http://www.cmj.org Table of contents of Chinese Medical Journal GUO Li-shao, ZHANG Jian-zhong http://www.cmj.org/Periodical/AbstractList.asp?titleid=CMJLW201038363277904738 2010-3-8 10:05:00 JI Su-yun, ZENG Fan-qin, GUO Qing, TAN Guo-zhen, TANG Hong-feng, LUO Yi-jin, TANG Zeng-qi, HAN Yan-fang http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038373316704275 Background Interstitial lung disease (ILD) is a serious lung complication in polymyositis (PM) and dermatomyositis (DM) which affects prognosis and requires a more aggressive approach in therapy. This study investigated the prevalence, characteristics, predictive factors and unfavourable prognostic factors of ILD in newly diagnosed PM, DM and amyopathic DM (ADM).Methods From January 2000 to December 2008, the medical records of 197 consecutive PM and DM patients at the Second Affiliated Hospital of Sun Yat-Sen University were reviewed excluding overlapping, juvenile, and malignancy-associated cases. The patients were assigned to an ILD (69 patients) and a non-ILD group (128 patients). The clinical features, laboratory findings, and prognosis were compared.Results The multivariate analysis indicated that older age at onset (OR 1.033, 95%CI 1.009每1.058, P=0.007), fever (OR 4.109, 95%CI 1.926每8.767, P <0.001) and arthritis/arthralgia (OR 2.274, 95%CI 1.101每4.695, P=0.026) were the independent predictive factors for developing ILD in PM/DM after excluding anti-Jo-1. Regarding anti-Jo-1, fever (OR 4.912, 95%CI 2.121每11.376, P <0.001) was associated with ILD. Poor survival in ILD patients was associated with ILD clinical subset (RR 0.122, 95%CI 0.049每0.399, P <0.001), ADM/DM/PM-ILD (RR 0.140, 95%CI 0.031每0.476, P=0.002), cardiac involvement (RR 4.654, 95%CI 1.391每15.577, P=0.013) and serum albumin level (RR 0.910, 95%CI 0.831每0.997, P=0.042).Conclusions Patients who presented with fever tended to have a higher frequency of PM/DM-associated ILD. A Hamman-Rich-like presentation, ADM-ILD, cardiac involvement and hypoalbuminemia were poor prognostic factors in ILD-PM/DM. 2010-3-8 10:22:00 WANG Yue, CUI Li-ying, CHEN Lin, LIU Ming-sheng, QI Xin, LI Ben-hong, DU Hua http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038376729203270 Background Involvement of peripheral nerves in dermatomyositis (DM) and polymyositis (PM) is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospital inpatients with a diagnosis of DM or PM to investigate the association of DM/PM and peripheral neuropathy.Methods The data of inpatients diagnosed with DM or PM were collected in Peking Union Medical College Hospital, and 186 patients (118 patients with DM and 68 with PM) were retrospectively analyzed. Nerve conduction studies (NCSs) of the median nerve, ulnar nerve, posterior tibial nerve, and common peroneal nerve were examined simultaneously. Results There were 71 (38.2%) patients with abnormal NCS findings, 37 (19.9%) with pure motor involvement (decreased compound muscle action potential, CMAP), and 34 (18.3%) with peripheral neuropathy. Of the 34 peripheral neuropathy patients, 14 (7.5%) had polyneuropathy, 1 (0.5%) had multiple mononeuropathy, 16 (8.6%) had carpal tunnel syndrome (CTS), 1 (0.5%) had trigeminal sensory neuropathy, 1 (0.5%) had ulnar sensory neuropathy, and 1 (0.5%) had brachial plexus involvement. The prevalence of malignant disease (3/34, 8.8%), other connective tissue diseases (CTDs) (7/34, 20.6%) and diabetes (6/34, 17.6%) was significantly greater in DM/PM patients with peripheral neuropathy (聿(2)=15.855, P=0.000) compared with DM/PM patients without involvement of peripheral nerves (5/115, 4.3% and 7/115, 6.1%, respectively).Conclusions Peripheral neuropathy in DM/PM often suggests a complication with cancer, other CTDs, diabetes or CTS. From a practical point of view, NCS for DM/PM may help find the underlying disorders. 2010-3-8 10:27:00 LAI Wei, ZHENG Yue, YE Zhang-zhang, SU Xiang-yang, WAN Miao-jian, GONG Zi-jian, XIE Xiao-yuan, LIU Wei http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038380505809337 Background Cathepsin B plays an important role in cell cycle, extracellular matrix changes and cutaneous tumorigenesis: whether it plays a role in photoaged skin remains unknown. This study aimed to investigate the role of cathepsin B in skin photoaging in vivo and in vitro. Methods The expressions of cathepsin B were compared with immunohistochemical methods in solar exposed skin and solar protected skin of six healthy Chinese volunteers. The mRNA and protein expression of cathepsin B in ultraviolet light A (UVA) induced premature senescence fibroblasts in vitro were detected by real-time reverse transcription polymerase chain reaction (RT-PCR) and Western blotting technique.Results Decreased expression of cathepsin B was observed in photoaged skin compared with that of the solar protected skin. In the UVA induced, premature senescence fibroblasts, a lower expression of cathepsin B was detected by Western blotting and a decreased synthesis of cathepsin B mRNA in the same cells was revealed by real-time RT-PCR.Conclusions The results demonstrated a significant negative correlation between skin photoaging and cathepsin B in vitro and in vivo. We propose that cathepsin B, besides matrix metalloproteinases and antioxidant enzymes, is involved in the process of skin photoaging in that it contributes to extracellular matrix remodelling and is a dominant protease in cellular apoptosis and senescence. 