2008年·第121卷第02期

Abstract：Background Laparoscopic splenectomy(LS)shows many advantages compared with open surgery except for the high cost.This study was aimed to recommend secondary pedicle division strategy as a method with high cost-effectiveness.Methods From January 2003 to June 2005,14 consecutive patients underwent laparoscopic splenectomy.The splenic pedicle was controlled by secondary pedicle division strategy in 8 cases and by Endo-GIA in the other 6 cases.A retrospective study was carried out to evaluate the operative time,blood loss,time to diet,operative morbidity,postoperative stay,and operative cost.Results LS was performed successfully in a totaI of 14 cases.There was no significant difference between the two strategies in operative time,blood loss,time to diet,operative morbidity and postoperative stay.The operative cost of secondary pedicle division strategy group(RMB 8354.38±752.10)was significantly lower than that of Endo-GIA group (RMB 11053.33±602.27)(P＜0.01).Conclusions Laparoscopic splenectomy by secondary pedicle division strategy is a safe,effective and economical procedure with the value of popularization in developing countries。

Abstract：Background Mutations in the cationic trypsinogen gene(PRSS1)have been detected in patients with hereditary pancreatitis(HP).This study investigated the prevalence of the R122H(c.365G＞A),A121T(c.361 G＞A)and D162D (c.488 C＞T)mutations or polymorphisms in the common,non-hereditary forms of chronic pancreatitis and in an HP family.Methods DNA was prepared from blood samples of 54 patients with chronic pancreatitis(35 alcoholic,17 idiopathic and 2 hereditary)and 120 normal controls.The PRSS1 genes were amplified by polymerase chain reaction (PCR) and their products were analyzed by sequencing and related clinical data were also collected.Results A new polymorphism(c.488 C＞T)of PRSS1 was found in 25 patients with chronic pancreatitis (including one affected member of the H P family)and six members of the normal controls.The C/T genotype was significantly increased in chronic pancreatitis(OR:16.379,95%CI:5.7522-52.3663),the frequency of c.488 C＞T change was in according with the Hardy-Weinberg equilibrium,but it doesn't affect the clinical phenotype.The commonly reported change of R122H (c.365G＞A)was not detected in any of the study subjects.c.361 G＞A was found in 2 affected members and one unaffected carrier in an HP family.One of the affected members of an HP family had c.361 G＞A mutation and polymorphism(c.488 C＞T)in the PRSS1 gene at the same time.The patient's clinical values(C3,C4,CA19-9 and HbA1c)were higher than those of the other patients with chronic pancreatitis.The two patients with HP developed diabetes mellitus and their father died with pancreatic cancer.Conclusion A new polymorphism(c.488 C＞T)in the PRSS1 gene is associated with chronic pancreatitis,but it did not affect the clinical phenotype while the A121T(c.361 G＞A)mutation in the gene shows a significant correlation in the patients with H P。

