[Endovascular repair of ruptured abdominal aortic aneurysms assisted by double balloon occlusion technique combined with intra-aneurysm fibrin binder injection technique]

Objective: To investigate the long-term efficacy and safety of alternating double balloon occlusion combined with intra-aneurysm injection of human fibrin binder in the endovascular repair of ruptured abdominal aortic aneurysm (rAAA). Methods: The clinical data of 28 patients with rAAA admitted to Department of Vascular Surgery, the Fourth Affiliated Hospital of Guangxi Medical University from January 2015 to December 2019 were retrospectively analyzed. There were 23 males and 5 females, aged (62±5) years (range: 46 to 88 years).The maximum diameter of the tumors was (65.2±10.5) mm (range: 47.3 to 100.5 mm), all of which were subrenal rAAA. The intraoperative EVAR for abdominal aortic aneurysm was successfully performed under the emergency green channel procedure, and this surgery was assisted used the double balloon occlusion technique in aorta of inferior renal and superior renalcombined with intraoperative human fibrin binder injection technique. Observation indexes included: patients with preoperative preparation, operation time, hospitalization days, surgical treatment success rate and the incidence of postoperative complications, and aortic stent form during the follow-up period, the incidence of leakage, branch stents patency rate and infection rates. Results: The preoperative preparation time of 28 patients was (45.5±8.5) minutes (range:20 to 100 minutes). The operation time was (100.0±15.5) minutes (range:85 to 210 minutes), the ICU stay time was (7±2) days(range:1 to 17 days). The length of hospitalization was (13.5±2.5) days(range:5 to 43 days). The success rate of surgical treatment was 92.9% (26/28). Two patients died, 1 case died of postoperative multifocal lacunar cerebral infarction and massive gastrointestinal hemorrhage, and another elderly patient (84 years old) died of massive abdominal fluid due to preoperative abdominal aortic aneurysm rupture, postoperative complicated with significant abdominal compartment syndrome, and secondary multiple organ failure. Balloon occlusion of the upper renal aorta took (13±2)minutes (range:12 to 30 minutes). The intraoperative injection of fibrin adhesive was (14±2) ml(range:6 to 28 ml) in 22 cases. The incidence of major postoperative complications was 57.1% (16/28). Among the 26 patients who survived the surgery, 69.2% (18/26) completed the 3-year follow-up, and the follow-up time was (30±3) months(range:13 to 36 months). During the follow-up, the aortic stent was in good shape without obvious displacement. The incidence of leakage within 6 months after the operation was 10.7% (3/28), and there was no internal leakage in the patients who were followed up for 36 months after the operation. The patency rate of renal artery and iliac artery branch stents was 16/18. The incidence of stent infection was 7.7% (2/26), 1 case occurred at 1 month and another case at 6 months, respectively. All patients recovered after prolonged intensive anti-infection therapy. Conclusions: Under the standard emergency treatment process, the double balloon alternating occlusion technique combined with the intra-aneurysm injection of human fibrin adhesive technique can assist the successful completion of the endovascular repair of rAAA, effectively improve the success rate of treatment for patients, and reduce the incidence of postoperative leakage and serious complications. The mid-term and long-term results of EVAR for rAAA are good, safe and reliable.

[Relationship between the ideal cardiovascular health behaviors and factors and newonset heart failure]

Objective: To explore the relationship between the ideal cardiovascular health behaviors and factors and newonset heart failure. Methods: It was a prospective cohort study. People who attended the 2006-2007 physical examination of Kailuan Group Company and with complete data of cardiovascular behaviors and related factors were eligible for this study. A total of 95 167 participants who were free of valvular heart diseases, congenital heart diseases and a prior history of heart failure were included. Basic cardiovascular health score (CHS) of each participant was calculated. Participants were divided into 3 groups according to CHS. Group 1:CHS<8 (n=26 640), Group 2:8≤CHS<10 (n=35 230), Group3:CHS≥10 (n=33 297). The general clinical data and laboratory test results were collected. The outcome was defined as the first occurrence of heart failure at the end of followup(December 31, 2016). Cox regression model was used to determine the association between baseline CHS and the risk of newonset heart failure. Results: After a median followup of 10.3 years, the incidence of newonset heart failure in the group of CHS<8,8≤CHS<10,CHS≥10 were 2.7%(729/26 640), 1.8%(651/35 230) and 1.1%(360/33 297),respectively. After adjustment for age, sex, history of myocardial infarction, history of atrial fibrillation, income, alcohol consumption, education and the use of antihypertensive, cholesterol-lowering, glucose-lowering medications, compared with the group of CHS<8, the Cox regression model showed that HRs of the group of 8≤CHS<10 and CHS≥10 were 0.68 (95%CI 0.61-0.75), 0.49 (95%CI 0.43-0.55), respectively. Cox regression analysis after removing each single cardiovascular behavior or factor showed that the HR value range ability was as follows:systolic blood pressure(HR=0.78,95%CI 0.74-0.82), body mass index(HR=0.78,95%CI 0.74-0.82), fasting blood glucose (HR=0.77,95%CI 0.73-0.81), total cholesterol(HR=0.76,95%CI 0.72-0.80), physical exercise(HR=0.72,95%CI 0.69-0.76), smoking(HR=0.75,95%CI 0.71-0.79) and salt intake(HR=0.73,95%CI 0.69-0.77). Conclusion: CHS is negatively associated with the risk of newonset heart failure, and there is a dose-response relationship between the two indexes.

Must pilots permanently quit flying career after treatment for colorectal cancer? - Medical waiver for Air Force pilots with colorectal cancer: Three case reports

BACKGROUND

Colorectal cancer (CRC) could seriously threaten the physical and mental health of pilots. Shall they end their flying after treatment of CRC? With this study, we investigated the possibility of a gradual medical waiver for such pilots to fly aircrafts again after treatment of CRC.

CASE SUMMARY

We analyzed the medical waiver and clinical data of 3 pilots with CRC, who had accepted the treatment at the Department of General Surgery, Air Force Medical Center (formerly, Air Force General Hospital) between 2013 and 2018. All 3 cases underwent a series of comprehensive treatment courses, including radical resection of CRC, sequential radiotherapy, and chemotherapy. The follow-up results were satisfactory. After passing through the high-risk period of recurrence and metastasis of CRC, they all were given a medical waiver for flying again. Medical observation showed that their flying operations were safe.

CONCLUSION

The CRC treatment shall follow the guidelines for diagnosis and treatment and should simultaneously protect the combating capabilities of pilots as much as possible. It is safe for pilots with CRC, who are continuously monitored under medical observation after passing through the high-risk period of recurrence and metastasis, to undertake military flight missions again.

[Impact of change of ideal cardiovascular behavior and related factors on healthy vascular aging]

Objective: To investigate the impact of change of ideal cardiovascular behavior and related factors on healthy vascular aging(HVA). Methods: This study was a multi-center cross-sectional survey. Six thousand three hundred and sixteen participants who underwent at least 2 healthy examinations from 2006 to 2015 at 11 hospitals, including Kailuan Hospital and so on, and examined brachial-ankle pulse wave velocity (baPWV) during 2010 and 2016, with available information about cardiovascular behavior and factors were included. The cardiovascular health score (CHS) was calculated. Basic CHS was collected from the first examination. The second CHS derived from the healthy examination in the same year of baPWV examination. Change of cardiovascular health score (ΔCHS) was calculated. Participants were defined into 5 groups according to ΔCHS, namely ΔCHS≤-2 (n=2 166), ΔCHS=-1 (n=1 284), ΔCHS=0 (n=1 187), ΔCHS=1 (n=860), and ΔCHS≥2 (n=819). Participants' characteristics, value of baPWV and proportion of HVA were compared among different groups. Multiple logistic regression analysis was used to investigate the association between ΔCHS and HVA. The ΔCHS was recalculated and included in multiple logistic regression analysis model again after each component of the cardiovascular health metrics was removed separately in order to investigate effects of removal factors on HVA by observing changes in effect values. Results: The percentage of the participants with HVA in the group of ΔCHS≤-2, ΔCHS=-1, ΔCHS=0, ΔCHS=1 and ΔCHS≥2 were 23.3%(505/2 166), 27.8%(357/1 284), 28.7%(341/1 187),31.9%(274/860) and 33.9%(278/819), respectively. After adjustment for age, sex, income, education, alcohol consumption and the basic CHS, a significant positive association between ΔCHS and proportion of participants with HVA was observed (OR=1.50, 95%CI 1.44-1.56). Multiple regression analysis after removing each single cardiovascular behavior or factor showed that the OR value decreased as follow systolic blood pressure (OR=1.04, 95%CI 1.00-1.09), fasting blood glucose (OR=1.14, 95%CI 1.09-1.18), physical exercise (OR=1.16, 95%CI 1.11-1.21), salt intake (OR=1.17, 95%CI 1.12-1.22), body mass index (OR=1.18, 95%CI 1.13-1.23), smoking(OR=1.18, 95%CI 1.13-1.23) and total cholesterol (OR=1.20, 95%CI 1.16-1.24). Conclusion: The improvement of every ideal cardiovascular behavior and factor is associated with the increase of the proportion of HVA population.

