2007年 · 第120卷第14期

Abstract：Background Computer-aided diagnosis (CAD) of lung cancer is the subject of many current researches. Statistical methods and artificial neural networks have been applied to more quantitatively characterize solitary pulmonary nodules (SPNs). In this study, we developed a CAD scheme based on an artificial neural network to distinguish malignant from benign SPNs on thin-section computed tomography (CT) images, and investigated how the CAD scheme can help radiologists with different levels of experience make diagnostic decisions.Methods Two hundred thin-section CT images of SPNs with proven diagnoses (135 small peripheral lung cancers and 65 benign nodules) were analyzed. Three clinical features and nine CT signs of each case were studied by radiologists,and the indices of qualitative diagnosis were quantified. One hundred and forty nodules were selected randomly to form training samples, on which the neural network model was built. The remaining 60 nodules, forming test samples, were presented to 9 radiologists with 3-20 years of clinical experience, accompanied by standard reference images. The radiologists were asked to determine whether a nodule was malignant or benign first without and then with CAD output.Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis.Results CAD outputs on test samples had higher agreement with pathological diagnoses (Kappa=0.841, P＜0.001).Compared with diagnostic results without CAD output, the average area under the ROC curve with CAD output was 0.96(P＜0.001) for junior radiologists, 0.94 (P=0.014) for secondary radiologists and 0.96 (P=0.221) for senior radiologists,respectively. The differences in diagnostic performance with CAD output among the three levels of radiologists were not statistically significant (P=0.584, 0.920 and 0.707, respectively).Conclusions This CAD scheme based on an artificial neural network could improve diagnostic performance and assist radiologists in distinguishing malignant from benign SPNs on thin-section CT images。

Abstract：Background Angiopoietin-2 (Ang-2) is one of the critical regulators of tumor angiogenesis. Studies have shown a significant correlation of Ang-2 expression to tumor invasion and metastasis in various human cancers, but little is known about the serum Ang-2 (sAng-2) levels in esophageal squamous cell cancer (ESCC) and its precursors. In this study, we aimed to investigate its role in screening for ESCC and its precursors.Methods We carried out a free endoscopic screening in Feicheng City, a high ESCC incidence area in Shandong Province of China. Serum samples were collected as follows: 91 from normal subjects, 44 from patients with esophagitis,85 from patients with hyperplasia, and 13 from patients with early ESCC. In addition, 28 serum samples were obtained from patients with invasive ESCC undergoing surgery in People's Hospital of Feicheng City. All the subjects of the five groups were diagnosed by histopathology. The sAng-2 levels were tested and compared, and the diagnostic power in early or/and invasive ESCC was calculated in terms of sensitivity and other parameters.Results The sAng-2 levels were (22.0±5.5), (21.3±3.2), (20.5±3.3), (24.0±5.0), and (29.8±5.0) U/ml in normal,esophagitis, hyperplasia, early ESCC, and invasive ESCC groups respectively. It was significantly higher in early ESCC than inhyperplasia group (P=0.009). The invasive ESCC group showed the highest Ang-2 level among all groups (all P=0.000). The sensitivities of sAng-2 to early and invasive ESCC were 23.1% and 78.6% respectively.Conclusion sAng-2 level is related to carcinogenesis and progression of ESCC, but it can not be used to screen for early ESCC。

Abstract：Background Tuberculosis remains the leading cause of human death. Currently, Bacillus Calmette-Guérin (BCG) is the only available vaccine against tuberculosis but its efficacy is highly variable. Thus, developing new tuberculosis vaccines becomes an urgent task. In this study, we evaluated in BALB/c mice the humoral and cellular immune responses of recombinant BCG expressing the antigen ESAT-6 from Mycobacterium tuberculosis.Methods Escherichia coli-BCG shuttle plasmid named pDE22-esat-6 was constructed by inserting the BamHI/EcoRI digested esat-6 gene PCR product into the similarly digested parental plasmid pDE22. BCG cells were transformed with pDE22-esat-6, which was named recombinant BCG (rBCG). BALB/c mice were immunized subcutaneously on the back with 100 μl normal saline containing 106 CFU of BCG or rBCG. They were sacrificed after 4 weeks to detect their humoral and cellular responses.Results There was no any significant differences in the growth characteristics between the conventional BCG and rBCG. In immunized mice, the IgG antibody titres of rBCG group were as high as 1:8000, which was significantly higher than that in BCG group (1:1400, P＜0.05). The elicited IFN-γ level of rBCG group was (1993±106) pg/ml, which was also significantly higher than that in BCG group ((1463±105) pg/ml, P＜0.05). The splenocyte proliferation index of rBCG group reached 4.34±0.31, which was higher than that of BCG group (3.79±0.24, P＜0.05).Conclusion rBCG secreted expressing antigen ESAT-6 stimulated stronger humoral and cellular immune responses than BCG did, and, therefore may be the better vaccine against mycobacterium tuberculosis。

