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经股动脉逆行导丝跨瓣是目前经导管主动脉瓣置换术中最常见的跨瓣方法。该文报道2例主动脉瓣置换术后瓣膜衰败的重度主动脉瓣狭窄患者，导丝逆行跨主动脉瓣难度大，采用穿刺房间隔顺行跨瓣方法成功建立轨道，人工瓣膜经股动脉逆行释放，避免顺行释放可能造成的二尖瓣损伤。术后超声心动图提示人工瓣膜流速、跨瓣压差明显改善，无明显瓣周漏，患者症状明显改善，短期临床效果满意。穿刺房间隔顺行跨瓣对于导丝跨瓣难度大的经导管主动脉瓣置换术患者是一种有效的替代方法。.

三尖瓣反流常继发于肺动脉高压、心房颤动、风湿性瓣膜病和外伤等，常伴有症状性心力衰竭及高死亡率，传统治疗方法为外科手术，但外科手术死亡率较高，且很多患者无法耐受外科手术，故目前尚无安全有效的治疗方法。该文报道1例外科手术高危的重度三尖瓣反流患者，行经股静脉异位三尖瓣介入治疗后临床症状改善，并结合文献分析了异位三尖瓣植入术围手术期注意事项，为临床实践提供参考。.

主动脉瓣生物瓣膜的使用期限为8~10年。该文报道1例85岁患者，经导管主动脉瓣置换术（TAVR）后10年因生物瓣衰败行瓣中瓣TAVR手术，手术成功，患者恢复良好。.

Depression is a common and recurrent mental disease, with complex etiology, which is mainly affected by genetic, metabolic and social factors. The specific pathogenesis is still unclear. In recent years, the hypothesis of inflammatory factors related to depression has attracted wide attention of researchers. A large number of clinical experimental studies have shown that depression is related to the increase of proinflammatory factors in central and peripheral blood. The inflammatory factors in peripheral blood can spread in the brain through the way of specific transporters across the blood-brain barrier, and activate or participate in the brain inflammatory response, and ultimately affect the neuronal activity and neurotransmitter release in the emotional regulation area of the brain, which in turn leads to depressive symptoms. This paper summarizes the relationship between inflammatory factors and depression and its possible mechanism, which provides reference for further prevention and control, clinical treatment and scientific research of depression.抑郁症是一种常见且容易复发的精神疾病，其病因复杂，主要由遗传、代谢和社会因素等多方面因素影响，具体的发病机制尚不明确。近年来，有关抑郁症的炎症因子假说引起了研究人员的广泛关注，大量临床实验研究显示抑郁症与中枢和外周血中促炎症因子的增加有关，外周血中炎症因子可通过特异性转运蛋白跨过血脑屏障的方式在脑中扩散，激活或参与脑部炎症反应，最终影响了脑部情绪调节区域的神经元活动和神经递质的释放，进而引发抑郁症状。本文总结归纳了炎症因子与抑郁症的关系及其可能机制，为进一步开展抑郁症预防控制、临床治疗和科学研究提供借鉴。.

Acute lymphoblastic leukemia (ALL) causes the dysfunction of the systemic blood system and immune system. The etiology and predisposing factors of ALL are unknown. The suppressor of cytokine signaling 1 (SOCS1) and SOCS2 are inhibitors of cytokine signal transduction. Gene polymorphisms of SOCS1 and SOCS2 and their expressions may be related to ALL.A total of 200 ALL patients in our hospital and 200 healthy people were enrolled in ALL group and control group, respectively. Genomic deoxyribonucleic acids (DNAs) and total RNAs were extracted from the peripheral blood of each subject. Gene polymorphisms of SOCS1 at rs33977706, rs243327, and rs33932899 and those of SOCS2 at rs3816997 were amplified by polymerase chain reaction (PCR) and sequenced. Besides, the expression levels of SOCS1 and SOCS2 in ALL patients were detected by real-time fluorescence quantitative PCR.The frequency of the allele C of SOCS1 rs33977706 in ALL group was lower than that in the control group, displaying a significant difference between the two groups (p=0.015). The frequency of allele A of SOCS2 rs3816997 was notably higher in ALL group than that of the control group (p=0.000). In addition, the frequency of CA genotype of SOCS1 rs33977706 in ALL group was markedly lower than that in the control group, showing a significant difference (p=0.000). ALL group had remarkably higher frequencies of AA genotype of SOCS2 rs3816997 (p=0.000) and ACC haplotype of SOCS gene (p=0.000), and lower frequencies of ATG (p=0.026) and CCC (p=0.006) haplotypes. The two loci, SOCS1 rs33932899 and SOCS1 rs243327, were linked to each other (D'=0.781). Moreover, the expression level of SOCS1 in ALL group was lower than that in the control group, in which the expression of the CT genotype of SOCS1 rs243327 was relatively higher (p=0.021). SOCS2 level was lower in ALL group. Particularly, SOCS2 level in ALL patients carrying AC genotype was lower than those carrying AA and CC genotypes (p=0.000). ALL patients carrying CT genotype of SOCS1 rs243327 had shorter period of agranulocytosis (p=0.000), a lower ratio of bone marrow primitive/immature cells (p=0.001), and a higher hemoglobin (Hb) level in blood (p=0.000). The ratio of bone marrow primordial/immature cells was lower in ALL patients with AC genotype of SOCS2 rs3816997 (p=0.038).The expression levels of SOCS1 and SOCS2 are prominently related to ALL, and their polymorphisms are associated with the susceptibility to ALL.

