Volume 92  ·   Issue 02  ·  2012

academic medicine is the foundation of academic medical centers and academic medical careers. Although they have deeply influenced all aspects of medical treatment, medical teaching and research in our country, there are still few studies. Facing the rapid development and the reform of medical and health system in our country, it is very necessary to understand them more clearly in order to promote the sound and rapid development of medical cause in our country [1-2]. Therefore, the origin, development, present situation and future of academic medicine are briefly analyzed as follows.

I. Overview: Consensus Purpose and Significance Acinetobacter baumannii has a strong ability to acquire Drug resistance and clone transmission. Multidrug-resistant, Extensively Resistant and fully Resistant Acinetobacter baumannii is a worldwide epidemic [1], and has become one of the most important pathogens of nosocomial infection in China. Multidrug-resistant Acinetobacter baumannii MDRAB refers to strains Resistant to at least three of the following five classes of antimicrobial drugs, including: anti-pseudomonas cephalosporins, anti-pseudomonas carbapenem antibiotics, compound preparations containing beta lactamase inhibitors (including piperacillin/tazobactam, cefoperazone/sulbactam, ampicillin/sulbactam), fluoroquinolone antibacterial drugs, aminoglycoside antibiotics. Extensively Drug Resistant A. baumannii (XDRAB) refers to strains susceptible to only 1 to 2 drugs with potential anti-Acinetobacter activity [mainly tigecycline and/or polymyxin].

Objective To investigate the safety,feasibility and short-term efficacy of laparoscopic surgery in patients with middle-low rectal cancer.Methods From January 2008 to January 2010,a total of 108 patients with middle-low rectal cancer at Department of Gastrointestinal Surgery,Affiliated Tumor Hospital,Xinjiang Medical University were divided into 2 groups by different treatments: laparoscopic resection group ( LR,n =63 ) and conventional open resection group ( OR,n =45 ).The choice of two surgical options was based on patient's desire.The outcomes of two patient groups with radical surgery were prospectively evaluated.Results Seven cases were converted into open surgery from the laparoscopic group.The operative durations in the LR and OR groups were (246 ± 57 ) min and (229 ± 53) min respectively ( P ＞0.05).The laparoscopic group had a lesser amount of blood loss during surgery ( (51 ±20) ml vs ( 110±41 ) ml,P ＜ 0.05 ).The time needed for the recovery of gastrointestinal functions in the laparoscopic group was significantly shorter than that in the open surgery group ( ( 3.0 ± 0.8 ) d vs ( 3.7 ± 1.3 ) d,P ＜0.05).In terms of the length of specimen,the range of radical surgery and the rate of complication,no significant difference were found between two groups ( all P ＞ 0.05 ).The numbers of dissected lymph nodes were 13 and 12 cases respectively ( P ＞ 0.05 ). No instance of incision implantation,local recurrence or short-term death was found in neither group.There was 2 cases with lung metastasis in the LR group and 2 cases with the metastasis of liver and lung in the OR group.Conclusion As a safe,feasible,effective and mini-invasive with similar radical resection and satisfactory short-term outcomes,laparoscopic surgery for low-middle rectal cancer has better prospects in the future.

Objective To explore the association between serum adipocyte fatty acid binding protein (A-FABP) levels and dyslipidemia in patients with obstructive sleep apnea syndromes (OSAS).Methods Eighty snoring patients were monitored by overnight polysomnography (PSG) in Second Affiliated Hospital of Soochow University from November 2010 to May 2011.There were 63 males and 17 females with a mean age of (48 ± 14) years (range: 22 -77 years).Based on the results of apnea-hypopnea index (AHI),they were divided into 3 groups: primary snoring group (AHI ＜5/h,n =19),mild-moderate OSAS group (5/h ≤AHI ≤40/h,n =22) and severe OSAS group ( AHI ＞ 40/h,n =39).The levels of A-FABP,total cholesterol ( TC ),triglyceride ( TG ),low-density lipoprotein cholesterol ( LDL-C ) and high-density lipoprotein cholesterol (HDL-C) were measured and compared between the primary snoring group and OSAS patients of different severities.And the correlations between serum A-FABP and plasma lipid as well as PSG parameters were further evaluated by partial correlation analysis.Results Compared with the primary snoring group ( ( 15.7 ± 3.3 ) μg/L) and mild-moderate group ( ( 17.3 ± 4.3 ) μg/L),there was a significant elevation of serum A-FABP level in the severe OSAS group ((20.4 ±4.6) μg/L) (P =0.001,P =0.026).Additionally,after adjustment for body mass index and age,the serum A-FABP level showed significant positive correlations with TC,TG and LDL-C ( r =0.469,P =0.000 ; r =0.239,P =0.035 andr=0.366,P =0.001 ).Serum A-FABP level was positively correlated with AHI and the time of oxygen saturation (SaO2) ＜90％ (r =0.231,P =0.042 and r =0.226,P =0.047).Nevertheless,the serum AFABP level showed significant negative correlations with the lowest SaO2 and the mean SaO2 (r =-0.234,P=0.039 and r =- 0.270,P =0.017 ).Conclusion Dyslipidemia and elevated level of serum A-FABP are common in OSAS patients.

