Impact of surgery and epirubicin intravesical chemotherapy on peripheral blood dendritic cell subsets in patients with superficial urothelial carcinoma of the bladder / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Superficial urothelial carcinoma (SUC) of the bladder is a common urinary tract tumor in China. There is a high recurrence rate of this tumor even after surgery and intravesical instillation. Previous reports have described a suppression of the immune system in cancer patients. Dendritic cells (DCs) play a pivotal role in the induction of an effective antitumor immune response. The aim of this study was to investigate the effects of surgery and epirubicin intravesical chemotherapy (IC) on peripheral blood DCs in subsets of patients with bladder SUC.</p><p><b>METHODS</b>A total of 66 SUC patients and 38 healthy controls were enrolled in this study. All the patients had undergone transurethral resection (TUR) of their cancer and adjunctive IC after tumor removal. The patients were divided into a non-recurrence group (n = 40) and a recurrence group (n = 26) based on the presence or absence of tumor recurrence. Blood samples were taken preoperatively (PreOP), on postoperative days (POD) 1 and 7, and at postoperative month (POM) 3. Flow cytometric analysis was used for the determination and quantitation of the surface markers CD80 and CD86 in circulating DC subsets.</p><p><b>RESULTS</b>The preoperative percentages of myeloid dendritic cells (mDCs) and expression of CD80 and CD86 were impaired in SUC patients compared to healthy controls (P < 0.05). The percentages of mDCs and these surface markers decreased significantly on POD 1 and increased on POD 7, remaining higher than the preoperative values in POM 3 (P < 0.05). The percentages of mDCs, and CD80 and CD86 in the non-recurrence group on PreOP, POD 7, and POM 3 were higher than those in recurrence group.</p><p><b>CONCLUSIONS</b>Surgical removal of SUC and adjunctive IC were associated with improved circulating mDC counts and function. Persistent depression of mDC counts and function after treatment in recurrence patients indicated lower antitumor immunity that may lead to tumor recurrence.</p>

Radiotherapy of unicentric mediastinal Castleman's disease / 癌症

Castleman's disease is a slowly progressive and rare lymphoproliferative disorder. Here, we report a 55-year-old woman with superior mediastinal Castleman's disease being misdiagnosed for a long term. We found a 4.3 cm mass localized in the superior mediastinum accompanied with severe clinical symptoms. The patient underwent an exploratory laparotomy, but the mass failed to be totally excised. Pathologic examination revealed a mediastinal mass of Castleman's disease. After radiotherapy of 30 Gy by 15 fractions, the patient no longer presented previous symptoms. At 3 months after radiotherapy of 60 Gy by 30 fractions, Computed tomography of the chest showed significantly smaller mass, indicating partial remission. Upon a 10-month follow-up, the patient was alive and free of symptoms.

