[The ninth edition of TNM staging for lung cancer: precise staging for precise diagnosis and treatment]

The ninth edition of TNM staging for lung cancer has been announced at the 2023 World Lung Cancer Congress and implemented from January 1, 2024. Te focus of the ninth TNM staging change is dividing N2 into N2a and N2b, as well as M1c into M1c1 and M1c2. Although the T staging has not changed, it has played an important role in verifying the eighth edition of the T staging. The subdivision of stage N2 has led some patients with ⅢA of the eighth edition to experience ascending or descending stages, which will more accurately help to assess the condition and prognosis of patients with mediastinal lymph node metastasis, as well as the design of related clinical studies. Modifying the M1c staging will help define oligometastasis and explore new treatment models in the future. The ninth edition of the TNM staging system provides a more detailed division of different tumor loads, but there is no clear explanation for the staging of lung cancer after neoadjuvant therapy. Further data analysis is needed, and it is expected to be answered in the tenth edition of TNM staging.

Adult Congenital Heart Disease Care in Canada: Has Quality of Care Improved in the Last Decade?

BACKGROUND

Patients with adult congenital heart disease (ACHD) are at increased risk of comorbidity and death compared with the age-matched population. Specialized care is shown to improve survival. The purpose of this study was to analyze current measures of quality of care in Canada compared with those published by our group in 2012.

METHODS

A survey focusing on structure and process measures of care quality in 2020 was sent to 15 ACHD centres registered with the Canadian Adult Congenital Heart Network. For each domain of quality, comparisons were made with those published in 2012.

RESULTS

In Canada, 36,708 patients with ACHD received specialized care between 2019 and 2020. Ninety-five cardiologists were affiliated with ACHD centres. The median number of patients per ACHD clinic was 2000 (interquartile range [IQR]: 1050, 2875). Compared with the 2012 results, this represents a 68% increase in patients with ACHD but only a 19% increase in ACHD cardiologists. Compared with 2012, all procedural volumes increased with cardiac surgeries, increasing by 12% and percutaneous intervention by 22%. Wait time for nonurgent consults and interventions all exceeded national recommendations by an average of 7 months and had increased compared with 2012 by an additional 2 months. Variability in resources were noted across provincial regions.

CONCLUSIONS

Over the past 10 years, ACHD care gaps have persisted, and personnel and infrastructure have not kept pace with estimates of ACHD population growth. Strategies are needed to improve and reduce disparity in ACHD care relative to training, staffing, and access to improved care for Canadians with ACHD.

[Preliminary results of Chinese magnetic sphincter augmentation in treating gastroesophageal reflux disease]

Objective: To examine the preliminary clinical efficacy of Chinese magnetic sphincter augmentation (MSA) in the treatment of gastroesophageal reflux disease (GERD). Methods: According to the enrollment criteria for the MSA developed by ShengJieKang Co. and Shanghai Chest Hospital (SS-MSA) clinical trial, a total of 19 GERD patients were treated with SS-MSA from August 2018 to January 2020 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University. The majority of registered cases were male patients with age of (32.2±7.3) years (range: 22 to 50 years), height of (170.7±6.2) cm (range: 160 to 179 cm) and weight of (65.2±10.3) kg (range: 47.5 to 90.0 kg). SS-MSA was implanted via laparoscopy. The major evaluation indexs of postoperative efficacy were the total time of acid exposure within 24 hours and the total number of reflux. Secondary efficacy indicators included: (1) evaluation of the average daily dose of proton pump inhibitor medications; (2) the score of GERD health related quality of life questionnaire (GERD-Q) before and after MSA implantation. Paired design t-test was used to evaluate the efficacy of the SS-MSA. Results: A total of 19 patients underwent SS-MSA surgery successfully. The history of the GERD were 19 (54) months (M(Q(R))). The operation time was 63 (22) minutes and the in-hospital stay was 3 (2) days. No obvious surgical complications occurred. Postoperative adverse events included 14 cases with mild to moderate dysphagia exited after surgery, gradually eased within 1 to 3 months, 1 case with the removal of the device after 1 month of severe swallowing difficulties, 1 case of diarrhea. No corrosion, perforation, displacement occurred. The GERD-Q score (11.0(4.5) vs. 6(1.0), t=4.274, P=0.013), 24-hour acid exposure time (6.2(4.8)% vs. 0.1(0.9)%, t=5.814, P=0.004), and Demeester score (23.72(16.20) vs. 0.96(3.10), t=6.678, P=0.003) were significantly decreased 1 year after surgery(n=5). Proton pump inhibitor reuse rates were 6/18, 5/15, 3/10, and 1/5 in 1, 3, 6 and 12 months after the operation, respectively. Conclusions: SS-MSA implantation is feasible and safe with short hospital stay and rare perioperative complications. The preliminary results is good after 1 year follow-up. It could be expected to be an ideal substitutive for future GERD treatment.

