Volume 92  ·   Issue 06  ·  2012

Objective To explore the clinical characteristics of spontaneous urinary extravasation caused by primary lower ureteral cancer.Methods Eight cases of spontaneous urinary extravasation caused by the obstruction of primary ureteral cancer from January 2005 to June 2010 from Department of Urology,Peking Union Medical College Hospital,were reported.There were 5 males and 3 females with an age range of 56 -81 years old.Six cases presented with an onset of acute flank pains and 2 cases complained of flank discomforts with a lower fever.All cases had peripelvic fluid collection of varying levels on computed tomography (CT) scan and extravasation of contrast medium was found in delayed enhanced CT.The tumors of ureter were detected in 6 cases through preoperative imaging examinations while another 2 cases had no evidence of tumor.Results Unilateral nephroureterectomy was performed in 6 cases,including 5 cases undergoing retroperitoneal laproscopic surgery and 1 case with open surgery.In 5 laproscopic operations,the mean operative duration was 152 ( 120 - 235 ) minutes and the mean estimated intraoperative blood loss 130(100-430) ml.The patient of open nephroureterectomy had an operative duration of 175 minutes and an intraoperative blood loss of 200 ml respectively. One patient underwent a local resection of ureteral carcinoma.A 81-year-old patient was diagnosed of tumor by uteroscopic biopsy and accepted neither surgery or adjunctive therapy.All patients had a pathological diagnosis of urotheial carcinoma.One patient received local radiotherapy and chemotherapy with gemcitabine after nephroureterectomy while another one had local radiotherapy only. During a follow-up period of 6 - 36 months,CT showed that five cases undergoing nephroureterectomy were free of recurrence. One patient with local lymphatic metastasis had a local recurrence,developed multiple metastases at Month 3 and died of exhaustion at Month 8 post-operation.The patient with a local resection had a local bladder recurrence at Month 6 and underwent unilateral nephroureterectomy and radical cystectomy after local radiotherapy and neoadjuvant chemotherapy. Tumor progression was found in the patient without surgery. No implantation metastasis was found.Conclusions Spontaneous urinary extravasation caused by the obstruction of primary lower ureteral cancer is rare and mostly peripelvic. Biopsy may exclude tumors for those patients with no obvious cause of ureteral obstruction.And radical operation is a preferred option.

Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus embolotherapy in the treatment of patients with gastroesophageal varices.Methods A total of 36 patients with gastroesophageal varices underwent the therapies of TIPS plus embolotherapy from July 2005 to March 2011 at Provincial Hospital Affiliated to Shandong University.The rechecked items included abdominal ultrasound examination,liver function test and blood routine examination at Day 7 post-operation.All received endoscopic examinations at Month 1.Results The technical success rate of TIPS plus embolotherapy was 100％.The portal vein pressures declined from (28 ± 8) mm Hg( 1 mm Hg =0.133 kPa)to (14 ± 7 ) mm Hg at post-operation. Angiography showed gastroesophageal varices disappeared in all patients.Both liver function and gastroesophageal varices markedly improved.During the follow-up period of 3 -6 months,4 cases had hepatic encephalopathy and 1 case stent restenosis at post-operation.And most cases were resolved after treatment. No rebleeding occurred during the follow-up period.Conclusions The combined modality of TIPS plus embolotherapy can effectively lower portal vein pressure and cure esophageal and gastric varice bleeding. As a safe and excellent interventional procedure with fewer complications and a lower recurrence rate of portal hypertension,it has great clinical values in the treatment of portal hypertension and gastroesophageal varices.

Objective To evaluate the efficacy of a 300 mg loading dose of clopidogrel followed by 150 mg as maintenance dose in patients with percutaneous coronary intervention (PCI).Methods A total of 108 consecutive patients undergoing elective PCI were recruited from our hospital from July 2007 to July 2008.A 300 mg loading dose was administered prior to PCI. Then they were randomized to receive clopidogrel75 mg (n =55) or 150 mg (n =46) daily for 30 days.From Day 30 to Month 6 post-operation,all of them received 75 mg/d clopidogrel and were followed up for a mean period of 6 months.Results Thirty days after PCI,the platelet inhibition of the 150 mg group was significantly higher than the 75 mg group (64.2％ ± 13.3％ vs 52.6％ ± 14.3％,P =0.00).The ratios of fatal or non-fatal myocardial infarction (MI) ( 1 ( 1.8％ ) vs 3 ( 6.5％ ),P =0.405 ) and target vessel revascularization (TVR) (4 (7.2％ ) vs 6 (13.0％),P =0.714) were significantly lower in the 150 mg group than those in the 75 mg group.So the overall incidence of MACE including death,MI and TVR was obviously lower in the 150 mg group than that in the 75 mg group ( 13.0％ vs 20.2％,absolute risk reduction 7.3％ ).Condusion A high clopidogrel maintenance dose of 150 mg daily for the first month after PCI reduces the risk of long-term adverse events in patients with elective percutaneous coronary intervention.