Rapamycin enhances the susceptibility of both androgen-dependent and -independent prostate carcinoma cells to docetaxel / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Docetaxel (DOC) therapy is well tolerated and shows high response rates in patients with hormone refractory prostate cancer (HRPC). There are many reports on the effect of rapamycin (RPM) on the treatment of carcinogenesis. The goal of this study was to test whether RPM could enhance the susceptibility of both androgen-dependent and -independent prostate carcinoma cells to DOC.</p><p><b>METHODS</b>Prostate cancer (PC) cell lines (LNCap, PC3 and AILNCap) were cultured and treated with RPM and DOC alone or in combination. The effects of therapeutic agents on cells were determined by the WST-1 assay. Apoptosis induction was confirmed by flow cytometric analysis. The apopcyto caspase colorimetric assay kit was applied to measure the activities of caspases 3 and 9. The antitumor effects of RPM and DOC against PC cells were also assessed in nude mice using four randomized groups: control, RPM, DOC and combination drug therapy by measuring tumor size. All the animals tolerated both RPM and DOC without significant weight loss.</p><p><b>RESULTS</b>RPM and DOC caused dosage-dependent growth suppression of PC cells. RPM could increase the susceptibility of PC cells to DOC significantly, and combined treatment with RPM and DOC caused synergistic growth suppression in all examined PC cell lines by isobolographic analysis. Both RPM and DOC significantly induced apoptosis in a dosage-dependent manner. RPM (10 nmol/L), DOC (1 nmol/L), and combined treatment induced apoptosis rate were 8%, 17% and 38%, respectively (the control was 2%). RPM could promote the apoptosis induced by DOC in PC cell lines. Both RPM and DOC significantly increased the caspase activity in a dosage-dependent manner. The relative activities of caspase 9 in control, RPM, DOC and RPM + DOC groups were 0.22 +/- 0.02, 0.36 +/- 0.06, 0.47 +/- 0.05 and 0.84 +/- 0.08, respectively. The relative activities of caspase 3 were 0.21 +/- 0.02, 0.24 +/- 0.05, 0.42 +/- 0.06 and 0.81 +/- 0.09, respectively. Either RPM or DOC alone significantly inhibited the growth of PC cells in nude mice compared to the control. The combination of RPM and DOC produced a significant reduction in tumor volume when compared to RPM or DOC alone. After 5-week treatment, the tumor sizes of LNCap in control, RPM, DOC and RPM + DOC groups were (570 +/- 56) mm(3), (412 +/- 41) mm(3), (425 +/- 46) mm(3) and (221 +/- 26) mm(3), respectively.</p><p><b>CONCLUSIONS</b>RPM could significantly increase the susceptibility of both androgen-dependent and -independent PC cells to DOC; the synergy of RPM and DOC was demonstrated. RPM enhanced the DOC-induced upregulation of caspase activity, resulting in an increasing number of cells in sub-G1 phases. The synergy of the combined treatment might be observed in both androgen-dependent and -independent PC cell lines.</p>

Prognosis of different operative procedures of coronary artery bypass grafting in the senile patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate myocardial protection and prognosis of the different operative procedures of coronary artery bypass grafting (CABG) for the senile patients with coronary artery disease.</p><p><b>METHODS</b>From July 2008 to June 2009, 125 cases (age ≥ 65 years old) underwent CABG were divided into 3 groups.Group A (70 cases) undertook off-pump CABG, group B (33 cases) undertook on-pump beating heart CABG. group C (22 cases) undertook on-pump CABG with cardiac arrest. Serum level of cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) activity were examined right before operation and 0, 24, 72 and 168 h after operation. The complications during perioperative period and the mortality were investigated.</p><p><b>RESULTS</b>No significant difference was found in the right before operation and 168 h after operation of the serum level of cTnI and CK-MB in the 3 groups (P > 0.05). The serum level of cTnI and CK-MB activity of group A was the lowest and group B was lower than group C. Group A was the best concerning the complications during perioperative period. The mortality of group A was lower than group B but no significant difference was found in the mortality between group A and C. No significant difference was found in the complications during perioperative period and the mortality between group B and C.</p><p><b>CONCLUSION</b>Off-pump CABG could reduce myocardial injury and the complications during perioperative period in the senile patients.</p>

Pilot study of intravesical instillation of two new generation anthracycline antibiotics in prevention of superficial bladder cancer recurrence / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Superficial bladder cancer accounts for 60% - 70% of all bladder cancer cases in China, when treatment consists of only transurethral resection of the bladder tumor (TUR-BT), recurrence and progresses in the bladder are observed in some patients. There are numerous reports of trials of intravesical instillation of anticancer agents with the objective of lowering this recurrence rate. The aim of this study was to compare the prophylactic efficacy and safety of epirubicin (EPI), pirarubicin (THP) and hydroxycamptothecin (HCPT) in superficial bladder cancer.</p><p><b>METHODS</b>This study enrolled a total of 189 patients who had been diagnosed with superficial bladder cancer during the period from 2004 through 2007 at Beijing Friendship Hospital. All patients were randomly allocated to one of three treatment groups. Patients in group A received 29 doses of EPI 30 mg/30 ml, patients in group B received 29 doses of THP 30 mg/30 ml, and patients in group C received 29 doses of HCPT 30 mg/30 ml, over a period of 24 months.</p><p><b>RESULTS</b>The recurrence-free rate in the 2 anthracycline treatment groups (A and B) were significantly better than that of the HCPT treatment group. In the safety evaluation, the incidences of pollakiuria, pain on urination, dysuria, hematuria, and contracted bladder were not significantly different between groups A and B, but some were significantly higher in groups A and B than that in group C.</p><p><b>CONCLUSION</b>The efficacy of EPI and THP was significantly better than HCPT in the prevention of bladder cancer recurrence.</p>

