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Objective: To investigate the influence of extending the waiting time on tumor regression after neoadjuvant chemoradiology (nCRT) in patients with locally advanced rectal cancer (LARC). Methods: Clinicopathological data from 728 LARC patients who completed nCRT treatment at the First Affiliated Hospital, Naval Medical University from January 2012 to December 2021 were collected for retrospective analysis. The primary research endpoint was the sustained complete response (SCR). There were 498 males and 230 females, with an age (M(IQR)) of 58 (15) years (range: 22 to 89 years). Logistic regression models were used to explore whether waiting time was an independent factor affecting SCR. Curve fitting was used to represent the relationship between the cumulative occurrence rate of SCR and the waiting time. The patients were divided into a conventional waiting time group (4 to <12 weeks, n=581) and an extended waiting time group (12 to<20 weeks, n=147). Comparisons regarding tumor regression, organ preservation, and surgical conditions between the two groups were made using the t test, Wilcoxon rank sum test, or χ2 test as appropriate. The Log-rank test was used to elucidate the survival discrepancies between the two groups. Results: The SCR rate of all patients was 21.6% (157/728). The waiting time was an independent influencing factor for SCR, with each additional day corresponding to an OR value of 1.010 (95%CI: 1.001 to 1.020, P=0.031). The cumulative rate of SCR occurrence gradually increased with the extension of waiting time, with the fastest increase between the 9th to <10th week. The SCR rate in the extended waiting time group was higher (27.9%(41/147) vs. 20.0%(116/581), χ2=3.901, P=0.048), and the organ preservation rate during the follow-up period was higher (21.1%(31/147) vs. 10.7%(62/581), χ2=10.510, P=0.001). The 3-year local recurrence/regrowth-free survival rates were 94.0% and 91.1%, the 3-year disease-free survival rates were 76.6% and 75.4%, and the 3-year overall survival rates were 95.6% and 92.2% for the conventional and extended waiting time groups, respectively, with no statistical differences in local recurrence/regrowth-free survival, disease-free survival and overall survival between the two groups (χ2=1.878, P=0.171; χ2=0.078, P=0.780; χ2=1.265, P=0.261). Conclusions: An extended waiting time is conducive to tumor regression, and extending the waiting time to 12 to <20 weeks after nCRT can improve the SCR rate and organ preservation rate, without increasing the difficulty of surgery or altering the oncological outcomes of patients.
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Objective:To explore the value of MRI high-resolution T2WI based-radiomics in predicting pathologic complete response (pCR) after neoadjuvant therapy for rectal cancer.Methods:This retrospective study included 80 patients with rectal cancer confirmed by postoperative pathology, who underwent high-resolution imaging of rectal MRI before neoadjuvant therapy from January 2018 to March 2019 in our hospital. After manually delineating the volume of interest (VOI) of the lesion in the high-resolution T2WI image, the radiomics features were extracted, and the least absolute shrinkage and selection operator (LASSO) algorithm was adopted to reduce the dimension and select the features that were valuable for tumor pCR. Using Random algorithm, the data were randomly divided into training set ( n=64) and test set ( n=16) for machine learning, and 4 kinds of machine learning models including decision tree (DT), logistic regression (LR), random forests (RF) and extreme gradient boosting (XGBoost) were established and ROC curves were drawn. The area under the curve (AUC), sensitivity, specificity and 95% CI were respectively calculated, and the difference of ROC curves was compared with DeLong test. Results:Among 80 patients with rectal cancer, there were 15 cases by pCR, accounting for 18.75%, and 65 cases were non-pCR, accounting for 81.25%. A total of 1 409 imaging features were extracted. After dimension reduction by LASSO algorithm, 8 most valuable features were selected. The AUC of DT, LR, RF and XGBoost in the test set group was 0.870, 0.801, 0.912, 0.945, the AUC of XGBoost was the largest, and the differences between XGBoost and DT, LR, RF were statistically significant ( P=0.008; P=0.006; P=0.009), and the pairwise comparisons of DT, LR, RF showed no statistically significant difference ( PLR-RF=0.083; PDT-LR=0.113; PDT-RF=0.879). The sensitivity was 78.57%, 64.29%, 78.57%, 85.71%, and the specificity was 95.38%, 84.62%, 92.31%, 98.46% respectively. The 95% CI was 0.775-0.935, 0.696-0.882, 0.827-0.964, 0.870-0.984. Conclusion:The radiomics based on high-resolution T2WI images has predictive value for pCR after neoadjuvant treatment of rectal cancer. XGBoost model has better predictive efficiency than DT, LR and RF, and can be used to guide clinical individualized treatment and related interventions.
