2012年 · 第125卷第13期

Abstract：Background Tetralogy of Fallot (TOF) is the most common malformation of children with an incidence of approximately 10％ of congenital heart disease patients.There can be a wide spectrum to the severity of the anatomic defects,which include ventricular septal defect,aortic override,right ventricular outflow tract obstruction,and right ventricular hypertrophy.We examined the relationship between right ventricular hypertrophy in patients with TOF and the gene expression of factors in the mitogen-activated protein kinase (MAPK) signal pathway.Methods To gain insight into the characteristic gene(s) involved in molecular mechanisms of right ventricular hypertrophy in TOF,differential mRNA and micro RNA expression profiles were assessed using expression-based micro array technology on right ventricular biopsies from young TOF patients who underwent primary correction and on normal heart tissue.We then analyzed the gene expression of the MAPK signal pathway using reverse transcription-polymerase chain reaction (RT-PCR) in normals and TOF patients.Results Using the micro RNA chip V3.0 and human whole genome oligonucleotide microarray V1.0 to detect the gene expression,we found 1068 genes showing altered expression of at least two-fold in TOF patients compared to the normal hearts,and 47 micro RNAs that showed a significant difference of at least two-fold in TOF patients.We then analyzed these mRNAs and micro RNAs by target gene predicting software Microcosm Targets version 5.0,and determined those mRNA highly relevant to the right ventricular hypertrophy by RT-PCR method.There were obvious differences in the gene expression of factors in the MAPK signal pathway when using RT-PCR,which was consistent to the results of the cDNA microarray.Conclusion The upregulation of genes in the MAPK signal pathway may be the key events that contribute to right ventricular hypertroohv and stunted angiogenesis in patients with TOF。

Abstract：Background Early loading statin therapy before percutaneous coronary intervention (PCI) is associated with reduced mortality and periprocedural myocardial injury.The aim of this study was to study the effect of rosuvastatin loading therapy before PCI in female patients with non-ST-segment elevation acute coronary syndrome (NSTEACS).Methods Consecutive 117 female patients with NSTEACS were randomly assigned to either the group of rosuvastatin loading before PCI (20 mg 12 hours before angioplasty procedure,with a further 10 mg dose 2 hours before procedure,the loading dose group,n=59) or the no rosuvastatin treatment group before PCI (control group,n=58).Periprocedural myocardial injury,periprocedural changes of high sensitivity C-reactive protein (hs-CRP),interleukin (IL)-1,IL-6,and tumor necrosis factor (TNF)-α in serum and the incidence of major adverse cardiac events (MACE) 3 months and 6 months later were assessed.Results The incidence of periprocedural myocardial injury was higher in control group than loading dose group (CKMB:10.17％ vs.25.86％,P=0.027; Troponin Ⅰ:11.86％ vs.29.31％,P=0.019).MACE occurred in 1.69％ of patients in loading dose group and 12.07％ of those in control group 3 months after procedure (P=0.026),3.39％ vs.17.24％ at 6 months (P=0.014).The levels of hs-CRP,IL-1,IL-6,and TNF-α in serum were not significantly different between the two groups before PCI,but after PCI they were significantly higher in control group.Conclusions High-dose rosuvastatin loading before PCI significantly reduced periprocedural myocardial injury and periprocedural inflammation cytokines release and improved 3-month and 6-month clinical outcomes in female patients with NSTEACS who underwent PCI。

Abstract：Background Recent evidence has implicated the gene for phosphodiesterase 4D (PDE4D) as susceptibility gene for ischemic stroke (IS) in lcelandic population.However,there are few reports on the associations between PDE4D gene polymorphisms and IS in Chinese individuals.The present study aimed to investigate the possible association of genetic polymorphisms in PDE4D gene with IS in Henan Han population.Methods A total of 400 patients with IS and 400 matched controls were examined using a case-control design.Two single nucleotide polymorphism (SNPs) (rs918592 and rs2910829) in PDE4D gene were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.Odds ratios (OR) and 95％ confidence intervals (95％ Cl) were calculated to test the association between the genetic factors and IS.Genetic parameter and association studies were carried out with SPSS 16.0.Results Among the two SNPs tested,the rs918592 was significantly associated with IS (OR:1.351,95％ Cl:1.110-1.645),especially in male patients (OR:1.427,95％ Cl:1.105-1.844).Haplotype analysis showed that A-T was associated with an increased risk of the IS (OR:2.114,95％ Cl:2.005-2.230) while G-T was associated with decreased risk of IS (OR:0.419,95％ Cl:0.302-0.583).Protecting effect of haplotype G-T was also significant in males (OR:0.264,95％ Cl:0.162-0.431).Conclusions The present study demonstrated a strong association of rs918592 with IS.Haplotype A-T increased the risk of IS while haplotype G-T had a protective effect in Henan Hen population.The association was sex-dependent with male patients showing stronger effect。

