2013年 · 第126卷第11期

Manifestations of diseases are determined by the.combined effect of genetic and environmental factors.Different physical,behavioral and social variations affect the prevalence and presentation of common diseases.Polycystic ovary syndrome (PCOS),with a heterogeneous presentation,is the most common endocrine disorder that affects about 5％-10％ women of reproductive age.It is characterized by clinical and/or biochemical hyperandrogenism,ovulatory dysfunction and polycystic ovaries。

Abstract：Background Central blood pressure (BP) is pathophysiologically more important than peripheral BP for the pathogenesis of cardiovascular disease.Arterial stiffness is also a good predictor of cardiovascular morbidity and mortality.The effects of benidipine,a unique dual L-/T-type calcium channel blocker,on central BP have not been reported.This study aimed to compare the effect of benidipine and losartan on the central BP and arterial stiffness in mild to moderate essential hypertensives.Methods This 24 weeks,multi-center,open label,randomized,active drug comparative,parallel group study was designed as a non-inferiority study.The eligible patients (n=200) were randomly assigned to receive benidipine (n=101)or losartan (n=99).Radial artery applanation tonometry and pulse wave analysis were used to measure the central BP,pulse wave velocity (PWV) and augmentation index (Alx).We also measured the metabolic and inflammatory markers.Results After 24 weeks,the central BP decreased significantly from baseline by (16.8+14.0/10.5+9.2) mmHg (1mmHg =0.133 kPa) (systolic/diastolic BP; P ＜0.001) in benidipine group and (18.9+14.7/12.1+10.2) mmHg (P ＜0.001)in losartan group respectively.Both benidipine and losartan groups significantly lowered peripheral BP (P ＜0.001) and Alx (P ＜0.05),but there were no significant differences between the two groups.The mean aortic,brachial and femoral PWV did not change in both groups after 24-week treatment.There were no significant changes of the blood metabolic and inflammatory biomarkers in each group.Conclusion Benidipine is as effective as losartan in lowering the central and peripheral BP,and improving arterial stiffness。

Abstract：Background Idiopathic flexible flatfoot in children most frequently improves with age and remains asymptomatic.It is a physiological variation of the normality that does not require treatment unless it becomes symptomatic.The aim of this research was to investigate the reason why some individuals with flexible flatfoot become symptomatic by analysis of the differences in the relative alignment of each segment of the foot between symptomatic and asymptomatic patients with idiopathic flexible flatfoot using radiographic measurements.Methods One hundred patients with idiopathic flexible flatfoot were retrospectively identified and divided into two groups:asymptomatic (n=50) and symptomatic (n=50).Standing anteroposterior and lateral radiographs of the foot were analyzed.Five measurements were calculated to describe the alignment of the foot.An independent-samples t-test and Logistic regression test were used for statistical analysis.Results Age and sex were similar in the two groups.The independent-samples test revealed significant differences in two parameters:the anteroposterior talonavicular coverage angle and the lateral talo-first metatarsal angle.When the Logistic regression test was performed,only the talonavicular coverage angle showed statistical significance.Conclusions The lateral displacement of the navicular bone,measured by the anteroposterior talonavicular coverage angle,seems to be related to the onset of symptoms.In individuals with otherwise normal flexible flatfoot,an increase in this angle might be an important risk factor for developing symptoms。