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BACKGROUND@#Insomnia is a common complaint that is closely related to gastrointestinal symptoms, which is consistent with the traditional Chinese medicine classical theory of "stomach disharmony leading to restless sleep." Acupuncture is an effective complementary and alternative medicine therapy to improve gastrointestinal function and restore the normal sleep-wake cycle. However, studies on the effectiveness of acupuncture for insomnia due to spleen-stomach disharmony syndrome are limited to case reports and few randomized controlled trials; deeper research on its mechanism is still lacking. This randomized controlled trial aims to assess the treatment efficacy of "harmonizing stomach to tranquilize mind" acupuncture for insomnia and its influence on the intestinal microbiome.@*METHODS/DESIGN@#This is a randomized, single-blind, parallel-group study. Sixty eligible patients with insomnia due to spleen-stomach disharmony syndrome will be randomly divided into two groups (1:1 allocation ratio). The intervention group will use "harmonizing stomach to tranquilize mind" acupuncture, and the control group will receive sham acupuncture. Participants will receive 5 acupuncture treatment sessions per week for 4 consecutive weeks. The Pittsburgh Sleep Quality Index will be used to evaluate the clinical efficacy of acupuncture treatment by making assessments at baseline, the end of treatment and the end of the follow-up. High-throughput 16S ribosomal ribonucleic acid gene sequencing will be performed to detect changes in the intestinal microbial composition before and after treatment.@*DISCUSSION@#The results of this trial are expected to confirm that "harmonizing stomach to tranquilize mind" acupuncture can effectively relieve insomnia and alter the intestinal microbiome.@*TRIAL REGISTRATION@#Chinese Clinical Trials Registry: ChiCTR1800017092.
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Objective@#To compare the evaluation effects of abdominal enhanced computed tomography (CT) coronal imaging versus three-dimensional (3D) vascular reconstruction for critical blood vessels in right colon cancer.@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients with right colon cancer who were admitted to Changhai Hospital Affiliated to Naval Medical University from January to September in 2018 were collected. There were 33 males and 17 females, aged from 33 to 86 years, with an average age of 63 years. All the 50 patients underwent abdominal multi-slice CT examination on the same CT equipment. The CT examination data were analyzed by two-dimensional (2D) coronal imaging and 3D vascular reconstruction. Observation indicators: (1) anatomical type of Henle trunk; (2) the length of Henle trunk and surgical trunk; (3) the positional relationship between ileocolic vein (ICV) and ileocolic artery (ICA). Measurement data with normal distribution were represented as Mean±SD, and count data were represented as absolute numbers. Kappa coefficients were used to measure the consistency between anatomical types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images. Pearson coefficients were used to evaluate the correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images. Bland-Altman method was used to assess the consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.@*Results@#(1) Anatomical type of Henle trunk: on the 2D coronal images, 43 of 50 patients had the Henle trunk and 7 had no Henle trunk. On the 3D vascular reconstructed images, 44 of 50 patients had the Henle trunk and 6 had no Henle trunk. There were 2, 21, 17, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 2D coronal images of 43 patients. There were 6, 19, 16, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 3D vascular reconstructed images of 44 patients. Six patients with no Henle trunk, 2 in type 0, 18 in type Ⅰ, 15 in type Ⅱ, and 3 in type Ⅲ had the same anatomical type of Henle trunk on the 2D and 3D images. The consistency between anatomic types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images was high (κ=0.830, 95% confidence interval: 0.705-0.956, P<0.05). (2) The length of Henle trunk and surgical trunk: on the 2D coronal images, 43 of 50 patients had the length of Henle trunk as (10±5)mm, and 42 of 50 patients had the length of surgical trunk as (34±12)mm. On the 3D vascular reconstructed images, 44 of 50 patients had the length of Henle trunk as (9±5)mm, and 43 of 50 patients had the length of surgical truck as (35±12)mm. The correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images was positive (r=0.872, 0.979, P<0.05). Bland-Altman plot showed a high consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images (P<0.05). (3) The positional relationship between ICV and ICA: on the 2D coronal images, 24 of 50 patients had anterior crossing between ICV and ICA, 26 had posterior crossing between ICV and ICA. On the 3D vascular reconstructed images, 24 of 50 patients had anterior crossing between ICV and ICA, 26 had posterior crossing between ICV and ICA. There was a complete consistency in the positional relationship between ICV and ICA on the 2D coronal images and on 3D vascular reconstructed images.@*Conclusion@#Abdominal enhanced CT coronal imaging and 3D vascular reconstruction have the similar evaluation effects for position of critical blood vessels in right colon cancer, with a good consistency.
