2011年 · 第124卷第24期

Abstract：Background Allergen micro-arrays are powerful tools for screening of serum IgE-reactivity.In this study allergen micro-arrays were used to identify dominating IgE-binding allergens and cross-reactivity patterns among selected Chinese allergy patients.Methods The study was conducted using patient sera from the cities of Guangzhou,Nanjing,Chengdu and Shenyang.In total 100 sera with Dermatophagoides pteronyssinus (Der p) specific IgE-levels higher than 50 kU/L were selected for testing against 103 individual allergens.Results Among 100 selected patients, 95％ showed IgE-reactivity towards house-dust mite allergens Dermatophagoides farinae (Der f) 1,Der f 2 and Der p 2 and 94％ were IgE positive against Der p 1,and 60％ of sera contained IgE reacting against allergen Euroglyphus maynei (Eur m) 2.IgE against cat allergen,Felisdomesticus (Fel d)1,was seen in 20％.Only 2％ showed specific IgE-reactivity to Der p 10,a panallergen belonging to the tropomyosin family.Serum IgE-reactivity towards other allergens was in general low.IgE-reactivity against pollen allergens showed geographic differences.Conclusions This study clearly confirms that group 1 and group 2 are major allergens of house dust mites.These selected house-dust mite allergy patients are close to being mono-sensitized.Der p 10 is not an important allergen for cross-reactivity.Specific IgE-sensitization towards pollen allergens is low in southern China compared to other regions.The prevalence of food and stinging insect allergens known to give rise to IgE-mediated cross-reactivity is 2％ or less。

Lungs are located in the chest and lie on both sides of mediastinum.The major function of lung is to balance the external and internal 'gas' environment and to maintain homeostatic equilibrium.Because lung is closely interacted with outside surroundings as well as general circulation,it is fair to say that lung is a delicate organ which may be attacked by so many noxious stimuli,such as bacterial or viral infections,chemical insults (smoke,dust,etc),radiation,autoimmune and allergic responses.Damage to lung tissue can result from these various acute or chronic stimuli,which in tum disrupt lung homeostasis and a dysregulated healing response will eventually occur, such as inflammation,anti-fibrinolytic coagulation cascade and accumulation of pro-angiogenic,and fibrogenic cytokines,growth factors and enzymes.Uncontrolled healing response could gradually evolve into a pathogenic fibrotic response when important checkpoints are missed and inflammation becomes unrelenting。

Abstract：Background A prospective 2-night polysomnographic (PSG) study in Chinese snorers was designed to assess the role of the first night effect (FNE) in PSG parameters and the diagnosis of obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Seventy-two snorers from two teaching hospitals underwent overnight PSG on two consecutive nights.The night-to-night variability of PSG parameters were recorded and analyzed.Results Sixty-six patients were analyzed.Among all the PSG parameters,only the total time of stage 2 presented a significant difference between two nights:219.50 (83.50-353.50) vs.215.25 (59.50-342.50) (P=0.000).Subgroup assessment showed a slight night-to-night difference in about 1-2 parameters in the group with the apnea-hypopnea index (AHI) ≥20 events per hour as well as the group with AHI ＜20 events per hour,but there was no night-to-night difference in the AHI in each group.And slighter FNE was found among patients ≥40 years old.There was no significant difference in diagnosis of OSAHS.In the decision of severity,a slight difference was found between the two nights with a Kappa value=0.531.Conclusions Only mild FNE can be found on two consecutive nights of PSG in adult Chinese snorers,but it has no effect on the diagnosis of OSAHS.A single polysomnographic night may be adequate for the diagnosis of OSAHS。

Abstract：Background Vagus nerve stimulation (VNS) is an alternative treatment for drug-resistant epilepsy (DRE).The study aimed to explore the potential factors of prognosis,safety and effect of VNS treatment in patients with DRE.Methods We retrospectively examined 45 cases of DRE that received VNS treatment in our center from June 2004 to June 2010 and analyzed the parameters (age of patient receiving VNS,seizure frequency before and after VNS as well as treatment duration) by Student's t test,Fisher's exact and Mann-Whitney U tests,and multivariate Logistic regression.Results The overall response rate was 64％ (29/45),67％ (6/9) for adults and 64％ (23/36) for children,with no significant difference (P=0.28).Twenty-two cases had been in VNS therapy for over 1 year with a treatment efficacy of 73％ (16/22),whereas 23 cases had been in VNS therapy no more than 1 year with a treatment effecacy of 57％ (13/23),and has statistically significant difference (P=0.03).The main side effect included hoarseness of voice and cough.One patient's device was removed due to infection.One patient's VNS was half-way terminated due to seizure aggravation.One patient died due to status epilepticus.Conclusions VNS is a safe and effective treatment for DRE.Duration of VNS therapy may be a crucial factor on prognosis。