[Advances of chronic tympanic membrane perforation animal model]

Chronic tympanic membrane perforation in an animal model has been widely used. The ideal model is a lasting and stable perforation without infection. For half a century, several physical modalities have been evolved, such as thermal injury, infolding technique, tympanostomy tube, re-myringotomy, and laser myringotomy. Chemical methods using chemical substance inhibiting growth and repair of cells as well as using gene defect animals are also applied. We have found the success rate is lower when using only one method and it would be better to combine physical and chemical approaches. In this article, we review the research advances in the establishment of chronic tympanic membrane perforation animal model.

[Canalplasty: surgical technique and analysis of the results]

Objective:To determine the applications and results of canalplasty for closed middle ear surgery.Method:Charts of 74 ears who underwent a canalplasty and closed middle ear surgery because of chronic otitis media or middle ear cholesterol granuloma between 2012 and 2016 were reviewed for general condition, disease, surgery methods,surgical outcome,complications,results of pure tone audiometry pre-and post-operatively.Result:Sixteen(21.6%) ears have some problems of their anterior ligament of malleus.Post-operative there are 69 ears totally epithelization, of which the rate is 93.2%,and the average epithelization time is 5.3 weeks. The myringoplasties are successful on 72 ears(97.3%).There are 5 ears(6.8%) occurring complications relating to canalplasty.One year after surgery the air-bone gap has decreased by 8 dB, which has been improved significantly than pre-operative(P<0.05).Conclusion:This study shows that technique for canalplasty is safe and effective,which can exposure the whole tympanic membrane and is easy for tympanoplasty. The epithelization rate of our technique is high.And it's good for myringoplasty and hearing outcomes.

[Transmastoidslotted labyrinthotomy approach cochlear implantation with customized electrode for patients with common cavity deformity]

Objective: To discuss the benefit of using transmastoid slotted labyrinthotomy approach (TSLA) and customized electrode for common cavity deformity (CCD) patients, and to evaluate the audiological outcomes. Methods: A retrospective analysis of the intraoperative monitoring data and postoperative auditory outcomes of 10 CCD cases who received cochlear implantation in Beijing Tongren Hospital,Capital Medical University from April 2016 to December 2017, was conducted using TSLA and customized electrod as a test group.At the same time, 10 cases of age and gender matched children with severe or severe sensorineural hearing loss and normal inner ear structures were recorded as a control group. Four questionnaires were collected from the two groupspre-operative, 6 months and 1 year after start-up. The Wilcoxon signed rank sum test was used to compare the scores of different time points. Rank sum test of two independent samples was used to compare the scores between different groups. Results: None of the patients exhibited CSF leakage or facial paralysis after operation. The average impedance of 8 CCD children in the experimental group was below 5 kΩ. The total extraction rate of auditory neural response telemetry (ART) of all stimulating electrodes was 55% (33/60), and the amplitude of the electricity induced complex action potential (ECAP) of electrodes at different positions ranged from 50.69 to 170.3 μV.The average surgical time of the TSLA group was 46.4 min, shorter than the traditional approach.There was significant difference between the scores of pre-operative, 6 months and 1 year after start-up for the TSLA group(categories of auditory performance,CAP: 2.0 (2.0,3.0) vs. 4.0 (3.8,4.0) , Z=-3.109, P=0.002; speech intelligibility rating,SIR: 2.0 (2.0,2.3) vs. 3.0 (2.8,4.0) , Z=-2.952, P=0.003; meaningful use of speech scale,MUSS: 4.0 (3.3,6.0) vs. 9.0 (6.0,11.8) , Z=-3.421, P=0.001; meaningful auditory integration scale, MAIS or infant-toddler and meaningful auditory integration scale, IT-MAIS: 5.5 (3.8,9.0) vs. 15.5 (10.8,18.5) , Z=-3.522, P=0.000 for the latter two).In addition, The scores of the TSLA group were significantly worse than the control group at 6 months and 1 year after start-up.The high-resolution CT scan showed good adhesion of the electrodes without displacementone week and one year after surgery. Conclusions: For CCD patients, TSLA and customized electrode is recommended due to lower surgical difficulty and post-operative risk, shortened surgical time; Intraoperative ART monitoring can be used to determine the integrity of the auditory pathway. Children with common cavity deformity have a longer period of auditory rehabilitation, and the individual differences in speech rehabilitation are significantly different, which is significantly worse than those with normal structure.

[The advance of materials for preventing adhesion in tympanoplasty]

For otitis media patients with severe mucosal lesions, adhesion is the most common poor prognosis of tympanoplasty. We generally consider tympanic cavity adhesion is due to eustachian tube dysfunction and poor middle ear ventilation. The mechanism of adhesion is unclear so far, which we thought is mainly associated with wounded surface and activation of the fibrinolytic system. To solve the problem of adhesion, several materials have been used in the middle ear surgery, such as plastic sheet, silicone sheet and absorbable material. And there are some benefits. The most widely used is silicone sheet, and there are some researches focused on its thickness, shape and components to achieve better anti-adhesion effect. In this article, we will do a review for the research advances of anti-adhesion materials in tympanoplasty.

[Clinical observation on the effect of glucocorticoid insensitivity on sudden sensorineural hearing loss patients]

Objective: To investigate the correlation between the proliferation inhibition effect of glucocorticoid (GC) on peripheral blood mononuclear cell (PBMC) and the pure tone average (PTA) improvement in SSNHL patients. Methods: Sixty inpatients with SSNHL were included from July 2013 to October 2015 in Nanjing Drum Tower Hospital, Medical School of Nanjing University. Peripheral venous blood was collected before receiving treatment, then the PBMC was isolated for GC proliferation inhibition. PBMCs of each patient were cultivated into 4 groups: Group A: PBMCs+ Medium; Group B: PBMCs+ Medium+ lipopolysaccharide (LPS, 1 μmol/L); Group C: PBMCs+ Medium+ LPS+ Dexamethasone; Group D: Medium. PBMCs were maintained in a humidified 5% CO(2) atmosphere at 37°C and were observed after 24 hours. 5-diphenyltetrazolium bromide (MTT) was used to measure PBMC proliferation inhibition rate. The PBMC proliferation inhibition rates were calculated according to the absorbance at 490 nm wavelength under a microtiter plate reader. Independent sample t tests of PBMC proliferation inhibition rate were performed between different groups. χ(2) tests were performed between gender, affected ear side, accompanied by vertigo or not, audiometric curve, time period from onset to treatment, PBMC proliferation inhibition rate and the improvement of pure tone average (PTA). Linear correlation analyses were performed between PBMC proliferation inhibition rate, the time period from onset to treatment and the hearing improvement. Results: The proliferation inhibition effect of GC on PBMC varied significantly among patients. The PBMC proliferation inhibition rate in GC insensitive group was lower than that in GC sensitive group (26.72%±21.82% vs 64.44%±25.48%, t=6.113, P<0.05). The PBMC proliferation inhibition rate in refractory group was lower than that in initial group (40.93%±28.57% vs 57.04%±31.19%, t=2.035, P=0.046). There was no statistical significance between gender, affected ear side, accompanied by vertigo or not, audiometric curve and the hearing improvement (χ(2) value was 2.320, 0.031, 2.143, 0.106, respectively, all P>0.05). Both in initial group and refractory group, the linear correlation analyses showed a significant positive correlation between PBMC proliferation inhibition rate and the PTA improvement (r value was 0.615, 0.657, respectively, all P<0.05), as well as a significant negative correlation between time period from onset to treatment and the PTA improvement(r value was -0.542, 0.370, respectively, all P<0.05). Conclusions: The proliferation inhibition rate of PBMC in vitro by GC is correlated with patients' hearing improvement. The proliferation inhibition test might be used to predict the sensitivity to GC treatment and be helpful for individualized treatment of SSNHLin clinical practice.

