Volume 92  ·   Issue 08  ·  2012

As early as the 19th century, Mahomed found that the level of uric acid in blood is related to the increase of blood pressure. In recent decades, people have gradually recognized that uric acid is closely related to the occurrence and development of hypertension, cardiovascular and cerebrovascular diseases, diabetes, metabolic syndrome and other diseases.

Lung cancer is a disease that seriously endangers human health, and its morbidity and mortality rate have occupied the first place among malignant tumors in the world. In recent decades, although the treatment of lung cancer has been improved obviously, its 5-year survival rate is still very low. The main reason is that the biological characteristics of lung cancer are very complex, the malignancy degree is high, and 80% of patients are advanced at the time of diagnosis. Therefore, exploring new diagnostic methods, improving the early diagnosis rate of lung cancer and correctly staging lung cancer have become the key to improve the prognosis of lung cancer patients [1].

The robotic surgical system has experienced three generations of development: AESOP (1994), Zeus (1999) and Da Vinci (2000). The Da Vinci robotic surgical system (DVSS) belongs to the master-servant robotic system. It is the first robotic surgical system approved by the US Food and Drug Administration (FDA) that can be used in the operating room, and it is also the most mature and widely used robotic surgical system in the world.

Objective To assess the efficacy of low dose ketoconazole therapy for Chinese patients with castration resistant prostate cancer (CRPC) and explore possible prognosis factors.Methods From August 2006 to August 2011,71 patients with CRPC were analyzed retrospectively,who received oral ketoconazole 200 mg,three times a day with prednisone 5 mg,twice a day.Prostate specific antigen(PSA) response rate was defined as the percentage of patients with PSA decline ≥50％ compared to baseline PSA level during low dose ketoconazole therapy.Multivariate Logistic regression analysis and receiver operating characteristic curve were used to assess the prognostic factors and their accuracy.Results The mean initial serum PSA level was ( 205 + 38 ) ng/ml for these patients with mean age ( 69 + 1 ) years old.After first androgen deprivation therapy failure,the prostate cancer progressed into castration resistant stage. The baseline PSA was (93 _+ 24)ng/ml and the baseline serum testosterone was (0.13 + 0.02)ng/ml.During the low dose ketoconazole therapy,31 patients (43.7％) had PSA decrease and 22 cases ( 31.0％ ) were effective with PSA decline more than 50％.PSA doubling time and baseline serum testosterone were positive correlation with PSA response rate by multivariate Logistic regression analysis.Patients with PSA doubling time of ≥3.0 months had a PSA response rate of 64.3％ and the PSA response rate in those with ＜ 3.0 months decreased to 22.8％,hazard rate (HR) =0.149 ( 95％ confidence interval[CI]0.029 - 0.766 ),P =0.023,area under the curve (AUC) =0.707.The PSA response rate for patients with baseline serum testosterone ≥ 0.1 and ＜ 0.1 μg/L were 55.6％ and 5.7％,respectively,HR =0.068 (95％ CI 0.012 -0.380),P =0.002,AUC =0.749.The common adverse reactions included liver dysfunction (17.9％),renal dysfunction ( 16.4％ ),fatigue ( 11.9％ ),nausea ( 6.0％ ) and anorexia ( 4.5％ ) and so on.Conclusions Low dose ketoconazole therapy was a moderate,low toxicity hormonal therapy option for patients with CRPC. PSA doubling time ≥ 3 months and baseline serum testosterone ≥ 0.1 μg/L were predictors of desired effect for low dose ketoconazole therapy.

Objective To analyze the stroma changes of benign and malignant human prostate tissues.Methods For the identification of stroma cells phenotype in human prostate cancer and benign prostate hyperplasia tissues,Masson method and immunohistochemical analysis of a-smooth muscle actin (α-SMA),desmin,and vimentin were performed.The relative volume of intratumor stroma (0％,Grade 0;1％ -33％,Grade 1; 34％ -66％,Grade 2; 67％ -100％,Grade 3) were quantified and analyzed in local and advanced prostate cancer tissues.Results Stroma myofibroblasts in prostate cancer were stained green by Masson staining and showed a co-expression of α-SMA and vimentin without an expression of desmin.It was significantly different from smooth muscle cells in benign prostate hyperplasia stained red and co-expressing a-SMA and desmin.Statistical analysis showed that high stroma volume (Grade 2/3 ) in advanced prostate cancer were significantly higher than that in an early stage of prostate cancer (83％ vs 55％,P ＜ 0.05). Conclusion Significant phenotypic differences of stroma cells existed in benign and malignant human prostate tissues.A high expression of myofibroblasts in advanced prostate cancer may play an important role in cancer progression.And its clinical significance should raise a high alert.