Abstract：Background HIV-1 infected and immune-activated macrophages and microglia secrete neurotoxins,such as tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β),which play major role in the neuronal death.It has been shown that different HIV-1 variants have varying abilities to elicit secretion of TNF-α by peripheral blood mononuclear cell (PBMC); however,whether the difference of gp120 gene could affect the secretion of TNF-α and IL-1β by glial cells is unknown.The aim of this study was to explore the association between gene diversity and induction of neurotoxic cytokines.Methods In this study,we constructed retroviral vectors MSCV-IRES-GFP/gp120 using HIV-1 gp120 genes isolated from four different tissues of one patient who died of AIDS dementia complex (ADC).Recombinant retroviruses produced by cotransfection of MSCV-IRES-GFP/gp120,pCMV-VSV-G and pUMVC into 293T cells were collected and added into U87 glial cells.Concentrations of TNF-α and IL-1β secreted by transduced U87 cells were assayed with ELISA separately.Results The four HIV-1 gp120 were in the different branch of the neighbor-joining tree.Compared to the pMIG retrovirus (gp120-negative) or U87 cells,all the gp120-positive recombinant retroviruses induced more TNF-α (P ＜0.01) and IL-1β (P ＜0.01).In addition,compared with the L/MIG retrovirus,all the three brain gp120-positive recombinant retroviruses induced less TNF-α (P ＜0.01) and IL-1β (P ＜0.01).Conclusions HIV-1 gp120 could induce U87 cells secret more TNF-α and IL-1β again.The more important is that difference of HIV-1 gp120,especially cell-tropism may account for the different ability in eliciting secretion of TNF-α and IL-1β,which might supply a novel idea helping understand the pathogenesis of ADC。

Abstract：Background Otitis media with effusion (OME) is a common pediatric disease,but its pathogenesis remains uncertain.The relationship between OME and Helicobacter pylori (HP) is currently being studied,and a relationship has not yet been confirmed.The purpose of this study was to show that a relationship does exist between HP and OME.Methods The study consisted of 60 patients who were diagnosed with OME and had ventilation tube insertions with or without an adenoidectomy.This study included an additional 30 patients who had only received an adenoidectomy without being diagnosed with OME.The effusion samples were analyzed with polymerase chain reaction (PCR) and the campylobacter-like organism (CLO) test.The adenoid tissue samples were analyzed with the CLO test.Results Eighteen patients among the 60 patients (30％) tested positive for HP.In the cases with adenoids,15.6％ of the OME patients and 13.3％ of the adenoidectomy only patients were positive for HP.There were no differences between the prevalence of HP in the adenoids of OME patients and the patients without OME.Conclusion HP can be considered one of the causes of OME。

Abstract：Background Metastatic lung cancer is one of the most common oncologic problems.This study aimed to evaluate the long-term clinical outcome of stereotactic body radiation therapy (SBRT) for metastatic lung tumors.Methods We retrospectively reviewed the 71 patients with lung metastases,who had 172 lesions treated with SBRT from January 2000 to December 2006.All patients were unfit or failed after surgery and/or chemotherapy.The median total dose was 48 Gy (range,30-60) in 4 (range,2-12) fractions.The median size of the irradiated lesions was 2.1 cm (range,0.9-7.9 cm).Results All but two patients received follow up.The median follow-up time was 24.7 months (range,2.9-114.4 months).The median follow-up time for living patients was 86.8 months (range,58.1-114.4 months).The 1-,3-,5-year local control and overall survival rates were 88.8％,75.4％,75.4％ and 78.9％,40.8％,25.2％.Multivariate analysis showed that the absence of extrapulmonary metastases (P=0.024; hazard ratio (HR),1.894; 95％ confidence interval (C/),1.086-3.303) and disease-free interval ≤12 months (P =0.014; HR,0.511; 95％ Cl,0.299-0.873) were independent prognostic factors.No grade 3 or more acute and late toxicities occurred.Only one patient developed a non-symptomatic rib fracture.Conclusion SBRT could be an alternative treatment to surgery for subsets of patients with lung metastases with favorable long-term survival and tolerable complications。