An algorithm of image mosaic based on binary tree and eliminating distortion error

The traditional image mosaic result based on SIFT feature points extraction, to some extent, has distortion errors: the larger the input image set, the greater the spliced panoramic distortion. To achieve the goal of creating a high-quality panorama, a new and improved algorithm based on the A-KAZE feature is proposed in this paper. This includes changing the way reference image are selected and putting forward a method for selecting a reference image based on the binary tree model, which takes the input image set as the leaf node set of a binary tree and uses the bottom-up approach to construct a complete binary tree. The root node image of the binary tree is the ultimate panorama obtained by stitching. Compared with the traditional way, the novel method improves the accuracy of feature points detection and enhances the stitching quality of the panorama. Additionally, the improved method proposes an automatic image straightening model to rectify the panorama, which further improves the panoramic distortion. The experimental results show that the proposed method cannot only enhance the efficiency of image stitching processing, but also reduce the panoramic distortion errors and obtain a better quality panoramic result.

[Application of lower abdominal aorta balloon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa]

Objective: To discuss the feasibility, effect and safety of lower abdominal aorta balloon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa. Methods: The clinical data of 40 patients with pernicious placenta previa complicated with placenta accreta from January 2015 to August 2017 in Liuzhou workers hospital were analyzed retrospectively. The study group included 20 cases, which were operated in the way of cesarean section combined lower abdominal aorta balloon occlusion technique by ultrasound guiding, while the control group also included 20 cases, which were operated in the way of the conventional cesarean section without balloon occlusion technique. The bleeding amount, blood transfusion volume, operative total time, hysterectomy and complications of the two groups were compared. Results: The bleeding amount and blood transfusion volume in study group were(850±100)ml and (400±50)ml, which were lower than that of the control group[(2 500±230)ml and (1 500±100)ml], the difference was statistically significant(t=35.624, 16.523, all P<0.05). In addition, the hysterectomy rate in study group was 5%, which was lower than that in the control group(30%), the difference was statistically significant(χ²=8.672, P<0.05). And the total time of operation was (2.0±0.5)h in the study group, which was shorter than that in the control group[(3.5±0.4)h]. The difference was statistically significant(t=11.362, P<0.05). No postoperative complications took place in the study group.The blood pressure, heart rate and blood oxygen fluctuated significantly, and the postoperative renal function was significantly reduced in the control group. Conclusions: The lower abdominal aorta balloon occlusion technique by ultrasound guiding during a caesarean section in patients with pernicious placenta previa can effectively control the bleeding during operation, and preserve reproductive function to the utmost degree.Therefore, the technique is safe, feasible, convenient and cheaper, and worthy of being widely applied in clinic.

[Clinical significance of continuous transfixion suture for nasal septum in septoplasty]

Objective:To systemically evaluate the clinical significance of continuous transfixion suture for nasal septum in septoplasty. Method:Forty patients with nasal septum deviation were randomly assigned to the suture group including 20 patients who underwent endoscopic septoplasty followed by continuous transfixion suture for nasal septum, or the nasal packing group including 20 patients who underwent endoscopic septoplasty followed by nasal packing. Two groups were compared for the visual analogue scale (VAS) scores for postoperative rhinalgia, headache, lacrimation, dysphagia and sleep disorder, changes in mucociliary transport time (MTT) before and after surgery, and postoperative capillary hemorrhage. Patients were followed up for 2 weeks to observe the short-term postoperative complications. Result:Mean VAS scores for rhinalgia, headache, lacrimation, dysphagia and sleep disorder were all higher in nasal packing group than those in suture group (P<0.05); compared to suture group, there was greater prolongation of MTT before and after surgery in packing group (P<0.05); there was significant difference between two groups in postoperative capillary hemorrhage volume (P<0.05); in the nasal packing group, nasal synechia, nasal dryness and hyposmia were observed in 1, 3 and 2 patients, respectively, within 2 weeks postoperatively, whereas no short-term complications were observed in the suture group. Conclusion:Use of continuous transfixion suture in place of nasal packing following septoplasty can significantly improve the postoperative symptoms, protect nasal mucociliary clearance, and reduce short-term postoperative complications.

[Establishment and characterization of an orthotopic murine model of mucosal malignant melanoma of the maxillary sinus]

Objective:To establish a stable and reliable orthotopic murine model of mucosal malignant melanoma of the maxillary sinus so as to provide animal models for further studying for pathogenesis and therapy of sinonasal malignancy.Method:B16 were implanted in the right maxillary sinus of male nude mice. After tumors appeared in right maxillary sinus, tumor growth and survival rate were recorded. The degree of tumor infiltration was observed through the MRI.Result:Mice with B16 implanted in right maxillary sinus developed primary tumors. The survival and the tumor volume were related to the number of tumor cells implanted. We found that the tumor can invade into nasal cavity, orbital cavity and the basilar region using MRI.Conclusion:We successfully established a model for mucosal malignant melanoma of the maxillary sinus. This model offers an experimental tool for further research on biological characteristics of sinonasal malignancy and the development of new therapy.

[Research progress in therapeutic action of mesenchymal stem cell in allergic rhinitis]

Allergic rhinitis (AR) is an allergic disease of nasal mucosa, currently the consensus has been reached that there is a Th1/Th2 imbalance in AR's pathogenesis, meanwhile there are defects in the number and/or function of Treg cells. Mesenchymal stem cells (MSCs) have characteristics of multiple differentiation potential, low immunogenicity and immunomodulation function, which can be migrated and implanted into the nasal inflammatory mucosal, recovering the Th1/Th2 immune balance and up-regulate the Treg cells by immunomodulatory function to improve AR. For the present, the treatment of AR by MSCs is basically at the animal experiment stage. This paper reviews the progress of MSCs in AR's treatment and provides a basis for the clinical treatment of MSCs.

[Effects of botulinum toxin type A injection for pathological characteristic of calf in rats with spinal cord injure]

Objective: To explore the effect of BoTN-A on pathological characteristics of calf (GM) and motor function of ankle dorsiflexors in SCI model rats. Methods: Thirty-six SD male rats (weight 260-280 g) were randomly allocated into normal control group and 12w-control group, NS-injection group and BT-injection group in this study.NS/BT-injection groups were divided into two subgroups separately (2w-NS, 2w-BT, 8w-NS, 8w-BT). No injection was applied in normal control group or 12w-control group.Saline/BoTN-A was injected in right GM in NS/BT-injection group at two different time points(2w, 8w). GM and Sol on right side of rats would be forwarded for pathologicalexaminations, such as muscle weight, myosin heavy chain (MyHC) electrophoretic analysisat the 12th week. Results: Compared with the other three groups, the muscle weights of GM and Sol in the BT-injection group significantly decreased.MyHC type ratioof GM and Sol on the right side in the BT-injection group also significantlychanged.According to subgroup comparisons, MyHC type ratio of GM and Sol on the injectedside in the 2w-BT subgroup was significant different from that of the 8w-BT subgroup.MyHC type ratios of GM on the non-injected side in the BT injection group also changed more than normal control group.The change of MyHC type ratio of non-injected GM was significantly higher in the 2 week-BT subgroup than that in the 8-week subgroup. Conclusions: BoNT-A intervention resulted in pathological changes not only in the injected GM in SCI rats, but also in non-injected GM and non-injected Sol.The effects of earlier (2 weeks) BoTN-A intervention on pathologic characteristicsof GM and Sol were larger than that of later intervention.

[Preoperative diagnosis and evaluation of cochlear implantation in patients with cochlear nerve deficiency]

Cochlear nerve deficiency (CND) refers to a small or absent cochlear branch of the vestibulocochlear nerve (VCN) or cochlear nerve (CN). Congenitally deaf children with CND who received cochlear implants (CIs) generally exhibit poorer auditory performance than CI children without CND. It is important to confirm the integrity of the auditory pathway before surgery. High-resolution computed tomography (HRCT) and three-dimensional magnetic resonance imaging (3D MRI) are major techniques used to diagnosis CND. In this paper, we reviewed the methods of preoperative evaluation, cochlear nerve embryonic development, techniques for diagnosis and outcomes of cochlear implantation.

Antiviral effect of initial combination therapy with adefovir dipivoxil and lamivudine vs adefovir dipivoxil added to ongoing lamivudine therapy after lamivudine resistance in patients with hepatitis B-related decompensated cirrhosis

AIM

To compare the antiviral effect of initial combination therapy with adefovir dipivoxil (ADV) and lamivudine (LAM) vs ADV added to ongoing LAM therapy after LAM resistance in patients with hepatitis B-related decompensated cirrhosis.