Abstract：Background Cerebral alveolar echinococcosis (CAE) grows infiltratively like a malignant tumor,causing great harm to the human body.It is possible to display mass lesions of CAE using various imaging systems,but regarding the infiltrating proliferation active regions,it is difficult to evaluate its actual range using conventional magnetic resonance imaging (cMRI).This research focused on proton magnetic resonance spectroscopy (1HMRS) techniques to find the mass and infiltration zone of CAE.We explored the marginal zone (MZ) of CAE nearly close to the actual infiltrating scope,to provide reliable images for clinical purposes,to overcome shortcomings of cMRI,to formulate beneficial clinical surgical plans and assess prognosis.Methods Between September 2005 and May 2011,15 patients who were suffering from CAE (36 effective lesions altogether) were examined by 1HMRS at the first affiliated hospital of Xinjiang Medical University.Multi-voxel 1HMRS was acquired with a 1.5T MRI scanner.Concentrations and the ratios of the metabolites of CAE were calculated.Furthermore,changes in the concentrations of the metabolites containing N-acetyl-aspartic-acid (NAA),choline (Cho),creatine (Cr),lipids and lactate (Lip+Lac) and the ratios of Cho/Cr,NAA/Cr,(Lip+Lac) /Cr were compared in the substantial region,0-10 mm MZ,and 11-20 mm MZ of the infiltration zone,as well as the corresponding contralateral part of the normal brain parenchyma area (control group).Results In this study,the ratios of Cho/Cr in the substantial region,0-10 mm MZ of infiltration zone and the control group were 1.78±0.70,1.90±0.54,and 0.78±0.15,respectively; the ratios of NAA/Cr were 1.60±0.20,1.80±0.42,2.24±0.86,respectively; the ratios of (Lip+Lac)/Cr were 25.69±13.84,25.18±16.03,and 0.61±0.15,respectively.From the control group,11-20 mm MZ to 0-10 mm MZ and the substantial region of CAE,the concentrations of the metabolites showed that NAA,and Cho decreased gradually and markedly.But (Lip+Lac) increased gradually and markedly.The ratios of Cho/Cr and NAA/Cr,(Lip+Lac)/Cr were statistically significant (P ＜0.0083) between the substantial region and the control group,as well as between the 0-10 mm MZ and the control group.The ratios of Cho/Cr and NAA/Cr,(Lip+Lac)/Cr displayed no statistically significant differences (P ＞0.0083) between the substantial region and the 0-10 mm MZ.Conclusions There was a pathological spectrum surrounding the infiltration zone of CAE.Multi-voxel 1HMRS has great clinical value for discaming the main lesion and the infiltration zone of CAE。