Abstract：Background Many basic and clinical studies have proved that anisodamine can produce significant effect on relieving microvascular spasm, improving and dredging the coronary microcirculation. It may be beneficial to the improvement of slow-reflow phenomenon (SRP) following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).So we investigated the effect of intracoronary administration of anisodamine on SRP of infarct related artery (IRA)following primary PCI in patients with ST segment elevated acute myocardial infarction (STEAMI).Methods Twenty-one patients with SRP from a total of 148 STEAMI patients accepted primary PCI were enrolled into this study from September 2004 to December 2005. When SRP happened, nitroglycerin (200 μg) was "bolus" injected firstly into IRA to exclude the spasm of epicardial artery and identify SRP as well as a baseline and self-control agent following PCI. Ten minutes later, 1000 μg of anisodamine was injected into IRA with SRP at 200 μg/s, while the coronary angiography (CAG) was taken before and at 1st, 3rd and 10th minute after administration of nitroglycerin or anisodamine,respectively. The corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG) and the diameter of IRA were calculated and analyzed by Gibson's TIMI frame count method using quantitative computer angiography (QCA)system to evaluate the influence of anisodamine on coronary flow and vessel lumen. In the meantime the invasive hemodynamic parameters of intracoronary and systemic artery (systolic, diastolic and mean pressure) and electrocardiogram (ECG) were measured and monitored. The changes of ventricular performance parameters and the adverse reaction were evaluated and followed-up at 1 month post-PCI.Results No significant changes in cTFCs and TMPGs were found at 1st, 3rd and 10th minute after intracoronary administration of nitroglycerin as compared with the baseline control (P＞0.05). cTFCs were decreased by 58.3%, 56.2%,and 54.6%, respectively (P＜0.001), and TMPGs were increased from 1.13±0.21 grade to 2.03±0.32, 2.65±0.45 and 2.51±0.57 grades (P＜0.05) at 1st, 3rd and 10th minute after intracoronary administration of anisodamine as compared with those after intracoronary administration of nitroglycerine, respectively. The average coronary blood flow of TIMI grade was improved from 1.76±0.43 to 2.71±0.46 (P＜0.05) while the diameter of middle segment in re-patented coronary artery was slightly increased from (3.20±0.40) mm to (3.40±0.50) mm at the 3rd minute after intracoronary administration of anisodamine (P＞0.05) as compared with those of nitroglycerine control. The systolic, diastolic and mean pressures of intracoronary artery after intracoronary administration of anisodamine increased from 115 to 123, 75 to 84, 88 to 95 mmHg (P＜0.05), respectively, along with the rise of heart rate from 68 to 84 beats per minute (P＜0.05). There were no significant changes in intervals of PR, QT and QRS (P＞0.05) and no any severe fast arrhythmia after intracoronary administration of anisodamine. The ventricular performance parameters were significantly improved and no major adverse cardiovascular events (MACE) were found during follow-up at 1 month post-PCI.Conclusions Intracoronary administration of 1000 μg anisodamine is effictive in reversing SRP following PCI in STEAMI patients, especially it is suitable for SRP patients with bradycardia or hypotension。