METHODS

Forty patients with hepatitis B e antigen (HBeAg) positive hepatitis B and decompensated cirrhosis were divided into either an observation group or a control group. The observation group underwent initial combination therapy with ADV and LAM, and the control group was given ADV after LAM resistance. The treatment lasted for 48 wk. Liver function, renal function, serum HBV DNA at baseline, 4, 12, 24, and 48 wk during treatment, as well as Child-Pugh score were compared between the two groups.

RESULTS

Alanine transaminase and total bilirubin were significantly improved in both groups after treatment compared with baseline levels (P < 0.05). After 48 wk of treatment, HBV DNA negative seroconversion rates were 90% (18/20) and 40% (8/20) in the observation group and the control group, respectively. HBeAg/anti-HBe serum conversion rates were 60% (12/20) and 20% (4/20). The difference between the two groups was significant (P < 0.05). At the 48^th week, Child-Pugh score was significantly better in the observation group than in the control group (P < 0.05).

CONCLUSION

For hepatitis B cirrhosis patients with decompensated cirrhosis, initial combination therapy with ADV and LAM is significantly better than ADV added to ongoing LAM therapy after LAM resistance.

[The characteristics of CT scan and MRI images of middle ear adenomas]

Objective:To analyze characteristics of CT scan and MRI images of middle ear adenomas,and provide pre-operation diagnosis and differential diagnosis combined with clinical manifestation.Method:Retrospective analysis of 8 cases of middle ear adenomas which were diagnosed and treated with surgery in Beijing Tongren Hospital between 2004 and 2014, patients' complain, clinical manifestation, physical examination, pure tone analysis, CT scan and MRI images were collected.Result:A total of 8 cases were included in this study with 5 females and 3 males. Age of onset ranged from 21 to 51 years old, with an average age of 37.5 years old, and middle age of 37 years old. All patients suffered from single side middle ear adenomas, 5 of left side and 3 of right side. All 8 patients suffered from hearing loss with tinnitus or stuffy feelings, 2 cases with otalgia, 1 with facial nerve paralysis. Physical examination showed 5 cases of bulging of tympanic membrane, 2 cases of out growth of mass into the external ear canal, and 1 with normal tympanic membrane. CT scan of 7 patients showed mass in tympanum and mastoid, with packaged ossicular chain and with no significant bone damage. 2 cases showed out growth of mass into the external ear canal, and 1 case showed limited mass in middle tympanum. MRI images of 5 cases showed equal T1 and T2 signals with intensifying in tympanum. Long T1 or equal T1 and long T2 signal in mastoid showed obstructive inflammation.Conclusion:Characters of middle ear adenomas includes mass in tympanum without bone damage in CT scan, and equal T1 and T2 signal with significant intensifying in tympanum in MRI images. Combined with clinical manifestation, this radiological information may provide benefit for pre-operation diagnosis.

Development and characterization of microsatellite markers for Solen grandis using Illumina sequencing approach

Solen grandis is an important economic and overexploited bivalve species. In order to perform its fine-scale genetic analyses, 105 pairs of microsatellites with polymorphism were identified through Illumina Hiseq platform and bioinformatic assembly technology in this study. The estimated fragment size ranged from 100 to 268 bp and the number of alleles per locus varied between 2 and 23. Observed and expected heterozygosities varied from 0.0667 to 1.0000 and 0.0966 to 0.9492, respectively. Fourteen loci deviated significantly from Hardy-Weinberg equilibrium after Bonferroni correction. These microsatellite markers developed in this study would be helpful for future genetic studies on S. grandis and closely related species.

[Association between the cardiovascular health score and new-onset atrial fibrillation]

OBJECTIVE

To observe the association between the cardiovascular health score and new-onset atrial fibrillation.

METHODS

A total of 95 026 participants who participated the health examination between July 2006 and October 2007 at Kailuan group and without history of atrial fibrillation were selected as the observation cohort. The second, the third and the fourth health examination were performed between July 2008 to October 2009, July 2010 to October 2011, July 2012 to October 2013, respectively.A total of 85 028 participants were included in the final analysis after excluding participants who had new-onset valvular atrial fibrillation and participants lost to follow-up. The participants were divided into 4 subgroups by cardiovascular health score at baseline according to the definition of AHA and cardiovascular health scoring system, namely group of 0-6 points (n=11 103), 7-8 points (n=24 487), 9-10 points (n=32 556), and 11-14 points (n=16 882). The incidence of atrial fibrillation in each subgroup was observed, and the association between cardiovascular health score and risk of new-onset atrial fibrillation was analyzed using multiple Cox regression analysis.

RESULTS

A total of 254 participants developed atrial fibrillation during the median of (5.6±1.4) years follow-up. The total incidence of new-onset atrial fibrillation was 0.53/1 000 person-year. The incidence of atrial fibrillation was 0.69/1 000 person-year, 0.60/1 000 person-year, 0.56/1 000 person-year, and 0.30/1 000 person-year, respectively in 0-6 points, 7-8 points, 9-10 points, and 11-14 points subgroups, respectively(P<0.01). After adjustment of age, gender, education level, income, drink, history of myocardial infarction, history of stroke, serum uric acid and C reactive protein level, multiple Cox regression analysis showed that one health score point increase was related to 8% reduction of new onset atrial fibrillation(HR=0.92, 95%CI 0.86-0.99, P<0.05). Compared with the group of 0-6 points group, the risk of atrial fibrillation in the group of 11-14 points group was reduced by 49% (HR=0.51, 95%CI 0.31-0.83, P<0.01).

CONCLUSION

The risk of new-onset atrial fibrillation is reduced in proportion to increase of cardiovascular health score. Clinical Trail Registry: Chinese Clinical Trail Registry, ChiCTR-TNRC-11001489.

[Impact of combined systolic blood pressure and body mass index on the risk of new-onset atrial fibrillation]

OBJECTIVE

To observe the impact of combined systolic blood pressure and body mass index (BMI) on the risk of new-onset atrial fibrillation.

METHODS

The participants who participated the health examination between July 2006 and October 2007 at Kailuan medical group and had no history of atrial fibrillation were selected as the observation cohort.The second, the third and the fourth health examination were conducted between July 2008 and October 2009, July 2010 and October 2011, July 2012 and October 2013, respectively.The participants were stratified by 3 systolic blood pressure levels (≤120, 120-140, ≥140 mmHg (1 mmHg=0.133 kPa))×3 BMI levels (≤24, 24-28, ≥28 kg/m(2)) at baseline.The combined effect of systolic blood pressure and BMI on the risk of new-onset atrial fibrillation was analyzed by multiple Cox regression analysis.

RESULTS

A total of 99 206 participants were recruited and 88 715 participants were included in the final analysis after excluding participants who had new-onset valvular atrial fibrillation or lost to follow-up.A total of 265 participants developed atrial fibrillation during the 5.6 years follow-up.The incidence of atrial fibrillation increased with the BMI and systolic blood pressure, the incidence of new onset of atrial fibrillation was significantly higher in the group with systolic blood pressure≥140 mmHg and BMI≥28 kg/m(2) than the group with systolic blood pressure≤120 mmHg and BMI≤24 kg/m(2)(1.15/1 000 person-year vs. 0.25/1 000 person-year). Multiple Cox regression analysis showed that participants in the group with systolic blood pressure≥140 mmHg and BMI≥28 kg/m(2) carried 2.08 (95%CI 1.18-3.67) times higher risk for atrial fibrillation than the group with systolic blood pressure≤120 mmHg and BMI≤24 kg/m(2) after adjustment for age, gender and other confounders at baseline.

CONCLUSION

Participants with systolic blood pressure≥140 mmHg and BMI≥28 kg/m(2) are at high risk for new onset of atrial fibrillation.

Primary analysis and screening of microRNAs in gastric cancer side population cells

AIM: To explore the microRNA (miRNA) profiles and to determine the key miRNAs within the side population (SP) cells of the gastric cancer cell line MKN-45.

METHODS: We used fluorescence-activated cell sorting and Hoechst 33342 labeling to obtain SP cells from the human gastric carcinoma cell line MKN-45. The miRNA expression profiles of the SP and major population (MP) cells were examined using a miRNA gene chip, and key miRNAs were obtained according to aberrant expression and the miRNAs’ possible targets as predicted by bioinformatics.

RESULTS: Using a significance criterion of a 1.5-fold or greater difference in expression level, we observed an increase in the expression of 34 miRNAs and a decrease in the expression of 34 miRNAs when comparing SP to MP cells. Using quantitative real-time reverse transcription-polymerase chain reaction to test for differentially expressed miRNAs combined with bioinformatics results, we found that the downregulated miRNAs, such as hsa-miR-3175 and hsa-miR-203, and the upregulated miRNAs, including hsa-miR-130a, hsa-miR-324-5p, hsa-miR-34a, and hsa-miR-25-star, may be important in maintaining and regulating the characteristics of SP cells.

