2010年 · 第123卷第08期

Abstract：Background Disequilibrium of Th1/Th2 is known as an important cause of allergic asthma with a biased Th2 type response. It has been shown that lipopolysaccharide (LPS) administration during post-sensitization modified the inflammation of asthma via upregulating the Th1 response that decrease the Th2 immunity. We would like to know if, during pre-sensitization, the elevated Th1 response is necessary for LPS exposure to modify the asthmatic response. Methods During pre- or post-sensitization, 40 μg LPS were intraperitoneal injected (i.p.) to asthmatic mice sensitized and challenged by Dermatophagoides farinae (D. farinea). Inflammation was assessed by examining bronchoalveolar lavage fluid (BALF) for the number and identity of cells and by cytokine titers measured by ELISA. Semi-quantified RT-PCR was used to evaluate the level of Toll-like receptor 4 (TLR4) mRNA in dendritic cells (DCs) from bone marrow (BMDCs). Results These investigations demonstrated that LPS exposure during pre-sensitization inhibited the Th2 cytokine and inflammatory infiltration, the same as with LPS exposure during post-sensitization in allergic asthma mice. Contrary to post-sensitization LPS exposure, the Th1 cytokines were not upregulated by pre-sensitization with LPS. Finally, the study failed to show any significant difference between TLR4 mRNA expressed in BMDCs with the two times of LPS exposure. Conclusions Our data suggest that elevated Th1 immunity is not required for the modification of the Th2 response induced by LPS exposure during pre-sensitization in asthmatic mice and that pre-sensitization differs from post-sensitization. Immune modulation with treatment is independent of TLR4 expression in BMDCs. This study implicates a potential way to protect from allergic disease and an inflammatory response。

Abstract：Background The cytotoxicity of dermal substitutes may be increased by the very processes used to deplete the cells. The present research aimed to investigate the method for monitoring the cytotoxicity of cell-free dermal substitutes using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) method.Methods The cytotoxicity of four dermal substitutes was evaluated using the MTT method according to the standards set by the Chinese State Food and Drug Administration (SFDA). Swine acellular dermal matrix (SADM) and goat acellular dermal matrix (GADM) were produced using a repeated freeze-thaw method. Human dermal matrix glutaraldehyde composite (HADM-G) and SADM cross-linked with glutaraldehyde (SADM-G) were produced using conventional methods. Results The cytotoxicity of all dermal substitutes ranged from Grade 0 to Grade 1, meeting the standards of the Chinese FDA. The OD_(490) of both SADM and GADM was higher than that of either HADM-G or SADM-G (P<0.05). Conclusion Dermal substitutes produced by the freeze-thaw method are less cytotoxic than those produced using conventional methods。

Abstract：Background Pulmonary endarterectomy is safe and effective surgical treatment for chronic thromboembolic pulmonary hypertension. This study aimed to evaluate the efficacy of pulmonary endarterectomy in treatment of thromboembolic pulmonary hypertension.Methods A retrospective study of 15 patients who underwent pulmonary endarterectomy in Beijing Chaoyang Hospital was performed. Obvious pulmonary hypertension and hypoxemia were observed in all patients. Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest. Results Two patients (2/15) died of residual postoperative pulmonary hypertension and bleeding complication. The other 13 cases had significant decrease in systolic pulmonary artery pressure ((92.8±27.4) mmHg vs. (49.3±18.6) mmHg) and pulmonary vascular resistance ((938.7±464.1) dynesscm~(-5) vs. (316.8±153.3) dynes-s-cm~(-5)), great improvement in cardiac index ((2.31 ±0.69) L·min~(-1)·m~(-2) vs. (3.85±1.21) L·min~(-1)·m~(-2)), arterial oxygen saturation (0.67±0.11 vs. 0.96±0.22) and mixed venous O_2 saturation (0.52±0.12 vs. 0.74±0.16) postoperatively compared to preoperative data. Mid-term follow-up showed that the cardiac function of all cases returned to NYHA class Ⅰ or Ⅱ, with great improvement in 6-minute walking distance ((138±36) m) and quality of life.Conclusions Bilateral pulmonary endarterectomy using cardiopulmonary bypass with the aid of deep hypothermia and circulatory arrest can effectively reduce pulmonary hypertension and provide good mid-term hemodynamic and symptomatic results with low surgical mortality rate and few complications。