患者男性，70岁，因"活动后气促1周，加重1 d"入院。诊断为重度钙化性主动脉瓣狭窄，中重度二尖瓣反流，心房颤动，纽约心脏协会（NYHA）心功能Ⅳ级，高血压，肝肾功能不全，2型糖尿病，轻度肺气肿。患者入院后在体外膜肺氧合（ECMO）辅助循环下成功实施了经导管主动脉瓣置换术，术后6 h撤离ECMO，未出现并发症，术后13 d顺利出院。经导管主动脉瓣置换术治疗高危主动脉瓣狭窄安全、有效，而ECMO支持可降低手术风险。.

Melanoma is regarded as one common malignancy in skin cancers, and there is growing evidence that microRNAs (miRNAs) play a vital role in the oncogenesis of tumors. This study aimed to investigate the roles and mechanism of miR-22 in melanoma.Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was utilized to detect the expressions of miR-22 and mRNA. The functions of miR-22 in melanoma cell proliferation, migration and invasion were investigated with functional assays, including MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) and transwell assay. Western blots were utilized to examine the protein expressions. Luciferase reporter analysis was conducted to confirm the interactions between formin-like 2 (FMNL2) and miR-22 in melanoma cells. FMNL2 expression levels in melanoma tissues were investigated by immunohistochemistry (IHC) assays.The qRT-PCR analysis demonstrated significant decreased miR-22 expressions in melanoma tissues. Decreased miR-22 in melanoma tissues were correlated with adverse clinicopathologic features and poor prognosis. Functional assays indicated that upregulation inhibited melanoma cell proliferation, invasion and migration capacities. Luciferase reporter assays showed that FMNL2 was targeted by miR-22 in melanoma cells. Western blots indicated that miR-22 exerted anti-tumor functions by regulating the Wnt/β-catenin and epithelial-mesenchymal transition (EMT).Our findings showed that miR-22 served as a tumor suppressor in melanoma progression, implying that miR-22 may function as a novel therapeutic target and prognostic biomarker for melanoma treatments.

本文报道1例男性患者，经皮冠状动脉介入治疗术前予替格瑞洛180 mg抗血小板治疗，服药后4 h，出现谵妄表现，停药后好转；术后第5天再次给予替格瑞洛，当晚再次出现谵妄，停药后好转。目前替格瑞洛引起谵妄的机制尚不明确，是否与其代谢途径或代谢产物相关尚需进一步明确。.

Long non-coding RNA HOX transcript antisense RNA (HOTAIR) is reported to make chromatin state, cell growth and cancer metastasis. However, the role of HOTAIR in non-small cell lung cancer (NSCLC) remains unknown. The aim of this study was to explore the regulatory mechanism of HOTAIR in NSCLC in relation to miR-217/Dachshund homolog 1 (DACH1) signaling pathway.The expression levels of HOTAIR and miR-217 were measured by quantitative Polymerase Chain Reaction (qPCR) in NSCLC cell lines and human bronchial epithelial cell line HBE. The direct target of HOTAIR and miR-217 in NSCLC was confirmed by a Luciferase reporter assay. The expression of DACH1 protein was examined by Western blot (WB) assay. Cell migration and invasion were examined with transwell assays, and cell proliferation was measured by Cell Counting Kit-8 (CCK8) assay.HOTAIR was up-regulated and miR-217 was down-regulated in NSCLC cell lines. Silencing of HOTAIR significantly repressed cell proliferation and inhibited cell migration and invasion in H1299 and A549 cells by facilitating miR-217 expression. Moreover, bioinformatics analysis and Luciferase reporter assay confirmed that DACH1 was a target of miR-217. Furthermore, the overexpression of miR-217 markedly repressed cell proliferation and inhibited cell migration and invasion in H1299 and A549 cells. DACH1 reverses the effects of miR-217 overexpression in NSCLC cells.HOTAIR was up-regulated in NSCLC cell and regulates the proliferation, migration, invasion through the miR-217/DACH1 signaling pathway. It provides a novel potential treatment strategy for NSCLC.

To investigate the association between the human 8-oxoguanine DNA glycosylase 1 (hOGG1) gene Ser326Cys polymorphism and male subfertility in Taiwanese patients with varicocele, we made a prospective study. Ninety young male patients with varicocele (group 1), 50 young male patients with subclinical varicocele (group 2) and 30 normal young male patients without varicocele (group 3) were recruited in this study. The hOGG1 null homozygous genotype (Cys/Cys) and the occurrence of a 4,977-bp deletion in mitochondrial DNA and mitochondrial copy number in spermatozoa were determined by polymerase chain reaction. The 8-hydroxy-2'-deoxyguanosine (8-OHdG) content of DNA in the spermatozoa was measured using high-performance liquid chromatography, and total antioxidant capacity (TAC) of seminal plasma was detected electrochemically. The rates of male subfertility were 31.1% (28/90) in group 1 and 22% (11/50) in group 2. Of 39 subfertile men, 74.4% (29/39) had the hOGG1 Cys/Cys genotype. Patients in groups 1 and 2 with hOGG1 Cys/Cys genotype had significantly higher 8-OHdG content in sperm DNA, lower mitochondrial copy number in spermatozoa and lower TAC in seminal plasma than those with Ser/Ser or Ser/Cys genotype. Clinicians should pay more attention to patients with varicocele with the hOGG1 Cys/Cys genotype.

