Volume 93  ·   Issue 24  ·  2013

To evaluate the incidence of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).

Comprehensive searches as of June 2012 were performed in Pub Med (1966—), Embase (1974—), Chinese Biomedical Literature Database (1978—), Chinese Journal Full-text Database (1979—) and VIP Database (1989—) for literatures on the incidence of pulmonary embolism in patients with acute exacerbations of COPD.Meta-analysis was conducted with Stata version 11.0.

Among 2273 articles identified, 5 studies met the inclusion criteria (4 in English,1 in Chinese).The total sample size was 762 patients, among whom 145 were diagnosed with pulmonary embolism.The incidence of pulmonary embolism ranged from 3.3% to 33.0%.Meta-analysis showed that the combined incidence was 15.8% (95% CI: 5.1%-26.4%).Among patients with acute exacerbations of COPD of unknown etiology, the incidence was 29.0% (95% CI: 20.8%-37.1%).

There is a high incidence of pulmonary embolism in patients with acute exacerbations of COPD,especially among those of an unknown etiology.More attention should be paid to this population.

To test the validity of Caprini risk assessment model in identifying high venous thromboembolism (VTE) risk patients among hospitalized medical patients.

A retrospective case-control study was performed among hospitalized medical patients admitted into West China Hospital, Sichuan University from January 2010 and December 2011.A total of 218 patients with definite VTE during hospitalization were recruited.And 394 controls were randomly selected from the patients without VTE admitted into the same departments within the same period.The risks of both cases and controls were retrospectively assessed with the Caprini risk assessment model.

The average Caprini cumulative risk score in cases was significant higher than that in controls (4.9±2.6 vs 3.2±2.0, P=0.000).There was no significant difference in the risk of VTE between the patients at a low risk by Caprini model and those at a moderate risk (OR=1.26,95% CI:0.62-2.56).Compared with a low risk, those with a high risk were associated with 2.00-fold increased risk of VTE (95% CI:1.10-3.61), a highest risk was associated with 5.76-fold increased risk of VTE (95% CI: 3.24-10.24)(both P<0.05).When further stratifying the highest risk level with cumulative risk score≥5 into 5-6, 7-8, and≥9 risk level, the patients with score 5-6 were associated with 4.15-fold increased risk of VTE (95% CI: 2.28-7.56), those with score 7-8 11.13-fold increased risk of VTE (95% CI: 4.88-25.36) and those with score≥9 21.00-fold increased risk of VTE (95% CI: 6.34-69.52) compared with low risk counterparts.

Caprini risk assessment model can effectively and quantitatively assess the risk of VTE among hospitalized medical patients based on their individual VTE risk factors.

To evaluate the dynamic changes of inflammation-related indices in blood during the development of venous thromboembolism (VTE) and the association between these indices and VTE.

A total of 95 VTE hospitalized patients (41 males,54 females) were recruited from Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital from January 2010 to December 2010.Comparisons of inflammation-related indices including white blood cell (WBC), neutrophil (NE), fibrinogen (FBG), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were conducted between VTE patients and normal ranges.And the dynamic changes of these indices during the development of VTE were evaluated.Then they were divided into subgroups according to disease stage, gender, age, VTE type, body mass index, smoking status and clinical manifestations.And statistical analyses were performed to elucidate the associations between these indices and VTE.