[Experiences of esophageal replacement with ileocolon graft: a series of 34 cases]

Objective: To evaluate the safety and effectiveness of esophageal replacement with ileocolon graft. Methods: Totally 34 cases of esophageal replacement with ileocolon graft from July 2015 to November 2017 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University were analyzed retrospectively, including 24 male and 10 female, aging from 7 to 72 years old. Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route except one subcutaneous route. The primary esophageal disease, postoperative complication rate and quality of life were analyzed. Results: The overall postoperative complication rate was 23.5% (8/34), cervical anastomotic leakage rate of 5.9% (2/34), necrosis of colon graft of 5.9% (2/34). There were 3 patients experienced re-operation including 2 patients with colon graft necrosis and 1 patient with intestinal obstruction after ERC. One patient with colon graft necrosis died of septic shock after reoperation. Six cases of cervical esophago-jejunal anastomosis stenosis and 1 case of diarrhea occurred in the later time. All patients were followed up for a median time of 9 months (range: 1 to 28 months), 32 cases survived but 1 patient died until last follow-up by the end of December 2017. Conclusion: Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route was safe and effective.

Classification of water contamination developed by 2-D Gabor wavelet analysis and support vector machine based on fluorescence spectroscopy

The identification of the specific categories of pollutants in the urban water supply system is necessary. Traditional detection methods are based mainly on common water quality indicators. However, inspecting these water quality indicators is made difficult by issues such as long analysis time, insufficient sensitivity, need for reagents, and generation of waste liquid. These problems hinder high-frequency water detection and monitoring. In this study, three-dimensional (3D) fluorescence spectroscopy is adopted as a monitoring method for water quality. An identification method based on two-dimensional (2D) Gabor wavelets and support vector machine (SVM) multi-classification is also proposed. The Delaunay triangulation method for interpolation is used to pre-process 3D fluorescence spectra and thereby eliminate Rayleigh scattering and Raman scattering. A 2D Gabor wavelet function generated by filters of different scales and rotation angles is proposed to extract the features of the spectra. The block statistics method, based on Gabor feature description, is employed to enhance the efficiency in describing spectra features. Then, multiple SVM classifiers are used in pollutant classification and recognition. By comparing the proposed method with principal component analysis, which is a commonly used feature extraction method, this study finds that the application of 2D Gabor wavelets and block statistics can effectively describe the characteristics of 3D fluorescence spectra. Moreover, 2D Gabor wavelets achieve high classification accuracy, especially for substances with closely positioned or overlapping characteristic peaks.

Experimental study on TGF-β1-mediated CD147 expression in oral submucous fibrosis

OBJECTIVE

Although previous evidence indicates that CD147 is closely involved in the progression of organ fibrosis and various signaling pathways have been proven to regulate its expression, the role of CD147 in oral submucous fibrosis (OSF) remains largely unknown.

METHODS

In this study, we investigated the expression of CD147 and transforming growth factor β1 (TGF-β1) in human samples of an OSF tissue array by immunohistopathology. Pearson's correlation analysis was conducted to explore the correlation between CD147 and TGF-β1. Immunofluorescence and Western blotting were used to investigate to levels of CD147 in Human Oral Keratinocytes (HOKs) followed by TGF-β1 or LY2157299, an inhibitor of TGF-β1 receptor and arecoline stimulation.

RESULTS

We found that CD147 was highly expressed in both HOKs and the fibrotic oral mucosa and that this expression was correlated with TGF-β1 expression. Additionally, CD147 levels were significantly associated with the fibrosis stage. The TGF-β1 signaling pathway was found to be mainly responsible for CD147 up-regulation after arecoline treatment whereas inhibition of TGF-β1 down-regulated CD147 expression.

CONCLUSION

Our findings suggest arecoline promotes CD147 expression via the TGF-β1 signaling pathway in HOKs, whereas overexpression of CD147 may promote OSF progression.

Comparative study of functional and aesthetically outcomes of reverse digital artery and reverse dorsal homodigital island flaps for fingertip repair

This retrospective study was designed to compare functional and cosmetic outcomes of the reverse digital artery island flap and reverse dorsal homodigital island flap in fingertip repair. A total of 23 patients were followed for 24 to 30 months. The reverse digital artery island flap was used in 12 patients, and reverse dorsal homodigital island flap in another 11 patients. Flap sensibility was assessed using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Patient satisfaction, active motion of the finger joints, complications and cold intolerance were evaluated. The static 2-point discrimination and Michigan Hand Outcomes Questionnaire (appearance) of the fingers treated with a reverse digital artery flap were significantly better than those with a reverse dorsal homodigital flap. The static 2-point discrimination of the skin-grafted donor sides after dorsal homodigital flap were poorer than that in the contralateral finger. No significant differences were found between the two flaps for pressure or touch sensibility, active ranges of digital motion, complications and cold intolerance.

LEVEL OF EVIDENCE

III.