Objective To retrospectively analyze the clinical value of difftision-weighted magnetic resonance imaging (MRDWI) in the detection of prostate cancer in suspected patients.Methods Between January 2009 and December 2010,141 patients with suspected prostate cancer underwent MRDWI and transrectal ultrasound (TRUS) guided prostate biopsy.They were divided into 4 groups by prostate surface antigen (PSA) ＜10 μg/L,10 μg/L≤PSA ＜20 μg/L,20 μg/L≤PSA ＜50 μg/L and PSA≥50 μg/LThen the diagnostic accuracy of MRDWI was tested.Results The diagnostic rate of patients with PSA ＜10 μg/L,10 μμg/L ≤ PSA ＜ 20 μg/L,20 μg/L ≤ PSA ＜ 50 μg/L and PSA ≥ 50 μg/L were 23.7％,35.5％,66.7％ and 96.3％ respectively.The sensitivity of MRDWI was significantly better than TRUS.In patients with PSA ＜ 10 μg/L,10 μg/L≤PSA ＜20 μμg/L,20 μg/L-≤PSA ＜50 μg/L and PSA≥50 μg/L,the patient-based sensitivities were 85.7％,72.7％,97.8％,100.0％ respectively; when based by segment of specimen,the sensitivities were 85.5％,71.9％,91.5％ and 94.4％ respectively.Conclusion The sensitivity of MDWI is significantly better than TRUS in the diagnosis of prostate cancer.The combined use of MDWI and TRUS has the benefit of guiding the biopsy of cancer foci in patients with suspected prostate cancer.

Objective To explore the expressions of CXC chemokine receptor 4 (CXCR4) and matrix metalloproteinase-9 (MMP-9) and examine their correlations with metastasis,and prognosis in small cell lung cancer (SCLC). Methods Immunohistochemistry was employed to detect the expressions of CXCR4 and MMP-9 in the tissue samples from 65 SCLC patients treated in Cancer Institute and Hospital Attached to Tianjin Medical University from January 2003 to October 2009.And their correlations with metastasis and prognosis were analyzed by Chi-square test and Kaplan-Meier method and Cox regression.Results The positive expression rates of CXCR4 and MMP-9 were 100.0％ (65/65) and 87.7％ (57/65) in SCLC tissues respectively. Significant difference of the expression rate of CXCR4 was found between patients undergoing bone metastasis or not ( P =0.004 ).But the differences were not significant between brain metastasis or not ( P =0.068 ) and lymph node metastasis or not ( P =0.085 ).A high expression rate of MMP-9 was significantly associated with pathological staging ( P =0.048 ).But the difference between lymph node metastasis or not was not significant (P =0.085 ).Univariate analysis suggested that a high expression rate of CXCR4 was significantly correlated with the disease-free survival (DFS) of SCLC patients ( P =0.005).But a high expression rate of MMP-9 was not associated with DFS (P =0.341 ).Multivariate analysis suggested that a high expression rate of CXCR4 was an independent prognostic factor for DFS in SCLC.Conclusions The elevated levels of CXCR4 and MMP-9 are found in SCLC tissues. And the expression rate of CXCR4 may be correlated with bone metastasis,but the correlation is not notable for MMP-9.The expression rate of CXCR4 is an independent prognostic factor for DFS in SCLC.

