2006年 · 第119卷第20期

Colorectal cancer is a common cause of cancer-related mortality.1 In China, it is one of eight cancers in the cancer control blueprint, which are suggested to have comprehensive treatment.Some patients with colorectal cancer presented no symptoms when they were diagnosed, yet the tumor had already penetrated the intestinal wall and involved adjacent organs. If the tumor is localized at time of diagnosis without distant metastases, it is termed locally advanced colorectal cancer (LACC)regardless of whether there is lymph node metastasis. LACC commonly encountered in clinical practice accounts for 5%-10% of all colorectal cancers.2

Abstract：Background Highly active antiretroviral therapy (HAART) roduces profound suppression of HIV replication, substantial increase in CD4+ T cells, and partial reconstitution of the immune system. However, the numbers of subjects were small in previous Chinese studies. This study evaluated the efficacy and side effects of HAART in Chinese advanced AIDS patients.Methods One hundred and three antiretroviral drug naive AIDS patients were enrolled in this study and were divided into two groups by their baseline CD4+ count: ＜100 cells/ μl or ≥ 100 cells/μl. Clinical, virological and immunological outcomes were monitored at baseline and at 1, 3, 6, 9 and 12 months during the course of treatment with HAART.Results One patient died and another was lost from the follow-up. For the remaining 101 HIV/AIDS patients at the 12th month during the HAART, the plasma viral load (VL) was reduced to (3.2±0.7) lg copies/ml, the CD4+ count increased to (168±51) cells/μl [among which the naive phenotype (CD45RA+CD62L+) increased to (49±27) cells/μl and the memory phenotype (CD45RA￣) increased to (119±55) cells/μl], and the percentage of CD4+CD28+ cells increased. At the same time, there was a significant reduction of CD8+ T cell activation. In the 69 patients with the baseline CD4+ count ＜100 cells/μl, 37 had a VL ＜50 copies/ml; while in the 34 patients with the baseline CD4+ count ≥ 100 cells/μl, 25 had a VL ＜50 copies/ml, the difference between the two groups was statistically significant. The CD4+ T cell count showed a two-phase increase during HAART and a significant positive correlation was shown between the change of CD4+ count and plasma VL. Over 12 months of HAART,10 patients had gastrointestinal side effects, 13 peripheral neuritis, 7 hepatic lesions, 8 hematological side effects,8 skin rashes, 10 lipodystrophy and 1 renal calculus.Conclusions Immune reconstitution as well as the significantly improved clinical outcomes is observed in Chinese advanced AIDS patients after HAART. Side effects are common during HAART and require clinical attention。

Congenital scoliosis results from defects formed during the embryologic development of the spinal vertebrae. Hemivertebra is a failure of vertebral formation carrying a risk of causing progressive scoliosis if it is fully segmented.1 When two hemivertebrae are present on the opposite sides of the spine and are separated by at least one normal vertebra, this condition then exemplifies a hemimetameric shift. The hemimetameric shift is often benign for progression, but it may also be problematic depending on the separation and the nature of the two hemivertebrae involved. If the two opposing hemivertebrae are close merely separated by one or two normal vertebrae, they tend to cause two small kinks in the spine and minimal cosmetic deformity. However, if the two hemivertebrae are in different regions of the spine, separate curves are then produced and the spine may become unbalanced, causing spinal decompensation and significant cosmetic deformity. In this article, we report one case for whom a hemimetameric shift was managed via a one-stage posterior hemivertebral resection。

Lupus nephritis is the most common visceral complication in the patients with systemic lupus erythematosus (SLE).1 It was evident that the anti-dsDNA antibodies were closely related to lupus nephritis, as seen in patients who had higher titers of serum anti-dsDNA antibodies had more severe renal lesions and even worse prognosis.2 So far it is still unknown how the dsDNA or anti-dsDNA antibody plays a role in the pathogenesis of lupus nephritis。

