Volume 91  ·   Issue 35  ·  2011

Objective To explore the expressions of urokinase-type plasminogen activator (uPA)and its receptor (uPAR) in vulvar tissues and elucidate the patterns. Methods Thirty cases of vulvar neoplasms, 30 vulvar intraepithelial neoplasia (VIN) and 30 cases of normal epithelial tissue were harvested. And the expressions of uPA and uPAR in paraffin-embedded tissues were detected by immunohistochemistry. And the differential expressions of various vulvar tissues were observed. And the differences were compared in clinical stage and lymph node metastasis. Results ( 1 ) The expressions of uPA and uPAR in normal tissues (0.422 ±0.022, 0.431 ±0.027), vulvar intraepithelial neoplasia (VIN)(0.462 ±0.018, 0.467 ±0.015) and vulvar neoplasms (0.508 ±0.020, 0.510 ± 0.020) were significantly different (P ＜0.01 ). (2) The expressions of uPA and uPAR in vulvar tissue significantly increased with a rising stage-level (P ＜ 0.05 ). ( 3 ) Compared with those without lymph node metastasis ,the patients with lymph node metastasis bad significantly higher expressions of uPA and uPAR in vulvar tissue ( P ＜ 0.05). Conclusion Thus uPA and uPAR play an important role in the development process of vulvar neoplasms with an elevated expression in normal vulvar tissue, VIN and vulvar neoplasms. The invasiveness and prognosis of vulvar neoplasms may be evaluated through detecting the tissue expressions of uPA and uPAR.

Objective To explore the feasibility, operating technique and precautions of endoscopic microvascular decompression for trigeminal neuralgia. Methods A retrospective analysis was conducted for 21 patients with primary trigeminal neuralgia. All underwent neuroendoscopic microvascular decompression for trigeminal nerves. Results The pains disappeared upon awaking post-anesthesia in 19 patients. In 2 patients, pains became significantly alleviated and disappeared after taking carbamazepine for 1 -3 months.No patient suffered the injuries of trigeminal nerve and other cranial nerves. None had cerebellum edema or death. During the follow-up period, there was no recurrence of pains. Conclusion Neuroendoscopic surgery may accomplish microvascular decompression for trigeminal nerve independently. As a minimally invasive and effective technique, it offers a clearer vision of local anatomy and decreases the probability of damaging nerves and vessels. There is no need for pulling cerebellum. It brings minimal damage to normal brain tissue compared with microsurgery. Further popularization is warranted.

Objective To explore the role of modified external ventricular drainage (mEVD) in the treatment of tuberculous meningitis obstructive hydrocephalus in children. Methods The records were retrospectively reviewed for 30 pediatric patients of tuberculous meningitis with hydrocephalus (TBMH)undergoing surgery between January 2007 and December 2010. The procedures included ventricular abdomen subcutaneous drainage (mEVD) (n =6), Ommaya reservoir ( n =9) and ventriculoperitoneal shunt (VPS)(n =15). White cell count and protein content of cerebrospinal fluid were measured repeatedly. And their clinical outcomes were assessed at 6 months post-operation. Results External drainage was extracted for 4 of 6 TBMH patients after 4 - 6 months of mEVD. Neither intracranial infections nor serious postoperative complications occurred. Two of 6 TBMH received VPS substituting for mEVD. No statistically significant difference in white cell count, protein content of cerebrospinal fluid and outcome was found between the mEVD and VPS groups. Conclusion Ventricular abdomen subcutaneous drainage is both safe and efficacious in the management of children with tuberculous meningitis hydrocephalus. This approach may avoid possible complications and long-term indwelling shunt so that it is worthy of further clinical application.