The levels of NE and CRP in VTE patients (0.72, 15.0 mg/L) and ESR in male VTE patients (20.0 mm/1 h) were elevated compared with normal ranges; while WBC (male 7.27×10⁹/L, female 8.67×10⁹/L), FBG (male 3621 mg/L, female 3201 mg/L) and female ESR (19.5 mm/1 h) in VTE patients were within the normal ranges.The level of CRP was higher in acute (mean rank order value: 49.72) and sub-acute (mean rank order value: 44.80) VTE patients than chronic V TE patients (mean rank order value: 30.25).The level of FBG, CRP and ESR in patients≥50 years old increased versus those<50 years old (mean rank order values 48.83 vs 34.53, 44.32 vs 28.90 and 45.95 vs 27.84 respectively), the patients whose body mass index (BMI) <25 kg/m² had higher WBC level than those whose BMI≥25 kg/m² (mean rank order values 52.96 vs 36.46); smoking V TE patients had elevated FBG and CRP levels than non-smoking V TE patients (mean rank order values 57.75 vs 42.69 and 53.92 vs 37.75 respectively); compared with those without clinical manifestations of periphery pulmonary artery involved, the patients with clinical manifestations had higher levels of FBG, CRP and ESR (mean rank order values 59.24 vs 37.39, 52.68 vs 33.19 and 50.08 vs 36.55 respectively).The above differences had statistical significance (all P<0.05).

Some inflammation-related indices frequently used in clinical settings become elevated in VTE patients.Part of these indices show higher levels in VTE acute and sub-acute stages, and in older, non-obese, smoking and periphery pulmonary artery involved VTE patients.

To explore the efficacies and adverse events of sorafenib in the treatment of advanced metastatic renal cell carcinoma.

A total of 57 patients with advanced kidney cancer were recruited from our hospital from April 2007 to October 2011.They were divided into sorafenib group (A, n=24) and sorafenib+ IFN group (B, n=33).The primary endpoints included objective response rate and progression-free survival (PFS).And the secondary endpoints were overall survival (OS) and incidence of adverse events.

The mean medication time of group A was 15 (7-56) months.The outcomes were partial response (PR, n=1), stable disease (SD, n=8), progressive disease (PD, n=1) and death (n=14).The rates of objective response and disease control were 4.2% (1/24) and 37.5% (9/24) respectively.For group B, the mean medication time was 15 (4-30) months.The outcomes were PR (n=2), and include 2 patients of PR, 21 examples of SD, 1 patient of PD and death.The rates of objective response and disease control were 6.1% (2/33) and 69.7% (23/33) respectively. Two groups had no significant difference in incidence or severity of adverse events (both P>0.05).

As a safe and effective agent for advanced kidney cancer, sorafenib is well-tolerated in patients.The combined use of interferon may improve the therapeutic efficacies without an occurrence of adverse events.

To study the feasibility and clinical value of 13th lymph nodes in predicting general lymph nodes metastases for periampullary carcinoma.

A total of 77 patients with pathologically confirmed periampullary carcinoma were recruited.And 26 (18 males and 8 females, age 38-79 years) of them underwent Whipple procedures during which 1% methylene blue or nanogate carbon was injected into tumor bed.The othor 51 patients as controls (33 males, 18 females, age 38-78 years).The dyed 13th lymph nodes were biopsied.Then routine lymphadenectomy was performed and their pathological results were analyzed.

In the experimental group, the lymph node drainage area of cancer was identified.However,in contrast with 51 patients in the control group, the labeling of 13th lymph nodes did not significantly increase the number of cleaned lymph nodes (15.8 (3-54) vs 17.6 (6-40),P=0.460).

13th lymph nodes are non-suitable as sentinels for predicting general lymph nodes metastases of periampullary carcinoma.

To evaluate the therapeutic strategy of Bosniak category Ⅱ renal cyst.

A total of 52 cases of Bosniak category Ⅱ renal cyst underwent surgery from 2004 to 2011.There were 32 males and 20 females with a mean age of 48 years.Their average diameter of renal cysts was 4.7 cm.There were 25 left,23 right and 4 bilateral lesions.

Renal cystectomy (n=47) and radical nephrectomy (n=5) were performed.Four cases of renal cyst with cystectomy had malignancy confirmed with intraoperative frozen section and underwent radical nephrectomy immediately.One case underwent radical nephrectomy in second stage because of a confirmation of malignant renal cyst after cystectomy.Malignant renal cyst were found in 5 cases and benign lesions in 47.The malignancy rate was 9.6% (5/52) with 14.3% (4/28) in ⅡF group and 4.2% (1/24) in non-ⅡF group.Forty-three cases were followed up for 1-8 years with 4 cases of malignancy and 39 cases of benign lesions.One case of malignancy had pulmonary metastasis at 3 years post-operation.