Objective To explore the influences of stable chronic obstructive pulmonary disease (COPD) on attention functions.Methods The research objects came from the Hospital Affiliated to Anhui Medical University from Februray to September in 2011.Attention network test (ANT) was employed to compare stable COPD patients ( n =38) with healthy controls ( n =36) in the efficiencies of anatomically defined attentional networks:alertness,orientation and executive attention.Results Significant group differences were found in orientation ( ( 27 ± 8 ) ms vs ( 57 ± 4 ) ms,P =0.001 ),but not in alertness ( ( 19 ± 7) ms vs (32 ± 4) ms,P =0.115) or executive attention network ( (94 ± 15) ms vs ( 119 ± 11 ) ms,P =0.196).The accuracy of attention network test was significantly slower in the COPD group than in the healthy controls (90.2％ ± 1.6％ vs 96.3％ ± 1.7％,P =0.011 ).The score of verbal fluency test was significantly lower in COPD patients than in healthy controls (18.2 ± 0.5 vs 21.4 ± 0.6,P =0.000).Conclusions The attention functions of COPD patients are impaired,especially oriental network efficiency.It is probably due to chronic hypoxia,hypoxia-related low blood flow of temporal or parietal lobe or long-term anticholinergic drug use.

Objective To evaluate the efficacy and safety of home noninvasive positive pressure ventilation (HNIPPV) in hypercapnic patients with stable severe chronic obstructive pulmonary disease (COPD).Methods Forty four patients (30 males and 14 females,mean age 68.5 years ( range:60 -80) ) were recruited from a total of 106 patients with arterial PaCO2 ≥ 55 mm Hg in Second Hospital Affiliated to Harbin Medical University from January 2009 to December 2010. Their clinical data were collected and analyzed. The patients in the HNIPPV group ( n =20 ) accepted tiotropium bromide,doxofylline tablets and HNIPPV treatment while those in the control group ( n =24) tiotropium bromide,doxofylline tablets and a low-flow inhalation of oxygen.The entire observation period was 6 months.The parameters before and after 6-month follow-up were compared,including lung function test,6-rain walking distance (6MWD),arterial blood gases (PaO2 and PaCO2 ),dyspnea grade,scores of emotional disorders and mean pulmonary artery pressure (mPAP).Results No significant difference existed in the baseline data between the HNIPPV and control groups.The forced expiratory volume in one second ( FEV1 ),forced vital capacity ( FVC),inspiratory capacity ( IC),6MWD,PaO2,PaCO2,dyspnea grade,hospitalization rate,anxiety scores,depression scores and mPAP showed no significant difference between the HNIPPV and control groups before treatment. However,at Month 6,the differences of IC,6MWD,PaO2,PaCO2,dyspnea grade,anxiety scores,depression scores and mPAP in HNIPPV group ( (1.80 ±0.14) L,(266 ±24) m,(62.6 ±4.6) mm Hg,(46.8 ±2.2) mm Hg,(2.2 ±0.5),(6.5 ±2.4),(6.0 ±1.6),(33.8 ±2.4) mm Hg) were statistically significant compared with the control group (( 1.62 ± 0.14) L,(194±23) m,(56.2±3.8) mmHg,(55.6±3.0) mmHg,(3.2±0.6),(10.6±2.8),( 10.2±2.4),(36.6 ±2.4) mmHg) (P values:0.031,0.018,0.025,0.026,0.001,0.013,0.002,0.014respectively).FEV1 and FVC in the HNIPPV group improved slightly but with no statistically significant difference (all P ＞ 0.05 ). Two patients in the control group were taken to hospital because of acute exacerbation.And hospitalization rates increased in the control group. But no statistically significant difference existed between the HNIPPV and control groups ( P ＞ 0.05 ).The tolerance and compliance of HNIPPV in the HNIPPV group were better and the patients in the HNIPPV group had no pulmonary barotraumas.Conclusion HNIPPV plus tiotropium bromide and doxofylline tablets is both effective and safe in the treatment of hypercapnic patient with stable severe COPD.