Abstract：Background Acute hypoxemic respiratory failure (AHRF) often develops acute respiratory distress syndrome (ARDS),and its incidence and mortalities in critically ill pediatric patients in China were 2％ and 40％ respectively.This study aimed at prospectively investigating incidence,causes,mortality and its risk factors,and any relationship to initial tidal volume (VT) levels of mechanical ventilation,in children ≤5 years of age with AHRF and ARDS.Methods In 12 consecutive months in 23 pediatric intensive care units (PICU),AHRF and ARDS were identified in those requiring ＞12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge.ARDS was diagnosed according to the American-European Consensus definitions.The mortality and ventilation free days (VFD) were measured as the primary outcome,and major complications,initial disease severity,and burden were measured as the secondary outcome.Results In 13 491 PICU admissions,there were 439 AHRE,of which 345 (78.6％) developed ARDS,resulting in incidences of 3.3％ and 2.6％,and corresponding mortalities of 30.3％ and 32.8％ respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia (62.9％) and sepsis (33.7％) as major underlying diseases respectively.No association was found in VT levels during the first 7 days with mortality,nor for VT at levels ＜6,6-8,8-10,and ＞10 ml/kg in the first 3 days with mortality or length of VFD.By binary Logistic regression analyses,higher pediatric risk of mortality score Ⅲ,higher initial oxygenation index,and age ＜1 year were associated with higher mortality or shorter VFD in AHRF.Conclusions The incidence and mortalities of AHRF and ARDS in children ≤5 years were similar to or lower than the previously reported rates (in age up to 15 years),associated with initial disease severity and other confounders,but causal relationship for the initial VT levels as the independent factor to the major outcome was not found。

Abstract：Background Acute-on-chronic hepatitis B liver failure (ACLF-HBV) is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome.The aim of this study was to evaluate the short-term prognostic predictability of the model for end-stage liver disease (MELD),MELD-based indices,and their dynamic changes in patients with ACLF-HBV,and to establish a new model for predicting the prognosis of ACLF-HBV.Methods A total of 172 patients with ACLF-HBV who stayed in the hospital for more than 2 weeks were retrospectively recruited.The predictive accuracy of MELD,MELD-based indices,and their dynamic change (△) were compared using the area under the receiver operating characteristic curve method.The associations between mortality and patient characteristics were studied by univariate and multivariate analyses.Results The 3-month mortality was 43.6％.The largest concordance (c) statistic predicting 3-month mortality was the MELD score at the end of 2 weeks of admission (0.8),followed by the MELD:sodium ratio (MESO) (0.796) and integrated MELD (iMELD) (0.758) scores,△MELD (0.752),△MESO (0.729),and MELD plus sodium (MELD-Na) (0.728) scores.In multivariate Logistic regression analysis,the independent factors predicting prognosis were hepatic encephalopathy (OR=-3.466),serum creatinine,international normalized ratio (INR),and total bilirubin at the end of 2 weeks of admission (OR=10.302,6.063,5.208,respectively),and cholinesterase on admission (OR=0.255).This regression model had a greater prognostic value (c=0.85,95％ Cl 0.791-0.909) compared to the MELD score at the end of 2 weeks of admission (Z=4.9851,P=-0.0256).Conclusions MELD score at the end of 2 weeks of admission is a useful predictor for 3-month mortality in ACLF-HBV patients.Hepatic encephalopathy,serum creatinine,international normalized ratio,and total bilirubin at the end of 2 weeks of admission and cholinesterase on admission are independent predictors of 3-month mortality。

Abstract：Background Endometrial polyps (EPs) occur in approximately 34.9％ of infertile women.Transvaginal sonography (TVS) is a routine,non-invasive component of fertility evaluation.Most ultrasonographic studies of EPs have focused on abnormal uterine bleeding; few have assessed EPs in infertile women.Furthermore,no studies have explored endometrial thickness and its correlation with EPs in infertile women.This study aimed to assess transvaginal sonographic assessment of endometrial thickness and its value in diagnosis and prediction of EPs in infertile women.Methods A retrospective study on 314 infertile women was conducted from June to December 2010.After TVS,endometrial biopsies were obtained by hysteroscopy.Pathologically confirmed EPs were taken as the gold standard.Results Based on recognized criteria,TVS had a sensitivity of 37.04％,specificity of 98.71％,positive predictive value of 90.91％,negative predictive value of 81.85％,and accuracy of 82.80％ for diagnosing EPs.Mean endometrial thickness was significantly different in patients with and without EPs (P=0.0001).In women in the mid and late-proliferative phase,the endometrial thickness was significantly greater in those with EPs than in those without them (P=0.0001 and 0.024).Receiver operating characteristic analysis showed that endometrial thickness had a sensitivity of 85.2％ and specificity of 38％ in the diagnosis of EPs,the area under the curve being 0.64.In the mid-proliferative phase,sensitivity was up to 90.9％,the area under the curve being 0.70.Conclusions rvs is poor at detecting EPs in infertile women; however,transvaginal sonographic measurement of endometrial thickness is helpful.It is suggested that the diagnostic value of TVS for EPs in infertile women could be improved by adding the measurement of endometrial thickness to the variables that are routinely assessed。