CONCLUSION: There are key miRNAs expressed within the SP cells of the gastric cancer cell line MKN-45, and include hsa-miR-3175, hsa-miR-203, hsa-miR-130a, hsa-miR-324-5p, hsa-miR-34a, and hsa-miR-25-star.

Non-surgical contraindication for acute appendicitis with secondary thrombocytopenia: A case report

A 26-year-old man presented with migrated right lower abdominal pain and without any history of hematological systemic diseases. Blood routine test showed a leukocyte count of 22.74 × 10⁹/L, with 91.4% neutrophils, and a platelet count of 4 × 10⁹/L before admission. The case question was whether the team should proceed with surgery. Obviously, a differential diagnosis is essential before making such a decision. Acute appendicitis was easily diagnosed based on clinical findings, including migrating abdominal pain, a leukocyte count of 22.74 × 10⁹/L and the result of abdominal computed tomography scan. However, it was not clear whether the severe thrombocytopenia was primary or secondary. So smear of peripheral blood and aspiration of bone marrow were ordered to exclude hematological diseases. Neither of the tests indicated obvious pathological hematological changes. There was no hepatosplenomegaly found by ultrasound examination of the liver and spleen. Therefore, operative intervention may be a unique clinical scenario in acute severe appendicitis patients with secondary thrombocytopenia.

Necrotizing fasciitis secondary to enterocutaneous fistula: Three case reports

Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management.

Module function and two-way clustering analysis of Epstein-Barr virus-related nasopharyngeal cancer

This study sought to identify and characterize the function of genes as diagnostic markers for Epstein-Barr virus (EBV)-related nasopharyngeal cancer (NPC). The gene expression profile of GSE13597 was downloaded from the Gene Expression Omnibus database, which included 28 EBV-related NPC gene expression profile data sets, 25 disease samples, and 3 control samples. Data were pre-processed, and differentially expressed genes were screened using the R language. The co-expression coefficient was calculated to construct a co-expression network using Cytoscape. ClusterONE was used to perform module analysis to find enriched gene families. The BiCAT software was used to perform a two-way clustering analysis of differentially expressed gene expression profiles based on the co-expression networks and to verify the enriched gene families, followed by functional enrichment analysis of these gene families. The MCM gene family was found to be enriched in EBV-related NPC. This gene family is essential for eukaryotic DNA replication. Functional analysis of differentially expressed genes in the co-expression network revealed that the enriched biological processes and pathways were mainly involved in the cell cycle. EBV-related NPC is likely associated mainly with the process of cell reproduction, providing a strong basis for the prevention, diagnosis, and treatment of EBV-related NPC and a direction for targeted chemotherapy.

Epithelial-mesenchymal transition in colorectal cancer tissue of patients with Lynch syndrome

AIM: To explore the epithelial-mesenchymal transition (EMT) in tissue from patients with Lynch syndrome, and to interpret biological behaviour of Lynch syndrome.

METHODS: Sixty-eight formalin-fixed and paraffin embedded tissue blocks were analyzed in this study, including tissues from Lynch syndrome (n = 30), sporadic colorectal carcinoma (CRC) (n = 30), and tumor-adjacent tissues (n = 8). Tissue sections were stained for human mutS homolog 2 (hMSH2), human mutL homolog 1 (hMLH1), transforming growth factor-β type II receptor (TGFβRII), E-cadherin, β-catenin, matrix metalloproteinase-7 (MMP-7) and tissue inhibitor of metalloproteinase-2 (TIMP-2) by immunohistochemical staining. Furthermore, clinical data such as age, gender and tumor-node-metastasis stage were also collected retrospectively.

RESULTS: The positive expression rates of hMSH2, hMLH1, TGFβRII, E-cadherin, β-catenin, MMP-7 and TIMP-2 were significantly related to the depth of invasion and lymph node metastasis, but not to sex or tumour size or location. The differences in the positive expression rates of hMSH2, hMLH1, TGFβRII, E-cadherin, cytomembrane β-catenin, cytoplasmic β-catenin, MMP-7 and TIMP-2 were significant between sporadic CRC and Lynch syndrome. The expression of hMSH2 had a positive correlation with that of hMLH1 in Lynch syndrome and sporadic CRC. The expression of TGFβRII had a positive correlation with that of hMSH2, hMLH1 and MMP-7, and a negative correlation with that of TIMP-2. The expression of MMP-7 had a negative correlation with that of TIMP-2 in Lynch syndrome and sporadic CRC. The expression of E-cadherin was positively correlated with that of cytomembrane β-catenin. However, the expression of cytomembrane β-catenin was negatively correlated with that of cytoplasmic β-catenin, and the expression of cytoplasmic β-catenin was positively correlated with that of MMP-7.

CONCLUSION: EMT may play an important role in the development and progression of Lynch syndrome. Lynch syndrome was caused by the mutations of mismatch repair genes, mainly hMSH2 and hMLH1, which also beget the mutational inactivation of TGFβRII. Therefore, the colorectal cancer of Lynch syndrome can escape the inhibitory effect of TGFβ1. However, TGFβ1 can up-regulate the expression of MMP-7 and down-regulate the expression of TIMP-2 in tumors by disassembling the E-cadherin/β-catenin complex in the cytomembrane.

[Comparison of content of total alkaloids and aconitine in Aconitum szechenyianum from different producing areas on basis of macroporous adsorption resin purification technology]

OBJECTIVE

To optimize the conditions of purifying the total alkaloids in Aconitum szechenyianum with macroporous adsorption resin, and compare the content of total alkaloids and aconitine in A. szechenyianum from different producing areas, in order to provide basis for further studies.

METHOD

The orthogonal experiment method was adopted for optimizing the conditions of purifying the total alkaloids in A. szechenyianum with macroporous adsorption resin. The content of total alkaloids and aconitine were determined by using the titration method. The total alkaloids in A. szechenyianum from different producing areas were purified under optimum processing conditions. Aconitine was determined by HPLC.

RESULT

Different processing conditions showed different influences on the purification of total alkaloids. The optimum conditions were resin type HPD-722, ethanol concentration of 80% , and ethanol elution volume of 80 mL x min(-1). The contents of aconitine in A. szechenyianum from different producing areas--Qinghai, Maxianshan, Ningxia and Yongdeng were 0.493 5, 0.883 5, 1.527 8, 1.664 4 mg x g(-1), respectively.

CONCLUSION

The optimum processing conditions used in this essay could be used for purifying the total alkaloids and aconitine. A. szechenyianum from Yongdeng and Gansu contains the highest content of aconitine.

Expression of key members of classical Wnt signal pathway in Peutz-Jeghers syndrome

AIM: To detect the expression of E-cadherin (E-Cad), β-catenin (β-Cat), matrix metalloproteinase-7 (MMP-7), c-Myc and Cyclin D1 proteins in Peutz-Jeghers syndrome (PJS).

METHODS: Immunohistochemistry was used to detect the protein expression of E-Cad, β-Cat, MMP-7, C-Myc and Cyclin D1 in 40 cases of PJS, 20 cases of colorectal cancer and 20 cases of normal colorectal mucosa. The clinical data for the included patients were analyzed retrospectively.

RESULTS: The positive rates of E-Cad and β-Cat expression on the membrane, β-Cat expression in the nucleus, and MMP-7, c-Myc and Cyclin D1 expression differed significantly among the normal mucosa group, PJS group and colorectal cancer group. In the PJS group, the expression of E-Cad and β-Cat on the membrane increased with the increase in patient age or polyp size, and the expression of β-Cat in the nucleus and the expression of MMP-7, c-Myc and Cyclin D1 increased with the increase in polyp size. The expression of E-Cad and β-Cat on the membrane had a negative correlation with that of β-Cat in the nucleus and the expression of MMP-7, c-Myc and Cyclin D1 in PJS.

CONCLUSION: The aberrant activation of classical Wnt pathway and the epithelial- mesenchymal transition mediated by Wnt signalling may play an important role in the tumorigenesis and development of PJS. This may correlate with the crosstalk with the LKB1/mTOR pathway.

