http://www.cmj.org Table of contents of Chinese Medical Journal YU Lan, LI Wen-ying, Ray Y. Chen, TANG Zhi-rong, PANG Jun, GUI Xiu-zhi, MENG Xiu-ning , ZHANG Fu-jie http://www.cmj.org/Periodical/AbstractList.asp?titleid=CMJLW201222579400306928 Background Six provinces in China accounted for 70%每80% of all reported HIV/AIDS cases in the country in 2009 and five provinces accounted for 78% of all reported mother-to-child transmission (MTCT) of HIV cases. Because Guangxi belonged to both groups, the Prevention of Mother-to-Child Transmission (PMTCT) Plus program was established there to understand better low birth weight (LBW) and preterm delivery (PD) birth outcomes and their associated risk factors better. Methods Pregnancy outcomes were examined among HIV-infected pregnant women who enrolled in the PMTCT Plus program from June 2006 to February 2009 in Guangxi, China. Multivariate Logistic regression analysis was used to explore the risk factors associated with LBW (<2500 g) and PD (gestational age <37 weeks). Results The prevalence of LBW and PD among 194 HIV-positive mothers was 19.6% (38/194) and 9.8% (19/194), respectively. Multivariate Logistic regression analysis showed that CD4 cell count <100 cell/米l (multivariate-adjusted odds ratio (AOR) 5.52; 95% CI 1.11每25.55) and CD4 cell count 100每199 cells/µl (AOR 3.40; 95% CI 1.03每11.25, compared to CD4 cell count ≡350 cells/µl), gestational age <37 weeks (AOR 4.38; 95% CI 1.29每14.82, compared to ≡37 weeks), maternal weight <45 kg (AOR 5.64; 95% CI 1.09每29.07) and maternal weight 45每54 kg (AOR 3.55; 95% CI 1.31每9.60, compared to ≡55 kg) at enrollment, and HIV RNA ≡100 000 copies/ml at enrollment (AOR 4.22; 95% CI 1.24每14.32) and 20 000每99 999 (AOR 2.77; 95% CI 1.01每7.77, compared to <20 000 copies/ml) were associated with a higher risk of LBW. For PD, only maternal injection drug use as the route of HIV transmission (AOR 5.30; 95% CI 1.33每21.14, compared to those infected with HIV through sexual transmission) was significantly associated with a higher risk of PD. Conclusions Lower CD4 cell count and higher HIV RNA viral load at enrollment were associated with LBW. Optimal antenatal care, including earlier antenatal screening and HIV diagnosis, is critical to earlier PMTCT prophylaxis and/or HIV treatment to prevent transmission of HIV to the infant and also to prevent LBW pregnancy outcomes. 2012-2-3 16:09:00 BU Liang, LI Yun, YANG Fan, ZHAO Hui, JIANG Guan-chao, LI Jian-feng, LIU Jun , WANG Jun http://www.cmj.org/Periodical/AbstractList.asp?titleid=CMJLW201223343289905145 Background Completely video-assisted thoracoscopic lobectomy is a reasonable treatment for early-stage non-small-cell lung cancer (NSCLC). At present, the indication for this procedure is stage Ia and Ib peripheral lung cancer (≒5 cm); however, for larger tumors, it remains controversial whether this surgical technique is comparable to open lobectomy. This study aimed to evaluate the safety, completeness, and efficacy of thoracoscopic lobectomy, and to compare this technique with open lobectomy for the treatment of non-small-cell lung cancer when the tumor＊s diameter was greater than 5 cm. Methods From May 2001 to April 2011, 802 patients underwent a lobectomy for treatment of non-small-cell lung cancer at our center. In 133 patients, the tumor was > 5 cm. There were 98 men and 35 women, median age 63 years (range: 29每81 years). We divided the patients into two groups, group V (completely video-assisted thoracoscopic surgery), and group T (open lobectomy), and evaluated the two groups for age, gender, tumor size, pathological type, location, duration of surgery, blood loss, lymph node dissection, pathological stage, time of drainage, hospitalization, complications, overall survival and recurrence. Results There were 46 cases in group V and 87 cases in group T. Age, gender, tumor size, location, pathological type and stage were similar between the two groups. Group V had shorter operative duration ((186.5㊣62.8) minutes vs. (256.7㊣67.5) minutes, P <0.001) and reduced bleeding ((218.5㊣174.6) ml vs. (556.9㊣187.2) ml, P <0.001). There were no significant differences between the two groups in complications, lymph node dissection, time of drainage and hospitalization. The recurrence between the two groups was equivalent (2.4% vs. 3.8%, P=0.670). The overall survival at 1, 2 and 3 years was 95.1%, 81.6% and 69.6% for group V and 88.3%, 78.8% and 64.0% for group T. Kaplan-Meier survival curves showed that there was no significant differences between the two groups (P=0.129). Conclusions Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety, completeness, and efficacy, but had a shorter operative duration, and reduced bleeding. This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size > 5 cm. 2012-2-3 16:09:00 CHEN Wei, LU Feng, LIU Si-jun, DU Jiang-bo, WANG Jian-ming, QIAN Yun, SHEN Chong, JIN Guang-fu, HU Zhi-bin , SHEN Hong-bing http://www.cmj.org/Periodical/AbstractList.asp?titleid=CMJLW201223429212707362 Background The key components of metabolic syndrome (MS) are waist circumference, blood pressure, fast blood glucose, high density lipoprotein cholesterol (HDL-c) and triglycerides (TG). These components have, separately and jointly, been associated with an increased risk of cardiovascular diseases. In this study, we aimed to explore the association between MS components and cancer risk in a population-based cohort in China. Methods We established a population-based cohort with 17 779 individuals aged 35 and above at baseline in 2004 and 2005 in Changzhou, Jiangsu Province, China. All participants were face-to-face interviewed to complete a questionnaire and were accepted physical examinations including blood tests for glucose and lipids and physical measurements for obesity and blood pressure. In 2009, a total of 16 284 subjects (6886 men and 9398 women, 91.6%) attended the flow-up interviews and the participants or their family members reported all the hospitalizations and diseases including cancer occurred during the follow-up period. Multivariate Cox regression was used to estimate the hazard ratios (HRs) of metabolic syndrome components and cancer incidence. Results There was a dose-response association between cancer risk and the number of MS components presented at baseline (P for trend=0.012) and the HR (95% confidence interval (CI)) was 2.63 (1.27每5.45) for subjects carrying 3 or more metabolic syndrome components after adjustment for possible confounding factors. Specifically, the multivariate-adjusted HRs (95% CIs) for cancer risk in subjects with central obesity, high fasting glucose, low HDL-c were 1.94 (1.01每3.74), 2.04 (1.10每3.77) and 2.05 (1.09每3.88), respectively. Conclusions In this population-based, prospective cohort study in China, we found MS components, e.g., central obesity, high fasting glucose, low HDL-c were risk factors for cancer development. Early intervention of MS components may be also beneficial to reduce cancer burden. 