Abstract：Background Multi-locus sequence typing (MLST) is widely used to explore the population structure of numerous bacterial pathogens.However,for genotypically-restricted pathogens,the sensitivity of MLST is limited by a paucity of variation within selected loci.For Bartonella henselae (B.henselae),although the MLST scheme currently used has been proven useful in defining the overall population structure of the species,its reliability for the accurate delineation of closely-related sequence types,between which allelic variation is usually limited to,at most,one or two nucleotide polymorphisms.Exploitation of high-throughput sequencing data allows a more informed selection of MLST loci and thus,potentially,a means of enhancing the sensitivity of the schemes they comprise.Methods We carried out SOLiD resequencing on 12 representative B.henselae isolates and explored these data using single nucleotide polymorphism (SNP) analysis.We determined the number and distribution of SNPs in the genes targeted by the established MLST scheme and modified the position of loci within these genes to capture as much genetic variation as possible.Results Using genome-wide SNP data,we found the distribution of SNPs within each open reading frame (ORF) of MLST loci,which were not represented by the established B.henselae MLST scheme.We then modified the position of loci in the MLST scheme to better reflect the polymorphism in the ORF as a whole.The use of amended loci in this scheme allowed previously indistinguishable ST1 strains to be differentiated.However,the diversity of B.henselae was still rare in China.Conclusions Our study demonstrates the use of SNP analysis to facilitate the selection of MLST loci to augment the currently-described scheme for B.henselae.And the diversity among B.henselae strains in China is markedly less than that observed in B.henselae populations elsewhere in the world。

Abstract：Background Increasing prevalence of Staphylococcus aureus (S.aureus),particularly methicillin-resistant S.aureus (MRSA) has been reported in China.In this study,we investigated the drug resistance characteristic,genetic background,and molecular epidemiological characteristic of S.aureus in Changsha.Methods Between January 2006 and December 2008,293 clinical isolates of S.aureus were collected from 11 hospitals in Changsha and identified by the Vitek-2 system.All the isolates were verified as MRSA by PCR amplification of both femA and mecA genes.K-B disk method was used to test drug sensitivity of S.aureus to antibiotics.Pulsed-field gel electrophoresis (PFGE) was performed for genotypic and homologous analysis of 115 isolates randomly selected from the original 293 clinical S.aureus isolates.Results S.aureus was highly resistant to penicillin,ampicillin,erythromycin,and ctindamycin with resistant rates of 96.6％,96.6％,77.1％,and 67.2％ respectively.All the isolates were susceptible to tecoplanin,vancomycin,and linezolid.MRSA accounted for 64.8％ (190/293) of all the S.aureus strains.The 115 S.aureus isolates were clustered into 39 PFGE types by PFGE typing,with 13 predominant pattems (designated types A to M) accounting for 89 isolates.The most prevalent PFGE type was type A (n=56,48.7％) and 100.0％ of type A strains were MRSA.PFGE type A included 13 subtypes,and the most prevalent subtype was subtype A1 (46.4％,26/56).Strains with PFGE type A were isolated from eight hospitals (8/11),and both subtypes A1 and A4 strains were isolated in a university hospital.Conclusions Clinical isolates of S.aureus in Changsha were resistant to multiple traditional antibiotics.There was an outbreak of PFGE type A MRSA in this area and the A1 subtype was the predominant epidemic clone.Dissemination of the same clone was an important reason for the wide spread of MRSA。

