http://www.cmj.org Table of contents of Chinese Medical Journal JIANG Qi, XIA Shu-jie http://www.cmj.org/Periodical/AbstractList.asp?titleid=CMJLW201257361609008276 2012-5-8 12:07:00 LI Xun-gang, ZHANG Dong-xu, CUI Xin-gang, XU Dan-feng, HONG Yi, LI Yao, GAO Yi, LIU Yu-shan, YIN Lei, QU Fa-jun, WANG Jun-kai, CHEN Ming, CHEN Jie, CHEN Lu, WANG Kai, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257373732904865 Background Although many midterm oncologic data have been reported for extraperitoneal laparoscopic radical prostatectomy (ELRP) in western countries, few oncologic data of the extraperitoneal procedure was published in China. The aim of the study was to evaluate the oncologic outcomes of patients treated with ELRP in China. Methods From January 2005 to March 2010, a total of 152 consecutive patients diagnosed with clinically localized prostate cancer were included in this study and treated with ELRP. The patients were staged according to the TNM (tumor, nodes, metastases) system. Median and mean postoperative follow-up were 28.1 months and 27.0 months, respectively. The patients were retrospectively analyzed for progression-free survival. Results One hundred and twelve cases (73.7%) were postoperatively diagnosed as pT2 in, and 40 cases (26.3%) as pT3. Positive lymph nodes were shown in 5 patients (3.3%). Gleason score was <7 in 49 men (32.2%), 7 in 69 men (45.4%), and >7 in 34 men (22.4%). Positive surgical margins (PSM) were observed in 15 patients (9.9%), which included 32.0% of all pT3a cases and 46.7% of all pT3b cases, respectively. The overall prostate-specific antigen recurrence-free survival rate was 86% in all patients. The recurrence-free survival rates were 91.8% and 62.2% in pT2N0 patients and pT3N0 patients, respectively. Preoperative prostate-specific antigen, surgical margins, tumor stage, and lymph nodal status were identified as independent predictors of biochemical recurrence-free survival using multivariate Cox proportional hazard model. Conclusions ELRP is a precise, safe and effective procedure at this particular Chinese institution. The prognostic power of prostate-specific antigen relapse after ELRP is not identical to that described previously with transperitoneal or open retropubic approaches. 2012-5-8 12:07:00 QI Jun, YU Yong-jiang, HUANG Tao, XU Ding, JIAO Yang, KANG Jian, CHEN Ya-qin , ZHU Yun-kai, HUANG Yi-ran, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257381473606824 Background Transurethral resection of prostate (TURP) has been widely used as a golden standard therapy of benign prostatic hyperplasia for over 40 years. However, not all patients achieved favorable outcome postoperatively. Since the level of bladder outlet obstruction and the dysfunction of detrusor (overactive and underactive) were both found to affect surgical efficacy, urodynamics was recommended as routine preoperative examination in selecting proper surgical candidates by International Continence Society in spite of its invasiveness and high cost. The aim of this research was to compare the predictive value between ultrasonography and urodynamics for TURP efficacy and determine if preoperative urodynamic test could be replaced by ultrasonography. Methods Two hundred and seventy-one patients took part in the retrospective analysis. All the subjects had preoperative evaluation of symptoms, life quality, and combined examination of ultrasonography and urodynamics. Surgical efficacy was measured according to the recovery of international prostate symptom score, quality of life score, and maximal flow rate 6 months after TURP. Fisher¡¯s linear discriminant analysis was applied to establish the predictive models of surgical efficacy by choosing parameters from ultrasonography or urodynamics as independent factors. Receiver¡¯s operating characteristic curve was then plotted to compare the values between the models. Results Sensitivity, specificity, positive and negative predictive value of models consisting of parameters from both ultrasonography and urodynamics were favorable. Corresponding models of ultrasonography and urodynamics were found to have non-significant difference in area under curve (P>0.05). Conclusions Preoperative ultrasonography has as strong value as urodynamics does in predicting surgical outcome of patients undergone TURP and might take the place of urodynamics in selecting surgical candidates. Further prospective analysis with larger popularity and longer period of follow up should be launched to verify the result of this research. 2012-5-8 12:07:00 LIU Ding-yi, HE Hong-chao, WANG Jian, TANG Qi, ZHOU Yan-feng, WANG Ming-wei, CHU Cheng-long , ZHANG Chong-yu, ZHU Yu, ZHOU Wen-long, SHEN Zhou-jun, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257387893404877 Background Improving the success rate of ureteroscopic lithotripsy for proximal ureteral stones is the hot issue in this field. Here we reported our experience on the treatment of proximal ureteral stones. Methods From 2005 to 2010, 187 consecutive patients with proximal ureteral stones who underwent ureteroscopic lithotripsy were enrolled. The initial 52 patients treated by semi-rigid ureteroscope alone were classified as group 1. The subsequent 135 patients treated by semi-rigid ureteroscope with the aid of stone basket and flexible ureteroscope were classified as group 2. Results In group 1, the overall stone-free rate was 67.3%. By a single procedure of ureteroscopic lithotripsy using a semi-rigid instrument, patients with ureteral stones below the 4th lumbar vertebra level achieved 91.7% stone-free rate, which was only 50% in patients with stones above the 4th lumbar vertebra level. Conversion to open surgery occurred in two patients since ureteral perforation was observed. In group 2, the stone-free rate achieved 93.2% with the aid of an N-Trap basket, which was significantly higher than that of patients without the aid of the basket (51.6%). Flexible ureteroscope was subsequently used in patients with fragment migration, thus making the overall success rate in group 2 increases to 97.0%. Conclusions Ureteroscopic lithotripsy is a safe and efficacious treatment for proximal ureteral stones. A single procedure of ureteroscopic lithotripsy using semi-rigid ureteroscope could achieve a satisfactory stone-free rate in patients with proximal ureteral stones below the 4th lumbar vertebra level. However, patients with ureteral stones above the 4th lumbar vertebra level experienced higher stone-migration rate, which would decrease the success rate. Fortunately, the stone-free state could possibly be achieved with the aid of an N-trap basket and flexible ureteroscope. 