2012-2-3 16:09:00 SUN Yi, LI Xiao-yi, YAO Lin-yan, ZHAO Lan, DAI Ning , WU Hao http://www.cmj.org/Periodical/AbstractList.asp?titleid=CMJLW201223486822006737 Background The etiology and pathology of functional constipation (FC) is unclear. Some researches suggest that psychological factors may be related to this common problem. This study aimed to investigate the relationship between attention processing and emotional status in FC patients compared with healthy controls. Methods We investigated selective attention and emotional status in patients with FC using the counting Stroop task. Thirty-five FC patients (FCP group) and 24 healthy controls (HCs) underwent an event-related potential (ERP) study while performing the task. Response time, latency and amplitude of P300 were collected and compared between the two groups. The Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Scale (HAMA), Symptom Checklist-90 (SCL-90) and Eysenck Personality Questionnaire (EPQ) were administered prior to the counting Stroop task. Results Scores for the FCP group differed significantly from those for the HCs on the HAMD-17, HAMA, SCL-90 (Global Severity Index, Positive Symptoms Total, dimensions of somatization, obsessive-compulsive, depression, anxiety, and psychosis), as well as extraversion and neurosis dimensions of the EPQ (P <0.05). There was no significant difference in response time or accuracy rate between the two groups (P >0.05). ERP results showed prolonged latency at F4, additionally found enhanced activation at F3, FC1 and T8, and decreased activation at sites FC6 and P7 in the patients with FC. Statistically, significant differences of P300 latency at site F4 (P <0.05) and P300 amplitude at F3, F4, T8, P7, FC1 and FC6 (P <0.05) between the patients with FC and the HC were revealed. Conclusions The findings suggest that patients with FC are more susceptible to depression and anxiety, as well as somatization, obsessive-compulsive tendencies and other neurotic personality characteristics. Patients may employ psychological defense mechanisms to avoid the pain of depression and anxiety. ERP results imply there may be some brain dysfunction and attention deficits in patients with FC. 2012-2-3 16:09:00 LIU Yang, GUO Jun, ZHAO Rui-fu , WANG Lin http://www.cmj.org/Periodical/AbstractList.asp?titleid=CMJLW201223562691401646 Congenital rubella syndrome is characterized by the triad of deafness, cataract and cardiovascular malformations. The great majority of the cases in the literature have been usually diagnosed in infancy and childhood because of various defects at birth. However, we report a rare case of suspected congenital rubella syndrome in an adult with unilateral pulmonary artery stenosis and late-onset cataract. 2012-2-3 16:09:00 LI Xiao-ping, XU Qi-ying, WANG Jian-liu, WANG Shi-jun, ZHAO Yan , WEI Li-hui http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201222581618601069 Background Phenotypic and genotypic heterogeneity is a known feature of many cancers. Whether serum tumor marker kinds vary and change following chemotherapy is still unclear. The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy, and the potential clinical significance in patients with epithelial ovarian carcinoma (EOC) or primary serous peritoneal carcinoma (PSPC). Methods Samples were collected before surgery, during chemotherapy and during follow-up for enzyme-linked immunosorbent assay (ELISA)-based evaluation of serum CA-125, CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy. In total, 72 patients were examined, including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy. Results In 35 de novo patients, 20% (7/35) demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma (57.1%, 4/7) showed resistance to chemotherapy. In the 37 recurrent patients, 51.4% (19/37) had changed serum tumor markers, of whom 57.9% (11/19) presented with serous carcinoma. There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers. However, for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group. In the 17 patients with secondary recurrence, 37.5% (6/17) had changed tumor marker levels. The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence. Conclusions Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence, indicating that in addition to the markers that are abnormal before surgery, those markers that are normal should also be monitored during chemotherapy and follow-up. 2012-2-3 16:09:00 LIU Ying, TIAN Jia-wei, XU Yi , CHENG Wen http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201222587194406005 Background Endometrial carcinoma is one of the most common gynecological malignancies among women. Early diagnosis and correct preoperative evaluation of myometrial invasion are necessary to improve the prognosis. This study aimed to determine whether features and time-intensity curves (TIC) of transvaginal contrast-enhanced ultrasound (CEUS) differ from those of conventional ultrasound for endometrial carcinoma, and to further explore the clinical role of transvaginal CEUS in the early diagnosis of endometrial carcinoma. Methods Forty women with a normal uterus and seventy-nine patients with endometrial carcinoma were examinedby the transvaginal CEUS with SonoVue (Bracco, Imaging B.V, Switzerland). The enhancement patterns and TIC of lesions were analyzed. The results of CEUS were compared with those of conventional ultrasound and pathology. Results In the early and late enhanced stages, the intensity of enhancement of the normal endometrium was always lower than that in the myometrium, and the boundary between normal endometrium and myometrium was clear. A total of 65.8% (52/79) of lesions presented with inhomogeneous enhancement, 34.2% (27/79) presented with homogeneous enhancement; 60.8% (48/79) presented with hyperechoic enhancement, 27.8% (22/79) presented with isoechoic enhancement, and 11.4% (9/79) presented with hypoechoic enhancement. The average arrival time, time to peak, rise time, half-wash out time of lesions were shorter than of normal endometrium (P <0.05). The average peak intensity, relative rise in intensity, half-wash out intensity of lesions were higher than of normal endometrium (P <0.05). There were 49 (must be and may be present) cases of endometrial carcinoma by ultrasound (US); 24 cases were consistent with pathology results, 16 cases were underestimated and 9 cases were overestimated. There were 72 (must be and may be present) cases of endometrial carcinoma by CEUS; 53 cases were consistent with pathology results, 12 cases were underestimated and 7 cases were overestimated. The qualitative diagnosis of endometrial carcinoma by CEUS was more accurate and definite than that by US (P <0.01). Conclusions By evaluating contrast-enhanced patterns and analyzing TIC, we found that CEUS can increase the accuracy of ultrasound qualitative diagnosis of endometrial carcinoma. CEUS shows lesions more clearly than conventional ultrasound, which is an advantage in evaluating the encroachment of endometrial carcinoma. 