Anti-CII antibody as a novel indicator to assess disease activity in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects a variety of organ systems. Anti-dsDNA Abs and complement factors have been used as indicators of lupus activity for more than 50 years. A novel indicator of activation in SLE is reported in this paper. Anti-collagen type II (CII) Ab was obviously elevated in patients with SLE compared to those patients with ankylosing spondylitis (AS) and healthy controls (HCs). Anti-CII-Ab-positive patients with SLE showed significantly higher levels of serum IgG and higher titers of ANA but lower levels of C3 and C4 than controls. A positive correlation was demonstrated between anti-CII Ab and serum IgG in SLE patients (r = 0.50, p < 0.0001). The negative correlations of anti-CII Ab with C3 and C4 were observed in SLE patients (r = -0.36, p = 0.0013; r = -0.37, p = 0.0006, respectively). The reduced anti-CII Ab level was accompanied by decreased level of serum IgG and increased levels of C3 and C4 after regular treatment. Therefore, anti-CII Ab could be a novel indicator for monitoring activity of SLE.

Dental Abnormalities Caused by Novel Compound Heterozygous CTSK Mutations

Cathepsin K (CTSK) is an important protease responsible for degrading type I collagen, osteopontin, and other bone matrix proteins. The mutations in the CTSK gene can cause pycnodysostosis (OMIM 265800), a rare autosomal recessive bone dysplasia. Patients with pycnodysostosis have been reported to present specific dental abnormalities; however, whether these dental abnormalities are related to dysfunctional CTSK has never been reported. Here we investigated the histologic changes of cementum and alveolar bone in a pycnodysostosis patient, caused by novel compound heterozygous mutations in the CTSK gene (c.87 G>A p.W29X and c.848 A>G p.Y283C). The most impressive manifestations in tooth were extensive periradicular high-density clumps with unclear periodontal space by orthopantomography examination and micro-computed tomography scanning analysis. Hematoxylin/eosin and toluidine blue staining and atomic force microscopy analysis showed that the cementum became significantly thickened, softened, and full of cementocytes. The disorganized bone structure was the main character of alveolar bone. The p.W29X mutation may represent the loss-of-function allele with an earlier termination codon in the precursor CTSK polypeptide. Residue Y283 is highly conserved among papain-like cysteine proteases. Three-dimensional structure modeling analysis found that the loss of the hydroxybenzene residue in the Y283C mutation would interrupt the hydrogen network and possibly affect the self-cleavage of the CTSK enzyme. Furthermore, p.Y283C mutation did not affect the mRNA and protein levels of overexpressed CTSK in COS-7 system but did reduce CTSK enzyme activity. In conclusion, the histologic and ultrastructural changes of cementum and alveolar bone might be affected by CTSK mutation via reduction of its enzyme activity (clinical trial registration: ChiCTR-TNC-10000876).

Changes and clinical significance of peripheral blood helper T lymphocyte and natural killer (NK) cells in unexplained recurrent spontaneous abortion (URSA) patients after abortion and successful pregnancy

OBJECTIVE

This study aims to investigate the number changes and the clinical significance of the peripheral blood T lymphocyte subsets and NK (natural killer) cells in unexplained recurrent spontaneous abortion (URSA) patients before and after abortion, as well as after successful pregnancy.

MATERIALS AND METHODS

Thirty-nine URSA patients (URSA-abortion group), among who 22 patients were followed up until the final successful parturition (URSA-pregnancy group), 31 normal-pregnancy (NP) cases and 25 normal non-pregnancy (NNP) control cases in which the peripheral blood T lymphocytes and subsets, B cells, and NK cells were assessed flow cytometry.

RESULTS

Compared with the URSA-pregnancy group and the NP group, the Th cells and NK cells of the URSA-abortion group increased (p < 0.05); compared with the NNP group, the total number of T cells decreased after the first, second, and third month of the URSA abortion (p < 0.05); Th cells decreased within one to six months of the URSA abortion (p < 0.05); proportion of NK cells was significantly higher in URSA patients (p < 0.05).

CONCLUSION

The abnormal numbers of the peripheral blood T cell subsets and NK cells were related with the occurrence of URSA.

Effect of sonication on UV disinfectability of primary effluents

In this paper, the effect of sonication on the UV disinfection kinetics of primary effluents was investigated. Wastewater samples were collected from local municipal treatment plants and were sonicated with a 20-kHz ultrasound reactor at constant power but varying sonication times. Sonicated samples were irradiated using low-pressure UV light to obtain the UV dose-response curves (DRC). Results showed that sonication improved the UV disinfection of primary effluents by (1) increasing the initial slope of DRC (i.e., k1) and (2) decreasing the tailing level of the UV dose-response curve (i.e., beta). This improvement was confirmed to be caused by the breakage of large particles (> 60 microm) that are known to protect coliforms from UV photons. It also was found that the log reduction of the tailing level of DRC was directly proportional to the log reduction of the number of large particles (> 60 microm) present in the effluent sample. Although the number of large particles was proportional to the coliform count at high UV dosage, the proportionality constant varied from 0.05 to 0.25, depending on the sample.

