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Objective Sleep is an essential physiological process that protects our physical and mental health. However, the causality of the association between sleep and coronary heart disease (CHD) is unknown. Mendelian randomization (MR), using genetic variants as instrumental variables to test for causality, can infer credible causal associations. We applied a two-sample MR framework to determine the causal association between sleep (sleeplessness, sleep duration, and daytime dozing) and CHD by integrating summary-level genome-wide association study (GWAS) data. Methods Data included in this study were the GWAS summary statistics datasets from the C4D Consortium for CHD; Neale Lab UKB-a:13 Consortium for sleeplessness; Neale Lab UKB-a:9 Consortium for sleep duration and Neale Lab UKB-a:15 Consortium for daytime dozing. The conventional MR approach (inverse variance weighted, IVW) method and Egger method were used. Heterogeneity was calculated using each of the different MR methods where possible. Horizontal pleiotropy was evaluated by p-value of the MR–Egger intercept. Results The IVW method estimate indicated that the odds ratio (OR) (95% confidence interval, CI) for CHD was 3.924 (1.345–11.447) per standard deviation increase in sleeplessness (p = 0.012). Results were consistent in MR–Egger method (OR, 4.654; 95% CI, 1.191–18.186; p = 0.009). The genetically predicted sleeplessness was positively casually associated with CHD. The causal association between sleep duration (or daytime dozing) and CHD was not established. Conclusion Our analysis provided evidence supporting a causal relationship between sleeplessness (not sleep duration or daytime dozing) and CHD.

BACKGROUND The treatment outcome of transarterial chemoembolization (TACE) in unresectable hepatocellular carcinoma (HCC) varies greatly due to the clinical heterogeneity of the patients. Therefore, several prognostic systems have been proposed for risk stratification and candidate identification for first TACE and repeated TACE (re-TACE). AIM To investigate the correlations between prognostic systems and radiological response, compare the predictive abilities, and integrate them in sequence for outcome prediction. METHODS This nationwide multicenter retrospective cohort consisted of 1107 unresectable HCC patients in 15 Chinese tertiary hospitals from January 2010 to May 2016. The Hepatoma Arterial-embolization Prognostic (HAP) score system and its modified versions (mHAP, mHAP2 and mHAP3), as well as the six-and-twelve criteria were compared in terms of their correlations with radiological response and overall survival (OS) prediction for first TACE. The same analyses were conducted in 912 patients receiving re-TACE to evaluate the ART (assessment for re-treatment with TACE) and ABCR (alpha-fetoprotein, Barcelona Clinic Liver Cancer, Child-Pugh and Response) systems for post re-TACE survival (PRTS). RESULTS All the prognostic systems were correlated with radiological response achieved by first TACE, and the six-and-twelve criteria exhibited the highest correlation (Spearman R = 0.39, P = 0.026) and consistency (Kappa = 0.14, P = 0.019), with optimal performance by area under the receiver operating characteristic curve of 0.71 [95% confidence interval (CI): 0.68-0.74]. With regard to the prediction of OS, the mHAP3 system identified patients with a favorable outcome with the highest concordance (C)-index of 0.60 (95%CI: 0.57-0.62) and the best area under the receiver operating characteristic curve at any time point during follow-up; whereas, PRTS was well-predicted by the ABCR system with a C-index of 0.61 (95%CI: 0.59-0.63), rather than ART. Finally, combining the mHAP3 and ABCR systems identified candidates suitable for TACE with an improved median PRTS of 36.6 mo, compared with non-candidates with a median PRTS of 20.0 mo (log-rank test P < 0.001). CONCLUSION Radiological response to TACE is closely associated with tumor burden, but superior prognostic prediction could be achieved with the combination of mHAP3 and ABCR in patients with unresectable liver-confined HCC.

Background and aims Evidence on the effect of omega-6 fats on coronary heart disease (CHD) risk remains inconclusive. We applied a network MR framework to determine the causal effects between omega-6 levels and CHD and the potential cholesterol metabolic risk factors (Total cholesterol, TC; Low-density lipoprotein cholesterol, LDL-C; High-density lipoprotein cholesterol, HDL-C; Triglycerides, TG) which might act as mediators in the link between omega-6 levels and CHD by integrating summary-level genome wide association study (GWAS) data. Methods and results Network MR analysis-an approach using genetic variants as the instrumental variables for both the exposure and mediator to infer causality was performed to examine the causal effects between omega-6 levels and CHD and cholesterol metabolic risk factors. Summary statistics from the Kettunen et al. ’s consortium were used (n = 13506) for omega-6, CARDIoGRAMplusC4D consortium data were used (n = 184305) for CHD, and GLGC consortia data were used (n = 108363) for TC, LDL-C, HDL-C, and TG. The IVW method estimate indicated that the odds ratio (OR) (95% confidence interval [CI]) for CHD was 1.210 (1.118–1.310) per standard deviation increase in omega-6. Results were consistent in MR Egger method (OR, 1.418; 95% CI, 1.087–1.851; P = 0.050) and weighted median methods (OR, 1.239; 95% CI, 1.125–1.364; P = 0.000). Omega-6 was positively causal associated with TC, LDL-C, and TG but was not associated with HDL-C. Moreover, TC, LDL-C, and TG were positively associated with CHD. Conclusions Using a network MR framework, we provided evidence supporting a positive causal relationship between omega-6 and CHD, which might be partially mediated by TC, LDL-C, and TG.