2012-5-8 12:07:00 ZHANG Quan-yu, LI Yi, GUAN Shao-yi, WANG Xiao-zeng, JING Quan-min, MA Ying-yan, WANG Geng , WANG Bin, DENG Jie , HAN Ya-ling , , , , http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257390473404948 Background Coronary stents are widely used in percutaneous coronary intervention (PCI) procedures. We aimed to explore the incidence, predictors and characteristics of stent thrombosis (ST) after coronary stent implantation in routine clinical practice. Methods From data of 18 063 consecutive patients who underwent successful stent implantation in Shenyang Northern Hospital from 2004 to 2010, we identified patients with definite ST (n=140) and control patients (n=280) matched on age, diagnosis, sex, current antiplatelet medication and stent type. The incidence, predictors and characteristics of ST after coronary stent implantation were investigated. Results The incidence of angiographically confirmed ST was 0.78% (140/18 063). The time distribution of ST was acute in 43 (30.7%), subacute in 50 (35.7%), and late in 47 (33.6%) patients. Binary Logistic regression analysis identified the angiotensin-converting enzyme inhibitor (ACEI) (odds ratio (OR)=0.472, 95% CI: 0.276¨C0.807, P=0.006) and heparin (OR=0.477, 95% CI: 0.278¨C0.819, P=0.007) were associated with an reduced risk of cumulative ST. Stent length (OR=1.042, 95% CI: 1.026¨C1.058, P <0.001), serum creatinine total (OR=1.020, 95% CI: 1.004¨C1.035, P=0.04), cholesterol (OR=1.267, 95% CI: 1.021¨C1.573, P=0.032), glucose (OR=1.086, 95% CI: 1.002¨C1.176, P=0.044), and platelet aggregation (OR=1.113, 95% CI: 1.075¨C1.154, P <0.001) were associated with an increased risk of cumulative ST. Conclusion ST is associated with longer stent length and higher level of total cholesterol, glucose and platelet aggregation. 2012-5-8 12:07:00 GUO Hong-wei, CHANG Qian, YU Cun-tao, SUN Xiao-gang, QIAN Xiang-yang, HU Sheng-shou, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257392959304403 Background Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, and SVA with discrete membranous subaortic stenosis is even rarer. The aim of the study was to make sure the incidence of SVA with discrete membraneous subaortic stenosis in SVA and their surgical results. We retrospectively analyzed 234 patients receiving surgical repair of SVA and reported the incidence of ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis. We also reported seven cases of SVA combined with discrete membranous subaortic stenosis and their surgical results. Methods Between January 1999 and December 2009, seven patients of SVA with discrete membranous subaortic stenosis underwent surgical repair of SVA and resection of subaortic discrete membrane. There were six male and one female patients. The mean age was (33.71¡À13.25) years (range 16¨C52 years). Associated cardiovascular lesions were aortic regurgitation (n=7), ventricular septal defect (n=5), coarctation of aorta (n=1), bicuspid aortic valve (n=1), patent ductus arteriosus (n=1), and aortic valve stenosis (n=1). The aortic valve was replaced in four patients and valvuloplasty was done in three. The other co-existing anomalies were corrected at the same time. All the seven patients were followed up from 18 to 125 months (mean (63.14¡À39.54) months). Among 234 SVA patients who underwent surgical repair, the number of cases with coexisting ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis was 129, 108, and 7, respectively. Results There was neither early death after operation nor late death during the follow-up period. All the seven patients were in the New York Heart Association (NYHA) functional classes I and II. There was no recurrence of discrete subaortic membrane during the follow-up period. The incidence of ventricular septal defect, aortic valve incompetence, and discrete membranous subaortic stenosis among 234 SVA patients was 55.13%, 46.15%, and 2.99%, respectively. Conclusions Surgical repair of SVA with discrete membranous subaortic stenosis showed good mid-term results. Resection of discrete subaortic membrane should be done actively while repairing SVAs. Long-term results need to be followed up. 2012-5-8 12:07:00 LI Yan-fang, CAO Fang-fang, LIU Fei, BAI Xue-yuan, LÜ Yang, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257396166004418 Background Chronic heart failure (CHF) had been characterized as an activated sympathetic system leading to the alteration of adrenergic receptor (AR) levels in the heart. Thus far, not much research has been done with regard to traditional Chinese medical treatment for CHF. We investigated the effect of Shexiangbaoxin pills (SXBXP) on the function of the heart and the expression of a(1)-AR and b-AR subtypes in the messenger RNA (mRNA) levels and protein levels of non-infarction left ventricular tissue from rats with CHF induced by myocardial infarction. Methods Models of CHF were established by left anterior descending coronary artery ligature. Fifty-four Wistar rats were randomly divided into five groups: normal control group (group A), sham operation group (group B), CHF model group (group C), positive medicine control group (group D), and small-dose SXBXP group (group E) and large-dose SXBXP group (group F), deployed intragastrically. Cardiac function was examined by echocardiography before and after therapy; mRNA expressed levels were measured by semiquantitative reverse transcription polymerase chain reaction (RT-PCR) for b(1)-AR, b(2)-AR, b(3)-AR, a(1A)-AR, a(1B)-AR, and a(1D)-AR; protein levels were measured by Western blotting analysis for b(1)-AR, b(2)-AR, a(1A)-AR, a(1B)-AR, and a(1D)-AR in non-infarction left ventricular tissue. Results There was no significant difference in the left ventricular ejection fraction (LVEF) between groups A and B. Compared to group B, LVEF of groups C, D, E, and F were significantly decreased (P <0.01) before therapy. After therapy, compared to group C, LVEF of group F was significantly improved (P <0.05). Compared to group B, b(1)-AR and a(1B)-AR expressed levels were markedly decreased (P <0.05), a(1A)-AR and b(3)-AR were significantly increased (P <0.01) in group