Abstract：Background Scavenger receptor that binds phosphatidylserine and oxidized lipoprotein/CXC chemokine ligand 16 (SR-PSOX/CXCL16)promotes foam cell formation through the tumor necrosis factor (TNF)-α mediated mechanism.Because chemokine CXCL16 could be expressed in atherosclerotic lesions and induce smooth muscle cell(SMC) proliferation,we presume that the monocle SR-PSOX/CXCL16 detection in the patients' peripheral blood will be important for early diagnosis and prognosis of atherosclerosis(AS).Methods Enrolled in this study were 40 patients with acute coronary syndrome(ACS),including 20 patients with acute myocardial infarction(AMI)and 20 patients with unstable angina pectoris(UAP),and 20 normal controls.Monocytes in the peripheral blood were isolated,and the changes of expression of CXCL16/SR-PSOX mRNA were compared using reverse transcription-polymerase chain reaction(RT-PCR),with β-actin as internal control.We compared the expression of CXCL16/SR-PSOX in the ACS subgroups,using Western-blot to analyze protein expression levels.Tissue sections were made from biopsy specimens taken from patients with infective endocarditis,liver cirrhosis,and lung cancer as well as normal controls.And the expression of CXCL16/SR-PSOX was analyzed with a confocal microscope.Results The expression of CXCL16/SR-PSOX mRNA and protein in the monocytes of peripheral blood was significantly higher in ACS patients than in normal controls(P＜0.05):however,there was no significant difference in CXCL16/SR-PSOX expression between UAP group and AMI group (P＞0.05).Immunofluorescence showed that there were low expression of SR-PSOX in normal vascular endothelial cells and enhanced expression in every layer of the Infected vessels,while spreading from endotheliaI cells to surrounding tissues as infection worsens.Confocal microscopy showed that the expression of SR-PSOX was enhanced in the infiltrated lymphocytes in liver cirrhosis, and that the expression level was proportionate to the degree of inflammation in the portaI hepatis and folia.Conclusions The expression of CXCL16/SR-PSOX in the monocytes of peripheral blood was significantly higher in ACS patients than in the controls.CXCL16/SR-PSOX-mediated inflammation may contribute to the pathogenesis of ACS,and CXCL16 may play an important role in the pathogenesis and development of AS in humans。

Abstract：Background Nevoid basal cell carcinoma syndrome(NBCCS)is a rare autosomal dominant disease characterized by a combination of development anomalies and a predisposition to tumour formation.Mutation of patched gene(PTCH),considered the molecular defect of NBCCS,in a Chinese NBCCS family was investigated in this study.Methods Genomic DNA was isolated from blood samples of all 12 members of this family.The mutated PTCH gene was screened by polymerase chain reaction amplification and di rect sequencing.Results A new mutation of 3 bp(GAT deletion)was found in all seven affected members of this family.This mutation caused one aspartate deletion in the fourth transmembrane domain of the PTCH protein located within the sterol sensing domain(SSD).This deletion was not found in any unaffected members of this family nor in 200 controI samples.Conclusions Our findings suggest that one 3-bp deletion in PTCH gene was the cause of nevoid basal cell carcinoma in a Chinese family through affecting the conformation and function of PTCH protein。

Abstract：Background Substrate modification guided bv CARTO system has been introduced to facilitate linear ablation of ventricular tachycardia(VT)after myocardial infarction(MI).However,there is no commonly accepted standard approach available for drawing these ablation Iines.Therefore,the aim of the present study was to practically refine this time consuming procedure.Methods Substrate modification was performed in 23 consecutive patients with frequent VTs after MI using the CARTO system.The initial target site(ITS)for ablation was identified by pace mapping(PM)during sinus rhythm and/or entrainment pacing(EM)during VT.According to the initial target site,two approaches were used.The initial target site in approach one has a similar QRS morphology as VT and an intervaI from the stimulus to the onset of QRS cmplex (S-QRS)of≥50 ms during PM in sinus rhIythm or a difference of the post pacing interval and VT cycle length≤30 ms during concealed entrainment pacing of VT;The initial target site in approach two has an similar QRS morphology as VT and an S-QRS of＜50 ms during PM in sinus rhythm.Results Overall,50 lines were performed with a length of(35±11)mm.Procedure time averaged (232±56)minutes,fluoroscopy time(10±8)minutes.Sixteen patients were initially involved into approach one.After completion of 3±1 ablation Iines,no further VT was inducible in 13 patients.The remaining 3 patients were switched to use the alternative approach.However,In none of them the alternative approaches were successful.Approach two was initially used in 7 patients.After completion of 3±1 ablation Iines,no further VT was inducible in only 2 patients.The remaining 5 patients were switched to approach one,which resulted in noninducibility of VT in 4 of them.The initial successfuI rate was significantly higher in the group of approach one compared to that in the group of approach two(13/16 patients vs 2/7patients,P=0.026).Conclusions The approach for substrate modification of VT after MI can be optimized by identifying the appropriate initiaI target site with specific characte ristics within the zone of slow conduction.The refined approach may facilitate linear ablation of VT and further reduce the procedure and fluoroscopy time。