Objective To evaluate the vitamin D status of healthy adult males living in Guiyang.Methods A total of 700 healthy volunteers aged 20 - 79 years were selected randomly from a community in Guiyang by stratified sampling method.Questionnaires for living habits and fasting blood samples were collected in the morning from November 2009 to January 2010.The serum concentrations of 25-hydroxyvitamin D were measured by the DiaSorin radioimmunoassay kit.Results The mean levels of serum 25(OH)D was (21 ± 10) μg/L.And the percentages of vitamin D deficiency (25(OH)D ＜20 μg/L),insufficiency (20 μg/L ≤25 (OH) D ＜ 30 μg/L) and sufficiency (25 (OH) D ≥30.0 μg/L) were 315(50.2％ ),202 (32.2％ ) and 110 ( 17.6％ ) respectively.The concentrations of serum 25 (OH) D in young,middle-aged and old adults were (18 ± 10) μg/L,(24 ± 10) μg/L and (22 ± 8 )μg/L respectively.The serum level of 25 (OH)D was lower in the smokers than that in the non-smokers (20 μg/L vs 22 μg/L,P =0.003).The serum concentrations of 25 (OH) D were (24 ± 10) μg/L,(23 ± 10) μg/L,(22 ± 9 ) μg/L and (18 ± 9) μg/L in education level ( ≤6,7 - 9,10 - 12 and ≥ 10 years in school) respectively.Significant inverse correlations existed between the concentrations of serum 25 (OH) D and the education levels (r =-0.138,P =0.000).Condusion The prevalence of hypovitaminosis D is common in healthy adult males in Guiyang,especially among the youth,smokers and higher educated groups.

A 54-year-old female came to the Second People's Hospital of Yunnan Province on November 4, 2010 due to retrosternal choking for more than 10 days when eating and drinking. Fiber-optic gastroscopy showed that a bulge was seen in the right wall of the esophagus (23.5~25.0 cm away from the incisors), and the surface was smooth and free of redness; Ultrasonic gastroscopy showed: space-occupying lesions of esophageal submucosa; He was admitted to hospital on November 8th. The patient suffered from chronic superficial gastritis, duodenitis and rheumatoid arthritis for more than 20 years, and was treated with self-medication intermittently, the details are unknown. After admission, no obvious abnormalities were found in blood routine, chest X-ray, electrocardiogram and alpha-fetoprotein. C14 urea breath test showed: Helicobacter pylori (Hp) (+).

Primary adrenocortical carcinoma (ACC) is a malignant tumor that occurs in the gland epithelium of the adrenal cortex. Although the incidence rate is low and clinically rare, it is highly aggressive, highly malignant, rapidly progresses and has poor prognosis. It is generally believed that the incidence rate of ACC is about (0.5~2.0) /1 million people [1], accounting for 0.2% of all malignant tumors. In recent years, the number of literature reports on ACC has increased to a certain extent, and some authors believe that the incidence rate of ACC is about (4~12) /1 million people [2]. The prognosis of malignant tumors is closely related to the extent of tumors, and an accurate staging system is of guiding significance for choosing treatment modes and judging prognosis of malignant tumors. At present, the mainstream staging system in the world is the TNM staging system jointly developed by the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Because of the low incidence rate, the staging research of ACC has been lacking sufficient data. At present, the most widely used staging systems of ACC in the world include: The TNM staging system of UICC/AJCC (Table 1), Macfarlane staging system and its improved staging system, SEER staging system, etc. There is no international agreement on the staging of ACC, and there are many controversies. Now we collect literature and evidence in this respect and make a review.

Asthma is a chronic airway inflammatory disease characterized by dendritic cell-mediated dominant immunity of type Ⅱ helper T cells (Th2 cells) [1]. It is related to polygenic inheritance, and is affected by both genetic and environmental factors. Individual atopic and environmental factors are the risk factors of the disease. cytotoxic T-lymphocyte antigen-4 (CTLA-4) is a membrane fusion protein expressed on the surface of activated T cells [2-3]. It can compete with CD28 to bind to B7 molecule on the surface of antigen presenting cells (APC), inhibit T cell activation and proliferation, induce T cell immune tolerance, and play an important role in anti-allergy, anti-tumor, anti-transplant rejection, anti-autoimmune diseases and allergic diseases. The relationship between CTLA-4 gene polymorphism and genetic susceptibility to asthma is summarized as follows.