Abstract：Background The current diagnostic algorithms for chronic cough require the establishment of the primary presumptive causes followed by the confirmation of diagnosis with the specific therapies.The aim of the study was to investigate the discrepancy between presumptive and definite causes and its clinical implication.Methods A total of 109 patients with chronic cough underwent laboratory investigations to identify the cause of cough; including sinus computerized tomography (if needed),histamine bronchial provocation,induced sputum cytology and 24-hour esophageal pH or multi-channel intraluminal impedance combined with pH monitoring.The presumptive causes were confirmed by treating them sequentially.The difference between presumptive and definite causes of chronic cough was compared.Results Single cause was more frequent in the definite diagnosis than in the presumptive diagnosis (78.9％ vs.54.1％,x2=15.01,P=0.0001).In contrast,multiple causes were significantly fewer in definite diagnosis than in the presumptive diagnosis (15.6％ vs.37.6％,x2=13.53,P=0.0002).There was a discrepancy between definite and presumptive causes in 30 patients (27.5％).Compared with the presumptive causes,definite upper airway cough syndrome (24.8％ vs.11.9％,x2=6.0,P=0.01) and gastroesophageal reflux disease (6.4％ vs.0,x2=7.23,P=0.007) was more frequent as a single cause of chronic cough while cough variant asthma plus gastroesophageal reflux disease (3.7％ vs.11.9％,x2=5.17,P=0.02) and upper airway cough syndrome plus nonasthmatic eosinophilic bronchitis (0 vs.9.2％,x2=10.48,P=0.001) were fewer as multiple causes of chronic cough.Conclusions A discrepancy was common between presumptive and definite causes of chronic cough.To treat presumptive causes sequentially may be a suitable solution for avoidance of erroneous multiple causes and possible over-treatment。

Abstract：Background Inhalational anesthesia with sevoflurane for endotracheal intubation without muscle relaxant is now used widely for pediatric patients.This study assessed the efficacy and safety of induction with high concentration sevoflurane and of nasotracheal intubation without muscle relaxant in infants with increased or decreased pulmonary blood flow (PBF) and undergoing surgery for congenital heart diseases.Methods Fifty-five infants aged 2-12 months,weighing 4.7-10.0 kg,and scheduled for congenital cardiac surgery were enrolled.Subjects were divided into those with increased (IPBF group,n=29) and decreased (DPBF group,n=26) pulmonary blood flow.All infants received inhalational induction with 8％ sevoflurane in 100.0％ oxygen at a gas flow rate of 6 L/min.Nasotracheal intubation was performed 4 minutes after induction.Sevoflurane vaporization was decreased to 4.0％ for placement of a peripheral intravenous line and invasive hemodynamic monitors.Five minutes later,sedatives and muscle relaxant were administered and the vaporizer was adjusted to 2％ for maintenance of anesthesia.Bispectral index (BIS) scores,circulatory parameters,satisfactory and successful intubation ratios,adverse reactions,and complications of intubation were recorded.Results Times to loss of lash and pain reflexes were longer for the DPBF group (P ＜0.01).Satisfactory intubation ratios were 93.1％ and 61.5％ for the IPBF and DPBF groups,respectively (P=0.008).Successful intubation ratios were 96.6％ and 76.9％ for the IPBF and DPBF groups,respectively (P=0.044).Following sevoflurane inhalation,blood pressures decreased significantly in the IPBF group but remained stable in the DPBF group.BIS scores declined to similar stable values,and a “nadir BIS” was recorded for both groups.No obvious adverse reactions or complications of intubation were noted perioperatively.Conclusions Induction with high concentration sevoflurane,although faster for infants with IPBF,is safe for infants with IPBF or DPBF.However,nasotracheal intubation without muscle relaxant after induction with high concentration sevoflurane is less successful and less satisfactory for infants with DPBF and should be used with caution in this patient group。

Abstract：Background Young children are susceptible to pulmonary injury,and acute lung injury (ALl) often results in a high mortality and financial costs in pediatric patients.A good ALl model will help us to gain a better understanding of the real pathophysiological picture and to evaluate novel treatment approaches to acute respiratory distress syndrome (ARDS) more accurately and liberally.This study aimed to establish a hemodynamically stable and reproducible model with ALl in piglet induced by oleic acid.Methods Six Chinese mini-piglets were used to establish ALl models by oleic acid.Hemodynamic and pulmonary function data were measured.Histopathological assessment was performed.Results Mean blood pressure,heart rate (HR),cardiac output (CO),central venous pressure (CVP) and left atrial pressure (LAP) were sharply decreased after oleic acid given,while the mean pulmonary arterial pressure (MPAP) was increased in comparison with baseline (P ＜0.05).pH,arterial partial pressure of O2 (PaO2),PaO2/inspired O2 fraction (FiO2) and lung compliance decreased,while PaCO2 and airway pressure increased in comparison with baseline (P ＜0.05).The lung histology showed severe inflammation,hyaline membranes,intra-alveolar and interstitial hemorrhage.Conclusion This experiment established a stable model which allows for a diversity of studies on early lung injury。