Abstract：Background Coronary artery damage from Kawasaki disease (KD) is closely linked to the dysfunction of endothelial progenitor cells (EPCs).The aim of the present study was to evaluate the therapeutic effect of EPCs transplantation in KD model.Methods Lactobacillus casei cell wall extract (LCWE)-induced KD model in C57BL/6 mice was established.The model mice were injected intravenously with bone marrow-derived in vitro expanded EPCs.Histological evaluation,number of circulating EPCs and the function of bone marrow EPCs were examined at day 56.Results Inflammation was found around the coronary artery of the model mice after 14 days,Elastin breakdown was observed after 56 days.CM-Dil labeled EPCs incorporated into vessel repairing foci was found.At day 56,the number of peripheral EPCs in the KD model group was lower than in EPCs transplanted and control group.The functional index of bone marrow EPCs from the KD model group decreased in proliferation,adhesion and migration.Increased number of circulating EPCs and improved function were observed on the EPCs transplanted group compared with model group.Conclusion Exogenously administered EPCs,which represent a novel strategy could prevent the dysfunction of EPCs,accelerate the repair of coronary artery endothelium lesion and decrease the occurrence of aneurysm。

Abstract：Background Enoxaparin is routinely used for prevention of venous thromboembolism (VTE) after total hip or knee arthroplasty.The purpose of this study was to compare the efficacy and safety of apixaban,a newly oral direct inhibitor of factor Xa versus enoxaparin.Methods We performed a meta-analysis of relevant randomized-controlled trials (RCTs) identified in PubMed,Cochrane Library,Embase China Biological Medical Literature database,Countries Journal full-text database,VIP database,and WanFang database.The primary efficacy outcome for our meta-analysis was all VTE and all-cause mortality.The secondary efficacy outcomes included major VTE,non-fatal pulmonary embolism,and mortality.The primary safety outcome was bleeding events,categorized as major,clinically relevant non-major,or minor events.Results Four RCTs,involving 14065 patients,were included in our meta-analysis.Compared to enoxaparin,thromboprophylaxis with apixaban was associated with significantly fewer VTE and all-cause mortality (8346 patients,risk ratio (RR):0.63,95％ Cl 0.42-0.95) and similar incidence of bleeding events (major bleeding,11 525 patients,RR 0.76,95％ Cl 0.43-1.33; clinically relevant non-major bleeding,11525 patients,RR 0.83,95％ Cl 0.69-1.01; and minor bleeding,11828 patients,RR 0.93,95％ Cl 0.79-1.09).However,our meta-analysis revealed similar effects of apixaban with enoxaparin for thromboprophylaxis with regard to the secondary efficacy outcomes.Conclusions Apixaban was more effective than recommended dose of enoxaparin and had a similar safety profile for thromboprophylaxis after hip and knee arthroplasty.But more evidence,especially well designed head-to-head RCTs,is needed to confirm the superior efficacy of apixaban。

Abstract：Atrial fibrillation (AF) is the most common sustained dysrhythmia in clinical practice.The bulk of evidence suggests that inflammatory processes,oxidative stress and matrix metalloproteinase are associated with development of AF.However,these agents may be involved in high mobility group box 1 protein (HMGB1).We hypothesized that HMGB1 may be a possible pathogenic link to AF.A growing body of evidence supports these hypotheses.First,the level of serum HMGB1 is significantly increased in patients with AF including paroxysmal and persistent AF.Second,HMGB1 has been identified as a new pro-inflammatory cytokine in cardiovascular diseases,along with tumor necrosis factor (TNF)-α,interleukin (IL)-6,and C-reactive protein,and there is cross-talk between HMGB1 and inflammatory cytokines.Third,oxidative stress is involved in the release of the pro-inflammatory cytokine,HMGB1,indicating there is cross-talk between oxidative stress and inflammation,and oxidative stress may reinforce the effect of inflammation on the pathogenesis of AF and inflammation may play a more important role in the pathogenesis of AF.Fourth,HMGB1 can promote matrix metalloproteinase-9 upregulation and activation.Fifth,HMGB1 receptors (receptor for advanced glycation end products,Toll-like receptor-2,4) may mediate the atrial structural remodeling or be up-regulated in patients with non-valvular AF.These results suggest that HMGB1 may participate in the pathogenesis of AF and provide a potential target for pharmacological interruption of AF。

Abstract：Epigenetic changes refer to stable alterations in gene expression with no underlying modifications in the genetic sequence itself.It has become clear that not only gene variations but also epigenetic modifications may contribute to varied diseases,including cancer.This review will provide an overview of how epigenetic factors,including genomic DNA methylation,histone modifications,and miRNA regulation,contribute to hepatocellular carcinoma (HCC) dissemination,invasion,and metastasis.Additionally,the reversal of dysregulated epigenetic changes has emerged as a potential strategy for the treatment of HCC,and we will summarize the latest epigenetic therapies for HCC。