Operation should be performed in ⅡF renal cyst and Ⅱ cyst with a diameter of>5 cm.Follow-ups should be performed in other category Ⅱ renal cysts, especially in young patients.

To evaluate the value of percentage of highly fluorescent lymphocytic cells (HFLC%) for rapidly assessing septicemia in tumor patients.

Blood samples were collected from 130 patients with tumors (60 septicemia patients and 70 non-septicemia patients) and 80 healthy controls.HFLC% was analyzed with Sysmex XE-5000, the level of C-reactive protein (CRP) measured with a commercially available turbidimetric immunoassay kit and the level of procalcitonin (PCT) determined with a semiquantitative chromato-graphic immunoassay kit.The diagnostic values of HFLC% and CRP in septicemia were evaluated with ROC analysis.

The values of HFLC% and CRP were significantly higher in the septicemia group than those in the non-septicemia and healthy groups (0.30% (0.10%-0.70%) vs 0.10% (0-0.20%),0.10% (0-0.20%); 80.3 (28.5-129.5) vs 3.3 (1.4-41.4),1.4 (0.6-2.5) mg/L, all P<0.01).The ROCAUCs for HFLC% and CRP for a diagnosis of septicemia were 0.72 (sensitivity 71.7%, specificity 58.7%) and 0.92 (sensitivity 96.7%, specificity 82.0%).Both of them could judge septicemia better.Additionally, HFLC% was correlated with the levels of PCT and CRP (r=0.637, 0.241, both P<0.01).

HFLC% may be used as a rapid and simple auxiliary indicator in the diagnosis of septicemia in patients with tumors.And it is conducive to make an early diagnosis of septicemia and avoid unnecessary use of antibiotics.

To explore the relevance between carotid plaque and the severity of coronary artery disease.

A total of 207 patients (149 males,58 females) undergoing coronary angiography were definitely diagnosed with coronary heart disease.They were divided into 3 groups of one-vessel disease (1VD,n=69), two-vessel disease (2VD,n=57) and three-or-more vessel disease (3VD,n=81) by the number of involved vessels.Their physical findings, biochemical data and carotid ultrasonographic results were collected.And the scores of Crouse, Gensini and Leaman were calculated to compare the relevance.

No significant differences existed among all three groups except for a higher age and the presence of plaque in 2VD and 3VD groups than 1VD group ((63±11) and (60±11) vs (57±10) years old,82% (n=47) and 81% (n=66) vs 65% (n=45), both P<0.05).Crouse had a positive correlation with Gensini (r=0.455, P<0.01) and Leaman scores (r=0.358,P<0.01).

Assessment of plaque scores by carotid ultrasonography is clinically relevant for predicting the severity of coronary artery disease.

To explore the dynamic changes of lung function in infants born at different gestational ages without respiratory complications.

A total of 110 cases of hospitalized neonatal patients were retrospectively recruited and analyzed at Shenzhen Children′s Hospital from July 2010 to August 2012.By gestational age they were divided into 3 groups of full term (37-40 weeks, n=55, 29 males and 26 females) with an average birth weight (3.1±0.3) kg, late preterm group (34-<37 weeks, n=30, 18 males and 12 females) with an average birth weight (2.1±0.3) kg and early preterm (<34 weeks,n=25, 16 males and 9 females) with an average birth weight (1.4±0.3) kg.At Days 1,14 and 28,lung function parameters of functional residual capacity (FRC) and lung clear index (LCI) were measured by multiple breath washouts with an ultrasonic flow meter and tidal breathing.One-way ANOVA was used for each index.