C, and in both mRNA and protein expressed levels b(2)-AR had no significant difference between groups B and C (P >0.05). a(1D)-AR mRNA levels were unchanged in each group (P >0.05), but a(1D)-AR protein level was significantly decreased in group C (P <0.05). After treatment, compared to group C, mRNA levels of b(1)-AR and a(1B)-AR were significantly increased (P <0.05 and P <0.01), and a(1A)-AR was markedly decreased in groups D, E, and F (P <0.05). b(3)-AR level significantly declined in both groups D and F (P <0.01), but b(2)-AR and a(1D)-AR expressed levels remained unchanged in each group (P >0.05). Protein levels, compared to group C, b(1)-AR was significantly increased (P <0.01, P <0.05, and P <0.01) and a(1A)-AR was markedly decreased in groups D, E, and F (P <0.05, P <0.01, and P <0.01). b(2)-AR expressed level was significantly increased in group F (P <0.05). a(1B)-AR expressed level was significantly increased in both groups E and F (P <0.05), and a(1D)-AR was remarkably increased in both groups D and F (P <0.05). Conclusions After SXBXP treatment, LVEF was increased and cardiac function was significantly ameliorated in rats with CHF. The therapeutic effect of SXBXP may be related to better blood supply for myocardium and up-regulation of b(1)-AR and a(1B)-AR, and down-regulation of a(1A)-AR and b(3)-AR. The results show that SXBXP can be used in treatment of CHF and the therapeutic effect of large-dose SXBXP is superior to small-dose SXBXP. 2012-5-8 12:07:00 XUE Rong-quan, GU Jun-chao, DU Song-tao, YU We, WANG Yu, ZHANG Zhong-tao, BAI Zhi-gang and , MA Xue-mei, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257401618108560 Background There is a significant association between obesity and breast cancer, which is possibly due to the expression of leptin. Therefore, it is important to clarify the role of leptin/ObR (leptin receptor) signaling during the progression of human breast cancer. Methods Nude mice with xenografts of MCF-7 human breast cancer cells were administered recombinant human leptin subcutaneous via injection around the tumor site. Mice in the experimental group were intratumorally injected with ObR-RNAi-lentivirus, while negative control group mice were injected with the same dose of negative-lentivirus. Tumor size was blindly measured every other day, and mRNA and protein expression levels of ObR, estrogen receptor a (ERa), and vascular endothelial growth factor (VEGF) for each group were determined. Results Knockdown of ObR-treated xenografted nude mice with a high leptin microenvironment was successfully established. Local injection of ObR-RNAi-lentivirus significantly suppressed the established tumor growth in nude mice. ObR level was significantly lower in the experimental group than in the negative control group, while the amounts of ER¦Á and VEGF expression were significantly lower in the leptin group than in the control group (P <0.01 for all). Conclusions Inhibition of leptin/ObR signaling is essential to breast cancer proliferation and possible crosstalk between ObR and ERa, and VEGF, and may lead to novel therapeutic treatments aiming at targeting ObR in breast cancers. 2012-5-8 12:07:00 GAO Qing-xiang, LEE Hua-yu, WU Wen-han, GAO Song, YANG Yin-mo, MA Irene Teting, CAI Meng-shan, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257411378404793 Background Because of the complexity and severity of the surgery and its associated complications, pancreaticoduodenectomy (PD) is associated with significant morbidity and mortality, especially the hemorrhage post-PD. Exploring the factors associated with post-PD hemorrhage is very important for the patients¡¯ safety. Methods Clinical data from 303 cases of PD between January 1998 and December 2008 were analyzed retrospectively. Results The overall mortality rate was 4.95% (15/303). However, post-operative bleeding occurred in 25 patients (8.25%) with nine episodes resulting in death (36.00%). Univariate analysis was performed and identified tumor size, Child¡¯s classification, total pancreatic uncinatic process resection, and pancreatic leakage as significant risk factors for post-PD hemorrhage. In the severe hemorrhage group, incomplete resection of uncinate process of pancreas and pancreatic leakage were the main causes. The multivariate Logistic regression analysis revealed that each of these variables is an independent risk factor. Conclusions Primary prevention of bleeding complications depends on total pancreatic uncinatic process resection and meticulous hemostatic techniques during surgery. In addition, several peri-operative factors were found to contribute to post-PD bleeding. 2012-5-8 12:07:00 WANG Shu-ye, YANG Xi-jing, YANG Shan-shan, WANG Wei, TIAN Yao-yao, CAO Feng-lin, ZHOU Jin, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257413833906673 Background While the incidence of paroxysmal nocturnal hemoglobinuria (PNH) is relatively high in Northern China, the exact mechanism of the disease remains unknown. Immunoregulatory cytokine polymorphisms can directly regulate the expression levels of cytokines, which play a crucial role in many diseases. The purpose of this study was to study cytokine gene single nucleotide polymorphisms (SNPs) and the correlated cytokine expression levels in relationship to the PNH pathogenesis. Methods Peripheral blood samples were collected from 30 PNH patients and 40 healthy donors; all of the samples were collected from the Han people of Northern China. Eight SNP loci in five cytokine genes, including tumor necrosis factor-alpha (TNF-¦Á), interferon-gamma (IFN-¦Ã), transforming growth factor-beta (TGF-¦Â), interleukin-6 (IL-6), and IL-10, and aplastic anemia (AA) were assessed. TNF-a, TGF-b, IFN-g, IL-6, and IL-10 were analyzed by sequence-specific primer polymerase chain reaction (PCR-SSP). The plasma protein levels of TNF-a, TGF-b, and IFN-g were assessed by an ELISA. Results The PNH patients had a lower frequency of the TC/GG genotype of the TGF-b gene (P <0.01) and a higher frequency of the C allele in the TGF-b gene (+10) compared to the controls (P <0.05). The predominant genotype of the +874 locus of the IFN-g gene was TA in the PNH patients, while that in the predominant genotype was AA in the control group and was statistically significant (P <0.001). The frequency of the T allele in the IFN-g gene was dramatically higher in the PNH patients than in the