2010-3-8 10:34:00 WANG Xiao-yan, HE Pei-ying, DU Juan, ZHANG Jian-zhong http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038387351504181 Background Oxidative stress plays an important role in the pathogenesis of epidermal diseases. This study aimed to investigate the effects of quercetin on the anti-oxidative response and on mitochondrial protection in cultured normal human keratinocytes.Methods Cultured HaCaT cells were treated with different concentrations of H(2)O(2) (0, 50, 100, 250, 500 米mol/L) for different periods of time (0.5, 1, 2, 4 hours) to establish an oxidative stress model. The cultured HaCaT cells were randomly assigned to control, H(2)O(2), and quercetin+H(2)O(2) groups. For the quercetin groups, the cells were treated with different concentrations of quercetin (0, 10, 25, 50 米mol/L) before exposure to H(2)O(2). Morphological changes of the cells were observed under an inverted microscope and an electron microscope. The cell viability was detected by the MTT method. The cell apoptosis (AnnexinV/propidium iodide double stain) and mitochondrial membrane potential (忖朵m) changes were detected by flow cytometry.Results An oxidative stress model of HaCaT cells was established under a suitable concentration (250 米mol/L) and treated time of H(2)O(2) (2 hours). The cell viability and 忖朵m decreased in a concentration-dependent and time-dependent manner while the percentage of apoptotic cells significantly increased in the H(2)O(2) groups compared with the control group (P <0.05). The cell viability and 忖朵m of the quercetin treated group increased (P <0.05) and the percentage of apoptotic cells decreased at concentrations of 1每50 米mol/L quercetin (P <0.01) compared with H(2)O(2) treated group.Conclusion Quercetin can relieve the cell damage and apoptosis from H(2)O(2) induced injury to HaCaT cells by anti-oxidation and mitochondrial protection. 2010-3-8 10:45:00 LI Tian-wang, ZHENG Ben-rong, HUANG Zhi-xiang, LIN Qu, ZHAO Li-ke, LIAO Ze-tao, ZHAO Ji-jun, LIN Zhi-ming, GU Jie-ruo http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW20103842131600539. Background Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation at the synovial membrane. Although great progress has been made recently in exploring the etiology and pathogenesis of RA, its molecular pathological mechanism remains to be further defined and it is still a great challenge in determining the diagnosis and in choosing the appropriate therapy in early patients. This study was performed to screen candidate RA-associated serum proteins by comparative proteomics to provide research clues to early diagnosis and treatment of RA. Methods Sera isolated from 6 RA patients and 6 healthy volunteers were pooled respectively and high-abundance proteins were depleted by Plasma 7 Multiple Affinity Removal System. The protein expression profiles between the two groups were then compared by two-dimensional gel electrophoresis (2-DE) and the proteins over/under-expressed by more than 3-fold were identified by mass spectrometry analysis. To validate the differential expression levels of the identified proteins between the two groups, ELISA was performed in two of the identified proteins in individual sera from 32 RA patients and 32 volunteers.Results Eight proteins which over/under-expressed in sera of RA patients were identified. Among them, chain A of transthyretin (TTR) was under-expressed, while serum amyloid A protein, apolipoprotein A (ApoA)-IV, ApoA-IV precursor, haptoglobin 2, ceruloplasmin (Cp), immunoglobulin superfamily 22 and HT016 were over-expressed. ELISA test confirmed that Cp expressed remarkably higher while TTR obviously lower in RA group compared with volunteer group. Conclusion There were 8 identified proteins differentially expressed between RA group and volunteer group, which might be candidate RA-associated proteins and might be promising diagnostic indicators or therapeutic targets for RA. 2010-3-8 11:42:00 FENG Li-juan, WAN Zhe, WANG Xiao-hong, LI Ruo-yu, LIU Wei http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038424491806621 Background The cytochrome P450 lanosterol 14汐-demethylase (Erg11p) encoded by ERG11 gene is the primary target for azole antifungals. Changes in azole affinity of this enzyme caused by amino