Abstract：Background The hypothalamus plays a central role in the regulation of metabolism by sensing metabolic demands and releasing regulatory neurotransmitters. This study investigated the response of the hypothalamus to glucose ingestion in rats by blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) and immunohistochemical techniques to determine the role of the hypothalamus in glycoregulation during disturbances in carbohydrate metabolism.Methods The signal intensity of the hypothalamus was monitored by fMRI for 60 minutes after oral glucose intake in 48 healthy rats (age 14 months), which included 24 normal weight rats (weighing (365±76.5) g) and 24 overweight rats (weighing (714±83.5) g). Then, 12 rats (6 normal, 6 overweight) underwent a repeat fMRI scan after consuming an equivalent amount of water without glucose on a separate day. The procedure for fMRI with water intake was the same as for glucose ingestion. fMRI data was processed using time cluster analysis and intensity averaging method. After fMRI,the expression of neuropeptide Y (NPY) and 5-hydroxytryptamine (5-HT) in the hypothalamus of all rats was determined by immunohistochemistry. Positive cells for NPY or 5-HT were counted.Results There was a transient, but significant, decrease in fMRI signal intensity in all rats (mean (3.12±0.78)%) in the hypothalamus within 19.5-25.5 minutes of oral glucose ingestion. In overweight rats, the decrease in signal intensity in response to the glucose ingestion was more markedly attenuated than that observed in normal weight rats ((2.2±1.5)%vs (4.2±0.7)% inhibition, t=2.12, P＜0.05). There was no significant response in the hypothalamus after oral water ingestion. The percentage of NPY positive cells in obese rats were slightly lower than those in control group (21% vs 23%,t=0.71, P＞0.05); but there was no significant difference between the two groups; the percentage of 5-HT positive cells in obese rats were significantly lower than those in the control group (22% vs 31%, t=3.25, P＜0.01).Conclusions There is a transient, but significant, decrease in BOLD signal intensity in the hypothalamus following glucose ingestion, which is similar to that observed in humans. The response of the hypothalamus to glucose ingestion was different in overweight and normal weight rats. The percentage of NPY positive cells in obese rats were lower than those in the control group, although this difference was not statistically significant. The percentage of 5-HT positive ceils in obese rats was significantly lower than those in the control group。

Abstract：Background Recent studies showed that aminoglycosides destroyed the cochlear cells and induced ototoxicity by producing reactive oxygen species, including free radicals in the mitochondria, damaging the membrane of mitochondria and resulting in apoptotic cell death. Bcl-xL is a well characterized anti-apoptotic member of the Bcl-2 family. The aim of this study was to determine the potential cochlear protective effect of Bcl-xL as a therapeutic agent in the murine model of aminoglycoside ototoxicity.Methods Serotype 2 of adeno-associated virus (AAV2) as a vector encoding the mouse Bcl-xL gene was injected into mice cochleae prior to injection of kanamycin. Bcl-xL expression in vitro and in vivo was examined with Western blotting and immunohistochemistry separately. Cochlear dissection and auditory steady state responses were checked to evaluate the cochlear structure and function.Results The animals in the AAV2-Bcl-xL/kanamycin group displayed better auditory steady state responses hearing thresholds and cochlear structure than those in the artificial perilymph/kanamycin or AAV2-enhanced humanized green fluorescent protein/kanamycin control group at all tested frequencies. The auditory steady state responses hearing thresholds and cochlear structure in the inoculated side were better than that in the contralateral side.Conclusions AAV2-Bcl-xL afforded significant preservation of the cochlear hair cells against ototoxic insults and protected the cochlear function. AAV2-mediated Bcl-xL might be an approach with respect to potential therapeutic application in the cochlear degeneration。

Abstract：Background Direct and indirect evidences have suggested that angiogenesis is a prerequisite for the development of endometriosis. Aiming at offering experimental evidences for anti-angiogenesis therapy, we transplanted the eutopic endometrium from patient with endometriosis into the severe combined immunodeficiency disease (SCID) mice, to evaluate the effect of the endostatin on the growth and angiogenesis of the established endometriosis lesions in SCID mice model.Methods Eutopic endometrium of women with endometriosis was transplanted into the SCID mice. The mice were randomized into treatment (n=10) and control groups (n=10). Two weeks after the implantation of endometrium fragment,whereas the control group received equivalent volume of PBS (200 μl/d). The volume of endometriotic lesions in SCID mice was measured every three days, and all the treatment lasted for 14 days. Immunohistochemistry was used to determine microvessel density (MVD) and the expression of VEGF. The results were analyzed by t test and X2 test to value the treating effect.Results Compared with the control group, growth of endometriosis lesion was reduced in the mice treated with YH-16.Statistically significant differences in the volume and weight of the ectopic lesions were observed between the treatment and the control groups (P＜0.05). Microscopical examination showed that after being treated with YH-16, the volume of the endometrial tissues decreased, the glands depauperated, and the glandular epithelium partially degenerated.Necrotic debris was observed in the endometrial stroma. MVD and expression of VEGF in the treatment group were significantly lower than those in the control group (P＜0.05).Conclusions Recombinant human endostatin affects the maintenance and growth of endometriotic tissues by inhibiting angiogenesis and reducing the expression of VEGF in ectopic lesion. The angiostatic agent may be promising as a therapy for endometriosis。