2012-2-3 16:09:00 Chung Pui Wah, Suen Sik Hung, Chan Oi Ka, Lao Tzu Hsi , Leung Tak Yeung http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201222589345505854 Background Hepatitis B virus (HBV) infection remains a global public health problem and it is an important cause of acute, chronic and fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma. The prevalence of HBV infection in Hong Kong over the past decade remained unchanged at 10%, despite the implementation of universal neonatal and availability of adult vaccination. We suspect that the current state of affairs is attributable to inadequate awareness and knowledge of HBV transmission and prevention in the general population, resulting in a low rate of uptake of HBV vaccination by the lay public. Therefore, we have embarked in this study to evaluate the awareness and knowledge on HBV infection in our local Chinese population, their attitude on the prevention of horizontal transmission of HBV, and the use of HBV vaccination, especially in those who were born before the era of universal neonatal vaccination. Methods The factors associated with HBV screening, vaccination uptake, and knowledge were examined in a face-to-face questionnaire survey on a group of adult Chinese in Hong Kong. Results Within this group, 14% was considered to have good knowledge for HBV infection, and 26% had HBV vaccination. Age, occupation, having children, and family monthly income, are independent factors associated with vaccination. Conclusion This study suggests insufficient public awareness of HBV infection in the Hong Kong Adult Chinese population. 2012-2-3 16:09:00 HUA Wei, WANG Dong-mei, CAI Lin, SUN Chao-feng, FU Guo-sheng, WANG Yu-tang, YAN Ji, LUO Zhi-ling, XU Jing, WANG Zhi-yong, XU Geng, SHEN Fa-rong, XU Wei, WANG Jing-feng, REN Xue-jun, JIN Wei, Nan Zhang, Elizabeth Oi-Yan Lau , ZHANG Shu http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201222602582608127 Background Cardiac resynchronization therapy (CRT) with biventricular pacing improves cardiac function, functional capacity and quality of life in selected patients with heart failure. The current study aimed to evaluate the efficacy of the intracardiac electrogram (IEGM)-based optimization method, QuickOpt(TM), in Chinese patients treated with CRT. Methods Aortic time velocity integrals (AVTI) achieved at the sensed atrioventricular (AV), paced AV and interventricular (VV) interval settings recommended by both QuickOpt(TM) and standard echocardiographic optimization were measured in 101 patients. Consistency and the strength of the relationship between the two timing cycle optimization methods were assessed by intra-class correlation coefficient (ICC). Results The ICC showed good agreement and correlation with what the AVTI achieved at the optimal sensed AV (ICC=0.9683 (0.9535每0.9785)), paced AV (ICC=0.9642 (0.9475每0.9757)) and VV (ICC=0.9730 (0.9602每0.9817)) interval settings determined by the two optimization methods. The average time required by echocardiographic optimization and by QuickOpt(TM )were (78.32㊣32.40) minutes and (1.98㊣1.64) minutes respectively (P <0.0001). Conclusion The QuickOpt(TM) algorithm provides a quicker, simpler and reliable alternative to the standard method for timing cycle optimization. (ClinicalTrial.gov Reference Number: NCT00918294) 2012-2-3 16:09:00 LIU Peng, YAN Xia, WANG Bo-shi , XU Xiao-dong http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223345902901707 Background Some leukemia patients before hematopoietic stem cell transplantation (HSCT) have nutritional risk or undernutrition, which was one of the main reasons that caused series of complications during transplantation. The aim of this study was to find out some appropriate methods to learn about the nutritional status of leukemia patients before HSCT. Methods Nutritional status of patients with leukemia was assessed with three common methods of nutritional assessment (nutritional risk screening 2002 (NRS2002), mini nutritional assessment (MNA) and subjective global assessment (SGA)) before HSCT. The assessment results of NRS2002 and MNA were compared by paired 聿(2) test. The consistency was analyzed by Kappa test. Results In this study, 13 of 50 patients (26.0%) with leukemia had nutritional risk before HSCT assessed by NRS2002, including 7 patients (14.0%) with undernutrition. Of 50 patients assessed by SGA, only 1 case (2.0%) was mild or moderate undernutrition, and the remaining 49 patients (98.0%) were well-nutrition. Assessed by MNA, 1 case (2.0%) was undernutrition, 11 cases (22.0%) were potential undernutrition, and 38 cases (76.0%) were well-nutrition. Paired 聿(2) test results showed that the difference between NRS2002 and MNA was statistically significant (聿(2)=13.64, P <0.05); Kappa test results showed that they were consistent between NRS2002 and MNA (Kappa=0.62, P <0.05). Conclusions It is important to know the nutritional status of patients with leukemia before HSCT, and NRS2002 should be the first choice of nutritional assessment for patients with leukemia. If NRS2002 and MNA used at the same time, the accuracy and comprehensiveness of the assessment can be improved. 2012-2-3 16:09:00 WANG Hui, LIU Qi-ji, CHEN Min-zhi, LI Li, ZHANG Kai, CHENG Guang-hui, MA Long , GONG Yao-qin http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223350764805205 Background Genetic factors contribute to the development of coronary artery disease (CAD). Recently, a missense mutation in the low density lipoprotein receptor related protein 6 (LRP6) gene, encoding low density lipoprotein receptor related protein 6, has been implicated in an autosomal dominant form of early-onset CAD. The aim of this study was to determine whether the common variants in LRP6 are associated with sporadic CAD in Chinese. Methods A total of 766 CAD patients and 806 healthy controls were included in this study. The presence of angiographic CAD was determined by coronary angiographic analysis. Six signal nucleotide polymorphisms (SNPs) were genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Results A significant association was detected between rs11054731 in LRP6 intron 2 and CAD in our cohort (P=0.001). The CC genotype and C allele frequency in the case group were 52% and 72%. Using a dominant model of inheritance, the C allele of rs11054731 was shown to be an independent risk factor for CAD with an OR of 1.45 (95% CI: 1.19每1.77, P=0.0002). With the stratification according to the number of affected coronary arteries, an association was observed between rs11054731 and CAD (P=0.0002). No significant association was observed between any other SNPs and the risk of CAD. Conclusion The C allele of the rs11054731 within the LRP6 gene was associated with increased risk and extent of CAD in Chinese. 