2011年 · 第124卷第07期

AIDS has been a serious problem threatening the health of people all over the world.In China,AIDS,as the new plague in the 21th century,has been listed as one of the major communicable diseases.Despite its low prevalence in China,AIDS has a high prevalence in certain populations and in local areas.China's AIDS plague was jointly accessed by the Ministry of Health of China,United Nations Programme on HIV and AIDS (UNAIDS) and World Health Organization (WHO),which indicated that by the end of 2007 there were about 0.7 million (0.55 to 0.85 million) people infected with HIV in China,with an infection rate of 0.05%.1 Great efforts have been continuously made to control the HIV infected cases to be within 1.5 million by the year of 2010.2 The severe challenge of preventing and treating AIDS has attracted extensive attention from both the government and the public and it has reached a top priority。

Abstract：Background Diagnosis and treatment for respiratory symptoms (RSs) of gastroesophageal reflux disease (GERD) is more difficult than that for common esophageal symptoms. The goal of this study was to evaluate the efficacy and safety of radiofrequency (RF) treatment on RSs of GERD in a preliminary 12-month follow-up observation.Methods From April 2006 to October 2008,505 GERD patients with mainly respiratory presentations such as wheezing,chronic cough or hoarseness,were treated by endoscopic RF. A questionnaire was completed before and after treatment,using a six-point scale ranging from 0 to 5 to assess symptom severity and frequency. The symptom score was the sum of frequency and severity.Results Symptom scores were significantly improved at the end of the follow-up period. The mean heartburn score decreased from 5.31 to 1.79. The mean regurgitation score decreased from 5.02 to 1.64;mean cough score decreased from 6.77 to 2.85;mean wheezing score decreased from 7.83 to 3.07;and mean hoarseness score decreased from 5.13 to 1.81 (P ＜0.01). No major complications or deaths occurred. Minor complications included temporary post-procedural retrosternal unease or pain (n=106;21.0%),mild fever (n=86;17.0%),transient nausea/vomiting (n=97;19.2%),and transient dysphagia (n=42;9.3%). Thirty-five (6.9%) patients had recurrence of symptoms. Endoscopic RF treatment was repeated in six patients,and laparoscopic fundoplication was performed in seven.Conclusion Endoscopic RF is an effective and safe means to treat RSs in patients with GERD。

Abstract：Background Carcinoma of unknown primary (CUP) encompasses a heterogeneous group of tumors with varying clinical features. The management of patients of CUP remains a clinical challenge. The purpose of this study was to evaluate the clinical applications of integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) information in patients with CUP,including detecting the occult primary tumor and effecting on disease therapy.Methods One hundred and forty-nine patients with histologically-proven metastases of CUP were included. For all patients,the conventional diagnostic work-up was unsuccessful in localizing the primary site. Whole-body PET/CT images were obtained approximately 60 minutes after intravenous injection of 350-425 MBq of 18F-FDG.Results In 24.8% of patients,FDG PET/CT detected primary tumors that were not apparent after conventional workup.In this group of patients,the overall sensitivity,specificity,and accuracy rates of FDG PET/CT in detecting unknown primary tumors were 86.0%,87.7%,and 87.2%,respectively. FDG PET/CT imaging also led to the detection of previously unrecognized metastases in 29.5% of patients. Forty-seven (31.5%,47 of 149) patients underwent a change in therapeutic management.Conclusions FDG PET/CT is a valuable tool in patients with CUP,because it assisted in detecting unknown primary tumors and previously unrecognized distant metastases,and optimized the mangement of these patients。

Abstract：Background Liver transplantation is the most effective treatment for end-stage liver diseases;however,infections after transplantation can seriously affect the patient's health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation.Methods Clinical data for 232 liver transplant patients at risk of fungal infection were examined for the presence of fungus in the blood,fluid,sputum,urine and stools of patients and by chest or abdominal CT scans. Patients diagnosed with a fungal infection were treated with Fluconazole or,if this was not effective,Voriconazole or Amphotericin B.Immunosuppressive therapy was also reviewed.Results Thirty-seven of 232 (15.9%) patients were diagnosed with a fungal infection,which occurred 4 to 34 days post-transplantation. Candida infections were diagnosed in 23 cases (62.2%) and Aspergillus infections in 12 cases (32.4%). Twenty-one cases were effectively treated with Fluconazole,11 cases with Voriconazole,and two cases with Amphotericin B;however,three cases were not effectively treated with any of the antifungal agents. Overall,treatment was effective in 91.9% of patients.Conclusions Fungal infection has a significant influence on survival rate after liver transplantation. Imaging studies,and pathogenic and biopsy examinations can diagnose fungal infections,which can be effectively treated with antifungal agents such as Fluconazole,Voriconazole or Amphotericin B。

