Table of Content

21 June 2013, Volume 34 Issue 3

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Changes of arterial iodine fraction (AIF) in cirrhotic patients of different Child-Pugh grades

ZHAO Liqin, HE Wen, HU Zhihai, CHEN Jianghong, YAN Bin, WANG Jue

2013, 34(3):  329-332.  doi:10.3969/j.issn.1006-7795.2013.03.001

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Objective To investigate the change modality of arterial iodine fraction obtained by dual energy spectral CT in cirrhotic patients of different Child-Pugh grade.Methods Ninety cirrhotic patients with portal hypertension were selected retrospectively into our study group, 31 cases were in Child-Pugh grade A, 40 in grade B, and 19 in grade C. The control group consisted of 18 cases with normal liver functionality. All cases underwent three-phase, dual-energy spectral CT scans on HDCT. The material decomposition images with water and iodine as basic material pairs were reconstructed using the HDCT spectral software package. The iodine concentrations for hepatic parenchyma in the arterial and portal vein phases were measured using the iodine-based material decomposition images. The arterial iodine fraction was obtained by dividing the iodine concentration in the arterial phase to that in the portal vein phase. AIF values from the study and control groups were compared using the analysis of variance and with the statistical significance of P<0.05. Results The AIF was 0.24±0.03 in control group. In the study group, these values were 0.29±0.09 in Child-Pugh grade A, 0.37±0.10 in grade B and 0.48±0.12 in grade C groups. The difference of AIF between the study and control groups was found statistically significant (P<0.05). Conclusion The arterial iodine fraction, obtained by dual energy spectral CT, has correlation with the Child-Pugh grade in cirrhotic patients.

Hemodynamics and compliance of Stanford type B aortic dissection: a phase-contrast MR angiography study

GENG Ji, FAN Zhanming, LI Yu, XIN Haiyan, ZHANG Nan

2013, 34(3):  333-338.  doi:10.3969/j.issn.1006-7795.2013.03.002

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Objective To evaluate the characteristics of hemodynamics and compliance using phase-contrast magnetic resonance angiography (PC-MRA) in Stanford type B aortic dissection patients.Methods A total of 25 consecutive patients with Stanford type B aortic dissection identified by computed tomography angiography were recruited in this study. All patients underwent PC-MRA before operation. The cross-sectional images of aorta for PC-MRA were acquired at the following 6 locations: 1pulmonary bifurcation;2aortic arch; 32 cm distal to the entry;4diaphragm;51 cm distal to the lower renal artery;6aorta-iliac bifurcation. Mean area, flow characteristics (including mean velocity, mean flow volume, net volume) of true and false lumens within one cardiac cycle were measured by using PC-MRA. The compliances of true and false lumens were also calculated. Paired t-test and Pearson correlation analysis were involved in statistical analysis Results The mean area of true lumen was significantly smaller than that of false lumen at location 3~6 (P<0.05); the mean velocity in true lumen was significantly higher than that in false lumen at 3~6 levels (P=0.000). At location 5、6, the mean flow volume and net volume in true lumen were significantly higher than that in false lumen (P<0.05). At location 3、6, the compliance of true lumen was significantly higher than that of false lumen (P<0.05), and positive correlation were found between them (r=0.667,P=0.001;r=0.545,P=0.019). Conclusion PC-MRA can quantitatively measure flow characteristics and compliance of true and false lumen in Stanford type B aortic dissection. It is important to provide a noninvasive hemodynamic monitoring tool for Stanford type B aortic dissection.

Accuracy of coronary computed tomography angiography on the evaluation of near-critical stenosis: a phantom study

DU Xiangying, GUO Ning, LI Pengyu, WANG Yan, LI Kuncheng

2013, 34(3):  339-341.  doi:10.3969/j.issn.1006-7795.2013.03.003

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Objective To evaluate the accuracy of coronary computed tomography angiography (CTA) on the imaging of near-critical stenosis using a pulsatile phantom of coronary arteries. Methods A pulsating cardiac phantom with acrylic tubes provided by GE CT lab was used to simulate beating heart and coronary arteries of two diameters (4 and 3 mm) and four stenosis degrees (40%, 45%, 55% and 60%) with plaques of two densities (800 Hu and 20 Hu simulating calcified plaque and soft plaque) at heart rate of 55 bpm. The contrast density was prepared to be 350 Hu inside the simulated vessels. The scans were performed with clinically typical parameters: 120 kV, 550 mA, 0.35 s/rotation, pitch 0.2. Based on the longitudinal images of the simulated coronary arteries, the stenosis rates were measured and compared with the actual values. In addition, the measured stenosis rates of different vessel sizes and plaque densities were compared.Results In the 4 mm vessels, all the stenosis parts were overestimated despite of density and stenosis degree. Even 40% stenosis could be overestimated as more than 50%. Measured stenosis rates with calcified plaques were higher than those with soft plaques (P<0.05). In the 3 mm vessels, only stenosis rate of 40% could be measured with calcified plaques, which was significantly overestimated. Stenosis caused by soft plaques were slightly overestimated in 3 mm vessels.Conclusion CTA tends to overestimate stenosis despite the composition of plaque, which may cause over-diagnose of coronary heart disease. Calcification can exaggerate the overestimation and cause trouble in stenosis determination.