Abstract：Background Neovascularization can cause vision loss in proliferative diabetic retinopathy (PDR) and may be affected by many factors. Stromal cell-derived factor-1 (SDF-1) is a potent stimulator of angiogenesis. The study was aimed to investigate the expression of SDF-1 and its correlation with vascular endothelial growth factor (VEGF) in the eyes with diabetic retinopathy.Methods The levels of SDF-1 and VEGF were measured by enzyme-linked immunosorbent assay in the vitreous of 41 eyes of 41 patients with PDR and 12 eyes of 12 patients with idiopathic macular hole (IMH). Vitreous fluid samples and fibrovascular preretinal membranes were obtained at vitrectomy. SDF-1 and VEGF were localized using immunohistochemistry.Results The vitreous concentration of VEGF was significantly higher in eyes with PDR ((2143.7±1685.21) pg/ml) than in eyes with IMH ((142.42±72.83) pg/ml, P<0.001). The vitreous level of SDF-1 was also significantly higher in eyes with PDR ((306.37±134.25) pg/ml) than in eyes with IMH ((86.91±55.05) pg/ml, P<0.001). The concentrations of both VEGF and SDF-1 were higher in eyes with active PDR than in eyes with inactive PDR. Panretinal photocoagulation (PRP) could decrease the SDF-1 levels in the vitreous of PDR patients. The vitreous concentration of SDF-1 correlated with that of VEGF in eyes with PDR (n=0.61, P <0.001). The costaining of SDF-1 and VEGF was confined to the vascular components in preretinal membranes.Conclusions SDF-1 protein is highly expressed in both the vitreous and preretinal membranes of PDR patients; SDF-1 may be correlated with VEGF in angiogenesis in PDR。

Abstract：Background Oligonucleotide microarrays are increasingly being used to identify gene expression profiles that associated with complex genetic diseases. Peripheral lymphocytes communicate with cells and extracellular matrixes in almost all tissues and organs in human body, suggesting that the gene expression profiles in peripheral lymphocytes may reflect the presence of disease in the body. This study aimed to identify molecular biomarkers for cervical cancer in peripheral blood lymphocytes by using oligonucleotide microarrays.Methods Total RNA was extracted from peripheral blood lymphocytes of 24 early stage cervical cancer patients and 18 healthy controls. We used 22K Human Genome microarrays to profile peripheral blood lymphocytes from 4 early stage cervical cancer patients and compared their gene expression profiles with those from 3 healthy controls. Differentially expressed genes would be identified if they had adjusted P values of less than 0.05 and a groupwise average fold change greater than 1.5 or less than 0.67. Then the selected 5 genes were validated in the remaining 20 early stage cervical cancer patients and the 15 healthy controls by using real-time reverse-transcription polymerase chain reaction (RT-PCR).Results Genes identified by the gene selection program expressed differently between the blood samples of the early stage cervical cancer patients and those of the healthy controls. To validate the gene expression data, 5 genes were analyzed by real-time RT-PCR. In three of the 5 identified genes, tenasin-c (TNC), nuceolin (NCL), and enolase 2 (ENO2) showed a significant up-regulation in the blood samples of the early stage cervical cancer patients versus that of the healthy controls.Conclusions The up-regulation of TNC, NCL, and ENO2 in peripheral blood may be used to identify novel blood biomarkers for detecting cervical cancer in a clinically accessible surrogate tissue, and thus to provide a possibility to develop a noninvasive and predictive diagnosis for the disease。