acid substitutions have been reported as a mechanism of azole antifungal resistance. This study aimed to investigate the relationship between amino acid substitutions in Erg11p from fluconazole resistant Candida albicans (C. albicans) isolates and their cross-resistance to azoles.Methods Mutations in ERG11 gene were screened in 10 clinical isolates of fluconazole resistant C. albicans strains. DNA sequence of ERG11 was determined by PCR based DNA sequencing.Results In the 10 isolates, 19 types of amino acid substitutions were found, of which 10 substitutions (F72S, F103L, F145I, F198L, G206D, G227D, N349S, F416S, F422L and T482A) have not been reported previously. Mutations in ERG11 gene were detected in 9 isolates of fluconazole resistant C. albicans, but were not detected in 1 isolate. Conclusions Although no definite correlation was found between the type of amino acid substitutions in Erg11p and the phenotype of cross-resistance to azoles, the substitutions F72S, F145I and G227D in our study may be highly associated with resistance to azoles because of their special location in Erg11p. 2010-3-8 11:47:00 HE Zhi-ming, FANG Qun, YANG Yong-zhong, LUO Yan-min, CHEN Jun-hong, CHEN Yong-zhen, ZHOU Yi, CHEN Min-ling http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038427805805019 Background Monochorionic multiple pregnancies (MMPs) are associated with higher rates of perinatal morbidity and mortality caused by interfetal vascular anastomoses in the monochorionic placenta, which can lead to fetal health interactions. In some circumstances, selective feticide of the affected fetus is necessary to save the healthy co-twin. We evaluated the effects and safety of our initial experiences using bipolar cord coagulation for the management of complicated MMPs.Methods Using ultrasound-guided bipolar cord coagulation, we performed selective feticide on 14 complicated MMPs (5 with twin-twin transfusion syndrome, 4 with acardia, 3 with discordant structural anomalies, and 2 with severe selective intrauterine growth restriction). One patient with monochorionic triplets received the procedure twice to terminate 2 affected fetuses for different indications. Data regarding the operations, complications and neonatal outcomes were analyzed.Results Cord occlusions were successfully performed in 13/14 (93%) cases. The failure happened in an acardiac fetus and the pregnancy was terminated by induction. The included cases delivered at a mean gestational age of 35.4 weeks with a perinatal survival rate of 11/13 (85%). Three operation-related complications occurred (21%), including membrane rupture of the terminated sac (1 case), preterm labor at 28 weeks gestation (1 case), and chorioamniotic membrane separation (1 case). Amnioinfusion was indicated in 11 procedures to expand the target sacs for entering the trocar and obtaining sufficient working space. However, in all 4 cases of acardia, the acardiac sacs showed extreme oligohydramnios and could not be well expanded by infusion; thus, the trocar had to be inserted from the sac of the preserved co-twin.Conclusions The application of bipolar cord coagulation in complicated MMPs is safe and improves the prognosis. Amnioinfusion is useful in helping to expand the target sac when the working space is limited. 2010-3-8 11:53:00 ZHENG Ming-ming, HU Ya-li, ZHANG Chun-yan, RU Tong, LIU Qi-lan, XU Bi-yun, CHEN Qi-guang, XU Zheng-feng, ZHANG Yin, ZHONG Xiao-ling http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038501172501725 Background The second-trimester maternal serum screening in twin pregnancy is still controversial, as the serum marker levels in twins are not as clear as those in singletons. This study aimed to evaluate the relationship between the levels of the second-trimester maternal serum free 汕-human chorionic gonadotropin (free 汕-HCG) and 汐-fetoprotein (AFP) in normal twin and singleton pregnancies and to estimate feasible analysis methods for utilizing these markers in second trimester screening for twin pregnancy.Methods On the basis of a prospective population-based study of second-trimester maternal serum screening, the concentrations of maternal serum AFP and free 汕-HCG of 195 normal twin pregnancy and 26 512 singleton controls at gestational weeks 15 to 20 were measured by time-resolved fluoroimmunoassay in one laboratory. The levels of markers were compared between the twins and singletons using weight-correction and gestational age-specific model. Results According to the research protocol, 95 communities were randomly sampled, which covered the whole Jiangsu province, the east of China. A total of 26 803 pregnant women (98%), from the target population accepted prenatal screening for maternal serum AFP, 汕-HCG detection, and all babies were followed up for at least six months. There were 197 (0.73%) twin pregnancies, of which one case