Abstract：Background Inhibition of the key costimulatory signals results in T cell anergy, indicating the alloantigen-specific immunologic unresponsiveness. In this study, the effect of blockage of costimulatory signal CD86 on murine abortion-prone model was studied.Methods Thirty CBA/J female mice cohabitated with DBA/2 male or BALB/c male mice were investigated. CBA/J ×DBA/2 matings were used as the abortion-prone model, and CBA/J × BALB/c matings were used as the normal pregnant model. The abortion-prone models were divided into experimental and control groups, and the normal pregnant models were set as a normal group (10 mice in each group). The mice in the experimental group were treated with anti-mouse CD86 monoclonal antibody (mAb) (100 μg) on day 4.5 of gestation, while the controls received irrelevant-isotype matched rat IgG2b. As for the normal group, nothing was given to the mice. The mice were killed on day 13.5 of gestation, embryo resorption rate and the expression of transforming growth factor β1 (TGF-β1), plasminogen activator inhibitor 1 (PAI-1), and matrix metalloproteinase 9 (MMP-9) were detected. Then the data were analyzed by Chi-square test and Fisher's exact test.Results The embryo resorption rate in the experimental (8.2%) and normal groups (7.7%) was significantly lower than that of the control (23.5%, P＜0.05). No significant difference was detected between the experimental and normal groups (P＞0.05). The positive expression rates of TGF-β1 and PAI-1 proteins in the experimental and normal groups were significantly higher than those in the control group (P＜0.05). The positive expression rate of MMP-9 protein in the experimental and normal groups was significantly lower than that in the control group (P＜0.05). No significant difference in the positive expression rates of the three proteins was detected between the experimental and normal groups (P＞0.05).Conclusions Blockage of costimulatory signal CD86 at early pregnancy can treat uncertain recurrent spontaneous abortion by stimulating the expression of TGF-β1, MMP-9 and PAI-1 and reducing the embryo resorption rate。

Abstract：Background In a previous study, we have verified that CXCR4 expression is correlated with tumor aggressive progression and poor prognosis in patients with epithelial ovarian cancer. The aim of this study was to explore the effect of CXCL12-CXCR4 axis on the metastasis of human ovarian cancer.Methods The expressions of CXCR4 and CXCL12 mRNA and protein in human ovarian cancer cell line CAOV-3 was detected by RT-PCR and immunocytochemistry. Methythiazolyltetrazolium (MTT) was used to analyze the effect of different concentrations of CXCL12 on the proliferation of CAOV-3 cells. Transwell invasion chamber and matrigel were used to evaluate the effect of various concentrations of CXCL12 and ascites on the migration and invasion of CAOV-3 cells. The expressions of integrin β1 and vascular endothelial growth factor-C (VEGF-C) mRNA were detected by RT-PCR. Data were analyzed using ANOVA by SAS 6.12.Results Under serum-free suboptimal culture conditions, CXCL12 (100 ng/ml) significantly enhanced the proliferation of CAOV-3 cells compared with the control and 10 ng/ml CXCL12 groups (0.428±0.051 vs. 0.325±0.045 and 0.328±0.039, P＜0.05). This enhancing effect of CXCL12 was significantly inhibited by 10 μg/ml neutralizing CXCR4 antibody or 1 μg/ml CXCR4 antagonist AMD3100. However, 10 μg/ml neutralizing CXCR4 antibody could not inhibit cell proliferation without CXCL12. The levels of migration and invasion of the CAOV-3 cells treated with 100 ng/ml CXCL12 were significantly higher than those in the control (migration: 523.3±25.2 vs 108.0±7.2; invasion: 39.3±4.0 vs. 4.0±1.0). The enhancing effect of CXCL12 on cell migration and invasion increased with the concentration of CXCL12 (100 ng/ml vs10 ng/ml: migration, 523.3±25.2 vs 211.7±24.7; invasion, 39.3±4.0 vs 15.7±3.1, P＜0.05), and was strongly inhibited by 10 μg/ml neutralizing CXCR4 antibody or 1 μg/ml AMD3100. The number of migrated and invading cells in the CAOV-3 added with ascites was significantly higher than those in the 100 ng/ml CXCL12 group (migration: 706.6±30.6 vs 523.3±25.2, invasion: 61.7±7.6 vs 39.3±4.0, P＜0.05). The level of integrin β1 mRNA was greatly increased at 3 hours after being treated with CXCL12 (0.53±0.10 vs. 1.53±0.16, P＜0.05), and VEGF-C mRNA displayed significant augment at 24 hours after being treated with CXCL12 (0.52±0.09 vs 1.11±0.15, P＜0.05).Conclusions CXCL12 and its receptor CXCR4 can promote the proliferation, migration, invasion of ovarian cancer cell line CAOV-3 and enhance its secretion of integrin β1 and VEGF-C. These effects can be inhibited by neutralizing CXCR4 antibody or AMD3100. CXCL12-CXCR4 axis plays an important role in ovarian cancer growth and metastasis。

