated with a low grade of differentiation, deep infiltration depth and high TNM staging (P ＜ 0. 05 ). A positive expression of CCN1 correlated with deep infiltration depth and high TNM staging ( P ＜ 0. 05) while a negative expression of SARI correlated with a lower survival rate than that of a positive expression ( x2 = 8.47, P ＜ 0. 05 ) ; additionally, the survival rate of patients with a negative expression of SARI plus a positive expression of CCN1 was further lowered ( x2 = 12. 56, P ＜0. 05). Conclusion The aberrant expressions of SARI and CCN1 correlate with the malignant biobehaviors of CRC. And a negative expression of SARI correlates with a worse prognosis of CRC.

Objective To evaluate various clinical features and laboratory biochemical markers so as to develop a predictive model for differentiating tuberculous pleurisy (TBP) from non-tuberculous pleurisy (non-TBP). Methods A total of 241 TBP patients and 212 non-TBP patients who were hospitalized between January 2007 and December 2009 at our hospital were studied retrospectively. Their symptoms and laboratory parameters were recorded. The statistically different variables were selected to undergo binary logistic regression to calculate a scoring system (range:0 -10) according to their β coefficients. A receiver operating characteristic (ROC) curve was used to calculate the best cut-off value. The performance of the model was tested in a sample of 82 new cases with pleural exudates. Results Seven variables were selected in the present scoring model: temperature ＞38 ℃ (1.0 point), purified protein derivative testing positive ( 1.0 point), serum C-reactive protein ≥26 mg/L ( 1.5 points), pleural fluid lymphocyte percentage ≥85％(1.0 point), pleural fluid protein ≥ 49 g/L (1.0 point), pleural fluid adenosine deaminase ≥ 43 U/L (2. 5 points) and serum and/or pleural fluid mycobacterium tuberculosis antibody positive (2. 0 points).With a cut-off value of 6. 0 points, the sensitivity, specificity and accuracy of differentiating TBP from nonTBP was 90. 1％, 94. 3％ and 92. 1％ respectively. With the application of this model, 82 new pleural effusions showed a sensitivity of 94. 1％, a specificity of 93.8％ and an accuracy of 93.9％. Conclusion The scoring model provided a simple and feasible way of facilitating a differential diagnosis of TBP and nonTBP patients.

Objective To evaluate the impact of left ventricular systolic function on the outcomes of percutaneous coronary intervention (PCI) for unprotected left main (ULM) disease. Methods The relevant baseline and outcome data of patients undergoing PCI for ULM disease at our hospital were collected from September 2006 to August 2009. The enrolled patients were divided into two groups according to left ventricular ejection fraction (LVEF) : LVEF≥40％ group (n = 130) and LVEF ＜40％ group (n =56).The baseline and outcome data were compared between two groups. Multivariable regression analysis was performed to appraise the prognostic role of LVEF ＜ 40％ in patients undergoing PCI for ULM disease. Results There were more patients with diabetes mellitus, a previous history of myocardial infarction, previous PCI/CABG (coronary artery bypass grafting) and NSTEMI (non-ST-segment elevation myocardial infarction) in LVEF ＜ 40％ group than LVEF ≥ 40％ group ( P ＜ 0. 05 ). The major adverse cardiovascular and cerebral vascular event (MACCE) rate was higher in LVEF ＜40％ group than LVEF ≥40％ group(33.9％ vs 18. 5％, P =0. 022). And the rates of cardiac death, all-cause death and MI were also higher in LVEF＜40％ group than LVEF ≥40％ group(7.1％ vs 1.5％, P=0.047; 10.7％ vs 3. 1％, P = 0. 034; 14. 3％ vs 4. 6％, P = 0. 022). Female gender, diabetes mellitus, previous PCI/CABG, NSTEMI/STEMI, LVEF ＜ 40％, multiple-vessel disease, LM distal or bifurcation lesion and multiple-stent implantation were independent predictors of MACCE in patients undergoing PCI for ULM disease. Conclusion Impaired left ventricular systolic function ( LVEF ＜ 40％ ) affects the prognosis of ULM patients undergoing PCI. Reduced LVEF( LVEF ＜40％ )is the strongest predictor of adverse events in these patients.