Abstract：Background It is now recognized that Cimicifuga foetida extract is effective in alleviating menopausal symptoms.But the durations reported were usually short.This paper compares the clinical effects of different regimens of three-month course on climacteric symptoms in Chinese women,so as to evaluate the efficacy and safety of Cimicifuga foetida extract.Methods This was a prospective,randomized trial.Ninety-six early menopausal women were recruited and randomly assigned into 3 groups to take different kinds of medicine for 3 months; participants were given Cimicifuga foetida extract daily in group A (n=32),given estradiol valerate and progesterone capsule cycle sequentially in group B (n=32),and given estradiol valerate and medroxyprogesterone acetate cycle sequentially in group C (n=32).The questionnaires of Kupperman menopause index,Menopause-Specific Quality of Life,and Hospital Anxiety and Depression Scale were finished before and after the treatment.The status of vaginal bleeding and breast tenderness was recorded every day.Results Eighty-nine participants (89/96,92.7％) completed the treatment.Kupperman menopause index decreased after taking the medicine for 3 months in each group (with all P＜0.001),but the score after the treatment was higher in group A than in the other 2 groups.Except for the score of sexual domain in group A (P=0.103),the scores of all domains of the Menopause-Specific Quality of Life decreased significantly after the treatment in all groups (with all P≤-0.01).Score of anxity decreased significantly in group A (P=0.015) and B (P=0.003).Incidence of breast tenderness was 12.9％ (4/31) in group A,36.7％ (11/30) in group B,and 14.3％ (4/28) in group C.Incidence of vaginal bleeding was 6.5％ (2/31) in group A,26.7％ (8/30) in group B,and 82.1％ (23/28) in group C.Conclusions Cimicifuga foetida extract is effective and safe in the treatment of menopausal syndrome.It is worth extending its use in the treatment of climacteric complaints,especially among those having contradiction for hormone replacement therapy。

Abstract：Background The Scale for the Assessment and Rating of Ataxia (SARA) was shown to be a reliable and valid measurement for patients with spinocerebellar ataxia (SCA).The Brazilian version and the Japanese version of SARAwere favorable for good reliability and validity.This study aimed to translate SARA into Chinese and test its reliability and validity in measurement of cerebellar ataxia.Methods SARA was translated into Chinese.A total 39 patients with degeneration cerebellar ataxia were evaluated independently by two neurologists with the Chinese version of SARA.Then the patients were evaluated by one of above neurologists with International Cooperative Ataxia Rating Scale (ICARS).The statistical analyses were performed using SPSS 17.0 for Windows.Results The Cronbach's alpha coefficient of the Chinese version of SARA was 0.78,which represents a good internal consistence.The correlation coefficient of the Chinese version of SARA scores between the two evaluators was 0.86,illustrating that the inter-rater reliability of Chinese version of SARA was good.The correlation coefficient between the Chinese version of SARA and ICARS was 0.91,illustrating that the criterion validity of Chinese version of SARA was not bad.Conclusions The Chinese version of SARA is reliable and effective for the assessment of degeneration cerebellar ataxia.Compared with ICARS,the evaluation of Chinese version of SARA is more objective,the assessment time is shortened,and the maneuverability is better。

Abstract：Background There is increasing evidence that CT pulmonary arteriography and venography allow a better diagnostic yield for deep vein thrombosis (DVT) in suspected acute pulmonary embolism (PE).The aim was to investigate the value for using such an approach in a multiracial Asian population.Methods A total of 135 consecutive subjects with clinically suspected PE in various clinical settings (postoperative in 23 subjects) were referred and evaluated for venous thromboembolism using CT pulmonary arteriography and venography in a tertiary hospital,Malaysia.The distribution of DVT was assessed based on the frequency rate of thrombosis in a particular anatomical region (inferior vena cava,pelvic,femoral and popliteal).Results In 130 subjects,excluding 5 subjects having poor images,both DVT and PE were detected in 11.5％ (15/130) subjects and DVT alone was detected in 6.9％ (9/130) subjects giving a combined rate of venous thromboembolism of 18.4％.A history of malignancy was significantly associated with positive scans,P=0.02.It was found that left pelvic veins (18.2％) and left femoral veins (19.5％) were more commonly thrombosed in this population.Conclusion CT pulmonary arteriography and venography is a useful technique in the evaluation of venous thromboembolism in a multi-racial Asian population。