Abstract：Background Gastric cancer (GC) is the second leading cause of cancer mortality worldwide,and surgical resection is currently the only possible curative approach. Duodenal stump leakage is the most serious complication after radical gastrectomy,and optimal treatment is still lacking.Methods We retrospectively reviewed 2034 cases of total or subtotal gastrectomy for GC from January 1995 to December 2009,including 465 cases of duodenal stump closure using purse-string suture (group A),835 cases of duodenal stump treated with linear cutting stapler and seromuscular layer suture (group B),and 734 cases of duodenal stump closure using full-thickness and seromuscular layer suture (group C). We evaluated the surgical cost,operative time for duodenal stump closure,short-term postoperative complications,perioperative blood loss,and postoperative recovery.Results There was no perioperative mortality in any group. Ninety-four postoperative (within 1 month) complications occurred:18 abdominal bleeding,14 anastomotic leakage,15 abdominal infection,36 wound infection,and 11 duodenal stump leakage. There was no significant difference among the groups in intra-abdominal hemorrhage,anastomotic leakage,abdominal infection and wound infection. No postoperative duodenal stump leakage occurred in group A,which had a significant difference compared with groups B and C (6 cases in group B and 5 cases in group C suffered duodenal stump leakage. P ＜0.01). The surgical cost in groups A and C was significantly lower than in group B (P ＜0.01),with no significant difference between groups A and C. The processing time for duodenal stump closure in groups A and B was significantly shorter than in group C (P ＜0.01),with no significant difference between groups A and B. There was no significant difference in blood loss and postoperative recovery among the groups.Conclusions Duodenal stump closure using purse-string suture seems to be a promising approach with shorter operative time,and lower cost and incidence of duodenal stump leakage in radical gastrectomy。

Abstract：Background Readmission rates after pancreaticoduodenectomy (PD) for malignant diseases have a significant impact on survival rate. Identification of risk factors for readmission may improve discharge plans and postoperative care. Data exist on the morbidity and mortality of patients undergoing PD,but there are few reports about hospital readmissions after this procedure. Our aims were to evaluate the proportion and reasons for readmissions after PD for malignant diseases,the factors influencing readmissions,and to analyze the relationship between readmission rate and survival rate.Methods Four hundred and thirty-six patients,who had undergone PD for malignant diseases in our centre from October 1999 to October 2009,a 10-year period,excluding perioperative (30-day) mortality,were identified. All readmissions within 1 year following PD were analyzed with respect to timing,location,reasons for readmission and outcome. We reviewed the hospitalization and readmissions for patients undergoing PD,and compared patients requiring readmission to patients that did not require readmission.Results One hundred and forty-five patients (33.26%) were readmitted within 1 year following PD,for further treatment or complications. In those cases,diagnoses associated with high rates of readmission included radiation and/or chemotherapy (48.96%),progression of disease (11.72%),infection (11.72%),gastrointestinal dysfunction/obstruction (6.20%),surgery-related complications (2.76%) and pain (4.14%). The proportion of T4 in readmission group was lower than no readmission group (P ＜0.05). The proportion of node positive cases in readmission group was much higher than no readmission group (P ＜0.01).The number of readmission for complications reduced gradually in the first three months,and reached a second peak in the sixth and seventh month. Median survival was lower for the readmission group compared with the no readmission group (21 versus 46 months,P=0.024).Conclusion These results may assist in both anticipating and facilitating postoperative care as well as managing patient expectations。