Objective To explore the effects and mechanism of thymoquinone in the growth inhibition of bladder cancer both in vitro and in vivo.Methods After the treatment of thymoquinone,the cellular proliferation of human bladder cancer cell line BIU-87 was detected by the method of methyl thiazolyl tetrazolium (MTT).Flow cytometry (FCM) was used to determine the cellular apoptosis.And the location of nuclear factor (NF)-κB was identified by the method of immunofluorescent histochemistry. Western blotting was employed to detect the cellular expressions of NF-κB,survivin and XIAP.BIU-87 cells were injected subcutaneously into nude mice to establish a xenograft model.After 2 weeks of implantation,the mice were randomized into 2 groups ( n =8):(a) vehicle alone (control),(b) thymoquinone ( 5 mg/kg daily by intragastric intubation).All treatments lasted for 2 weeks.At Week 7 post-implantation,the mice were sacrificed and their tumor weights and inhibition rates evaluated. Immunohistochemistry was used to detect the positive expressions of Ki-67,NF-κB and XIAP in tumors.Results The proliferation of bladder cancer cells was inhibited significantly by thymoquinone at 20,40,80 μmol/L(81.2％±4.6％,72.5％ ± 6.5％,58.4％ ± 8.9％ vs 100％,all P ＜ 0.05).Apoptosis rate induced by thymoquinone was more significant than that of the control (7.6％ ± 1.6％,11.2％ ± 2.1％,14.3％ ± 2.8％ vs 1.6％ ± 0.5％,all P ＜ 0.05).Immunofluorescent histochemistry showed that thymoquinone could significantly lower the nuclear expression of NF-κB.The expressions of NF-κB and XIAP were down-regulated in BIU-87 cells after the treatment of thymoquinone.But thymoquinone had no effect on the expression of survivin.The final tumor weight showed significant decrease in the test group versus the control group( (0.41 ± 0.12) vs (0.89 ± 0.23)g,P ＜ 0.05).Furthermore,the positive expressions of Ki-67,NF-κB and XIAP decreased in tumors after the administration of thymoquinone.Conclusion Thymoquinone exerts anti-tumor effects on bladder cancer both in vitro and in vivo through the down-regulations of NF-κB and its regulated molecules such as XIAP.

Objective To compared the effects of three immunosuppressive agents,i.e.sirolimus (SRL),cyclosporine A (CsA) and mycophenolate mofetil (MMF),with different mechanisms of action on the in vitro growth of various tumor cell lines of human transitional cell carcinoma of bladder cell lines EJ and T24 and in vivo growth of cell line of EJ in nude mice model.Methods The effects of SRL,CsA and MMF on the proliferation of transitional cell carcinoma of bladder cell lines were examined with the method of methyl thiazolyl tetrazolium (MTT). The effects of these immunosuppressants on tumor growth and metastasis were explored in a nude mice model with human transitional cell carcinoma of bladder cell line EJ.Forty-two nude mice were divided into 7 groups to receive normal saline (control),SRL,CsA,MMF,SRL + CsA,SRL + MMF and CsA + MMF respectively ( n =6 each).Results The in vitro cell proliferation was inhibited by SRL and MMF versus the control groups. But no obvious inhibition of proliferation was observed at ＜1000 ng/ml in the CsA-treated group.In the in vivo nude mice mode,the tumor volume of SRL,CsA group were lower than that in control group ( (441 ± 231 ),(463 ± 110)vs (1032 ± 382 )mm3,both P ＜0.05).In the in vivo nude mice mode of EJ treated by SRL,CsA,SRL + CsA,SRL + MMF and CsA + MMF,tumor volume at Day 23 was the lowest in the SRL + CsA group ( (191 ±92) vs (1032 ±382)mm3,P ＜ 0.05 ). There was an inhibition of 75.26％ in SRL + CsA group versus the control groups.Conclusions SRL and MMF demonstrate dose-dependent antiproliferative effects in human transitional cell carcinoma of bladder cell both in vitro and in vivo.CsA can inhibit the growth of human transitional cell carcinoma of bladder cell lines EJ cells in vivo.