Objective To explore the surgical approaches and clinical outcomes of chronic radiation intestinal injury ( CRII ).Methods From January 1,2001 to December 31,2010,at Department of Surgery,Nanjing General Hospital of Nanjing Command a consecutive series of 206 CRII patients undergoing surgical interventions was reviewed retrospectively.There were 64 males and 142 females with an age range of (50 ± 11 ) years old.The indications,surgical approaches,surgical complications and mortality were analyzed.Results 206 CRII patients received 229 surgical treatment,31 patients underwent two or more operations.The course of surgical interventions included intestinal obstruction ( n =142 ),intestinal fistula (n=56),proctitis (n =12),bleeding (n =6) and others (n =13).They underwent 229 laparotomies including intestinal resection and primary anastomosis (n =142),intestinal resection and enterostomy (n =57),exclusion of radiation-related gastrointestinal diseases ( n =14 ) and other procedures ( n =16).The occurrence rate of postoperative intestinal complications was 25.7％ ( 53/206 ).Five patients ( 2.4％ ) died within the postoperative 28 days.Conclusion Surgery is often required for patients with chronic radiationinduced intestinal obstruction,fistula,hemorrhage and perforation,etc.Resection and primary anastomosis with undamaged segments may be performed safely in selected patients.And a judicious use of stoma can reduce the rates of major surgical mortality and morbidity.

Objective To explore the effects of soluble epoxide hydrolase inhibitor (sEHi) on the expressions of fatty acid synthase (FASN) mRNA and protein in peripheral blood mononuclear cell (PBMCs) of patients with acute coronary syndrome (ACS) and to discuss the influences of sEHi in the regulated expression of FASN and inflammatory reaction.Methods The hospitalized ACS patients were selected as the ACS group (n =35 ) while the healthy normal subjects as the control group (n =30).The levels of lipoproteins,fasting blood glucose,myocardial enzyme and hs-CRP (high-sensitive C-reactive protein) were measured within 24 hours after admission.Meanwhile the PBMCs were separated and cultured and then t-AUCB was added in various concentrations (0,1,10,50,100 μmol/L). The cellular expressions of FASN,IL-6 mRNA and protein were detected by real-time PCR (polymerase chain reaction)and Western blot respectively.Results ( 1 )The serum concentration of hs-CRP reached (5.6 ± 4.1 )mg/L in the ACS group.And it was obviously higher than ( 1.3 ± 0.9 ) mg/L in the control group ( P ＜ 0.05 ).Compared with the control group,the expression levels of FASN,IL-6 mRNA and protein significantly increased in the ACS group ( the relative expression amount of FASN mRNA: 1 vs 1.709 ± 0.272,FASN protein: 0.407 ± 0.065 vs 1.298 ± 0.087 ; relative expression amount of IL-6 mRNA: 1 vs 2.302 ± 0.200,IL-6 protein: 0.715 ± 0.058 vs 1.146 ± 0.083,P ＜ 0.05 ).Moreover,the levels of FASN and IL-6 mRNA had positive correlations with the serum concentration of hs-CRP ( r =0.714,P ＜ 0.01 ; r =0.685,P ＜0.01).(2) Compared with the control group (t-AUCB 0 μmol/L),10,50,100 μmol/L t-AUCB had inhibited the expressions quantity of FASN,IL,-6 mRNA and protein in PBMCs from the ACS group (P ＜ 0.05 ).The relative expressions of FASN mRNA in t-AUCB 0,10,50,100 μmol/L group were 1,0.813 ± 0.038,0.564 ±0.100,0.293 ±0.043 respectively.The relative expressions of FASN protein in t-AUCB 0,10,50 and 100 μmol/L group were 0.957 ± 0.280,0.935 ± 0.275,0.855 ± 0.253,0.685 ± 0.206respectively.Conclusion The inflammatory level increases obviously in the ACS group.And the expression level of FASN in PBMCs is closely correlated with the inflammatory level in the ACS patients; t-AUCB may prevent the ruptures of atherosclerotic lesions by regulating FASN and inhibiting inflammatory reactions in ACS patients.