Abstract：Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of acute coronary syndrome(ACS).It is of potential significance to explore the blood indexes predicting plaque characteristics.We investigated the relationship among soluble CD105,hypersensitive C-reactive protein(hs-CRP),and coronary plaque morphology.Methods A clinical study from April 2004 to December 2006 was conducted in 130 patients who were divided into 3 groups:56 patients(43.1%)in stable angina(SA)group,52 patients(40.0%)in unstable angina(UA)group and 22 patients(16.9%)in acute myocardial infarction group.The concentrations of soluble CD105 and hs-CRP were measured ln all of the patients by cardioangiography(CAG).Plasma samples of arterial blood were collected prior to the procedure.The levels of soluble CD105 and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA).Results Unstable and ruptured plaque was found more frequently in patients with acute myocardial infarction and UA.External elastic membrane cross-sectional area(EEM CSA),plaque area,lipid pool area and plaque burden were significantly larger in the ruptured and unstable plaque group.Positive remodeling,thinner fabric-cap,smaller minimal lumen cross-sectional area(MLA),dissection and thrombus were significantly more frequent in the ruptured and unstable plaque group.Remodeling index(RI)was positively correlated with the levels of soluble CD105 in the UA group (r=0.628,P＜0.01)and the acute myocardial infarction group(r=0.639,P＜0.01).The Ievels of soluble CD105 and hs-CRP were higher in the ruptu red plaque group.Soluble CD105＞4.3 ng/ml was used to predict ruptured plaque with a receiver operating characteristic(ROC)curve area of 0.77(95%confidence interval(Cl),66.8%-87.2%),a sensitivity of 72.8%,a specificity of 78.0%and an accuracy of 70.2%(P＜0.01),similarly for hs-CRP＞5.0 mg/ml with a ROC curve area of 0.70 (95%Cl,59.2%-80.2%),a sensitivity of 70.2%,a specificity of 76.2%and an accuracy of 67.2%(P＜0.01).Conclusions The plaque characteristics correlate with the clinical presentation.The elevation of soluble CD105 and hs-CRP is related to the plaque instability and rupture。

Abstract：Background yon Willebrand factor(vWF)mediates the initial capture of platelets to vascular subendothelium and is essential for platelet aggregation under high fluid shear stress as in arteriaI stenosis.On release frOm endothelial cells,vWF is rapidly cleaved by ADAMTSl 3/vWF-cleaving protease (vWF-CP).We investigated the clinical significance of changes in plasma vWF and vWF-CP activities in chronic renal disease.Methods Plasma vWF and vWF-CP activities were measured using enzyme-linked immunosorbent assay(ELISA)and residual collagen binding assay respectively in patients with lupus nephritis(n=31),primary nephritic syndrome(n=25),diabetic nephropathy(n=45),chronic glomerulonephritis(n=38)and 40 normal controls.The reIation of their levels with pathological and renal status was analyzed.Results In all diseased patients the levels of vWF were significantly higher and vWF-CP activity significantly lower than the controls(both P＜0.01).vWF in the four subgroups did not correlate with the stage of disease but correlated negatively with vWF-CP activity.vWF-CP activity was not changed two weeks after renal transplantation.Renal biopsy demonstrated that the vWF level in stage Ⅳ was higher than in stages Ⅱ and Ⅲ while vWF-CP activity was lower in patients with lupus nephritis.After eight-week treatment,the vWF level significantly decreased and the vWF-CP activity significantly increased in systemic lupus erythema,disease activity index＜9,but not with index≥9.Even though the vWF-CP activity was significantly lower in membranous nephropathy than in minimal change disease,mesangial proliferative glomerulonephritis or IgA glomerulonephritis,the vWF level was not significantly different.Conclusions The alterations of plasma vWF and vWF-CP activities were associated with different renal pathologies.Injury to endothelial cells and autoantibodies against vWF-CP activity may result in higher vWF Ievel and Iower vWF-CP activity in chronic renaI disease and thus a mechanism for worsening of chronic renal disease and thrombosis。