Objective: To assess the diagnostic test accuracy (DTA) of photodynamic diagnosis with 5-aminolaevulinic acid (5-ALA), hexylaminolevulinate (HAL) and narrow band imaging (NBI) for non-muscle-invasive bladder cancer (NMIBC), with white light-guided cystoscopy (WLC) as reference standard. Materials and Methods: A systematic review and narrative synthesis was performed in accordance with PRISMA. Major electronic databases were searched until 20th May 2019. All studies assessing the DTA of 5-ALA, HAL and NBI compared with WLC at patient and lesion-level were included. Relevant sensitivity analyses and risk of bias (RoB) assessment were undertaken. Results: 26 studies recruiting 3979 patients were eligible for inclusion. For patient-level analysis, NBI appeared to be the best (median sensitivity (SSY) 100%, median specificity (SPY) 68.45%, median positive predictive value (PPV) 90.75%, median negative predictive value (NPV) 100% and median false positive rate (FPR) 31.55%), showing better DTA outcomes than either HAL or 5-ALA. For lesion-level analysis, median SSY across NBI, HAL and 5-ALA were 93.08% (IQR 87.04-98.81%), 93.16% (IQR 91.48-97.04%) and 94.42% (IQR 82.37-95.73%) respectively. As for FPR, median values for NBI, HAL and 5-ALA were 20.40% (IQR 13.68-27.36%), 17.43% (IQR 12.79-22.40%) and 28.12% (IQR 22.08-42.39%), respectively. Sensitivity analyses based on studies with low to moderate RoB and studies with n>100 patients show similar findings. Conclusions: NBI appears to outperform 5-ALA and HAL in terms of diagnostic accuracy. All three modalities present high FPR, hence indicating the ability to detect additional cases and lesions beyond WLC.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Low serum albumin level is linked to the emergence of many cardiovascular diseases, including AF. In this study, we aim to characterize the nature and magnitude of the prospective association between serum albumin and incident AF in the Atherosclerosis Risk in Communities (ARIC) Study and investigate any causal relevance to the association between them. ARIC Study is a population-based, prospective, cohort study of cardiovascular risk factors in four US communities, initially consisting of 15,792 participants, aged 45–64 years, recruited between 1987 and 1989 (visit 1). The final sample size was 12,833 in this study. Baseline (visit 1) characteristics were compared between groups using one-way ANOVA test, Chi square test, or Kruskal–Wallis test as appropriate. We used multivariable Cox’ hazard regression models to assess the association between albumin and incident AF. Two-sample Mendelian randomization (MR) based on publicly available summary-level data from genome-wide association studies was used to estimate the causal influence of the serum albumin and incident AF. During a median follow-up of 25.1 years, 2259 (17.6%) participants developed incident AF. After multiple adjustment, serum albumin was inversely associated with incidence of AF [HR = 0.90, 95% CI 0.86–0.94, per SD (0.27 g/dL) increase; HR = 0.80, 95% CI 0.71–0.91, Q4 vs. Q1]. In MR analysis, we detected no evidence for a causal relation between serum albumin level and AF in inverse-variance weighted (IVW) method (odds ratio: 0.996, 95% CI 0.980–1.012, per 1 g/dL increase of albumin; P = 0.620) without evidence of heterogeneity between estimates from individual SNPs (Pheterogeneity = 0.981 [MR-Egger] and Pheterogeneity = 0.860 [IVW]) nor pleiotropy effect (Ppleiotropy = 0.193). The serum albumin level is independently inverse associated with incident AF in a linear pattern. However, MR analyses did not support a causal role of serum albumin in the etiology of AF.