2012-2-3 16:09:00 YANG Yan-li, XU Kan-lun, ZHOU Yan, GAO Xin , CHEN Li-rong http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223355317409277 Background Esophageal squamous cell carcinoma (ESCC) is one of the most frequent malignancies in China and epidermal growth factor receptor (EGFR) is widely distributed in human epithelial cell membrane. The aim of this study was to investigate the protein overexpression and gene copy number of EGFR in ESCC, and help to identify patients who may benefit from EGFR targeted therapies. Methods Immunohistochemistry (IHC) was performed to analyze the expression of EGFR in 105 cases of ESCC, 16 cases of squamous epithelial atypical hyperplasia, and 11 cases of normal esophageal tissue. Fluorescence in situ hybridization (FISH) was performed to analyze the gene copy number in 80 cases of ESCC, eight cases of squamous epithelial atypical hyperplasia, and eight samples of normal esophageal tissue. Results The IHC-positive rates of EGFR in 105 cases of ESCC, 16 cases of squamous epithelial atypical hyperplasia, and 11 normal esophageal tissues were 97% (102/105), 44% (7/16), and 18% (2/11) respectively. The difference in the expression of EGFR among different esophageal tissue groups had statistically significance (P <0.05). Among the 105 cases of ESCC, overexpression of EGFR was found in 90 cases (86%), of which 55 cases scored 3+ for EGFR staining and 35 cases scored 2+. In ESCC, the expression of EGFR was significantly correlated with depth of invasion and TNM stage (P <0.05), but not with other parameters. The FISH-positive rates of EGFR in 80 cases of ESCC, the eight cases of squamous epithelial atypical hyperplasia, and eight samples of normal esophageal tissue were 31.3% (25/80), 0 (0/8) and 0 (0/8) respectively. In ESCC, EGFR gene amplification was found in 17 (21%) cases, high polysomy in 8 (10%) cases, disomy in 34 cases, low trisomy in 17 cases, and high trisomy in four cases. EGFR FISH-positive was significantly correlated with depth of invasion and lymph node metastasis (P <0.05). EGFR FISH-positive was significantly associated with overexpression of EGFR. Conclusion Protein overexpression and/or increased gene copy number of EGFR is common in ESCC, and EGFR targeted therapy may be appropriate for ESCC patients. 2012-2-3 16:09:00 WANG Lu-xi, LI Xiu-jun, FANG Li-qun, WANG Duo-chun, CAO Wu-chun , KAN Biao http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223366449806708 Background Typhoid/paratyphoid fever (TPF) is endemic in Guizhou. We conducted wavelet analysis and Spearman＊s rank correlation analysis to explore the impact of meteorological variations on TPF infection in Guizhou, in an attempt to assess the risk factors associated with TPF epidemics. Methods We examined the association between TPF incidence in Guizhou and temperature, precipitation and relative humidity using 24 years of data from 1984 to 2007. Periodicities of TPF incidence and the impact of climate factors on the TPF were detected by Spearman＊s rank correlation and wavelet analysis, Results Temperature and precipitation with a 1-month lag were positively correlated with the monthly incidence of TPF. The multiyear incidence pattern of TPF in Guizhou was explicitly periodic. Moreover, the association and driving effect of precipitation on TPF were observed, and the results showed that the incidence of TPF in Guizhou had a closer correlation with precipitation than with temperature. Conclusions Safe water supply is the key issue for TPF control in Guizhou. Moreover, climate variation might impact the enteric infections, which may inform policy assessment for TPF control in Guizhou. 2012-2-3 16:09:00 HU Xiao-peng, YIN Hang , ZHANG Xiao-dong http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223369420107046 Background Marginal renal grafts may alleviate the shortage of suitable organs to meet an increasing demand of kidney transplantation, especially when live donors are currently limited to relatives of patients in China. The aim of this study was to investigate how to increase the available donors pool, evaluation, and treatment of marginal donors. Methods We had performed 121 kidney transplantation cases with living relative donors. Five out of these cases applied marginal grafts with surgical diseases, including one renal stone, one duplex kidney, one renal leiomyoma and two cases of simple renal cysts. In each case, particular surgical interventions were exerted on the graft prior to standard engrafting procedures. Results All recipients recovered with functioning transplants given that their serum creatinine levels declined to a normal range within one week after operation. These recipients were subsequently followed up for 10 months on average and their kidney functions remained stable. Conclusions Marginal renal grafts with surgical diseases, which can be treated surgically before engrafting, may provide satisfying transplantation outcomes. Positive and cautious consideration of these grafts may increase renal donor pool. 2012-2-3 16:09:00 YAN Wen-wen, WANG Le-min, CHE Lin, SONG Hao-ming, JIANG Jin-fa, XU Jia-hong, SHEN Yu-qin , ZHANG Qi-ping http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223373756502088 Background There is no research, either at home or abroad, focusing on assessing the cardiopulmonary functional reserve and exercise tolerance in patients with pulmonary embolism (PE), but the benefits of early exercise are well recognized. The goals of this study were to assess cardiopulmonary functional reserve in treated PE patients using the inert gas rebreathing method of the cardiopulmonary exercise test (CPET), and to compare it with traditional methods. Methods CPET on the bicycle ergometer were performed in 40 patients with age, gender, body mass index, systolic blood pressure, and pulmonary function matched. The first group was the PE group composed of 16 PE patients (5 male, 11 female) who were given the standard antithrombotic therapy for two weeks. The second group was composed of 24 normal individuals (10 male, 14 female). Both groups were evaluated by cardiac ultrasound examination, 6-minute walking test (6MWT), and CPET. Results (1) Right ventricular systolic pressure (RVSP) in the PE group increased significantly compared to the control group, (34.81㊣8.15) mmHg to (19.75㊣3.47) mmHg (P <0.01). But neither right atrial end-systolic diameter (RASD) nor right ventricular end-diastolic diameter (RVDD) in the PE patients had changed when compared with the controls. The 6-minute walk distance was significantly reduced in the PE patients compared