Postoperative nausea and vomiting (PONV) and fentanyl-induced cough (FIC) are two common anaesthesia-related events, which seem to have common risk factors. In this prospective cohort study, we investigate whether patients who have FIC during induction of anaesthesia have an increased incidence of PONV.We studied adult non-smoking gynaecological surgical patients enrolled between July 1, 2011 and July 30, 2012. The presence of FIC during induction and the occurrence of PONV were recorded. Fentanyl-induced cough and other perioperative variables were subjected to multivariate analysis to determine the association between FIC and PONV.All 502 patients enrolled in this study had at least two risk factors for PONV, and 154 (31%) developed FIC. The incidence of PONV in the FIC group was higher than in the non-FIC group (56.5 vs 38.2%; P0.0001). Multivariate logistic regression analysis found FIC to be a predictive risk factor for the development of PONV (adjusted odds ratio 2.08, 95% confidence interval 1.41-3.07).Non-smoking women undergoing gynaecological surgery who develop FIC during induction of anaesthesia have a higher incidence of PONV.

We made a retrospective study to determine useful parameters for predicting subfertility in patients with subclinical varicocele (SV). One hundred and fifty men with SV and 17 age-matched men without SV were divided into three groups: Group 1, subfertile patients (n = 15); Group 2, fertile patients (n = 135); and Group 3, control patients (n = 17). Their age, body mass index (BMI), semen analysis, scrotal temperature, testicular volume, resistive index (RI), pulsatility index (PI) and peak retrograde flow (PRF) were compared. Subfertile patients (Group 1) with SV had significantly lower testicular volume and higher scrotal temperature, RI, PI and PRF than fertile men with SV (Group 2) and the control group (Group 3). Elderly men (50 years, n = 30) with SV had a significantly higher incidence of bilateral SV than young men with SV (10/30; 33.3% vs. 12/120; 10%). There was no difference in age and BMI among the three groups. Patients with SV and RI0.55 ml/s, PI0.99 ml/s, total testicular volume27 cc, scrotal temperature34.9°C and PRF29 cm/s have higher incidence of subfertility. Patients with SV may suffer from subfertility regardless of age. Close follow-up with colour Doppler ultrasound may be beneficial.

To analyze the drug-resistance of clinical Mycobacterium tuberculosis strains isolated from the tuberculosis(TB)patients in six provinces in China and related risk factors, and provide evidences for the effective prevention and treatment of drug resistant TB.Six provinces were selected from China. The background information of the TB patients was investigated with questionnaire survey, and the drug susceptibilities of the clinical M. tuberculosis strains to isoniazid, rifampin, ethambutol and streptomycin were tested by means of the proportional drug susceptibility test. Then the results and related risk factors were analyzed with software SPSS 20.0.The overall drug resistant rate and multi drug-resistant(MDR)rate were 23.42% and 13.51% respectively. The overall drug resistant rate and MDR rate in Beijing, Jilin, Hunan, Henan, Shaanxi, Xinjiang were 21.50%, 12.24%, 36.27%, 42.86%, 27.78%, 24.39% and 4.67%, 8.16%, 24.51%, 26.53%, 15.28%, 14.15%, respectively. The χ(2) analysis results showed that the differences in single drug-resistant rate, overall drug resistant rate and MDR rate in these provinces had significant differences(P=0.000). The univariate statistical analysis results showed that the retreatment for TB and TB treatment history were the risk factors associated with drug resistance(P0.05).The drug resistance of TB was very serious in China, but the TB drug resistance varied with province. The preventive intervention should be strengthened against all the major risk factors associated with the drug resistance for the better prevention and control of TB.

To study the diversities of human B cell epitopes of five proteins (Mpt83, Mpt70, LpqH, PstS3, GroES) in Mycobacterium tuberculosis isolates from China.We selected 179 strains isolated from patients with tuberculosis in different regions of China, and cultured these strains by L-J medium. The gene sequences of these 5 proteins were amplified and sequenced by PCR. The variations (single nucleotide polymorphisms, SNP) of the DNA sequences were compared and analyzed according to the immune epitope database (IEDB). The synonymous mutation rate (dS), non-synonymous mutation rate (dN) and dN/dS values were calculated with MEGA6 software.Among the 179 clinical MTBC isolates, 7 SNP mutations were found in the mpt83gene. The dN/dS value of the whole mpt83 gene was 0.88. One SNP mutation was found in the mpt70 gene. The dN/dS values of the whole pstS3 gene and non-B epitopes areas were 1.74 and 1.40 respectively. But no mutation was found in the groES gene.The mpt83, lpqH and pstS3 genes of 179 MTBC strains contain gene SNPs and human B cell epitopes diversities, while the coding gene and human B cell epitopes of protein mpt70 and groES were conservative.