Abstract：Background Localization of sensory cortical areas during the operation is essential to preserve the sensory function.Intraoperative direct electrostimulation under awake anesthesia is the golden standard but time-consuming. We applied 3T high field blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to identify the relationship between glioma and cortical sensory areas preoperatively and to guide intraoperative direct electrostimulation for quick and precise localization.Methods Five glioma patients with sensory cortex involvement by or next to the lesion had preoperative BOLD fMRI to determine the spatial relationship of cortical sensory areas to the tumours. Bilateral hand opposite movement was performed by these patients for fMRI. Precentral and postcentral gyri were identified by electrical stimulation during the operation. Karnofsky Performance Status scores of the patients' pre- and postoperative and the role of BOLD fMRI were evaluated.Results The cortical sensory areas were all activated in five glioma patients involving postcentral gyrus areas by BOLDf MRI with bilateral hand opposite movement. The detected activation areas corresponded with the results from cortical electrical stimulation.Conclusions The relationship between cortical sensory areas and tumour can be accurately shown by BOLD fMRI before operation. And the information used to make the tumour resection could obtain good clinical results。

Abstract：Background The prevalence of HIV/AIDS in Chinese ethnic minorities is an important component of China's AIDS issues. In this study, we launched an intervention programme in Yunnan Province of China, where the Dai people live, to carry out the community-based HIV/AIDS health education and behavioral interventions on ordinary Dai farmers. The Dai people believe in Theravada Buddhism.Methods Four rural communities were randomly divided into two groups. In one group (Buddhist group), HIV/AIDS health education and behavioral intervention were carried out by monks. The other group (women group) was instructed by women volunteers. The intervention continued for one year and the data were collected before and after the intervention project.Results In the Buddhist group, the villagers' AIDS related knowledge score was boosted from 3.11 to 3.65 (P<0.001),and some indices of the villagers' behavior using condoms improved after the intervention. But this improvement was poorer than that in the women group. In the Buddhist group, the villager's attitude score towards the people living with HIV and AIDS (PLWHA) also increased significantly from 1.51 to 2.16 (P<0.001).Conclusion The results suggested that the Buddhist organization has limited success in promoting the use of condoms,but plays an important role in eliminating HIV/AIDS related discrimination。

Abstract：Background The infection rate of methicillin-resistant Staphylococcus aureus (MRSA) is increasing yearly due to the overprescription of antibiotics. Traditional Chinese compound medicines are less inclined to induce bacterial resistance in the clinical setting because of their multi-acting mechanisms. However, most current research is limited to bacteriostasis in vitro using single extracts or formulations. Plasma pharmacology is an in vitro method, using what is called "medicine serum". The aim of this study was to investigate whether the medicine serum of compound Qingre granules (QRKL) alone or in combination with antibiotics may treat MRSA infection in the clinic.Methods An animal model of MRSA resistance was created by injecting rabbits with the standard strain of MRSA ATCC43300. Infected rabbits were treated with QRKL by intragastric administration. Sixty minutes after the last intragastric administration, serum was obtained from the rabbits by heart puncture to obtain what is termed "medicine serum". The minimum inhibitory concentration (MIC) of QRKL, medicine serum alone, or serum combined with antibiotics was assessed by agar dilution. Results were compared with the growth of sixteen isolates of MRSA. Results The MIC of QRKL to the standard strain ATCC43300 was 10.00 mg/ml. The MIC_(90)of vancomycin was 1.00 ug/ml, which, when combined with QRKL, dropped to 0.50 μg/ml. The MIC_(90) of cefuroxime alone was 512.00 μg/ml- This level also decreased to 256.00 μ g/ml when combined with QRKL. The addition of QRKL thus significantly reduced the MIC of both cefuroxime and vancomycin compared with antibiotics alone (P <0.01). The MIC90 of vancomycin with medicine serum decreased to 0.50 μ g/ml, and the MIC of vancomycin with medicine serum also descended compared with using vancomycin alone (P<0.01).Conclusions The growth of MRSA can be inhibited by QRKL or medicine serum of QRKL in vitro. The addition of QRKL results in increased sensitivity of MRSA to vancomycin and this may provide a novel treatment for patients with MRSA infection。