Red blood cell growth promoter (ESA) is a synthetic erythropoietic drug, a human protein called erythropoietin, which can stimulate bone marrow blast cells to produce red blood cells. It is mainly used to treat certain types of anemia caused by chronic kidney disease (CKD), chemotherapy and other diseases. Such drugs include epoetin alfa (trade name: Epogen and Procrit) and darbepoetin alfa (trade name: Aranesp).

Objective To evaluate whether or not apigenin regulates the activation of inflammasome and elucidate its underlying mechanism. Methods Cultured THP-1 (acute monocytic leukemia cell line) cells were treated with dimethyl sulfoxide (DMSO) alone (control group), lipopolysaccharides (LPS), LPS plus apigenin (25/50 μmol/L) or LPS plus Z-VAD (a caspase inhibitor). The supernatant was harvested and the content of secreted interleukin (IL)-1β3 was determined by enzyme-linked immunosorbent assay (ELISA). The effects of apigenin on the cleavage of pro-IL-1β and pro-caspase-1 were determined by Western blot. And the effect of apigenin on the nuclear factor (NF) -κB activation was detected by reporter gene assay. ResultsMTT assays showed that the cytotoxicity of apigenin was low. Apigenin could sigrificantly inhibit the LPS-induced secretion of IL-1β in THP-1 cells. The concentration of IL-1β was (362 ±64) pg/ml in the control group, ( 1549 ±320) pg/ml in the LPS group, (397 ± 150) pg/ml in the LPS plus 25 μmol/L apigenin group and (268 ± 142) pg/ml in the LPS plus 50 μmol/L apigenin group (P ＜0. 05).The results of Western blot indicated that apigenin inhibited the maturation of pro-IL-1β and pro-caspase-1.It could also inhibit the LPS-induced activation of NF-κB. The value of relative light unit was 0. 6 ± 0. 1 in the control group, 32. 7 ±0. 8 in the LPS group, 12. 9 ± 1.8 in the LPS plus 25 μmol/L apigenin group and 10. 0 ± 3. 2 in the LPS plus 50 μmol/L apigenin group respectively (P ＜ 0. 05 ) . Conclusion Apigenin may inhibit the LPS-induced activation of inflammasome through an inhibited muturation of caspase-1.

Objective To explore the correlation of age-related hearing loss and cognition impairment in C57BL/6J mice by observing hearing, cognitive function and synapses. Methods C57BL/6J and CBA/CaJ mice were divided into 3 groups. The hearing and cognitive functions of each animal was tested. And the ultrastructure of synapses was simultaneously observed for C57BL/6J mice. Results The 24-26-week-old C57BL/6J mice developed moderate hearing loss while the 42- 44-week-old C57BL/6J counterparts suffered profound hearing loss. Whereas excellent hearing was maintained in 3 groups of CBA/CaJ mice within 44 weeks. During cognitive test, the performance of 42 -44-week-old C57BL/6J mice was significantly worse than CBA/CaJ mice. During probe test, the number of platform crossing of 42 - 44-week-old C57BL/6J mice was smaller than that of CBA/CaJ mice(0.5 ± 0.6 vs 1.9 ± 1.6; P ＜ 0.05 ). The 42 -44-week-old C57BL/6J mice had a wider synaptic cleft and a thinner postsynaptic density than the 24 -26-week-old C57 BL/6J counterparts [synaptic cleft: ( 19.4 ± 0.5 ) nm vs ( 1 1. 9 ± 0.7 ) nm; postsynaptic density:(15.2 ±0. 5) nm vs (27.8 ±2.0) nm; both P ＜0.05]. Furthermore, the degeneration of synapses in hippocampus CA3 area of C57BL/6J mice were clearly observed at 42 -44 weeks of age, but not seen in CBA/CaJ mice. Conclusion Age-related hearing loss might impact on the cognition impairment in C57 BL/6J mice.