Background To compare transrectal ultrasound (TRUS)-guided biopsy of the prostate and transurethral resection of the prostate (TURP) for detection of prostate cancer (PCa) in patients with moderate lower urinary tract symptoms (LUTS) by retrospective chart review. Methods Between January 2004 and December 2008, a total of 520 patients, aged 50.3-81.5 years, with moderate LUTS (International Prostate Symptom Score, 8-19), and elevation of prostate-specific antigen (≥ 4 ng/mL), or abnormal findings by digital rectal examination, were enrolled for evaluation. All the patients were recommended to receive TRUSguided biopsy of the prostate (TRUS biopsy group) or TURP (TURP group) due to the possibility of PCa, according to their choice after full explanation by the doctors. Results There were 379 patients in the TRUS biopsy group and 141 in the TURP group. PCa was detected in 80 patients (21.1%) in the TRUS group and in 27 (19.1%) in the TURP group. Clinically localized PCa (T1-2N0M0) was found in 46 patients (57.5%) in the TRUS biopsy group and in 16 (59.3%) in the TURP group. Bone metastasis was noticed in 22 (27.5%) patients in the TRUS biopsy group and in 7 (25.9%) in the TURP group. The percentage of low-grade tumor was significantly higher in the TURP group than in the TRUS biopsy group (11.1% vs. 5%). Conclusion TURP was not superior to TRUS-guided biopsy of the prostate for detection of PCa in patients with moderate LUTS and prostate-specific antigen ≥ 4 ng/mL.

Trisomy 11 in myelodysplastic syndromes (MDS) is rare, with undefined clinical significance and is currently assigned to the International Prognostic Scoring System (IPSS) intermediate-risk group. Over a 15-year period, we identified 17 MDS patients with trisomy 11 either as a sole abnormality (n=10) or associated with one or two additional alterations (n=7), comprising 0.3% of all MDS cases reviewed. Of 16 patients with Bone Marrow material available for review, 14 (88%) patients presented with excess blasts, 69% patients evolved to acute myeloid leukemia (AML) in a 5-month median interval and the median survival was 14 months. For comparison, we studied 19 AML patients with trisomy 11 in a noncomplex karyotype, of which, a substantial subset of patients had morphologic dysplasia, and/or preexisting cytopenia(s)/MDS. Genomic DNA PCR showed MLL partial tandem duplication in 5 of 10 MDS and 7 of 11 AML patients. A review of literature identified 17 additional cases of MDS with trisomy 11, showing similar clinicopathologic features to our patients. Compared with our historical data comprising 1165 MDS patients, MDS patients with trisomy 11 had a significantly inferior survival to patients in the IPSS intermediate-risk cytogenetic group (P=0.0002), but comparable to the poor-risk group (P=0.97). We conclude that trisomy 11 in MDS correlates with clinical aggressiveness, may suggest an early/evolving AML with myelodysplasia-related changes and is best considered a high-risk cytogenetic abnormality in MDS prognostication.

Objectives - The autosomal dominant cerebellar ataxias (ADCAs) are a group of genetically diverse neurological conditions linked by progressive deterioration in balance and coordination. Spinocerebellar Ataxia Type 2 (SCA2) is one of the ADCAs and also belongs to a special group caused by the expansion of an unstable CAG repeat encoding a polyglutamine tract. We aimed to investigate the frequency of SCA2 mutation in the ataxia patients referred to the clinic. Materials and methods - We screened 58 families with inherent cerebellar ataxia and 57 normal individuals by the use of radioactive genomic polymerase chain reaction (PCR) method. A simple non-radioactive PCR for rapid detection of the expanded SCA2 alleles via agarose gel electrophoresis was also employed. Results - Eight SCA2 affected patients and 1 at-risk individual in 5 unrelated SCA2 families were identified. The CAG repeats of normal alleles in the sample studied range in size from 16 to 30 repeat units, while those of SCA2 chromosomes are expanded to 34 to 49 repeat units. Our results also showed that unlike SCA I and SCA3/MJD, the size distribution of the normal alleles showed few polymorphisms, with the 22 repeat allele accounting for 90.1%. Homozygosity in normal individuals was 80.2%. No overlap in ataxin-2 allele size between normal and expanded chromosomes was observed. Conclusion - This is the first report of the SCA2 gene distributions in the population of Taiwan. The SCA2 mutation accounts for 8.6% of ADCA type I families referred to us, intermediate between SCAI (1.7%) and SCA3/MJD (24%) of the ADCA type I families in our collection.

The purpose of this study was to evaluate parathyroid function at monthly intervals following the implantation of TheraCyte-encapsulated live human parathyroid cells into ovariectomized rats and to determine the effect on bone mineral density (BMD) 4 months after ovariectomy ( 3 months after implantation).Parathyroid tissues were obtained from patients undergoing surgery for secondary hyperparathyroidism. In total, 21 Sprague-Dawley rats divided randomly into three groups were subjected to one of three treatments: (1) implanted with TheraCyte A-encapsulated 4x10(6) live parathyroid cells; (2) implanted with TheraCyte B-encapsulated 4x10(5) live parathyroid cells; (3) a sham operation; the control group. Rats were ovariectomized 1 month prior to the implantation of the TheraCyte. Blood was drawn at the time of implantation and at monthly intervals thereafter for 3 months to check the levels of calcium, phosphorus and intact parathyroid hormone (iPTH). The BMD of the lumbar spine (L1-L5) and of the left femoral bone was measured with dual-energy-X-ray absorptiometry (DEXA) 1 month after ovariectomy and 3 months after implantation of the TheraCyte (4 months after ovariectomy).We found that the viability ratio of cryopreserved tissues was between 55 and 79% after thawing. In the control group, the BMD of the lumbar spine (L1-L5) had not decreased significantly (p=0.237) nor had the BMD of the left femoral bone increased significantly (p=0.063) 3 months after implantation. In the TheraCyte A group, the BMD of both the lumbar spine (p=0.018) and left femoral bone (p=0.018) had increased significantly 3 months after implantation. In the TheraCyte B group, the BMD of both the lumbar spine (p=0.017) and the left femoral bone (p=0.025) had also increased significantly 3 months after implantation. Serum iPTH levels were higher in the TheraCyte A group than in the TheraCyte B group (p=0.006), and higher in the TheraCyte B group than in the control group (p=0.040). Serum calcium levels were not significantly higher in the TheraCyte group A than in the TheraCyte B group or in the control group. Serum phosphorus levels were not significantly different between the TheraCyte A and TheraCyte B groups.Implantation of TheraCyte A-encapsulated 4x10(5) live parathyroid cells and TheraCyte B-encapsulated 4x10(6) cells can increase the BMD of ovariectomized rats within 3 months of implantation. Neither cause high serum calcium and low phosphorus concentrations.