had fetal trisomy 18, and one case with fetal anencephaly. The others were normal twin pregnancy. From a total enrollment of 26 803 women participants, 26 512 women with normal singleton pregnancies were selected as the model controls. The other 291 pregnancies, including trisomy 21, neural tube defect (NTD), trisomy 18, and other fetal abnormalities, were excluded. No significant differences were found in the medians of gestational age-specific maternal serum free 汕-hCG and AFP in normal twin pregnancy comparing with twice those in model controls with the exception of the medians for free 汕-hCG during the 16th gestational week (P=0.012).Conclusion The weight-correction and gestational age-specific levels of Chinese Han population maternal serum free 汕-hCG and AFP in normal twins were twice the levels as those in the singleton controls during the 17每19 gestational weeks. 2010-3-8 13:55:00 GAO Yang-xu, XU Ling, YE Jing-ming, WANG Dong-min, ZHAO Jian-xin, ZHANG Lan-bo, DUAN Xue-ning, LIU Yin-hua http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038503677203936 Background Adjuvant chemotherapy has become an important component of standard therapy for breast cancer. However, until now, there have been few reports on the surgical site infections (SSI) after breast cancer surgery, specially after adjuvent chemotherapy. To study the risk factors of SSI of breast cancer, we analyzed patients diagnosed with breast cancer and treated with surgery.Methods Fifty-five patients diagnosed with breast cancer and received breast conserving or modified radical operations in our hospital during January 2008 to March 2008 were selected. Factors (patients＊ age, body mass index (BMI), diabetes mellitus, no or administered adjuvant chemotherapy, with or without onset of myelosuppression and the degree, surgical approaches, duration of operation, postoperative drainage duration and total drainage volume) associated with SSI were retrospectively reviewed and statistically analyzed by single factor analysis. Results Five patients suffered SSI (5/55, 9.1%); nineteen receiving adjuvant chemotherapy experienced Grade III+ myelosuppression, among which 4 had SSI; only 1 out of the remaining 36 patients without adjuvant chemotherapy had SSI. The difference between the two groups was significant (P=0.043). The incidence of SSI in patients with post- operative drainage tube indwelling longer than 10 days was 5/21, whereas no SSI occurred in that less than 10 days (P=0.009). In our study, there was no significient difference in other associated factors.Conclusions Concurrent Grade III+ myelosuppression after adjuvant chemotherapy is an important risk factor of SSI in breast cancer and needs further study. No SSI was detected with indwelling time of post operative drainage less than 10 days. 2010-3-8 13:59:00 YANG Yi, REN Liang, ZHANG Yong, LIU Hang, CAO Bin, ZHANG Xiao-dong http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038506980903737 Background Nosocomial infection in early post-transplantation period is a tough problem for kidney transplantation. Few reports have explored the relations between biochemical parameters and nosocomial infection in kidney transplantation. This retrospective study was carried out to describe the characteristics of nosocomial infection in the very early period of kidney transplantation and to determine the risk factors in biochemical parameters and their alterations.Methods Patients who underwent their first kidney transplantation from January 2001 to March 2009 in Beijing Chao-Yang Hospital were recruited and the nosocomial infectious episodes were collected for this study. Gender, age, donor type, delayed graft function (DGF) and biochemical parameters such as serum uric acid, lipids files and albumin on day 0 (before transplantation) and day 1 (24 hours after transplantation) and their changes were analyzed with Logistic regression models for nosocomial infection.Results A total of 405 patients (315 men and 90 women) were involved in this study. There were 80 patients experiencing 113 infection episodes and 105 strains of microorganism were indentified. In univariate analysis, there were significant differences in DGF, albumin on day 0, lipoprotein (a) (Lp(a)) on day 1, change in low density lipoprotein-cholesterol (LDL-C, day 1每day 0) and change in uric acid (day 1每day 0) between nosocomial infection patients and noninfectious patients (P <0.05). In multivariate analysis, change in uric acid (day 1每day 0) (OR 5.139, 95% CI 1.176每22.465, P <0.05), change in LDL-C (day 1每day 0) (OR 4.179, 95% CI 1.375每12.703, P <0.05) and DGF (OR 14.409, 95% CI 1.603每129.522, P <0.05) were identified as independent risk factors for nosocomial infection in kidney transplantation.Conclusions Most nosocomial infections in early postoperative period of kidney transplantation are bacterial, especially with Gram-negative bacteria. The most common infection sites are respiratory tract, urinary tract and surgical site. DGF, decrease of LDL-C and increase of uric acid could increase the risk for nosocomial infections. 