Abstract：Background Nitric oxide (NO) plays an important role in acute lung injury (ALI), acute respiratory distress syndrome (ARDS), and in ventilator-induced lung injury (VILI). A change in the balance of endothelin-1 (ET-1) and NO in the ALI/ARDS can also add to these problems. However, the profile of ET-1 and the balance of ET-1 and NO are still unknown in a VILI model.Methods Models of oleic acid induced ALI were established in dogs; these models were then randomized into three groups undergone different tidal volume (VT) mechanical ventilation, which included a VT6 group (VT equaled to 6 ml/kg body weight, positive end expiratory pressure (PEEP) equaled to 10 cmH_2O, n=6), a VT10 group (VT equaled to 10 ml/kg body weight, PEEP equaled to 10 cmH_2O, n=4) and a VT20 group (VT equaled to 20 ml/kg body weight, PEEP equaled to 10 cmH_2O, n=6) for 6-hour ventilation. The levels of ET-1 and NO in serum and tissue homogenates of lung were observed throughout the trial.Results PaO_2 was increased after mechanical ventilation, but hypercapnia occurred in the VT6 group. The magnitudes of lung injury in the VT20 group were more severe than those in the VT6 group and the VT10 group. Serum levels of ET-1 and NO increased after ALI models were established and slightly decreased after a 6-hour ventilation in both the VT6 group and the VT20 group. The serum ET-1 level in the VT20 group was higher than that in the VT6 group and the VT10 group after the 6-hour ventilation (P <0.05) while the serum NO levels were similar in the three groups (all P >0.05). There was no significant difference in serum ratio of ET-1/NO between any two out of three groups (P >0.05), although there was a significant positive relationship between serum ET-1 and serum NO (r=0.80, P<0.01). The levels of ET-1 and NO in the lung were increased after ventilation. The lung ET-1 level in the VT20 group was significantly higher than that in the VT6 group and VT10 group (both P<0.05) while there was no significant difference in lung NO levels between two groups (P>0.05). In the lung tissue, the ratio of ET-1/NO was significantly higher in the VT20 group than in the VT6 group and VT10 group after the 6-hour ventilation (P<0.05) as there was a significant positive relationship between ET-1 and NO in the lung (r=0.54, P<0.05).Conclusions The production of ET-1 and NO was increased in serum and lung tissue in a VILI model. But the ET-1 levels increased much more than the NO levels in the lung, though there was a significant positive relationship between levels of ET-1 and NO. These results showed that there was an interaction between ET-1 and NO in a VILI model and changing the balance of ET-1 and NO levels might contribute to the pathophysiologic process of VILI。

Abstract：Background Recent research suggests that β_2-adrenergic agonists increase alveolar fluid clearance (AFC) under physiologic and pathologic conditions. It is unknown whether β_3-adrenergic agonists also increase AFC under pathologic conditions. The aim of this study was to investigate the effect of β_3 -adrenergic agonists on AFC following hypoxic lung injury and the mechanisms involved.Methods Hypoxic rats were exposed to 10% oxygen. BRL-37344 (β_3-adrenergic agonist) or CGP-12177 (selective β_3-adrenergic agonist) alone or combined with β receptor antagonists, sodium channel blockers, or Na~+/K~+-ATPase blockers were perfused into the alveolar space of rats exposed to 10% oxygen for 48 hours. Total lung water content (TLW) and AFC were measured.Results AFC did not change for the first 24 hours but then decreased after 48-hour exposure to 10% oxygen. The perfusion of BRL-37344 or CGP-12177 significantly increased AFC in normal and hypoxic rats. The AFC-stimulating effect of CGP-12177 was lowered with amiloride (a Na~+ channel blocker) and ouabain (a Na~+/K~+-ATPase inhibitor) by 37% and 49%, respectively. Colchicine significantly inhibited the effect of CGP-12177.Conclusions These findings suggest that (β3-adrenergic agonists can increase AFC during hypoxic lung injury in rats and accelerate the amelioration of pulmonary edema。