Abstract：Background Regulatory T cells (Tregs) may play an important role in immunopathology during HIV-1 infection.Transcription factor forkhead box P3 (FoxP3) orchestrates the development of Tregs and is a useful marker to identify this population.Using a FoxP3 phenotype to define Tregs,we investigated the level and phenotype of peripheral blood natural CD4+Tregs and assessed the relationship between the frequencies and absolute numbers of CD4+Tregs and disease progression among untreated HIV-infected men who have sex with men (HIV+MSM) in China.Methods Fifty-two untreated HIV+MSM with CD4+T-cell counts of ≤350 cells/μl or ＞350 cells/μl were compared in a cresssectional study.Twelve age-matched HIV-uninfected MSM and nine patients receiving antiratroviral therapy for at least 1 year were also included.Expression of CD25,CD127,CD45RA,CCR7 and CTLA-4 was assessed on CD4+Tregs using polychromatic flow cytometry.Results The percentage of CD4+Tregs was increased significantly,whereas CD4+Tregs expressed less CTLA-4 in HIV+MSM compared with controls.CD4+Tregs displayed predominantly an effector memory phenotype (CD45RA-CCR7-),phenotypically distinct from conventional CD4+T cells.Moreover,the expansive frequencies of CD4+Tregs coincided with lower CD4+T-cell counts and higher viral loads whereas the absolute numbers of CD4+Tregs were associated with higher CD4+T-cell counts and lower viral loads.The expansion of Tregs was also associated with CD8+T-cell activation.Conclusion Increased proportions and decreased numbers of CD4+Tregs are associated with HIV progression,and their functions may impair with the progression of HIV infection。

Abstract：Background Glioblastoma is the most common and lethal cancer of the central nervous system.Global genomic hypomethylation and some CpG island hypermethylation are common hallmarks of these malignancies,but the effects of these methylation abnormalities on glioblastomas are still largely unclear.Methylation of the O6-methylguanine-DNA methyltransferase promoter is currently an only confirmed molecular predictor of better outcome in temozolomide treatment.To better understand the relationship between CpG island methylation status and patient outcome,this study launched DNA methylation profiles for thirty-three primary glioblastomas (pGBMs) and nine secondary glioblastomas (sGBMs) with the expectation to identify valuable prognostic and therapeutic targets.Methods We evaluated the methylation status of testis derived transcript (TES) gene promoter by microarray analysis of glioblastomas and the prognostic value for TES methylation in the clinical outcome of pGBM patients.Significance analysis of microarrays was used for genes significantly differently methylated between 33 pGBM and nine sGBM.Survival curves were calculated according to the Kaplan-Meier method,and differences between curves were assessed using the log-rank test.Then,we treated glioblastoma cell lines (U87 and U251) with 5-aza-2-deoxycytidines (5-aza-dC) and detected cell biological behaviors.Results Microarray data analysis identified TES promoter was hypermethylated in pGBMs compared with sGBMs (P＜0.05).Survival curves from the Kaplan-Meier method analysis revealed that the patients with TES hypermethylation had a short overall survival (P ＜0.05).This abnormality is also confirmed in glioblastoma cell lines (U87 and U251).Treating these cells with 5-aza-dC released TES protein expression resulted in significant inhibition of cell growth (P=0.013).Conclusions Hypermethylation of TES gene promoter highly correlated with worse outcome in pGBM patients.TES might represent a valuable prognostic marker for glioblastoma。

Abstract：Background C-Jun N-terminal kinase (JNK) signaling pathway and ankylosis gene (ANK) play a critical role in endplate chondrocytes degeneration.The purpose of this study was to investigate whether the expression levels of ANK was associated with the activation of JNK.Methods Cartilage endplates of 49 patients were divided into the control group (n=19) and the experimental group (n=30).The patients in the control group were graded 0 and those in the experimental group were graded Ⅰ-Ⅲ according to Miller's classification.Endplate chondrocytes were isolated by enzyme digestion and cultured in vitro.The inverted phase contrast microscope,teluidine blue staining,HE staining,real time RT-PCR,and MTT were used to observe morphological appearances,biological characteristics,and growth curve of endplate chondrocytes from the cartilage endplate of the two groups.Real time RT-PCR and Western blotting were used to analyze the mRNA and protein expression levels of associated factors in the degeneration process in the cultured endplate chondrocytes with or without subjected SP600125.Results The expression levels of type Ⅱ collagen,aggrecan,and ANK in endplate chondrocytes of experimental group were lower than that of control group and phosphorylation level of JNK in the experimental group which was higher than that in the control group.Application of JNK phosphorylation inhibitor to degeneration chondrocytes resulted in a marked decrease in the phosphorylation level of JNK and a significant increase in the expression levels of type Ⅱ collagen,aggrecan,and ANK.Conclusion The degeneration of the human cervical endplate chondrocytes might be promoted by JNK phosphorylation by down-regulating the expression of ANK