Objective To explore the surgical approaches,efficacy and safety of percutaneous nephroscopic 2 μm laser incision and drainage in the treatment of peripelvic renal cysts.Methods The peripelvic renal cysts were punctured percutaneously.A 1.5-4.0 cm incision was made at thin avascular area between cyst and pelvis by the 2 μm laser to connect the cyst with the renal collecting system with the help of injecting methylene blue solution into renal pelvis through ureteral catheter.The double-J tube was placed for drainage.Results The operations were successful in all cases.There were 16 males and 15 females with a mean age of 49 years old.The operative durations ranged from 25 to 120 minutes.And no severe complications occurred.The patients were followed up for an average of 12 months (range: 3 -36) Among them,cysts disappeared in 18 cases and diminished over 1/3 in 13 cases.There was no recurrence of peripelvic renal cyst.Conclusion Percutaneous nephroscopic 2-μm laser incision and drainage for peripelvic renal cyst is safe,effective and mini-invasive.

Objective To analyze the ocular features of multiple endocrine neoplasia type 2b( MEN 2b).Methods Three cases with MEN 2b were reviewed and their ocular features analyzed.Results All patients had medullary thyroid carcinoma and thickened corneal nerve fibers.Adrenal pheochromocytoma,oral mucosal neuroma,marfanoid body habitus,eyelid nodule and conjunctival nodule were found in two patients.And iris nodule was found in one patient.Conclusions The most comman ocular manifestations of MEN 2b is thickened corneal nerve fibers.

Objective To explore the diagnostic value of soluble B7-H4 (sB7-H4) in tuberculous pleural effusion and malignant pleural effusion.Methods A total of 98 patients of pleural effusion treated in Nanjing Chest Hospital from January 2007 to December 2009 were enrolled.The etiologies were tuberculous (n =48) and malignant (n =50). The levels of sB7-H4 in pleural effusion were detected by sandwich enzyme linked immunosorbent assay. The rational clinical diagnostic value was established by receiver operating characteristic ( ROC ) curves.Results The level of sB7-H4 in malignant pleural effusion was significant higher than that in tuberculous effusion ( (65.7 ±5.8) vs (28.6 ±8.7) μg/L,P＜0.05).The cut-off value of sB7-H4 was 36.5 μg/L for malignant pleural effusion. And the rates of sensitivity,specificity and accuracy were 92.0％,83.3％ and 87.8％ respectively.Conclusion The level of sB7-H4 may be used as a valuable parameter in the differentiation of tuberculous from malignant effusion.

Objective To introduce a novel technique of ureterointestinal anastomosis for urinary diversion and report the preliminary clinical data.Methods Between June 2007 and June 2011,a total of 50 patients underwent radical cystectomy and ileal neobladder for invasive bladder carcinoma or carcinoma in situ.A novel,separate and direct end-to-end technique for ureteral reimplantation to the entrance of a segment of ileum was applied. in all patients. Details are as follow. The entrance of afferent loop was divided equally in to two lumens. Then each ureter was directly,end-to-end anastomosed to the above lumens respectively after lengthwise incisions for 1.5 cm.The mean follow-up period was 22 months ( range,3-48 months). Results Ureterointestinal anastomosis was performed successfully in 100 units. The operative durations were (18.4 ±4.2) minutes.Ureteral stricture developed in 4 of 100 (4％) units and refluxing in 6 of 100 (6％) units. One patient with stricture was successful repaired by balloon dilation.Conclusion With low stricture and reflux rates, this novel procedure of ureterointestinal anastomosis is simple to handle and worthy of further promotion.

Objective To explore the clinical features and related factors of sexual dysfunctions in male patients with pituitary adenomas.Methods The questionnaires of sexual functions were collected from 86 male patients with pituitary adenomas. We examined the clinical features of sexual dysfunctions and analyzed the correlations between sexual behaviors and age,tumor type,invasiveness,tumor size,serum levels of prolactin (PRL) and testosterone.Results The incidence of sexual dysfunctions was 80.2％ (69/86).Sexual dysfunctions were found in 84.6％ (66/78) of the patients with functioning pituitary adenomas and 37.5％ (3/8) of those with non-functioning pituitary adenoma respectively.In the PRL group,the incidence of erectile dysfunctions was 92.1％ (35/38) and it was higher than those in the FSH (folliclestimulating hormone) and GH (growth hormone) groups (P ＜ 0.05).In the FSH group,the incidence of reduced sexual desire was 78.3％ (18/23).In the GH group,the incidence of erectile dysfunctions was 70.6％ ( 12/17 ) and the incidence of reduced sexual desire or ejaculation dysfunction was lower than that of the PRL/FSH group (P ＜ 0.05).Conclusion The incidence of sexual dysfunctions is quite high in males with pituitary adenomas,especially for those with functioning pituitary adenomas.The clinical features of sexual dysfunctions vary in different types of functioning pituitary adenoma. The incidence of erectile dysfunctions is the highest in the PRL group.Pathological type of pituitary tumors is a major risk factor of sexual dysfunctions.