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Objective To compare the evaluation effects of abdominal enhanced computed tomography (CT) coronal imaging versus three-dimensional (3D) vascular reconstruction for critical blood vessels in right colon cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 50 patients with right colon cancer who were admitted to Changhai Hospital Affiliated to Naval Medical University from January to September in 2018 were collected.There were 33 males and 17 females,aged from 33 to 86 years,with an average age of 63 years.All the 50 patients underwent abdominal multi-slice CT examination on the same CT equipment.The CT examination data were analyzed by two-dimensional (2D) coronal imaging and 3D vascular reconstruction.Observation indicators:(1) anatomical type of Henle trunk;(2) the length of Henle trunk and surgical trunk;(3) the positional relationship between ileocolic vein (ICV) and ileocolic artery (ICA).Measurement data with normal distribution were represented as Mean±SD,and count data were represented as absolute numbers.Kappa coefficients were used to measure the consistency between anatomical types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images.Pearson coefficients were used to evaluate the correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.Bland-Ahman method was used to assess the consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.Results (1) Anatomical type of Henle trunk:on the 2D coronal images,43 of 50 patients had the Henle trunk and 7 had no Henle trunk.On the 3D vascular reconstructed images,44 of 50 patients had the Henle trunk and 6 had no Henle trunk.There were 2,21,17,3 patients classified as type 0,Ⅰ,Ⅱ,Ⅲ of Henle trunk on the 2D coronal images of 43 patients.There were 6,19,16,3 patients classified as type 0,Ⅰ,Ⅱ,Ⅲ of Henle trunk on the 3D vascular reconstructed images of 44 patients.Six patients with no Henle trunk,2 in type 0,18 in type Ⅰ,15 in type Ⅱ,and 3 in type Ⅲ had the same anatomical type of Henle trunk on the 2D and 3D images.The consistency between anatomic types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images was high (κ =0.830,95％ confidence interval:0.705-0.956,P＜0.05).(2) The length of Henle trunk and surgical trunk:on the 2D coronal images,43 of 50 patients had the length of Henle trunk as (10±5)mm,and 42 of 50 patients had the length of surgical trunk as (34± 12)mm.On the 3D vascular reconstructed images,44 of 50 patients had the length of Henle trunk as (9±5)mm,and 43 of 50 patients had the length of surgical truck as (35± 12)mm.The correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images was positive (r=0.872,0.979,P＜0.05).Bland-Altman plot showed a high consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images (P＜0.05).(3) The positional relationship between ICV and ICA:on the 2D coronal images,24 of 50 patients had anterior crossing between ICV and ICA,26 had posterior crossing between ICV and ICA.On the 3D vascular reconstructed images,24 of 50 patients had anterior crossing between ICV and ICA,26 had posterior crossing between ICV and ICA.There was a complete consistency in the positional relationship between ICV and ICA on the 2D coronal images and on 3D vascular reconstructed images.Conclusion Abdominal enhanced CT coronal imaging and 3D vascular reconstruction have the similar evaluation effects for position of critical blood vessels in right colon cancer,with a good consistency.