Tidal expiratory flow 75% remaining tidal volume (TEF75), tidal expiratory flow 50% remaining tidal volume (TEF50) and tidal expiratory flow 25% remaining tidal volume (TEF25) gradually increased at Days 1, 14 and 28 in 3 groups.However respiratory rate (RR) gradually decreased.Compared with full term and late preterm, the early preterm infants had lower TEF75, TEF50 and TEF25, lower the ratios of time to peak expiratory flow and expiratory time (TPTEF/TE), lower ratios of volume to peak expiratory flow and expiratory volume (VPEF/VE)((71±21) and (66±16) vs (55±19) ml/s, (70±20) and (62±17) vs (51±16) ml/s, (54±17) and (51±13) vs (38±10) ml/s,37%±8% and 34%±9% vs 29%±6%,38%±6% and 33%±8% vs 28%±7%,F=5.82, 8.74, 11.30,7.72, 16.40, all P<0.01), higher RR and LCIat Day 28 ((49±6) and (51±8) vs (56±7) /min, 8.6±2.7 and 8.9±2.2 vs 10.8±2.0,F=10.09, 7.15, both P<0.05).At a matched post-menstrual age of 40 weeks, compared with full term and late preterm, the early preterm group had lower TEF50, TEF25, TPTEF/TE, VPEF/VE ((65±21) and (62±12) vs (50±17) ml/s, (51±13) and (47±10) vs (39±10) ml/s, 36%±8% and 31%±7% vs 30%±6%,37%±10% and 32%±8% vs 29%±6%,F=4.41, 8.23, 9.08, 7.35, all P<0.05).

Lung function improves with the elongation of days.The parameters of lung function in early infants are worse than those in full and late-preterm counterparts.At a corrected gestational age of 40 weeks, early preterm infants fail to achieve catch-up growth in lung function.Dynamic monitoring of lung function in preterm infants of different gestational ages is of vital importantance for gauging respiratory maturity and assessing lung development especially for preterm infants.

To explore the pathophysiological changes in the functional connectivity of posterior cingulate cortex (PCC) with other brain regions in children with attention-deficit or hyperactivity disorder (ADHD) on resting-state functional magnetic resonance imaging (fMRI) and explore the neural mechanisms of ADHD at the point of relationships between brain regions.

Thirty children with ADHD from the Third Affiliated Hospital of Soochow University from June 2008 to April 2010 and another 30 age-and-gender-matched controls from a normal primary school over the same period underwent resting-state fMRI scans.And blood oxygenation level dependent (BOLD) signal was acquired to calculate the functional connectivity of PCC with other brain regions controls.Singnificant differences of connectivity between groups were analyzed with REST software.

The pattern of functional connectivity of PCC for the ADHD group was similar to that of the control group.Significant positive functional connectivity with PCC was observed in the default mode of network (DMN) while negative functional connectivity was present in dorlateral prefrontal cortex,anterior cingulate, parietal cotex and basal ganglia (all P<0.05, corrected).Compared to the controls, the ADHD group exhibited decreased positive connectivity with PCC in bilateral medial prefrontal cortex (0.07±0.20 vs 0.33±0.23, t=-5.47), right posterior cingulate gyrus (0.25±0.28 vs 0.48±0.30, t=-3.44), right inferior temporal gyrus (-0.05±0.19 vs 0.22±0.22, t=-4.61) and cerebellar posterior lobe (-0.04±0.21 vs 0.17±0.16, t=-3.99), while decreased negative functional connectivity with PCC was observed in left insula (-0.10±0.26 vs-0.30±0.19,t=3.71), right inferior parietal lobule (0.02±0.18 vs-0.23±0.17, t=5.20), left postcentral gyrus (0.08±0.26 vs -0.17±0.25, t=4.06), left superior temporal gyrus (-0.04±0.25 vs -0.27±0.17, t=4.27), right superior temporal gyrus (-0.08±0.25 vs -0.31±0.21,t=3.80) and left fusiform gyrus (-0.01±0.25 vs -0.18±0.17,t=3.57)(all P<0.05, corrected).