Value of International Prophylaxis Study Group (IPSG) magnetic resonance imaging scale system in the evaluation of hemophiliac arthropathy joint changes in children

ZHANG Ningning, PENG Yun, WU Runhui, Andrea S. Doria, LIU Yue

2013, 34(3):  342-347.  doi:10.3969/j.issn.1006-7795.2013.03.004

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Objective The International Prophylaxis Study Group (IPSG) magnetic resonance imaging (MRI) scale was used to evaluate the severity of haemophilic arthropathy joints and analyze the correlation of MRI performance and clinical factors. Methods Sagittal and coronal T1W, T2W and T2W FFE MRI images of knees, ankles and elbows were obtained from 22 joints of 18 boys who were clinically diagnosed hemophilia were studied ［age range from 2 to 15 years; mean (8.06±3.37) years］ with moderate and severe hemophilia diagnosed in our hospital. The severity of hemophilia from soft tissue and osteochondral domains with the IPSG MRI scale system was assessed.Results The soft tissue domain of 22 joints were appraised with regard to frequency of findings: effusion, 18/22(81.8%); synovial hypertrophy, 20/22(90.9%); hemosiderin deposition, 19/22(86.4%). The severity of soft tissue joint changes on MRI was mild, 9/22 (40.4%); moderate, 7/22(31.8%); and severe 6/22(27.3%), respectively. The severity of osteochondral joints changes on MRI was normal, 8/22(36.4%); mild, 3/22 (13.6%); moderate, 7/22(31.8%); and severe, 4/22(18.2%), respectively. The frequency of bone erosions was 14/22(63.6%),bone cysts, 9/22(40.9%),and cartilage loss, 14/22(63.6%). The intrareader reliability for each item of the IPSG MRI scale was excellent by Kappa analysis. The correlations between the osteochondral domain of the MRI scale and bleeding frequency as well as patients' age were moderate(r=0.501,P=0.018;r=0.557,P=0.007). The correlation between the IPSG final score and patients' age was also moderate(r=0.543,P=0.009). The correlation between age at first bleed and presence of subchondral cysts was moderate(r=-0.479,P=0.044)as well. Otherwise, no significant correlations were noted between items of the soft tissue domain and clinical factors(|r|<0.3).Conclusion The IPSG scoring system is highly reliable within readers' interpretation, is able to discriminate severity of joint changes in HA and provide detailed evaluation of soft tissue and osteochondral joint components. However, its correlation with clinical constructs is suboptimal.

Diagnostic value of diffusion tensor imaging in lumbosacral nerve root entrapment

ZHOU Yang, GAO Peiyi

2013, 34(3):  348-352.  doi:10.3969/j.issn.1006-7795.2013.03.005

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Objective To evaluate the diagnostic value of diffusion tensor imaging (DTI) in lumbosacral nerve root entrapment.Methods Seven patients with back pain and single sciatica and eight healthy volunteers underwent 3T MR imaging. The MR protocol consisted of sagittal T1-and T2-weighted spin echo sequence, followed by an axial T2-weighted spin echo sequence focused on the lumbar disc. In all subjects, DTI was performed with echo-planar imaging and the lumbosacral nerve roots were visualized with fiber tractography. Fractional anisotropy (FA) values in the lumbar nerve roots were quantified on DTI images. Results Respectively, mean FA values of the roots of healthy volunteers was 0.314±0.021 (left L3), 0.305±0.018 (right L3), 0.343±0.055 (left L4), 0.330±0.055 (right L4), 0.347±0.016 (left L5), 0.338±0.028 (right L5), 0.338±0.027 (left S1), 0.343±0.032 (right S1). Statistically significant differences were not found between the left and right side nerve roots at the same lumbosacral segment. In all subjects, the lumbar nerve roots were clearly visualized with fiber tractography. There were nine entrapped roots in seven patients. FA values were lower in entrapped roots than in intact roots. The side of the entrapped roots shown on fiber tractography image was consistent to the symptom, while conventional MR imaging was not. Compared with conventional MR imaging, diffusion tensor imaging fiber tractography was a better tool to evaluate lumbosacral nerve root related to the symptom.

Analysis of adult zygomatico-facial tube anatomy based on spiral CT

LV Han, LI Jing, ZHAO Pengfei, WANG Zhenchang

2013, 34(3):  353-357.  doi:10.3969/j.issn.1006-7795.2013.03.006

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Objective To observe the anatomy of zygomatico-facial tube to provide data for surgical design and differentiation of fractures.Methods Images of totally 50 adults (100 sides) were observed after standardization. The presence, morphology, branches, mean length, origin, distance from the outer opening foramen (ZFF, zygomatico-facial foramen) to the inner margin of lateral orbit wall, number and diameter of the openings (inner one, ZOF, zygomatico-orbital foramen; outer one, ZFF) of the zygomatico-facial tube were evaluated. Results The presence of zygomatico-facial tube was seen in 89.0% of the cases. It may be straight or tortuous. A branch course into the zygomatic bone was present in 45 of 100 cases. The zygomatico-facial tube can be classified into six types based on the morphology: single tube (21.0%), double tubes (17.0%), triple tubes (1.0%), bifurcation (31.0%), double tubes with bifurcation (2.0%), and single tube combined with bifurcation (17.0%). The mean length was (10.2±2.0) mm with a gender difference. The ZFF were (8.7±1.7) mm away from the inner margin of the lateral orbit wall. One to three foramina of the origin foramen (ZOF, zygomatico-orbital foramen) and ZFF were seen. The diameter of ZOF and ZTF was (1.3±0.4) mm, 0.8 (1.5±0.5) mm respectively.Conclusion The zygomatico-facial tube is commonly present in the lateral orbital wall with a variety of morphology, origin and openings.