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Hilar cholangiocarcinoma (HCCA) or Klatskin tumor is a scirrhous adenocarcinoma that arises from the conjunction of bile duct and hepatic ducts.Hepatic magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) are important methods for the diagnosis of HCCA.In this article,the clinical data of 42 patients in the Changhai Hospital and 18 patients in the Eastern Hepatobiliary Surgery Hospital who received MRI and MRCP examination from October 2010 to October 2012 were retrospectively analyzed.According to the pathological features,HCCA could be divided into mass-forming type,infiltrating type and intraductal type.Based on the results of imaging examination and intra-and postoperative pathological examination,Bismuth-Corlette types were decided pre-and postoperatively.The coincidence rate of pre-and postoperative Bismuth-Corlette types was 89.7％ (35/39).Infiltration of liver parenchyma was both detected pre-and postoperatively in 19 patients (16 patients were detected by MRI preoperatively),and the sensitivity of MRI was 84.2％ ; vascular invasion was both detected pre-and postoperatively in 10 patients (12 patients were detected by MRI preoperatively),and the sensitivity of MRI was 83.3％ ; hilar and retroperitoneal lymph node metastasis was both detected pre-and postoperatively in 6 patients (4 patients were detected by MRI preoperatively),and the sensitivity of MRI was 66.7％.Combined application of different sequences and techniques of MRI is helpful in the diagnosis,staging and treatment of HCCA.
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Objective To identify the epidemic characteristics and risk factors of an emerging infectious disease-severe fever with thrombocytopenia syndrome (SFTS) in Hubei province.Methods Active surveillance program on SFTS was set up in monitoring sites-hospitals,at the township level or above,in Suizhou,Huanggang and Wuhan from January to December,2010.Specific surveillance program on SFTS was launched across the province in hospitals above the county level.Cases that matched the definition of surveillance case were identified and reported to Centers for Disease Control and Prevention (CDCs).Cases were interviewed and their blood samples collected and detected using PCR and virus isolation.We also conducted serum antibody surveys among healthy population and livestock and surveillance on vector ticks in those high-epidemic areas.Results 188 cases that matched the definition of surveillance case and 21 deaths were reported in 11 cities,32 countries and 100 towns in 2010,with an incidence rate of 0.33/106.The fatality rate was 11.2％.Data showed that the patients were from hilly areas at the altitude elevated between 28-940 meters.The epidemic period was between April and December with the peak from May to September.The youngest case was an 11-year old,while the eldest was 81 with median age as 56-year old.95.3 ％ of the patients were farmers.All Patients did not have the history of traveling,two weeks before the onset of SFTS.93.6％ of the patients engaged in different kind of work which was associated with agriculture.52.8％ of the patients had been exposed to ticks.22.0％ of the patients had been bitten by ticks.Skin injury was found in 64.2％ of the patients.Samples from 129 cases (68.6％) were collected and detected,with 67.4％ of them (87 cases) showed positive by Real time-PCR for SFTS virus.An elevation in antibody titer by a factor of four or evidence of sero-conversion was observed in 11 patients; SFTS virus was isolated from 2 patients.The total antibody positive rates were 3.8％,55.0％ (6/11 ),36.7％ (2/3) and 80.0％ (4/5) respectively in healthy population,dogs,sheep and cows.Ticks from grass,cattle and sheep were detected positive by Real time-PCR.Conclusion Most cases of SFTS in Hubei were infected by SFTS virus,and cases of livestock were infected by SFTS virus.Ticks might serve as an important vector.Skin injury,exposure to tick bites seemed to be the risk factors.