The connectivity of DMN between brain regions is abnormal in ADHD group.And the strengthen of negative relationship between DMN and task activated network becomes reduced.It is surmised that the decreased internal synchronization of default network and disrupted balance between DMN and prefrontal-parietal attentional networks may be important neural mechanisms of ADHD.

To explore the transcriptional expression and promoter methylalion status of SIX2 gene in peripheral blood of pediatric children with nephroblastoma and discuss their clinicopathological correlations.

Approved by the hospital ethics committee, peripheral blood samples were collected from 45 children with Wilms′tumor (case group) at the Department of Pediatric Surgery, First Affiliated Hospital, Zhengzhou University from October 2008 to January 2012.And another 15 pediatric cases genderand-age matched, were selected as the control group (excluding cancer and other malignant diseases).The real-time quantitative (qRT) -PCR and methylation-specific PCR (MSP) were used to detect the mRNA expression level and methylation status of SIX2 gene. t or χχ² test were used.Then analyzed their clinicopathological correlations in the case group and how SIX2 gene methylation affected its transcription.

Relative quantity (RQ) of SIX2 mRNA in the case group was higher than that of the control group (1.93±1.10 vs 0.57±0.39,t=5.354,P=0.000).There were8 SIX2 gene methylation-positive cases in the case group versus 12 cases in the control group.And the methylation positive ratio was extremely lower in the case group (χ²=19.600, P=0.000).RQ values in the case group was associated with tumor size, clinical stage, pathological type, lymph node metastasis, treatment and outcome (all P<0.05).RQ values in the methylated group was lower than that of the unmethylated group both in case and control group (1.35±0.44 vs 1.95±1.15,0.43±0.29 vs 1.13±0.20,t=2.459 and 3.896, P=0.020 and 0.002).RQ values of case group was higher than that of the control group in methylated group (t=5.624, P=0.000).No statistical significance existed in RQ values between the case and control groups of unmethylated group (t=1.222, P=0.229).

A close correlation between SIX2 low methylation and high mRNA expression in blood suggests that aberrant promoter methylation is possibly one of gene expression regulations,and may be correlated with the occurrence and development of Wilms′tumor.And SIX2 gene in methylated Wilms′tumor may play the role of oncogenes.A negative correlation exists between the overexpression in transcriptional level and its methylation status.

To explore the disease course and outcomes of severe or critical pregnant women with 2009 pandemic H1N1 (pH1N1) infection in China.

A retrospective observational study was conducted for 394 severe or critical pregnant women with pH1N1 influenza admitted into hospital in 27 Chinese provinces from September 1,2009 to December 31, 2009.Their clinical features in different trimesters were analyzed.The viral infection of pH1N1 was verified by real-time reverse transcription (rRT)-PCR.Severe and critical cases were defined according to the 2009 H1N1 clinical guidelines.

Among them,374 (94.9%) were infected in the second or third trimester.Fever and cough were the most common symptoms in all trimesters.However, hemoptysis, dyspnea and associated pneumonia were likely to occur in the second or third trimester.The ratio of required mechanical ventilation in the second or third trimester (44.7%,167/374) was significantly higher than that in the first trimester (3/20).Among 77 mortality cases, 72.7% (56/77) died in the third trimester.Pregnancy was terminated after the onset of pH1N1 symptoms in 52.5% (207/394) pregnant women.And 57.0% (118/207) of them had delivery<37 weeks and 29.0% (60/207) fetuses deceased.

A clinician should be on a high alert for pH1N1 infection in pregnant women, particularly in the second or third trimester.

To explore a new method of establishing acute myocardial infarction model in diabetic miniature pigs through video-assisted thoracoscopic surgery (VATS).

Seven normal miniature pigs and 7 diabetic miniature pigs underwent VATS by selectively ligating left anterior descending coronary artery and then were evaluated through serology,imaging and histology.