Differential diagnostic value of two dimensional multi-breath-hold susceptibility weighted imaging for hepatocellular carcinoma and hepatic hemangioma

LI Yunfang, LI Hongjun, ZHAO Dawei

2013, 34(3):  358-363.  doi:10.3969/j.issn.1006-7795.2013.03.007

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Objective To compare the efficacy of susceptibility weighted imaging (SWI) in detection and differentiation of hepatocellular carcinoma and hemangioma. Methods The data of 41 patients with 51 hepatocellular carcinoma lesions and 13 patients with 23 hemangioma lesions during Jan to Feb,2012 were selected.All patients underwent MR including SWI in the study. Two radiologists interpreted SWI images and measured the signal intensity (SI) of the lesions,adjacent liver parenchyma SI and standard deviation (Sd), while the signal noise ratio (SNR) and the contrast noise ratio (CNR) were calculated. The detecting rates of the lesions and the mean SNR and CNR were compared between the two diseases. Results There were no significant difference in the detecting rate of hemangioma and hepatocellular carcinoma by SWI. The SNR and CNR of hemangioma were higher than those of hepatocellular carcinoma on DWI (P<0.05), and there was a significant difference between the two diseases as for the SNR and CNR. Conclusion SWI is valuable in diagnosis and differential diagnosis of hepatocellular carcinoma and hemangioma.

Progress in medical imaging

LI Kuncheng, LU Jie

2013, 34(3):  364-367.  doi:10.3969/j.issn.1006-7795.2013.03.008

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In recent years, medical imaging including computed tomography(CT), magnetic resonance imaging(MRI), positron emission tomography(PET), and one set of two functions PET/CT, PET/MRI, DSA/CT has the rapidly development. In particular the new techniques of CT and MRI could display abnormal morphology of the diseases and can provide blood flow, metabolic change of the pathophysiologic information. This is very useful to provide a more Objective and detailed image data for clinical diagnosis and treatment and further understand the nature and evolution of disease. With the progress of medical imaging, it will play an increasingly important role in the diagnosis, treatment and prognosis of disease.

Collecting duct carcinoma of the kidney: the analysis of its poor prognosis

ZHANG Yinan, WANG Guomin, JIN Xunbo, LIU Yujun, ZHAO Nan, FU Yunfeng

2013, 34(3):  368-371.  doi:10.3969/j.issn.1006-7795.2013.03.009

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Objective To analyze the prognosis of collecting duct carcinoma (CDC) of the kidney, and the possible reasons that caused its poor prognosis.Methods Through a multicenter retrospective study, the clinical, pathological, operational and adjuvant therapeutic data of 9 CDC cases out of 1 013 renal cell carcinoma (RCC) cases from 4 institutions were recorded and analyzed.Results Nine CDC cases, 0.888% of the total RCC cases, were finally confirmed, in which there were 6 male and 3 female CDC patients with the mean age of 60.8 (range from 37 to 84) years old. Lumbodynia, hematuria, abdominal masses were observed in 6 cases. Three of 9 cases were in AJCC clinical stage I, and the other 6 in stage IV, with the mean tumor volume of 8.2 cm×6.7 cm×5.9 cm. Intrarenal metastasis (5 cases), hematogenous metastasis (6 cases), regional lymph nodes metastases (5 cases), local invasion (2 cases) and liver metastasis (1 case) were histologically observed. Five cases underwent radical nephrectomy (1 case of hand-assistant laparoscopic radical nephrectomy) and 4 underwent palliative nephrectomy (1 case of hand-assistant laparoscopic palliative nephrectomy). Seven cases underwent adjuvant immunotherapy, and 2 cases underwent salvage chemotherapy. The mean follow-up period was 13.7 months (ranged from 7 to 22 months); the mean survival time of 6 patients was 12.7 months.Conclusion The prognosis of CDC was poor. The highly aggressive biological behavior is basically responsible for its prognosis. Due to lack of knowledge of the CDC, the treatment for CDC had no specificity. With the accumulation of the reported cases, the understanding of CDC's prognosis would be more objective.

One period retroperitoneal laparoscopic surgery in treating patients with bilateral renal cell carcinoma

SONG Liming, XING Nianzeng, NIU Yinong, ZHANG Junhui, TIAN Xiquan, WANG Jianwen

2013, 34(3):  372-375.  doi:10.3969/j.issn.1006-7795.2013.03.010

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Objective To explore the feasibility of one-period retroperitoneal laparoscopic surgery for bilateral renal cell carcinoma. Methods Two patients of bilateral renal cell carcinoma received one-period retroperitoneal laparoscopic operation including unilateral retroperitoneal laparoscopic nephron-sparing surgery and contralateral retroperitoneal laparoscopic radical nephrectomy. Results Retroperitoneal laparoscopic surgery was performed successfully in two cases without conversion to open surgery. Operative time was 6 hours and 4.5 hours, respectively. Blocking time of renal artery branch was 25 minutes and 18 minutes, respectively. Blood loss was 600 mL and 100 mL respectively. Postoperative hospital stay was 33 days and 9 days, respectively. Renal function deteriorated slightly postoperatively, and one case with chronic renal failure preoperatively required hemodialysis regularly of one to two times per week. There were no tumor recurrence and metastasis in 4 to 33 months following up.Conclusion One period retroperitoneal laparoscopic surgery was safe, effective and feasible in treating patients with bilateral renal cell carcinoma which was minimally invasive, and had small blood loss, rapid recovery and a good short-term outcome.