Abstract：Background The best age for the arterial switch operation (ASO) in complete transposition of great arteries with ventricular septal defect is usually considered to be within six months.This is because of severe pulmonary arterial hypertension and pulmonary arterial obstructive pathological changes.There are few reports on ASO surgery in children older than three years old.Methods We studied 41 children,including 24 males and 17 females,from January 2010 to December 2011.They were divided into three groups by operation age; 15 patients were ＜1 year old,13 were 1-3 years old,and 13 were ＞3 years old.Associated cardiac abnormalities included patent ductus arteriosus in six cases,atrial septal defect in five cases,and mitral regurgitation in two cases.All the patients had echocardiography before the operation.Seventeen patients underwent a coronary computed tomography examination and five patients underwent right heart catheterization.All ASO surgeries were performed under inhalation anesthesia and hypothermic cardiopulmonary bypass.Results Three operative deaths occurred.Two were in the ＜1 year old group,who died from severe postoperative low cardiac output.The other was two years old and died of postoperative multiple organ failure.There was no significant difference in postoperative mortality and the recent mid-term survival rate among the three groups.Thirty-eight cases were followed up for an average of 11.2 months,ranging 6-20 months.One seven years old patient died of acute diarrhea and electrolyte disturbance arrhythmia caused by food poisoning.Three patients more than three years old still had residual pulmonary arterial hypertension.Conclusion Children older than three years old can still undergo the ASO procedure,but residual pulmonary hypertension is present。

Abstract：Background The incidence of autosomal trisomy in livebirths is strongly dependent on maternal age.Special consideration is given to the provision of prenatal screening and cytogenetic testing to women of advanced maternal age (AMA).The aim of this study was to evaluate the effectiveness of second trimester prenatal screening and amniocentesis for Down syndrome (DS) and compare the trends of choice of screening and amniocentesis among AMAwomen.Methods A total of 5404 AMA patients with natural singleton pregnancy were recruited for this prospective study from January 2008 to December 2010.The gestational weeks were from 15 weeks to 20+6 weeks.The patients referred were grouped into a screening group (2107 cases) and an amniocentesis group (3297 cases) by their own decision.The prevalence of DS was compared between the two groups by chi-square test.Choice rates for each maternal age with trends were compared by regression analysis.Results There were 18 cases of fetal DS detected in the screening group with a prevalence of 8.54‰ (18/2107).Twentyfive cases of fetal DS were diagnosed in the amniocentesis group with a prevalence of 7.58‰ (25/3297).No statistical difference was observed in the prevalence of DS between the screening and amniocentesis group (P=0.928).The invasive testing rate for DS in the amniocentesis group was 5.54 times higher than that of the screening group (1/131.88 vs.1/23.78).With the increase of the maternal age,the choice of amniocentesis increased while the choice of the screening showed an opposite trend.The choice of the AMA women between the screening and amniocantesis was significantly age relevant (P=0.012).Conclusions The second trimester serum screening in combination with maternal age was more effective than maternal age alone to screen for DS.We suggest educating the patients by recommending AMA women be informed of both screening and amniocentesis options。

Abstract：Background Currently,all the diagnostic indicators for endometriosis lack perfect sensitivity and specificity.According to the characteristic of endometriosis,we analyzed the new biomarker neutrophil-to-lymphocyte ratio (NLR) and the combination of NLR and serum CA-125 to investigate their diagnostic value for identifying stages Ⅲ and Ⅳ endometriosis.Methods The values of serum CA-125 and routine blood tests were collected from 197 patients with endometriosis,102 with benign tumors and 112 healthy individuals.We investigated the sensitivity and specificity of NLR and its combination with serum-CA-125 for diagnosing stages Ⅲ and Ⅳ endometriosis by using receiver operating characteristic (ROC).Results The mean values of NLR,the combination of serum CA-125 and NLR (combination) of the groups with stages Ⅲ and Ⅳ endometriosis were significantly higher than the other two groups.Serum CA-125,NLR,and the combined biomarkers could significantly discriminate the stages Ⅲ and Ⅳ endometriosis group from the other two groups (P＜0.05).NLR shows a lower sensitivity of 57.9％ and specificity of 65.2％ with a cutoff value at 1.82.And the combination of biomarkers has the highest AUC of 0.949 with a sensitivity of 86.8％ and specificity of 92.0％ at the cutoff value of 44.40.In addition,for patients with negative CA-125,55.36％ and 53.57％ of the patients were able to be diagnosed with endometriosis by using NLR alone and the combination of biomarkers.Conclusion For diagnosing stages Ⅲ and Ⅳ endometriosis,the neutrophil-to-lymphocyte ratio is a better adjuvant to serum CA-125,and the neutrophil-to-lymphocyte ratio is valuable in diagnosing stages Ⅲ and Ⅳ endometriosis for patients with negative serum CA-125。