Abstract：Background Allergic rhinitis (AR) is a Th2 dominant cytokine response. Chloride channel-3 (CIC-3) plays an important role in nasal mucosal edema and inflammatory pathologic changes in AR. Antiallergic herbal agents (AHA) are antiallergic herbal products. In the previous study, we have demonstrated that AHA clearly inhibited allergic medium and relieved allergic reaction of AR. The aim of this study was to evaluate the function of CIC-3 and discuss the possible therapeutic effects of AHA on immune microenvironment in AR.Methods AHA were produced and used to treat AR. An animal model of an AR rabbit was established by ovalbumin (OVA). The rhinitis rabbits were randomly divided into three groups: AHA treated group (AHATG), model group (MG) and healthy control group (HCG). The expressions of CIC-3 protein were examined by immunohistochemical method. The mucosal epithelial cells of all the rabbit groups were primarily cultured with tissue culture method in vitro with or without rhlL-4 or rhlL-2. Furthermore, the expressions of CIC-3 mRNA were detected by real-time PCR. The levels of monocyte chemotactic factor-1 (MCP-1) and vascular cell adhesion molecule-1 (VCAM-1) protein in culture supernatants were measured by ELISA.Results The expressions of CIC-3 mRNA increased more in mucosal epithelial cells of MG than those in AHATG and HCG (P<0.01). The levels of CIC-3 mRNA, MCP-1 and VCAM-1 protein in culture supernatants of MG were significantly higher than those in the other two groups (P<0.01). Those were significantly increased in MG untreated 12 hours later than those in other two groups (P <0.01). The expressions of CIC-3 mRNA, MCP-1 and VCAM-1 protein in culture supernatants of MG and HCG treated with rhlL-4 were significantly higher than those in the AHATG treated with rhlL-4 (P <0.01). The levels of CIC-3 mRNA, MCP-1 and VCAM-1 protein in culture supernatants of all groups treated with rhlL-2 showed no significant changes (P>0.05).Conclusions AHA can inhibit the secretions of CIC-3, MCP-1 and VCAM-1 in mucosal epithelia and improve inflammatory reaction of AR. CIC-3 plays an important role in the secretion of cytokines and mucosal inflammatory response in AR. RhlL-4 can enhance the secretion of CIC-3, MCP-1 and VCAM-1 in mucosal epithelial cells, especially during the AR process. These enhanced effects of rhlL-4 were significantly suppressed by AHA. The secretions of CIC-3, MCP-1 and VCAM-1 can not be induced obviously by rhlL-2 in mucosal epithelial cells in AR。