Abstract：Background High microvascular permeability plays an essential role in pathological process of multiple diseases such as septic shock,acute lung injury and acute respiratory distress syndrome,and burns.Inhibiting hyperpermeability is significant for controlling these conditions.Cdc42,as a main member of the small Rho GTPase family,plays a critical role in controlling and regulating the endothelial junctional permeability.We aimed to generate and identify endothelial specific cdc42-deficient mice by the Cre/Ioxp recombination approach,for examination in an animal model of the contribution of the cdc42 gene in the microvascular barrier function.Methods We crossed cdc42Flox/Flox mice with mice expressing endothelial cell-specific Cre recombinase,and the offspring with the genotype cdc42Flox/+Tie2Cre+/- were back-crossed with the cdc42Flox/Flox mice. The cdc42Flox/FloxTie2Cre+/- mice in the F2 generation were the target mice.If the cdc42 deficient mice did not survive,we would observe the cdc42 deficient mice embryos,and compare them with wild-type mice embryos.Results Cdc42Flox/+Cre+/- mice were mated with the cdc42Flox/Flox mice and among the living offspring there were no cdc42Flox/FloxCre+/- target mice.We found the endothelial special cdc42 deficient embryos at the E7.5-E16.5 stage.We observed that cdc42 deficient embryos were much smaller,had fewer vessels and were a little more swollen compared with the wild-type embryos.Conclusions Endothelial specific knockout of cdc42 caused embryonic lethality and the mice did not survive to birth.The target embryos were much smaller,had fewer vessels and were a little more swollen compared with the wild-type embryos.These results demonstrated that the cdc42 plays an important role in development of embryos and in development of microvessels as well as microvascular permeability。

Abstract：Background Interleukin 16 (IL-16) can be detected by ELISA in pleural effusion (PE) and its concentration is higher than in serum.This study investigated the cellular sources of IL-16 in PE.Methods The samples of PE were collected from 34 patients who were newly diagnosed having PE in the pleural cavity.We performed cell culture to purify the pleural mesothelial cells (PMC),Wright staining to count the purity and immunocytochemical stain to identify the cultured cells.The intracellular IL-16 expression was detected by flow cytometry (FCM).The different cells in PE were first separated by magnetic cell sorting (MCAS) then the separated cells were cultured in RPMI1640 with 10％ fetal calf serum (FCS).We extracted the supernatant and detected IL-16 concentration by ELISA.The IL-16 protein was detected by immunohistochemistry and double immunofluorescence staining.Results The percentages of cells which secreted IL-16 were:CD3+CD8 cells ((74.27±15.56)％,n=34); CD3+CD8+ cells ((69.86±18.55)％,n=34); CD19+ cells ((45.30±18.77)％,n=15); CD14+ cells ((16.91±16.69)％,n=15); and PMC ((2.05±1.85)％,n=7).The concentrations of IL-16 in the supernatant from cultured cells were:CD4+ cells ((102.50±42.51) ng/L,n=5); CD8+ cells ((92.58±18.34) ng/L,n=5); CD19+ cells ((79.85±5.62) ng/L,n=5); CD14+ cells ((58.51±25.38) ng/L,n=5); and PMC ((18.14±8.37) ng/L,n=5).In lymphocytes,monocytes/macrophages and PMC,we could observe the cells that expressed IL-16 protein.In paraffin-embedded sections,we also could observe by immunohistochemistry the CD4+IL-16+ cells,CD8+IL-16+ cells,CD19+IL-16+ cells,and CD14+IL-16+ cells.Conclusions IL-16 in PE is mainly secreted by T lymphocytes,including CD3+CD8- cells and CD3+CD8+celIs.CD19+ cells and CD14+ cells can also secrete IL-16,but the percentage of PMC that can secrete IL-16 is very low。

Abstract：Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment.The aim of this study was to identify preoperative prognostic factors associated with the chance of achieving long-term seizure freedom.Methods We retrospectively reviewed seizure outcomes and clinical,electroencephalography (EEG),magnetic resonance imaging (MRI),histopathology,and surgical variables from 99 epilepsy surgery patients with at least one year of postoperative follow-up.Seizure outcomes were categorized based on the modified classification by the International League Against Epilepsy.Results We found that the seizure-free rate was 27.9％ after one year,and that it stabilized at about 20.0％ between two and six years after surgery.Univariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis,MRI with visible focal lesions concordant with EEG,and regional ictal EEG and electrocorticography patterns were associated with a favorable surgical outcome.On the other hand,seizure recurrence within six months,incomplete focus resection,and surgical complications were associated with a poor outcome.Multivariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis and MRI with visible focal lesions were independent presurgical predictors of a favorable outcome (P ＜0.01).Seizure recurrence within six months was the only significant independent predictor associated with a poor outcome (P ＜0.01).Conclusion Hippocampal sclerosis and abnormal MRI findings are strongly associated with a favorable surgical outcome,whereas seizure recurrence within six months is associated with a poor outcome。