Abstract：Background Human embryonic stem cells have prospective uses in regenerative medicine and drug screening. Every human embryonic stem cell line has its own genetic background,which determines its specific ability for differentiation as well as susceptibility to drugs. It is necessary to compile many human embryonic stem cell lines with various backgrounds for future clinical use,especially in China due to its large population. This study contributes to isolating new Chinese human embryonic stem cell lines with clarified directly differentiation ability.Methods Donated embryos that exceeded clinical use in our in vitro fertilization-embryo transfer (IVF-ET) center were collected to establish human embryonic stem cells lines with informed consent. The classic growth factors of basic fibroblast growth factor (bFGF) and recombinant human leukaemia inhibitory factor (hLIF) for culturing embryonic stem cells were used to capture the stem cells from the plated embryos. Mechanical and enzymetic methods were used to propogate the newly established human embryonic stem cells line. The new cell line was checked for pluripotent characteristics with detecting the expression of stemness genes and observing spontaneous differentiation both in vitro and in vivo. Finally similar step-wise protocols from definitive endoderm to target specific cells were used to check the cell line's ability to directly differentiate into pancreatic and hepatic cells.Results We generated a new Chinese human embryonic stem cells line,CH1. This cell line showed the same characteristics as other reported Chinese human embryonic stem cells lines:normal morphology,karyotype and pluripotency in vitro and in vivo. The CH1 cells could be directly differentiated towards pancreatic and hepatic cells with equal efficiency compared to the H1 cell line.Conclusions This newly established Chinese cell line,CH1,which is pluripotent and has high potential to differentiate into pancreatic and hepatic cells,will provide a useful tool for embryo development research,along with clinical treatments for diabetes and some hepatic diseases。

Abstract：Background This paper presents a retrospective study to classify patients into subtypes of the treatment according to baseline and longitudinally observed values considering heterogenity in migraine prognosis. In the classical prospective clinical studies,participants are classified with respect to baseline status and followed within a certain time period.However,latent growth mixture model is the most suitable method,which considers the population heterogenity and is not affected drop-outs if they are missing at random. Hence,we planned this comprehensive study to identify prognostic factors in migraine.Methods The study data have been based on a 10-year computer-based follow-up data of Mersin University Headache Outpatient Department. The developmental trajectories within subgroups were described for the severity,frequency,and duration of headache separately and the probabilities of each subgroup were estimated by using latent growth mixture models. SAS PROC TRAJ procedures,semiparametric and group-based mixture modeling approach,were applied to define the developmental trajectories.Results While the three-group model for the severity (mild,moderate,severe) and frequency (low,medium,high) of headache appeared to be appropriate,the four-group model for the duration (low,medium,high,extremely high) was more suitable. The severity of headache increased in the patients with nausea,vomiting,photophobia and phonophobia.The frequency of headache was especially related with increasing age and unilateral pain. Nausea and photophobia were also related with headache duration.Conclusions Nausea,vomiting and photophobia were the most significant factors to identify developmental trajectories.The remission time was not the same for the severity,frequency,and duration of headache。

Abstract：Background Mounting evidence suggests that tumors are histologically heterogeneous and are maintained by a small population of tumor cells termed cancer stem cells. CD133 has been identified as a candidate marker of cancer stem cells in laryngeal carcinoma. This study aimed to analyze the chemoresistance of CD133+ cancer stem cells.Methods The response of Hep-2 cells to different chemotherapeutic agents was investigated and the expression of CD133 was studied. Fluorescence-activated cell sorting analysis was used to identify CD133,and the CD133+ subset of cells was separated and analyzed in colony formation assays,cell invasion assays,chemotherapy resistance studies,and analyzed for the expression of the drug resistance gene ABCG2.Results About 1%-2% of Hep-2 cells were CD133+ cells,and the CD133+ proportion was enriched by chemotherapy.CD133+ cancer stem cells exhibited higher potential for clonogenicity and invasion,and were more resistant to chemotherapy. This resistance was correlated with higher expression of ABCG2.Conclusions This study suggested that CD133+ cancer stem cells are more resistant to chemotherapy. The expression of ABCG2 could be partially responsible for this. Targeting this small population of CD133+ cancer stem cells could be a strategy to develop more effective treatments for laryngeal carcinoma。