Objective To compare the clinical outcomes of laparoscopic-assisted versus handassisted laparoscopic radical operations in colorectal cancer and evaluate the safety and indications of handassisted laparoscopic operations. Methods A total of 64 consecutive colorectal cancer patients enrolled from November 2009 to December 2011 at our hospital were randomly and prospectively divided into 2 groups: hand-assisted laparoscopic operation (HALS) ( n =32) and laparoscopic-assisted operation ( n =32). And such clinicopathologic features as safety, operative curability and postoperative recovery were compared between two groups. Results Neither death nor conversion-to-open-surgery was reported among all patients. There were no statistical differences in such clinicopathologic features as age, gender, body mass index, mass size and location( all P ＞0.05 ). There were statistically a shorter operation time [( 127 ±31 ) min vs ( 184 ± 71 ) min, P =0.022] and a smaller number of Trocar(2.4 vs 5.0, P =0.015 ) in the HALS group. However, the laparoscopic-assisted group had a lesser volume of blood loss [(82 ±31 ) ml vs ( 150 ±42) ml, P =0.008] and a smaller postoperative 48 h drainage flow [( 170 ±52) ml vs (208 ±58)ml, P =0.020]. Moreover, no statistical differences existed in the length of bowel resection [(19 ±5) cm vs (18 ± 4) cm], amount of lymph nodes dissection (16 ± 4 vs 16 ± 3), postoperative complications [12.5％(4/32) vs25.0％ (8/32)], time of intestinal function recovery [(1.7 ±0.9) d vs (1.8 ±0.7) d], time of semifluid tolerance [(2.9 ± 1.3) vs (2.8 ± 1.2) d], hospitalization expenses [(4.8 ±0.6 ) 10000 yuan vs ( 4.9 ± 0.4 ) 10000 yuan] and postoperative hospital stay [( 6.7 ± 2.3 ) d vs ( 6.6 ±2.3 ) d] ( all P ＞ 0.05 ). Conclusion HALS is both safe and efficacious for colorectal cancer patients.

Objective To explore the feasibility of detecting vimentin, oncostatin M receptor (OMSR) and tissue factor pathway inhibitor 2 (TFPI2)gene methylation status in stool samples as a noninvasive screening tool for colorectal cancer and precancerous lesions. Methods Stool samples were collected from 60 patients with colorectal cancer, 17 patients with adenoma and 30 normal volunteers. And fecal DNA was extracted and vimentin, OMSR and TFP12 gene methylation status was analyzed by methylation-specific polymerase chain reaction (MSP). Results The methylated vimentin, OMSR and TFPI2 was detected in 53.3％ (32/60) , 68.3％ (41/60) and 75.0％ (45/60) of colorectal cancer, and 5, 7 and 11 cases of colorectal adenoma respectively. The sensitivities of combined study, using three markers for the detection of colorectal cancer and colorectal adenomas, were 86.7％ (26/30) and 76.5％(13/17) respectively. And the specifieity was 86.7％ (52/60). Conclusion As a feasible epigenetic marker, promoter hypermethylation for vimentin, OMSR and TFPI2 in stool samples is a sensitive, specific and noninvasive alternative for colorectal cancer screening.

Objective To evaluate the short-term efficacies of Fufangkushen Injection plus chemotherapy in patients with solid tumors. Methods A comprehensive retrieval of the relevant literatures was performed by searching major biomedical databases of Medline, Embase, the Cochrane Library, Chinese Biomedical Literature Database (CBM), China Academic Journals Full-text Database (CNKI), Chinese Medical Current Contents (CMCC) and China Online Journals (Wangfang). And study selection and assessment, data collection and analysis were undertaken by two reviewers according to the Cochrane Handbook for Systematic Reviews of Interventions. Short-term efficacies were analyzed in each corresponding subgroup according to the type of tumor. Statistical analysis was performed by Review Manager Software 4.2 ( RevMan 4.2). Results Overall there were 33 studies of randomized controlled trials with a total of 2897 patients. All were of excellent homogeneity. The four subgroup-analyses ( colorectal cancer, NSCLC ( nonsmall cell lung cancer), breast cancer and gastric cancer) were performed with a fixed-effects model. The results of meta-analysis demonstrated that the short-term efficacies in patients with colorectal cancer, NSCLC and breast cancer receiving Fufangkushen Injection plus chemotherapy were significantly better than for those receiving chemotherapy alone (OR =2.48(1.59, 3.90), Z=3.94, P＜0.0001; OR =1.43(1.20,1.71 ), Z =3.97, P =0.0001 ; OR =2.06 ( 1.28, 3.34), Z =2.96, P =0.003, respectively). However the patients with gastric cancer on combined chemotherapy were not significantly different from those on chemotherapy alone ( OR =1.25(0.73,2.13), Z =0.81, P =0.46). Conclusion Fufangkushen Injection might improve the efficacies of chemotherapy in patients with colorectal cancer, NSCLC and breast cancer. Further large-scale multicenter and better designed studies are warranted to offer more convincing evidences.