Objective To explore the diagnostic values of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the patients with hilar and mediastinal masses.Methods A total of 91 patients with mediastinal/hilar masses undergoing EBUS-TBNA in Zhongshan Hospital between September 2009 and March 2011 were retrospectively enrolled.Their unknown etiologies were difficult to be assessed by a traditional biopsy.The association of pathologic examinations and clinical data were analyzed.Results Among them,61 patients had malignant lesions while 30 patients were diagnosed with benign diseases.In the cases with malignant lesions,the diagnostic sensitivity,specificity and accordance rate were 91.67％,100％ and 91.80％ respectively.The diagnostic accordance rate of benign lesions was 60％.And 36.9％ (24/65) of the samples were small-sized so as to improve the diagnostic accuracy.The combination of cytology and histology significantly increased the diagnostic accordance versus cytology alone in all cases (P ＜0.01 ). But there was no statistically significant difference in the malignant lesion subgroup with a better tendency (P ＞ 0.05 ). No severe complication occurred. Conclusion With a high diagnostic accuracy and a low complication rate for the patients with hilar and mediastinal masses of unknown etiologies,EBUS-TBNA has different values for diagnosing malignant and benign lesions.

Objective To evaluate the efficacies of gefitinib plus radiotherapy in the treatment of brain metastases in non-small-cell lung carcinoma (NSCLC) patients.Methods A retrospective analysis was conducted for 161 NSCLC patients with brain metastases treated in Xinqiao Hospital from January 2001 to January 2010.And 38 patients aged 38 - 77 years old received the combined regimen of gefitinib plus radiotherapy.It consisted of synchronically practicing general or stereotactic brain radiotherapy and an oral intake of gefitinib (250 mg,QD for at least 8 consecutive weeks).The efficacies and toxicity were evaluated at Week 12 after the initial treatment.A total of 123 patients aged 37 - 76 years old undergoing whole brain or stereotactic radiotherapy were used as control.X2 test between two groups was carried out to evaluate the objective response rate (ORR),disease control rate (DCR),brain metastasis related symptoms and Ⅲ - Ⅳ degree of toxicity. Non-parametric rank tests were performed to compare the U.S. Eastern Cooperative Oncology Group (ECOG) performance status score between two groups. Results In the combination therapy group,the levels of ORR and DCR were significantly higher than those in the conventional treatment group (31.6％,78.9％ vs 15.4％,60.2％ ).The differences were statistically significant ( x2 =4.859,P =0.027 and X2 =4.479,P =0.034) ; significant difference existed in brain metastasis-related symptoms between two groups (x2 =4.612,P =0.037) ; the ECOG scores were evaluated in the combination therapy group.And they were as follows:0 - 1 ( n =18 ),2 ( n =11 ),3 - 4 ( n =9) at pre-treatment vs 0 - 1 ( n =27),2 ( n =6),3 - 4 ( n =5 ) at post-treatment.The ECOG score significantly improved after treatment (Z =-2.012,P =0.044).Regarding the Ⅲ-Ⅳ degree of toxicity,the combination therapy group had 4 patients with acne-like rash and it was significantly higher than that in the conventional therapy group ( n =0) (P =0.003).But no difference existed in the occurrence of fatigue,nausea,vomiting,diarrhea and myelosuppression. Conclusion The combined regimen of gefitinib plus radiotherapy can improve the therapeutic efficacies of brain metastases and enhance the quality-of-life in NSCLC patients,side effects are tolerable.

Objective To evaluate the feasibility of laparoscopic adrenalectomy in the treatment of adrenal ganglioneuromas.Methods The clinical data of 12 cases of adrenal ganglioneuromas undergoing laparoscopic adrenalectomy between February 2002 and August 2010 were reviewed retrospectively.Results None of them had endocrine function.The average long diameter of ganglioneuromas was 6.5 cm ( range:1.5 - 16.8 cm).Ten tumors were resected through retroperitoneal approach with an average long diameter of 6.0 cm and another two through transperitoneal approach with 7.5 and 10.7 cm in size respectively.Three tumors surrounded renal pedicle and one adhered to kidney. The average operative duration was 144 minutes,average blood loss 194 ml and average postoperative hospitalization stay 5.4 days.None had local recurrence and distant metastasis during a mean follow-up period of 45 months.Conclusion Laparoscopic adrenalectomy is both safe and feasible for adrenal ganglioneuromas if an appropriate approach is chosen and renal pedicle well-protected..