Segmental bone tissue engineering by seeding osteoblast precursor cells into titanium mesh-coral composite scaffolds

The size and specific shape of bone grafts are important for jaw reconstruction. In this experiment, segmental bone grafts were engineered in a predetermined shape via seeding osteoblast precursor cells into titanium mesh-coral composite scaffolds. Titanium meshes were moulded into the shape of a column with length 12 mm and diameter 8mm. The column was filled with natural coral granules and the complex acted as a cell-seeding scaffold. About 4 x 10(7) osteoblast precursor cells in 200 microl cell-culture medium were seeded into each of six scaffolds and incubated in vitro for 2 days. Then, the composites were implanted subcutaneously into the backs of nude mice and incubated in vivo. Two months after implantation, the animals were killed and new bone formed in the scaffolds was investigated by gross inspection, X-ray examination, histological observation and mechanical testing. The results showed that newly formed tissue was red and presented the gross appearance of bone, and kept the original shape of the column. Titanium mesh was situated on the surface of the bone graft. An X-ray blocking shadow was observed in and around the titanium scaffolds; most of the coral granules had been absorbed. Histological observation demonstrated a large amount of new bone formed and integrated well with titanium mesh. Mechanical testing showed that new bone improved the mechanical property of the graft significantly. In conclusion, a titanium mesh-coral composite scaffold with osteoblast precursor cells is an efficient means to engineer segmental bone, possessing the desired shape and mechanical strength.

Performance of high-rate sludge digesters fed with sonicated sludge

A major limitation of anaerobic sludge digestion is the long hydraulic retention time (HRT) required for satisfactory stabilization which results in large digester size. This study explored a possibility of operating digesters at shortened HRTs by sonication pretreatment of secondary sludges. Four identical digesters designated D1, D2, D3 and D4 were fed with untreated and sludge sonicated at densities of 0.18 W/ml, 0.33 W/ml and 0.52 W/ml, respectively. All digesters were operated at three HRTs of 8-day, 4-day and 2-day. Comparing with the control digester (D1), total solids removal efficiencies improved by 12-19%, 17-36% and 20-39% in digesters D2, D3 and D4, respectively. The volatile solids removal was also increased by 11-21%, 17-33% and 19-36% in the respective digesters. The improved solids degradation corresponded with increase in biogas production by 1.4-2.5, 1.9-3.0 and 1.6-3.1 times, respectively. Increase in methane composition by 2-17% was also noted in all digesters fed with sonicated sludge. An analysis indicated that sonication pretreatment could enhance degradation of carbon, nitrogen and sulfur substances in the digestion. The study suggested that sonication of sludge is a possible pretreatment to shorten the digester operating HRT with improvement in solids degradation, biogas production and methane content. It can be deduced that to maintain a consistent solids loading at a desire performance, sludge digester with smaller size can be designed.

A comparison of ultrasound treatment on primary and secondary sludges

Ultrasound treatment of primary and secondary sludges was conducted to improve the qualities of sludges for the anaerobic digestion. The impacts of different sonication times, sonication densities and solids concentrations on ultrasonication efficiency were examined. The experimental results indicated that the significant reduction in particle size and increase in soluble organics could be achieved, implying that ultrasonication could offer a feasible treatment method to efficiently disintegrate sludge. The greater decrease in particle size and increase in soluble organics of sludge indicated that the secondary sludge has a more remarkable improvement after sonication over the primary sludge. With respects to the extent of disintegration and energy consumption, higher sonication density performed more effectively in terms of specific energy. There exists an optimal solids concentration range for both the sludges for optimum sonication. Within the optimal solids concentration range, efficient sonication can be effected and sludge would be disintegrated efficiently. The ultrasound would be attenuated by scattering and absorption if the solids concentration exceeds the optimal range. It appeared from the study that the mechanical shear forces caused by ultrasonic cavitation could be a key factor for sludge disintegration and collapse of cavitation bubbles could significantly alter the sludge characteristics.

Injectable bone

Temperature-dependent polymerising polyethylene oxide hydrogel was used as a vehicle to deliver bone marrow mesenchymal cells by injection in six nude mice, four mice acting as controls, to study generation of new bone in the cell-hydrogel complex. Mesenchymal cells were harvested by in vitro cell culture, and cells were seeded into polyethylene oxide solution. The density of the suspension was adjusted to 5 x 10(7)ml(-1). The hydrogel was obtained by adjusting the temperature to over 6 degrees C. Aliquots of 0.5 ml of the cell-hydrogel complexes were injected subcutaneously into the backs of the six experimental mice, and 0.5 ml of hydrogel alone was injected into the four controls. Generation of new bone was studied by gross inspection, radiographs, and histological examination. Two months after injection hard nodes had formed subcutaneously in all six mice, whereas in the control group the hydrogel had been absorbed completely and only soft tissue was present at the site of injection. A shadow could be seen on the radiographs of all cell-seeded mice. On histological examination of the nodes there was trabecular bone and some areas of neocartilage. This method of generating new bone might be of potential clinical use.