controls (P <0.05). The PNH patients had a reduced frequency of the GC and CC genotypes, as well as the C allele at locus ¨C174 of the IL-6 gene compared to the controls (P <0.01). In addition, the plasma concentrations of TNF-a, TGF-b, and IFN-g were significantly higher in the PNH group compared to the control group (P <0.01). Conclusions Expression levels of the TNF-a, TGF-b, and IFN-g cytokines play an important role in PNH. The GC and CC genotypes, as well as the C allele of the IL-6 gene may protect the Han people of Northern China against PNH. Additionally, the TC/GG genotype of the TGF-b gene may be the protective allele. In contrast, the TA genotype and the T allele for the IFN-g gene, as well as the C allele of TGF-b may be susceptible to PNH. However, SNPs in the TNF-a and IL-10 genes did not correlate with PNH development. Alternatively, the increased plasma concentrations of TNF-a, TGF-b, and IFN-g in PNH patients may also be related to PNH development. 2012-5-8 12:07:00 WANG Jian-ting, GONG Shu-sheng http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257416071207144 Background The relationship between apoptosis and tumors is a major focus in cancer research. RNA interference (RNAi) technology has emerged as a very potent tool to generate cellular knockdown phenotypes of a desired gene. The aim of this study was to explore the effect of siRNA specific to the protein casein kinase 2¦Á (CK2¦Á) on apoptosis of laryngeal carcinoma cells and to explore possible mechanisms. Methods An siRNA expression plasmid specific to CK2¦Á, psiRNA-hH1neo-CK2¦Á, and a non-specific siRNA expression plasmid, psiRNA-hH1neo-cont, were constructed and transfected into Hep-2 cells by a lipofectamine method. The mRNA and protein levels of CK2¦Á in transfected cells were determined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting analysis. Apoptosis was measured by Annexin V-fluorescein isothiocyanate (FITC)/ propidium iodide (PI) double-staining methods. The morphological changes to Hep-2 cells were observed under transmission electron microscopy (TEM). The levels of Bcl-2 and Bax proteins were measured by Western blotting analysis. Results Levels of CK2¦Á mRNA and protein were significantly decreased in the psiRNA-hH1neo-CK2¦Á group compared to the other groups (P <0.05). The apoptotic rate of the psiRNA-hH1neo-CK2¦Á transfected group was significantly higher compared to that in the untransfected group and the siRNA-hH1neo-cont transfected group (25.66%¡À0.83%, 3.66%¡À0.43%, and 5.18%¡À0.22%) (P <0.05). Compared with the untransfected group and the siRNA-hH1neo-cont transfected group, the psiRNA-hH1neo-CK2¦Á transfected group presented with classical ultrastructural features of apoptosis, such as karyopyknosis, chromatic agglutination adjacent to the nuclear membrane, and apoptotic bodies. Compared with the other two groups, the level of Bcl-2 protein in the psiRNA-hH1neo-CK2¦Á transfected group was decreased (0.20¡À0.09 vs. 0.72¡À0.16, 0.56¡À0.11, P <0.01), while the Bax protein level was increased (0.81¡À0.17 vs. 0.26¡À0.12, 0.33¡À0.17, P <0.01) and the ratio of Bcl-2 to Bax was decreased (0.25¡À0.05 vs. 2.76¡À0.21, 1.70¡À0.22, P <0.01). Conclusions The siRNA expression plasmid specific to CK2¦Á could suppress CK2¦Á expression and induce the apoptosis of laryngeal carcinoma cells. This is possibly by decreasing the Bcl-2/Bax ratio. CK2¦Á may provide a potential therapeutic target against human laryngeal carcinoma. 2012-5-8 12:07:00 LI Hui-ying, YUAN Zhi-yi, WANG Yu-gang, WAN Hong-jiao, HU Jun, CHAI Yu-shuang, LEI Fan, XING Dong-ming, DU Li-jun, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257420020101256 Background Baicalin has a significant anti-inflammation effect and is widely used in the clinical treatment of stroke. Most of the studies of Toll-like receptor 2/4 (TLR2/4) during cerebral ischemia had defined their specific expressions in microglia in hippocampus tissue. To explore the targets of baicalin in stroke, we detected the expressions of TLR2/4 in vitro/vivo. Methods By constructing a cerebral ischemia-reperfusion model in vivo and glucose oxygen deprivation model, we successfully induced neuron damage, then added baicalin and detected expressions of TLR2/4, nuclear factor-kB (NF-kB), tumor necrosis factor-alpha (TNF¦Á), and interleukin-1¦Â (IL-1¦Â) in mRNA level and protein level. Results We found distinct upregulations of TLR2/4 and TNF¦Á in both mRNA level and protein level in PC12 cells and primary neurons. Moreover, TLR2/4 and TNF¦Á expressions were significantly higher in mice hippocampus treated with cerebral ischemia-reperfusion. Baicalin could downregulate the expressions of TLR2/4 and TNF¦Á in the damaged cells and mice hippocampus effectively. Conclusions Neurons could respond to the damage and activate the related signal pathway directly. TLR2/4 responsed to the damage and sent the signal to downstream factor TNF¦Á through activating NF-kB. Baicalin could inhibit the inflammatory reaction in neuron damage and TLR might be its targets, which explained why baicalin could widely be used in the clinical treatment of stroke. 2012-5-8 12:07:00 JIANG Lin, WU Yi-dong, XU Xue-feng, DU Li-zhong , http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257423560403831 Background Previous reports indicated that mutations in the adenosine triphosphate (ATP)-binding cassette transporter A3 (ABCA3) cause fatal respiratory failure in term infants, and common ABCA3 gene polymorphisms have been characterized at the population level in Caucasians. But the role of ABCA3 in relation to respiratory distress syndrome (RDS) in newborns has not been evaluated within a Chinese population. The aim of this study was to analyze eight single-nucleotide polymorphisms (SNPs) of the ABCA3 gene, and to assess the ABCA3 gene as a candidate gene for susceptibility to RDS in newborns. Methods Eight SNPs were selected and genotyped in 203 newborns. The data analysis and statistical tests were used for allele frequencies, haplotype and Hardy-Weinberg equilibrium pairwise linkage disequilibrium measures. Results There was a haplotype association with SNP rs313909 and SNP rs170447, but no haplotype association was observed among the newborns with and without RDS (P >0.05). The minor allele frequency (G) of the coding SNP (cSNP) rs323043 (P585P) was significantly increased in preterm infants with RDS. Conclusion