Abstract：Background The high mobility group A1 (HMGA1) proteins are architectural transcription factors found to be overexpressed in lung adenocarcinoma. Lentivirus-mediated RNA interference (RNAi) technology is a powerful tool for silencing endogenous or exogenous genes in human cancer cells. Our preliminary study shows that gemcitabine inhibits growth of the human lung cancer cell line SPCA-1 and induces apoptosis,and this effect might link with down-regulation of HMGA1 expression. This study aimed to investigate the chemosensitivity change of the lung adenocarcinoma cells SPCA-1 after HMGA1 inhibition by lentivirus-mediated RNAi.Methods We studied a highly malignant lung adenocarcinoma cell line (SPCA-1 cells). Lentiviral short-hairpin RNA (shHMGA1) expression vectors targeting HMGA1 were used for generation of lentiviral particles. After being transfected into the lung adenocarcinoma cell line SPCA-1,the expression of HMGA1 was determined by retrotranscriptase polymerase chain reaction (RT-PCR) and Western blotting. The effect of gemcitabine on proliferation of positive and negative cells was observed by methyl thiazolyl tetrazolium (MTT) assay and clonogenic survival assay. Apoptosis was observed by flow cytometery. Chemosensitivity to gemcitabine was determined by IC50 analysis. Caspase activity was quantitated by a caspase colorimetric protease assay kit.Results HMGA1-siRNA silenced its target mRNA specifically and effectively in SPCA-1 cells. The apoptotic rates of the scramble control group were (7.43±0.21)%,(11.00±0.20)%,and (14.93±0.31)%,and the apoptotic rates in the silenced group were (9.53±0.42)%,(16.67±0.45)%,and (25.40±0.79)% under exposure to 0.05,0.5 and 5.0 μg/ml of gemcitabine (P ＜0.05). The IC5o of the silenced group was (0.309±0.003) μg/ml which was significantly lower than in the scramble control group,(0.653±0.003) μg/ml (P ＜0.05). It reduced cancer cell proliferation and increased apoptotic cell death after being treated with gemcitabine compared with the scramble control group. HMGA1 silencing resulted in reduction in the phosphorylation of Akt,and promoted the activation of caspases 3,8 and 9 upon exposure to gemcitabine.Conclusions Lentivirus-mediated RNA interference of HMGA1 enhanced chemosensitivity to gemcitabine in lung adenocarcinoma cells. The mechanism may be associated with the PI-3K/Akt signal pathway. HMGA1 may represent a novel therapeutic target in lung cancer。

Abstract：Background Alpha 2A adrenergic receptor (AR) is a subtype of α2 AR belonging to G protein-coupled receptors,and exerts a variety of biological effects. Recent studies have demonstrated that the α2A AR activation was closely related with inflammatory reaction. The present study aimed to investigate the influence of α2A AR antagonist,yohimbine,on the severity of endotoxin-induced acute lung injury in rats.Methods A total of 72 male Sprague-Dawley rats were randomly divided into three groups:control group,lipopolysaccharide (LPS) group and LPS + yohimbine group. Rats were intratracheally administrated with normal saline or LPS (300 μg),and the rats in the LPS + yohimbine group were treated with additional yohimbine (2 mg/kg,i.p) soon after LPS administration. Six,24 and 48 hours after treatment,arterial blood gas analysis was carried out,and optical microscopy was performed to evaluate pathological changes in the lung,and lung injury score was assessed. The count of white blood cells in bronchoalveolar lavage fluid (BALF) was determined. The levels of norepinephrine,tumor necrosis factor (TNF)-α,interleukin (IL)-1β and IL-6 in BALF were measured with enzyme-linked immunosorbent assay.Immunocytochemistry was performed for the detection of α2AAR on inflammatory cells in BALF.Results When compared with the control group,the oxygenation index in the LPS group was significantly decreased,and white blood cell count,the lung histopathological scores,levels of norepinephrine and IL-6 as well as α2A AR expression on inflammatory cells in the BALF were dramatically increased at different time points,and the concentrations of TNF-α and IL-1β were also increased except at 48 hours after LPS administration. The oxygenation index decreased while white blood cell count in BALF and the lung histopathological scores were obviously increased in the LPS +yohimbine group. The level of norepinephrine in BALF was increased at each time interval in the LPS + yohimbine group,and so did the levels of TNF-α,IL-1β and IL-6 at 6 and 48 hours after LPS administration respectively. When compared with the LPS group,the oxygenation index,white blood cell count,the lung histopathological scores and the level of IL-6 in the LPS + yohimbine group were significantly improved at each time interval,and the concentrations of TNF-α and IL-1β were also lower at 24 hours of LPS administration (all P ＜0.05). Correlation analysis indicated the level of norepinephrine was related to the levels of TNF-α,IL-1β and IL-6 in the BALF and the lung histopathological scores (r=0.703,r=0.595,r=0.487 and r=0.688,respectively,P ＜0.001) and the intensity scores of immunoreactivity to α2A AR on inflammatory cells were also associated with the levels of TNF-α,IL-1β and IL-6 as well as the lung histopathologial scores (r=0.803,r=0.978,r=0.716 and r=0.808,respectively,P ＜0.001).Conclusions Yohimbine can inhibit TNF-α,IL-1β and IL-6 overproduction and relieve the severity of pulmonary inflammation induced by endotoxin,which is maybe mediated by blockade of α2A AR on inflammatory cells。