Renovascular management in laparoscopic partial nephrectomy

JIN Xunbo, ZHANG Hui

2013, 34(3):  376-379.  doi:10.3969/j.issn.1006-7795.2013.03.011

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Ischemia-reperfusion injury caused by vascular clamping contributes to the decline in glomerular filtration rate following laparoscopic partial nephrectomy (LPN). Warm ischemia time (WIT) is the most important and main modifiable factor that determines postoperative renal function. Nowadays LPN with or without clamping renal vessels or clamping segmental renal artery are the three main methods in dealing with renal vessels. They all have their own advantages and disadvantages on WIT and renal function. Surgery should design a detailed operation plan according to the patients' condition, surgeries' surgical skills and the local medical levels.

Differential expressions of DNMT3B gene in glioblastoma

BAI Yu, CHEN Yan, GUO Tianzhu, LIU Qingyang, YANG Xue, FENG Ying, YAN Zhuohong, WANG Lijia, ZHANG Quangeng

2013, 34(3):  380-384.  doi:10.3969/j.issn.1006-7795.2013.03.012

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Objective Global genomic hypomethylation widely exists in glioblastoma (GBM). This study aimed to clarify the molecular mechanism of this abnormality. Methods Totally 25 GBM samples were examined in this study.Total RNA was extracted from these patient samples. Full-length cDNA was amplified by RT-PCR and sequenced. Sequences obtained from each sample were compared to NCBI published standard sequences by using DNASTAR software. Results We successfully amplified DNMT3B from each patient sample. No point mutation which alters amino acids was identified. But several splicing variants were identified in these patient samples which were differentially exited in the tumor samples. Conclusion No point mutation of DNMT3B was found in GBM patient samples. Two major DNMT3B splice variants ( DNMT3b-V3 and DNMT3b-V7 ) were found differentially exist in these tumor samples. Functions of these variants are subject to further elucidation.

Autophagy is involved in DJ-1 protecting against rotenone-induced dopaminergic neurons injuries of substantia nigra in rats

LIU Huifeng, YANG Weiwei, GAO Hua, YANG Hui

2013, 34(3):  385-390.  doi:10.3969/j.issn.1006-7795.2013.03.013

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Objective To observe whether DJ-1 overexpression could attenuate rotenone-induced dopaminergic neurons injuries in substantia nigra (SN) of rats and its mechanism. Methods AAV vectors encoding human wild-type DJ-1, LacZ or GFP-DJ-1, GFP genes were stereotactically injected into the rat SN 4 weeks prior to rotenone lesion in SN. As identification of DJ-1 gene expression by immunohistochemistry, the numbers of TH positive neurons were detected to verify the neuron-protective effect of DJ-1. Autophagy-related proteins expression were investigated via Western blotting. Results After 4 weeks rotenone injected, the numbers of TH positive neurons increased significantly in impaired SN of rats in DJ-1 overexpressing group compared to rotenone-injected rats (P<0.05). Autophagy-related protein Beclin1, p-mTOR expression and LC3Ⅱ/Ⅰ ratio were detected in impaired SN of animals according to Western blotting. In DJ-1 overexpression group, Beclin 1 expression and the ratio of LC3Ⅱ to LC3I increased significantly compared with control groups, while p-mTOR protein expression decreased significantly compared with control groups (P<0.05).Conclusion DJ-1 could attenuate dopaminergic cells injuries induced by rotenone and upregulated autophagy level.

Adoptive transfer of murine bone-marrow derived macrophages tracing in vivo and application in hypertensive cardiac injury

LI Yulin, WU Yina, ZHANG Congcong, KAN Xiaoyu, A Xi, ZHAO Wei, WANG Lvya, DU Jie

2013, 34(3):  391-397.  doi:10.3969/j.issn.1006-7795.2013.03.014

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Objective Two types of mice enhanced green fluorescent protein (EGFP) transgenic mice and CD45 type I (CD45.1) mice) to observe whether the adoptive transfusion of murine bone-marrow derived macrophages(BMM)might affect the hypertensive damage to heart in murine hypertension model. Methods After obtaining bone marrow cells from EGFP transgenic mice and inducing cells with macrophage colony-stimulating factor (M-CSF) to BMM, wild-type mice received injection of 2×10⁶ EGFP⁺BMMs or phosphate-buffered saline (PBS) through tail vein and observed survival proportion of EGFP⁺cells in peripheral blood at 1st day and 7th day. Then we collected heart, liver and spleen to determine expression of GFP⁺ cells. Likewise we used CD45.1 BMM to inject into CD45.2 mice and determine the proportion of CD45.1⁺ cells in peripheral blood. Then angiotensin Ⅱ (Ang Ⅱ) was infused to the mice and EGFP⁺BMMs or PBS was infused as previously described. After 7 days infiltration of EGFP⁺BMM, inflammation and fibrosis in heart were determined.Results The proportion of EGFP⁺cells in peripheral blood in EGFP⁺BMMs injection group were 1st day:(4.6±0.5)%; 7th day:(4.4±0.5)% while none in control group. After 7 days GFP⁺cells expressed in spleen while none in liver, kidney or heart. The proportion of CD45.1⁺cells in peripheral blood in CD45.1⁺BMMs injection group was (4.3±0.4)% while none in control group. In contrast to control group, AngⅡ infused group had accelerated increased blood pressure, infiltration of inflammatory cells and collagen deposition. Injection of EGFP⁺BMMs could infiltrate in heart and accelerate inflammation and fibrosis, but did not affect blood pressure. Conclusion This study proved that adoptive transfuse BMMs could survive in recipient and accelerate cardiac fibrosis. We settled the problem of tracing the adoptive transfused BMM in vivo.