There is an association between a synonymous cSNP rs323043 and the development of RDS. 2012-5-8 12:07:00 LAN Yong-lian, YU Lan, JIA Chan-wei, WU Yu-mei, WANG Shu-yu, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257426033604459 Background The 3q26 chromosome region, where the human telomerase RNA gene (hTERC) is located, is a biomarker for cervical cancer and precancerous lesions. The aim of this study was to confirm the value of measuring hTERC gene gain in predicting the progression of cervical intraepithelial neoplasia grade I or II (CIN-I and -II, respectively) to CIN-III and cervical cancer. Methods Liquid-based cytological samples from 54 patients with CIN-I or CIN-II lesions were enrolled in this study. Follow-up was performed with colposcopy and biopsy within 24 months after the diagnosis of CIN-I or CIN-II. Copy numbers of the hTERC gene were measured by fluorescence in situ hybridization with a dual-color probe mix containing the hTERC gene probe (labeled red) and the control, the chromosome 3 centromere-specific probe (labeled green). Results All patients whose lesions progressed from CIN-I or CIN-II to CIN-III displayed a gain of the hTERC gene, whereas patients where the hTERC gene was not amplified did not subsequently progress to CIN-III or cervical cancer. The signal ratio pattern per cell was recorded as N:N (green: red). The numbers of cells with the signal ratio pattern of 4:4 or N:¡Ý5 in patients whose lesions progressed to CIN-III were significantly higher than those whose lesions did not progress. Significantly, none of the patients with a 4:4 signal ratio pattern regressed spontaneously. Conclusions In conclusion, measurement of hTERC gene gain in CIN-I or CIN-II patients using liquid-based cytological samples could be a useful biomarker to predict the progression of such cervical lesions. In addition, a 4:4 or N:¡Ý5 signal ratio pattern may indicate the unlikeness of spontaneous regression of CIN-I or CIN-II lesions. 2012-5-8 12:07:00 MENG Cui-da, ZHU Dong-dong, JIANG Xiao-dan, LI Lin, SHA Ji-chao, DONG Zhen, KONG Hong , http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257429190607623 Background Interleukin-l7 (IL-17), which exerts strong pro-inflammatory effects, has emerged as an important mediator in inflammation-associated cancer. The aim of this study was to clarify the relationship between IL-17 and tumor associated macrophages (TAMs), and the correlation of the microvessel density in the development of laryngeal squamous cell carcinoma (LSCC). Methods Histopathological observations and immunohistochemistry staining for IL-17, CD68, and CD34 were performed on 72 specimens (32 cases of LSCC, 20 cases of adjacent tissues of carcinoma as controls, and 20 cases of chronic hypertrophic laryngitis). Double immunohistochemical staining was done to determine which cells expressed IL-17. Real-time quantitative PCR determined the mRNA expression of IL-17. ELISA was used to detect the expression of the serum level of IL-17 in the three groups. Results The inflammation response had increased in LSCC. Overexpression of IL-17 and CD68 protein were seen in LSCC (P <0.01). The expression of IL-17 was different between well and poorly differentiated LSCC (P <0.01). The IL-17 expressing cells were mainly located in macrophages (CD68(+)/IL17(+)) as demonstrated by double immunohistochemical staining. IL-17 expression significantly correlated with high microvessel density (CD34(+)) in LSCC (P <0.05). Relatively higher mRNA expression levels of IL-17 were seen in LSCC compared to the controls (P <0.05). The serum expression of IL-17 was similar among the three groups (P >0.05). Conclusion IL-17 was expressed by TAMs, and IL-17 may significantly correlate to the differentiation and angiogenesis in the development of LSCC. 2012-5-8 12:07:00 ZUO Dong-mei, WANG Chao-hong, WANG Yue-heng, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257435573606261 Background Umbilical cord around neck, a common obstetric complication, affects fetal hemodynamics. Does it influence fetal cardiac functions? The purpose of this study was to investigate the left and right ventricular systolic and diastolic functions of fetuses with umbilical cord around neck in the third trimester by applying velocity vector imaging (VVI). Methods Thirty-five cases of fetuses with umbilical cord around neck whose gestational ages from 35 to 40 weeks were selected, including 20 cases of umbilical artery ratio of the highest systolic velocity (S) to the lowest diastolic velocity (D) (S/D) <3.0 and 15 cases of umbilical artery S/D ¡Ý3.0, while 20 cases of normal fetuses of 35¨C40 gestational weeks were selected as the control group. The changes in longitudinal velocity, strain, and strain rate of fetal left and right ventricle in systole and diastole in two groups, and the changes in fetal cardiac function under the situation of umbilical cord around neck were analyzed. Results Longitudinal strain and strain rate overall of fetal left and right ventricle in systole and diastole were less in fetuses with umbilical artery S/D ³3.0 and umbilical cord around neck than those in fetuses with umbilical artery S/D <3.0 and those in control group (P <0.05); there was no significant difference (P >0.05) in longitudinal strain and strain rate overall of fetal left and right ventricle in systole and diastole between fetuses with umbilical artery S/D <3.0 and those in control group. Conclusions Left and right ventricular systolic and diastolic dysfunction was detected in fetuses with umbilical cord around neck and umbilical artery S/D ³3.0. VVI could sensitively respond to cardiac function changes in fetuses with umbilical cord around neck, which provides another valuable method in the evaluation of fetal cardiac function. 