Congenital central hypoventilation syndrome(CCHS, OMIM #209880) is a rare autosomal dominant disorder of the autonomic nervous system(ANS) characterized by an abnormal autonomic ventilatory response to progressive hypercarbia and sustained hypoxemia. Patients typically present in the newborn period with hypoventilation or apnea asleep, awake, or both, without any associated cardiac, pulmonary, neuromuscular or brainstem lesions. Rarely, some patients may present at a later age and are diagnosed to have late onset central hypoventilation syndrome (LOCHS).1 Other features of ANS dysfunction such as feeding difficulty due to oesophageal dysmotility, severe constipation in the absence of Hirschsprung disease, poor regulation of basal body temperature, episodes of profuse sweating, pupillary and ocular abnormalities,decreased beat-to-beat variability of heart rate,attenuated response of heart rate to exercise,abnormal fluctuation of blood pressure, decreased perception to pain, and decreased perception to anxiety may be variably present but not essential for diagnosis。

Abstract：Background Bladder cancer is the most common type of urinary system tumours. It is frequently associated with genetic mutations that deregulate the cell cycle and render these tumours resistant to apoptosis. Survivin, a newly discovered member inhibitor of apoptosis protein (IAP) family in several human cancers, by inducing cell proliferation and inhibiting apoptosis is frequently activated in bladder cancer. We studied the influence of small interfering RNA (siRNA) targeting survivin on the biological behaviour of bladder cancer cells.Methods A double strand survivin target sequence specific siRNA was designed and synthesized. After transfection of bladder cancer cell line T24 by siRNA/liposome complex with increasing concentrations(50-200 nmol/L), the transfectant cells were intratumourally injected at different doses (5 μg or 50μg). The effects were measured in vitro and in vivo.Results The selected siRNA efficiently down-regulated survivin mRNA expression in a dose and time dependent manner. The maximal effect was achieved at the concentration of 100 nmol/L, at which survivin expression level was down-regulated by 75.91%. The inhibition rate of cell growth was 55.29% (P＜0.01) and the markedly increased apoptotic rate was 45.70% (P＜0.01). In vivo intratumoural injection of 50 μg siRNA-survivin could notably prevent the growth of bladder cancer (P＜0.01) in xenografted animals.Conclusion The application of siRNA-survivin could markedly inhibit survivin expression in bladder cancer cell line by inducing apoptosis and inhibiting the growth of the tumour. It may become a new gene therapy tool for bladder cancer。

Abstract：Background Portacaval shunt (PCS) prevent hepatotrophic factors from flowing into the liver, but they enter directly the systemic circulation and worsen liver injury. This study was designed to investigate the effects of hepatotrophic factors through the portal vein on the liver in rats with portal hypertension after portacaval shunt.Methods Intrahepatic portal hypertension (IHPH) was induced by intragastric administration of carbon tetrachloride, and end-to-side PCS was performed. Eight normal rats served as controls, and eight rats with IHPH served as IHPH model (IHPH group). Another 32 rats with IHPH-PCS were randomly subdivided into 4 groups:normal saline (NS) given to 8 rats, hepatocyte growth factor (HGF) 8, insulin (INS) 8, hepatocyte growth factor and insulin (HGF+INS) 8. Hepatotrophic factors were infused into the portal vein through an intravenous catheter.Portal venous pressure (PVP) was measured. The levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were tested biochemically and those of hyaluronic acid (HA) and laminin (LN) were measured by radioimmunoassay. Hepatic fibrosis was assessed histologically and the expression of collagens type Ⅰ and Ⅲ were detected immunohistochemically. Ultrastructural change of hepatocytes and the number of mitochondria were observed under an electron microscope. The data were compared between groups and subgroups by Student-Newman-Keuls procedure with SPSS 10.0.Results PVP was significantly higher in the IHPH rats than in the control rats (P＜0.05). The levels of serum ALT, AST, HA, and LN, hepatic fibrosis score, the amount of collagen deposition, collagens type Ⅰ and Ⅲ increased more significantly in the IHPH group than in the control rats (P＜0.05). The number of mitochondria decreased more significantly in the IHPH rats than in the control rats (P＜0.05). The levels of serum ALT, AST,HA and LN as well as hepatic fibrosis score, the amount of collagen deposition, and the amount of collagens type Ⅰ and Ⅲ in the HGF and HGF+INS rats were significantly lower than those in the NS rats (P＜0.05). The damage to hepatocyte ultrastructure was markedly alleviated and the number of mitochondria was increased more significantly in the HGF and HGF+INS rats than in the NS rats under an electron microscope.Conclusions Perfusion of exogenous hepatotrophic factors through the portal vein can alleviate liver injury,minimize the damage to the ultrastructure of hepatocyte, protect liver function, and lessen hepatic fibrosis in rats with portal hypertension after PCS。