The discovery of cell-free fetal DNA in maternal plasma in 1997 has opened up new possibilities for noninvasive diagnosis.1 By RT-PCR, circulating fetal DNA can be detected in the plasma of pregnant women,even in the first trimester of pregnancy,2,3 and thus can be used for noninvasive prenatal diagnosis of sex-linked disorders,4-6 the RhD status of fetuses,7 and single gene disorders such as beta-thalassaemia,8,9 congenital adrenal hyperplasia,10 and achondroplasia.11 In addition,quantitative aberrations of circulating fetal DNA may indicate various pregnancy-associated disorders,including1 Preeclampsia,12-14 preterm labor15,16 and fetal trisomy 21.17

Since discovery and cloning of the non-classical human leukocyte antigen (HLA) class Ⅰ antigen HLA-G by Geraghty et al1 in 1987, a large number of studies have been carried out. HLA-G has a low polymorphism, limited distribution to normal tissues and seven isoforms resulting from its primary mRNA alternative splicing.2 HLA-G expression was first found on the extravillous cytotrophoblasts, at the fetal-maternal interface during normal pregnancy, which lacks the expression of HLA-A, -B and HLA Ⅱ antigens. Initial studies on HLA-G mainly addressed its function in fetal-maternal immunotolerance.3 Two decades later,HLA-G is now considered to be a very important immune molecule which plays a vital immune inhibitory role in the context of reproduction, oncology, transplantation,infection and also in autoimmune disease.4 A number of Chinese research teams are interested in, and have contributed to, the publication of more than 80 peer-reviewed articles and reviews on HLA-G over the past ten years. We summarize the key points in this field that were presented and discussed by them。

Arsenic trioxide (ATO) can induce cellular apoptosis and inhibit the activities of multiple myeloma (MM)cells in vitro,1 but how it works is not very clear. Recent studies showed that ATO worked on the voltagedependent potassium channel and L-type calcium channel in myocardial cells,2-5 but the effect of ATO on ion channels of tumor cells was rarely reported. As the potassium channel plays an important role in controlling cell proliferation,6 we studied the effects of ATO on the voltage-dependent potassium current (Ikv) of the voltage-dependent potassium channel in an MM cell line,and probed into the relationship between changes of the Ikv caused by ATO and cell proliferation。

In the past, living donor nephrectomy required an open flank incision that results in postoperative morbidity and a prolonged hospital stay. Since its introduction in 1995, laparoscopic living donor nephrectomy has been shown to decrease postoperative pain and hospital stay,reduce blood loss, and improve cosmesis while hastening recovery of normal activities of donors.1 With decreased morbidity and favorable graft function, this procedure as a novel approach has been used to address the increasing disparity between organ need and availability.2 Better graft function and survival are noted in living-donor kidney transplantation than in cadaveric kidney transplantation. 1,2

Pupillary constriction occurs with intravenous administration of opioids such as sufentanil.1 However, few studies have investigated the pupillary effects of intrathecal (IT) sufentanil. It has previously been demonstrated that the cephalad spread within the cerebrospinal fluid of IT sufentanil results in side effects.2,3 There are two principal findings of the present study: (1) spinal sufentanil combined with low-dose of bupivacaine in patients with lower abdominal or lower extremity procedures induces a dose-dependent pupillary constriction that is far more sensitive than other centrally-mediated side effects; (2) the pupillary effect of IT sufentanil correlates closely with the adequacy of spinal anesthesia。