Correlation between major histocompatibility complex class I-related chain A gene alleles and graft rejection in small intestine, liver and kidney transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the correlation between major histocompatibility complex (MHC) class I chain-related gene A (MICA) gene alleles matching rates and graft rejection in small intestine, liver and kidney transplantation.</p><p><b>METHODS</b>Genome DNA were extracted from blood samples or pathological sections collected from donors and recipients of living-related transplantation, included 4 cases of small bowel transplantation, 5 cases of liver transplantation and 6 cases of kidney transplantation. The correlation between MICA alleles matching rates and acute graft rejection was analyzed following 13 MICA alleles determination by polymerase chain reaction based on sequence-specific primers (PCR-SSP).</p><p><b>RESULTS</b>HLA zygosity of all donors and recipients was confirmed to be half-matching. The recipients displaying higher matching rates of MICA alleles with donors showed lighter clinical and pathological rejection and longer survival time. On the contrary, recipients with lower matching rates of MICA alleles with donors showed severer clinical and pathological rejection and shorter survival time relatively.</p><p><b>CONCLUSION</b>Matching rates of MICA alleles has negative relevance to acute rejection, and positive relevance to survival time of recipients in small bowel, liver, and kidney transplantation.</p>

Comparison of transient changes in renal function between off-pump and on-pump coronary artery bypass grafting / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute renal failure following coronary artery bypass grafting (CABG) surgery is associated with high morbidity and mortality. Approximately half of all patients who develop acute kidney injury (AKI) subsequently develop acute renal failure (ARF). The purpose of the study was to compare early transient changes in renal function within the first post-operative week following CABG in patients that were either off-pump or on-pump.</p><p><b>METHODS</b>Eight hundred and forty-nine consecutive patients with isolated CABG in a single institution between January 1990 and August 2006 were retrospectively analyzed, including 518 off-pump and 331 on-pump patients. A multivariate Logistic regression model was constructed to identify risk factors for the development of AKI.</p><p><b>RESULTS</b>Sixty-one off-pump patients and 63 on-pump patients developed AKI. Risk factors for the development of post-operative AKI included an ejection fraction > or =50% or < or =30%, a pulse pressure > or =60 mmHg, peripheral vascular disease, diabetes, emergent procedure, triple-vessel disease, body mass index, peri-operative and post-operative. intra-aortic balloon pumping, NYHA class III and IV, and cardiopulmonary bypass. An ejection fraction > or =50% and peri-operative and post-operative intra-aortic balloon pumping were protective (OR <1). Peak serum creatinine for post-operative AKI was noted 12 hours and 24 hours in the off-pump and on-pump patients, respectively. Serum creatinine kinetics revealed rapid recovery in the 24th to 48th hour (off-pump) and the 48th to 72nd hour (on-pump).</p><p><b>CONCLUSION</b>Renal protection strategies are indicated from general anesthesia induction until 48 and 72 hours post-operatively in off-pump and on-pump patients, respectively.</p>