Abstract：Background For esthetic consideration, dentin color post core materials were normally used for all-ceramic crown restorations. However, in some cases, clinicians have to consider combining a full ceramic crown with a metal post core. Therefore, this experiment was conducted to test the esthetical possibility of applying cast metal post core in a full ceramic crown restoration.Methods The color of full ceramic crowns on gold and Nickel-Chrome post cores was compared with the color of the same crowns on tooth colored post cores. Different try-in pastes were used to imitate the influence of a composite cementation on the color of different restorative combinations. The majority of patients could not detect any color difference less than △E 1.8 between the two ceramic samples. So, △E 1.8 was taken as the objective evaluative criterion for the evaluation of color matching and patients' satisfaction.Results When the Empress 2 crown was combined with the gold alloy post core, the color of the resulting material was similar to that of a glass fiber reinforced resin post core (△E = 0.3). The gold alloy post core and the try-in paste did not show a perceptible color change in the full ceramic crowns, which indicated that the color of the crowns might not be susceptible to change between lab and clinic as well as during the process of composite cementation. Without an opaque covering the Ni-Cr post core would cause an unacceptable color effect on the crown (△E = 2.0), but with opaque covering, the color effect became more clinically satisfactory (△E=1.8).Conclusions It may be possible to apply a gold alloy post core in the Empress 2 full ceramic crown restoration when necessary. If a non-extractible Ni-Cr post core exists in the root canal, it might be possible to restore the tooth with an Empress 2 crown after coveting the labial surface of the core with one layer of opaque resin cement。

Abstract：Background We have used suppression subtractive hybridization to construct a subtracted cDNA library of hepatocellular carcinoma (HCC) and isolated a panel of differential expression sequence tag (ESTs). By using bioinformatics and rapid amplification of cDNA ends (RACE), we found a novel HCC-associated gene IDD01.To further investigate its function, a recombinant eukaryotic vector pEGFP/ORF was constructed and transfected into the HepG2 cell line.Methods The open reading frame (ORF) of IDD01 was amplified by RT-PCR, digested with Bamh I and Hind Ⅲ, and subcloned into the pEGFP-C 1 vector. The ligation reaction was conducted with T4 DNA ligase, and the recombinant vector was named pEGFP/ORF. Untransfer control (control group), pEGFP-C 1 (HepG2/C 1 group)and pEGFP/ORF (HepG2/ORF group) transfer groups were designed. Gene transfer was conducted with lipofectamine. To obtain stable transfection in HepG2 cells, selection was initiated with 500μg/ml G418. Cellular IDD01 mRNA levels were assayed by semi-quantitative RT-PCR. The MTT colorimetric method and flow cytometry were used to determine the cell proliferation. The tumorigenic potential of transformed cells was determined from their ability to grow as anchorage-independent colonies on soft agar. Transient transfections were performed to observe subcellular location of GFP-IDD01 fusion protein.Results A 778 bp specific band of ORF was obtained by RT-PCR, and the positive clone of recombinant plasmid pEGFP/ORF (5.5 Kb) was identified by restriction endonuclease cleavage and sequence. The brighmess ratio of IDD01 mRNA was not obvious between control and pEGFP/C1 groups, whereas the ratio of pEGFP/ORF was higher than that in the other two groups. After culture for 24-72 hours, the A490 values in pEGFP/ORF were higher than those in the other two groups (P＜0.01). On histograms of flow cytometry, the S phase ratio of HepG2/ORF cells was significantly higher than that of the control and HepG2/C1 groups. The HepG2/ORF cells were able to form more colonies in soft agar compared with other HepG2 cell lines (P＜0.01). GFP-IDD01 fusion protein predominantly localized in the plasma, whereas EGFP protein diffused all over the cell.Conclusion The IDD01 gene is a positive effector in cell proliferation and contributes to the carcinogenesis and progression of HCC. This gene may serve as a potential target for pharmaceutical intervention of HCC。