with normal subjects, (447.81㊣79.20) m vs. (513.75㊣31.45) m (P <0.01). Both anaerobic threshold oxygen consumption (VO(2)AT) and peak oxygen consumption (VO(2)peak) were significantly lower in patients with PE, while CO(2) equivalent ventilation (VE/VCO(2) slope) was higher; VO(2)AT (9.44㊣3.82) ml∙kg(-1)∙min(-1 )vs. (14.62㊣2.93) ml∙kg(-1)∙min(-1) (P <0.01) and VO(2)peak (12.26㊣4.06) ml∙kg(-1)∙min(-1) vs. (23.46㊣6.15) ml∙kg(-1)∙min(-1) (P <0.01) and VE/VCO(2) slope 35.47㊣6.66 vs. 26.94㊣3.16 (P <0.01). There was no significant difference in resting cardiac output (CO) between the PE and normal groups, whereas peak cardiac output (peak CO) and the difference between exercise and resting cardiac output (忖CO) were both significantly reduced in the PE group; peak CO (5.97㊣2.25) L/min( )to (8.50㊣3.13) L/min (P <0.01), 忖CO (1.29㊣1.59) L/min( )to (3.97㊣2.02) L/min (P <0.01). (2) The 6-minute walk distance did not correlated with CPET except for the VO(2 )peak in patients with PE, r=0.675 (P <0.01). Conclusions The cardiopulmonary functional reserve was reduced in patients with PE. CPET is an accurate, quantitative evaluation of cardiopulmonary functional reserve for PE patients. 2012-2-3 16:09:00 XU Ling-juan, SONG Xiu-sheng, ZHAO Jing, SUN Shi-ying , XIE Li-xin http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223377714903216 Background Hypopyon is common in eyes with fungal keratitis. The evaluation of the clinical features, culture results and the risk factors for hypopyon and of the possible correlation between hypopyon and the treatment outcome could be helpful for making treatment decisions. Methods The medical records of 1066 inpatients (1069 eyes) with fungal keratitis seen at the Shandong Eye Institute from January 2000 to December 2009 were reviewed retrospectively for demographic features, risk factors, clinical characteristics, laboratory findings and treatment outcomes. The incidence of hypopyon, the fungal culture positivity for hypopyon, risk factors for hypopyon and the effect of hypopyon on the treatment and prognosis were determined. Results We identified 1069 eyes with fungal keratitis. Of the 850 fungal culture-positive eyes, the Fusarium species was the most frequent (73.6%), followed by Alternaria (10.0%) and Aspergillus (9.0%). Upon admission, 562 (52.6%) eyes with hypopyon were identified. The hypopyon of 66 eyes was evaluated via fungal culturing, and 31 eyes (47.0%) were positive. A total of 194 eyes had ocular hypertension, and 172 (88.7%) of these eyes had hypopyon (P <0.001). Risk factors for incident hypopyon included long duration of symptoms (P <0.001), large lesion size (P <0.001) and infection caused by the Fusarium and Aspergillus species (P <0.001). The positivity of fungal culture for hypopyon was associated with duration of symptoms and lesion size. Surgical intervention was more common in cases with hypopyon (P <0.001). Hypopyon was a risk factor for the recurrence of fungal keratitis after corneal transplantation (P=0.002). Conclusions Hypopyon is common in patients with severe fungal keratitis and can cause ocular hypertension. About half of the hypopyon cases were positive based on fungal culture. Long duration of symptoms, large lesion size and infection with the Fusarium and Aspergillus species were risk factors for hypopyon. The presence of hypopyon increases the likelihood of surgical intervention. 2012-2-3 16:09:00 WANG Hong, Jacqueline B. Hetmanski, Ingo Ruczinski, Kung Yee Liang, M. Daniele Fallin, Richard J. Redett, Gerald V. Raymond, Yah-Huei Wu Chou, Philip Kuo-Ting Chen, Vincent Yeow, Samuel S. Chong, Felicia SH Cheah, Ethylin Wang Jabs, Alan F. Scott , Terri H. Beaty http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223423418508840 Background The receptor tyrosine kinase-like orphan receptor 2 (ROR2) gene has been recently shown to play important roles in palatal development in animal models and resides in the chromosomal region linked to non syndromic cleft lip with or without cleft palate in humans. The aim of this study was to investigate the possible association between ROR2 gene and non-syndromic oral clefts. Methods Here we tested 38 eligible single-nucleotide polymorphisms (SNPs) in ROR2 gene in 297 non-syndromic cleft lip with or without cleft palate and in 82 non-syndromic cleft palate case parent trios recruited from Asia and Maryland. Family Based Association Test was used to test for deviation from Mendelian inheritance. Plink software was used to test potential parent of origin effect. Possible maternally mediated in utero effects were assessed using the TRIad Multi-Marker approach under an assumption of mating symmetry in the population. Results Significant evidence of linkage and association was shown for 3 SNPs (rs7858435, rs10820914 and rs3905385) among 57 Asian non-syndromic cleft palate trios in Family Based Association Tests. P values for these 3 SNPs equaled to 0.000068, 0.000115 and 0.000464 respectively which were all less than the significance level (0.05/38=0.0013) adjusted by strict Bonferroni correction. Relevant odds ratios for the risk allele were 3.42 (1.80每6.50), 3.45 (1.75每6.67) and 2.94 (1.56每5.56), respectively. Statistical evidence of linkage and association was not shown for study groups other than non-syndromic cleft palate. Neither evidence for parent-of-origin nor maternal genotypic effect was shown for any of the ROR2 markers in our analysis for all study groups. Conclusion Our results provided evidence of linkage and association between the ROR2 gene and a gene controlling risk to non-syndromic cleft palate. 2012-2-3 16:09:00 Nguyen Van Luu, YANG Jiong, QU Xue-ju, GUO Ming, WANG Xin, XIAN Qiao-yang, TANG Zhi-jiao, HUANG Zhi-xiang , WANG Yong http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223495873701377 Background Azithromycin can reduce neutrophil accumulation in neutrophilic pulmonary diseases. However, the precise mechanism behind this action remains unknown. Our experiment assessed whether azithromycin inhibits neutrophil accumulation in the airways by affecting interleukin-17 (IL-17) downstream signals. Methods Mice were pretreated with azithromycin before murine IL-17A (mIL-17) stimulation. After the mIL-17 stimulation, the levels of six neutrophil-mobilizing cytokines were determined by enzyme-linked immunosorbent assay (ELISA) tests in bronchoalveolar lavage (BAL) fluid; IL-6, CXC chemokine ligand-1 (CXCL-1), CXCL-5, macrophage inflammatory protein-2 (MIP-2), granulocyte colony-stimulating factor (G-CSF), and granulocyte macrophage colony-stimulating factor (GM-CSF). The number of neutrophils in BAL fluid were evaluated by cytospin preparations. Results (1) Azithromycin pretreatment significantly inhibited both the release of three neutrophil-mobilizing cytokines (MIP-2, CXCL-5 and GM-CSF) and the accumulation of neutrophils in airways caused by mIL-17 stimulation. (2) The levels of three neutrophil-mobilizing cytokines (IL-6, MIP-2 and GM-CSF) were positively correlated with the numbers of neutrophil in BAL fluid. Conclusions Azithromycin can inhibit neutrophil accumulation in the airways by affecting IL-17 downstream signals. This finding suggests that macrolide antibiotic application might be useful in prevention of neutrophilic pulmonary diseases characterized by high levels of IL-17. 