Objective To examine the expression of E-cadherin and the methylation status of CDH1 and explore their clinical significance in salivary adenoid cystic carcinoma (SACC).Methods The expression of E-cadherin was detected by the immunohistochemical method.And the methylation of CDH1 gene promoter 5'-CpG island was analyzed by real-time methylation-specific polymerase chain reaction ( realtime MSP) in salivary adenoid cystic carcinoma and normal salivary gland tissue respectively.Results The expression rate of E-cadherin was lower in SACC than that in normal salivary gland tissue ( 100.0％ vs 55.6％,P ＜ 0.05).And the expression of E-cadherin was associated with different histopathological types,T-stage,nerve invasion,lymphatic and distant metastasis (P ＜ 0.05).However,there was no correlation between the expression of E-cadherin and gender,age and tumor location.Partial methylation of CDH1 was detected in 3 of 30 cases with a positive expression of E-cadherin and full methylation of CDH1 in 23 of 24 cases with a negative expression of E-cadherin.There was a negative correlation between the expression of Ecadherin and the methylation of CDH1 in salivary adenoid cystic carcinoma ( r =- 0.483,P ＜ 0.001 ).Conclusion The down-regulation of E-cadherin,as modulated by the methylation of CDH1,may contribute to nerve invasion,lymphatic and distant metastasis in SACC.Thus it may be used as a biological indicator of malignancy and prognosis.

Objective To explore the effects of gene transfer of insulin like growth factor-1 (IGF-1) on the penis of senile rats and the altered levels of mRNA and protein of endothelial nitric oxide synthase (eNOS).Methods Ten young (4 months) and 20 senile (24 months) Sprague-Dawley male rats were selected.The senile rats were divided into 2 groups: phosphate buffer solution ( PBS)-only ( n =10)and 100 μg IGF-1 plasmid treatment group (n =10).After a 4-week injection of IGF-1,the responses of intracavernous pressure (ICP) with electrical stimulation to the cavernous nerve and systemic mean arterial pressure (MAP) were evaluated.In the control and transfected senile rats,the levels of eNOS mRNA and protein were examined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot respectively.Results The ICP/MAP and total ICP were significantly higher in the young control group versus the PBS-only group at Week 4 (P ＜ 0.05).The ICP/MAP and total ICP were significantly higher in the young control group and the 100 μg IGF-1 treatment group versus the PBS-only group at Week 4 ( P ＜0.05).The levels of mRNA and protein of eNOS were higher in the 100 μg IGF-1 treatment group versus the PBS-only group at Week 4 (0.62 ± 0.16 vs 0.25 ± 0.08,0.71 ± 0.19 vs 0.27 ± 0.09,both P ＜ 0.05,respectively).Conclusion The gene therapy of IGF-1 can ameliorate erectile functions and improve the levels of mRNA and protein of eNOS in senile rats.

Objective To explore the relationship between interferon (IFN) α and all-trans retinoic acid (ATRA)-induced signaling pathways in the expression of retinoic acid-induced gene G (RIG-G).Methods Acute promyelocytic leukemia cell line NB4 and signal transducer and activator of transcription (STAT) 1-deficient U3A cells were used. The protein levels of tyrosine-phosphorylated STAT2 in ATRA-treated NB4 cells were detected by Western blot.The culture supernatants of NB4 cells treated with ATRA for different time or U3A cells transfected with interferon regulatory factor (IRF)-1 were respectively collected. And the concentration of IFN-α was determined by enzyme-linked immunosorbent assay (ELISA).The effects of NB4 cell culture supernatants on the phosphorylation of STAT2 and the expression of RIG-G were detected by Western blot.Results The level of phosphorylated-STAT2 was obviously upregulated in NB4 cells treated with ATRA for 72 hour,as well as the concentration of IFN-α in culture supernatants. The concentration of IFN-α increased from (1.5 ± 0.5 ) pg/ml in the untreated group to (7.6 ±0.3) pg/ml (P ＜0.05).After a 96-hour treatment,the concentration of IFN-α was up to (63.8 ±5.8) pg/ml. And these culture supernatants could induce the tyrosine phosphorylaton of STAT2 and upregulate the protein level of RIG-G. As for U3A cells transfected with IRF-1,the concentration of IFN-αfrom the culture supernatant also increased 3-fold versus the control group transfected with empty vectors [(8.8±1.4) pg/ml vs (3.4 ±0.4)pg/ml,P＜0.05].Conclusions RIG-G gene expression is closely correlated with the cross-talk between ATRA and IFN-α -induced signaling pathways.ATRA increases the secretion of IFN-α by up-regulating the protein level of IRF-1.Then the secreted IFN-α may induce the phosphorylation of STAT2 and reinforce the expression of RIG-G.