2012-5-8 12:08:00 ZHAO Ru, WANG Xiao-jun, SONG Ke-xin, ZHU Lan, LI Bin, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257475334207994 Background Wide excision is considered the treatment of endometriosis. It is difficult to surgeon for reconstruction of a large full-thickness defect through the abdominal-wall. We introduce a method of mini-abdominoplasty combined with mesh that can be used for reconstruction of a large full-thickness defect through the abdominal-wall after wide excision of abdominal wall endometriosis. Methods This retrospective study includes a series of patients who underwent wide excision of abdominal wall endometriosis and reconstruction of a large full-thickness defect through the abdominal-wall over a 5-year period. Information obtained from chart reviews includes age, size of lesion and defect, complications and revisions. Results The method was used for 8 patients including 2 patients with recurrence. The mean size of the masses was (3.5¡À2.0) cm. The mean size of the fascia defects was 7.1 cm ¡Á 8.6 cm. The mean length of follow-up was (24¡À12) months. There was no recurrence, no hernia, and no other complications. The technique generated only a horizontal scar. The scar and contour of the lower abdomen provided a more pleasant appearance than the traditional procedure. Conclusions Mini-abdominoplasty combined with mesh is a useful and acceptable reconstruction method for large full-thickness defects through the abdominal wall after endometriosis resection. It is feasible for wide excision with 1 cm normal tissues around the margin. It provides an aesthetically pleasing result. 2012-5-8 12:08:00 YAN Hua, ZHANG Hong-wei, WU Qiao-li, ZHANG Guo-bin, LIU Kui, ZHI Da-shi, HU Zhen-bo, ZENG Xian-wei, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257498785805709 Background Although traumatic brain injury can lead to opening the blood-brain barrier and leaking of blood substances (including water) into brain tissue, few studies of brain antigens leaking into the blood and the pathways have been reported. Brain antigens result in damage to brain tissues by stimulating the immune system to produce anti-brain antibodies, but no treatment has been reported to reduce the production of anti-brain antibodies and protect the brain tissue. The aim of the study is to confirm the relationship between immune injury and arachnoid granulations following traumatic brain injury, and provide some new methods to inhibit the immune injury. Methods In part one, methylene blue was injected into the rabbits¡¯ cisterna magna after traumatic brain injury, and concentrations of methylene blue and tumor necrosis factor (TNF)-¦Á in blood were detected to determine the permeability of arachnoid granulations. In part two, umbilical cord mesenchymal stem cells and immature dendritic cells were injected into veins, and concentrations of interleukin 1 (IL-1), IL-10, interferon (IFN)-¦Ã, transforming growth factor (TGF)-¦Â, anti-brain antibodies (ABAb), and IL-12 were measured by ELISA on days 1, 3, 7, 14 and 21 after injury, and the numbers of leukocytes in the blood were counted. Twenty-one days after injury, expression of glutamate in brain tissue was determined by immunohistochemical staining, and neuronal degeneration was detected by H&E staining. Results In part one, blood concentrations of methylene blue and TNF-¦Á in the traumatic brain injury group were higher than in the control group (P <0.05). Concentrations of methylene blue and TNF-¦Á in the trauma cerebrospinal fluid (CSF) injected group were higher than in the control cerebrospinal fluid injected group (P <0.05). In part two, concentrations of IL-1, IFN-¦Ã, ABAb, IL-12, expression of glutamate (Glu), neuronal degeneration and number of peripheral blood leukocytes were lower in the group with cell treatment compared to the control group. IL-10 and TGF-¦Â were elevated compared to the control group. Conclusions Traumatic brain injury can lead to stronger arachnoid granulations (AGs) permeability; umbilical cord mesenchymal stem cells and immature dendritic cells can induce immune tolerance and reduce inflammation and anti-brain antibodies to protect the brain tissue. 2012-5-8 12:08:00 REN Xiu-jun, CHEN Hong-yan, WANG Bao-guo, ZHAO Bai-xiao, LI Shao-wu, ZHANG Lei, DAI Jian-ping , LIU Xiao-yuan, LUO Fang, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257514967909886 Background The mechanism of acupuncture analgesia in craniotomy has been widely studied. However, the theoretical basis for selection of acupoints has not been examined. In this study, we used the regional homogeneity method blood oxygen level-dependent (BOLD) signals to determine changes in brain activity in response to transcutaneous electrical stimulation on acupoints and non-acupoints in resting state functional magnetic resonance imaging (fMRI). Methods Twelve healthy volunteers were enrolled in this study. BOLD fMRI scanning of the brain was performed for 306 seconds before and 30 minutes after transcutaneous electrical stimulation on acupoints UB63 (Jinmen), LV3 (Tai chong), ST36 (Zusanli), and GB40 (Qiuxu). The procedure was repeated after one week with stimulation on non-acupoints (one was 9 above BL67, the second was 12 above BL67 (Kunlun), the third was 7 above KI3, and the fourth was 10 above KI3 (Taixi)). Results The regional homogeneity in the acupoint group was increased in the left thalamus, caudate, putamen, lentiform nucleus (BA19, 30, 39), postcentral gyrus, precentral gyrus (BA3, 4, 30, 32), calcarine fissure, middle temporal gyrus (BA30), right superior temporal gyrus, inferior temporal gyrus (BA38), cuneus, and precuneus (BA7, 19) when compared to the non-acupoint group. The regional homogeneity of the acupoint group was decreased in the left cerebellum posterior lobe, middle frontal gyrus (BA10), double-side precuneus (BA7), and the postcentral gyrus (BA40). Conclusions The brain region activated following acupoint stimulation is the ipsilateral pain-related brain region, which may relate to the therapeutic effect of acupuncture on pain relief. Further acupoint stimulation causes different central nervous responses compared to non-acupoint stimulation. 