Abstract：Background The levels of long-term elevated serum or intracellular free fatty acid (FFA) induce insulin resistance associated with central obesity. The insulin-mimetic protein visfatin is preferentially produced by visceral adipose tissues and has been implicated in obesity and insulin resistance. To identify that FFA is capable of inducing insulin resistance and to clarify the role of FFA on visfatin, we examined the effect of monounsaturated FFA oleate (C18:1) and saturated FFA palmitate (C16:0) on glucose transport and visfatin gene expression in cultured 3T3-L1 adipocytes or preadipocytes.Methods FFA-free DMEM/F12, 0.125 mmol/L, 0.5 mmol/1 and 1.0 mmol/L oleate or palmitate was added to cultured 3T3-L1 adipocytes or preadipocytes and incubated overnight. Glucose transport was assessed as 3H-2-deoxy-glucose uptake. Total RNA was extracted and subjected to RT-PCR for the measurement of visfatin mRNA levels. Statistical comparisons between control group and other groups were performed with the two-tailed paired t test, and one-way ANOVA was used to compare the mean values among the groups.Results Insulin increased specific membrane glucose transport in 3T3-L1 preadipocytes. Upregulation was evident from 15 minutes to 1 hour exposure to insulin. However, after 6-hour exposure to insulin, there was a downregulation in the response to insulin. Dose response studies demonstrated that 2-deoxy glucose transport was increased by 336% at 50 nmol/L insulin (P＜0.01), and reached a maximal effect at 100 nmol/L insulin(P＜0.01). Oleate and palmitate treatment did not influence basal glucose transport (without insulin stimulation),whereas insulin-stimulated glucose transport was inhibited after overnight oleate and palmitate treatment in preadipocytes and adipocytes. In 3T3-L1 preadipocytes, insulin resistance could be achieved at 0.125 mmol/L oleate or palmitate (P＜0.05, respectively), and the inhibition was dose dependent. In adipocytes, the inhibition was noted at 0.5 mmol/L oleate or 1.0 mmol/L palmitate. Visfatin mRNA expression increased during differentiation more than 1.5-fold. Bovine serum albumin (BSA) did not influence visfatin mRNA expression compared with the control group. Dose-response studies demonstrated that addition of 0.125 mmol/L oleate and palmitate to 3T3-L1 adipocytes decreased visfatin mRNA expression significantly (78%, 77%, respectively,relative to untreated control, P＜0.05), and further to 65% (relative to untreated control, P＜0.05) and 55% (relative to untreated control, P＜0.01) at 1.0 mmol/L FFA. Furthermore, the suppression on preadipocytes was similar to that of adipocytes, which reached a maximal reduction of 44% (oleate, P＜0.05) and 47% (palmitate, P＜0.05) at 1.0 mmol/L FFA.Conclusions Oleic acid and palmitic acid may induce insulin resistance in 3T3-L1 adipocytes and preadipocytes. Downregulation of visfatin mRNA may contribute to impair insulin sensitivity caused by oleate and palmitate。

Abstract：Background Cleft lip (CL) and cleft palate (CP) are two of the most frequent congenital malformations.Many epidemiologic studies on this deformity have been conducted worldwide, often producing inconsistent results. This study assessed epidemiology and some genetic aspects of cleft lip and palate in a Chinese sample from the Smile Train Program and to compare with other methodologically sound surveys.Methods The general information, family history, classification of cleft and associated malformations of 8000CL and CP surgery patients were analyzed.Results Of the 8000 cases, 7812 had complete data. The distribution of cleft types is 17.04% with CP, 23.39%with CL and 59.58% with cleft lip and palate (CLP). Unilateral clefts were more common than bilateral, with involved 29 CP cases, 41 CL and 156 CLP. The frequency of associated malformations in CLP (3.35%) was higher than CL (2.24%) and CP (2.22%) (P＜0.05). Patients with CP or CLP were born less often in the winter than in the summer (P＜0.05). A history of family members having clefts occurred in 6.84% of patients. The proportion of CLP cases (7.56%) was significantly higher than that of CL cases (5.64%) (P＜0.05).Conclusions The different types of clefts appeared in the highest proportion in CLP and lowest proportion in CP. Males are more common with CL and CLP and less common with CP. These characteristics are the same as those of other Chinese surveys but different from some European reports。