Abstract：Background Treatment with inhaled carbon monoxide (CO) has been shown to ameliorate intestinal injury in experimental animals induced by lipopolysaccharide (LPS) or ischemia-reperfusion. We hypothesized that CO intraperitoneal administration (i.p.) might provide similar protection to inhaled gas. This study aimed to investigate the effects of continuous 2 L/min of 250 ppm CO i.p. on rat intestine injury induced by LPS and to try to develop a more practical means of delivering the gas.Methods A total of 72 male Sprague-Dawley rats were randomly assigned to 4 groups: control group, CO i.p. group, LPS group and LPS+CO i.p. group. One hour after intravenously received 5 mg/kg LPS, the rats in LPS group and LPS+CO i.p. group were exposed to room air and 2 L/min of 250 ppm CO i.p., respectively, and the rats of control group and CO i.p. group intravenously received an equal volume of 0.9% NaClI and 1 hour later, were exposed to room air and 2 L/min of 250 ppm CO i.p., respectively. One, 3 and 6 hour of each group after treated with room air or CO i.p., the animals (n=6 for each time point) were sacrificed and intestinal tissues were collected for determinating the levels of platelet activator factor (PAF) and intercellular adhesion molecule-1 (ICAM-1) with enzyme-lined immunosorbent assays. The maleic dialdehyde (MDA) content and the myeloperoxidase (MPO) activity were determined with a chemical method. The phosphorylated p38 mitogen activated protein kinase (MAPK) expression was assayed with Western blotting and the cell apoptotic rate with flow cytometery. The arterial oxygenation was measured by blood gas analysis, and the pathology determined by light microscope.Results After treatment with 2 L/min of 250 ppm CO i.p., the increase of PAF, ICAM-1, MDA, MPO, and cell apoptotic rate induced by LPS was markedly reduced (P<0.05 or 0.01), and accompanied by ameliorating intestine injury. Western blotting showed that these effects of CO i.p. were mediated by p38 MAPK pathway. There were no significant differences in all observed parameters between control group and CO i.p. group.Conclusion The injury to the intestine via anti-oxidant, anti-inflammation and anti-apoptosis, which may involve the p38 MAPK pathway, was induced by 2 L/min of 250 ppm CO i.p. exerting potent protection against LPS。

Abstract：Background L-glutamate (L-GLU) is a major neurotransmitter in the nucleus ambiguus (NA), which can modulate respiration, arterial pressure, heart rate, etc. This study investigated the effects and mechanisms of L-GLU microinjected into NA on gastric motility in rats.Methods A latex balloon connected with a pressure transducer was inserted into the pylorus through the forestomach for continuous recording of the gastric motility. The total amplitude, total duration, and motility index of gastric contraction waves within 5 minutes before microinjection and after microinjection were measured.Results L-GLU (5 nmol, 10 nmol and 20 nmol in 50 nl normal saline (PS) respectively) microinjected into the right NA significantly inhibited gastric motility, while microinjection of physiological saline at the same position and the same volume did not change the gastric motility. The inhibitory effect was blocked by D-2-amino-5-phophonovalerate (D-AP5, 5 nmol, in 50 nl PS), the specific N-methyl-D-aspartic acid (NMDA) receptor antagonist, but was not influenced by 6-cyaon-7-nitroquinoxaline-2,3-(1H,4H)-dione (CNQX) (5 nmol, in 50 nl PS), the non-NMDA ionotropic receptor antagonist. Bilateral subdiaphragmatic vagotomy abolished the inhibitory effect by microinjection of L-GLU into NA. Conclusions Microinjection of L-GLU into NA inhibits the gastric motility through specific NMDA receptor activity, not non-NMDA receptor activity, and the efferent pathway is the vagal nerves。

Abstract：Background Mutations in the lamin A/C gene (LMNA) may cause familial dilated cardiomyopathy (dilated cardiomyopathy) characterized by early onset atrio-ventricular block (A-V block) before the manifestation of dilated cardiomyopathy and high risk of sudden death due to ventricular arrhythmia, which is very similar to the phenotype of gap junction related heart disease. This study aimed to determine the expression and localization of connexins in neonatal myocytes transfected with wild-type (WT) or mutant LMNA to elucidate how these mutations cause heart diseases. Methods We studied the connexin 43 (Cx43) and connexin 40 (Cx40) expression in cultured neonatal myocytes transfected with wild-type (WT) or mutant LMNA (Glu82Lys (E82K) and Arg644Cys (R644C) using confocal imaging and Western blotting analysis.Results Cx43 protein expression was reduced by 40% in cells transfected with LMNA E82K than that in cells transfected with WT LMNA cDNA. Confocal imaging showed that the Cx43 located inside the cells by LMNA E82K. By contrast, LMNA E82K mutation had no effect on expression and localization of Cx40. LMNA R644C transfection did not show any significant effects on gap junctions at all.Conclusions Our findings suggest that LMNA E82K significantly reduced the Cx43 expression and altered its localization which may be one of the pathological mechanisms underlying LMNA-related heart disease。