ObjectiveTo assess in a prospective study the use of a new variable, the residual prostatic weight ratio (RPWR), for evaluating the clinical outcome after transurethral resection of the prostate (TURP). Patients and methodsFrom April 1996 to June 1997, 40 men (mean age 70.4 years, range 53–85) with symptomatic benign prostatic hyperplasia were evaluated using the American Urological Association (AUA) symptom score, measurements of the mean and maximum urinary flow rate (Qave and Qmax), and by transrectal ultrasonography (TRUS) before and 16 weeks after TURP. The estimated total prostate weight was derived as 0.52 × length × width × height × the specific gravity of the prostate (1.010). The RPWR was calculated as the prostate weight after TURP divided by the initial weight, where the value after TURP was the initial weight minus that of the TURP specimen. The clinical outcome was evaluated by the difference (Δ) in AUA score, Qmax and Qave before and 16 weeks after surgery. ResultsThere was a close correlation between the estimated prostate weight and the actual weight of the TURP specimen (r = 0.82 and 0.80 for the adenoma and total prostate, respectively). The mean (sd) RPWR, ΔAUA score, ΔQmax and ΔQave were 50.1 (17.1)%, 11.5 (5.3), 9.0 (4.2) mL/s and 6.2 (2.9) mL/s, respectively. There was a negative correlation between the RPWR and the ΔAUA, ΔQmax and ΔQave (r = −0.81, −0.68, and −0.70, respectively, P

Objective To evaluate the clinical significance of serum alkaline phosphatase (ALP), ALP bone isoenzyme (ALPb) and prostate specific antigen (PSA) levels in predicting bony metastasis in prostatic carcinoma. Patients and methods The levels of serum ALP, ALPb and PSA were assessed in 32 patients with prostatic carcinoma and bony metastasis (group 1), 31 with prostatic carcinoma without bony metastasis (group 2), and 31 with benign prostatic hyperplasia (group 3). Bony metastases were detected using whole-body bone scintigraphy and ALPb was estimated electrophoretically before surgical or medical treatment. The levels of the three markers were compared for their ability to predict bony metastasis. Results In groups 1, 2 and 3, respectively, the mean (sd) serum levels of ALP were 304 (322.2), 76.6 (47.5) and 63.8 (14.7) IU/L, of ALPb were 79.9 (76.9), 23.6 (9.9) and 25.3 (9.0) IU/L and of PSA were 478.1 (352.2), 46.9 (32.1) and 8.1 (1.8) ng/mL. The differences in serum ALP and ALPb between groups 1 and 2, and between groups 1 and 3 were significant (P < 0.05), but not those between groups 2 and 3. The positive predictive value (PPV) for bony metastasis in patients with prostatic carcinoma was 91.3% (21/23) and 100% (18/18) and the negative predictive value (NPV) was 71.8% (28/39) and 68.9% (31/45) for ALP and ALPb, respectively. Conclusion Both serum ALP and ALPb were increased significantly in patients with prostatic carcinoma with bony metastasis. The level of ALPb had a higher PPV and specificity for bony metastasis than had the level of ALP, but a lower NPV and sensitivity than ALP or PSA (at PSA levels>20 ng/mL).

To examine the predictive factors of successful redo varicocelectomy in infertile patients with recurrent varicocele, we made a retrospective study. Twenty-one patients who had improved quality of spermatozoon 6 months after RV were designated as group 1, those with no improvement as group 2 (17 subjects) and those who received close surveillance as group 3 (10 patients) were recruited. The predictive factors included were time to recurrent varicocele; semen quality; testicular volume; number of ligated veins; body mass index; serum levels of follicle-stimulating hormone (FSH), luteinising hormone and testosterone; scrotal temperature; and peak retrograde flow (PRF) and maximal vein diameter (MVD) by colour Doppler ultrasound. The quality of spermatozoon improved significantly 6 months after RV in group 1 patients (21, 55.3%), and no improvement in group 2 and 3 patients. Patients in group 1 also had significantly lower FSH and PRF, longer time to recurrent varicocele, higher number of ligated veins and larger testicular volume than the group 2 (17, 44.7%) and group 3 patients. The significant predictive factors of successful RV were lower FSH and PRF; longer time to recurrent varicocele; and larger testicular volume preoperatively and a higher number of ligated veins during redo varicocelectomy.