Abstract：Background Coronary artery fistulas (CAFs) are rare congenital abnormality often unintentionally found in patients with coronary artery disease.Clinical diagnosis of CAFs is difficult due to symptomless or lack of specific symptoms.Dual-source computed tomography (DSCT) might be a useful diagnostic tool for CAFs.The study aimed to retrospectively summarize the imaging features of CAFs delineated at DSCT in 48 CAF patients detected from consecutive 6624 patients with suspected or confirmed coronary artery disease in our institution.Methods Forty-eight patients underwent DSCT angiography by using retrospective electrocardiographic (ECG) gating after infusion of 70 ml of intravenous contrast material during breath hold.Maximum intensity projection (MIP),curved planar reconstruction (CPR),and volume rendering technique (VR) were obtained.Anomalous termination of coronary artery in each subject was evaluated by two radiologists (with more than 10 years experience with cardiovascular imaging),and disagreement between diagnosis readers was settled by a consensus reading.Ten of 48 patients also underwent traditional coronary angiography (CAG) simultaneously.Results In each CAF case,DSCT angiography clearly demonstrated the origin,the termination,the size of abnormal vessel and its course in relation to surrounding great vessels.CAF arising from right coronary artery was the most common type,left circumflex was the least one involved among three coronaries,and pulmonary artery was the most common drainage site.Aneurismal fistulous tract,coronary atherosclerosis,myocardial bridging and anomalous origin of coronary artery were also detected in this group.The demonstration of drainage sites in CAG was consistent with DSCT angiography in 9 patients,and judgment on one anomalous connection in CAG was inconsistent with that in DSCT angiography.Conclusions DSCT angiography could provide accurate delineation of anomalous communications,size and numbers of fistulas in patients with CAFs.It suggested that DSCT is a useful tool for the assessment of CAFs and may be considered as the first-choice imaging modality,especially for patients with coronary artery disease。

Abstract：Background There is still a paucity of data on hepati tis B virus (HBV) subgenotype prevalence in North China based on sequencing of large-size samples.In addition,whether HBV genotypes impact drug-resistance-associated and HBV e antigen (HBeAg)-Ioss-associated mutations in patients with chronic hepatitis B (CHB) is still under investigation.This study aimed to disclose clinical prevalence of HBV genotypes/subgenotypes in North China and the clinical implications of HBV genotype classification in respect to HBeAg loss and drug-resistant occurrence.Methods Sera were collected from 1301 nucleos(t)ide analog-experienced CHB patients.Viral DNA was extracted and used as template for HBV genome amplification by nested PCR.DNA sequencing was performed for the analysis of HBV genotypes/subgenotypes,drug-resistance-associated mutations in polymerase gene and HBeAg-loss-associated mutations in precore/basal core promoter (BCP) regions.Results HBV/B,HBV/C,and HBV/D were detected in 190 (14.6％),1096 (84.2％),and 15 (1.2％) patients,respectively.HBV/B2 (182/190),HBV/C2 (1069/1096),and HBV/D1 (12/15) were predominant subgenotypes within individual genotypes.By contrast,C2 prevalence is relatively lower in Beijing area (77.2％) than in other north areas (84.9％-87.4％).HBV/C-infected patients had an older age and a lower serum albumin level but similar HBV DNA and alanine aminotransferase (ALT) levels compared to HBV/B-infected patients.HBV/C infection had a higher incidence of lamivudine-resistant mutations rtM2041/V (44.9％ vs.30.2％,P ＜0.01) and BCP mutations A1762T+G1764A (65.8％ vs.40.0％,P＜0.01) compared with HBV/B infection.Conclusions C2 is the most prevalent HBV subgenotype followed by B2 in CHB patients in North China; and HBV genotype prevalence is influenced by immigrant population.HBV/C infection is likely to have longer disease duration and severer liver functional impairment and might be more susceptible to develop lamivudine resistance compared to HBV/B infection。