Objective To explore the clinical presentations, diagnosis and treatment of diverticulums in laryngopharynx and cervical esophagus. Methods Nineteen cases of diverticulums in laryngopharynx and cervical esophagus with general clinical information available from 1985 to 2010 at Peking Union Medical College Hospital were reviewed retrospectively and analyzed with a literature review.Results One case of lateral hypopharyngeal pouch presented with fetor oris and pharyngalgia.Three cases of Killian-Jamieson diverticulums had fetor oris and dysphagia.Among 15 cases of Zenker diverticulums,3had fetor otis,sour regurgitation and dysphagia while another 12 cases were asymptomatic.Seven patients with subjective complaints underwent diverticulectomy through open surgeries or endoluminal approaches and their symptoms were resolved and no recurrences were found during a follow-up period of 6 months - 18 years.In 12 cases of asymptomatic Zenker diverticulums,observation was adopted and there was no complaint during a follow-up period of 1 -25 years.Conclusion Lateral hypopharyngeal pouch,Killian-Jamieson diverticulum and Zenker's diverticulum are rare entities with different clinical presentations.For symptomatic diverticulum,the most common treatment is surgical resection of diverticulectom and the prognosis is satisfactory.But for asymptomatic diverticulum,observation suffices.

Objective To compare the hemodynamic effects of domestic levosimendan versus dobutamine on patients with acute decompensated heart failure (ADHF).Methods A total of 78 ADHF patients with pulmonary capillary wedge pressure (PCWP) ≥ 15 mm Hg and cardiac index (CI) ≤ 2.5L · min-1 · m-2 were enrolled into this blind,positive-controlled,randomized and multicenter study to receive 24 h intravenous levosimendan or dobutamine therapy. They were randomized into 2 groups:levosimendan and dobutamine ( n =39 each). Results In the levosimendan group,the PCWP 24 h decreased significantly ( ( 14.2 + 7.6) vs ( 23.1 + 8.1 ) mm Hg,P ＜ 0.01 ) and CI increased significantly versus the baseline levels ( (2.8 =0.7) L · min -1 · m-2 vs (2.0 ±0.4) L · min -1 · m-2, P ＜0.01 ).As compared with the dobutamine group,the change percentages versus baseline in PCWP,pulmonary arterialmean pressure (PAMP),systemic vascular resistance (SVR) at 24 h (median)decreased or increased significantly in the levosimendan group 45.5％ vs 22.1％ ( P ＜ 0.05 ) ; 20.8％ vs 15.0％ ( P ＜ 0.05 ) ;34.5％ vs12.7％ (P＜0.01); CI increased 39.8％ vs 13.5％ (P＜0.01).As compared with the baseline level,LVEF increased at 24 h in the levosimendan group (27.4％ +6.1％ vs 32.5％ + 8.7％,P ＜0.05).Both PCWP and CI at 24 h correlated significantly with NT-proBNP at Day 3 (r=0.31,P ＜ 0.01 ; r =- 0.29,P ＜ 0.05).Dyspnea improved greatly at 24 h in the levosimendan group than that in the dobutamine group.Conclusion As compared with dobutamine,domestic levosimendan may bring about better outcomes of hemodynamics and dyspnea.

Objective To develop a simplified risk scoring system of contrast induced nephropathy (CIN) after pereutaneous coronary intervention (PCI).Methods A retrospecttive study was performed on 1500 patients in the development set undergoing PCI from January 2008 to December 2009. And 1000 patients treated from January 2010 to May 2011 were selected for the validation set. Logistic regression analysis was applied to identify the risk factors of CIN.Based on the odds ratio,the sum of integers was a total risk score for each patient.Results ( 1 ) Among them,CIN occurred in 246 patients with an overall incidence of 16.4％. (2) Eleven identified variables were identified as the risk factors of CIN (with weighted integer):diabetes (3 scores),hypotension (3 scores),left ventricular ejection fraction (LVEF ≤45％) (3 scores),eGFR ＜60[ml · min-1 · (1.73 m2) -1](3 scores),age ＞70 years (2 scores),myocardial infarction (2 scores),emergency PCI (2 scores),anemia (2 scores),decreased high-density lipoprotein(HDL) concentration ( ＜1 mmoVL) (2 scores),contrast agent dose ＞200 ml (2 scores) and low permeability contrast agent (1 score).(3) The sum of integers was a total risk score for each patient.The incidence of CIN was 5.2％ in the low-risk group ( ≤4),13.6％ in the moderate-risk group (5 - 10),32.3％ in the high-risk group (11 -14) and 59.0％ in the very-high-risk group (≥15).(4) Good discriminative power was found in the validation population.And the risk score was strongly correlated with CIN(c-statistic =0.82).Conclusion This scoring system provides a good estimate of the risk of CIN after PCI.It may be used for the prevention and treatment of CIN.