Information concerning the clinical characteristics in elderly men with varicocoele is relatively limited. This study was assessed to evaluate the differences in clinical characteristics between young and elderly patients with varicocoele by retrospective chart review. Between June 2003 and February 2011, 169 young (18-30 years) men and 156 elderly (45-55 years) men with varicocoele, and 30 age-matched men without varicocoele were recruited for this study. All the patients were divided into six groups. Thirty-one infertile patients were assigned to Group 1, 138 fertile patients to Group 2, 35 infertile patients to Group 3 and 121 fertile patients to Group 4. Group 5 (15 young) and 6 (15 elderly) were control groups. The parameters for comparison included body mass index (BMI), semen quality (sperm motility, morphology and density) and pH value, serum concentration of follicle-stimulating hormone (FSH), luteinizing hormones (LH), testosterone, testicular volume, grade of varicocoele and peak retrograde flow (PRF) and maximal vein diameter (MVD) by colour Doppler ultrasound (CDS). Elderly men with varicocoele had a higher incidence of bilateral varicocoele (25.5% vs. 14.8%), but a lower incidence of unilateral right varicocoele (2.6% vs. 7.7%) than young patients with varicocoele. In addition, patients with varicocoele had lower BMI than those without, and infertile young patients with varicocoele had the lowest levels of BMI. Furthermore, infertile patients (Groups 1 and 3) with varicocoele had significantly lower testicular volume and semen pH, lower levels of testosterone, higher levels of FSH and LH and higher PRF than fertile men with varicocoele (Groups 2 and 4). In conclusion, infertile elderly patients with varicocoele had significantly lower levels of testosterone and higher levels of FSH and LH than infertile young men with varicocoele. In addition, infertile elderly patients with bilateral varicocoele (Group 3, n = 8) had the lowest levels of testosterone.

To assess the possible risk factors for developing pain in normospermic adult varicocoele patients, 42 adult patients with left painful varicocoele (group 1) and 35 age-matched patients with left painless varicocoele (group 2) were recruited to this study. All the patients had normal semen quality (spermatozoa density, motility and morphology). Pain score on a 10-cm visual analogue scale was used to assess the scrotal pain as a result of varicocoele. The severity of pain was defined as follows: mild pain (1-3 cm), moderate pain (4-6 cm) and severe pain (7-10 cm). The parameters for comparison included body mass index (BMI), the distance from the renal hilum to scrotum (DRS), semen quality and pH value, serum concentration of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone, alkaline phosphatase (Alk-p), lactate dehydrogenase (LDH), testicular volume and discrepancy (%), grade of varicocoele and peak retrograde flow (PRF) and spontaneous venous reflux (SVR) by colour Doppler ultrasound and scrotal temperature (ST). The mean ages were 27.8 and 27.1 years old in groups 1 and 2, respectively. By multivariate analysis, patients in group 1 had significantly higher PRF, ST, DRS and rate of SVR, and lower BMI than those in group 2. Furthermore, there were significant differences in PRF, DRS and BMI among patients in group 1 with different degrees of pain. Conclusively, normospermic adult patients with left painful varicocoele had significantly higher peak retrograde flow, ST, distance from the renal hilum to scrotum, and rate of spontaneous venous reflux and lower BMI than those with left painless varicocoele. Furthermore, varicocoele patients with severe pain had significantly higher peak retrograde flow and distance from the renal hilum to scrotum, and lower BMI than those with moderate and mild pain.

Background: This study was undertaken to evaluate whether or not pretreatment serum biochemical markers are prog- nostic factors for prostatic cancer with bony metastasis in patients on hormonal treatment. Methods: Between 1983 and 1998, 127 patients with prostatic cancer and bony metastasis were included for evalua- tion. Serum prostate-specific antigen, alkaline phosphatase, calcium (Ca), lactic dehydrogenase, inorganic phosphate, γ-glutamine transpeptidase, uric acid, albumin (Alb), iron, cholesterol (Cho), triglyceride, alanine aminotransferase, aspar- tate aminotransferase, and hemoglobin (Hb) were checked before treatment. The patients were divided into 2 groups according to their response (group 1, good response; group 2, poor response). Results: There were 54 patients in group 1 and 73 patients in group 2. Pretreatment levels of serum Ca, Alb, Cho and Hb were higher in group 1 than in group 2, while the other parameters were lower in group 1 than in group 2; only pre- treatment levels of serum Ca, Alb and Hb were significantly different between groups (p < 0.05). When stratified by tumor grading, patients in group 1 still had significantly higher pretreatment levels of Ca, Alb and Hb than those in group 2. Conclusion: Higher pretreatment serum levels of Ca, Alb and Hb are good prognostic factors for patients with metastatic prostatic cancer on hormonal treatment, irrespective of tumor grading. (J Chin Med Assoc 2009;72(6):301-306)

Following the development of reliable methods for inferring the direction of mutations of the single nucleotide polymorphism (SNP), and the revealing of the human isochore map, it has become possible to investigate the evolution of the isochore structure in a continuous region. In this study, the recent evolution of the isochore structure on human chromosome 18, as inferred from the SNP, was examined. A remarkable mutation bias was found, which was destroying the present isochore structure. However, a fixation bias contributed by the biased gene conversion (BGC) effect and a rising fixation probability of derived alleles with increasing GC content was extending the present isochore structure. Combining the two opposing processes, the old isochore structure was declining and a more homogenous isochore structure with higher GC content was being formed on the chromosome. During this process, both the CpG and genic sites, which were present in the isochore but were paid little attention to before, played an important role. In addition, the recombination was confirmed to promote the GC alleles fixed in the genome because of the BGC effect. For the first time, it was observed that with the occurrence of little recombination, AT alleles had the identical fixation probability with GC alleles in the recombination cold spots.