2010-3-8 14:04:00 ZHA Bing-bing, LIANG Wang, LIU Jun, CHENG Juan, HONG Xiao-wu, LIU Jing, LI Yi-ming, MA Duan http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038517324808048 Background Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant cancer syndrome which is caused by germline mutations of the tumor suppressor gene MEN1. This study aimed to identify mutations in a Chinese pedigree with MEN1.Methods A large Chinese family with MEN1 was collected. All of the coded regions and their adjacent sequences of the MEN1 gene were amplified and sequenced.Results In this family, a heterozygous cytosine insertion in exon 10 (c.1546_1547insC) inducing a frame shift mutation of MEN1 was found in the proband and the other two suffering members of his family. This mutation was linked to a novel single nucleotide polymorphism (SNP) in intron 3 (IVS3+18C>T).Conclusions The mutation in exon 10 of MEN1 gene might induce development of parathyroid hyperplasia and pituitary adenoma and cosegregate with MEN1 syndrome. The significance of the new found IVS3+18C>T of MEN1 needs a further investigation. 2010-3-8 14:22:00 CHEN Bai-lian, LI En-dong, Kazunobu Yamawuchi, Ken Kato, Shinji Naganawa, MIAO Wei-jun http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038525223907034 Background As an important determinant of patient satisfaction, waiting time, has gained increasing attention in the field of health care services. The present study aimed to illustrate the distribution characteristics of waiting time in a community hospital and explore the impact of potential measures to reduce outpatient waiting time based on a computer simulation approach.Methods During a one-month study period in 2006, a cross-sectional study was conducted in a community hospital located in Shanghai, China. Baseline data of outpatient waiting time were calculated according to the records of registration time and payment time. A simulation technique was adopted to investigate the impact of perspective reform methods on reducing waiting time. Results Data from a total of 10 092 patients and 26 816 medical consultations were collected in the study and 19 947 medical consultations were included. The average of the total visit time for outpatients in this hospital was 43.6 minutes in the morning, 19.1 minutes in the afternoon, and 34.3 minutes for the whole day studied period. The simulation results suggested that waiting time for outpatients could be greatly reduced through the introduction of appointment system and flexible demand-orientated doctor scheduling according to the numbers of patients waiting at different time of the workday. Conclusion Adoption of an appointment system and flexible management of doctor scheduling may be effective way to achieve decreased waiting time. 2010-3-8 14:35:00 HOU Jing-bo, LIU Hui-min, MA Li-jia, YANG Shuang, MENG Ling-bo, HAN Zhi-gang, ZHANG Shuo, YU Bo http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038528631206198 Background Late stent malapposition was frequently observed after DES implantation, which has been associated with the occurrence of late stent thrombosis due to poor neointimal coverage. This study was designed to evaluate the frequency of late stent malapposition at least 1 year after different DESs implantation by optical coherence tomography (OCT).Methods Angiographic and OCT examinations were given to 68 patients who had received total 126 various DESs implantation for at least 1 year to detect late stent malapposition. Malapposed strut distance (MSD), malapposed strut area (MSA), reference lumen area (RLA) and reference stent area (RSA) were checked with off-line OCT analysis.Results Totally 26 Cypher Select stents, 15 Taxus Liberte stents, 51 Partner stents and 34 Firebird I stents were examined. Among 68 patients who underwent DES implantation, 7 patients (10.3%) had late malapposition. Average RSA , MSA and MSD were (7.9㊣2.8) mm(2),(2.0㊣1.6) mm(2) and (590㊣270) µm respectively. According to the MSA/RSA ratio, 4 patients had slight malapposition, 2 patients had moderate malapposition and 1 patient had severe malapposition. Conclusions Late stent malapposition is detected frequently after implantation of DES, but if this predisposes to late stent thrombosis and requires any specific therapy needs to be further elucidated. 