Abstract：Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China,it is necessary to investigate the risk of positive surgical margin and biochemical recurrence,and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study,we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.Methods From 2000 to 2009,149 patients with prostate cancer received radical prostatectomy and were followed up.Among these patients,111 received retropubic radical prostatectomies,38 received laparoscopic radical prostatectomies.All patients were followed-up on in the 3rd month,6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint,serum prostate-specific antigen (PSA),full biochemical test and uroflowmetry was acquired.Results The average age was (69.0±6.1) years,preoperative average serum PSA was (10.1 ±12.1) ng/ml and average Gleason score was 6.4±1.3. The incidence of total complications was about 47.7%,the incidence of the most common complication,bladder outlet obstruction,was about 26.8%,and that of the second most common complication,urinary stress incontinence,was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4±17.6) ng/ml),average Gleason score (7.1±1.3) and pathological T stage score (7.0±1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0±5.8) ng/ml,6.0±1.2 and 5.4±1.4,respectively) (P=0.004,P=0.001 and P=0.001,respectively). A univariate analysis showed that positive surgical margin had a positive statistical association with serum PSA (P=0.007),Gleason score (P ＜0.001),pathological T stage score (P ＜0.001) and biochemical recurrence (BCR) (P=0.035). The most common location of a positive surgical margin was in the apex of the prostate,which was about 63% (36/57). Sixty-four percent (23/36) of patients with positive surgical margin in apex were also involved in prostate lobe;other locations were prostate lobe (23%,13/57),seminal vesicle (9%,5/57). The multivariate analysis showed that positive surgical margin had a positive statistical association with Gleason score (P=0.03) and pathological T stage score (P=0.02). Neither univariate analysis or multivariate analysis showed any statistical relationship between BCR and any other risk factors covered in this study.Conclusions Positive surgical margin is associated with pre-operative PSA,Gleason score,pathological T stage and biochemical recurrence. Earlier diagnosis and improved techniques of dissection of prostate apex could decrease the incidence of positive surgical margins。