Abstract：Objective To summarize the main findings seen on conventional and advanced magnetic resonance imaging (MRI)used to assess gray matter (GM) involvement in patients with multiple sclerosis (MS).Data sources The data used in this review were obtained mainly from studies reported in the PubMed database using the terms of multiple sclerosis,gray matter,magnetic resonance imaging.Study selection Relevant literatures on studies of GM involvement in MS patients were identified,retrieved and reviewed.Results MS is the most common chronic,disabling central nervous system disease in young adults.Although traditional thinking has considered MS to be a chronic inflammatory demyelinating condition affecting solely the white matter (WM) of the central nervous system,over the last few years it has been shown that GM pathology is also common and extensive.GM demyelinating lesions can not only be found in the cerebral cortex but also in the deep gray nuclei.Apart from focal demyelinatad lesions,diffuse neuronal loss and atrophy is also present in the GM of MS patients.Conclusions The widespread use of conventional and quantitative MRI based techniques in MS has led to an improved understanding of the mechanisms underlying the inflammatory and neurodegenerative processes of the disease.However,more researches are needed to unravel GM pathology in MS patients,which at present remains enigmatic。

Abstract：Objective This review discusses the experimental and clinical studies those show the expression of connexin 36 in the central nervous system and the possible role of connexin 36 in epileptic seizure.Data sources All articles used in this review were mainly searched from PubMed published in English from 1996 to 2012.Study selection Odginal articles and reviews were selected if they were related to the expression of connexin 36 in the central nervous system and its role in epilepsy.Results The distribution of connexin 36 is developmentally regulated,cell-specific and region-specific.Connexin 36 is involved in some neuronal functions and epileptic synchronization.Changes in the connexin 36 gene and protein were accompanied by seizures.Selective gap junction blockers have exerted anticonvulsant actions in a variety of experiments examined in both humans end experimental animals.Conclusions Connexin 36 plays an important role in both physiological and pathological conditions in the central nervous system.A better understanding of the role of connexin 36 in seizure activity may contribute to the development of new therapeutic approaches to treating epilepsy。

Abstract：Objective This review discusses progress in the studies of hepatitis B virus (HBV)/human immunodeficiency virus (HIV) coinfection and focuses on the interaction among HIV infection,chronic HBV infection,and host immunity.Data sources Data and studies published mainly from 2008 to 2011 were selected using PubMed.Study selection Original articles and critical reviews concerning HBV/HIV coinfection and HBV and HIV pathogenesis were selected.Results HIV may accelerate HBV progression by lowering CD4 count,weakening HBV-specific immunity,“enriching”HBV mutants,causing immune activation,etc.On the other hand,HBV may enhance HIV replication by activating HIV long terminal repeat (LTR) with X protein (HBX) and cause immune activation in synergy with HIV.Paradoxically,HBV may also inhibit HIV dissemination via dendritic cells.Conclusions The interaction among HIV,HBV,and host immunity remains poorly understood.Further research is warranted to elucidate the detailed molecular mechanisms and to translate these mechanisms into clinical practice。

Abstract：Background We were interested in determining how the tumor suppressor gene RBM5 is regulated in lung cancers.Previous studies suggested that the gene expression is related to histological subtype and smoking exposure,since in small cell lung cancers the RBM5 gene is deleted whereas in non-small cell lung carcinomas (NSCLC) RBM5 expression is reduced.Of particular interest was the recent finding that in lung adenocarcinomas,a histological subtype of NSCLC,smoking exposure correlated with mutational activity in the transforming growth factor alpha (TGF-α) signaling pathway.Lung adenocarcinomas from smokers were associated with activating KRAS mutations,whereas lung adenocarcinomas from never-smokers were associated with activating epidermal growth factor receptor (EGFR) mutations.We hypothesized that inhibition of RBM5 in lung adenocarcinomas is achieved indirectly via these activating mutations.The objective of the research described herein was to determine if EGFR activation and RBM5 expression are negatively correlated.Methods EGFR expression in the lung adenocarcinoma cell line NCI-H1975 was inhibited using small interfering RNA.RBM5 expression was examined by real-time quantitative polymerase chain reaction and Western blotting.Results Reduced EGFR expression did not correlate with any change in RBM5 expression at either the RNA or protein level.Conclusion These results suggest that RBM5 expression is not directly regulated by EGFR in non-smoker related lung adenocarinomas,and that some other mechanism operates to inhibit either the expression or function of this potential tumour suppressor in lung cancers that retain the RBM5 gene。