Objective To reduce the risk of therapy related complication during the treatment and keeps the long term event free survival,and to evaluate the results and risk factors of SCMC- lymphoblastic leukemia( ALL)-2005 protocol. Methods Designed the new protocol SCMC-ALL-2005 based on the previous protocol XH-99 for ALL.Divided the patients into low,median and high risk groups depends on risk factors including day 33 and 55 minimal residual disease (MRD) level.The higher risk group,the more intensive therapy was given.All the cases were registed on pediatric oncology network database (POND).All the abandonment patients were counted as event.From May 1st 2005 to April 30th 2009,351 children who were newly diagnosed as B lineage ALL were enrolled in this study. The prognoses relating to risk grouping,age,mutation gene and MRD level were analyzed.Results Up to June 30,2011,273 patients were followed up with median time 49 months (range 26 to 74 months). Three hundred and forty-five patients(98.29％ ) achieved complete remission on day 35 induction.12 cases were younger than 1 year old (3.42％),285 cases between 1 and 9 years old (81.20％),54 cases 10 to 18 years old( 15.38％ ).Five year event-free survival (EFS) was 34％,72％ and 63％,respectively.One hundred and fifty-six cases belonged to lowere risk (44.44％ ),177 to middle risk (50.43％ ) and 18 to higher risk ( 5.13％ ).Five year EFS was 78％,64％ and 30％,respectively.In this study,18 patients were detected positive for BCR/ABL,3 for MLL/AF4,16 for PBX/E2A,and 36 for TEL/AML.The 5 year EFS were 11％,66％,75％ and 74％,respectively.A total of 300 cases were tested for MRD levels on day 35.Of them,241 cases were with MRD ≤0.01％ ( negative),and 59 cases ＞ 0.01％ (positive).The 5 year relapse free survival (RFS) was 79％ and 58％,respectively.Total 6 patients died of complication ( 1.71％ ).18 patients were abundant treatment with no disease progress.70 patientsrelapsed ( 19.94％ ),including 52 bone marrow,8 central nerve system(CNS),1 both in bone marrow and CNS,1 second caner( M4 ) and 8 testis.Five year overall survival (OS) and EFS are 84％ and 69％.Conclusions The risk of therapy related death is low with the protocol SCMC-ALL-2005.MRD affects the prognosis.The long term prognosis is poor for high risk group,with BCR/ABL and positive MRD.

Objective To examine the correlation of serum uric acid and islet beta cell functions in female type 2 diabetics.Methods A total of 533 female type 2 diabetics were recruited. And their clinicobiochemical parameters were measured.The levels of acute insulin response (AIR) and acute Cpoptide response (ACPR) were measured by a stimulation of arginine.Among them,262 patients received the examinations of OGTT (oral glucose tolerance test),area under the curve of insulin (AUC-insulin) and C peptide (AUC-C peptide).Serum uric acid ＞ 360 μmol/L was defined as hyperuricemia.Results The serum uric acid levels of the hyperuricemia and control groups were (430 + 8) and ( 248 + 3 ) μmol/Lrespectively.The AIR,ACPR,AUC-insulin and AUC-C peptide levels were significantly higher in the hyperuricemia group than those in the control group (P ＜ 0.01 ).There was a significant positive correlation between serum uric acid and AIR,ACPR,AUC-insulin and AUC-C peptide (r =0.194,P ＜ 0.01; r =0.146,P ＜ 0.01 ; r =0.307,P ＜ 0.01 and r =0.420,P ＜ 0.01 ).The serum levels of uric acid were significantly different between tertile groups of AIR (260 +_ 7 ),(264 + 8 ),( 302 + 7 ) μmol/L,ACPR ((263_+8),( 271 +7),(296+7) μmo]/L),AUC-insulin ((241 +10),(279 +10),(301 +8) μmol/L)and AUC-C peptide ( ( 229 + 8 ),( 265 ± 9 ),( 326 ± 10 ) μmol/L,P ＜ 0.01 ).Multivariate linear regression demonstrated that the serum level of uric acid were associated with AIR (β =0.002,95％ CI0.0010 - 0.0030,P ＜ 0.01 ),ACPR ( α =0.001,95％ CI 0.0002 - 0.0020,P =0.02 ),AUC-insulin ( β =0.002,95 ％ CI 0.0004 - 0.0030,P ＜ 0.01 ) and AUC-C peptide ( α =0.003,95 ％ CI 0.0020 -0.0030,P ＜ 0.01 ) after an adjustment of related risk factors.Conclusion The serum level of uric acid is significantly correlated with AIR,ACPR,AUC-insulin and AUC-C peptide in female type 2 diabetics.And it may be an independent risk factor of predicting islet beta cell functions in female type 2 diabetics.