Abstract：Background Laser in situ keratomileusis(LASIK)has become an efficient and commonly performed procedure to reduce refractive errors.In order to further increase the postoperative visual quality,the wavefront-guided refractive surgery has been a research hotspot in customized surgery. This study was conducted to compare the visual acuity,higher-order aberration,and contrast sensitivity of wavefront-guided LAStK with iris-registration and conventional LASIK.Methods Two hundred and eleven myopic eyes of 109 patients were enrolled in this prospective study and randomly divided into two groups:the wavefront-guided LASIK(wg LASIK)group(94 eyes)and conventional LASIK group(117 eyes).A Wavescan Wavefront aberrometer was used to analyze Zernike coefficients and the root-mean-square(RMS)of higher order aberrations with 6.0 mm pupil size,and Optec 6500 visual function instrument was used to measure contrast sensitivity(CS)under 5 spatiaI frequencies before and after surgery in both groups.Results The uncorrected visual acuity(UCVA)and the mean spherical equivalent(SE)in wg LASIK group were significantly better than those in conventional LASIK(UCVA,z=2.339,P=0.019;SE,t=2.838,P=0.005)at 3 months after surgery.Moreover,the increase in Z3-3,Z3 1,Z3 3,Z4 0,Z5 -1,Z5 1,Z5 5 and Z6 -6 in wg LASIK group was statistically smaller than that in conventional LASIK group(P＜0.05).In wg LASIK group,eyes with a higher amount of the preoperative RMS of the higher order aberrations(RMSh≥0.30 μm)showed a statistically lower increase(13.5%)than those in conventional LASIK group at 3 months after surgery(33.3%)(P=0.004).And the values of 4th order spherical aberration(4thSA)and the root mean square of 6th order aberration(RMS6)in wg LASIK group were significantly lower than those in conventional group in eyes which had higher preoperative astigmatism(≥1.0D)(4thSA,P=0.03;RMS6,P=0.02).Wg LASIK group showed better CS values than the correspondingly preoperative values at all spatial frequencies with and without glare at 3 months after the surgery while conventional LASIK group displayed reduced CS values except for 1.5 and 3 cycles per degree with glare.The differences between the two groups were statistically significant (P＜0.001).Conclusions Wavefront-guided LASlK with iris-registration is efficient to reduce higher order aberrations especially spherical and coma aberrations,and to improve pOstOperative visual acuity and contrast sensitivity compared with conventional LASlK.The application of wavefront-guided LASIK with iris-registration is particularly suitable for eyes with higher preoperative RMSh values and eyes with higher preoperative astigmatism。

Abstract：Background Endothelial progenitor cells(EPCs)derived from bone marrow may differentiate into endothelial cells and participate In endothelial repair.These cells can be mobilized into peripheral blood by cytokines,including granulocyte colony-stimulating factor(G-CSF).In the present study,we investigated the effects of G-CSF on neointimal formation and restenosis in a canine model of arterial balloon injury.or normal saline(n=8)for 1 week.On the fifth day of treatment,the dogs underwent renal arterial angioplasty.At 8 weeks after arterial balloon injury,angiographic obsewations were made and injured arteries were processed for morphometric analysis of neointimal formation.Results Peripheral white blood cell counts were increased by 3.34-fold compared to baseline on the fifth day Of administration of G-CSF.Angiographies revealed that one stenosis had occurred among the eight injured renaI arteries from dogs treated with G-CSF,whereas all injured renal arteries from dogs treated with normal saline remained patent.The mean extent of stenosis among injured arteries was 18.3%±17.9%in the G-CSF treated group compared to 12.5%±7.6%in the saline treated control group(P=0.10).G-CSF treatment slightly increased neointimal thickness (0.42±0.15 mm vs 0.25±0.06 mm,P=0.08)with an intima to media ratio of 0.83±0.49 vs 0.54±0.18 (P=0.11).Conclusions G-CSF treatment does not aftenuate neointimal hyperplasia and restenosis formation in a canine model of renal arterial inJury,suggesting that the therapeutic strategy for preventing restenosis by stem cell mobilization should be investigated further。