2012-2-3 16:09:00 LIU Jun-feng, DU Zhong-dong, CHEN Zhi, LU Dun-xiang, LI Li, GUAN Yun-qian , WAN Sui-gui http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223500704202036 Background Cardiovascular complications of Kawasaki disease (KD) are a common cause of heart disease in pediatric populations. Previous studies have suggested a role for endothelial progenitor cells (EPCs) in coronary artery lesions associated with KD. However, long-term observations of EPCs during the natural progression of this disorder are lacking. Using an experimental model of KD, we aimed to determine whether the coronary artery lesions are associated with down-regulation of EPCs. Methods To induce KD, C57BL/6 mice were administered an intraperitoneal injection of Lactobacillus casei cell wall extract (LCWE; phosphate buffered saline used as control vehicle). Study groups included: group A (14 days following LCWE injection), group B (56 days following LCWE injection) and group C (controls). Numbers of circulating EPCs (positively staining for both CD34 and Flk-1 while staining negative for CD45) were evaluated using flow cytometry. Bone marrow mononuclear cells were cultured in vitro to expand EPCs for functional analysis. In vitro EPC proliferation, adhesion and migration were assessed. Results The model was shown to exhibit similar coronary artery lesions to KD patients with coronary aneurysms. Numbers of circulating EPCs decreased significantly in the KD models (groups A and B) compared to controls ((0.017㊣0.008)% vs. (0.028㊣0.007)%, P <0.05 and (0.016㊣0.007)% vs. (0.028㊣0.007)%, P <0.05). Proliferative, adhesive and migratory properties of EPCs were markedly impaired in groups A and B. Conclusion Coronary artery lesions in KD occur as a consequence of impaired vascular injury repair, resulting from excess consumption of EPCs together with a functional impairment of bone marrow EPCs and their precursors. 2012-2-3 16:09:00 LI Fei, D. Marshall Porterfield, ZHENG Xi-yan, WANG Wen-jun, XU Yue , ZHANG Zong-ming http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223517192604043 Background Abnormal insulin secretion of pancreatic beta cells is now regarded as the more primary defect than the insulin function in the etiology of type 2 diabetes. Previous studies found impaired mitochondrial function and impaired Ca(2+) influx in beta cells in diabetic patients and animal models, suggesting a role for these processes in proper insulin secretion. The aim of this study was to investigate the detailed relationship of mitochondrial function, Ca(2+) influx, and defective insulin secretion. Methods We investigated mitochondrial function and morphology in pancreatic beta cell of diabetic KK-Ay mice and C57BL/6J mice. Two types of Ca(2+) channel activities, L-type and store-operated Ca(2+) (SOC), were evaluated using whole-cell patch-clamp recording. The glucose induced Ca(2+) influx was measured by a non-invasive micro-test technique (NMT). Results Mitochondria in KK-Ay mice pancreatic beta cells were swollen with disordered cristae, and mitochondrial function decreased compared with C57BL/6J mice. Ca(2+) channel activity was increased and glucose induced Ca(2+) influx was impaired, but could be recovered by genipin. Conclusion Defective mitochondrial function in diabetic mice pancreatic beta cells is a key cause of abnormal insulin secretion by altering Ca(2+) influx, but not via Ca(2+) channel activity. 2012-2-3 16:09:00 LI An-sheng, PAN Wei-hua, WU Shao-xi, Taguchi Hideaki, GUO Ning-ru, SHEN Yong-nian, LU Gui-xia, PAN Ru-gui, ZHU Miao-chang, CHEN Min, SHI Wei-ming , LIAO Wan-qing http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223524507204909 Background Despite recent reports on the molecular epidemiology of cryptococcal infections in China, clinical isolates have been mostly reported from human immunodeficiency virus (HIV)-negative patients, and environmental isolates from China have rarely been included. The aim of this study was to investigate the ecological profile of Cryptococcus (C.) neoformans and C. gattii in China. Methods A survey was performed in 10 cities from 20∼N (North latitude) to 50∼N and in a Eucalyptus (E.) camaldulensis forestry farm at the Guixi forestry center, China. Results Six hundred and twenty samples of pigeon droppings from 10 cities and 819 E. camaldulensis tree samples were collected and inoculated on caffeic acid cornmeal agar (CACA). The brown-colored colonies were recultured to observe their morphology, growth on canavanine-glycine-bromothymol-blue (CGB) medium, phenol oxidase and urease activities, serotype and mating type. There were obvious differences in the positive sample rates of C. neoformans in pigeon droppings collected from the different cities, ranging from 50% in the cities located at latitudes from 30∼N每40∼N, 29% at 20∼N每30∼N and 13% at 40∼N每50∼N. Conclusions There were no differences in positive bevy rates (approximately 80%) among the three grouped cities. Mycological tests of 101 isolates purified from pigeon droppings revealed that they were C. neoformans var. grubii. We also observed variable capsular size around the C. neoformans cells in colonies with variable melanin production and the bio-adhesion of the natural C. neoformans cells with other microorganisms. One urease-negative C. neoformans isolate was isolated from pigeon droppings in Jinan city. No C. gattii was isolated in this study. 