Objective To explore the alterations of immune status in liver transplant recipients with sepsis so as to provide rationales for the adjustments of immunosuppressive agents.Methods A total of 47 cases complicated with sepsis after abdominal operations from January 2009 to December 2010 were divided into 4 groups according to the type of operations and the stage of sepsis:A.sepsis after transplantation ( TS,n =11 ),B.severe sepsis after transplantation ( TSS,n =10),C.sepsis without transplantation ( NTS,n =15) and D.severe sepsis without transplantation (NTSS,n =11 ).Ten healthy volunteers were selected as the control group.Blood samples were collected from these patients to measure the immunological parameters associated with T lymphocyte.Results The APACH Ⅱ and SOFA score of TSS group and NTSS group were both higher than TS group and NTS group respectively (all P ＜ 0.01 ). In addition,SOFA score in TSS group was significantly higher than that in NTSS group ( 17.0 + 4.5 vs 12.1 ± 2.8,P ＜ 0.01 ).The percentages of T cell in 4 groups were all significantly lower than healthy volunteers ( all P ＜ 0.01 ).The CD4/CD8 ratio was slightly lower in the TSS group than those in the control group and the other three groups ( P =0.095 ).As compared with the control group,the IFN-γ/IL-4 ratios were significant lower in the TSS and NTSS groups (0.039 +0.012,0.047 ± 0.018 vs 0.062 + 0.006) while the level of IL-10 was higher ( (32.6±7.5),(25.9 +4.3) vs (8.2 ± 1.4)ng/L,all P ＜0.05).And the difference was more significant in the TSS group.As compared with the healther,the percentage of CD4 + CD25 + Foxp3 + Treg was lower in NTS group (2.21％ ± 0.96％ vs 4.06％ ± 0.52％,P ＜ 0.01 ),and significantly higher in NTSS group (8.02％ ± 3.57％ vs 4.06％ ±0.52％,P =0.003).No significant difference existed in the percentage of Treg between the TS and control groups (P =0.398).And it was significantly higher that in the TSS group (5.16％ ±0.99％ vs 4.06％ ±0.52％,P =0.006).But the magnitude of increase level was not so great as that in the NTSS group.The changes of Foxp3 mRNA demonstrated the similar trend as the percentage of Treg.Conclusions The immune states of transplant recipients with sepsis are comparable with healthy persons during sepsis. It may subsequently develop into serious immunosuppression.Immunosuppressant should be withdrawn in severe sepsis stage so as to reconstitute the immune system.

Objective To explore the angiogenesis-promoting effects of perlecan or vascular endothelial growth factor (VEGF) at different timepoints through quantitative analysis of microvessel density (MVD).Methods Four kinds of scaffolds:open-cell polylatice acid (OPLA) (control),OPLA + VEGF-165,OPLA + perlecan and OPLA + VEGF-165 + perlecan were implanted into mice.At Weeks 1,2,3,4,6 and 8,OPLA was harvested and then HE and immunocytochemistry were employed to detect the angiogenesis-promoting effects of scaffold. MVD of each group was appraised by the Tukey test. Results The scaffolds exhibited excellent biocompatibility with tissue. Numerous vessels were spotted obviously around the implants,especially at Week 8.And the OPLA scaffold degraded with the elapsing of time and its inner part was divided into many sections along with the ingrowth of vessels.Compared with the other three groups,the MVD of the OPLA + VEGF-165 + perlecan group was the highest at all timepoints.There were statistical differences between the OPLA + VEGF-165 + perlecan and OPLA groups at Week 1 (3.30 +0.42 vs 1.80 +0.29) ; MVD of the OPLA + VEGF-165 + perlecan group was thrice as much as the OPLA group at Week 3 ( 11.70 + 0.87 vs 4.50 + 0.34) ; at Week 8,MVD of the OPLA + VEGF-165 + perlecan group was more than thrice as much as the OPLA group(31.40 + 1.35 vs 9.90 + 0.67).Conclusion Angiogensis is synergistically enhanced by the combined application of VEGF-165 and perlecan in mice.