Abstract：Background Mesenchymal stem cells are a promising cell type for cell transplantation in myocardial infarction.Type Ⅰ neuregulins-1,also known as heregulin,can promote the survival of cardiomyocytes and stimulate angiogenesis.The purpose of this study was to investigate the expression of heregulin and ErbB receptors in mesenchymaI stem cells,then further detect the secretion of heregulin and the changes in expression of heregulin and ErbB receptors under conditions of serum deprivation and hypoxia.Methods Mesenchymal stem cells lsolated frOm bone marrow of 180 g male Sprague-Dawley rats were cultured.Passage 3 cells were detected experimentally by regular reverse transcriptase-polymerase chain reaction(RT-PCR),quantitative real time PCR and Western blotting.Results Heregulin and ErbB receptors were expressed in mesenchymal stem cells,and all three ErbB receptors mRNA expressions were significantly down-regulated by serum deprivation and hypoxia,but serum deprivation and hypoxia significantly increased the protein expression of heregulin.Serum deprivation and hypoxia more than 12 hours could induce the secretion of heregulin.Conclusions Mesenchymal stem cells can express all three ErbB receptors and heregulin.Serum deprivation and hypoxia decrease the mRNA expression of ErbB receptors,increase the expression of heregulin,and activate the secretion of heregulin。

Abstract：Background Tong-xin-luo capsule(TXL),used as a traditional Chinese herb,offeres a therapeutic potential for treatment of cardiovascular diseases.It has been shown to exert a variety of pharmacological effects,including antihypertensiVe effects,and is able to improve ventricular remodeling.However,the mechanisms of its action are not completely understood.The aim of this study was to evaluate the molecular mechanisms of Tong-xin-luo capsule on left ventricular remodeling in spontaneously hypertensive rats (SHR).Methods Sixteen eight-week-old SHRs were randomized into an SHR group(n=8)and a TXL group(n=8)that were given Tong-xin-luo capsule(1.5 mg·kg-1·d-1).Eight Wistar Kyoto(WKY)rats fed with 0.9%NaCl served as the control group(WKY group).Systolic blood pressure(BP),body weight and heart rate were monitored once every two weeks.Ventricular remodeling was detected by hjstopathological examination.Nuclear factor kappa B P65(NF-κB P65)and peroxisome proliferators activated receptor γ(PPAR-γ)protein and phosphorylated inhibitor kappa α(IκBα)protein were detected by immunohistochemistry and western blot respectively.The physical interaction of the P65-P50 heterodimer with IκBα and NF-κB were measured by co-immunoprecipitation.PPAR-Y mRNA,collagen Ⅰ mRNA and collagenⅢ mHNA were measured by real-time PCR.Results TXL inhibited NF-κKB P65 expression and ventricular remodeling and suppressed the activation of NF-κB compared with the SHR group(P＜0.01,P＜0.05).TXL reduced IκBα phosphorylation,increased expression of PPAR-Yprotein and enhanced the physical interaction of the P65-P50 heterodimer with IκBα.The mRNA expression of PPAR-γwas enhanced but the mRNA expression of collagen Ⅰ mRNA and collagen Ⅲ mRNA were suppressed by TXL.Conclusions In spontaneously hypertensive rats,TXL could inhibit ventricular remodeling induced by hypertension,and the inhibitory effect might be associated with the process of TXL increasing the expression of PPAR-γ that could result in the inhibition of the activation of NF-κB。