Incidence and risk factors of acute kidney injury post off-pump and on-pump coronary artery bypass grafting / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the incidence and risk factors of acute kidney injury (AKI) within the first postoperative week after off-pump or on-pump coronary artery bypass (OPCAB or CCAB) surgery.</p><p><b>METHODS</b>Consecutive patients underwent CABG between January 1990 and August 2006 in our institution and had normal serum creatinine (Scr) and estimated creatinine clearance (Ccr) values before operation were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify risk factors for the development of AKI defined as Scr 130 - 199 micromol/L or Ccr 30 - 60 mlxmin(-1)x1.73 m(-2).</p><p><b>RESULTS</b>Incidence of AKI was significantly higher in patients underwent CCAB compared to those underwent OPCAB (63/331 vs. 61/518, P < 0.01). Peak Scr value was seen at 12th hour post OPCAB and 24th hour post CCAB, respectively. The rapid recovering of Scr occurred between 24th hour to 48th hour in patients underwent OPCAB and 48th hour to 72th hour in patients underwent CCAB surgery. Multivariate forward stepwise logistic regression analysis showed that LVEF < 30%, pulse pressure >/= 60 mm Hg (1 mm Hg = 0.133 kPa), peripheral vascular disease, diabetes, emergent procedure, triple-vessel disease, higher body mass index (kg/m(2)), intraoperative and postoperative IABP, NYHA class III or IV and cardiopulmonary bypass were risk factors for the development of postoperative AKI following CABG, while LVEF > 50% and intraoperative and postoperative IABP were associated with lower incidence of AKI (OR < 1).</p><p><b>CONCLUSION</b>AKI is not a rare complication post OPCAB or CCAB surgery, especially in patients with reduced LVEF, increased pulse pressure, peripheral vascular disease, diabetes, emergent procedure, triple-vessel disease, higher body mass index, intraoperative and postoperative IABP.</p>

Hepatocyte growth factor combined with insulin like growth factor-1 improves expression of GATA-4 in mesenchymal stem cells cocultured with cardiomyocytes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In a suitable microenvironment, bone marrow mesenchymal stem cells (BMSCs) can transdifferentiate into myocardial cells whose special gene can be expressed as structural proteins. Growth factor (GF) plays an important role in the cell migration, survival and differentiation. However, the effect of GF on the cellular differentiation is not well understood. In this study, the hepatocyte growth factor (HGF) and insulin like growth factor-1 (IGF-1) were used in the mixed culture of BMSCs and myocardial cells and the effects of these growth factors on the GATA-4 expression of BMSCs were investigated.</p><p><b>METHODS</b>BMSCs were isolated from the marrow of rabbit femurs and tibias and foetal rabbit ventricular myocytes were isolated with trypsin sequential digestion. These two kinds of cells were cocultured in a ratio of 1:1 for 6 weeks; cocultured cells with added HGF and IGF-1 were the experimental group. The differentiated BMSCs were collected using the laser capture, microdissection system and their RNA isolated. Immunocytochemical staining, transmission electron microscopy and reverse transcription-polymerase chain reaction were used to evaluate the transformation of the stem cells into cardiomyocytes like cells.</p><p><b>RESULTS</b>When cultured separately, BMSCs did not express alpha-actin and the stem cells had many nucleoli. However, when cocultured with cardiomyocytes, BMSCs expressed alpha-actin and the cardiac transcription factor GATA-4 and showed cardiomyocyte like ultrastructure. In comparison with the control group, the experimental group exhibited the enhanced expression level of GATA-4. The GATA-4 expression of BMSCs increased gradually following the addition of HGF and IGF-1, reached the maximal level after two weeks and decreased slightly thereafter.</p><p><b>CONCLUSIONS</b>BMSCs can transdifferentiate into cardiomyocytes like cells and express the cardiac transcription factor GATA-4 after being cocultured with myocardial cells. HGF and IGF-1 can stimulate transdifferentiation of BMSCs into cardiac phenotype and enhance the expression of GATA-4. These results indicate that growth factors have a great potential in clinical cellular therapy.</p>