2012-2-3 16:09:00 HE Jing-dong, LUO Hong-lei, LI Jin, FENG Wan-ting , CHEN Long-bang http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223527934208484 Background Interferon-induced transmembrane protein 1 (IFITM1) has been identified as a molecular marker of the colorectal tumors; however its influences on the biological behaviors of the colorectal cancer cells are currently unknown. We aimed to study the influences of IFITM1 on the proliferation, invasion, and metastasis of the colorectal cancer SW480 cell lines. Methods We constructed IFITM1/pEGFP-C3 recombinant plasmids and transfected them into the colorectal cancer SW480 cell lines. IFITM1/pEGFP-C3 recombinant plasmids were identified by means of immunofluorescence, laser confocal scanning microscopy, and reverse transcription polymerase chain reaction. IFITM1/SW480 cells with stable over-expression of IFITM1 were confirmed by G418 screening. The influences of IFITM1 on the proliferation of the SW480 cell lines were investigated by MTT assay and tumor transplantation experiments in nude mice. Cell invasion experiments were performed to determine the invasion capacity of the IFITM1/SW480 cells. Matrix metalloproteinase 2 (MMP-2) and MMP-9 activities were detected by the gelatin zymographic analysis, and MMP-9 expression by the Western blotting analysis. Results IFITM1/pEGFP-C3 recombinant plasmids were successfully constructed in this study, and the IFITM1/SW480 cells with stable IFITM1 gene over-expression were confirmed by G418 screening. MTT results showed that the proliferation of the IFITM1/SW480 cells was significantly enhanced (P <0.01). Tumors were harvested from four weeks old mice. Tumor volumes were (1347.00㊣60.94) mm(3), (1032.40㊣111.38) mm(3) and (1018.78㊣28.83) mm(3); and tumor weights were (1522.34㊣62.76) mg, (1137.78㊣97.22) mg and (1155.76㊣133.31) mg for mice inoculated with the IFITM1/SW480 cells, pEGFP-C3/SW480 cells and SW480 cells, respectively. Tumor volumes and weights from mice inoculated with the IFITM1/SW480 cells were significantly increased (P <0.01). In addition, the numbers of the SW480 cells and IFITM1/SW480 cells that migrated through Matrigel were 448.64㊣38.09 and 540.45㊣44.61, respectively; so the invasive ability of the SW480 cells transfected with IFITM1 gene was significantly greater than that of the SW480 cells (P <0.01). Gelatin zymographic analysis showed that MMP-9 and MMP-2 protein activities in the IFITM1/SW480 cells were significantly enhanced, and Western blotting analysis showed that MMP-9 expression in the IFITM1/SW480 cells was also increased. Conclusion IFITM1 can enhance the proliferation, invasion, and metastasis of the colorectal cancer SW480 cell lines. 2012-2-3 16:09:00 ZHU Han-yu, Liu Mo-yan, HONG Quan, ZHANG Dong, GENG Wen-jia, XIE Yuan-sheng , CHEN Xiang-mei http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223533709902600 Background Cisplatin (DDP) is one of most effective and most commonly used therapeutic agent in treating tumors, it can accumulate in the kidney and lead to acute renal failure. MicroRNA-181a can induce cell apoptosis by suppressing the expression of Bcl-2 family. In the present study, we investigated the role of microRNA-181a in the apoptosis of tubular epithelial cell induced by DDP. Methods HK-2 cells were cultured, transfected with microRNA-181a inhibitor for 48 hours, and stimulated with 50 µmol/L cisplatin for 24 hours. MicroRNA-181a expression was analyzed by real time PCR, and cell apoptosis was detected by flow cytometry. Moreover, Bcl-2 and Bcl-2-associated X protein (Bax) expression were measured by Western blotting. Results MicroRNA-181a expression significantly down-regulated in cells transfected with microRNA-181a inhibitor, compared with that in untransfectd cells (21.19㊣2.01 vs. 38.87㊣1.97, P <0.05). Cell apoptosis induced by DDP significantly decreased in cells transfected with MicroRNA-181a inhibitor. Compared with DDP treated cells alone, Bcl-2 expression strikingly was up-regulated and Bax expression was down-regulated in cells transfected with microRNA-181a inhibitor. Conclusion One pathway of DDP induces apoptosis of tubular epithelial cell by suppressing Bcl-2 expression is achieved by regulating the target gene of MicroRNA-181a. 2012-2-3 16:09:00 WANG Xiao-chun, LI Yong, FAN LI-qiao, TAN Bi-bo, LI Zhong, LIU Yu , ZHANG Zhi-dong http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223538223203461 Background Integrase interactor 1 (INI1), which encodes a component of the ATP-dependent chromatin remodeling hSWI-SNF complex, has been identified as a tumor suppressor in many tumors. Nonetheless, the role of INI1 in gastric tumor progression is not known exactly. The aim of this research was to investigate the effect of INI1 in the carcinogenesis and progression of gastric cancer. Methods Gastric tumor tissues with different differentiation levels from clinical gastric carcinoma samples and adjacent control normal tissues were taken. Expression levels of INI1 were detected by quantitative reverse transcriptation-polymerase chain reaction (RT-PCR) and Western blotting. Gastric cancer cell line SGC7901 was transfected with INI1 eukaryotic expressing vector INI1-GFP. Cell proliferation activities were assessed by MTT; cell count and cell cycle were detected by flow cytometry (FCM); cell apoptosis were measured by TUNEL and FCM; cell migration and invasiveness were evaluated by wound healing and transwell assays. Expression levels of INI1 and proliferation-related genes including p16, p21, cyclin D1 and cyclin A, apoptosis genes p53, B-cell non-Hodgkin lymphoma-2 (Bcl-2), Bcl-2-associated x protein (Bax) and caspase-3, and invasion-related genes including intercellular adhesion molecule 1 (ICAM1), matrix metalloproteinase 2 (MMP2), MMP9 and tissue inhibitor of matrix metalloproteinase 1 (TIMP1), were detected by quantitative RT-PCR and Western blotting. Results INI1 expression levels were lower in gastric carcinoma compared with adjacent control normal tissues. Overexpression of INI1 in SGC7901 cells inhibited its proliferation and invasiveness, but increased anoikis and G(0)/G(1) cell number. INI1-GFP transfection upregulated expression of INI1 and proliferation related genes p16 and p21, apoptosis genes p53 and Bax, and invasion-related genes TIMP1; cyclin D1, cyclin A, Bcl2, ICAM1, MMP2 and MMP9 were downregulated, and there was no significant change in caspase 3 levels. Conclusion INI1 plays a key role in gastric carcinogenesis by affecting proliferation, apoptosis and invasion. 2012-2-3 16:09:00 WANG Li-ming, SONG Hao, SONG Xiao , ZHOU Xiao-bin http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223542573208969 Background With the advent of color Doppler flow imaging (CDFI) and technological development of detection of serum tumor markers, new opportunities are presented to the improved risk of malignancy index (RMI) based on Jacobs＊ research for predicting ovarian malignancy in patients with adnexal masses. Methods One hundred and eighty women with an adnexal mass admitted for primary laparotomy were studied. Tumor specific growth factor (TSGF) adjusted ultrasound scores and the results of Doppler blood flow analysis were obtained before the operation. Based on the parameters which had been studied in Jacobs＊ research, TSGF levels and the findings of color Doppler flow imaging, the risk of malignancy model was redesigned using a binary Logistic regression model. The diagnostic efficacy of the improved risk of malignancy index (improved RMI) was compared with the Jacobs＊ model RMI by receiver operator characteristic (ROC) curve. Results The ROC curve showed a higher sensitivity (Mcnamer＊s test, P <0.05) in the discrimination between benign and malignant adnexal masses for the improved RMI than the RMI. Compared with the RMI, the improved RMI had an advantage in prediction of ovarian germ cell tumors and granular cell tumor (28.57% vs.71.43%, P <0.05) and the early stage tumors and borderline tumors (33.33% vs. 66.67%, P <0.05). Conclusion The predictability of the improved RMI is better than the classic Jacobs＊ model, especially in diagnosis of the ovarian germ cell tumors and granular cell tumor and other early stage adnexal tumors. 