Advances in the prevention, diagnosis and treatment of Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disease caused by inactivating germline mutations of the LKB1/STK11 gene and characterized by mucocutaneous pigmentation, multiple gastrointestinal hamartomatous polyps and family history. Life-threatening complications include intestinal obstruction and an increased risk for developing gastrointestinal malignancies and extraintestinal cancers. Surgery and endoscopic therapy are still main ways to manage gastrointestinal polyposis in PJS patients, and double-balloon enteroscopy has important clinical significance in the diagnosis and treatment of this disease. With the development of translational medicine, molecular targeted therapy (e.g., selective COX-2 inhibitors) brings a new approach to preventive treatment of gastrointestinal polyposis in PJS patients. Traditional Chinese medicine provides an alternative choice. In this paper, we review the recent advances in the prevention, diagnosis and treatment of PJS.

Clinical significance of the expression of multidrug resistance gene products in colorectal carcinoma

AIM: To detect the expression of multidrug resistance gene product in colorectal carcinoma (CRC) and analyze their significance in the chemotherapy for CRC.

METHODS: Fifty-six CRC patients who underwent radical surgery from May 2007 to May 2009 at our hospital were randomly selected. Ten healthy subjects who underwent colonoscopy and biopsy were randomly selected as controls. The streptavidin-peroxidase (SP) immunohistochemistry was used to detect the expression of GST-π, P-gp, Topo-II, TS and MRP in CRC tissues and normal mucosal tissues. The clinicopathological data of the patients were analysed retrospectively.

RESULTS: The expression of GST-π, P-gp, Topo-II, TS and MRP proteins showed significant differences between CRC patients and control patients (all P < 0.01 or 0.05). The positive expression rates of GST-π, P-gp, Topo-II, TS and MRP proteins in CRC were 73.2% (41/56), 66.1% (37/56), 48.2% (27/56), 41.1% (23/56) and 37.5% (21/56), respectively. The positive expression rates of these proteins were closely correlated with histological type and degree of differentiation, but not correlated with patient sex, age, tumors site, tumor size, invasive depth and lymph node metastasis.

CONCLUSION: The expression of GST-π, P-gp, Topo-II, TS and MRP proteins in CRC shows obvious heterogeneity. The overexpression of these protein underlies the multidrug resistance in CRC.

Expression of EGFR, HER-2, VEGF in tumour tissues and their directive significance for the molecular targeting therapy of colorectal carcinoma

AIM: To detect the characteristics of epidermal growth factor receptor (EGFR), human epidermal receptor-2 (HER-2) and vascular endothelial growth factor (VEGF) expression in colorectal carcinoma (CRC) tumor tissues, and to analyze their directive significance for the molecular targeting therapy of colorectal carcinoma (CRC).

METHODS: Seventy eight patients with CRC were randomly selected, who underwent radical surgery in the department of general surgery at our hospital from May 2005 to March 2009. The SP Immunohistochemical staining was used to detect EGFR, HER-2 and VEGF protein expression in 78 CRC tumor tissue samples. And their corresponding clinical data were analysed retrospectively.

RESULTS: The expression rates of EGFR, HER-2 and VEGF protein in CRC tumour tissue were 38.5% (30/78), 53.8% (42/78) and 41.0% (32/78). Positive rates of EGFR, HER-2 and VEGF protein were closely relevant to the tumour size, knubbly invasive depth and lymph node metastasis; but not to the patient's sex, age, tumor site or histology grade. There was a stable positive relationship among EGFR, HER-2 and VEGF expression in CRC tumour tissue samples. The related coefficients were 0.421, 0.484 and 0.469 respectively (P = 0.019, 0.012 and 0.016).

CONCLUSION: The present study demonstrates that the EGFR, HER-2 and VEGF expression participate in the development, invasion and metastasis process of CRC. Their joint detection can be looked as an important symbol for judging the prognosis of CRC, screening the high-risk metastasis patients and guiding the molecular targeting therapy of colorectal carcinoma.

Cyclooxgenase-2, β-catenin and matrix metalloproteinase-7 expression and their correlation with invasion/metastasis behaviours of hereditary nonpolyposis colorectal cancer

AIM: To detect cyclooxgenase-2 (COX-2), β-catenin (β-cat) and matrix metalloproteinase-7 (MMP-7) expression in hereditary nonpolyposis colorectal cancer (HNPCC) and sporadic colorectal carcinoma (CRC), and to analyze their relationship with the biological behaviour of HNPCC.

METHODS: The SP Immunohistochemical staining was used to detect COX-2, β-cat and MMP-7 protein expression in sample tissues of 28 HNPCC, 30 sporadic CRC and 10 normal colorectal cancer. All of the specimens were selected beforehand by hMSH2 and hMLH1 Immunohistochemical staining. And their corresponding clinical data were analyzed retrospectively.

RESULTS: The positive expression rates of COX-2, β-cat in cytoplasm and MMP-7 expression differed significantly between HNPCC and sporadic CRC (χ² = 14.8352, P = 0.0001; χ² = 5.6425, P = 0.0175; χ² = 10.6454, P = 0.0011). Positive rates of malposed β-cat and MMP-7 were closely correlated with the neoplastic invasive depth in HNPCC group and sporadic CRC group (P = 0.0127, P = 0.0001; P = 0.0227, P = 0.0261) and lymph node metastasis (P = 0.0000, P = 0.0001; P = 0.0227, P = 0.0261), but not with the sex, the size or position of the tumour. COX-2 expression was bound up with the neoplastic invasive depth (P = 0.0166) in HNPCC group, but not with the lymph node metastasis. However, in sporadic CRC group, COX-2 expression was related with neither neoplastic invasive depth nor lymph node metastasis. There was a stable positive relationship among COX-2, malposed β-cat and MMP-7 expression both in HNPCC and sporadic CRC (COX-2 and malposed β-cat: r = 0.417, P = 0.011, r = 0.504, P = 0.006; malposed β-cat and MMP-7: r = 0.396, P = 0.027, r = 0.429, P = 0.021; COX-2 and MMP-7: r = 0.315, P = 0.028, r = 0.429, P = 0.021).

CONCLUSION: The present study demonstrates that the COX-2, β-cat in cytoplasm and MMP-7 expression has marked difference among HNPCC, sporadic CRC and normal colorectal tissues. This may be an important reason why HNPCC tumors have a less invasive and metastatic potential compared with sporadic variants.

Axillary Metastasis as the First Manifestation of Occult Breast Cancer in a Male Patient

SUMMARY: BACKGROUND: The aim of this study was to investigate the clinicopathologic features of male breast cancer. CASE REPORT: We present the clinicopathologic data of a 72-year-old male patient with occult breast cancer, who was diagnosed and underwent surgery in our hospital. The diagnosis was confirmed by histological examination, and the patient underwent modified radical mastectomy and axillary dissection. The histological examination showed no tumor foci in the resected breast tissue, but 2 of 15 dissected axillary lymph nodes were invaded by infiltrating ductal carcinoma. Immunohistochemistry staining was negative for both estrogen and progesterone receptors, but showed expression of p53 protein (+++), proliferating cell nuclear antigen (PCNA) (+++), Bcl-2 on-coprotein (+++), nm23 protein (++), multidrug resistance protein (MRP) (++), and human epidermal receptor (HER-2) oncoprotein (+++). 24 months after being diagnosed, the patient is alive without any residual or metastatic disease. CONCLUSIONS: Breast cancer is very rare in men, and the occurrence of occult breast cancer is even less common. Axillary metastases can present as the first manifestation of breast cancer in a male.

Axillary metastasis as the first manifestation of male breast cancer: a case report

Background

Breast cancer is very rare in men, and the occurrence of occult breast cancer which present axillary metastasis as the first manifestation is even rarer in men.

Case presentation

We report a 72-year-old male Han-Chinese patient who presented axillary metastasis as the first manifestation of breast cancer and got correctly diagnoses by histological examination. He underwent modified radical mastectomy and axillary dissection on 11 Apr 2006. The histopathologic examination showed that no tumor focus was found in his breast tissue, but two out of fifteen of axillary lymph nodes were invaded by infiltrating ductal carcinoma. The IHC stain showed that estrogen receptor (ER) and progestin receptor (PR) were negative, Human epidermal receptor (HER-2) oncoprotein (+++), P53 protein expressed (+++), Bcl-2 oncoprotein (+++), nm23 protein (++), proliferating cell nuclear antigen (PCNA) (+++) and multidrug-resistance protein (MRP) (++). After operation, he did not receive endocrine therapy, chemotherapy and radiotherapy because of his senility. He is alive without any residual or metastasis disease 29 months after being diagnosed.

Conclusion

This is the first case in our hospital that presents axillary metastases as the first manifestation of male breast cancer.