Background Although sudden death (SD) is a rare complication after atrioventricular junction (AVJ) ablation and permanent pacemaker implantation, the risk factors leading to this SD remain unknown. The purpose of this study was to investigate SD and its risk factors after ablate-and-pace strategy for rate control in atrial fibrillation (AF) patients during long-term follow-up. Hypothesis Methods From January 2005 to December 2009, we enrolled into this study 517 AF patients with AVJ ablation and right ventricular pacemaker implantation. Patients were divided into 2 groups, SD and non-SD. Cox proportional hazards models were used to assess potential risk factors for overall mortality and SD. Results During a mean follow-up of 25.8 ± 18.6 months (range, 3 days to 63.8 months), 53 patients died (15 with SD). Cox proportional hazards models showed that the presence of congestive heart failure, New York Heart Association functional class, chronic renal failure, and nonsustained ventricular tachycardia were risk factors that predicted overall mortality. For SD, the presence of dilated cardiomyopathy and mitral stenosis were associated risk factors. SD was exclusively seen in patients who had narrow QRS complex or right bundle branch block prior to AVJ ablation and pacemaker implantation; SD was not seen in any patient with preexisting complete left bundle branch block. Conclusions Dilated cardiomyopathy, mitral stenosis, and baseline QRS morphology should be examined as potential risk factors for SD after AVJ ablation and pacemaker implantation.

Selenium (Se), a nutritionally essential trace element, is associated with health and disease. Selenoprotein T (SelT) was identified as a redoxin protein with a selenocystein, localizing in the endoplasmic reticulum. The myosin light chain kinase (MLCK) and myosin light chain (MLC) play key roles in the contraction process of smooth muscle. The present study was to detect the effect and mechanism of SelT on the contraction process of gastric smooth muscle. The WT rats were fed with different Se concentration diets, and Se and Ca(2+) concentrations were detected in the gastric smooth muscle. Western blot and qPCR were performed to determine SelT, CaM, MLCK, and MLC expressions. MLCK activity was measured by identifying the rates of [γ-32P]ATP incorporated into the MLC. The results showed Se and Ca(2+) concentrations were enhanced with Se intake in gastric smooth muscle tissues. With increasing Se, SelT, CaM, MLCK and MLC expressions increased, and MLCK and MLC activation improved in gastric smooth muscle tissue. The SelT RNA interference experiments showed that Ca(2+) release, MLCK activation, and MLC phosphorylation were regulated by SelT. Se affected the gastric smooth muscle constriction by regulating Ca(2+) release, MLCK activation, and MLC phosphorylation through SelT. Se plays a major role in regulating the contraction processes of gastric smooth muscle with the SelT.

Use different concentrations of biological activity water on corn seeds (Zhen Dan 958) by soaking to deal with, dilution multiple is primary liquid、10 times、50 times、100 times、200 times、400 times and 800 times respectively, as a comparison with distilled water, exploring the influence of biological activity water on corn seeds germination and seedling growth. The result shows: the highest germination rate、germination potential、germination index and germination energy of corn seeds are dealt with by dilute 800 times biological activity water, the aboveground part and root of maze seedlings’ dry weight is largest; dealing with by dilute 800 times biological activity water of maze seedlings’ chlorophyll are at its highest. The experiment tells that biological activity water has effect on corn seeds germination and seedling growth, its effect and dilute strength are related.

Purpose: To describe the clinical, imaging, and pathologic characteristics and diagnostic methods of telangiectatic osteosarcoma (TOS) for improving the diagnostic level. Materials and methods: The authors retrospectively reviewed patient demographics, serum alkaline phosphatase (AKP) levels, preoperative biopsy pathologic reports, pathologic materials, imaging findings, and treatment outcomes from 26 patients with TOS. Patient images from radiography (26 cases) and magnetic resonance (MR) imaging (22 cases) were evaluated by 3 authors in consensus for intrinsic characteristics. There were 15 male and 11 female patients in the study, with an age of 9–32 years (mean age 15.9 years). Results: Eighteen of 26 patients died of lung metastases within 5 years of follow-up. The distal femur was affected more commonly (14 cases, 53.8%). Regarding serum AKP, normal (8 cases) or mildly elevated (18 cases) levels were found before preoperative chemotherapy. Radiographs showed geographic bone lysis without sclerotic margin (26 cases), cortical destruction (26 cases), periosteal new bone formation (24 cases), soft-tissue mass (23 cases), and matrix mineralization (4 cases). The aggressive radiographic features of TOS simulated the appearance of conventional high-grade intramedullary osteosarcoma, though different from aneurysmal bone cyst. MR images demonstrated multiple big (16 cases) or small (6 cases) cystic spaces, fluid-fluid levels (14 cases), soft-tissue mass (22 cases), and thick peripheral and septal enhancement (22 cases). Nine of 26 cases were misdiagnosed as aneurysmal bone cysts by preoperative core-needle biopsy, owing to the absence of viable high-grade sarcomatous cells in the small tissue samples. Conclusion: The aggressive growth pattern with occasional matrix mineralization, and multiple big or small fluid-filled cavities with thick peripheral, septal, and nodular tissue surrounding the fluid-filled cavities are characteristic imaging features of TOS, and these features are helpful in making the correct preoperative diagnosis of TOS.