Objective To evaluate the clinical utility of novel gene urothelial carcinoma antigen 1 ( UCA1 ) as a urinary tumor marker for the diagnosis of bladder urothelial carcinoma.Methods A cohort of 180 cases of bladder cancer (including 94 cases in previous study),144 cases of non-bladder-cancer individuals as control group (including 85 cases in previous study ) from 2005 to 2009 were recruited.Reverse transcription PCR (RT-PCR) of urinary sediments was performed to detect the expression of UCA1.RNasin was added to the urinary sediments colleted after 2007 from 86 cases of bladder cancer and 59 cases in control group to improve the quantity and quality of RNA isolation.The parameters of sensitivity,specificity,area under curve (AUC) of ROC and its 95％ CI were calculated.x2 test was used to compare the sensitivity of UCA1 with NMP22 and cytology in 116 cases of bladder cancer with the parallel data of UCA1 and NMP22 and in 108 cases with the parallel data of UCA1 and cytology.Results 95.4％ of RNA was isolated successfully from urinary sediments after the addition of RNasin UCA1 was highly specific (92.4％,133/144) and quite sensitive (84.4％,152/180) in the diagnosis of bladder cancer with a favorable AUC-ROC of 0.898 (95％ CI:0.851 -0.945 ).It was especially valuable for superficial G2 -G3 patients (sensitivity:86.4％,92.3％ ) at a high risk for muscular invasion.Conclusion With a high level of sensitivity and specificity,UCA1 is a promising urinary marker for the diagnosis of bladder cancer.

Objective To explore the expression patterns of cadherins (N-cadherin and Ecadherin) in urothelial carcinomas and understand the values of N-E cadherin switch in the predictions of postoperative recurrence and prognosis.Methods The expressions of N-cadherin and E-cadherin were measured by immunohistochemistry in 64 transurethral bladder tumer resection (TURBT) or partial cystectomy samples(48 cases)in 2005 by the method of streptavidin-biotin peroxidase.Results A positive expression of N-cadherin and a negative expression of E-cadherin were noted in 27 (42.2％ ) and 16 (25.0％ ) specimens respectively.Patients with more poorly differentiated bladder cancer were accompanied with a higher expression of N-cadherin and a lower expression of E-cadherin ( both P ＜ 0.05 ).A positive expression of N-cadherin decreased the recurrence-free and cancer-related survival rates while a negative expression of E-cadherin was correlated with a lower cancer-related survival rate ( all P ＜ 0.05 ). No significant association was found between the expression of E-cadherin and the recurrence-free survival rate.Furthermore,the N-E cadherin switch ( a negative expression of E-cadherin and a positive expression of Ncadherin) showed a higher predictive power in both recurrence-free and cancer-related survival according to multivariate analysis(HR =0.428,95％ CI:0.217 - 0.845,HR =0.098,95％ CI:0.013 - 0.767 ).No significant association was found between the expressions of two cadherins and postoperative progression.Conclusion Although the expressions of E-cadherin and N-cadherin appear to be correlated with survival outcomes in bladder cancer,N-E cadherin switch may be a better predicator for postoperative recurrence and cancer-related survival.

Bladder cancer is the tumor with the highest incidence of urinary system. There are about 300,000 new cases worldwide every year, and 15% ~25% of the new cases are patients with muscle invasive bladder cancer [1]. For the treatment of muscle invasive bladder cancer, surgery is still the first choice of surgeons. Despite the continuous progress of surgical technique, the overall 5-year survival rate of patients can only reach 65%, and for patients with T3~ T4 or lymph node positivity, the 5-year survival rate is only 25% ~35%. The reason that affects the long-term survival of patients is that 50% of patients with invasive bladder cancer already have potential metastasis before surgery, so surgery or radiotherapy alone often fails in distant metastasis, while chemotherapy is difficult to achieve thorough local control.

With the application of new techniques for diagnosis of gastric cancer, such as magnifying endoscopy, intelligent staining endoscopy and laser confocal endoscopy, the detection rate of early gastric cancer is gradually increasing, and more and more patients are suitable for endoscopic treatment. For patients with early gastric cancer without lymph node metastasis, endoscopic mucosal resection or mucosal dissection can be cured, but gastric cancer with lymph node metastasis is a contraindication for minimally invasive treatment under endoscopy, and should be treated by radical surgery. Therefore, the presence or absence of lymph node metastasis is an important index of choosing treatment plan for patients with gastric cancer.