The therapeutic effect of Ginkgo biloba extract in SHR rats and its possible mechanisms based on cerebral microvascular flow and vasomotion

This paper aimed to investigate the therapeutic effect of an extract of Ginkgo biloba leaves (EGb 761) on hypertension and its possible mechanisms in the view of cerebral microcirculation. Twenty normotensive rats and 24 SHR rats were used. Surgical preparation was made to produce a cranial window for observation of the capillary network on the cerebral cortex. The intravital videomicroscopy equipped with digital image processing system and laser Doppler flowmeter were used for this study. The arterial blood pressure, red cell velocity (V), microvacular diameter (D), number of open capillaries (OCN), circulating endothelial cells (CEC) in blood, relative blood flow (Flow) and frequency (Fc), amplitude (AMP) of vasomotion were measured. The obtained data were compared between EGb-treated rats that received per os 100 mg/kg/d for 9 days and placebo control rats. Untreated SHR rats showed very severe dysfunction in the microcirculation with high blood pressure (213 +/- 16.7 mmHg). The blood pressure decreased significantly to 153 +/- 20 mmHg in EGb-treated SHRs group, compared with those of untreated rats (p < 0.01). Both normotensive and hypertensive rats increased the blood flow velocity and LDF flow after EGb-treatment. The vasomotion property, the CEC and OCN changed greatly in EGb-treated SHR rats, but no significant difference was observed in normotensive rats. It was suggested that EGb 761 had therapeutic effect on SHR rats by increasing blood perfusion, regulating vasomotion function, opening efficiently capillaries and releasing the peripheral resistance. The injured vascular endothelium of SHR rats was also partly reversed by EGb-treatment. It was concluded that EGb 761 could be used to regulate hypertension and to protect the cerebral microcirculatory function.

[The construction and physical-mechanical characterization of polymer foams of D. L-PLA]

This study was intended to construct biogradable polymer foam used in tissue engineering. The D. L-PLA was supplied by chengdu institute of organic chemistry. Biogradable polymer membranes were prepared with a novel solvent-casting particulate-leaching technique, then, the constituent membranes with the proper order were laminated to produce three-dimensional foams with continuous pore structure and morphology. Afterwards, the physical-mechanical property of polymer foams were tested. The test results indicated that the lamination process did not change the physical-mechanical property of the polymer membranes.

Vascular osteomuscular autograft prefabrication using coral, type I collagen and recombinant human bone morphogenetic protein-2

In 20 male Sprague-Dawley rats, 10 pieces of L-shaped coral combined with type I collagen and recombinant human bone morphogenetic protein-2 (rhBMP-2) and 10 discs (diameter 5 mm) were wrapped in the gracilis muscle, and left pedicled on the femoral vessels. Untreated coral was buried in muscle at a distant control site in 4 animals. After 3 weeks, autografts were examined for the shape of new bone, vascular patency, and induction of bone. In all grafts in viable tissue, heterotopic bone was formed. The shape of the new bone was the same as that of the coral, and there was no significant inflammatory reaction. Part of the coral in the composite was absorbed. Bone was not formed in any of the control sites. Coral and type 1 collagen are effective as a carrier for BMP to prefabricate vascular osteomuscular autografts with designed shape. There is a potential clinical application for BMP to bioengineer microvascular free flaps with intrinsic skeletal muscle for maxillofacial reconstruction.

Prolonged asymptomatic dense deposit disease in Chinese. Report of 2 cases in Taiwan

Dense deposit disease (DDD) is a less common form of membranoproliferative glomerulonephritis (MPGN). The disease occurs predominantly in children and young adults and the prognosis is variable. DDD varies considerably in incidence among different populations and has not been reported in Chinese. Herein we reported 2 cases of DDD in young Chinese girls in Taiwan. Although 1 case (case 2) had mild hypertension, both patients had asymptomatic proteinuria and ran a benign course of 8 and 14 years, respectively. The histological features of case 1 resembled membranous glomerulonephritis (MGN) on hematoxylin-eosin stain, but revealed DDD on periodic acid Schiff and chromotrope-2R silver methenamine stains. Whereas case 2 showed focal MPGN on light microscopy, she had a fine granular immunofluorescence pattern resembling MGN. Characteristic intramembranous dense deposits were demonstrated by electron microscopy in the basement membranes of the glomeruli, Bowman's capsules and the renal tubules. Both patients were followed closely, and had stable normal renal function 1 year after renal biopsy.