Abstract：Background Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is the most frequent type of non-Hodgkin's lymphoma (NHL) that primarily involves the lungs. It represents a rare entity accounting for less than 1%of all NHLs and the clinical features have yet to be clearly elucidated.Methods The clinicopathological features and radiological data of 23 patients with pulmonary MALT lymphoma confirmed by biopsy in Peking Union Medical College Hospital from January 2001 to December 2010 were retrospectively analyzed.Results At diagnosis,there were 15 women and 8 men. The median age was 55.1 years (range,37-73 years). One patient had a history of primary Sjoren's syndrome,another patient had a history of systemic lupus erythematosus (SLE)and secondary Sjoren's syndrome. One patient had a history of previous hematological malignancy (lymphomatoid papulosis in complete remission). In addition,one patient had simultaneous gastric and pulmonary involvement and one patient had simultaneous parotid gland and pulmonary involvement. The other 21 patients had disease localized within the lungs at the initial diagnosis. Among them,10 patients were asymptomatic while two had non-specific pulmonary symptoms. There were six patients with fever,four patients had low grade fever and two patients had moderate-high fever.The most common manifestations were cough (n=10),expectoration (n=8),exertional dyspnea (n=8),fatigue (n=7),body weight loss (n=6) and crackles (n=6). Blood tests showed low to moderate anemia in six cases,elevated erythrocyte semimentation rate (ESR) in 10 cases and only one patient had elevated lactate dehydrogenase (LDH). High resolution computed tomography (HRCT) of the chest revealed bilateral disease in 13 patients,air space consolidation with or without air bronchogram in 15 patients,lung nodules in 15 patients,patchy opacities in eight patients,lung mass in three patients and pleural effusion in five patients. Flexible fiberoptic bronchoscopy showed multiple nodules in five patients and almost normal morphology in 18 patients. Pathological diagnosis was obtained by bronchial biopsies in three cases,by CT-guided percutaneous lung biopsies in 11 cases and by surgical biopsies in nine cases. Of the 23 patients,one remained untreated,while 22 received various combinations of treatment (surgery alone in three patients,surgery plus chemotherapy in six patients,and chemotherapy alone in 13 patients). Twenty-one patients remained alive during the median follow-up of 23 (0.25-84) months,while one patient died from unknown causes,one patient died from lung infection.Conclusions Pulmonary MALT lymphoma tends to occur in old-aged females and to be limited to the lungs on the initial diagnosis and LDH's level was normal in most patients. Lung nodules,patchy opacities and air space consolidation

Abstract：Background Appropriate planning and staffing for medical services at large-scale athletic events is essential to provide for a safe and successful competition. There are few well-documented accounts describing the demand for such services.The present study provided the data from the Beijing 2008 Olympics and Paralympics,with a view to provide the guidance for planning future events.Methods A total of 22 029 and 8046 patients,who received medical care from a physician at an Olympic or Paralympic medical station,were included. The patient proportion among different personnel,various disease proportions at different kinds of venues,and the disease spectrum at specified venues at the Olympics and Paralympics were analyzed.Results At both games,the patient proportion varied by accreditation status. The staff accounted for the largest number of visits at the Olympics (44.83%) and Paralympics (36.95%),with respiratory diseases the most common. Various disease spectrums were discovered at the different kinds of venues. Surgical diseases were the most frequently listed reason for visits,both at competition and non-competition venues,especially during the Paralympics. The sport-related injuries accounted for a majority of the surgical cases during both games. At training venues,ear nose and throat diseases accounted for the greatest number of visits during both games.Conclusions During both games,people contracted different diseases at different venues. Adequate surgeons should be designated to offer assistance mostly in trauma situations. Appropriate numbers of physicians in respiratory diseases and otorhinolaryngology is of great importance。

Abstract：Background Sevoflurane is currently used as a volatile inhalation anesthetic with many clinical advantages. A representative degradation product,compound A,was quantitatively measured to investigate whether there are different reactions between two kinds of water content sevoflurane formulations with different carbon dioxide (CO2) absorbents.Methods A closed-circle breathe bag with the Dr(a)ger Fabius GS anesthesia apparatus was used as an artificial rubber lung. The experiments were grouped according to different sevoflurane formulations:group A:higher-water sevoflurane (Ultane);group B:lower-water sevoflurane (Sevoness). During the experiment,CO2 (200 ml/min) was continually perfused to keep the end-tidal pressure of CO2 (PETCO2)at 35-45 mmHg. The artificial ventilation was set to 6 L/min,and the breathing rate at 12 breaths/min. The circuit was operated with constant fresh gas flow rate (1 L/min) and the sevoflurane concentration was kept at 1.0 minimum alveolar concentration (MAC) for 240 minutes. At 0,10,20,30,60,90,120,180 and 240 minutes,gas was collected from the Y-piece. Gas chromatography/mass spectrometry (GC/MS)was used to quantify the major degradation product,compound A,with different water content sevoflurane. PETCO2 and sevoflurane concentration,and the temperature of the canister were continuously monitored during the experiment.Results There were no significant differences in PETCO2 and sevoflurane concentrations between the two groups.Dr(a)gersorb 800 plus produced the highest concentrations of compound A compared with other sodalimes,and Sevoness in Dr(a)gersorb 800 plus generated more compound A than Ultane (P ＜0.05). There were significant differences in the peak and average compound A concentrations between Ultane and Sevoness with Dr(a)gersorb 800 plus (P ＜0.05),while the compound A concentration produced by Sodasorb grase and sofonolime in the two groups showed no significant difference (P ＞0.05). In the same group,the peak and average of compound A concentration produced by Sodasorb grase and sofonolime showed significant difference with Dr(a)gersorb 800 plus (P ＜0.05).Conclusion The water content of sevoflurane and potassium hydroxide in CO2 absorbent can influence compound A production。