Objective To explore the relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD) based on symptoms. Methods A total of 1090 patients undergoing upper digestive tract motility test were invited to complete the surveys of reflux disease questionnaire and reflux symptom index from August 2007 to October 2010. And 895 responders provided valid answers. There were 474 females and 421 males. Results Among 895 responders, 351 patients had neither, 218 suffered both conditions, 237 were diagnosed as GERD alone and 89 LPRD alone. No difference was found in age ( P =0.383 ) or gender ratio ( P =0.227 ). In 455 GERD patients, there were 218 LPRD cases (47.9％). In 307 LPRD patients, 218 (71.0％) had concurrent GERD. In GERD patients, the frequency and degree of feeling of stomach content reflux into mouth were correlated with RSI ( r =0.115,0.141, P =0.007, 0.001 ). Conclusion GERD and LPRD may coexist or occur alone. Because of a high concurrent ratio of LPRD in GERD, the treatment strategy of GERD should be modified accordingly. In GERD patients, the feeling of stomach content reflux into mouth may suggest a possibility of LPRD.

Objective To explore the efficacy of arthroscopic repair of medial patellofemoral ligament (MPFL) for adolescents with epiphyseal non-closure by allogenic tendon in the treatment of instable patellofemoral joint. Methods There were a total of 38 cases including 61 knees with patellofemoral instability from June 2008 to January 2010 at our department. They were diagnosed according to the history of illness, apprehension test and tangential position radiograph in patellofemoral joint. Results A total of 33 patients with 52 knees were followed up for an average of 12 months (range:8 -19). All apprehension tests were negative. No recurrent displacement was found. The pre-operative Lysholm score of 75.5 ± 4.7 increased to 91.1 ±5.7. There was significant difference. Conclusion Arthroscope-assisted allograft reconstruction of medial patellofemoral ligament tendon is both mini-invasive and reliable for the treatment of epiphyseal nonclosure adolescents with traumatic patellofemoral instability.

Objective To analyze the clinical features of ultra longitudinally extensive transverse myelitis (uLETM). Methods Four first-onset uLETM patients hospitalized during September 2009 and March 2011 were recruited and retrospectively analyzed for clinical and MRI ( magnetic resonance imaging)features, as well as therapeutic profiles and prognoses. Results The male-to-female ratio was 1∶3 and the age-of-onset 29-33 years old. Extremity paralysis and intrinsic sphincter disorders were initially observed. The clinical manifestations include visual, motor, sense and intrinsic sphincter disorders caused by optic nerve and spinal cord lesions. Uric acid decreased in 3 cases. Seropositivity for autoimmune antibody spectrum and NMO-IgG ( neuromyelitis optica-immunoglobulin G) was found in some patients. Spinal MRI showed overall hypointense T1 and hyperintense T2 lesions in spinal cord with partial swelling and negative in brain MRI. Sjogren's syndrome associated with uLETM was diagnosed in 2 patients. Three cases improved after treatment with high-dose corticosteroids, intravenous immunoglobulin and other immunosuppressive agents. One patient died. Conclusion uLETM is commonly found in young women. Spinal cord is frequently affected. And it may occur concurrently with optical abnormalities and other autoimmune diseases, Intracranial parenchyma is rarely affected. The therapy of corticosteroids is recommended.