Abstract：Background Rosiglitazone is known as the most potent and specific peroxisome proliferators-activated receptor γ (PPAR-γ)ligand.It has potentially far-reaching effects on pathophysiological processes,from cancer to atherosclerosis and diabetes.However,it is not clear whether rosifllitazone affects the protein expression of transforming growth factor β3(TGF-β3)and lhe cell proliferation in human uterine leiomyoma cells in vitro.Methods Human uterine leiomyoma tissues were dissected and cultured.Cells were divided into 5 groups:one control group and other four groups with different concentrations of rosiglitazone(1O-7,10-8,10-9 and 10-10 mol/L).Cells were cultured for 72 hours in serum-free Dulbecco's modified Eagle's medium.MTT reduction assay was used to detect the cell proliferation.Reverse transcription polymerase chain reaction(RT-PCR)was used to detect the mRNA expression of PPAR-γ and TGF-β3.Immunofluorescence staining was used to detect the expressions of PPAR-γand TGF-β3 proteins.Results MTT reduction assay indicated that the treatment with rosiglitazone(from 10-7 to 10-9 mol/L) resulted in an inhibition of the cell growths after 72 hours(P＜0.01).RT-PCR analysis revealed that 10-7 mol/L rosiglitazone significantly affected the gene expression at 72-hour:PPAR-γ mRNA expression was up-regulated and TGF-β3 mRNA was down-regulated and rosiglitazone at the concentration of 10-7mol/L affected these most effectively(P＜0.01).Immunofluorescence staining demonstrated that treatment with 10-7mol/L rosifllitazone resulted in the significant changes of PPAR-γ and TGF-β3 protein expressions compared with the other treatment groups and the control group at 72-hour(P＜0.01).All the effects of rosiglitazone on uterine leiomyoma cells were dose-and time-dependent in vitro.Conclusions The present study demonstrates that the PPAR-γ activator,rosiglitazone,inhibits the cell proliferation partly through the regulations of PPAR-γ and TGF-β3 expressions.The cross-talk between the signal pathways of PPAR-γ and TGF-β3 may be jnvolved in the process。

Obstructive sleep apnea(OSA)is a disorder in which transient obstruction fcomplete or partiall of the airway during sleep causes loud snoring,oxyhemoglobin desaturation and frequent arousal.1-4 OSA has been identified to relate to many cardiovascular diseases such as hypertension,coronary heart disease,heart failure,and cardiac arrhythmia.In this article,we attempt to discuss the association between OSA and atrial fibrillation (AF) while reviewing the recent data on OSA and AF。

Menkes disease is a rare X-linked recessive hereditary disorder first described bv Menkes et al in 1962.1The gene mutation results in clinical features including pili torti, unusual facies, mental/growth retardation and metabolic dysfunction.The Dathogenic gene ATP7A was identified in 1993。

The treatment of pathological fractures of the femoral neck and trochanteric region secondary to benign lesions can be a challenge for orthopaedic surgeons because of the size and nature of the lesions,the resulting bony defect,the risk of recurrence,the possible associated defortuities,and the risk of osteonecrosis。

Type 1 diabetes is classified as either autoimmune (type 1A)or idiopathic(type 1B)diabetes.1Recently,fulminant type 1 diabetes has been identified as a new subtyDe Of idiopathic diabetes.2,3It is characterized by an abrupt onset of diabetic ketoacidosis within a short period of time(4 days on average),complete destruction of pancreatic β cells。

The use of mesh plug in hernioplasty was introduced by Shulman et al 1 in 1990 as a"rolled plug"fixed with two stitches to close the internal inguinal ring.Robbins and Rutkow 2 described their mesh plug technique in 1993。

Because of the lack of specific clinical signs and symptoms,acute renal infarction is apt to be missed in diagnosis and hence has a"low"incidence.In this report,a case of acute renal infarction due to idiopathic renal arterial thrombosis is presented。

Eosinophilic ureteritis is a rare disease.No cases of the disease have been reported until now in China.We present here a female case with eosinophilic ureteritisseen by our department。

When you ask who are the pioneers of surgery in China in the last centuary,the late professor WU Ying-kai is one of them.Dr。

Many interesting stories in this book tell how Chinese cardiothoracic surgery developed from its embryonic stage to maturity or to the present status after overcoming numerous difficulties which were partly due to the political and socioeconomic conditions。