2010-3-8 14:41:00 ZHOU Hai-tao, ZHOU Zhi-xiang, ZHANG Hai-zeng, BI Jian-jun, ZHAO Ping http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038534366805454 Background Anorectal malignant melanoma was a rare disease with extremely poor prognosis. The aim of this study was to explore the clinical characteristic, diagnosis and treatment strategies of anorectal malignant melanoma. Methods The data of 57 patients with anorectal malignant melanoma was collected and retrospectively analyzed. Results Rectal bleeding and anal mass were found to be common symptoms of anorectal malignant melanoma. The preoperative diagnosis rate of anorectal malignant melanoma was 48.6%. The overall 3-year and 5-year survival rate was 38.0% and 21.3% respectively. The 3-year survival rates of stage I and II patients were 63.0% and 16.7% respectively (P=0.000), and the 5-year survival rates were 33.3% and 11.1% (P=0.001), which both had significant statistic differences. The 3-year survival rate of patients undergone abdmoninoperineal resection and patients undergone wide local excision were 36.7% and 53.0% respectively (P=0.280), while the 5-year survival rate were 24.1% and 23.1% (P=0.642), which both had no significant statistic differences. Conclusions This study identified no survival advantage to abdominoperineal resection in treatment of anorectal malignant melanoma, and we propose that wide local excision could be considered as the initial treatment of choice. 2010-3-8 14:50:00 WEI Jun-min, ZHU Ming-wei, ZHANG Zhong-tao, JIA Zhen-geng, HE Xiao-dong, WAN Yuan-lian, WANG Shan, XIU Dian-rong, TANG Yun, LI Jie, XU Jing-yong, HENG Qing-shan http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038538690609708 Background Hemocoagulase Agkistrodon for injection is a single component thrombin which has passed phases I and II clinical trials. The purpose of this phase III clinical trial was to evaluate the effect of Hemocoagulase Agkistrodon on hemostasis and coagulation in abdominal skin and subcutaneous incisions and to assess the safety of this agent in surgical patients. Methods This is a phase III, prospective, randomized, double-blind, and controlled multicenter clinical trial including 432 consecutive patients randomized into either a study group (injected with hemocoagulase Agkistrodon at 2 U, n=324) or a control group (injected with hemocoagulase Atrox, n=108). The hemostatic time, hemorrhagic volume, hemorrhagic volume per unit area, blood coagulation, and adverse events were measured and compared between the two groups. Results The mean hemostatic time in the study group was (36.8㊣18.7) seconds; the hemorrhagic volume was (3.77㊣3.93) g; and the hemorrhagic volume per unit area was (0.091㊣0.125) g/cm(2). In the control group, the corresponding values were (38.1㊣19.7) seconds, (4.00㊣4.75) g, and (0.095㊣0.101) g/cm(2), respectively. No significant difference in values existed between the two groups (P >0.05). Blood coagulation results and hepatic and renal function were also similar between the two groups. Adverse events were reported in two cases, but were deemed non-drug-related. Conclusions Hemocoagulase Agkistrodon has good hemostatic and coagulative function and is safe for the use of arresting capillary hemorrhage that occurs while incising the abdomen during surgery. 2010-3-8 14:57:00 LU Lin, ZHANG Qi, XU Yan, ZHU Zheng-bin, GENG Liang, WANG Ling-jie, JIN Cao, CHEN Qiu-jing, Ann Marie Schmidt, SHEN Wei-feng http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038552432803727 Background The cardioprotective effects of soluble receptor for advanced glycation end-products (sRAGE) have not been evaluated in large animals and the underlying mechanisms are not fully understood. This study aimed to evaluate the effects of intra-coronary administration of sRAGE on left ventricular function and myocardial remodeling in a porcine model of ischemia-reperfusion (I/R) injury.Methods Ten male minipigs with I/R injury were randomly allocated to receive intra-coronary administration of sRAGE (sRAGE group, n=5) or saline (control group, n=5). Echocardiography was performed before and 2 months after infarction. Myocardial expression of transforming growth factor (TGF)-汕1 was determined by immunohistochemistry and fibrosis was evaluated by Sirius red staining. Results As compared with the baseline values in the control animals, left ventricular end-diastolic volume (from (19.5㊣5.1) to (32.3㊣5.6) ml, P <0.05) and end-systolic volume (from (8.3㊣3.2) to (15.2㊣4.1) ml, P <0.05) were significantly increased, whereas ejection fraction was decreased (from (61.6㊣13.3)% to (50.2㊣11.9)%, P <0.05). No obvious change in these parameters was observed in the sRAGE group. Myocardial expression of TGF-汕1 was significantly elevated in the infarct and non-infarct regions in the control group, as compared with sRAGE group (both P <0.01). Fibrotic lesions were consistently more prominent in the infarct region of the myocardium in the control animals (P <0.05). Conclusion Intra-coronary sRAGE administration attenuates RAGE-mediated myocardial fibrosis and I/R injury through a TGF-汕1-dependent mechanism, suggesting a clinical potential in treating RAGE/ligand-associated cardiovascular diseases. 