Cocoa procyanidins and human cytokine transcription and secretion

We examined whether cocoa, in its isolated procyanidin fractions (monomer through decamer), would modulate cytokine production at the levels of transcription and protein secretion in both resting and phytohemagglutinin (PHA)-stimulated peripheral blood mononuclear cells (PBMC). In resting cells, interleukin (IL)-1beta and IL-4 gene expression from cocoa-treated cells varied markedly among the subjects tested. However, at the protein level, the larger fractions (pentamer through decamer) stimulated a dramatic increase in IL-1beta concentration (up to ninefold) with increasing degree of polymerization. Similarly, these larger fractions augmented IL-4 concentration by as much as 2 pg/ml, whereas the control displayed levels nearly undetectable. In the presence of PHA, gene expression also seemed to be most affected by the larger procyanidin fractions. The pentameric through decameric fractions increased IL-1 beta expression by 7-19% compared with PHA control, whereas the hexameric through decameric fractions significantly inhibited PHA-induced IL-4 transcription in the range of 71-86%. This observation at the transcription level for IL-1 beta was reflected at the protein level in PHA-stimulated PBMC. Significant reductions in mitogen-induced IL-4 production were also seen at the protein level with the hexamer, heptamer and octamer. Individual oligomeric cocoa fractions were unstimulatory for IL-2 in resting PBMC. However, when induced with PHA, the pentamer, hexamer and heptamer fractions caused a 61-73% inhibition in IL-2 gene expression. This study offers additional data for the consideration of the health benefits of dietary polyphenols from a wide variety of foods, including those benefits associated specifically with cocoa and chocolate consumption.

[The experimental study on the activity of rhBMP-2, coral and collagen composites inducing intramuscle bone]

OBJECTIVE

To investigate the ectopic bone induction activity of the composite of coral, collagen and rhBMP-2, and the degradation of the carriers of rhBMP-2.

METHODS

The composites of rhBMP-2, coral and collagen were implanted into the muscle pouches of mice. The mice were divided into the following four groups. Group H: each composite had 2 mg rhBMP-2, Group L: each composite had 0.5 mg rhBMP-2, Group J: each composite had only type I collagen, Group C: only coral was implanted in the muscle of mouse. Each group had 20 mice. Every 5 mice in each group were killed postoperatively after 1, 2, 4 and 8 weeks. The ectopic osteoinductive activity was assessed with histology and histomorphometry. The point counting method was applied to measure the formation of new bone and cartilage and the degradation of coral in the composites. The data was analyzed statistically using t test.

RESULTS

There was no obvious morbidity in any of the animals in this study, and no wound infection, bleeding, or feeding difficulties postoperatively. The samples were examined histologically. Cartilage and bone induction occurred in Group H and L. After 1 Week, new bone was observed in Group H, and cartilage formation occurred mainly in Group L. After 2 weeks, both cancellous bone and bone marrow elements were present in Group H and L. New bone formation was not uniform throughout the specimen. Part of the coral in the composites was not absorbed between 2 to 4 weeks postoperatively. At the 8th week, the coral in the composite was absorbed completely. While in Group J and C there was not any new cartilage or bone formation. According to the statistical analysis, bone formation occurred 2 weeks earlier in Group H than in Group L after operation. From 4 postoperative weeks, no difference of the bone formation rate was observed between Group H and Group L. The degradation rate of coral in Group C was the fastest among the four groups.

CONCLUSION

The composites of rhBMP-2, coral and collagen are degradable bone substitutes with bone induction and conduction, and induce dosedependent and time-dependent amounts of intramuscle bone in mice during limited postoperative period. The coral in the composites could be absorbed completely.

[Experimental study on prefabricating iliac grafts using composite bone]

OBJECTIVE

To investigate the feasibility of prefabricating a specified shape autograft capable of transfer using coral and type I collagen as a carrier for recombinant human bone morphogenetic protein-2 (rhBMP-2).

METHODS

In this study, the composite of rhBMP-2, coral and type I collagen was made certain shape to prefabricate vascularized osteomuscular autograft capable of microvascular free tissue transfer and autogenous bone graft with certain shape and titanium implant in it. The composite was implanted in the iliac area in dog with the titanium implant at the same time. After 3 months and 4 and a half months of implantation, the composites were studied with gross measurement, X-ray, and histological examinations.

RESULTS

After 3 months, composited bone was turned to bone tissue, and the shape of iliac bone was changed with implant in it, bone interface was seen between new bone and implant. And new bone was matured after 4 and a half months.

CONCLUSION

Coral and type I collagen are effective carrier for rhBMP-2 to prefabricate vascular osteomuscular autograft with certain shape. The use of rhBMP-2 for tissue engineered microvascular free bone flaps has an unlimited potential and adds a new dimension to maxillofacial reconstruction.