To investigate the prevalence and genetic characteristics of myotonic dystrophy type 1 (DM1) in Taiwan, DM-suspected patients and their families identified during the period of 1990–2001 had their clinical records reevaluated and the CTG repeat sizes at the DM1 locus examined. A total of 96 subjects belonging to 26 families were identified as DM1 patients, which gave a minimal disease prevalence of 0.46/100,000 inhabitants. Clinical anticipation was frequently observed in affected families, even in some parent-child pairs with transmission contraction of the CTG repeat size. The inverse correlation between age at onset and CTG repeat length was significant only in patients with small expansions. In addition, a DM1 carrier with a childhood-onset son was found to have CTG length heterogeneity in the range of 40–50, indicating that premutation alleles could be unstable during gametogenesis as well as in somatic tissues. Our data demonstrated that DM1 is a rare disease in Taiwan and showed that transmission contraction of repeat size is more likely to occur in alleles with large repeats.

A system for measuring the pulmonary function was reported. The System consists of Fleisch flow transducer, a pressure transducer an amplifier, A/D converter, and a 486 computer. It can measure the indices of respiratory function under tidal breathing, the indices of tidal breathing flow volume loop and the dynamic indices of passive respiration.

A replication-deficient recombinant retrovirus containing the cDNA coding for human vascular endothelial growth factor (VEGF) was generated, and then infected rabbit primary skin fibroblasts. After selection with G418, the transduced colonies have the ability of producing VEGF. The integration and expression of VEGF in transduced cells were confirmed by Southern blot, PCR, Northern blot and RT-PCR assay. The VEGF secreted by transduced cells has strong bioactivity when assayed by endothelial proliferation and Miles vascular permeability assay. Thus, this study pave the way for future study of biological and physiological effect of VEGF in vivo.

Adenoid cystic carcinoma (ACC) of the salivary glands is a highly infiltrative malignant tumour with a tendency for lung metastasis. Gene therapy could be a potentially effective therapy for ACC and its metastasis. The aims of the study were: To transduce interleukin-2 (IL-2) gene into an ACC cell line with predisposition for lung metastasis (ACC-M); to compare the bioactivity of the gene-transduced cells and the parent cell line in vitro and in vivo . The IL-2 gene was transduced via a bicistronic retroviral vector into the ACC-M cells. The growth rate and DNA cell cycles of the parent ACC-M, the control viral vector AmGCEN, and the gene transduced AmIL-2 cell cultures were compared quantitatively and by flow cytometry, respectively. The tumourigenic ability of the three cell lines was verified by inoculation in athymic nude mice. The tumours developed were extracted and compared quantitatively and histologically. There was no difference in the growth rate and the DNA count between the ACC-M, AmGCEN, and AmIL-2 cell cultures. In the animal experiment, both the ACC-M and AmGCEN cells stimulated lung metastasis in all the mice, whereas there was no tumour found in the 1×10 6 AmIL-2 cells inoculation. On 3×10 6 AmIL-2 cells stimulation, three out of six mice developed tumours but the mass and volume of the tumours were smaller than the other two groups. Under light microscopy, the ACC-M tumours were mainly poorly differentiated with minimal cellular matrix, whereas the AmIL-2 tumours were well differentiated with ample matrix. The transduction of IL-2 gene can reduce the tumourigenicity of ACC-M cells and induces tumour cell differentiation in mice. The IL-2 gene can be a potential effective gene for the treatment of adenoid cystic carcinoma of salivary glands and its lung metastasis.

A 35-year-old man came for a second opinion because of a hepatic lesion noted by ultrasound at a local clinic. The physical examination was unremarkable. Abdominal ultrasound showed a 1.2 cm subcapsular hypoechoic area in segment VI of the liver on a background of increased echogenicity, which was confirmed to be focal fatty sparing on subsequent computed tomography (CT) study of the abdomen. CT imaging disclosed that the tail and a portion of the body of the pancreas were absent (Figure 1), while …