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<p><b>OBJECTIVE</b>To study the therapeutic effects of combined anterior-posterior (small incision or micro-incision) approach for complex tibial plateau and posterior condylar fractures.</p><p><b>METHODS</b>From 2000 to 2008, 79 patients (81 limbs) with complex tibial plateau and posterior condylar fractures were reviewed. There were 45 males and 34 females, ranging in age from 19 to 66 years, with an average of 40.6 years. Thirty-nine limbs were treated using small incision through combined anterior-posterior approach, in which 13 limbs were Schatzker type IV, 15 limbs were type V ,and 11 limbs were type VI. Other 42 limbs were treated using micro-incision through combined anterior-posterior approach, in which 18 limbs were Schatzker type IV, 16 limbs were type V, and 8 limbs were type VI. The Rasmussen scores for knee joint and radio scores were used to evaluate therapeutic effects after the treatment. The complications such as cutaneous necrosis and incision infection were observed.</p><p><b>RESULTS</b>All the patients were followed up. According to Rasmussen criterion, in small incision group, 16 limbs got an excellent result, 13 good, 7 fair and 3 bad; in micro-incision group,above data were 19, 11, 8 and 4 respectively. Comparison between the two groups, P = 0.924. Comparison of complications such as cutaneous necrosis and incision infection: in small incision group,10 limbs had the complications, and in micro-incision group were 4 limbs; the occurrence rate of small incision group were higher than that of micro-incision group (P = 0.047).</p><p><b>CONCLUSION</b>There are no significant differences between the two groups in the knee joint function rehabilitation; however, there is smaller rate for cutaneous necrosis and incision infection in micro-incision group.</p>
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Tornozelo , Cirurgia Geral , Estudos de Casos e Controles , Fixação de Fratura , Métodos , Articulação do Joelho , Complicações Pós-Operatórias , Epidemiologia , Estudos Retrospectivos , Fraturas da Tíbia , Cirurgia GeralRESUMO
<p><b>BACKGROUND AND OBJECTIVE</b>It has been proven that Ezrin protein may interact with E-cadherin protein and take part in metastasis of tumor cells. This study was to investigate the expressions of Ezrin and E-cadherin in esophageal squamous cell carcinoma (ESCC) and their relationship with the clinicopathologic factors, and analyze their diagnostic values for ESCC.</p><p><b>METHODS</b>The expression of Ezrin and E-cadherin in 72 specimen of ESCC and the paracancer normal squamous epithelium was detected using tissue array with SP immunohistochemistry. Their correlations to the clinicopathologic factors were analyzed statistically.</p><p><b>RESULTS</b>The positive rate of Ezrin was significantly higher in ESCC than in para-cancer normal squamous epithelium (90.7% vs. 46.0%, P < 0.001); the positive rate of E-cadherin was significantly lower in ESCC than in para-cancer normal squamous epithelium (27.6% vs. 97.4%, P < 0.001). Ezrin expression was related to the invasiveness and lymph node metastasis of ESCC (P < 0.05); E-cadherin expression was related to the differentiation and lymph node metastasis of ESCC (P < 0.05). The high expression of Ezrin was related to the low expression of E-cadherin (P < 0.05).</p><p><b>CONCLUSION</b>The activation of Ezrin and the absence of E-cadherin contribute to the tumorigenesis and metastasis of ESCC.</p>
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Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Caderinas , Metabolismo , Carcinoma de Células Escamosas , Metabolismo , Patologia , Diferenciação Celular , Proteínas do Citoesqueleto , Metabolismo , Neoplasias Esofágicas , Metabolismo , Patologia , Metástase Linfática , Invasividade NeoplásicaRESUMO
<p><b>OBJECTIVE</b>To evaluate the clinical value of retrospective electrocardiogram (ECG) -editing technique in dual-source computed tomography (CT) coronary angiography in patients with arrhythmia.</p><p><b>METHODS</b>Totally 73 patients with arrhythmia during dual-source CT coronary angiography were included into this study. A retrospective gating technique and ECG-editing technique (Insert Sync; Disable Sync; Delete Sync; Shift R-peak) were used in patients who needed ECG-editing. Two experienced radiologists evaluated in consensus all pre-editing and post-editing reconstructed images and recorded scores according to the American Heart Association guidelines on coronary segmentation on a per segment basis. Image quality of all coronary segments was assessed using a four-point grading scale from excellent (4 scores) to non-assessable (1 score) .