Abstract：Background Bioactive proteins,such as cytokines and chemokines,have not been systematically evaluated in healthy and preeclamptic pregnancies.We aimed to investigate the difference of these proteins between healthy and preeclamptic pregnancies in order to help clarify their potential roles in the pathogenesis of hypertension and proteinuria in preeclampsia.Methods Samples of amniotic fluid and maternal/umbilical cord blood were collected from normal pregnancies and women with preeclampsia for examination of bioactive proteins.Fifty-three pregnant women were enrolled in this study.Of them,30 pregnant women were recruited as healthy controls,and 23 pregnant women were diagnosed with preeclampsia.An antibody array was used to screen for higher levels of cytokines and related proteins in amniotic fluid than in the blood samples,and these proteins were then selected for quantification by immunoassay.Results Interleukin-1 receptor 4,hepatocyte growth factor,and urokinase plasminogen activator receptor were significantly elevated in the blood of preeclampsia patients.In particular,interleukin-1 receptor 4 was 8-fold higher in preeclampsia patients than in the healthy pregnancies.Moreover,in cord blood samples hepatocyte growth factor and interleukin-8 were significantly higher in preeclampsia patients.Conclusions Because of the biologic activities,Interleukin-1 receptor 4,hepatocyte growth factor,urokinase plasminogen activator receptor and interleukin-8 in maternal and/or cord blood could play a role in the pathogenesis of hypertension and proteinuria in preeclampsia。

Abstract：Background The health-care workers (HCWs) are at high risk of acquiring infection with Mycobacterium tuberculosis.The objectives of this study were to compare the performance of the T-SPOT.TB and tuberculin skin test (TST) for latent tuberculosis infection (LTBI),evaluate diagnostic concordance and risk factors for LTBI,and observe the progression to active tuberculosis (TB) disease among HCWs in a general hospital in Beijing.Methods The prospective cohort study enrolled HCWs in a tertiary general hospital in Beijing,China,to evaluate LTBI with T-SPOT.TB and TST.The subjects were evaluated every 12 months during the 60-month follow-up.Results Of 101 participating HCWs,96 and 101 had valid TST and T-SPOT.TB results,respectively.Twenty-nine (28.7％,95％ confidence interval (CI),19.9％-37.5％) were defined as positive by T-SPOT.TB and 53 (55.2％,95％ CI,45.2％-64.9％) were defined as positive by TST (using a ≥10 mm cutoff).An agreement between the two tests was poor (57.3％,K=0.18,95％ CI,0.01％-0.52％).In multivariate analysis,direct exposure to sputum smear-positive TB patients was a significant risk factor for a positive T-SPOT.TB (OR 5.76; 95％ CI 1.38-24.00).Pooled frequency of antigenspecific IFN-γ secreting T-cells for subjects who reported direct contact with sputum smear-positive TB patients was significantly higher than that for participants without direct contact (P=-0.045).One of 20 participants with positive result of T-SPOT.TB and TST developed active TB at 24-month follow-up.Conclusion T-SPOT.TB is a more accurate,targeted method of diagnosing LTBI than TST。