Abstract：Background In the past two decades enormously scientific researches on posttraumatic stress disorder (PTSD) have been undertaken and many related meta-analyses have been published. Citation analysis was used to get comprehensive perspectives of meta-analysis articles (MA articles) on PTSD for the purpose of facilitating the researchers,physicians and policy-makers to understand the PTSD.Methods MA articles on PTSD in any languages from January 1980 to March 2009 were included if they presented meta-analytical methods and received at least one citation recorded in the Web of Science (WoS). Whereas studies,in which any effect sizes of PTSD were not distinguished from other psychological disorders,were excluded. Citations to and by identified MA articles were documented basing on records in WoS. Citation analysis was used to examine distribution patterns of characteristics and citation impact of MA articles on PTSD. Canonical analysis was used to explore the relationship between the characteristics of MA articles and citation impact.Results Thirty-four MA articles published during 1998 and 2008 were identified and revealed multiple study topics on PTSD:10 (29.4%) were about epidemiology,13 (38.2%) about treatment or intervention,6 (17.6%) about pathophysiology or neurophysiology or neuroendocrine,3 (8.8%) about childhood and 2 (5.9%) about psychosocial adversity. Two articles cited most frequently with 456 and 145 counts were published in Journal of Consulting and Clinical Psychology by Brewin (2000) and Psychological Bulletin by Ozer (2003),respectively. Mean cited count was 7.48±10.56and mean age (year 2009 minus article publication year) was (4.24±2.91) years. They had been cited approximately by 67 disciplines and by authors from 42 countries or territories. Characteristics of meta-analysis highly correlated with citation impact and reflected by canonical correlation of 0.899 (P ＜0.000 01).Conclusions The age of MA articles predicted their citation impact. Citation analysis would serve to capture the global perspectives and topics of MA articles on PTSD.

Abstract：Background Atypical meningioma accounts for about 4.7% to 7.2% of all kinds of meningiomas,which is invasive with a relatively high recurrence and mortality. The objective of this study was to investigate the clinical manifestations and therapeutic strategies of atypical meningioma.Methods A total of 74 patients who underwent surgical treatment and pathologically confirmed for atypical meningioma in Neurosurgery Department of Beijing Tiantan Hospital from January 2003 to December 2008 were enrolled in this study.The characteristics of the tumors as well as therapeutic regimens and follow-up data were reviewed. After surgery,56patients underwent radiotherapy. Patients were followed up for about 3.5 years (range,0.5-6.0 years),and 58 patients completed follow-up.Results Of the 58 patients who completed follow-up,good recovery was found in 30,neurological dysfunction in 15,and death in 13. Of the 58 patients,21 had recurrent meningioma and 18 underwent a second surgery.Conclusions Atypical meningioma is difficult to manage,with a high recurrence rate and poor survival. The extent of tumor resection and histological grade are the key determinants of outcome. Radiation therapy can be used as an adjunctive treatment after total or partial resection。