Abstract：Background Intracranial infection is a common postoperative complication of neurosurgery.This study aimed to identify risk factors of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea and to suggest proposals for the prevention.Methods A total of 167 patients (113 males and 54 males,average age of 34.4 years) with cerebrospinal fluid rhinorrhea operated on by the senior author were retrospectively reviewed.The data collected included etiology,previous history,clinical manifestation,site of bone defect,operative approach,and postoperative complications.Risk factor(s) for postoperative infection were analyzed using the stepwise multiple Logistic regression.Results Eighteen (10.8％) patients were infected post-operatively.The independent risk factors for infection were the site of defect (RR=0.508,95％ Cl 0.306-0.843,P=0.009) and historical meningitis (RR=0.290,95％ Cl 0.094-0.893,P=0.031).Patients with multiple defects and saddle floor defects had a higher infection rate.The germiculture was positive in 11 patients,and vancomycin was sensitive to all the pathogenesis.Nine infected patients needed lumbar drainage.Ten patients had hyponatremia,and hydrocephalus occurred in two patients with serious trauma.Conclusions To prevent the infection,we should pay closer attention to the high-risk patients pre-operation.During the operation,the methods those can improve wound healing,such as using blood-supply materials,reliable fixation,and eliminating dead space are all helpful.Conducting lumbar drainage and choosing effective prophylactic antibiotics in the early postoperative stage for the high-risk patients are methods of postoperative management。

To the Editor:We read with great enthusiasm an interesting and exciting review article Targeting glioma stem cells:enough to terminate gliomagenesis? by Dong and Huang,1 who believed that single targeting therapy against glioma stem cells is unsuccessful and ameliorating the local tumor inducing/promoting microenvironment should be a reasonable strategy.Our group is enduringly engaged in the study of glioma,and we also put much concern upon the research of tumor microecosystem (TMES).In fact,the targeting therapy against cancer stem cells (CSCs) involves two aspects.One is the marked molecular target against CSCs.The other is how to deal with CSCs,by cytotoxic against CSCs,or inducing tumor stem cells to differentiate,or others?

To the Editor:Recently,I read,with great interest,the article Patterns in the occurrence and development of tumors by Lin published in your honored journal.The author of the paper suggests that the mechanism of the occurrence and progress of tumors could involve the self-renewal of the cells and repair of injured tissue.The key players are the responding cells,which,due to a functional defect,mistakenly “interpret” such a process as incomplete,thus resulting in continuous replication.During this process,tumor angiogenesis provides nutrition to those responding cells in tumor tissue.Tumor growth depends on its angiogenesis,and anti-angiogenic therapy is one of the new clinical anti-tumor treatment strategies.Unfortunately,clinical practice has proved that anti-angiogenic therapy is not as effective as expected;moreover,it could induce drug-resistance.Recent studies suggest that,under hypoxia or mionectic circumstances,tumor cells could transform into vascular endothelial cells through the deformation movement,2 or develop vasculogenic mimicry,3 in order to obtain the required nutrients for survival.We recently have found that vascular mimicry do exist in human gliomas.4 The formation of vascular mimicry could be one Dof the supplemental microcirculation structures.3,5 These results are in accordance with Lin's “nutritional selection” in tumors - tumor angiogenesis is the result of tumor development。

Abstract：Background It is well accepted that the minimally invasive surgery (MIS) for total hip arthroplasty (THA) should combine with less or no muscle damage and is different from mini-incision technique and MIS should have better outcomes than mini-incision surgery.The aim of current analysis was to apply an explicitly defined sub-group analysis to confirm whether this hypothesis is true.Methods A computerized literature search was applied to find any data concerning MIS or mini-incision THAs.A multistage screening was then performed to identify randomized studies fulfilling the inclusive criteria for the analysis.The data were extracted,and sub-group analyses of MIS or mini-incision surgery for different kinds of outcomes were carried out.The P(sub) value for difference between MIS sub-group and mini-incision sub-group was also calculated.Results Eleven studies that fulfilling the inclusion criteria were included,with 472 cases in the study group (MIS or mini-incision) and 492 cases in the conventional group.The overall analysis showed the study group would achieve less surgical duration (P=0.037),intraoperative blood (P ＜0.001) and incision length (P ＜0.001) than conventional group.The difference between sub-groups showed,the MIS would achieve shorter incision length (P(sub) ＜0.05) and bigger cup abduction angle (P(sub) ＜0.05),and cause more blood loss (P (sub) ＜0.05) than mini-incision technique.Other indexeswere comparable between the two sub-groups.Conclusions Though further high quality studies are still needed,the result of current analysis offered an initial conclusion that MIS THA failed to achieve a better clinical outcome than mini-incision technique.The exact definition of MIS still needs to be improved。