Confocal laser microendoscopy (CLE) is a new technology, which can perform non-invasive histological examination of living bodies and obtain real-time dynamic virtual imaging. It can not only observe the mucosal layer, but also has unique advantages in submucosal vascular imaging. Intravenous contrast agent can make early diagnosis of lesions by early recognition of vascular structural changes. CLE can narrow the biopsy range by observing suspicious lesions in large area, achieve higher biopsy positive rate and avoid repeated endoscopy and biopsy, which is a milestone breakthrough in the history of endoscopy.

Human leukocyte antigen G (HLA-G) is an important immunoregulatory molecule in the body. In recent years, the relationship between HLA-G and tumor immunity has been extensively studied. The initial research focused on the induced expression frequency of HLA-G on tumor tissues, but now it has deeply focused on the expression of HLA-G molecule and tumor development, prognosis, diagnosis and tumor biological immunotherapy based on HLA-G.

The new type of influenza A (H1N1), which originated in the United States and Mexican in March 2009, spread rapidly to the world in just a few months, causing a huge impact on human public health safety [1]. As of March 31, 2010, a total of 127,000 confirmed cases of influenza A (H1N1) were reported in 31 provinces in mainland China, including 800 deaths [2]. The incubation period duration of influenza A (H1N1) is 1~7 days, which is longer than that of seasonal influenza and avian influenza [3]. Human infection with influenza A (H1N1) is mostly self-limiting diseases with diverse clinical manifestations. Most patients are mainly symptomatic of upper respiratory tract infection such as fever and cough, and a few severe patients are secondary to severe pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), septic shock, etc., and finally lead to death.

Sorafenib is a new multi-target biological targeted therapy anti-cancer drug, which is currently mainly used to treat advanced renal cell carcinoma and hepatocellular carcinoma. The Department of Cancer Surgery, Cancer Prevention and Treatment Center, Dongguan People's Hospital, Guangdong Province recently treated a patient with acute drug-induced liver damage after taking a new targeted therapy anti-cancer drug sorafenib tosylate (trade name: Dojimei), which is reported as follows.

calcifying fibrous tumor (CFT) is a rare benign tumor derived from mesenchymal cells. The latest classification of WHO classifies it as a type of fibroblast/myofibroblast tumor and calls it CFT [1]. Although CFT belongs to the category of benign tumor, it has unique clinicopathological characteristics. It is very important to strengthen the correct understanding of this type of tumor to judge the prognosis of patients and choose the treatment plan. The clinical and pathological examinations of 2 patients with CFT are summarized as follows.

The patient was a male, 6 years old and 3 months old. The left calf was cold and painful at night for 3 months, and he often woke up with pain at night, each time lasting for 1~2h. The local county hospital diagnosed it as "vein obstruction", and the pain was relieved by giving drugs for relaxing muscles and activating blood circulation (details unknown). Two months before admission, the calf pain appeared after walking, which gradually worsened, and the gait was claudicated. The outpatient clinic of Children's Hospital affiliated to Chongqing Medical University was admitted to the hospital with "left popliteal artery disease". Physical examination: pain appeared after walking 10~15 m. The temperature difference between the two sides of the limb was 8℃. The left dorsal pedis artery could not be palpable. Doppler detection showed blood flow signal at the proximal end of the popliteal artery, but no signal at the distal end and dorsal pedis artery.

The patient was a 24-year-old female. She went to the doctor for 2 years because of scaly papules on her trunk. The patient started to find scattered small black spots in her lower abdomen without obvious inducement 2 years ago, and she was asymptomatic. The above-mentioned rash was more frequent in winter, and the rash increased, but the rash could be naturally alleviated in summer. The patient complained that the rash could be removed with fingernails. Because the rash gradually increased, she came to the dermatology department of our hospital in June 2009. The patient was in good health and had no history of other systemic diseases. He denied the genetic history of family ichthyosis, and denied the systemic history of tuberculosis and hepatitis. Physical examination: No abnormalities were found in systemic examination.