2010-3-8 15:20:00 ZHU Jing-yin, YE Wen, GONG Hai-yan http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038556196804975 Background Elevation of intraocular pressure is usually associated with primary open angle glaucoma and caused by increased outflow resistance. A two-color fluorescent tracer technique was developed to investigate the hydrodynamics of aqueous humor outflow with changing intraocular pressure within the same eye, to better understand the relationship between outflow facility and effective filtration area.Methods Eighteen enucleated bovine eyes were first perfused at 30 mmHg with Dulbecco＊s phosphate-buffered saline containing 5.5 mmol/L D-glucose. After a stable baseline facility, red fluorescent microspheres (0.5 米m, 0.002% v/v) were exchanged and perfused. Eyes in the one-color control group (n=6) were immediately perfused with fixative. In the experimental group (n=6), eyes were perfused with green tracer after intraocular pressure reduced to 7 mmHg, while in the two-color control group (n=6), eyes were perfused with green tracer with intraocular pressure remaining at 30 mmHg. All 12 eyes were then perfusion-fixed. Outflow facility was continuously recorded in all eyes. Confocal images were taken along the inner wall of the aqueous plexus and the percent of the effective filtration length (PEFL; length of inner wall exhibiting tracer labeling/total length of inner wall) was measured. The relationships between outflow facility and PEFL were analyzed statistically.Results No significant differences were found in baseline facilities (米l∙min(-1)∙mmHg(-1)) among the three groups (the experimental group: 0.93㊣0.12; the two-color control group: 0.90㊣0.19; the one-color control group: 0.98㊣0.13). In the experimental group, the outflow facility was significantly higher at 7 mmHg (4.29㊣1.01) than that at 30 mmHg (1.90㊣0.67, P <0.001), which corresponded to a significant increase in the PEFL at 7 mmHg (54.70㊣8.42) from that at 30 mmHg ((11.76㊣4.56)%, P <0.001). The PEFL labeled by red fluorescent microspheres in the experimental group ((11.76㊣4.56)%) showed no significant difference from that of the one-color control group ((13.39㊣2.19)%, P=0.473) or the two-color control group ((11.49㊣4.95)%, P=0.930). The PEFL labeled by green fluorescent microspheres in the experimental group ((54.70㊣8.42)%) was significantly higher than that of the two color control group ((37.34㊣8.17)%, P=0.010). A positive correlation was found between outflow facility and PEFL(r=0.897, R(2)=0.804) in the experimental group. Conclusions Changes in aqueous humor outflow patterns before and after a change in intraocular pressure can be successfully distinguished within the same eye using our newly developed two-color tracer perfusion technique. The PEFL showed positive correlation with the outflow facility. 2010-3-8 15:26:00 HU Yan-hua, WU De-quan, GAO Feng, LI Guo-dong, ZHANG Xin-chen http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038564786409438 Background Human umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) could be induced to differentiate into insulin producing cells (IPCs) in vitro, which have good application potential in the cell replacement treatment of type-1 diabetes. However, the mechanisms regulating this differentiation have remained largely unknown. Notch signaling is critical in cell differentiation. This study investigated whether Notch signaling could regulate the IPCs differentiation of human UCB-MSCs.Methods Using an interfering Notch signaling protocol in vitro, we studied the role of Notch signaling in differentiation of human UCB-MSCs into IPCs. In a control group the induction took place without interfering Notch signaling.Results Human UCB-MSCs expressed the genes of Notch receptors (Notch 1 and Notch 2) and ligands (Jagged 1 and Deltalike 1). Human UCB-MSCs with over-expressing Notch signaling in differentiation resulted in the down-regulation of insulin gene level, proinsulin protein expression, and insulin-positive cells percentage compared with the control group. These results showed that over-expressing Notch signaling inhibited IPCs differentiation. Conversely, when Notch signaling was attenuated by receptor inhibitor, the induced cells increased on average by 3.06-fold (n=4, P <0.001) in insulin gene level, 2.60-fold (n=3, P <0.02) in proinsulin protein expression, and 1.62-fold (n=6, P <0.001) in the rate of IPCs compared with the control group. Notch signaling inhibition significantly promoted IPCs differentiation with about 40% of human UCB-MSCs that converted to IPCs, but these IPCs were not responsive to glucose challenge very well both in vitro and in vivo. Hence, further research has to be carried out in the future. Conclusions Notch signaling may be an important mechanism regulating IPCs differentiation of human UCB-MSCs in vitro and Notch signaling inhibition may be an efficient way to increase the number of IPCs, which may resolve the shortage of islet of cell replacement treatment of type-1 diabetes. 