Coral as a carrier for recombinant human bone morphogenetic protein-2

By combining coral with recombinant human bone morphogenetic protein-2 (rhBMP-2), rhBMP-2/coral composite was obtained in this study. Following implantation of the composite into the muscle pouches of mice, cartilage growth was induced in the pores or on the surface of the implants at one week, woven bone at three week and lamellar bone with bone marrow at six week, and coral was absorbed partially. The induced formation of endochondral bone was time-related and rhBMP-2 dose-related. The results of this study indicate that the composite possesses a superior ability of osteogenesis, and coral acts as one of the most suitable rhBMP-2 slowrelease carriers currently available. The composite will be a new type of bone substitute to be used in orthopaedics and maxillofacial surgery.

[Cartilage matrix synthetic ability of rabbit articular chondrocytes cultured in vitro]

OBJECTIVE

To observe the ability of matrix synthesis of rabbit articular chondrocytes cultured in vitro.

METHODS

Rabbit articular chondrocytes were acquired by digestion of 0.1% type II collagenase and cultured in vitro, then cell morphology and ultrastructure were observed with phase-contrast microscope and scanning electronic microscope. With continuous culturing of chondrocytes in DMEM medium containing 15% FBS, synthesis of cartilage matrix was observed by using microscope and safranine-O staining.

RESULTS

The cultured chondrocytes were polygonal cells. There were many rough endoplasmic reticula and mitochondria in cytoplasm, and a lot of secretory vesicles under cell membrane and in the cytoplasm. When cultured for 10 days, some small and white nodules were formed on the bottom of the culture dishes, and volcanic-mouth-like structures were formed when cultured for 20 days. Both these nodules and structures contained GAG-positive substances were demonstrated by safranine-O staining.

CONCLUSION

Chondrocytes can produce matrix and cartilage-like tissue in vitro, so it is feasible to produce cartilage by culturing chondrocytes in vitro.

An experimental study on rhBMP-2 composite bone substitute for repairing craniomaxillary bone defects

OBJECTIVE

To measure bone regenerative effects in animal calvarial or mandibular critical-size defects using recombinant human bone morphogenetic protein-2 (rhBMP-2) combined with four selected carriers.

MATERIALS AND METHODS

The composite bone grafts were obtained by combining rhBMP-2 with chitin, coral, coral-based porous HA (CHA), and xenogeneic cancellous bone, respectively. These materials were implanted on the calvarial or mandibular defect of rabbits and on the calvarial defect of rats. Each carrier material was also studied as a control group. The animals were examined 2, 4, 8, and 12 weeks after implantation by radiography, histology (under light microscope and scanning electron microscope), immunohistochemistry, and biomechanics.

RESULTS

The results showed that the composite graft was absorbed gradually after it was implanted into the defect, during which time new bone was formed within the combined material in the defect site; the amount of new bone increased as time elapsed. At 12 weeks the composite was replaced completely by bone except in the CHA group. In contrast, a large amount of fibrous tissue, and little new bone, formed on the area of the bone defect when the carrier material alone was implanted.

CONCLUSIONS

All materials tested seem to be suitable carriers for rhBMP-2, which plays a very important role in new bone formation. These composite bone substitutes may be ideal materials for repairing various bone defects in the craniomaxillofacial region.

Isolation and identification of berberine from cell cultures of Coptis chinensis

Calli were formed by the young leaves of Coptis chinensis inoculated onto a 6,7-V solid medium containing 1.0-2.0 mg/L of 2,4-D and 0.1 mg/L of kinetin. The loose calli were chosen and transferred into a liquid medium and free cells and cell aggregates were obtained. Cell lines with a higher content of berberine were selected by irradiation of suspension culture and a plate-screening technique. After 35 subcultures, the selected cell lines were cultured in a larger quantity for the extraction of alkaloids. Yellow crystals were obtained from the extracts and identified as berberine by TCL, UV and IR absorption, and mass spectrography. They have the same molecular structure and anti-bacterium activities as the berberine obtained from natural plants.

[An experimental study on the bone repairing ability of recombinant human bone morphogenetic protein-2-coral composited artificial bone]

OBJECTIVE

To improve the bone repairing ability of coral.

METHODS

Recombinant human bone morphogenetic protein-2 (rhBMP-2)-coral composited artificial bone was used. The composite was implanted into rabbit calvarial critical-size defects, and coral alone was implanted as control. The rabbits were sacrificed at 2, 6, 12 weeks respectively after operation. The bone repairing ability was assessed by histology and image analysis system.

RESULTS

The composite repairing the bone defect both in osteoconductive and osteoinductive manners was seen, repairing ability and effect were better than those of coral.

CONCLUSION

The composite is ideal as a bone graft substitute.

[An experimental study on the effect of xenogeneic bone combined with human recombinant bone morphogenetic protein-2]

OBJECTIVE

To determine the ability of a new type of composited xenogeneic bone to repair the bone defect.

METHODS

The new type of composited xenogeneic bone was obtained by combining the treated cancellous bone with recombinant human bone morphogenetic protein-2 (rhBMP-2) and was implanted in the bone defect of rabbit.

RESULTS

There were a large amount of new bone formation within the combined material and the amount was increasing as the time lapsed in the area of the bone defect. In contrast, there were a lot of fibrous tissues with a little new bone formed when the treated cancellous bone was implanted alone.