Objective To analyze the expressions of TrkB and TRIM29 in biopsy tissues from preoperative gastroscopy in patients with gastric cancer and investigate the relationship between their expression and rate of lymph node metastasis.Methods Through immunohistochemistry,the authors analyzed the expression status of TRIM29 and TrkB in biopsy tissues from preoperative gastroscopy in 67 patients with a diagnosis of gastric cancer undergoing radical operations during 2005-2009 at Peking University Third Hospital.There were 39 males and 28 females.Then the relationship was explored between the expression of both proteins and lymph node metastasis and other clinical pathological factors.Image pro Plus 6.0 software was used for image analysis.The data underwent a logarithmic process and were analyzed through SPSS 17.0 statistical software.Results The expression of TrkB in lymph node metastasis (n =42)was higher than that in without lymph node metastasis ( n =25 ) ( lgA 4.79 ± 0.42 vs 3.98 ± 0.71,t =-5.873,P =0.003 ),while the expression of TRIM29 with lymph node metastasis (n =36)was also higer than that in without lymph node metastasis ( n =24) ( 5.21 ± 0.27 vs 5.02 ± 0.37,t =- 2.257,P =0.040).Logistic regression analysis showed that the TrkB expression was an independent predictor for lymph node metastasis. A discriminant was set based on the result ( discriminant value =1.705 × TrkB lgA +1.803 x TRIM29 lgA - 16.880,cutoff value =0).This discriminant achieved a prediction accuracy of 80.0％ (48/60),a positive likelihood ratio 3.332 and a negative likelihood ratio 0.223.Patients with a high expression of TrkB showed a worse survival rate than those with a low TrkB expression[ 36.0％ (9/25)vs 66.7％ ( 16/24),P =0.047 ).Patients with a high TRIM 29 expression showed a worse survival rate than those with a low TRIM29 expression [ 38.1％ ( 8/21 ) vs 66.7％ ( 14/21 ),P =0.044 ].Conclusion The expressions of TrkB and TRIM29 are correlated with lymph node metastasis in gastric cancer,and discriminant based on the expressions of TrkB and TRIM29 had important values for preoperative prediction of lymph node metastasis in gastric cancer.

Objective To detect the expression of GC-C mRNA in peripheral blood of gastric carcinoma patients and determine its potential candidacy as a molecular biological marker for predicting the micrometastasis and determining the status of gastric cancer.Methods GC-C mRNA from peripheral blood samples of gastric carcinoma ( n =60 ),displastia ( n =21 ),intestinal metaplasia ( n =15 ) and healthy cases (n =20) from November 2009 to August 2010 at Affiliated Hospital of Nantong University were assessed by real-time fluorescent quantitative PCR (RFQ-PCR).Results The expressions of GC-C mRNA in peripheral blood from patients with dysplasia,intestinal metaplasia and healthy controls were absent or very low.And a high level of GC-C mRNA was detected in the patients with gastric carcinoma than those with displastia and intestinal metaplasia,and the positive rate were 48.3％ (29/60),9.5％ (2/21),20.0％ (3/15),respectively ( all P ＜ 0.05 ).The levels of GC-C mRNA were significantly correlated with Lauren typing,clinical stage,tumor differentiation degree,depth of invasion and lymph node metastasis ( all P ＜ 0.05 ). The GC-C mRNA expressions were positively correlated in peripheral blood and gastric carcinomas tissues ( r =0.4009,P =0.0015).Conclusions The over-expression of GC-C mRNA is found in peripheral blood from gastric carcinoma patients.Due to its close correlation with clinical stage and lymph node metastasis,it may become a potential prognostic marker of gastric carcinoma.