Abstract：Background Immunological sensitization remains a major problem following renal transplantation. There is no consensus for the management of sensitized renal allograft recipients. The patients become tethered to dialysis while waiting for compatible donors. This study was designed to evaluate the efficacy and safety of preoperative single- bolus high-dose antithymocyte globulin (ATG) as induction therapy in sensitized renal transplant recipients.Methods A total of 56 patients were divided into two groups according to the level of panel reactive antibody(PRA): non-sensitized group (PRA＜10%, n=30) and sensitized group (PRA≥ 10%, n=26). The characteristics of the recipients and donors were comparable between the two groups. Mycophenolate mofetil (MMF, 1 g) or ATG(iv. 9 mg/kg) were given preoperatively in the two groups as induction therapy. After the transplantation, the patients were treated with standard triple therapy regimen consisting of tacrolimus (FK-506) or cyclosporine A,MMF, and prednisolone. Acute rejection (AR) and infection episodes were recorded and renal function was monitored during a 12-month follow-up. X2 test and t test were used to analyze the data.Results During the follow-up, 6 patients (20.0%) suffered AR episodes in the non-sensitized group and 4(15.4%) in the sensitized group (P=0.737); 8 patients (26.7%) experienced 11 infection episodes (average, 1.4episodes per infected patient) in the non-sensitized group, and 6 (23.1%) experienced 10 infection episodes (average, 1.7 episodes per infected patient) in the sensitized group (P=0.757, 0.890). The safety of the drugs,which was assessed by the occurrence of side effects, was comparable between the two groups. The hospital stay was 13-25 days (mean, 16.7±3.3) in the nonsensitized group and 14-29 days (mean, 16.2±3.1) in the sensitized group, respectively (P=0.563). No delayed graft function (DGF) was observed in all the patients. Both the 12-month actuarial patient and graft survival rates were 100% in the two groups.Conclusion Preoperative single-bolus high-dose ATG is an effective and safe induction therapy yielding acceptable acute rejection rate in sensitized renal transplant recipients。

Abstract：Background The myocardial ATP sensitive potassium channel (KATP channel) has been known for more than two decades, the properties of this channel have been intensively investigated, especially the myocardial protection effect by opening this channel. Numerous studies, including hypothermic, using KATP agonists to achieve a hyperpolarizing cardioplegic arrest, have shown a better myocardial protection than potassium arrest.However, there is no evidence showing that KATP channel could be opened by its agonists under profound hypothermia. We investigated the effect of temperature on activation of myocardial KATP channel by nicorandil.Methods Isolated ventricular myocytes were obtained by collagenase digestion of the hearts of guinea pigs and stored in KB solution at 4℃. With a steady ground current, the myocytes were perfused with 1 mmol/L nicorandil until a steady IKATP occurred. Then the cells were perfused with 1 mmol/L nicorandil plus 1 μmol/L glybenclamide. Currents signals were recorded on whole cells using patch clamp technique at several temperatures. The temperature of the bath solution around myocytes was monitored and was controlled at 4℃,10℃, 20℃, 25℃ and 35℃ respectively. About 10 cells were tested at each temperature, the cells were considered useful only when the outward current could be induced by nicorandil and blocked by glybenclamide.All data were analyzed using Graphpad PRISM 3.0 (Graphpad, San Diego, CA, USA). Nonlinear curve fitting was done in Clampfit (Axon) or Sigmaplot (SPSS).Results At 4℃, 10℃, 20℃, 25℃ and 35℃, the time needed to open the myocardial KATP channel was (81.0±0)minutes, (50.5±11.7) minutes, (28.8±2.3) minutes, (9.4±10.2) minutes and (2.3± 1.0) minutes respectively (P=0.003). The linear relationship between temperature and time needed to open the channel was y (min) =(4348.790-124.277x)/60, where y (min) is time needed to open KATP channel, x is temperature, correlation coefficient r =-0.942 (P=0.00), regression coefficient b =-124.277 (P=0.00). The current densities among different temperatures were statistically different (P=0.022), the current density was greater after the activation of KATP channel at higher temperatures. The lower the temperature, the fewer cells in which KATP channels could be opened. At 4℃, only one cell in which the KATP channel could be opened, took a quite long time (81 minutes)and the I-V curve was quite untypical.Conclusions KATP channel activated by nicorandil is temperature dependent and the temperature linearly related to time needed to open KATP channel; the lower the temperature, the longer the time needed to open channel and the smaller the current density. At profound hypothermia, it is difficult to activate KATP channels。