Abstract：Non-small cell lung cancer is one of the leading causes of all cancer deaths,but despite years of research,it is still difficult to predict the response and clinical outcome of the disease.In recent years,new treatment strategies targeting the epidermal growth factor receptors (EGFR) have been developed.EGFR is one of the most frequently over expressed proteins in various cancers,including lung cancer,and signaling through this receptor has been known to cause tumor progression as well as resistance to different treatments.Therefore,EGFR has become an attractive target for various treatment strategies.However,it is important to note that not all patients with lung cancer are suitable for targeted treatment,and that patients should be selected for this treatment.Several studies have proven that the status of the EGFR can be both an indicator of suitability for treatment with,and predict the likelihood of response to EGFR targeted therapy.There are many standard techniques to be used for the detection of EGFR.This overview summarizes the ongoing and future investigations to determine the status of the EGFR。

Abstract：Idiopathic pulmonary fibrosis (IPF) is a progressive and often fatal form of interstitial lung disease.Despite extensive efforts in research during recent years,the mechanisms of the disease remain poorly understood.Evidence of an inflammatory mechanism,both supportive and contrary,is briefly reviewed in this paper.However,growing evidence has indicated that the apoptosis of alveolar epithelial cells (AECs) may be the early driving force of progression,with subsequent disrupted integrity of the alveolar-capillary basement membrane leading to an abnormal wound healing pathway.Thus,this paper will focus on outlining a process of pathogenesis of IPF from initial apoptosis of AECs to end lung remodeling。

Abstract：Objective To review articles aiming to present an overview of the principles,progress,uses and limitations of laser speckle flowgraphy (LSFG) in posterior fundus circulation research.Data sources The data used in this review was obtained mainly from the studies reported in PubMed using the key terms “laser speckle”,“ocular blood flowmetry” and “retinal imaging”.Study selection Relevant literatures on studies of LSFG were selected.Results LSFG is a unique,noninvasive imaging instrument to quantitatively visualize posterior fundus circulation in vivo.This review delineates the LSFG principles and development,demonstrates its extensive applicability for measurement of retina,choroid and optic nerve head circulation,compares it with other retinal imaging technologies and discusses unresolved issues.Conclusions LSFG is a noninvasive,two-dimensional objective diagnostic technique that has become a powerful method for the clinical and scientific assessment of posterior fundus circulation.Further studies may help to develop a more comprehensive evidence-based measurement and facilitate the correlation with other methods for chorioretinal circulation assessment。

Abstract：Background Her-2/neu gene overexpression has been found in several malignancies,and is associated with poor prognosis; while its role in the tumorigenesis and progression of prostate cancer (PCa) is still controversial.This study aimed to evaluate the prognostic value of Her-2/neu protein expression and clinicopathologic factors in antiandrogen-treated Chinese men with PCa for disease progression and PCa-specific death.Methods Her-2/neu protein expression was determined using immunohistochemistry (IHC) in specimens collected from 124 prostate biopsies and transurethral resection of prostate (TURP) from seven prostate cancer patients.Results Her-2/neu protein expression was 0,1+,2+,and 3+ in 40 (30.5％),8 (6.1％),67 (51.1％),and 16 (12.2％) cases,respectively.Her-2/neu protein expression showed significant correlation as judged by Gleason score (P=0.049),clinical tumor-node-metastases (cTNM) stage (P=0.018) and disease progression (P=0.001),but did not correlate with prostate-specific antigen (PSA) (P=0.126) or PCa-specific death (P=0.585).PSA (P=0.001),Gleason score (P=0.017),cTNM (P=0.000) and Her-2/neu protein expression (P=0.001) had prognostic value for evaluating the progression of PCa in univariate analysis.In Kaplan-Meier plots,both Gleason score (P=0.035) and cTNM (P=0.013) correlated with PCa-specific death.In multivariate analysis,only cTNM was significant for both disease progression (P=0.001) and PCa-specific death (P=0.031).Conclusions Her-2/neu protein expression is significantly correlated with Gleason score,cTNM and disease progression,although it is not an independent predictor of disease progression and PCa-specific death.cTNM staging serves as an independent prognostic factor for disease progression and PCa-specific death。

Abstract：Cerebral lipiodol embolism (CLE) is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma.To our knowledge,only 11 cases have been previously reported.We recently encountered two cases of CLE in our clinical work.Reviewing the 11 cases in the literature and the two cases in our report indicates that large dose lipiodol infusion and absence of particulate embolization should be avoided.The presence of a right-to-left shunt and inferior phrenic artery injection seems to increase the risk of CLE.More caution should be taken in these situations。