Abstract：Background The most critical mechanism governing drug resistance in Candida albicans (C.albicans) involves efflux pumps,the functionality of which largely depends on energy metabolism.Alcohol dehydrogenase Ⅰ (ADH1) plays an important role in intracellular energy metabolism.The aim of this study was to explore the relationship between ADH1 and drug resistance in C.albicans.Methods Twenty clinical C.albicans samples isolated from individual patients diagnosed with vulvovaginal candidiasis,and two C.albicans strains obtained from a single parental source (the fluconazole (FLC)-sensitive strain CA-1S and the FLC-resistant strain CA-16R) were included in our study.In accordance with the Clinical and Laboratory Standards Institute (CLSI) M27-A3 guidelines,we used the microdilution method to examine the FLC minimum inhibitory concentrations (MICs) and real-time reverse transcription polymerase chain reaction (RT-PCR) to measure the mRNA expression levels of ADH1 and the azole resistance genes CDR1,CDR2,MDR1,FLU1 and ERG11 in all the isolates.Results A highly significant positive correlation between the mRNA levels of ADH1 and the MICs (rs =0.921,P=0.000),as well as positive correlations between the mRNA level of ADH1 and those of CDR1,CDR2 and FLU1 (rs of 0.704,0.772 and 0.779,respectively,P ＜0.01),were observed in the 20 clinical C.albicans samples.The relative expression of ADH1 was upregulated 10.63-to 17.61-fold in all of the drug-resistant isolates.No correlations were found between the mRNA levels of ADH1 and those of MDR1 or ERG11 (P ＞0.05).The mRNA levels of the examined drug resistance genes were higher in the CA-16R strain than in CA-1S,and the mRNA levels of ADH1 in CA-16R were 11.64-fold higher than those in CA-1S (P ＜0.05).Conclusions These results suggest that high levels of ADH1 transcription are implicated in FLC resistance in C.albicans and that the mRNA expression levels of ADH1 are positively correlated with those of CDR1,CDR2 and FLU1。

Abstract：Background Laparoscopic splenectomy (LS) for massive splenomegaly is more technically challenging than for a normal-sized spleen.The purpose of this study was to determine the effect of operative experience on perioperative outcomes of LS for massive splenomegaly.Methods Between January 2008 and December 2010,36 consecutive patients who were diagnosed with massive splenomegaly underwent LS in our department.The perioperative outcomes were evaluated for evidence of a learning curve effect.Patients were divided into three groups (1,2,and 3) of 12 consecutive patients,and outcomes of each group were compared.Results The mean operative time decreased significantly from 252 minutes of Group 1 to 179 minutes of Group 3.The estimated blood loss and length of post-operative hospital stay showed a similar trend.No significant differences were found in the splenic length and weight,transfusion rate,or average amount of drainage.In this cohort,there were three cases with surgical complications and one conversion to open laparotomy.Conclusions The first 24 cases constitute the early stage of the learning curve for LS for massive splenomegaly.LS for massive splenomegaly is a technically challenging operation with a long learning curve,and strategies for developing training programs must address these challenges。

Abstract：Background Plasma galectin-3,a mediator of fibrogenesis and inflammation,its potential to associate with type 2 diabetes (T2DM) is poorly investigated.Here,we explored its interaction with the serum galectin-3 and vascular complications.Methods We conducted a population-based cross-sectional survey in Zhejiang,China involving 165 men and 119 women (age range,43-84 years),investigating the relationship between serum galectin-3 and vascular disease in patients with T2DM.Results Serum galectin-3 was higher in subjects with T2DM than that in control participants (27.4 vs.17.6 ng/ml,P ＜0.001).Compared with subjects with galectin-3 values in the lowest quartile,those with values in the highest quartile had an increased likelihood of vascular complications (4th quartile odds ratio (OR) 2.52,95％ confidence interval (CI),1.25-4.07).Increased risk of micro-or macrovascular complications corrrelated with serum galectin-3 concentration (ORs 11.4and 8.5,respectively).An increased number of vascular complications was associated with high serum galectin-3 levels (P＜0.05).Patients with serum galectin-3 levels ＞25 ng/ml had an elevated risk of diabetes relative to patients with levels ＜10ng/ml (OR for any vascular complication 2.64,for heart failure 3.97,for nephropathy 4.09,for peripheral arterial disease (PAD) 4.18; all P ＜0.05).Complication risk was higher in patients with neurogenic,stroke,or retinopathy complications,but this difference was not significant after risk factor adjustment.Serum galectin-3 levels correlated with diabetes duration,C-reactive protein (CRP) levels,and albuminuria.Conclusion High galectin-3 values were associated with increased odds of developing heart failure,nephropathy,and peripheral arterial disease in patients with T2DM。