2012-5-8 12:08:00 WANG Qi-jin, ZHA Xiao-juan, KANG Zhi-min, XU Mao-jin, HUANG Qin, ZOU Da-jin, , http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257518121801774 Background Molecular hydrogen, as a novel antioxidant, has been proven effective in treating many diseases. This study aimed to evaluate the therapeutic effects of hydrogen saturated saline in treatment of a rat model of diabetes mellitus and a rat model of insulin resistant. Methods A rat diabetes mellitus model was established by feeding a high fat/high carbohydrate diet followed by injection of a small dose of streptozotocin, and an insulin resistant model was induced with a high glucose and high fat diet. Hydrogen saturated saline was administered to rats with both models conditions on a daily basis for eight weeks. A pioglitazone-treated group and normal saline-treated group served as positive and negative controls. The general condition, body weight, blood glucose, blood lipids, and serum insulin levels of rats were examined at the 8th week after treatment. The oxidative stress indices, including serum superoxide dismutase (SOD), glutathione (GSH) and malondialdehyde (MDA) were also evaluated after eight weeks of treatment using the commercial kits. Results Hydrogen saturated saline showed great efficiency in improving the insulin sensitivity and lowering blood glucose and lipids. Meanwhile, the therapeutic effects of hydrogen saturated saline were superior to those of pioglitazone. Hydrogen saturated saline markedly attenuated the MDA level and elevated the levels of antioxidants SOD and GSH. Conclusion Hydrogen saturated saline may improve the insulin resistance and alleviate the symptoms of diabetes mellitus by reducing the oxidative stress and enhancing the anti-oxidant system. 2012-5-8 12:08:00 CHU Yang, LIU Hong-gang, YU Zhen-kun , http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257521017904848 Background Sinonasal malignancy with orbital invasion is rare. The objective of the current study was to evaluate the clinical and pathological features, treatment outcomes and survival rates for these malignancies. Methods Ninety-three patients who were treated between 1997 and 2007 were retrospectively reviewed. Age, life style, symptoms, location of lesions, previous occurrences, histological subtypes, and treatment modalities were analyzed. Results Ninety-three patients were evaluated, including 51 men and 42 women: the gender ratio was 1.2 men to 1.0 women. The median age was 40.5 years old. The nasal cavity (34.4%), the maxillary sinus (29.0%) and the ethmoid sinus (19.4%) were the most common primary malignant tumor sites. Almost half of the patients, 44.1% had squamous cell carcinoma, 13.9% had neuroectodermal carcinoma, 11.7% had rhabdomyosarcoma, 9% had adenocarcinoma and salivary gland-type carcinoma, and 11% had other malignancy. The majority of patients presented with T3/T4 (99%), N0 (93.1%), M0 (98%) disease. The distant metastasis rate was 20.9%. The overall survival and disease-free survival rates were 68.1% and 40.9% at three years, respectively. When the overall survival rate was computed according to the epicenter of the original malignant tumor, patients with nasal cavity malignancy and maxillary sinus had the best survival, and patients with ethmoid sinus malignancy had the worse survival (P=0.03). According to their pathology classification, patients with rhabdomyosarcoma had worse overall survival than those with squamous cell carcinoma, or neuroendocrine carcinoma (P <0.001). Squamous cell carcinoma and rhabdomyosarcoma invaded the orbit more often and malignancy of the nasal cavity invaded the orbit more than malignancy of the nasal sinus. Conclusions For nasal orbital tumors early diagnosis is crucial. Orbital exenteration and postoperative rehabilitation should be carefully considered. The current data suggest that surgical resection with postoperative radiation therapy may offer durable local control. 2012-5-8 12:08:00 ZHANG Ming-zhi, LU Yi-ping, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257523591509311 Prostate specific antigen (PSA) has a wide clinical use for the early detection of prostatic carcinoma (PCa); however, it has never been a perfect marker due to its low specificity and low positive predictive value which ranges between 4 ng/ml and 10 ng/ml. The discovery of different PSA molecular forms in serum in the early 1990s brought insight into searching for more specific markers. Since then free PSA (fPSA) has been used routinely to increase the specificity for PCa and to reduce unnecessary biopsies. More recently, promising data is emerging regarding one proenzyme molecular form of free PSA, proPSA, and a few truncated proPSA isoforms. The purpose of this article is to review the recent studies on clinical utility of proPSA, especially [-2]pPSA, an isoform of proPSA, and parameters involving [-2]pPSA as well as other PSA derivatives in early detection of PCa. 2012-5-8 12:08:00 ZHANG Li, PENG Li-pan, WU Nan, LI Le-ping, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257528996709099 Objective To review the in vitro development of bone marrow mesenchymal stem cells culture (BM-MSC). Data sources The data cited in this review were mainly obtained from articles listed in Medline and PubMed. The search terms were ¡°bone marrow mesenchymal stem cell¡± and ¡°cell culture¡±. Study selection Articles regarding the in vitro development of BM-MSCs culture, as well as the challenge of optimizing cell culture environment in two-dimensional (2D) vs. 3D. Results Improving the culture conditions increases the proliferation and reduces the differentiation. Optimal values for many culture parameters remain to be identified. Expansion of BM-MSCs under defined conditions remains challenging, including the development of optimal culture conditions for BMSC and large-volume production systems. Conclusions Expansion of BM-MSCs under defined conditions remains challenges, including the development of optimal culture conditions for BMSC and scale-up to large-volume production systems. Optimal values for many culture parameters remain to be identified. 2012-5-8 12:08:00 RAN Bo, Tuergan Aili, SHAO Ying-mei, JIANG Tie-ming, LI Hai-tao, WANG Yu-jie , WEN Hao, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257533390009006 Background Alveolar echinococcosis located in the adrenal gland can be considered a rare and aggressive infestation that radiologically and macroscopically mimics a malignant neoplasm. Its pathogenesis is poorly understood. This paper describes its clinical and radiological aspects and discusses its proper management. Methods The records of two patients with adrenal gland alveolar echinococcosis who were diagnosed and treated in our center in 2009 were evaluated. Results Neither patient showed any signs of recurrence following radical surgical treatment and postoperative oral anthelmintic therapy. Conclusion Radical surgery can be a feasible, effective management option that results in a good prospective outcome. 