Bentall operation combined with total arch replacement and stented elephant trunk implantation for serious Debakey I aortic dissecting aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical experience of Bentall operation combined with total arch replacement and stented elephant trunk implantation for serious Debakey I aortic dissecting aneurysm.</p><p><b>METHODS</b>Twelve patients with serious Debakey I aortic dissecting aneurysm underwent surgical treatment from January 2005 to December 2007. There were 10 male and 2 female with the mean age of (40.1 +/- 9.5) years old. There were acute aortic dissection in 9 cases, chronic aortic dissection in 3 cases. The inner diameter of aorta was (5.3 +/- 1.8) cm. There were Marfan syndrome in 4 cases, aortic regurgitation in all cases, severely persistent chest pain in 9 cases, acute left heart failure in 8 cases, and cardiac tamponade in 4 cases. Bentall operations combined with total arch replacement and stented elephant trunk implantation were performed by using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion in all cases.</p><p><b>RESULTS</b>Urgent surgery underwent in 9 cases. The mean interval between the onset of aortic dissection and the accomplishment of surgery was (41.0 +/- 15.9) hours. Cardiopulmonary bypass time was (191 +/- 26) min, average cross clamp time was (134 +/- 31) min, and average deep hypothermic circulatory arrest time was (50.0 +/- 14.5) min. One patient died in hospital. The time stayed in ICU was 3 to 27 d. Mental disorder in 6 cases, hemi-paralysis in 1 case, amputation in 1 case, hemorrhage of anastomosis in 1 case, hemorrhage of alimentary tract in 1 case, and pleural effusion in 4 cases were recorded. Eleven cases were followed-up for 8 weeks to 36 months. There were no bending of the stents and no obstruction in the vascular prosthesis.No re-operation was needed. One case died 6 months postoperatively.</p><p><b>CONCLUSION</b>Bentall operation combined with total arch replacement and stented elephant trunk implantation is safe and effective for serious Debakey I aortic dissecting aneurysm, while good organs protection and consummate cardiopulmonary bypass were taken.</p>

Exploration of the auditory effects of diabetes mellitus using distortion product otoacoustic emissions / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of diabetes mellitus on amplitude of distortion product otoacoustic emissions ( DPOAE) and whether streptozotocin has ototoxicity or not.</p><p><b>METHODS</b>Twenty-four SD rats were divided into diabetes mellitus group, insulin therapy group and control group. Diabetes was induced by streptozotocin. The blood glucose of insulin group was controlled by insulin. The amplitude of DPOAE was tested before streptozotocin injection and 3 months, 5 months after injection, respectively.</p><p><b>RESULTS</b>The amplitude of DPOAE in diabetes rats was decreased in 3 months and there was statistical significance (P <0. 05) in 1038, 4126 and 5200 Hz, while obviously reduced in 5 months in all frequencies and there was also statistical significance (P <0. 01). The amplitude of DPOAE in all frequencies lacked of any significance between insulin therapy group and control group.</p><p><b>CONCLUSIONS</b>Diabetes mellitus could induce the amplitude of DPOAE decreasing. Streptozotocin had not evident toxicity for inner ear.</p>

X-chromosomal inactivation skewing in blood cells is associated with early development of lung / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To observe the relationship between skewed X-chromosomal inactivation (SXCI) and development of lung cancer in females.</p><p><b>METHODS</b>DNA was isolated from peripheral blood cells from patients with primary lung cancer (n = 148) and control subjects (n =289). Exon 1 of androgen receptor ( AR) gene was amplified, with its products from different alleles resolved on denaturing polyacrylamide gels and visualized by silver staining. The corrected ratio (CR) between products from different AR alleles before and after Hpa II pretreatment was calculated. All statistical tests were two-sided.</p><p><b>RESULTS</b>With CR> or = 10 adopted as the criterion, SXCI was found more frequently in the younger patients ( C50 years; 7. 9%) than in the controls of the same age group (1. 2% ; P = 0. 046). The SXCI frequency, however, were not significantly different between the old patients ( > 50 years; 4. 5% ) and the controls of the same age group (5. 4% ; P =0. 488). Whether taking CR> or =3 or CR> or =10 as the criteria, the average ages of the patients with SXCI were more than 10 years younger than those without SXCI (P < 0. 05).</p><p><b>CONCLUSION</b>SXCI in blood cells is associated with early development of lung cancer in females.</p>

Prevention and treatment of HBV recurrence with lamivudine in HBsAg positive renal allograft recipients / 中华器官移植杂志