2012-2-3 16:09:00 BI Jing-tao, GUO Yan-tong, ZHAO Jing-ming , ZHANG Zhong-tao http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223544832601380 Stercoral perforation of the colon is an unusual pathological condition with fewer than 150 cases reported in the literature to date. We present a case of stercoral colonic perforation mimicking upper gastrointestinal perforation, which was diagnosed by computed tomography preoperatively. However, at laparotomy, stercoral colonic diverticulum perforation with jejunal diverticulitis became the most appropriate diagnosis. 2012-2-3 16:09:00 ZHANG Zhen-hai, YANG Xin-jian, WU Zhong-xue, LI You-xiang , JIANG Peng http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223547639401002 This report documents the treatment of a giant aneurysm of the internal carotid artery bifurcation with a fistula to the cavernous sinus, which appeared following closed head trauma. A 39-year-old man suffered from a blunt head trauma in an automobile accident. Two weeks after the trauma, progressive chemosis of left eye was presented. Four months after the trauma, digital subtraction angiography showed an internal carotid artery bifurcation aneurysm, with drainage into the cavernous sinus. The lesion was successfully obliterated with preservation of the parent artery by using coils in conjunction with Onyx. Follow-up angiography obtained 3 months postoperatively revealed persistent obliteration of the aneurysm and fistula as well as patency of the parent artery. Endovascular treatment involving the use of coils combined with Onyx appears to be a feasible and effective option for treatment of this hard-to-treat lesion. 2012-2-3 16:09:00 SHEN Hong-liang, YANG Pei-qian, DU Lin-dong, LÜ Wen-cheng , TIAN Ye http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223551161506456 Horseshoe kidney and retrocaval ureter are uncommon congenital anomalies of the genitourinary system that are easily diagnosed by typical imaging features. Both anomalies presenting in one patient is a rare disease characterized by isthmus of horseshoe kidney between the abdominal aorta and inferior vena cava. The clinical diagnosis and treatment of horseshoe kidney with retrocaval ureter remain a challenge. Here, we reported a case of a 44-year-old man with the two anomalies who was preoperatively diagnosed by unenhanced computed tomography scanning immediately after retrograde pyelography. The literatures on such combined anomalies are reviewed and the diagnostic evaluation and surgical management of this rare entity are discussed. 2012-2-3 16:09:00 LU Qun, CHEN Xi, LI Yang, ZHANG Xiao-hong, LIANG Rong, ZHAO Yong-ping, WEI Li-hui , SHEN Huan http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223557226605225 Total or near-total fertilization failure after intracytoplasmic sperm injection (ICSI) is a rare event, but it occurs repeatedly because of sperm defects in activating oocyte. The case presents a successful pregnancy and live birth after calcium ionophore A23187 (A23187) activation on one-day-old unfertilized oocytes in a patient whose husband suffered oligoasthenoteratozoospermia, and who had experienced repeated near-total fertilization failure after ICSI. In the second ICSI cycle, only one oocyte was fertilized while nine were unfertilized. Oocyte activation with A23187 were performed on the one-day-old unfertilized oocytes after ICSI and resulted in fertilization and embryo transfer. A clinical pregnancy was achieved and a healthy baby was born. To our knowledge, this is the first reported case of a healthy birth after oocyte activation on the one-day-old unfertilized oocyte. This indicates that ※rescue oocyte activation§ on one-day-old unfertilized oocytes after ICSI may be helpful for preventing total or near-total fertilization failure after ICSI. 2012-2-3 16:09:00 JI Cheng, CHEN Gang, CAI Hou-rong, MENG Fan-qin, CHEN Yan-bin, GUO Ling-chuan, HUANG Jian-an , LING Chun-hua http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223568341001493 Welder＊s siderosis was traditionally described as ※benign pneumoconiosis§ because of the absence of associated symptoms, functional impairment or pulmonary fibrosis. Although several authors have reported evidence of fibrosis in the lungs of welders, siderosis with local massive fibrosis has been rarely described. In this paper, we present a case of Welder＊s siderosis with local massive fibrosis mimicking lung cancer. 2012-2-3 16:09:00 ZHAO Jun-ying, ZHANG Rui-na, DUAN Xiao-han, XU Zhi-li, LI Hong-wei , GU Fu-sheng http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223572321603173 Primary systemic amyloidosis is a relatively rare disease, caused when abnormal extracellular deposition of fibrillary protein builds up in a variety of target organs, such as heart, kidneys, lungs liver, and so forth. The symptoms of the disease are usually vague, while many kinds of auxiliary or laboratory examinations especially pathologic biopsy can provide a clue for the diagnosis. Here we described a case who had purpura-like lesions in the initial stage, followed by progressive malfunctions in the kidneys, the heart, the lungs, as well as the liver. The final diagnosis was primary systemic amyloidosis determined by skin pathologic biopsy. And the disease led to a fatal outcome within three months after the diagnosis. 2012-2-3 16:09:00 WEN Peng-fei , WANG Lin http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201223579591203209 Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves. In this article, we present a 45-year-old man and a 39-year-old women who suffered from asymptomatic irregular erythemas on their trunk and extremities. Since both patients denied the history of exposure to leprosy patients and were absent clinical signs of superficial sensation dysfunction and enlarged peripheral nerves, they were diagnosed of mycosis fungoides and livedo reticularis clinically. Nevertheless the biopsies of erythemas showed perineural and periadnexal foamy-cell granulomas in the dermis and Fite staining revealed a large number of acid-fast bacilli. A diagnosis of multibacillary leprosy was made finally. These cases revealed that since leprosy is still epidemic in some remote area in China and in other developing countries and its clinical manifestations may be very weird sometimes, the dermatologists should be alert of it and skin biopsy could confirm the diagnosis. 2012-2-3 16:09:00