2012-5-8 12:08:00 Ji Hyun Lee, Kyung Min Kim, Jun Won Lee, Sung Gyun Ahn, Young Jin Youn , http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257537999007089 Very late stent thrombosis (VLST) is increasingly being regarded as a complication of drug-eluting stents (DES), and delayed endothelization, local hypersensitivity reactions, and late stent malapposition due to excessive positive remodeling have been postulated as mechanisms. Considering that stent endothelialization seems to be completed within 4 weeks following bare-metal stent (BMS) placement and that BMS do not possess antiproliferative coating, the mechanism of VLST may differ between patients with DES and those with BMS. We report a case of VLST 9 years after BMS implantation, in which thrombus from the ruptured neointima was confirmed by intravascular ultrasound. This finding suggests that de novo plaque rupture at the neointimal layer within the stent may be one of the explanations for VLST. 2012-5-8 12:08:00 LI Jia-xin, WU Hong, HUANG Ji-wei , Pankaj Prasoon , ZENG Yong http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257541288401760 The solid pseudopapillary tumors of the pancreas (SPTP) are rare tumors, which are commonly found in adolescent women. Radical surgical resection of the primary tumor or metastases is the standard treatment for SPTP and could achieve long-term survival. We reported a case of a 20-year-old female with multiple liver metastases of SPTP, and performed surgical resection for primary tumor 14 cm in diameter and 2 major liver metastases (both 5 cm in diameter), radiofrequency ablation (RFA) for small lesions and one major liver metastase 6 cm in diameter successfully. No evidence of recurrence in situ or in the liver was found by computed tomography (CT) scan 3 months after the operation. RFA is a safe and effective treatment for unresectable multiple liver metastases of SPTP. 2012-5-8 12:08:00 TU Guo-wei, JU Min-jie, XU Ming, RONG Rui-min, ZHU Tong-yu, LUO Zhe, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257546093701621 Antithymocyte globulin (ATG) has long been used for immune-induction and anti-rejection treatments for solid organ transplantations. To date, few cases of ATG-induced acute respiratory distress syndrome (ARDS) have been published. Here, we present a case of ARDS caused by a single low-dose of ATG in a renal transplant recipient and the subsequent treatments administered. Although the patient suffered from ARDS and delayed graft function, he was successfully treated. We emphasize that the presence of such complications should be considered when unexplained respiratory distress occurs. Early use of corticosteroids, adjustment of immunosuppressive regimens, and conservative fluid management, as well as empiric antimicrobial therapies, may be effective strategies for the treatment of ARDS caused by ATG. 2012-5-8 12:08:00 Doh-jeing Yong, Hailani Iskandar, Mohd-Yunus Mohd Razif, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257548034605438 The significance of metastastic disease in the cervical lymph nodes has long been appreciated. The rich lymphatics of the upper aerodigestive tract explained the high incidence of cervical metastasis, occasional bilaterally spread. Even with appropriate treatment, cervical recurrences do occur. Nonetheless, with the resurgence of tuberculosis, the differential of tuberculous cervical lymphadenitis should be excluded. Appropriate modalities should be employed in making the appropriate diagnosis possible. 2012-5-8 12:08:00 ZHONG Zhao-dong, LUO Yi, ZOU Ping, ZHENG Jin-e, YAO Jun-xia, HUANG Shi-ang, ZHOU Dong-feng, YOU Yong, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201257551475902397 A female patient diagnosed with acute myelocytic leukemia M5a (AML-M5a) relapsed 986 days after her allogeneic peripheral blood stem cell transplantation (allo-PBSCT) from an unrelated male donor with matched human leukocyte antigen (HLA). Three re-induction chemotherapies were administered, and partial remission was achieved. The patient was given repetitive infusion of cytokine-induced killer (CIK) cells expanded from recipient peripheral mononuclear cells of full donor chimerism due to loss of contact of quondam donor for donor lymphocyte infusion (DLI) and rejection of second transplantation. The patient achieved complete cytogenetical remission. This strategy might overcome the obstacle of donor unavailability and present an appealing new therapeutic alternative to donor-recruited adoptive immunotherapy for relapsed disease at post-transplantation. 2012-5-8 12:08:00 SHENG Jia-yan, HE Hong-chao, ZHU Yu, WU Yu-xuan, SHEN Zhou-jun, ZHAO Ju-ping, MA Gui, XU Yun-ze, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201258342426001670 Myxoid adrenocortical neoplasms are rare. Surgical resection of the mass is the first-line therapy. Here we reported a total of four patients, aged 44¨C66 years, diagnosed with myxoid adrenocortical tumor. The clinical characteristics and immunohistochemical features of the tumor are discussed in the current literature. 2012-5-8 12:08:00 MA Xiao-li, SHEN Kun-ling, WANG Bin, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201258345117303648 Clinical categories of Langerhans cell histiocytosis (LCH) include single and multi-system disease. Pulmonary LCH is rare, which is an unusual interstitial lung disease with the characteristics of monoclonal proliferation and infiltration of Langerhans¡¯ cells to organs. We report our experience of a rare LCH case of multiple organs such as pulmonary and liver as the main clinical manifestation. The patient was treated with chemotherapy which included prednisone, vinblastine, methotrexate and 6-mercaptopurine for 52 weeks and follow up all along. The patient has a favorable clinical outcome. 2012-5-8 12:07:00 DAI Wei, ZHONG Ming, SHEN Wei, ZOU Ke, BAI Chen-guang, http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201258347224608254 Natural killer T-cell lymphoma (NKTL) is a malignant neoplasm which usually involves the nasal cavity or paranasal sinuses, while an orbit origin is extremely rare. Here we report the clinical, radiological and histopathologic features of a patient with NKTL originating from the orbit. We analyzed the clinical and radiologic records in the whole course of the disease. We also reviewed the morphology and immunohistochemistry of the neoplasm biopsy, including the presence of CD56, CD3 and cytotoxic molecules. This case demonstrated that nasal-type NKTL with a poor prognosis can originate from the orbit. 2012-5-8 12:07:00