Objective To observe the monocytic expression of CD40 and plasma IL-8 concentration in senile CHD (coronary heart disease ) patients with depressive disorder and examine the effects of immunological factors in depressive disorder and CHD. Methods A total of 100 senile CHD patients ( ＞60yr old) were divided into 3 group: control group (A, n =30), depression score ≤20 & anxiety score ≤6;therapy group ( B, n =35 ) , depression score ≥ 30 & anxiety score ≤ 6, psychological evaluations with HAMD( Hamilton depression rating scale)from Day 1 pre-operation to Day 7 post-operation; non-therapy group ( C, n =35 ), depression score ≥30 & anxiety score ≤6. They underwent the same operation : lumbar decompression & fusion, stripping of great saphenous vein and repair of indirect hernia. At Day 1 preoperation and Day 7 post-operation, 2 ml venous blood was drawn for the detection of monocytic expression of CD40 and plasma concentration of IL-8 ( interleukin-8 ). Results Depressive value of Group B at postoperation was lower than that at pre-operation and Group C ( (25.1 ± 2.9) vs ( 33.2 ± 1.4) & (34.2 ±0.8), P ＜ 0.05 ) ; the pre-operative expression of CD40 of Group A was lower than the other groups ((123 ±18) vs (197 ±23) & (204 ±26) , P ＜0.05). And Group B at post-operation was lower than Group C (( 147 ± 19) vs (212 ± 18 ), P ＜ 0.05 ); the pre-operative concentration of IL-8 was lowest in Group A ( (85 ± 16 ) ng/L vs ( 151 ± 18 ) ng/L & ( 164 ± 22 ) ng/L, P ＜ 0.05 ). And Group B at postoperation was lower than Group C ( ( 158 ± 19 ) ng/L vs ( 197 ± 24 ) ng/L, P ＜ 0.05 ) . There were significantly positive correlations between depression scores, the expression of CD40 and the plasma concentration of IL-8. Conclusion Depressive disorders elevate the monocytic expression of CD40 and raise the plasma concentration of IL-8 in senile CHD patients. Some immunological factors may play a important role in depressive disorder and CHD.

Objective To develop an in vivo intervertebral disc organ culture model for a physiological environment and evaluate its clinical significance. Methods Murine functional spine units (FSUs) were isolated from 10-week-old mouse lumbar spines. FSUs consisted of two vertebrae surrounding one disc. Murine FSUs were cultured in medium and different concentrations of bupivacaine for different periods. Histological change and cell viability within intervertebral disc tissue were assessed by histological staining and MTT (3-(4,5-cimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay. Results Murine disc organs cultured for up to 4 weeks showed minimal changes in tissue histology and cell viability. A 1 -hour incubation in 0.25％ bupivacaine resulted in about 25％ cell death while 0.5％ bupivacaine exposure yielded 60％ cell death over the same time. Conclusion Murine intervertebral disc maintains the integrity of tissue structures and cell functions for an ex vivo 4-week culture. And the exposure to bupivacaine dramatically decreases cell viability in a dose-dependent manner.