Objective To analyze the effect of prevention and treatment with lamivudine in HBsAg positive renal allograft recipients with HBV recurrence.Methods In 28 patients with chronic renal failure whose HBsAg was positive,8 cases were positive for HBV-DNA positive.All these 28 cases had normal liver function without hepatic cirrhosis before renal transplantation.All donors were negative for HBsAg.Twenty patients received lamivudine prophylactic treatment:14 cases positive for HBsAg but negative for HBV-DNA before transplantation received lamivudine treatment immedia- tely after transplantation and 6 cases positive for both HBsAg and HBV-DNA received lamidudine treatment before transplantation.Eight patients were treated with lamivudine when their hepatic dys- function with recurrent HBV antigenemia were developed after transplantation.Lamivudine was orally taken and its initial dosage was 100 rag/day.Results The follow-up period of the 28 patients were 13- 54 months with the average of 23.6 months,and 2 died during this period.Mild hepatic dysfunction with recurrent HBV antigenemia developed in 3 of 20 hepatitis antigenemia patients received lamivu- dine prophylactic treatment with a mean duration of 9.3 months after transplantation.The highest average level of serum ALT was 87.5 U/L.The liver function returned to the normal with HBV-DNA negative after lamivudine treatment in 3 patients.The other 17 patients maintained normal liver func- tion with HBV-DNA negative during the follow-up period.Hepatic dysfunction with recurrent HBV antigenemia(or HBV-DNA titer increased significantly)developed with a mean duration of 4.6 months in all 8 patients without receiving lamivudine prophylactic treatment.The highest average level of serum ALT was 174.5 U/L.The liver function returned to the normal with HBV-DNA negative after larnivudine treatment in the 8 cases.HBV-DNA,however,reappeared in 5 eases without any dis- continuation of lamivudine.The creatinine level remained normal without any severe drug side effects in 28 patients during lamivudine treatment.Conclusion Lamivudine treatment before hepatic dysfunc- tion might be a safe and effective strategy for prevention of recurrence of hepatitis B viremia in HBsAg positive renal allograft recipients.

Relationship between genetic polymorphism of NAT2 and susceptibility to urinary bladder cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the relationship between genetic polymorphism of NAT2 and susceptibility to bladder cancer.</p><p><b>METHODS</b>NAT2 genotypes were determined by PCR-RFLP method in 69 patients with bladder transitional cell carcinoma and 88 healthy controls.</p><p><b>RESULTS</b>The frequency of NAT2 slow genotypes was 26.1% (18/69) in patients compared with 14.8% (13/88) in controls (P < 0.05). Bladder cancer risk in patients with NAT2 slow genotypes was 2 fold as high as that in patients with NAT2 rapid genotypes. When NAT2 rapid genotypes/non-smoker were used as reference, bladder cancer risk increased to 5.8-fold (P < 0.05). Among the smokers with PY higher than 10, the patients showed a higher frequency of NAT2 slow genotype than controls (P < 0.05). It was also shown that the patients with slow NAT2 genotypes were more likely to have high grade tumor (P < 0.05) and advanced stage tumor (P < 0.01).</p><p><b>CONCLUSION</b>The results suggest that NAT2 genetic polymorphism is associated with bladder cancer susceptibility. People with NAT2 slow genotype have higher bladder cancer risk.</p>

Treatment analysis of 26 patients with breast ductal carcinoma in situ / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the appropriate surgical treatment for breast ductal carcinoma in situ (DCIS).</p><p><b>METHODS</b>Twenty-six such patients treated between 1992 and 2001 were retrospectively analyzed. Among them, 3 patients were treated by simple mastectomy, 23 patients by mastectomy and axillary lymph node dissection, 8 patients by chemotherapy and one patient by radiotherapy after operation. Median follow-up was 42 m (rang 12 - 112 m).</p><p><b>RESULTS</b>Except 3 of these 26 patients lost in follow-up and 1 patient died from diabetes mellitus, all the other 22 patients survived over 5 years. All lymph nodes dissected from 23 patients were negative. After surgery, 3 patients developed lymph edema of the arm.</p><p><b>CONCLUSION</b>DCIS, lacking the potential of metastasis, is not invasive. Conservative breast surgery without lymph node dissection is feasible for most DCIS patients.</p>