Abstract：Lymphangiomas are malformations of the lymphatic system,which is a common disease in children,usually superficial in body,but seldom seen in visceral organs.We present the case of a child with lymphangioma of the gallbladder.Also we reviewed the literatures.A 2-year-6-month-old boy complained of progressing difficulty in walking for 6 months.Cerebral MRI showed abnormal signals in the white matter suggesting leukodystrophy.Ultrasound of abdomen showed a mixed-echoic mass in the site of gallbladder.CT scan showed an enlarged gallbladder with increased density.Bloodcounting,liver function,and alpha fetal protein were within normal range.Exploratory laparotomy was done in order to rule out malignancy.The liver was found normal at surgery,and the gallbladder looked enlarged and deformed.The gallbladder wall was thick and edematous,and adherent with liver.The gallbladder was excised.Pathological examination gave the dia gnosis as lymphangioma of the gallbladder wall.The postoperative recovery was uneventful.There was no evidence of recurrence.Searching in literatures,three cases of lymphangioma of gallbladder in adults were found.According to the pathology of lymphangioma and the anatomy of gallbladder,the outcome of this disease should be benign and may be symptomless throughout the life.No death was reported due to lymphangioma of gall bladder,nor severe complications endangering life at any age.The only indication for surgery in the reported cases was to rule out the risk of being malignancy.If MRI or other means can make a definite preoperative diagnosis of lymphangioma,being a stable lesion,surgery would be unnecessary unless there is a progressive organic obstruction causing repeated infection or persistent abdominal pain。

Abstract：A 39-year-old man presented with recurrent lower back and leg pain for 8 months due to repeated hemorrhage into an L5 ligamentum flavum cyst.Lumbar MR imaging showed an extradural cystic mass originating from the ligamentum flavum on the right side in the L5 segment.Microsurgical laminotomy and flavectomy were performed.The symptoms resolved completely and the patient had an uneventful postoperative recovery。

Abstract：Coronary vasospasm of the left main coronary artery (LMCA) is a rare condition with potentially devastating consequences.We present 2 patients with LMCA vasospasm-related angina,the first being a 46-year-old woman and the second a 51-year-old woman.Both of them developed ST-segment ischemic changes on treadmill exercise tests.Coronary angiography showed spontaneous LMCA vasospasm in one patient and methylergonovine-induced LMCA vasospasm in the other patient.Follow-up treadmill exercise tests revealed no exercise-induced ischemia after calcium antagonist monotherapy.These cases demonstrate the importance of identifying LMCA vasospasm,as the treatment of choice varies in patients with angina pectoris.Reversible myocardial ischemia caused by LMCA vasospastic angina can be controlled by calcium antagonist monotherapy and detected by repeat non-invasive stress testing。

Abstract：Blastomycosis is a fungal disease that is endemic in parts of North America.It is very rare in China and also commonly misdiagnosed,often as cancer or other infectious diseases.The clinical profile of a case of disseminated blastomycosis with pulmonary changes and skin ulcers was described.He had been misdiagnosed with tuberculosis,after adequate therapy with a lipid formulation of amphotericin B,followed by itraconazole,the lung and skin lesions improved.Then the five cases reported in China and literatures were reviewed.The aim of this report was to improve the knowledge regarding blastomycosis for physicians in China to avoid delaying adequate therapy。

Abstract：Gastrointestinal stromal tumor (GIST) represents the most common intramural mesenchymal tumor of the gastrointestinal tract,but the synchronous occurrence of GIST in the stomach and gynecological cancer is rare.We present a unique case of a 56-year-old female patient who was diagnosed with the synchronous development of GIST and an isolated parenchymal splenic metastasis of ovarian cancer.She underwent a wide local excision of gastric lesions with splenectomy.A morphological (histological and immunohistochemical) study established a spindle-cell type of gastrointestinal tumor that expressed CD117,and a parenchymal recurrence of ovarian papillary serous adenocarcinoma.The patient has remained alive and disease-free for 30 months since the last operation.A small GIST concomitant with an isolated parenchymal splenic metastasis of ovarian cancer is rarely encountered.The coexistence of GIST with other malignancies constitutes an intriguing oncologic model.Surgeons are advised to be alert against possible primary GIST accompanying other neoplasms。

Abstract：Phyllodes tumor is a rare breast tumor.A 45-year-old woman who underwent left mastectomy 12 years ago was found to have infiltrates in both lungs in a health examination.Combining histological examinations of the lung and breast samples,the diagnosis of borderline phyllodes tumor metastases to the lung was made.It is the longest interval to our knowledge that the metastases occurred 12 years after primary phyllodes tumor。

Abstract：The development of thrombus on the tricuspid valve is very rare.This report describes a case of acute pulmonary embolism (PE) with a mass on the tricuspid valve in a normal heart,detected by bedside transthoracic echocardiography (TTE).After successful surgical management,the histopathological examination revealed the mass from the tricuspid valve to be mixed thrombus.The early use of bedside TrE can facilitate the prompt diagnosis and aggressive therapy when PE is suspected。