Objective To explore the association between the Helicobacter pylori (H.pylori)infection and the expression and methylation of energy-related genes in gastric cancer.Methods Real-time fluorescence quantitative reverse transcription (RT)-PCR was performed to quantify the expressions level of lactate dehydrogenase (LDH),dihydrolipoamide dehydrogenase (DLD) and Ran-specific GTPase-activating protein (RanGAP) genes in the samples of human gastric cancer (n =30),metastatic lymph node (n =30)and peri-cancerous tissues ( n =30) as confirmed by pathological examinations.Those patients were chosen of Affiliated Hospital of Guiyang Medical University,from January 2005 to December 2009.The relationship between the gene expression and H.pylori infection was analyzed.The methylation of LDH,DLD and RanGAP genes at promoter CpG island was measured by bisulfite sequencing(BSP).Results The relative gene expressions of LDH,DLD and RanGAP in peri-cancerous tissues,gastric cancer and metastatic lymph nodes were 1.0,3.1,3.0 and 1.0,3.1,2.8,and 1.0,0.4,0.5 respectively ( all P ＜ 0.05 ).The expression levels of LDH and DLD genes in H.pylori-positive gastric cancer was high than those in the negative group (2.3 vs 1.0,3.0 vs 1.0,2.6 vs 1.0,all P ＜ 0.05).The demethylation of LDH and DLD genes at promoter -2325 and - 1885 site as well as the overmethylation of RanGAP gene at the promoter -570 and - 170 sites respectively were detected in H.pylori infection and cagA-overexpressed cells.Conclusion H.pylori infection may promote the development and progression of gastric cancer by inducing the aberrant methylation of LDH,DLD and RanGAP genes to up-regulate the gene expressions of LDH and DLD and down-regulate the gene expression of RanGAP.

Objective To explore the effects of erythropoietin (EPO) on the differentiation and secretion of cultured bone marrow-derived mesenchymal stem cells (BM-MSC) in the microenvironment of acute kidney injury (AKI).Methods C57BL/6 murine BM-MSC (mBM-MSC) were successfully isolated by the methods of Percoll density gradient centrifugation and adherence cultivation.The AKI murine model was induced by ischemia/reperfusion (I/R).The homogenate supernatants were prepared for normal and I/R murine kidney.P3-mBM-MSC were treated differently:Group A:low glucose DMEM medium with 10％ fetal bovine serum,Group B:normal murine kidney homogenate supernatant intervention,Group C:I/R kidney homogenate supernatant intervention,Group D:I/R kidney homogenate supernatant plus different concentrations of EPO (1,5,10,50 U/ml).Each group was incubated for 1,3,5 and 7 days.Inverted microscope was used to observe the morphological changes of these cells and their ultrastructural changes were observed by transmission electron microscope.Cytokeratin-18 was detected by flow cytometry.The levels of bone morphogenetic protein-7 (BMP-7),hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) were detected by ELISA in culture medium.Results The cells yielded a high expression of CD29 and CD44 and a low expression of CD34 and CD45.Compared with Groups A and B,the cells of Group C presented oval and short fusiform shapes.After the intervention of EPO,Group D showed a cobble appearance.More organelles were also found.A trace expression of CK18 was found in Groups A and B.A positive expression of CK18 was significantly higher in Groups C and D than Groups A and B(P ＜ 0.01 ).The expression of EPO 50 U/ml at Day 5 and 7 was higher than Group C of the same time (5 d:35.22 ± 4.04 vs 8.72 ± 0.38,7 d:42.00 ± 5.39 vs 13.20 ± 1.14,both P ＜ 0.01 ).The results of ELISA showed that the levels of BMP-7,HGF and VEGF in Group C decreased significantly ( P ＜ 0.01 or P ＜0.05).Conclusion The intervention of EPO may boost the differentiation of mBM-MSC but reverse its low secretion.

1. systematic review and Cochrane systematic review systematic review (SR), also known as systematic review, belongs to secondary research. It aims at a specific problem, collects, collates and evaluates all research results comprehensively, and draws comprehensive and reliable conclusions, thus guiding practice and decision-making [1]. Meta-analysis (SR) is a statistical method that may be used in systematic review, which is a quantitative combination of original research results to improve the accuracy of results and the estimation of effects [1]. Because systematic review and meta-analysis emphasize clear research purposes and inclusion and exclusion criteria, systematic and comprehensive literature retrieval and bias assessment, scientific and standardized qualitative description and quantitative combination, well-designed systematic review and meta-analysis are regarded as one of the highest level of medical research evidence for evidence-based decision-making.

Activation of tyrosine kinase receptor signaling pathway leads to abnormal healing of lung lesions and scar formation, which is the cause of idiopathic pulmonary interstitial fibrosis (IPF), and inhibition of these receptors can slow the disease progression.Animal experiments showed that extracellular tyrosine kinase receptor antagonist BIBF1120 can prevent bleomycin-induced IPF.A 12-month randomized, double-blind, placebo-controlled, phase II clinical trial further evaluated the efficacy and safety of BIBF1120 in the treatment of IPF (N Engl J Med, 2011, 365:1079-1088.).