A multi-residue method for the analysis of pesticides in tea was developed by online size exclusion chromatography (SEC)-GC/MS with full scan mode. The sample was fortified with chlorpyrifos-d 10 isotope internal standard and extracted by acetonitrile. After purification by primary secondary amine sorbent and solvent exchange by SEC mobile phase, the sample was detected by online SEC-GC/MS. The purification result of the online system was evaluated by comparing the correlation between Chinese cabbage and tea matrix. The factors for method optimization included sample preparation, matrix effects and the instrument parameters of each online component. Scatter plot was introduced in this study to directly illustrate the results of the condition optimization and matrix effects in the online system. For most of the pesticides, the average recoveries ranged from 70 to 130% and the RSD were below 15%. The feasibility of the application of full scan mode in multi-residue determination of trace amounts of pesticides (LODs below 0.01 mg/kg) in a complex matrix was discussed.

Purpose To study the value of postoperative transcatheter arterial chemoembolization (TACE) to improve the efficacy of hepatectomy and tumor thrombus removal for patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). Experimental design From January 1996 to December 2004, 126 patients with HCC and PVTT were randomly assigned into 2 groups: a control group and a TACE group. The control group underwent liver resection combined with PVTT removal, and the TACE group underwent liver resection combined with adjuvant TACE after surgery. Survival time in the 2 groups was studied. Results The 2 groups were comparable with regard to all clinicopathologic data. The median survival time was 13 months (95% confidence interval [CI] 6.25 to 19.75 months) for the TACE group and 9 months (95% CI 6.90 to 11.10 months) for the control group. Estimated survival rates for 1, 3 and 5 years were better in the TACE group (50.9%, 33.8%, 21.5%; respectively) than the control group (33.3%, 17.0%, 8.5%, respectively; log rank P = .0094). Conclusions Postoperative TACE enhances the effect of liver resection combined with PVTT removal for HCC patients with PVTT.

Objective To analyze at one institution the endovascular treatment for aortic arch and proximal thoracic aortic lesions, categorize open arch reconstruction, and make preliminary recommendations based on pathology (dissection vs aneurysm), and anatomical extent of disease. Methods A retrospective review of aortic arch and descending thoracic aortic lesions managed with endovascular treatment between June 2002 and June 2007. Results Thirty-four patients received endovascular repair for aortic dissection (n = 28) and aneurysm (n = 6). Open supra-aortic transposition or debranching of the great vessels was performed in 14 cases of dissection (50%) and six cases (100%) of aneurysm. In 14 dissections, the entry tear was located in the distal aortic arch, enabling the left subclavian artery to be sealed without reconstruction. The procedures were successful in 33 patients (97.1%); one intraoperative death occurred. Type I endoleaks were found intraoperatively in eight cases. After management with balloon angioplasty and by extending the stent implantation, the endoleaks resolved in four cases and decreased in four cases. One patient with Stanford type A dissection died from an unknown cause 3 months after treatment. The overall survival rate was 94.1% (32/34), and all bypass grafts remained patent during the follow-up period. Conclusions Endovascular stent grafting is a safe and effective method for the treatment of aortic arch lesions. Transposition of the supra-aortic great vessels can be effectively combined with endovascular stent grafting to ensure both cerebral blood supply and enough landing area for the stent graft.

To evaluate the effect of transcatheter arterial chemoembolization (TACE) for osteosarcoma and to describe the clinicopathologic features produced by TACE as well as the effect of different embolic materials. From January 1998 to December 2003, preoperative TACE was carried out in 32 patients. The preoperative and postoperative clinical response, levels of alkaline phosphatase (AKP), leukocyte count, and clinicopathologic features were recorded. We also compared the effect of different embolic materials: adriblastine gelatin microspheres, anhydrous alcohol, common bletilla tuber, and gelatin sponge particles. The levels of AKP were significantly decreased after treatment (p