DL0805 inhibits the vasoconstriction induced by angiotensin Ⅱ in a Ca²⁺-dependent and Ca²⁺-independent manner in the rat aorta

LI Li, YUAN Tianyi, GUO Jing, FANG Lianhua, YANG Haiguang, ZHANG Li, DU Guanhua

2013, 34(3):  398-403.  doi:10.3969/j.issn.1006-7795.2013.03.015

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Objective To investigate the mechanisms of DL0805, a Rho kinase inhibitor, in the relaxation on the contraction induced by angiotensin Ⅱ(Ang Ⅱ) in the rat thoracic aorta. Methods Intracellular ［Ca²⁺］ (［Ca²⁺］i) was measured with Fura2/AM in vascular smooth muscle cell(VSMC). Protein level of Rho kinase 1(ROCK1), the phosphorylation levels of myosin phosphatase target subunit 1 (MYPT1) and Akt in the rat aortic rings were detected by Western blotting. Results DL0805 (1, 10 μmol/L) were shown to inhibit both Ang Ⅱ(100 nmol/L)-induced Ca²⁺ release from internal stores and Ca²⁺ influx. DL0805 (25、50 μmol/L) significantly attenuated the increased protein level of ROCK1, the increased phosphorylation levels of MYPT1 and Akt in the aorta stimulated by Ang Ⅱ(100 nmol/L). Conclusions DL0805 inhibits the vasoconstriction induced by Ang Ⅱ in a Ca²⁺-dependent and Ca²⁺-independent manner in the rat thoracic aorta.

Effects of Th17-related cytokines in acute rejection in rat small bowel transplantation

LI Xiaosong, WANG Pengcheng, REN Songlin, GUI Jiayu, WANG Dayong

2013, 34(3):  404-410.  doi:10.3969/j.issn.1006-7795.2013.03.016

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Objective Through using FK506 pre-treatment model in acute rejection of rat small bowel transplantation(SBT), the pathological change and the expressions of Th17-related cytokines were investigated.This study aimed to analyze the effects of Th17-related cytokines in acute rejection in SBT, and to find a new strategy for preventing acute rejection in SBT. Methods Twenty healthy male F344 and Lewis rats, 6-8 weeks old, were randomly divided into three groups: allograft control group (Lewis 5 pairs), allogeneic control group (F344, 5; Lewis, 5) and FK506 pre-treatment group (F344, 5; Lewis, 5). For FK506 pre-treatment group: FK506 was daily injected intramuscularly with 2 mg/Kg dose for 3 days before operation, and the dose was adjusted to 0.3 mg·kg^-1·d^-1 postoperatively. The recipients were sacrificed on 7 day postoperatively or before dying. The intestinal samples were obtained for pathological and immunohistochemical analyses. The blood was taken from right ventricular puncture for the detection of the concentration of IL-17, IL-23, IL-6, TGF-beta, and IFN-γ by ELISA. Results The transplanted bowel mucosa has significant pathological changes in acute rejection of small bowel transplantation. The control group 1 showed the most significant changes in pathological morphology, pathological changes in experimental group were relatively mild, the control group 2 showed mildest. The immunohistochemical staining suggested that the infiltration of macrophages was the most obvious in the control group 1, followed by the experimental group, and the control group 2 showed the mildest. The IL-6, IL-17, IL-23 and TGF-beta levels in the experimental and control groups had the same trend; all of them in control group 1 were the highest. Conclusion The pathological findings suggested that pretreatment FK506 could reduce the mucosal injury caused by acute rejection in SBT which may be related to the reduced infiltration of macrophages in transplanted intestine. In control group 1 and experimental group, IL-17 and IL-23 cytokine levels were higher than those of the control group 2, suggesting that these cytokines may be involved in acute rejection in SBT. The blockade of Th17-related cytokines may be beneficial to alleviate acute rejection in SBT.

Expression of matrix metalloproteinase-3 in different sites of osteoarthritis of knee synovial membrane and clinical significance

Li Shoulong, Maimaiti·Aiyireti, PAN Haitao, ZENG Zheng

2013, 34(3):  411-415.  doi:10.3969/j.issn.1006-7795.2013.03.017

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Objective To determine the expression intensity of matrix metalloproteinase-3 (MMP-3) in different sites of osteoarthritis of knee synovial membrane and to explore its relationship with the pathogenesis of KOA. Methods Forty-eight KOA patients treated in our hospital were chosen as study subject. Knee synovial membrane specimens were excised separately from medial compartment,supra-patellar bursa and the lateral compartment during arthroscopy. Clinical scores of these patients were assessed by the comprehensive score system. Through immunohistochemical staining,MMP-3 positive expression intensity was compared among different sites of KOA synovial membrane. Moreover,the correlation between MMP-3 positive expression intensity and clinical scores was analyzed.Results 1MMP-3 positive expression intensity was 3.45±0.22 for medial compartment synovial membrane,2.69±0.21 for supra-patellar bursa,and 1.99±0.16 for lateral compartment,with statistically significant difference (P<0.001). 2MMP-3 positive expression intensity in synovial membrane of medial compartment and supra-patellar bursa presented a positive correlation with clinical scores,and the correlation coefficients were r₁=0.894(P<0.001) and r₂=0.803(P<0.001). There was no significant correlation between clinical scores and the positive expression intensity of MMP-3 in the lateral compartment with r₃=0.485(P=0.057).Conclusion MMP-3 expression intensity in synovial membrane of medial compartment was the highest of the three sites,which coincided with the manifestation that medial part of the involved knee joint suffers the most severe symptom. The disease degree of synovial membrane was positively correlated with clinical scores,providing a basis for improving the joint function and relieving the knee pain through limited resection of diseased synovial membrane by arthroscopy in clinical work.