Sclerosing mesenteritis as a rare cause of abdominal pain and intraabdominal mass: a cases report and review of the literature

Sclerosing mesenteritis is a rare, benign, and chronic fibrosing inflammation disease with unknown etiology that affects the mesentery of small bowel and colon. The disease has two well-established histological types: the acute or subacute form known as mesenteric panniculitis and the chronic form known as retractile or sclerosing mesenteritis. Because the sclerosing mesenteritis is lack of special clinical manifestation and typical signs, so the patients are very easy to be misdiagnosed. The correct diagnosis of sclerosing mesenteritis depends on pathological examination and exploratory laparotomy. We report a case of sclerosing mesenteritis in a 52-year-old male who presented with chronic abdominal pain and intraabdominal mass. This patient had a long-term and heavy drinking history. He was misdiagnosed as celiac teratoma by CT examination and then underwent an exploratory laparotomy at March 2 2004. A mass, its diameter being about 5 cm, was detected in mesentery of distal ileum. Although a few small intestines tightly adhered on the mass, the involved intestine had no obstruction. The intraoperative biopsy indicated that it was an inflammatory mass. The mass and adhered intestines were removed. He was diagnosed with sclerosing mesenteritis by histopathological examination of paraffin section. After operation, this patient went well and lives without recrudescence at the time we wrote this paper.

Diagnosis and treatment of Gardner syndrome with gastric polyposis: A case report and review of the literature

Gardner syndrome (GS) is an autosomal dominant disease characterized by the presence of colonic polyposis, osteoma and soft tissue tumors. It is regarded as a clinical subgroup of familial adenomatous polyposis (FAP) and may present at any age from 2 mo to 70 years with a variety of symptoms, either colonic or extracolonic. We present a case of a 23-year-old female patient with GS who presented with gastric polyposis and was successively treated with restorative proctocolectomy in combination with ileal pouch anal anastomosis (RPC/IPAA), ileostomy, ileostomy closure operation, snare polypectomy during 8 mo. After operation, the patient took oral traditional Chinese medicine pills made of Fructus mume and Bombyx batryticatu for about 6 mo. The innutrition and anaemia of this patient were gradually improved. Gastroscopy showed that the remnant gastric polypi gradually decreased and finally disappeared 19 mo after the first operation. The patient had 2-3 times of solid stool per day at the time we wrote this paper.

Expression of E-cadherin, β-catenin, matrix metalloproteinase-7 and its correlation to invasion/metastasis of hereditary non-polyposis colorectal cancer

AIM: To detect expression of E-cadherin (E-cad), β-catenin (β-cat) and matrix metalloproteinase-7 (MMP-7) in hereditary non-polyposis colorectal cancer (HNPCC) and sporadic colorectal cancer (CRC), and to analyze its relationship to the biological behavior of HNPCC.

METHODS: Protein expression of E-cad, β-cat and MMP-7 in 30 specimens of HNPCC, 30 of sporadic CRC and eight of normal colorectal tissues was detected by SP immunohistochemistry. Their corresponding clinical data were analyzed retrospectively.

RESULTS: The positive expression rates of E-cad and membrane β-cat in HNPCC patients were higher than those in sporadic CRC (E-cad, 86.7% vs 60.0%; membrane β-cat, 83.3% vs 50.0%, all P < 0.05). The positive expression rates of cytoplasm β-cat and MMP-7 in HNPCC patients were lower than those in sporadic CRC patients (cytoplasm β-cat, 46.7% vs 80.0%; MMP-7, 46.7% vs 86.7%; both P > 0.05). Positive rates of E-cad, β-cat and MMP-7 in the two groups were significantly related to depth of invasion and lymph node metastasis (r = 0.732, P < 0.05), but not to sex or the size or position of the tumor. Protein expression of E-cad was positively correlated with expression of membrane β-cat (r = 0.477, P < 0.05), however, expression of membrane β-cat was negatively correlated with expression of cytoplasmic β-cat (r = -0.419, P < 0.05), while expression of cytoplasm β-cat was positively correlated with expression of MMP-7 (r = 0.380, P < 0.05).

CONCLUSION: There are remarkable differences in expressions of E-cad, β-cat and MMP-7 between HNPCC and sporadic CRC. This could be the reason that HNPCC tumors are less invasive and have less metastatic potential compared to sporadic cancers.

Expression of hMSH2, hMLH1, transforming growth factor β receptor type Ⅱ, matrix metalloproteinase-7, tissue inhibitor of metalloproteinase-2 and their correlations with the biological behaviors of hereditary nonpolyposis colorectal cancer

AIM: To investigate the correlation of hMSH2, hMLH1, transforming growth factor β receptor type Ⅱ (TβRⅡ), matrix metalloproteinase-7 (MMP-7) and tissue inhibitor of metalloprotei-nase-2 (TIMP-2) expression with the biological behaviours of human hereditary nonpolyposis colorectal cancer (HNPCC).

METHODS: Immunohistochemical staining was used to detect the expression of hMSH2, hMLH1, TβRⅡ, MMP-7 and TIMP-2 protein in 30 cases of sporadic colorectal cancer (SCRC), 30 cases of HNPCC and 8 cases of normal colorectal mucosa, and their corresponding clinical datas were studied retrospectively.

RESULTS: The positive rates of hMSH2, hMLH1, TβRⅡ, MMP-7 and TIMP-2 expression were significantly related to the depth of invasion and lymph node metastasis, but not to the sex of patients and the size or position of tumors. The positive rates of hMSH2, hMLH1, TβRⅡ, MMP-7 and TIMP-2 expression were remarkably different between SCRC and HNPCC (P < 0.05). The expression of hMSH2 had a positive correlation with hMLH1 (r = 0.835, P < 0.01); The expression of TβRⅡ had positive correlations with hMSH2 (r = 0.592, P < 0.01), hMLH1 (r = 0.472, P < 0.01) and MMP-7 (r = 0.735, P < 0.01), while the expression of MMP-7 had negative correlations with TβRⅡ(r = -0.582, P < 0.01), TIMP-2 (r = -0.421, P < 0.01) in HNPCC.

CONCLUSION: The mutations of hMSH2 and hMLH1 beget the inactivation of TβRⅡ in HNPCC, which induces down-regulated expression of MMP-7 and up-regulated expression of TIMP-2. This might be one reason for the special biological behaviours of HNPCC.

Expression of transforming growth factor β receptor Type Ⅱ, matrix metalloproteinase-7 and tissue inhibitor of metalloproteinase-2 and their roles in the invasion and metastasis of hereditary nonpolyposis colorectal cancer

AIM: To investigate the roles of transforming growth factor β receptor Type Ⅱ (TβRⅡ), matrix metalloproteinase-7 (MMP-7) and tissue inhibitor of metalloproteinase-2 (TIMP-2) expression in the invasion and metastasis of human hereditary nonpolyposis colorectal cancer (HNPCC).

METHODS: Immunohistochemical staining was used to detect the expressions of TβRⅡ, MMP-7 and TIMP-2 protein in 30 cases of sporadic colorectal cancer (sporadic CRC) and 30 cases of HNPCC, and their corresponding clinical data were analyzed retrospectively.

RESULTS: The positive rates of TβRⅡ, MMP-7 and TIMP-2 expression in HNPCC were 40.0%, 46.7% and 63.3% respectively, while in sporadic CRC, the rates were 73.3%, 86.7% and 20.0% respectively. The ratio of MMP-7(+~++) to TIMP-2(-) in sporadic CRC was higher while that of MMP-7(-) to TIMP-2(+~++) was lower significantly than that in HNPCC. TβRⅡ, MMP-7 and TIMP-2 expression were closely related to the depth of invasion and lymph node metastasis, but not to the sex of patients, tumor size and position. The positive rate of MMP-7 expression was significantly increased in tissues with extra-chorion invasion and metastasis, but the expression of TβRⅡ and TIMP-2 were markedly decreased (P < 0.05). In HNPCC and sporadic CRC, positive correlation was found between TβRⅡ and MMP-7 expression (r = 0.735, P = 0.000; r = 0.792, P = 0.000), while negative correlation existed between TIMP-2 and TβRⅡ expression (r = -0.582, P = 0.001; r = -0.394, P = 0.031) as well as between TIMP-2 and MMP-7 expression (r = -0.473, P = 0.008; r = -0.388, P = 0.034).

CONCLUSION: TβRⅡ, MMP-7 and TIMP-2 are differently expressed in HNPCC and sporadic CRC. The expression rates and intensities of TβRⅡ and MMP-7 are obviously higher in sporadic CRC than those in HNPCC, while the positive expression of TIMP-2 was a reverse situation. So the imbalance of MMP-7/TIMP-2 is increased in sporadic CRC. Down-regulated expression of MMP-7, TβRⅡ and up-regulated expression of TIMP-2 may play important roles in the invasion and metastasis of HNPCC.