Objective To explore the functions and adhesive properties of circulating endothelial cells after acute thrombosis in rats. Methods The inferior caval venous thrombosis model were treated with heparin ( n =45 ), urokinase ( n =45 ) and a combination of heparin and urokinase ( n =45 ) respectively. The sham group was treated similarly ( n =30). The thrombosed caval veins were harvested at Days 1, 3, 7,14 and 28 post-thrombosis. Structural integrity and intimal hyperplasia were observed by light microscope. Scanning electron microscopy was used to assess the damage of endothelial cells in inferior caval vein wall. The level of thrombotic adhesion was measured in different phases. At Day 28, endothelial cell layer was observed under scanning electron microscope. Measurements were taken for circulating endothelial cells count, CEPC (circulating endothelial progenitor cell) count and CEPC adhesive capacity. Results The adhesion to caval vein wall was lower in groups B and C than that in group A at Day 3 post-thrombosis ( all P ＜ 0.01 ). The endothelial damage in group A was more serious than groups B and C at Day 7 ( P ＜ 0.05 ). And the endothelial damage was less severe in group C at Day 28 ( P ＜ 0.05 ). For the rats in A, B, C, SH groups,the numbers of circulating endothelial cell [(6.3 ±2.2) × 106, (4.76 ±3.1 ) × 106, ( 1.9 ±0.8)× 106,(0.91 ±0.3) ×106], CEPC count (18.9 ±5.33, 37.4 ±6.0, 55.4±8.0, 64.1 ±3.2) and CEPC adhesion(9.6 ± 2.9, 17.5 ± 3.2, 22.1 ± 4.4, 28.3 ± 2.0) increased successively. There was statistical significance. Conclusion A combination of heparin and urokinase for the treatment of acute inferior caval venous thrombosis may effectively maintain the endothelial integrity of vein wall and decrease the fibroblast proliferation of thrombosed vein. Adhesion to caval vein wall is relatively lower during an early postthrombotic period.

Objective To investigate the effects of Ginkgo biloba extract (GBE) on the expression of endothelial nitric oxide synthase (eNOS) and the release of nitric oxide (NO) in mesenteric arterioles of aging rats. Methods ( 1 ) Cytologic experiment: human umbilical vein endothelial cells ( HUVEC ) were randomly divided into 3 groups: control group, NG-nitro-L-arginine methyl ester (L-NAME) group and GBE group. L-NAME group:100 μmol/L L-NAME was added into HUNEC for a 48-hour incubation. GBE group:After HUVEC was exposed to 100 μmol/L L-NAME for 24 hours, 20 g/L GBE was added for another 24-hour co-incubation. Then the expression of eNOS protein was observed in each group. (2) Animal experiment : Thirty-two 24-month-old male SD rats were randomly divided into normal control group ( n =8)and GBE group (n =24). The GBE group was further divided into 3 groups receiving an orally dosed GBE for 3, 5, 7 days respectively. Afterward the diameter of first-order mesenteric arteriole was measured under the pressures of 20, 40, 60, 80, 100, 120, 140 mm Hg(1 mm Hg =0.133 kPa) and the elasticity of blood vessels calculated. The release of NO, the expression of eNOS protein and its mRNA in mesenteric arterioles stimulated by the same shear stress ( 15 dyn/cm2 ) were evaluated respectively. Results ( 1 ) Cytological studies indicated that the expression of eNOS protein of the L-NAME group was significantly lower than those of the control and GBE groups (0.57 ±0.06 vs 0.96 ±0.05,0.81 ±0.09, both P ＜0.01 ). (2) After the dosing of GBE for 3, 5, 7 days, the release of NO was significantly higher than that of the control group [(8.01 ±0.24, 12.11 ±0.78, 14.72 ±0.70 vs 5.83 ±0.75) pmol · mm-2 · min-1, all P ＜0.05] ; the expressions of eNOS protein were significantly higher than those of the control group (0.59 ± 0.20, 0.86 ±0.02, 1.09 ±0.13 vs 0.41 ±0.16, all P ＜0.05). And GBE was highest at Day 7 ; the expression levels of eNOS mRNA were significantly higher than those of the control group (0.79 ± 0.04, 0.85 ± 0.07, 0.99 ±0.03 vs 0.58 ± 0.05, all P ＜ 0.05 ). And GBE was also highest at Day 7. Conclusion GBE can improve vascular flexibility through increasing the expression of eNOS and the release of NO, protecting the functions of blood vessels.