To evaluate whether pretreatment serum hormone levels are a prognostic factor for prostatic cancer with bony metastasis under hormonal treatment.Between 1980 and 1994, 96 patients with prostate cancer and bony metastasis were included for an evaluation by a retrospective review of their charts. All 96 had received hormonal treatment after a diagnosis of metastatic prostatic carcinoma. Serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin were assessed before treatment. The patients were divided into two groups according to their response during the follow-up. Group 1 (good response) had no change or resolution of metastatic lesion(s) on the bone scan and a declining prostate-specific antigen (PSA) level. Group 2 had increased PSA or progression of metastatic lesion(s) on the bone scan. Tumours were graded as low (2-4), intermediate (5-7) and high (8-10) using the Gleason score.There were 43 patients in group 1 and 53 in group 2; the overall mean (sd) age was 72.5 (6.8) years and the follow-up 29.5 (0.5) months. The respective mean (sd) levels of testosterone, LH, FSH and prolactin before treatment were 4.6 (1.6) ng/mL, 20.2 (13.3) mIU/mL, 19.6 (18.6) mIU/mL and 20.7 (12.1) ng/mL in group 1, and 2.6 (1.0) ng/mL, 27.3 (11.0) mIU/mL, 27.1 (9.8) mIU/mL and 41.3 (28.4) ng/mL in group 2. The level of testosterone was significantly higher in group 1 than in group 2, while LH, FSH and prolactin were significantly lower in group 1 than in group 2. When stratified by tumour grade, patients in group 1 still had significantly higher pretreatment testosterone and lower LH, FSH and prolactin than those in group 2.Higher testosterone and lower LH, FSH and prolactin levels were good prognostic factors for patients with metastatic prostatic cancer under hormonal treatment, irrespective of tumour grading.

Intradural spinal lipoma not associated with spinal dysraphism is a rare tumor often presenting with nonspecific symptoms and indolent clinical course. Its intradural location and fat component is the key for proper preoperative diagnosis, which could hardly be made by traditional imaging studies including plain film and myelography. Both CT and MRI can reveal the fat component of the tumor, but MRI is superior to CT in demonstrating its relationship with adjacent normal nerve tissue. We report a 32-year-old man who had back pain for years and the symptom progressed rapidly in recent two months. MRI revealed an intradural tumor at T12 level with high signal intensity on both T1- and T2-weighted images. The signal intensity dropped dramatically with fat saturation technique, which confirmed fat as its main component. The patient received surgery and the tumor was proved to be an intraspinal lipoma.

Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are both demyelinating white matter disorders. It is difficult to differentiate ADEM from single episode MS because of the similar clinical presentation, cerebral spinal fluid (CSF) analysis, histological finding and magnetic resonance image (MRI) appearance. We report an ADEM case with unusual clinical presentations of predominant psychiatric symptoms, and relatively long disease course. Initially, we were not able to distinguish it from single episode MS. By means of sequential MR images followed up 2 years and spectroscopy studies, and the dramatic clinical improvement after corticosteroid therapy, ADEM was diagnosed as the disease entity of this patient. In this case report we will present the MR findings of this patient and discuss the differentiation between the ADEM and MS.

In order to understand lesions involving the suprazygomatic masticator space (SZMS) demonstrated on computered tomography (CT) or magnetic resonance (MR) images, we collected 45 cases of lesions in SZMS. There were hematomas in 26 cases, tumors in 16 cases, and abscesses in 3 cases. The location of these lesions in compartments of the SZMS and adjacent structures was analyzed. Most commonly hematoma was found in the deep loose connective tissue (80.8%), followed by the superficial dense connective tissue (61.5%). Only 2 SZMS hematoma involved the superficial fat pad. Five patients had air accumulation in the SZMS, and all were in the deep fat pad and with maxillary sinus fracture. Of the sixteen cases which were tumors, 12 were extended from adjacent structures, and four were primary tumor. In cases of tumor, compartments of SZMS involved most frequently were temporal muscles (15 of 16 cases), followed by deep fat pad (8 of 16 cases). The connective tissue layer of SZMS is a communication pathway for superficial spread of infection, hematoma, or tumor invasion to or from the scalp and face. Compartments of deep fat pad and temporal muscle are also pathways for the spread of disease to or from the face, intracranium and orbit. The primary tumors in infratemporal fossa and SZMS are rare. Malignant tumors in SZMS usually come from surrounding spaces.

We report a case of the direct carotid-cavernous fistula (CCF) with high-grade stenosis of the internal carotid artery (ICA) and treatment via the transarterial route after percutaneous transluminal angioplasty (PTA). A 46-year-old man was found to have a CCF after a motorcycle accident. Transarterial embolization was attempted, but it failed due to stenosis of the left cervical ICA. After the procedure of PTA for dilatation of the stenotic ICA, the fistula was successfully obliterated by detachable balloon subsequently. There were no complications or recurrence of the fistula at the three-year clinical follow up.

We report a case of direct carotid-cavernous fistula complicated with occlusion of internal carotid artery (ICA) at attempted endovascular obliteration via ICA and subsequent successful embolization via the posterior communicating artery (PCoA) approach. After a thorough understanding of vascular anatomical alterations associated with initial technical failure with detachable balloons, a microcatheter was navigated to the fistula site via the vertebro-basilar-PCoA to the distal cavernous segment of the left ICA. Embolization of the fistula was performed with deposition of three platinum microcoils. Angiograms after embolization showed complete disappearance of the fistula. There was no procedural complication and no recurrence of fistula at one-year clinical follow up.

Multiple aneurysms at the site of a basilar artery fenestration (BAF) are extremely rare. We report a case of BAF in association with two aneurysms successfully treated with Guglielmi Detachable Coils (GDCs). A 42-year-old male presented with subarachnoid hemorrhage and consciousness change. Angiograms of the vertebrobasilar artery demonstrated fenestration of the proximal basilar artery associated with two aneurysms. Embolization of aneurysms was done by using GDCs. Aneurysms were almost completely obliterated with preservation of the flow and lumen of the vertebrobasilar system. The patient remains asymptomatic at clinical follow-up of 18 months.