Abstract：Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of the acute coronary syndrome (ACS). It is of potential significance to explore the blood indexes predicting plaque characteristics. Little studies have focused on this field. Therefore we investigated the relationship between hypersensitive C-reactive protein (hs-CRP), pro-matrix metalloproteinase-1 (proMMP-1),tissue inhibitors of matrix metalloproteinase-1 (TIMP-1) and coronary plaque morphology.Methods Intravascular ultrasound (IVUS) examination was done in 152 patients with confirmed coronary heart disease before percutaneous coronary intervention from February 2003 to July 2005. Plasma samples of arterial blood were collected prior to the procedure. The level of hs-CRP, proMMP-1 and TIMP-1 were respectively measured by enzyme-linked immunosorbent assay (ELISA).Results Unstable and ruptured plaque were found more frequently in patients with acute myocardial infarction and unstable angina. External elastic membrane cross-sectional area (EEM CSA), plaque area, lipid pool area and plaque burden were significantly larger in ruptured and unstable plaque group. Positive remolding, thinner frequent in ruptured and unstable plaque group. The levels of plasma hs-CRP, proMMP-1 and TIMP-1 were higher in ruptured plaque group. hs-CRP＞8.94 mg/L was used to predict ruptured plaque with a ROC curve area of 0.76 [95% confidence interval (CI), 67.0%-85.8%], sensitivity of 71.8%, specificity of 77.0% and accuracy of 69.2% (P＜0.01), similarly for proMMP-1＞0.12 ng/ml with a ROC curve area of 0.69 [95% CI, 58.2%-80.2%], sensitivity of 69.2%, specificity of 75.2% and accuracy of 66.2% (P＜0.01), and TIMP-1＞83.45 ng/ml with a ROC curve area of 0.67 [95% CI, 56.2%-78.3%], sensitivity of 66.7%, specificity of 61.9% and accuracy of 66.2% (P＜0.01).Conclusion The plaque characteristics correlate with the clinical presentation. The elevation of hs-CRP,proMMP-1 and TIMP-1 are related to the plaque instability and rupture。

As a source of transplantable stem cells, the CD34+ subpopulation in human umbilical cord blood (HUCB) has been used extensively to treat some hematopoietic system diseases. However,whether CD34+ cells hold the therapeutic potential to cerebral ischemia is unknown. The purpose of this study was to observe the recovery of neural function after transplantation of CD34+ cells derived from HUCB into ischemic cerebral tissue in rats。

Locally advanced carcinoma in sigmoid colon and rectum often invades adjacent organs in the pelvis; whereas local invasion of the pancreas or duodenum is rare. Consequently combined hemicolectomy and pancreatico-duodenectomy in the treatment of locally advanced colorectal carcinoma is uncommon.1 To the best of our knowledge, there are currently only three such cases reported in the Chinese literature to date.2 This paper reports five cases of synchronous right hemicolectomy (RH) and pancreatico-duodenectomy(PD) for the treatment of locally advanced right colon carcinoma。

To the Editor: Bird flu or avian flu, caused by H5N1 virus, is a new emerging infectious disease. It is noted that this H5N1 virus jumped the species barrier and caused severe disease with high mortality in humans in many countries. The continued westward dissemination of H5N1 influenza A viruses in avian populations and the nearly 50% mortality of humans infected with H5N1 are a source of great international concern.1Providing sufficient antiviral drugs and development and approval of new vaccines are the keys for control of the possible emerging pandemic of this atypical influenza.1,2 Based on the advance in bioinformatics, the immunomics becomes a new alternative in vaccine development.3