Abstract：Background Retrocaval ureter is a rare congenital abnormality.Operative repair is always suggested in cases of significant functional obstruction.Laparoscopic procedures have been employed as the minimally invasive therapeutic option for retrocaval ureter.However,the laparoscopic techniques for retrocaval ureter might be technically challenging to some surgeons.The aim of this article was to present our experience and surgical techniques of pure transperitoneal laparoscopic pyelopyelostomy and ureteroureterostomy in nine patients with retrocaval ureter.Methods A total of nine patients of retrocaval ureter underwent pure laparoscopic pyelopyelostomy or ureteroureterostomy.The operation was performed with the patients placed in the 70-degree lateral decubitus position via a three port transperitoneal approach with two 10-mm and one 5-mm ports.The distal part of the dilated renal pelvis was transected at the ureteropelvic junction and the ureter was relocated anterior to the inferior vena cava.The tension-free pyeloureteral or ureteroureteral anastomosis was completed with the intracorporal freehand suturing and in situ knot-tying techniques combined with interrupted and continuous fashion.A double J ureteral stent was inserted in an antegrade manner during laparoscopy.Intravenous urography or computerized tomography and renal ultrasonography were performed after 3 months postoperatively.Results All operations were completed laparoscopically,and no open conversion was required.The mean operative time was 135 minutes (range,70-250 minutes),with minimal blood loss (less than 60 ml).No intra-operative complications or significant bleeding occurred.All patients presented mild postoperative pain and quick convalescence.The symptoms disappeared and hydronephrosis decreased substantially after surgery.Conclusions Pure transperitoneal laparoscopic correction for retrocaval ureter was associated with an excellent outcome,minimal invasiveness and short hospital stay.It is technically feasible and reliable for retrocaval ureter treatment.Laparoscopic surgery could be the standard treatment for retrocaval ureter。

Abstract：Sclerosing angiomatoid nodular transformation (SANT) of the spleen,a newly defined primary lesion of the spleen,is very rare.Immunohistochemistry is the only way to confirm the diagnosis of SANT.We present the clinical characteristics and postoperative outcomes of five SANT cases that underwent splenectomy from January 2007 to October 2010.Although SANT had specific imaging findings,differential diagnosis from other splenic tuomrs or malignant lesions preoperatively was difficult.The hand-assisted laparoscopic splenectomy was a useful and effective technique for the management and postoperative diagnosis of SANT.All SANT patients had good prognosis without recurrence after splenectomy。

Abstract：We describe a case of systemic sclerosis (SSc) complicated with portal hypertensive ascites which did not improve with diuretics and ascitic drainage.When corticosteroid added,her ascites diminished dramatically.Though portal hypertension can be imputed to other causes,such as polycystic liver in this case,it can occur in limited SSc with positive anti-centromere antibody and respond to corticosteroid treatment。

Abstract：We reported an unusual case of disseminated cryptococcal lymphadenitis in an immunocompetent host who presented with fever and lymphadenopathy,which were the only two symptoms and signs.Latex agglutination test of serum and cerebrospinal fluid (CSF) were negative,while lymph node biopsy showed Cryptococcus neoformans.A diagnosis of disseminated cryptococcal lymphadenitis was made.Then the patient was treated with amphotericin B for 15 days as initial therapy and itraconazole for 6 months as maintenance therapy respectively.The patient received re-examination per 6 months and was followed up for 2 years.Swollen lymph nodes diminished gradually,and no fever or other symptoms were found.Latex agglutination test of serum and CSF were negative throughout the follow-up period,and anti-HIV,syphilis and tuberculosis antibody were all negative。