Down regulation of vascular endothelial growth factor (VEGF) and receptors related to apoplexy in human pituitary adenomas

JIA Wang, LIU Xiao, LU Runchun, JIA Guijun, NI Ming, SUN Jing, XU Zhiqing

2013, 34(3):  416-421.  doi:10.3969/j.issn.1006-7795.2013.03.018

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Objective To investigate the expression of vascular endothelial growth factor (VEGF) and its receptor in human pituitary adenoma apoplexy.Methods Pituitary adenomas from 166 patients were included in the study. Fresh pituitary adenomas were obtained immediately after surgery and processed for histological and molecular based analyses. Real-time quantitative PCR detection system (QPCR) were used to detect mRNA expression of VEGF and its receptor. Combined with the results of pathology, immunohistochemistry and clinical data were statistically analyzed for the characteristics of packet. Results The expression levels of VEGF and VEGF-3 were significantly lower in nonfunctional pituitary adenoma group with apoplexy, is closely linked to the tumor apoplexy (P<0.05); the expression level of VEGFR-1 and VEGFR-2 was not correlated with tumor apoplexy (P>0.05). Conclusion Down regulation of VEGF and VEGFR-3 in nonfunctional pituitary adenoma was associated with tumor apoplexy. VEGF and VEGFR-3 thus has an important predictive and prognostic value in patients with pituitary tumors.

A Meta-analysis on the effects of regimen XELOX versus FOLFOXs for treatment of Chinese patients with metastatic gastric cancer

ZHANG Ruixue, YAN Han, WANG Min, JIN Qicheng, YANG Yifan, CAO Bangwei

2013, 34(3):  422-427.  doi:10.3969/j.issn.1006-7795.2013.03.019

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Objective Fluoropyrimidine combined with oxaliplatin were often used to treat the metastasis gastric cancer. In this paper, the clinical outcome and adverse reactions will be compared between the regimens XELOX and FOLFOXs for chemotherapy of metastasis gastric cancer in Chinese population.Methods The original articles on randomized controlled trials (RCTs) comparing the chemotherapy of XELOX and FOLFOXs in Chinese patients with advanced gastric cancer were recruited from the PubMed, Wanfang, VIP, and CNKI databases. The quality of the selected trials was assessed by Jadad-scale method. All eligible individuals were Chinese patients who had locally advanced or metastatic gastric cancer. Meta-analysis about the efficacy and safety of the two chemotherapy methods was performed by using Revman 5.0 and Stata 10.0 software. Egger's test was used to evaluate the publication bias. Results Thirteen RCT reports, including 783 Chinese patients with advanced gastric cancer, were recruited in this study based on the selected standard. The overall response rate was 53.52% in the XELOX treatment group which included 398 patients and 45.71% in FOLFOXs group which included 385 patients; respectively (OR=1.18, 95%CI: 1.02-1.35, P=0.03). For the safety evaluation, the nausea and vomiting incidence in XELOX treatment group possessed a higher rate than in FOLFOXs group (P<0.05). But the incidence of hand-foot syndrome was lower in FOLFOXs treatment group (P<0.05). The adverse reactions such as leukopenia, anemia, thrombocytopenia, peripheral nerve injury, and stomatitis did not exhibit any significant differences between the two groups (P>0.05). The Egger's test reveled that no significant publication bias was found (P=0.993). Conclusion In the chemotherapy of advanced or metastatic gastric cancer, the clinical response rate of XELOX was higher and the incidence of adverse reactions was slightly lower compared to FOLFOXs in Chinese patients.

Impact of hormone therapy on quality of life of women with menopausal syndrome

YIN Dongmei, LIU Zhen, Ruan Xiangyan, WANG Juan

2013, 34(3):  428-431.  doi:10.3969/j.issn.1006-7795.2013.03.020

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Objective To evaluate the effects of hormone replacement therapy on climacteric patient's physical condition as well as psychology.Methods An observational study on 125 patients with climacteric syndrome was conducted, the patients were divided into two groups according to whether they were treated with hormone therapy: group A had 65 patients without any hormone therapy, group B had 60 patients who received hormone replacement therapy for 6 months; the basic parameters and complete Kupperman scale, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Menopause-specific Quality of Life Questionnaire (MENQOL) were applied for evaluation.Results In the 60 patients with menopausal syndrome who received hormone replacement therapy, the scores of Kupperman index, SAS, SDS, MENQOL were significantly lower than those of the untreated patients' group; of whom 35 patients showed significant difference between the scores obtained before and after treatment in 4 scalel. Conclusion Hormone replacement therapy could significantly alleviate the perimenopausal physical discomfort, but also could improve anxiety and depression,therefore,could improve the quality of life of menopausal women.

Analysis of menstrual disorder relevant factors in the child-bearing age women with chronic renal failure