Objective To explore the effects of matrix metallopeptidase 9 (MMP-9) on the proliferation, apoptosis, type Ⅰ and Ⅲ procollagen synthesis of rat dermal fibroblasts. Methods Lipopolysaccharide (LPS) at 0.1 and 1.0,μg/ml was used to stimulate fibroblasts to up-regulate the expression of MMP-9 for 18 and 48 h. And then RNA interference was employed to inhibit the high expression of MMP-9.Cell proliferation was tested by CCK-8,cell apoptosis by flow cytometry and type Ⅰ and Ⅲ procollagen expressions by quantitative reverse transcriptase PCR (qRT-PCR). Results The MMP-9 expression of fibroblasts increased after the stimulation of LPS.And the 1.0 μg/ml LPS stimulation of 48 hours was 14.25 times of mRNA expression and 2.31 times of protein expression versus that of the normal group (both P ＜ 0.05 ).The RNA interference obviously inhibited the high expression of MMP-9.The mRNA expression was 1/8 and protein expression 1/3 ( both P ＜ 0.05) as compared with the control group.Cell proliferation decreased with the rising expression of MMP-9 to some extent[( 1.08 ±0.08) vs ( 1.18 ±0.09),P ＜0.05]and improved after the inhibition of high expression of MMP-9[(1.78 ±0.17) vs (1.53 ±0.15),P ＜0.01].There was no change of apoptosis accompanied with high expression of MMP-9 (P ＞ 0.05 ).Apoptosis decreased after the inhibition of high expression of MMP-9 for 48 hours ( 3.53％ ± 0.22％ vs 4.47％ ±0.46％,P ＜0.05).The synthesis of type Ⅰ proeollagen was the same no matter up-regulation or down-regulation of MMP-9 expression (P ＞ 0.05).As the expression of MMP-9 increased,the synthesis of type Ⅲ procollagen decreased (P ＜0.01 ),but not increased by 1.02 folds after the inhibited expression of MMP-9 (P ＞ 0.05).Conclusion MMP-9 can affect the biological behaviors of rat dermal fibroblasts.

gastrointestinal stromal tumors (GIST) originated from Cajal interstitial cells, and are the most common mesenchymal tumors in the digestive tract, which can occur in the whole digestive tract, among which the stomach and small intestine are the most common, and 95% of GIST patients have positive expression of KIT gene (CD117). Surgery is the first choice for the treatment of GIST with localized lesions and resectable surgery, but many patients still face the risk of tumor recurrence and metastasis after surgery. Imatinib is a selective tyrosine kinase inhibitor (TKI) that inhibits the proliferation and induces apoptosis of GIST cells by blocking the function of tyrosine kinase receptor.

A 66-year-old male was admitted to the Department of Medical Oncology, Affiliated Cancer Hospital of Nanjing Medical University on August 25, 2011 due to tongue squamous cell carcinoma for more than 1 year and general pain for more than 1 month. In December 2009, the patient underwent pathological biopsy due to left tongue margin ulcer with pain, which showed grade I squamous cell carcinoma of the left tongue margin. In January 2010, he underwent combined radical resection of left tongue, jaw and neck + free transplantation of left forearm flap. Postoperative pathology showed: grade I squamous cell pain of left tongue, invasion of muscle, left submandibular gland (1), and 15 lymph nodes of left neck (1) (Figure 1). The patient was not treated after operation. In early September 2011, a mass in the left axil was found, and a puncture biopsy of the axillary mass was performed in our hospital. The pathology showed malignant tumor cells (squamous cell carcinoma). One month before admission, he developed severe insomnia, general pain and difficulty in walking.