Patients with thoracic malignancies invading the superior vena cava (SVC) and innominate vein that cause venous flow obstruction have a poor quality of life and short survival time. Dartevelle et al1 reported that the 3-year survival rates were 27% for patients with mediastinal malignancies and non-small cell lung cancer.Recently, some surgeons' experience suggested that the results of extensive resection and reconstruction of the SVC and innominate vein were excellent.2-4 From May 2003 to December 2005, radical resection and reconstruction of the SVC and/or innominate vein were performed in a group of patients for mediastinal or lung tumors invading the superior vena cava and/or innominate vein. We reported our experience in this retrospective study to explore the operative method, the optimal vascular graft, and the benefits of extended resection and reconstruction of SVC and/or innominate vein for invasive thoracic tumors.…… Biography：Correspondence to:Dr. ZHAI Chun-bo,Department of Cardiothoracic Surgery,Second Xiangya Hospital,Central South University,Changsha 410011,China (Tel:86-731-5295104 or 86-13607496519. Fax:86-731-5533525. Email:zhaichunbo@gmail.com)

Marker chromosome (mar) is a structurally abnormal chromosome that can not be identified with conventional cytogenetic techniques (ISCN, 2005).1 The incidence of supernumerary marker chromosomes (SMCs)found at prenatal diagnosis varies from 0.4/1000 to 1.5/1000.2-5 Their genetic effects may range from harmless to detrimental, and in de novo cases, the rate of phenotypic abnormalities is statistically increased.5 Therefore, identification of SMCs has become imperative in prenatal diagnosis。

Angiomyolipoma (AML) is a tumour of uncertain histogenesis originally believed to be a hamartomatous lesion, but recently recognized as a usually benign clonal mesenchymal neoplasm.1 Along with lymphagiomyomatosis (LAM), clear cell "sugar"tumour (CCST) and clear cell myelomelanocytic tumour (CCMMT), AML was classified in the so called perivascular epithelioid cell (PEComa) neoplasm family.1 Kidney constitutes the principal site of its development.Extrarenal AMLs are rare and to the best of our knowledge, only two cases of AML development in the soft tissues have been reported so far.2,3 We presented a 23 years old female patient with an AML arising in the left gluteal region。

Spontaneous cerebrospinal fluid (CSF) rhinorrhea is rarely found, especially in patients with brain tumors.Similarly, reports of tentorial meningioma coexisting with acquired Chiari Ⅰ malformation with hydromyelia are also few. No doubt, one patient with cerebrospinal fluid rhinorrhea, tentorial meningioma and Chiari Ⅰ malformation with hydromyelia is hardly ever found. We reported one case of this rare condition。

Glomus tumors, also known as glomangiomas, are rare and originate in the neuromyoarterial glomus, a normal arteriovenous shunt which is abundantly supplied with nerve fibers and fulfills a temperature-regulating function. The classic location of glomus tumor is the subungual region, but the tumor can occur elsewhere in the skin, soft tissues, nerves, stomach, nasal cavity, and trachea.1 In the gastrointestinal (GI) tract the tumor occurs more often in the stomach than other parts, and typically occurs as a solitary submucosal nodule in the antrum.2 We reported a case of glomus tumor originating from the greater curvature of stomach which was studied with contrast-enhanced helical computed tomography (CT) and described the characteristic helical CT findings of the rare lesion。

Surgical complications after the transthoracic operation for esophageal cancer mainly include anastomatic fistula, thoraco-stomach fistula, stenosis of anastomosis,gastric perforation, gastric volvulus, diaphragmatic hernia,wound infection, and some other pulmonary complications. Unfortunately, there are few reports about the complications caused by position change of the chest tube until now. We presented an unusual case of a patient who underwent a transthoracic operation for esophageal cancer in our department on August 17, 2006, and a lot of intragastric material was found in his chest tube 17 days later, endoscopic examination suggested that the chest tube had inserted into the stomach. We tried to discuss the etiology and clinical management for this case as well。

In the case of a previous offspring with trisomy 21,recurrence risk for Down syndrome is about 1%.1 It may be due to chance, but the possibility of germline mosaicism for trisomy 21 in one of the parents has important implications for the recurrence. Here we report a young healthy mother, who has a second pregnancy of trisomy 21。