The serum levels of troponin (cTni) and myoglobin (MYO) in both groups significantly increased by over 10 folds of upper normal limit after VATS.Echocardiography, MRI and histopathologic analysis showed that the affected myocardial parts were apex, left ventricular wall and interventricular septum cosco section.But heart function of diabetic miniature pigs were relatively lower| infarction area/area-at-risk ratio higher (18.4%±5.5% vs 5.3%±3.9%,P=0.03), myocardial infarction through-wall degree more severe.These were in accordance with poor ischemic tolerance in diabetic myocardia.

VATS is a safe and effective method for establishing AMI model in diabetic miniature pigs.

To establish a lapatinib resistance cell line for elucidating the mechanisms of drug resistance of lapatinib in human breast cancer cells.

The human breast cancer MDAMB-231 cells were exposed in an incremental dose of lapatinib to establish a lapatinib resistance rMDA-MB-231 cell line.The assay of methyl thiazolyl tetrazolium (MTT) was used to detect the cytotoxic activity of lapatinib against MDA-MB-231 and rMDA-MB-231 cells.The protein expression was detected by Western blot.Small interfering RNA was used to specifically knock down mammalian-target-of-rapamycin (mTOR) in rMDA-MB-231 cells.Apoptosis was determined by fluorescein isothiocyanate (FITC)-annexin V/PI staining and flow cytometry.

The human breast cancer lapatinib resistance cell line rMDA-MB-231 was induced by lapatinib.The half maximal inhibitory concentration (IC₅₀) values of lapatinib against MDA-MB-231 and rMDA-MB-231 cells were (6.1±0.6) and (34.9±2.7) μmol/L respectively (P<0.01).Compared with MDA-MB-231 cells, the protein expresssion of m TOR in rMDA-MB-231 cells was significantly up-regulated.The protein expression of mTOR was significantly down-regulated by specific siRNA duplexes in rMDA-M B-231 cells.After siRNA interference, 20μmol/L lapatinib was added into control, negative siRNA control and mTOR-targeted siRNA groups respectively.The percents of cell apoptosis in control, negative control and targeted siRNA groups were 13.4%±2.5%, 14.2%±2.8% and 34.6%±5.8% respectively, there was no significance between the first two groups (P>0.05), and there was significant difference between the control and targeted siRNA group (P<0.01).

The up-regulation of mTOR plays an important role in the lapatinib-resistant phenotype of human breast cancer rMDA-MB-231 cells.And the down-regulation of mTOR increases the apoptotic death of lapatinib against rMDA-MB-231 cells.

To explore the protective effects of leflunomide (A771726) on the expression of podocalyxin, NF-κB and matrix metalloproteinase-9 (MMP-9) in podocytes exposed to high glucose environment and elucidate its mechanism.

Podocytes were cultured in high glucose.And the altered expressions of podocyte protein podocalyxin were detected by Western blotting at different timepoints.Then podocytes were divided into 4 groups of normal glucose control, leflunomide, high glucose and hypertonic control.The expression level of podocalyxin protein in each group was detected by Western blotting.And NF-κB p65 and phosphorylation of NF-κB p65 (P-NF-κBp65) in podocytes cultured in high glucose were detected at different timepoints.And then the podocytes were divided into 5 groups of normal glucose, mannitol, hypertonic control, high glucose, leflunomide and PDTC (NF-κB blocker).And the expressions of MMP-9 protein in these groups were also detected by Western blotting.

In the high glucose environment, the expression of podocalyxin declined instantly.Compared with the high-glucose group, the podocalyxin expression of the leflunomide group was significantly higher than the high glucose group (0.46±0.04 vs 0.13±0.03,P<0.05).After 30-minute stimulation by high glucose, the activation of NF-κB started and the expression of P-NF-κBp65 protein increased.Such activities peaked at 60 minutes and reverted to a basic level after 6 hours.Compared with the high glucose group, the expressions of MMP-9 in PDTC and leflunomide groups were significantly lower than the high glucose group.And the differences were statistically significant (0.71±0.01, 0.64±0.03 vs 1.64±0.03, both P<0.05).