Background: Sorafenib is a promising drug for advanced hepatocellular carcinoma (HCC); however, treatment may be discontinued for multiple reasons, such as progressive disease, adverse events, or the cost of treatment. The consequences of sorafenib discontinuation and continuation are uncertain. Materials and Methods: We retrospectively analyzed 88 HCC patients treated with sorafenib from July 2007 to January 2013. Overall survival (OS), post-disease progression overall survival (pOS), and time to disease progression (TTP) were compared for survival analysis. Cox proportional hazard regression was performed to assess the effect of important factors on OS in the overall patient population and on pOS in patients who continued sorafenib treatment. Results: Sorafenib was discontinued and continued in 24 and 64 patients, respectively. The median OS (355 vs 517 days respectively; p=0.015) and median post-PD OS (260 vs 317 days, respectively; p=0.020) were statistically different between the discontinuation and continuation groups. Neither the median time to first PD nor the time to second PD were significantly different between the 2 groups. In the discontinuation group, 3 of the 24 patients (12.5%) suffered disease outbreaks. In Cox proportional hazard regression analysis after correction for confounding factors, BCLC stage (p=0.002) and PD site (p=0.024) were significantly correlated with pOS in patients who continued sorafenib treatment. Conclusions: Sorafenib discontinuation may cause HCC flares or outbreaks. It is advisable to continue sorafenib treatment after first PD, particularly in patients with Barcelona Clinic Liver Cancer stage B disease or only intrahepatic PD.

Spontaneous hemoperitoneum in pregnancy is a rare but potentially life-threatening condition for the mother and fetus. A case of spontaneous hemoperitoneumwith intrahepatic cholestasis of pregnancy during the third trimester is presented. The bleeding site remained undiscovered after two exploratory laparotomies. A 33-year-old woman (G5, P1) at 32 weeks of pregnancy presented at the affiliated hospital of North Szechwan Medical College in January 2012 with acute pain in the right middle abdomen that had been ongoing for 6 hours. The patient reported no history of trauma or previous cesarean delivery, had no vaginal bleeding, no fever or vomiting, and had not received regular prenatal check-ups. Her vital signs were stable and there was severe abdominal tenderness on physical examination. Fundal height was 32 cm and the patient’s cervix was not effaced. A nonstress test was reactive and uterine contractions were not detected. The laboratory results indicated infection and mild anemia (Table 1). Sonographic examination showed a singleton fetus in vertex presentation and the patient’s liver, spleen, and gallbladder were normal; appendicitis was suspected. An exploratory laparotomy was performed under epidural anesthesia. The incision was made over the right lower quadrant and a profuse amount of blood and a blood clot were observed. The appendix was intact. A right paramedian incision was then performed under general anesthetic. After removing 1.5 liters of intraperitoneal clotted blood, the peritoneal cavity was palpated carefully to find the source of the bleeding. The explorationwas suboptimal owing to the enlarged uterus, and no obvious active bleeding was found. The patient’s condition was stable and preterm delivery was avoided. Surgical drainswere left in place postoperatively tomonitor the output. The daily output was 30–50 mL of exudative sanguineous fluid and there was no evidence of new active bleeding. The patient received dexamethasone, formula supplements including vitamin B complex, aminofusin, and potassium and magnesium aspartate, and a red blood cell suspension transfusion of 7 units. Laboratory results on the seventh day after the first laparotomy raised suspicion for intrahepatic cholestasis of pregnancy with associated hypoproteinemia (Table 1). A viable male neonate weighing 2390 g was delivered by emergency cesarean and treated in the intensive care unit. APGAR scores were 9 and 10 at 1 and 5 minutes, respectively. Following closure of the uterine incision, a second laparotomy was performed to check the abdominal and pelvic organs, but the origin of the hemorrhage could still not be located. The postoperative period was uneventful. The patient and neonate were discharged on the ninth day after delivery. No further hemoperitoneum or adverse outcomes occurred during the next six months of follow-up. Spontaneous hemoperitoneum during the second or third trimester of pregnancy is rare. Thepathogenesis of spontaneous hemoperitoneum is unclear because it may develop from the rupture of various abdominal or pelvic structures, including the liver, spleen, uterus, and blood vessels [1]. A review of the literature and 25 cases reported that endometriosis might be another risk factor for the condition [2]. Only one International Journal of Gynecology and Obstetrics 127 (2014) 297–300

Purpose: To describe the clinical, imaging, and pathologic characteristics and diagnostic methods of telangiectatic osteosarcoma (TOS) for improving the diagnostic level. Materials and methods: The authors retrospectively reviewed patient demographics, serum alkaline phosphatase (AKP) levels, preoperative biopsy pathologic reports, pathologic materials, imaging findings, and treatment outcomes from 26 patients with TOS. Patient images from radiography (26 cases) and magnetic resonance (MR) imaging (22 cases) were evaluated by 3 authors in consensus for intrinsic characteristics. There were 15 male and 11 female patients in the study, with an age of 9–32 years (mean age 15.9 years). Results: Eighteen of 26 patients died of lung metastases within 5 years of follow-up. The distal femur was affected more commonly (14 cases, 53.8%). Regarding serum AKP, normal (8 cases) or mildly elevated (18 cases) levels were found before preoperative chemotherapy. Radiographs showed geographic bone lysis without sclerotic margin (26 cases), cortical destruction (26 cases), periosteal new bone formation (24 cases), soft-tissue mass (23 cases), and matrix mineralization (4 cases). The aggressive radiographic features of TOS simulated the appearance of conventional high-grade intramedullary osteosarcoma, though different from aneurysmal bone cyst. MR images demonstrated multiple big (16 cases) or small (6 cases) cystic spaces, fluid-fluid levels (14 cases), soft-tissue mass (22 cases), and thick peripheral and septal enhancement (22 cases). Nine of 26 cases were misdiagnosed as aneurysmal bone cysts by preoperative core-needle biopsy, owing to the absence of viable high-grade sarcomatous cells in the small tissue samples. Conclusion: The aggressive growth pattern with occasional matrix mineralization, and multiple big or small fluid-filled cavities with thick peripheral, septal, and nodular tissue surrounding the fluid-filled cavities are characteristic imaging features of TOS, and these features are helpful in making the correct preoperative diagnosis of TOS.