2010-3-8 15:41:00 ZHOU Yu-long, LI Yue-chuan, SHOU Feng, LIU Chang-qi, PU Yong, TANG Hua http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038568844503675 Background Whether WW domain containing oxidoreductase (WWOX) gene is a tumor-suppressor is still controversial. Some researchers found that the transcription of the WWOX gene was lacking not only in tumor tissues but also in non-tumorous tissues and sometimes in normal tissues. Hence it is important to explore the role of the expression of the exogenous WWOX gene in the proliferation and apoptosis of primary cultured lung carcinoma cells. Methods Lipofection technique was used to determine primary cultured lung carcinoma cells containing the highly expressed exogenous WWOX gene and primary cultured cells with vectors as controls. An animal model of lung cancer was made by subcutaneous implantation of tumor cells into nude mice. RT-PCR, Western blotting, flow cytometry, and TUNEL were used to detect the transcription, expression of the exogenous gene and the effect of the expression of targeted genes on the proliferation and apoptosis of the primary cultured lung carcinoma cells. Results The growth, clone formation rate (CFR) ((5.33㊣1.53)%) of the primary lung cancer cells transfected with the WWOX gene, tumor size and weight were significantly lower than those of the non-transfected lung cancer cells (CFR: (14.33㊣1.53)%) and the primary lung cancer cells transfected with blank plasmids (CFR: (11.00㊣1.73)%, P <0.05). The apoptosis level of primary lung cancer cells transfected with the WWOX gene ((40.72㊣5.20)%) was significantly higher than that of the non-transfected lung cancer cells ((2.76㊣0.02)%) and the primary lung cancer cells transfected with blank plasmids ((2.72㊣0.15)%, P <0.05). Conclusion The expression of the exogenous WWOX gene can significantly inhibit the proliferation of lung cancer cells and induce their apoptosis, suggesting that the WWOX gene possesses tumor-suppressing effect. 2010-3-8 15:48:00 ZHANG Jie, WANG Ting, WANG Juan, PEI Ying-hua, XU Min, WANG Yu-ling, ZHANG Xia, WANG Chen http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038572710004325 Background Therapeutic approaches for tracheal stenosis caused by the formation of exuberant granulation tissues usually include electrocautery, mechanical dilation, laser therapy, argon plasma coagulation (APC), cryotherapy and stent placement. However, restenosis after stent insertion remains a significant limitation. We examined the efficacy of three different approaches, including induction of mechanical lesions, APC performed with different powers or durations and cryotherapy, to identify the method that limited the formation of granulation tissue. Methods Twelve specially bred research mongrel dogs were divided into three groups. In group 1 (four dogs) mild (procedure 1; two dogs) or moderate (procedure 2; two dogs) damage was induced mechanically. Group 2 (six dogs) received APC at different powers or durations (procedure 3: 30 W, 1 cm/s; procedure 4: 30 W, 2 cm/s; procedure 5: 25 W, 3 cm/s). Group 3 (two dogs) received cryotherapy (procedure 6: two freeze-thaw cycles of 30 seconds). Uncovered self-expandable metallic stents were inserted in all dogs to maintain a continuous stimulus to the trachea mucosa. Dogs were monitored for 4 weeks and the relationship between granulation tissue proliferation and method used was analyzed.Results In group 1, granulation tissue growth increased with more severe mechanical damage. The growth of granulation tissue in group 2 was more pronounced than in group 1, and both dogs in procedure 3 died because of severe stenosis. In this group, the formation of granulation tissue decreased with decreasing power and duration. In group 3, no obvious granulation tissue was found at week 4.Conclusions Lesions and stimuli from a foreign body (the stent) are two important factors that lead to overgrowth of granulation tissue. Thermal lesions, such as APC, seem to induce greater granulation tissue growth and cartilage damage compared with mechanical and cryotherapy lesions. Cryotherapy in combination with mechanical dilation may be a safe and effective treatment method for managing tracheal stenosis caused by the formation of granulation tissue. 2010-3-8 15:54:00 HU Gang, WEI Yu-ping, FENG Jie http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038574739203593 2010-3-8 15:57:00 KUO Hsu-tung, JENG Chii-yuan http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038577994209199 2010-3-8 16:03:00 FAN Wen-ge, QU Yun http://www.cmj.org/Periodical/AbstractList.asp?titleid=LW201038579705008448 2010-3-8 16:06:00