Abstract：Although we have made great progress in understanding tumor pathogenesis through studies on gene mutation and cancer stem cells,the clinical outcome continues to be unfavorable for many cancers. The biological characteristics of cancers including autonomous proliferation,invasion,metastasis,and post-treatment recurrence result from interactions between cancers and their microenvironment,which involves complex molecular interactions. However,the patterns underlying these complex mechanisms are still unclear. In this review,several potential patterns in the occurrence and development of cancers were elucidated. The core relationship between a tumor and its host microenvironment is the nutritional and signal interactions between cancer stem cells and endothelial cells. The nutritional interaction between the cancer and the host triggers the invasion and metastasis of cancers;the imbalance between tissue responses of cancer stem cells and the feedback regulation of self-renewal or post-injury repair leads to the autonomous proliferation of cancers. Cancers can restore the growth balance and maintain homeostasis,depending on residual nutritional factors,and these abilities are the determinants of therapeutic efficacy. These findings have been beneficial to developing novel strategies for cancer therapies。

Abstract：We report the effects of biventricular pacing in a patient with hypertrophic obstructive cardiomyopathy (HOCM) refractory to medical therapy. A 58-year-old man with HOCM had suffered from dyspnea,chest pain and palpitation for 5 years. Cardiac catheterization showed a left ventricular outflow tract (LVOT) gradient of 80 mmHg. He refused septal myomectomy and the septal ablation was not available. Based on intraoperative pressure measurements,he was implanted with biventricular pacing and LVOT gradient decreased to 10 mmHg. During the follow-up period of 6 months, the patient's symptoms were markedly improved. Biventricular pacing may be an alternative therapy for patients with HOCM。

Abstract：A 46,XY gonadal dysgenetic woman gave birth to two healthy girls following vitrified oocytes donation. The loss of SRY gene was considered as the cause of this patient. Although similar cases have been reported about pregnancies of 46,XY pure gonadal dysgenetic women,successful delivery from vitrified oocytes has been hardly reported yet. Oocytes vitrification technique provides a beneficial way by saving superfluous oocytes from the pregnancy patients to these women who need。

Abstract：Subcutaneous implantation of benign thyroid tissue is a rare complication of thyroid surgery. Here the authors report two cases of subcutaneous implantation of benign thyroid tissue following conventional thyroid surgery. The diagnosis and differential diagnosis of cervical subcutaneous thyroid tissue implantation,and their clinical pathological characteristics are retrospectively investigated. The mechanism of the implantation process is analyzed. The management of patient with cervical subcutaneous soft tissue implantation is also discussed.Institute of Social Medicine and Family Medicine,School of Medicine,Zhejiang University,Hangzhou,Zhejiang 310058,

Abstract：Refractory gelastic seizure is one of the most common clinical manifestations in patients with hypothalamic hamartoma (HH) and HH is usually regarded as the epileptogenic focus. A young female patient with a small HH and refractory seizures is reported here. However,both the seizure semiology and results of electroencephalogram monitoring indicated the right temporal region was the epileptogenic focus. Thus a standard right anterior temporal lobectomy was performed while the hamartoma preserved. There was a marked improvement in both seizure frequency and quality of life during a 13-month follow-up. The outcome supported the concept that independent epileptogenic focus outside of the hypothalamus might occur in patients with HH。

To the editor:We read with attention the research article titled Long-term prognostic value of analysis of sympathetic drive by myocardial 123I-metaiodobenzylganidine scintigraphy in chronic heart failure by Cao et al.1 Cardiac metaiodobenzylguanidine 123iodine (123I-MIBG) scintigraphy was performed in 64 patients with dilated cardiomyopathy,and its prognostic value was assessed in a 54-month follow-up period.The cut-off value was set as 1.68for the heart-mediastinum ratio (HMR).The values below 1.68were emphasized to have an excellent predictive value for the prognosis。

To the editor:With great interest I have read the recent paper by Cui and colleagues regarding optimized criteria for microscopic smear review after automated hematology analysis.1Although they have reached a certain level of optimization with their approach,I believe that considerable further optimization could have been achieved if the clinical relevance of performing smear reviews was taken into account.In my opinion,smear review should only be performed when the objective is to find clinically relevant abnormalities and as all hematologists know,not all morphologic abnormalities that can be seen microscopically,are clinically relevant.For example,it has been demonstrated that finding left shift or counting band neutrophils has no additional value over reporting absolute neutrophil counts.2 Thus laboratories should not spend time on finding morphological abnormalities that do not have any effect on the diagnostic or therapeutic process。