Expression of E-cadherin, β-catenin, matrix metalloproteinase-7 and their significances in colorectal carcinoma

AIM: To detect expression of E-cadherin, β-catenin and matrix metalloproteinase-7 (MMP-7) as well as their correlations in colorectal carcinoma (CRC).

METHODS: Immunohistochemistry was used to detect the expression of E-cadherin, β-catenin and MMP-7 protein in 60 specimens of CRC and 8 specimens of normal colorectal tissues. The corresponding clinical data were analyzed retrospectively.

RESULTS: The positive rates of E-cadherin, normal β-catenin, abnormal β-catenin and MMP-7 expression in CRC were 73.3%, 66.7%, 63.3% and 73.3%, respectively, which were significantly correlated with the depth of invasion and lymph node metastasis, but not with the age, sex and tumor size or position and differentiation of the patients’. The normal expression of β-catenin was positively correlated with E-cadherin expression (r = 0.359, P = 0.005) in CRC, but negatively correlated with the abnormal expression of β-catenin (r = -0.324, P = 0.012). There existed positive correlation between the expression of MMP-7 and the abnormal expression of β-catenin (r = 0.487, P = 0.000).

CONCLUSION: The expression of E-cadherin, β-catenin and MMP-7 are closely correlated with the invasion/metastasis and prognosis of CRC, and they may serve as effective markers in the judgement CRC prognosis.

Immunohistochemical expression of carcinoembryonic antigen, P53, nm23, Ki-67, multidrug resistance-associated protein and their correlations with the clinicopathology in colorectal carcinoma

AIM: To investigate the mechanism of cyclooxygenase-2 (COX-2), basic fibroblast growth factor (bFGF) in the carcinogenesis of colorectal carcinoma and adenoma.

METHODS: The expression of CEA, P53, nm23, Ki-67 and MRP protein were detected by SP immunohistochemistry in colorectal carcinoma (n = 73) admitted from January 2003 to July 2006, and their clinical data and follow-up documents were analyzed retrospectively.

RESULTS: The positive rates of CEA, P53, nm23, Ki-67 and MRP protein expression in colorectal cancer were 82.2%, 68.5%, 75.3%, 84.9% and 64.4%, respectively. CEA and MRP expression had no correlations with the patients'ages, sex, tumor size or location and differentiation types of tumor, depth of invasion and lymph node metastasis, while P53, Ki-67 and nm23 expression were significantly correlated with the depth of invasion and lymph node metastasis. The positive rates of P53 and Ki-67 expression was significantly higher in Dukes C, D stages than those in Dukes A, B stages (82.8% vs 59.1%, P < 0.05; 100% vs 75.0%, P < 0.05), while the positive rate of nm23 expression was markedly lower (58.6% vs 86.4%, P < 0.05). The expression of CEA had a negative correlations with that of nm23 (r = -0.296, P = 0.011) in colorectal carcinoma. However, the expression of P53 had a positive correlations with that of Ki-67 (r = 0.308, P = 0.008). P53, Ki-67 and nm23 expression were significantly related to the prognosis. The positive rate of nm23 expression was notably higher in patients survived over or equal to 3 years than that in ones survived less than 3 years (92.9% vs 71.2%, P < 0.05), but the positive rates of P53 and Ki-67 expression were just in the opposite situation (42.9% vs 74.6%, P < 0.05; 64.3% vs 89.8%, P < 0.05).

CONCLUSION: P53, Ki-67 and nm23 were significantly correlated with the invasion, metastasis and prognosis of colorectal carcinoma. CEA may be a stimulative factor in the invasion and metastasis of colorectal cancer and MRP-induced drug resistance may be relatively independent. CEA, P53, nm23 and Ki-67 can serve as effective markers ini reflecting the invasion, metastasis and prognosis of colorectal carcinoma.

Histopathological and immunohistochemical features of gastrointestinal stromal tumors

AIM: To explore the histopathological and immunohistochemical features of gastrointesti-nal stromal tumors (GIST).

METHODS: Immunohistochemistry was performed in GIST, for a panel of antibodies such as CD117, CD34, Vim, SMA, S-100 by SP staining methods. Clinical data and follow-up documents of 24 patients with GIST admitted from January 2000 to May 2006 were studied retrospectively.

RESULTS: There were 24 patients (males and 8 females) aged from 29 to 75 (mean 54.5 ± 13.5). The tumors were mainly located at the stomach, small bowel and rectum. The initial presentations were bellyache (33.3%), abdomen mass (25.0%) and gastrointestinal bleeding (20.8%) in the most cases. All patients received successful surgical resection of tumor and the total resection rate was 100%. The rate of recurrence and metastasis was 14.3% (3/21) after operation. The most cases were diagnosed after surgical resection. Tumor size varied from 2 to 16 cm (mean 6.6 cm). The cells were spindle-like, and the epithelioid cells were rare. The mitotic count was higher than 5/50HPF in 5 cases, in which the tumor sizes were over or equal to 5 cm in diameter, and cystification, hemorrhage or necrosis was observed in 4 cases. The mitotic count was 2-5/50HPF in 4 cases, in which the tumor sizes were 3-5 cm in diameter. Immunohistochemically, CD117, CD34 and Vim showed diffuse and strong expression, and the positive rates were 91.7%, 62.5% and 66.7%, respectively. S-100 was hardly present, and SMA was focally present or absent.

CONCLUSION: GIST predominantly occurs in the middle aged or old patients without specific manifestations, so early diagnosis is fairly difficult. Surgery remains the standard treatment for non-metastasis patients with GIST. The tumor cells have various kinds of types and different arrangements. Immunohistochemical staining is positive for CD117, CD34 and Vim, negative for S-100, and focal positive for SMA.

Multiple primary colorectal carcinomas: an analysis of 42 cases

AIM: To conclude the clinical characteristics of multiple primary colorectal carcinoma (MPCC).

METHODS: The clinical data of 42 patients with MPCC out of 1354 primary colorectal cancer cases, who were treated in our hospital from 1980 to 2005, were retrospectively analyzed.

RESULTS: The percentage of patients with MPCC was 3.10% (synchronous: 0.96%; metachronous: 2.14%). Of the 42 cases, 20 (1.48%) were accompanied by carcinoma of other organs. Adenocarcinoma was the most common cancer, locating at the right colon (46.3%) and rectum (31.3%). The tumors of other organs were mainly located at stomach, small intestine, breast, ovary and uterus. The data of 12 cases (12/42, 28.6%) were in accordance with Amsterdam criteria Ⅱ for hereditary nonpolyposis colorectal cancer (HNPCC), and the data of 16 cases (16/42, 37.2%) were in accordance with the Chinese criteria for HNPCC. Colon fiberscopy was helpful in the diagnosis of MPC.

CONCLUSION: MPCC, with a high incidence rate, has particular epidemic, clinical and pathological characteristics. Colon fiberscopy is important in the diagnosis of MPC, and postoperative following up should be strengthened for the diagnosis of HNPCC.

Nicorandil inhibits the release of TNFα from a lymphocyte cell line and peripheral blood lymphocytes

Modulation of cytokine release may be of interest in modulating inflammatory diseases. This study determined whether nicorandil, a potassium channel opener, and nitric oxide (NO) donor could inhibit the release of tumour necrosis factor alpha (TNFalpha) from lymphocytes. Nicorandil significantly and dose-dependently inhibited the TNFalpha release from a human Epstein Barr virus-transformed B lymphocyte cell line (EBV-B) and peripheral blood B and T lymphocytes. The inhibition was reversed by the addition of both potassium channel inhibitor glibenclamide and the guanylyl cyclase inhibitor 1H-(1,2,4) oxadiazolo (4,3) quinoxalin-1-one (ODQ). Other potassium channel openers, pinacidil, or the nicorandil analogue SG-209, however, failed to demonstrate inhibition of TNFalpha release. The NO scavenger haemoglobin was unable to reverse the nicorandil-induced TNFalpha inhibition, but in contrast to this, sodium nitroprusside (SNP) partially inhibited the release, which was reversed by haemoglobin. Nicorandil is able to inhibit TNFalpha release from lymphocytes, which requires the dual modes of both potassium channel opening and the nitrate moiety. Moreover, NO donation mechanism appears to be more dominant in the nicorandil inhibitory activity in lymphocytes.The dual mechanism involved in the inhibition of this cytokines may represent a novel therapeutical approach in the modulation of inflammatory disease.