Abstract：Background Elective radiation of lower neck is controversial for nasopharyngeal carcinoma (NPC) without lymph node metastasis (N0 disease).Tumor volume is an important prognostic indicator.The objective of this study is to explore the potential impact of tumor volume on the indication of the lower neck irradiation for N0-NPC,by a qualitative evaluation of the relationship between tumor volume and nodal metastasis.Methods Magnetic resonance (MR) images of 99 consecutive patients with NPC who underwent treatment were retrospectively reviewed.Primary tumor volumes of NPC were semi-automatically measured,nodal metastases were N-classified and neck level involvements were examined.Distributions of tumor volumes among N-category-based groups and distributions of N-categories among tumor volume-based groups were analyzed,respectively.Results The numbers of patients with N0 to N3 disease were 12,39,32,and 16,respectively.The volumes of primary tumor were from 3.3 to 89.6 ml,with a median of 17.1 ml.For patients with nodal metastasis,tumor volume did not increase significantly with the advancing of N-category (P ＞0.05).No significant difference was found for the distribution of N1,N2,and N3 categories among tumor volume-based groups (P ＞0.05).Nevertheless patients with nodal metastasis had significantly larger tumor volumes than those without metastasis (P ＜0.05).Patients with larger tumor volumes were associated with an increased incidence of nodal metastasis.Conclusions Certain positive correlations existed between tumor volume and the presence of nodal metastasis.The tumor volume (＞10 ml) is a potential indicator for the lower neck irradiation for N0-NPC。

Abstract：Background Hepatoblastoma (HB) is a rare childhood tumor.We investigated the effect of intraoperative management of the intrahepatic major vessels in children with HB.Methods Between April 2005 and August 2012,surgical resection was performed on 50 children with hepatoblastoma.These children were divided into a vessel-ligation group (n=20) and a vessel-repair group (n=30).In the vessel-ligation group,the intrahepatic major vessels were ligated and removed together with the tumor and the affected liver lobe/liver parenchyma.In the vessel-repair group,the affected intrahepatic major vessels were dissected and preserved as much as possible and the normal liver lobe/liver parenchyma and blood supply from these vessels were also preserved.The outcomes were analyzed by postoperative follow-up.Results In the vessel-ligation group,two patients gave up surgery,six patients underwent palliative resection,and 12 patients underwent en b/oc resection; four patients died of liver failure and eight patients fully recovered and were discharged.In the vessel-repair group,all 30 patients underwent en b/oc resection and were discharged after satisfactory healing.After a follow-up time of 5-36 months (median:20 months),two patient in the vessel-ligation group survived and 22 patients in the vessel-repair group survived.Conclusions Patients with HB can be successfully treated by tumor resection with vascular repair.This method prevents postoperative liver failure,ensures Patient safetv during the perioperative period,and allows for early chemotherapy。

Abstract：Background The cholesterol-lowering statin drugs have some non-lipid-lowering effects,such as inhibiting myocardial remodeling.However,the underlying mechanism is still unclear.Methods The left anterior descending coronary artery was ligated to establish a rat model of heart failure,and the rats were divided into a sham operation (SO) group,myocardial infarction model (MI) group,and MI-atorvastatin group.Changes in hemodynamic parameters were recorded after the final drug administration.Histological diagnosis was made by reviewing hematoxylin and eosin (HE) stained tissue.Real-time quantitative polymerase chain reaction (PCR)was performed to determine the expressions of type Ⅰ and type Ⅲ collagen,matrix metalloproteinase-2 (MMP-2),and tissue matrix metalloproteinase inhibitor-2 (TIMP-2).Further,primary rat cardiac fibroblasts were cultured and the MTT assay was performed to determine the effect of atorvastatin on cardiac fibroblast proliferation.Results The model of heart failure was established and the results of HE staining and Masson's trichrome staining revealed that the rats in the heart failure group showed obvious hyperplasia of fibrotic tissue,which was significantly reduced in the atorvastatin group.Real-time quantitative PCR showed that the MI group showed a significantly increased expression of type Ⅰ and type Ⅲ collagen,MMP-2,and TIMP-2,but a significantly reduced MMP-2/TIMP-2 ratio.Compared with the MI group,the atorvastatin group showed significantly reduced expression of type Ⅰ and Ⅲcollagen,unchanged expression of MMP-2,significantly reduced expression of TIMP-2,and an increased MMP-2/TIMP-2 ratio.We further found that atorvastatin significantly inhibited the Ang Ⅱ-induced flbroblast proliferation and the expression of type Ⅰ and type Ⅲ collagen in cardiac flbroblasts while increasing the MMP-2/TIMP-2 ratio.Conclusions These data suggest that atorvastatin can inhibit cardiac fibroblast proliferation and enhance collagen degradation by increasing the MMP-2/TIMP-2 ratio,thereby inhibiting the formation of myocardial fibrosis in rats with heart failure after myocardial infarction。