The persistence of the Tertiary relict tree Tetracentron sinense Oliv. on the eastern slope of the Ailao Mountains, Yunnan, SW China, was here studied in terms of population structure (size, age) and regeneration patterns. T. sinense occurred in unstable habitats by stream banks, on steep slopes, on scree slopes, or on roadsides near streams in narrow valleys, all places subject to frequent natural disturbances, whereas none were found on stable gentle slopes free of major disturbances at similar altitudes. Further, no established saplings of T. sinense were found in forests having high bamboo (Yushania crassicollis Yi) coverage in their understory. The size and age structure of T. sinense were multimodal. The reproduction of the tree was either by means of abundant minute wind-dispersed seeds or by resprouts in unstable habitats. These populations depended on disturbance or gap regeneration to survive. T. sinense, along with other tree life-forms including evergreen broad-leaved species and conifers, dominated in the forest canopy layer, even reaching the emergent layer in places. Results of the study provide insight into the ecological characteristics and survival mechanisms of this East Asian paleoendemic tree species. The study will provide a scientific basis for recommendations for the conservation of this species and for other Tertiary relict plants having similar regeneration dynamics.

To examine the selective killing effects of pEGFP-C1-mediated double suicide gene system driven by the hTERT promoter (hTERT-CDglyTK) on hepatic carcinoma cells.The hTERT promoter and gene fragments SV40, yCD and TKgly were amplified by PCR (polymerase chain reaction) and then inserted into pEGFP-C1. And the constructs of pEGFP-hTERT-CD, pEGFP-hTERT-TK and pEGFP-hTERT-CDglyTK were transfected to SMMC 7721 or HL7702 respectively. The transfection effects were observed and the cellular expressions of suicide genes detected by RT-PCR (reverse transcription-polymerase chain reaction), QPCR (quantitative polymerase chain reaction) and Western blot. The transfected cells were treated with 5-fluorocytosine and ganciclovir at different concentrations and the cell-killing and bystander effects evaluated by the method of MTT (3-(4,5)-dimethyl thiadiazole (-z-y1)-3,5-di-phenytetrazoliumromide). The activity of cell telomerase was detected by the method of TRAP-argentation and the apoptotic rates analyzed by flow cytometry. All results of double and single gene systems were analyzed.The fragments of enzyme digestion corresponded to the expectations. RT-PCR, QPCR and Western blot demonstrated the expressions of CD, TK and CDglyTK. pEGFP-hTERT-CD, pEGFP-hTERT-TK and pEGFP-hTERT-CDglyTK showed the similar transfection efficiencies in SMMC7721 (74.5%, 76.3%, 76.9%). More sensitive to the prodrugs (P = 0.020, P = 0.015), higher apoptotic rates (P = 0.023, P = 0.017) and bystander effects (P = 0.012, P = 0.001)and lower telomerase activities (P = 0.045, P = 0.038) were observed in double gene system versus those in single gene system. However, the transfection and growth of HL7702 cell could not be infected by this double suicide gene.The plasmid of CDglyTK fusion gene system driven by hTERT promoter has been successfully constructed. It has demonstrated highly specific killing effects on hepatic carcinoma cells.