Leflunomide has protective effects on podocytes in high glucose.And its mechanism is possibly due to a lowered expression of MMP-9 through an inhibition of NF-κB activation.

To explore the expression of Notch1 receptor in renal tubular epithelial cells transfected with hepatitis B virus X (HBx) gene and its role in immunologic activity.

The eukaryotic vector pcDNA3.1/myc-HBx containing HBx gene or vector pcDNA3.1/myc-Notch1 containing Notch1 gene was transiently transfected into HK-2 cells.And the shRNA technique was used to silence Notch1.HK-2 cells were divided into 7 groups,including normal culture, pcDNA3.1/ myc, HBx, HBx+ pcDN A3.1/myc, HBx+ Notch1, HBx+ shRNA and HBx+ Notch1 shRNA.Real-time PCR and Western blotting were used to detect the expression of Notch1.The expressions of MHC-Ⅱ and CD40 were examined by flow cytometry. And the supernatant contents of IL-4 and IFN-γwere measured by enzyme-linked immunosorbent assay (ELISA).

The results of real-time PCR and Western blotting verified that HBx and Notch1 were successfully expressed in HK-2 cells after transfection.The transfection efficiency of shRNA was 70%.Compared with normal culture and pcDNA3.1/myc groups, the expression of Notch1 increased.The expressions of MHC-Ⅱ and CD40 also significantly increased in the HBx+ Notch1 group (9.69%±0.52% vs 4.90%±0.32%,21.56%±0.71% vs 15.74%±0.20%, both P<0.05).The supernatant level of IFN-γwas lower in HBx+Notch1 group (11.9±1.7 vs 18.8±0.8, P<0.05) while the level of IL-4 was higher than control groups (50.2±0.6 vs 28.1±1.2,P<0.05).And the HBx+ Notch1 shRNA group had the opposite results.

An over-expression of HBx gene may up-regulate the expression of Notch1.And Notch1 promotes the expression of immune molecules of renal tubular epithelial cell and regulates the secretion of cytokines so as to cause injury of cells and dysfunction of immunomicroenviroment.

To explore the feasibility of laparoscopic with extralevator abdominoperineal excision (LEL APE group) for low rectal cancer.

From June 2011 to January 2013, 35 patients with low rectal cancer undergoing laparoscopic abdominoperineal excision at the Department of Gastroenterological Surgery, Beijing Hospital were analyzed retrospectively.Among them, 20 received laparoscopic abdominoperineal excision (LAPE group). There were 12 males and 8 females with an average age of (63±6) years old.Another 15 patients underwent laparoscopic extralevator abdominoperineal excision (LELAPE group).There were 10 males and 5 females with an average age of (61±7) years old.Operative duration, blood loss volume,time of postoperative out-of-bed activity, recovery of gastrointestinal function, removal time of drainage tube, edge of perineal position take out stitches time, postoperative hospital stay and complication rates were relative analyzed.

There was no significant difference in operative time, time of postoperative out-of-bed activity, recovery of gastrointestinal function, removal time of perineal stitches, postoperative hospital stay and complication rates between 2 groups ((259±52) vs (246±55) min, (35±13) vs (33±9) d, (61±25) vs (63±20) h, (15.7±2.5) vs (16.8±2.9) d, (12±3) vs (15±4) d, 2/15 vs 3/20, all P>0.05).Blood loss volume of perineal position in LELAPE group was less than those in LAPE group ((76±31) vs (148±36) ml, P<0.05).Removal of perineal drainage tube in LELAPE group was earlier than that in LAPE group ((6.2±1.6) vs (10.3±1.8) d, P<0.05).

LELAPE is a safe and feasible surgical approach for low rectal cancer.