Objective To study the effect of tissue factor (TF) on human hepatocellular carcinoma cells when their inner TF gene was knocked down by RNA interference. Methods The eukaryotic expression vector bearing siRNA sequence that targeted at TF gene was transfected into human hepatocellular carcinoma cell line HepG2. RT-PCR and Western blot were used to detect the changes of TF gene expression. Transwell invasion assay invitro were used to show the invasive ability of HepG2 cells with transfected pGPU6/GFP/Neo-TFsiRNA. Results RT-PCR and Western blot analysis showed that HepG2 cells with pGPU6/GFP/Neo-TFsiRNA transfected decreased the endogenous TF gene expression. Correspondingly the mean invading cells was 14 ± 10 for pGPU6/GFP/Neo-TFsiRNA transfection and 128 ± 18 for the NCsiRNA transfection,respectively by the Transwell invasion test in vitro( P ＜0.05 ). The results indicated that the invasive ability of the HepG2 cells with pGPU6/GFP/Neo-TFsiRNA transfected decreased obviously. Conclusions TF is involved in the progression of hepatocellular carcinoma and inhibiting the expression of TF can decrease the invasion and metastasis ability of tumor cell in vitro.

Abstract of medical records The patient was a 60-year-old female. Due to swelling and pain of multiple joints for 3 months, numbness of both hands and feet with drooping feet for 10 days, he was hospitalized in the Department of Rheumatology of the People's Liberation Army General Hospital on October 5, 2010. Three months ago, the symptoms of swelling, pain and limited movement of the metatarsophalangeal joints of both feet began to appear, and then gradually involved the proximal interfalangeal joints, metacarpophalangeal joints, wrists, shoulders, temporomandibular joints and bilateral sternocostal joints of both hands. The morning stiffness lasted for half a day without relief. On September 24, 2010, the apricot serum rheumatoid factor was 1.20×106 IU/L, and anti-keratin antibody, anti-cyclic guanidine polypeptide antibody and anti-perinuclear factor were positive in the outpatient department of the Chinese People's Liberation Army General Hospital.

tamiflu, whose chemical generic name is Oseltamivir phosphate, is a drug produced by Genentech, a subsidiary of Roche Pharmaceutical Group in Switzerland. It was listed in my country in October 2001. The drug is a neuraminase inhibitor that can help shorten the flu symptoms of patients, such as nasal congestion or runny nose, sore throat, cough, muscle or joint pain, tiredness, headache, fever, etc. It has a miracle effect on inhibiting H5N1 avian influenza.

Usually, the surgical treatment of spinal tumors is to remove the lesion by curettage or block resection, while the palliative resection of spinal metastases is only given after the symptoms of nerve compression. This surgical method must have a high recurrence rate of local tumors [1]. In recent years, with the advancement of tumor theory research, tumor staging system and the improvement of surgical technology, the treatment of spinal tumor has undergone fundamental changes. Total spinal resection is increasingly used in the treatment of primary malignant and solitary metastatic tumors of the spine, especially total spinal block resection, which can completely remove tumors, effectively reduce the contamination of tumors to surrounding tissues, significantly reduce the recurrence rate of tumors, and significantly improve the survival rate of patients [2-3]. The thoracolumbar spine is a high incidence site of spinal tumors, but the operation of thoracolumbar spinal tumors is still controversial, and the choice of surgical methods is still random and blind. The surgical treatment methods, treatment principles and indications of thoracolumbar spinal tumors are reviewed.

A 39-year-old female suffered from irregular vaginal bleeding for 4 months. He was admitted to Peking University People's Hospital on 28 July 2010. The patient usually had regular menstruation. Four months ago, he had irregular vaginal bleeding, which was small in amount, accompanied by lower abdominal pain, and no vaginal discharge. There was no obvious improvement in hemostasis and anti-infective treatment in other hospitals. 10 days before the hospital, the patient went to the doctor again due to vaginal bleeding and tissue shedding. The pathological examination results of the shedded tissue in other hospitals suggested that it was "malignant", so he came to Peking University People's Hospital for further diagnosis and treatment. Gynecological examination: vaginal patency, a small amount of dark red blood, smooth cervix, normal size, anterior position of sub-organ, often large, good activity, and no abnormalities in double appendages.