To detect the protein expressions of survivin and NF (nuclear factor)-κB and investigate their roles in the pathogenesis of hepatocellular carcinoma.A total of 206 cases were diagnosed as hepatocellular carcinoma, and immunohistochemical technique was used to detect the protein expressions of survivin and NF-κB in hepatocellular carcinoma samples and normal liver tissue specimens. Statistical analysis was performed to analyze the relationship of protein expressions of survivin and NF-κB and clinico-pathological parameters and prognosis.The expression of survivin was predominant in cytoplasm while that of NF-κB was in nucleolus. The positive rate of survivin protein was 78.2% in hepatocellular carcinoma and that of NF-κB was 81.1%. The positive rate of survivin and NF-κB was higher in hepatocellular carcinoma than that in benign hepatic tissue (11.7% and 15.5%). Significant differences existed in the expressions of survivin and NF-κB between hepatocellular carcinoma and normal hepatic tissue (P0.01). The expression of survivin was related to amicula invasion, portal vein tumor thrombus, lymph node metastasis and clinical stage in hepatocellular carcinoma (P0.01). The expression of NF-κB was also related to portal vein tumor thrombus, lymph node metastasis and clinical stage in hepatocellular carcinoma (P0.05). There was an obviously positive correlation between the expressions of survivin and NF-κB in hepatocellular carcinoma (r = 0.52, P0.01). Survival rate of patients for 1, 3 year of positive expression of survivin and NF-κB in hepatocellular carcinoma was 70.3% and 30.4%, respectively. And it was obviously lower than that of those of negative expression (88.5% and 61.5%). There was significant difference in the expressions of survivin and NF-κB between positive and negative subjects in 1, 3 year (P0.05).Protein expressions of survivin and NF-κB are higher in hepatocellular carcinoma. And they play mutually promoting roles in the development of hepatocellular carcinoma. Thus, an important prognostic indicator may be adopted.

This study was designed to detect the protein expression of VEGF, EGFR and MMP-9, to investigate the potential roles they might play in the pathogenesis of NSCLC and to discuss their relationship and their clinical significance.For 136 cases who were diagnosed of NSCLC, immunohistochemistry was used to detect protein expression of VEGF, EGFR and MMP-9 tumour and normal lung tissue specimens. Statistical analysis was performed on the relationship between protein expression of VEGF, EGFR and MMP-9 and clinico-pathological parameters and prognosis.Expression of VEGF and MMMP-9 was mostly in the cytoplasm, while EGFR wasfound in both cytoplasm and membranes. In NSCLCs, the positive rate of VEGF protein was 79.4% (108/136), for EGFR was 75.0% (102/136) and for MMP-9 was 68.4% (93/136), significantly greater than the normal tissue values of 16.0% (8/50), 12.0% (6/50) and 8.0% (4/50), respectively (P0.01). Expression of VEGF, EGFR and MMP-9 was related to pathology grading, lymph node metastasis and clinical staging in NSCLC (P0.01), while being independent of other clinicopathologic parameters (P0.05). There was an obvious positive correlation among the expression of VEGF and EGFR (r=0.25; P0.01), VEGF and MMP-9 (r=0.28; P0.01), EGFR and MMP-9 (r=0.19; P0.05) in NSCLCs.Protein expression of VEGF, EGFR and MMP-9 is elevated higher in NSCLC, correlating with progression.

To explore the technical success rate, efficacy, overall survival, recurrence-free survival and prognostic factors of transcatheter arterial chemoembolization (TACE) plus thermal ablations of radiofrequency ablation (RFA) and microwave ablation (MWA) in the patients with large hepatocellular carcinoma (HCC).Forty-five cases with Child-pugh class A, B cirrhosis and large HCC with a maximum tumor between 5.0 cm to 10.0 cm underwent TACE and thermal ablation. Twenty-five patients received TACE plus RFA while the other 20 patients underwent TACE plus MWA. Their efficacy, long-term survival and prognostic factors were statistically analyzed.TACE plus thermal ablation were performed in 84 tumors with a successful rate of 100% (86/86) and a complete ablation rate of 94.0% (79/84). The major complication rate was 6.7% (3/45). Local and distant recurrence rates were 66.7% (30/45) and 71.1% (32/45) respectively. The 1 and 2-year recurrence-free survival rates were 26.7% (12/45) and 13.3% (6/45). And the 1, 2 and 3-year survival rates were 80.0% (36/45), 33.3% (15/45) and 6.7% (3/45) respectively. Univariate and Cox regression analyses indicated that tumor size7.0 cm, multi-nodularity, incomplete necrosis and pretherapy α-fetoprotein (AFP) ≥ 200 µg/L were 4 unfavorable prognostic factors for the long-term survival.The combined procedures of TACE and percutaneous thermal ablation are both safe and effective for the unresectable large HCC (5.0 cm). It represents an alleviate treatment for those patients with tumor size7.0 cm. Tumor size, tumor number, completeness of necrosis and AFP level are all significant prognostic factors.