Abstract：Objective To evaluate the human neurobfastoma SH-SY5Y cell line as an in vitro model of dopaminergic (Daergic) neurons for Parkinson's disease (PD) research and to determine the effect of differentiation on this cell model. Data sources The data of this review were selected from the original reports and reviews related to SH-SY5Y cells published in Chinese and foreign journals (Pubmed 1973 to 2009). Study selection After searching the literature, 60 articles were selected to address this review. Results The SH-SY5Y cell line has become a popular cell model for PD research because this cell line posses many characteristics of Daergic neurons. For example, these cells express tyrosine hydroxylase and dopamine-β-hydroxylase,as well as the dopamine transporter. Moreover, this cell line can be differentiated into a functionally mature neuronal phenotype in the presence of various agents. Upon differentiation, SH-SY5Y cells stop proliferating and a constant cell number is subsequently maintained. However, different differentiating agents induce different neuronal phenotypes and biochemical changes. For example, retinoic acid induces differentiation toward a cholinergic neuronal phenotype and increases the susceptibility of SH-SY5Y cells to neurotoxins and neuroprotective agents, whereas treatment with retinoic acid followed by phorbol ester 12-0-tetradecanoylphorbol-13-acetate results in a Daergic neuronal phenotype and decreases the susceptibility of cells to neurotoxins and neuroprotective agents. Some differentiating agents also alter kinetics of 1-methyl-4-phenyl-pyridinium (MPP~+) uptake, making SH-SY5Y cells more similar to primary mesencephalic neurons.Conclusions Differentiated and undifferentiated SH-SY5Y cells have been widely used as a cell model of Daergic neurons for PD research. Some differentiating agents afford SH-SY5Y cells with more potential for studying neurotoxicity and neuroprotection and are thus more relevant to experimental PD research。

In 2001, Laskin et al~1 firstly described a series of 14 seemly distinctive mesenchymal tumors that occurred exclusively in the superficial lamina propria of the vagina and cervix of middle to old-aged women. They proposed the term "superficial cervicovaginal myofibroblastoma (SCVM)" to highlight the unique features of this tumor: the superficial subepithelial location and myofibroblastic differentiation of the tumor cells. SCVM appears less well recognized with only three additional reports have been documented in the English literatures.~(2-4) In this study, we described four new cases of SCVM to further characterize the clinical and pathological features of this rare entity。

Congenital absence of the cruciate ligaments is an extremely rare condition with a prevalence of 0.017 per 1000 live births.~1 Niebauer and King~2 first reported this disease in 1960, and after that, similar cases have been reported. These cases are usually associated with other deformities of the knee joint, such as the joint dislocation, absence of the tibial intercondylar eminence, deformity of the meniscus, dysplasia of the distal femur, etc.~3 However, its association with multiple congenital abnormalities in other areas of the body has been rarely reported. Here, we report a patient with congenital deficiency of bilateral anterior cruciate ligaments associated with scoliosis and hip dysplasia, together with the result of four years follow-up along with a literature review。

To the editor: Recently, the International Expert Committee recommended using HbAlc as a diagnosing tool for diabetes and suggested HbAlc value of 6.5% as cut-off for the diagnosis.~1 In this recommendation, pre-diabetes was replaced by "sub-diabetes or high risk status" which was defined by HbAlc between 6.0% and 6.5%. The recommendation has triggered wide discussion on its potential influence on diabetes care, for example, the impact of the new diabetes diagnosis criteria on the prevalence of diabetes. We have noticed that the level of HbAlc correlated with oral glucose tolerance test (OGTT) based diabetes diagnosis criteria~2 is lower than 6.5%.~(3,4) We hypothesized that the new diagnosis criteria will reduce the prevalence of both diabetes and high risk population in Chinese population. To test this hypothesis, we calculated the prevalence of diabetes and high risk individuals in both community and hospital based diabetes screening population by using both OGTT based2 and HbAlc based diagnosis criteria。