ZHAO Xiuling, WANG Shuzhen, ZHANG Zhenyu, CUI Xiuping, LIU Yingqiao

2013, 34(3):  432-436.  doi:10.3969/j.issn.1006-7795.2013.03.021

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Objective To evaluate the factors relevant to menstrual disorders in women of childbearing age with chronic renal failure. Methods A cross sectional study was conducted by questionnaire investigation on 222 women with chronic renal failure of childbearing age, who received hemodialysis in Beijing Chaoyang Hospital and Tongzhou Luhe Teaching Hospital of Capital Medical University,between 1st, September to 30th, November 2010, 129 patients were enrolled into the study. Results ①Among 129 women, 69.76% patients suffered from the menstrual disturbances, while 39 patients without any menstrual problem served as controls; there were no significant differences between both groups in respect to age, age of menarche, time of hemodialysis, and body mass index and so on, but suffering from the endometrial hyperplasia, and with history of dysfunctional uterine bleeding were associated with the development menstrual disturbances (P<0.05). ②They were divided into five groups according to their menstrual pattern: amenorrhea (n=23, 25.56%), polymenorrhea (n=33, 36.67%), oligomenorrhea (n=14, 15.56%), eumenorrhea (n=20,22.22%),the normal menstruation (n=39,30.23%). ③Among 90 cases of menstrual disturbances, 48 (53.33%) had normal menstruation after hemodialysis, suffering from the myoma and endometrial hyperplasia, and longer interval between renal insufficiency and hemodialysis were associated with sustained menstrual disturbances.④The association of renal failure and endometrial lesions: 40 patients were D and C indicated the abnormal menstruation, and 13 cases were diagnosed as endometrial lesions (32.5%), 8 cases (20%) simple hyperplasia; 1 case complex hyperplasia; 3 of them (7.5%) had atypical hyperplasia; only one patient (2.5%) had endometrial carcinoma. Longer interval between renal insufficiency and hemodialysis, severe renal insufficiency were associated with the endometrial lesions (P<0.05). Conclusion The women with chronic renal failure often suffer from menstrual disturbances and endometrial lesions.With the uterus myoma and endometrial hyperplasia, and with history of dysfunctional uterine bleeding were associated with the development of menstrual disturbances. Longer interval between renal insufficiency and hemodialysis, severe renal insufficiency were associated with endometrial lesions.

A cohort study on the levels of serum inflammatory factors and secondary prevention in patients with acute ST segment elevation myocardial infarction

TAN Jing, HUA Qi

2013, 34(3):  437-440.  doi:10.3969/j.issn.1006-7795.2013.03.022

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Objective To investigate the changes of the levels of serum inflammatory factors and secondary prevention in patients with acute ST segment elevation myocardial infarction (STEMI) during the 3-years follow-up. Methods A vertical sectional survey was performed on 84 patients with first STEMI who were admitted to our institute within 6 h of symptoms onset. Clinical data were collected, and serum levels of interleukin-6 (IL-6), soluble CD40 ligand (sCD40L), metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured by sandwich enzyme-linked immunosorbent assay (ELISA) at baseline and 3 years of follow-up.Results STEMI patients at 3-years follow up had lower levels of serum IL-6, sCD40L and MMP-9, and a higher level of TIMP-1 compared with admission phrase. During the 3-years follow-up period, the proportion of STEMI patients who took angiotensin-converting enzyme inhibitors, or angiotensin Ⅱ receptor blocker and statins were 54.8%, 73.8% and 57.1% respectively, which were decreased significantly compared with those measured during hospitalization, and the rate of achieving goal of blood pressure, 1ow-density lipoprotein cholesterol and body mass index were 39.9%, 27.4% and 45.2%, respectively. Conclusion The present study indicates that elevated circulating level of interleukin-6, sCD40L, MMP-9 and imbalance between MMP-9 and TIMP-1 may be responsible at least in part for atherosclerotic plaque development and rupture. We should carry out intensive follow-up management including antihypertensive and lipid lowing intervention to improve the secondary prevention of STEMI patients after discharge.

An experimental study on the effects of interposed abdominal compression cardiopulmonary resuscitation in a swine model of asphyxia

HANG Chenchen, LI Chunsheng, WU Caijun, YANG Jun, ZHANG Yi, GUO Zhijun, YIN Qin

2013, 34(3):  441-445.  doi:10.3969/j.issn.1006-7795.2013.03.023

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Objective To compare the hemodynamic influences of standard cardiopulmonary resuscitation (STD-CPR) and interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) in a swine model of asphyxia cardiac arrest, and evaluate the effectiveness of IAC-CPR and the recovery method of asphyxic cardiac arrest. Methods Eighteen Wuzhishan inbred mini pigs underwent asphyxia by occlusion of the tracheal intubation at the end of expiration followed by cardiopulmonary resuscitation after 8 minutes without intervention. Then the pigs were randomly divided into two groups, with 9 pigs in each group and conducted STD-CPR and IAC-CPR respectively. Heart rate (HR), aorta systolic blood pressure (SBP), diastolic blood pressure (DBP), central venous pressure (CVP), arterial oxygen saturation (SaO₂%) were recorded at the baseline, CPR and ROSC 15 minutes. The aortal mean arterial pressure (MAP) and coronary perfusion pressure (CPP) were calculated and the return of spontaneous circulation (ROSC) rate and complication after ROSC were monitored. Results There were no significant differences in MAP between two groups: (46.30±13.49)mmHg vs. (54.04±13.07)mmHg, (P>0.05). The CPP in STD-CPR group was lower than in IAC-CPR group: (20.44±19.63)mmHg vs (29.56±11.57)mmHg, (P<0.05). There were no significant differences in ROSC rate. The pigs in two groups all had chest and abdomen complications, including pulmonary hemorrhage, pulmonary infarction, rib fractures, epileptic seizure and abdominal viscera ischemic necrosis. Conclusion IAC-CPR could effectively improve the CPP, but could not improve the ROSC rate.