CONCLUSION

The results imply that the rhBMP-2 plays a very important role in new bone formation and the composited xenogeneic bone appears to be an ideal material for the repair of bone defect.

[A biomechanical study on the bone repairing ability of recombinant human bone morphogenetic protein-2-coral composited artificial bone]

To improve bone repairing ability of coral, recombinant human bone morphogenetic protein-2 (rhBMP-2)-coral composited artificial bone was obtained by combining coral with rhBMP-2 in this experiment. The composite was implanted into rabbit calvarial critical-size defects and coral alone was implanted as control. The bone repairing ability was assessed by radiography, histology and biomechanics. The results showed that implants were absorbed gradually after they was implanted into the defects. In the meantime, the new bone was formed and the mechanical strength was reinforced uninterruptedly in bone defect regions. At 12 weeks, the implants were replaced completely by bone, and the mechanical strength was entirely restored. These suggest that the composite possess a superior bone repairing ability and may be one of the most perfect bone graft substitutes currently available.

[Relationship between insulin resistance and coronary heart disease in non-insulin-dependent diabetes mellitus patients]

Recent clinical studies showed that an independent association between hyper-insulinaemia and coronary heart disease (CHD) in men with normal glucose tolerance. In non-insulin-dependent diabetes mellitus (NIDDM) it is less clear. Therefore, we evaluated insulin-sensitivity index, plasma glucose, insulin, lipoproteins and apolipoproteins in 40 male NIDDM patients with CHD, and compared them with 36 male NIDDM patients without CHD. The insulin-sensitivity index determined by the reverse of fasting plasma glucose and insulin product. The results showed that the subjects with CHD had significantly lower insulin-sensitivity index (P < 0.01) compared to those without CHD. Using step-wise logistic regression analgsis, we found insulin-sensitivity indexes (OR 0.237, 95%CI 0.0909-0.6167, P = 0.0032) were negatively associated with CHD, and were independent from other cardiovascular risk factors such as age, body mass index, hypertension, and hyperlipemia. We conclude that in NIDDM patients with CHD are more insulin resistant compared to those without CHD. Insulin resistance is associated with CHD, and independent from other cardiovascular risk factors.

[Relationship between elevated plasma endothelin-1 level and renal function in patients with diabetic nephropathy]

Plasma endothelin-1 (ET-1) level was measured with radioimmunoassay in 33 normal subjects and 92 patients with different stages of diabetic nephropathy, consisting of 35 cases of diabetes mellitus with normal urinary albumin excretion (DM), 22 cases of incipient diabetic nephropathy (IDN), 22 cases of overt diabetic nephropathy (ODN), 8 cases with azotemia (DNa) and 5 cases with uremia (DNu). The results showed that plasma ET-1 levels in DNa and DNu groups (30.24 +/- 1.93 ng/L and 36.38 +/- 3.62 ng/L respectively) were significantly higher than those in other groups (P < 0.05); ET-1 level in ODN group (20.50 +/- 0.93 ng/L) was significantly higher than those in DM and IDN groups (P < 0.001); ET-1 level in IDN group was also significantly higher than that in DM group (17.79 +/- 0.74 vs. 15.06 +/- 0.63 ng/L, P < 0.01); All the above values were significantly higher than that in normal subjects (7.08 +/- 0.22 ng/L) (P < 0.001). There was significant positive correlation between ET-1 level and HbA1c, systolic pressure, diastolic pressure, blood urea nitrogen, serum creatine, uAER and a significant negative correlation between ET-1 level and glomerular filtration rate. It is shown that progressive elevation of plasma ET-1 level is closely related with different stages of renal function impairment, suggesting strongly the role of ET-1 in the development and progression of diabetic nephropathy.

[Clinical significance on expression of the ras gene product P21 in human cervical carcinoma tissues]

Using MAB-P21 as a probe, the expression of gene product was studied by immunohistochemical ABC method, ABC staining of gel electrophoresis and ELISA quantitative analysis. The expression of P21 was detected in 107 cases of uterine cervix tissues, among which 70 were cervical carcinoma, 30 were chronic cervicitis and 7 normal cervix. Experimental results showed that obviously positive expression was noted in the specimens of cervical carcinoma and its positive rate was 72.8% (51/70). It was observed that the expression of P21 varied with grades of cell differentiation in cervical carcinoma. The level of P21 expression in high differentiated type was higher than that of the middle and low differentiated types. On the contrary, there was no detectable ras P21 in the normal cervix tissue and only 2 cases of cervicitis expressed positively (2/30). The results of ABC staining of electrophoresis showed that there was a P21 special staining band in cervical carcinoma tissues. And the contents of P21 protein were higher in cervical carcinoma than in normal cervix and cervicitis (t test, P less than 0.001). The expression of P21 was considerably enhanced in malignant tissue as compared with that in benign lesion.