Abstract：Background The emergence of bacterial resistance to commonly used antibiotics,such as macrolides,is complicating the management of respiratory tract infections (RTIs).Telithromycin,a ketolide antimicrobial structurally related to macrolides,is approved for the treatment of community-acquired RTIs,and shows lower pathogen resistance rates.The purpose of this study was to compare the efficacy and safety of telithromycin with clarithromycin,a macrolide routinely used as therapy for RTIs.Methods We performed a meta-analysis of relevant randomized-controlled trials (RCTs) identified in PubMed,the Cochrane Library,Embase,CNKI and VIP databases.The primary efficacy outcome was clinical treatment success assessed at the test-of-cure time in the per-protocol population,and the primary safety outcome was drug related adverse effects.Results Seven RCTs,involving 2845 patients with RTIs,were included in the meta-analysis.Oral telithromycin and clarithromycin showed a similar clinical treatment success in modified intention to treat and per-protocol population (cure and improvement) (odds ratios (ORs):0.84,95％ confidence intervals (CI):0.64-1.11 and OR:1.14,95％ CI:0.71-1.85,respectively).Similar findings were obtained for secondary efficacy outcomes:clinical treatment success at a late posttherapy visit (OR:0.92,95％ CI:0.57-1.48) and microbiological treatment success at the test-of-cure time (OR:1.14; 95％CI:0.71-1.85).The safety outcome analysis indicated telithromycin had a similar risk of drug-related adverse effect and serious adverse effect with clarithromycin.Conclusions Our findings indicate that oral telithromycin and clarithromycin have similar treatment efficacy and adverse effect.The advantages of lower antimicrobial resistance rates,once-daily short-duration dosing and reported lower healthcare costs make oral telithromycin a useful option for the empiric management of mild-to-moderate RTIs。

Abstract：Objective To review the presentation,diagnosis,staging and treatment of thymoma.Data sources Data were obtained from papers on thymoma published in English within the last 30 years.No formal systematic review was conducted,but an effort was made to be comprehensive.Study selection Studies were selected if they contained data relevant to the topic addressed in the particular section.In particular,standards adopted by the International Thymic Malignancies Interest Group through a formal process of achieving worldwide consensus are featured.Because of the limited length of this article,we have frequently referenced recent reviews that contain a comprehensive amalgamation of literature rather than the actual source papers.Results Thymomas are rare malignant tumors.They account for about half (47％) of anterior mediastinal tumors.About one third of these are associated with myasthenia gravis.Computed tomography with intravenous contrast is the standard diagnostic modality.Thymomas appear as round or oval masses in early stages but irregular shapes with calcifications occurring in later stages.They can invade surrounding structures including mediastinal fat,pleura,major blood vessels and nerves.Fine needle aspiration,core needle biopsy or open biopsy is used to obtain tissue diagnosis.Masaoka-Koga classification is currently used to stage thymomas.All thymomas should be considered for resection due to their malignant potential.A complete resection is a major prognostic factor and every effort should be made to achieve this even if this means resection and reconstruction of a major thoracic structure.Median sternotomy is the standard approach for thymoma resection.A number of minimally invasive techniques are used in selective centers.While stage Ⅰ and Ⅱ tumors undergo primary surgery,preoperative chemotherapy appears to increase the chances of complete resection for stage Ⅲ and Ⅳa tumors.Postoperative radiation could be considered for patients with residual disease.Excellent 5 and 10-year survival rates are noted for completely resected early stage thymomas.Conclusions Thymic malignancies are rare tumors.Standards have recently been achieved to allow better communication and promote collaborative research.Surgical resection is the mainstay of treatment,but a multimodality approach is useful for many patients。