Clinical observation of oxaliplatin combined with S1 capsule in the treatment of advanced gastric cancer

KONG Man, PEI Wenzhong, YANG Jiandong

2013, 34(3):  446-449.  doi:10.3969/j.issn.1006-7795.2013.03.024

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Objective To investigate the safety and effectiveness of S-1 capsule combined with oxaliplatin in the treatment of advanced gastric cancer.Methods Fifty-two patients with advanced gastric cancer were treated with the chemotherapy: composed of S-1 capsule 80 mg·m^-2·d^-1, twice daily, oral, d_1－14;oxaliplatin 130 mg·m^-2, intravenous drip, d₁. One treatment cycle covered 3 weeks. The effects and toxicities were evaluated after 4 cycles.Results The effective rate was 44.2% (23/52). The clinical beneficial response was 76.9%(40/52). The main side effects included myelosuppressio,gastrointestinal reactions and neurotoxicity.Conclusion S-1 capsule combined with oxaliplatin is effective in the treatment of advanced gastric cancer, and the toxicities can be tolerated. These results indicate that further clinical study and application are warranted.

Relationship between serum level of fibroblast growth factor 23 and phosphorus and parathyroid hormone in dialysis patients

XU Fengbo, LIU Huilan, SUN Yi

2013, 34(3):  450-453.  doi:10.3969/j.issn.1006-7795.2013.03.025

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Objective To determine the serum level of fibroblast growth factor 23 (FGF23) in maintenance hemodialysis (MHD) patients and explore the relationship between FGF23 and phosphorus and serum parathyroid hormone (PTH). Methods Fifty MHD patients and thirty healthy persons (control group) whose renal functions were normal were enrolled in this study. According to the PTH level, MHD patients were divided into three groups: group A1(PTH<300 pg/mL), group A2(PTH 300-500 pg/mL), group A3(PTH>500 pg/mL). Phosphate, calcium, alkaline phosphatase in their serum were determined too. The level of FGF23 and 1,25-(OH)₂D₃ in serum were detected by the method of ELISA. Results ①The Log FGF23 in MHD group was much higher than that of control, Log1,25-(OH)₂D₃ in MHD group was lower than that of control. ②The Log FGF23 in group A3 was much higher than group A1.③Log FGF23 was positively correlated with serum phosphorus, Log PTH and Log ALP,negatively correlated with Log 1,25-(OH)₂D₃. ④Multiple linear regression analysis revealed that the level of serum level of FGF23 in MHD patients was extremely high. Conclusion The serum level of FGF23 in MHD patients was extremely high.

Evaluation on clinical applications of florida probes

SONG Chenmin, HUANG Shaoling, XIONG Jimin

2013, 34(3):  454-457.  doi:10.3969/j.issn.1006-7795.2013.03.026

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Objective To evaluate the clinical applications of Florida probes. Methods The probing depth (PD) of ten periodontitis patients was recorded by the same examiner using the Florida and conventional manual probe. The readings were obtained at 6 sites for each tooth, distobuccal (DB), midbuccal (B), mesiobuccal (MB), distolingual (DL), midlingual (L) and mesiolingual (ML) sites. The consistency and correlation between Florida probe measurements and conventional manual probe measurements were investigated. The comfort index by visual analogue scale was recorded and compared. Results The readings of PD from Florida probe were highly correlated(r=0.784)and highly consistent(Kappa=0.638)with that from conventional periodontal probe measurement, with higher consistency in shallow sites than that in deeper sites. The results from comfort scale showed that the Florida probe produced less patient discomfort than that the conventional probe did. Conclusion The Florida probe can be used as an alternative for periodontal probing in routine dental practice.

Effect of two different pontics of bridge on periodontal tissues

ZHANG Jian

2013, 34(3):  458-460.  doi:10.3969/j.issn.1006-7795.2013.03.027

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Objective To explore the effect of two different pontics of bridge on periodontal tissues. Methods Thirty patients who received restoration with closed modified ridge lap pontic because of failure of fixed partial denture (FPD) were chosen for this study. All the patients had serious gum inflammation in the pontic contacting area. This study used self-control method, that was the patients with the old prosthesis were selected as central group; while the patients with the newly designed prosthesis were selected as the test group. The outcome measures included bleeding parameters, plaque variables and pocket depth.Results All the parameters/variables were improved in the test group, the most effective one was bleeding parameters, which had significant difference as compared with the control group (P<0.001). The rate of "very effective" was 73.3%, while the rate "effective" was 26.7%. Conclusion The extensive modified ridge lap pontic could effectively control the development of inflammation. Therefore the extensive modified ridge lap pontic should be recommended for the patients with poor periodontal health to protect the gingival health in connecting area between retainer and pontic.

Interpretation of United States brain activity map project

ZHANG Ting, WANG Xiaomin

2013, 34(3):  472-474.  doi:10.3969/j.issn.1006-7795.2013.03.031

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Brain Activity Map (BAM) Project is a proposed collaborative research initiative announced by the Obama administration on April 2, 2013, with the goal of mapping the activity of every neuron in the human brain. Based upon the Human Genome Project, the initiative has been projected to cost more than 300 million per year for ten years. This project has been detailed described in Science and Neuron. This paper summarized the background, goals, methods, roadmap and benefits of BAM project.

Recognize the avian influenza A virus H7N9

SONG Rui, CHENG Jun

2013, 34(3):  475-478.  doi:10.3969/j.issn.1006-7795.2013.03.032

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On March 31, 2013, the Centers for Disease Control and Prevention of China first reported 3 laboratory confirmed cases of human infection with influenza A subtype H7N9 virus, a new avian influenza virus (AIV) in the eastern China. All these patients had severe respiratory illness and the reason was unknown. The influenza A (H7N9) virus is low pathogenic to birds and poultry but high in human beings. There's no evidence for person-to-person transmission. This article aims to discuss the clinical features of the infection with the influenza A (H7N9) virus.