</p><p><b>RESULTS</b>The overall mean image quality of 34 patients who did not need ECG-editing was 3.42 ± 0.20. In 39 patients who needed ECG-editing, the overall mean image quality before and after ECG-editing was 2.39?0.37 and 3.22?0.24. The mean image quality in every segment between pre-editing and post-editing was also significantly different (P<0.01) .</p><p><b>CONCLUSION</b>ECG-editing technique can remarkably improve image quality of coronary artery segments by reducing or even eliminating the artifact produced by arrhythmia during dual-source CT coronary angiography.</p>
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Arritmias Cardíacas , Diagnóstico por Imagem , Angiografia Coronária , Métodos , Eletrocardiografia , Processamento de Imagem Assistida por Computador , Métodos , Tomografia Computadorizada por Raios X , MétodosRESUMO
<p><b>OBJECTIVE</b>Multilocular brain abscess in children is a serious neurosurgical emergency and remains a serious, life-threatening disease. This study evaluated the role of neuroendoscopy in treating multilocular brain abscess in children.</p><p><b>METHODS</b>Between January 2002 and June 2007, 16 children with multilocular brain abscess underwent an operation using a pure endoscopic procedure.</p><p><b>RESULTS</b>Increased intracranial pressure was relieved after operation in the 16 patients. CT/MRI after operation showed the abscess cavities disappeared and only the residual abscess walls existed in the 16 patients. Fourteen patients were followed up for 6 months to 5 years after surgery. Abscess walls disappeared in 13 patients and abscess recurred only in 1 patient.</p><p><b>CONCLUSIONS</b>Neuroendoscopy for treatment of multilocular brain abscess is safe and effective in children.</p>
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Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Antibacterianos , Usos Terapêuticos , Abscesso Encefálico , Cirurgia Geral , Neuroendoscopia , MétodosRESUMO
OBJECTIVE@#To determine the mRNA and protein expressions of RCAS1 in human astrocytic tumors, and to explore the relation between their expression and the genesis and development of tumor.@*METHODS@#The RCAS1 mRNA expression in human astrocytic tumors was evaluated by RT-PCR, and the RCAS1 protein expression was studied by immunohistochemical staining.@*RESULTS@#The quantities of RCAS1 mRNA expression between diffusive astrocytoma(Grade II) and anaplastic astrocytoma(Grade III), anaplastic astrocytoma and glioblastoma(Grade IV) were significantly different(P<0.05), while the expression scores of RCAS1 protein were different only between the anaplastic astrocytoma and glioblastoma(P<0.01). RCAS1 protein expression was positively correlated with the tumor grade (r=0.573,P<0.001). The RCAS1 protein was not detected in normal brain tissues by immunohistochemical staining.@*CONCLUSION@#The RCAS1 expression is related to the histological grade of astrocytic tumor. In astrocytic tumors, the RCAS1 expression is regulated transcriptionally and posttranscriptionally.
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Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Antígenos de Neoplasias , Genética , Metabolismo , Astrocitoma , Genética , Metabolismo , Neoplasias Encefálicas , Genética , Metabolismo , RNA Mensageiro , GenéticaRESUMO
<p><b>OBJECTIVE</b>To observe the relationship between murine double minute 2 (mdm2) expression and AngII and ceramide induced human umbilical endothelial cells apoptosis.</p><p><b>METHOD</b>Human umbilical endothelial cells (ECs) were cultured in vitro and treated with angiotensin II alone or in combination with losartan (an inhibitor of AT1), PD123319 (an inhibitor of AT2) and FB1 (an inhibitor of ceramidase) respectively. ECs were also treated with different doses of C2-ceramide. The apoptosis of ECs was detected with Tunel, the mdm2 mRNA and protein expressions were measured with reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.</p><p><b>RESULTS</b>PD123319 and FB1 but not losartan inhibited AngII induced ECs apoptosis and down-regulated the AngII induced increased mdm2 expressions. C2-ceramide also induces ECs apoptosis and down-regulated mdm2 expressions at protein and mRNA levels in a dose-dependent manner.</p><p><b>CONCLUSIONS</b>AngII binding with AT2 induces ECs apoptosis via ceramide. AngII and ceramide induce EC apoptosis by inhibiting mdm2.</p>