Abstract of medical records The patient was a 26-year-old female. The digital rectal examination before admission revealed a round cystic mass in the retrosacral area of the uterus with smooth edges, pressing the uterus and surrounding intestines forward, and another round mass outside the right wall of the rectum. He was admitted to hospital on 9 November 2009. T: 36.5°C, P: 91 times/min; R: 17 times/min; BP: 130/80 mm Hg (1 mm Hg =0.133 kPa). Routine physical examination (I). Anorectal specialist situation: there is more hair in the sacrococcygeal region, normal skin color and no deformity. Digital rectal examination: 2 cm into the finger, palpable-1.5 cm ×1.0 cm cystic mass from the posterior wall of the rectum to the tip of the coccyx, tough in texture, mobile, and no blood staining on the finger cuff.

The patient, a 73-year-old male, was admitted to the hospital on March 2, 2010 due to "repeated cough for half a year, aggravated for 1 month, and chest tightness for 10 days". The patient began to cough repeatedly six months ago, occasionally coughing a small amount of white sticky phlegm, without fear of cold, fever, chest tightness and shortness of breath. In the past month, the cough has worsened, with frequent attacks and occasional shortness of breath. In the past 10 days, I felt that the symptoms of chest tightness and shortness of breath worsened in the local hospital. Chest CT showed a massive shadow in the lower lobe of the left lung, a slightly larger left hilum, and emphysema in the left lung. Considering "lung tumor", I came to our hospital for further diagnosis and treatment and was admitted to the hospital with "lung shadow".

Graft-versus-Host Disease (GVHD) is a systemic Disease with multiple system damage (skin, esophagus, gastrointestinal, liver, etc.) after bone marrow transplantation (BMT), which is one of the important causes of death. Current treatment methods for GVHD are mainly glucocorticoid therapy, such as prednisone, and the mechanism is to inhibit T lymphocyte-mediated immune attack response to receptors. However, hormone therapy is not very ideal. Two studies have shown that the sustained complete effectiveness of hormone therapy is only 18% and 35% [1-2]. High-dose hormone therapy will increase the risk of infection and tumor recurrence. Therefore, the treatment of GVHD needs safer and more effective new therapies.

A 72-year-old male was admitted to the hospital on 23 February 2011 due to repeated cough and expectoration accompanied by shortness of breath after activity for 5 years, aggravated for 1 month. Five years ago, the patient began to have repeated cough and expectoration, accompanied by shortness of breath after activity. He visited other hospitals many times and was diagnosed with chronic bronchitis and chronic obstructive emphysema. After anti-inflammatory and symptomatic treatment, the symptoms could be slightly relieved. One month ago, the patient's cough and sputum aggravated after catching a cold, which was yellow sticky sputum with a large amount. The symptoms did not improve significantly after anti-inflammatory treatment. CT examination of the chest revealed a soft tissue mass in the lumen of the right main bronchus (Figure 1) and multiple bullae in both lungs. Fiberoptic bronchoscopy (referred to as fiberoptic bronchoscopy for short) revealed new organisms in the lumen of the right main bronchus (Figure 2).

Using a new in vivo screening system, Whitehead Institute researchers have identified a protein in the serine biosynthetic pathway that is necessary for estrogen receptor (ER) -negative breast cancer. Estrogen receptor (ER) negative breast cancer is a well-known difficult disease with a low 5-year survival rate. According to the researchers, when the expression of the gene encoding this protein, phosphate dehydrogenase (PHGDH), is inhibited in tumors and in cell lines with too much of this protein, the cell growth rate decreases significantly.