Genomic amplification of the human telomerase RNA gene (hTERC), located in the chromosome 3q26 region, has been documented in tumorigenesis. The present study was designed to detect hTERC amplification in cervical lesions and evaluate whether this might serve as a supportive biomarker to cytopathology or histopathology in the diagnosis of cervical lesions.Liquid-based thin-layer cytopathologic examination and detection of amplification by fluorescence in situ hybridization (FISH) was conducted in 130 women, along with assessment of human papillomavirus DNA, colposcopy with biopsy, and histopathologic examination.In cytopathologic examinations, hTERC amplification rates for negative for intraepithelial lesion or malignancy (NILM),atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC) cases were 0% (0/10), 4% (1/25), 20% (6/30), 77% (27/35), and 100% (10/10), respectively. The difference among abnormal cellular change groups was statistically significant (P0.05). In histopathologic examinations, hTERC amplification rates in normal squamous cell with or without inflammatory, cervical intraepithelial neoplasia 1 (CIN 1), CIN 2, CIN 3 and SCC cases were 3.8% (2/52), 18.2% (6/33), 66.7% (6/9), 84.6% (22/26), 100% (10/10), respectively. There were significant differences among CIN1, CIN2, CIN3 and SCC cases (P0.05). The hTERC amplification was more specific than HPV positivity in differentiating lowgrade from high-grade cervical disorders (specificity: 88.5% vs. 70.8%, P0.05).FISH detection of hTERC amplification could be an effective adjunct to cytopathologic or histopathologic examination for differential diagnosis of low- and high-grade cervical squamous cell disorders.

To analyze the relationship between the radiological progression and quality of life in ankylosing spondylitis (AS) patients using etanercept/methotrexate (MTX) combination therapy.A total of 153 AS cases fulfilling the 1984 modified New York diagnostic criteria were reviewed. All patients received radiological evolution at baseline and during a follow-up period. Radiological progression, clinical remission and life quality were recorded and analyzed for their relations.The radiological assessments of mSASSS (modified Stoke ankylosing spondylitis spine score) were recorded at baseline, 3, 612 months after treatment. Life quality assessments were recorded with SF (short-form)-36 simultaneously. No significant radiological improvement was observed at the end points. However, most patients reported a significant improvement of life quality after a combination therapy of etanercept/MTX. BASDAI (Bath ankylosing spondylitis disease activity index), C-reactive protein and erythrocyte sedimentation rate demonstrated similar trends. With no relevance with mSASSS, life quality was significantly correlated with disease activity and pain control.The combination therapy of etanercept/MTX greatly improves life quality in AS patients. Yet clinical remission and pain control offer no hint of a suspension of radiological progression. Routine radiological assessment is required throughout the follow-up period of AS even if life quality index reaches a high level.

Background Sixty percent of paragangliomas are located unilaterally at the carotid bifurcation. These are referred to as carotid body tumors (CBTs). Objective To present our 10-year experience in the management of patients with CBTs, and to evaluate the efficacy of angiography and preoperative embolization technique in this retrospective study. Methods Sixty-two patients with surgically removed CBTs (Shamblin class II and III), were divided into two groups. Group I, the preoperative embolization group, included 33 patients with 11 class II lesions and 25 class III lesions. Group II, the group that had surgery only, without preoperative embolization, included 29 patients with 9 class II lesions and 21 class III lesions. Comparisons were made between the groups in terms of mean intraoperative blood loss, mean operation time, mean postoperative hospital stay, and clinical complications. Results In group I, post-embolization angiography demonstrated complete tumor devascularization in 25 (76%) lesions and partial devascularization in 11 (24%) lesions. All but 1 (2%) lesion were completely excised. Mean intraoperative blood loss, mean operation time, and mean hospital stay were 354.8 ± 334.4 mL, 170.3 ± 75.4 min, 8.0 ± 2.1 days in group I and 656.4 ± 497.4 mL, 224.6 ± 114.0 min, 9.5 ± 3.5 days in group II, respectively. In group II, 27 lesions (91%) were completely removed. The transient ischemic attack (TIA) and cranial nerve injury incidence rates were 10.3% and 13.8% in group II and only 3% for TIA in group I. Conclusion These results suggest angiography is highly valuable for the diagnosis of CBT. Preoperative selective embolization of CBT is an effective and safe adjunct for surgical resection, especially for Shamblin class II and III tumors.

To explore protective mechanism of Lipo-PGE(1) on hepatic ischemia-reperfusion injury.Twenty-one adult dogs were divided into three groups randomly: CON group, IV group and SMA group, each group includes seven dogs. Animals were occluded porta hepatis 45 min and reperfused 60 min to establish I/R injury models. Lipo-PGE(1) administration was conducted once before porta occlusion 5 min and after reperfusion 60 min in IV and SMA group, the dosage of Lipo-PGE(1) was microgxkg(-1) and rate was 0.05 microgxkg(-1)xmin(-1); and 0.9% sodium chloride administration was conducted once at same time, the rate of NS was 2 mlxkg(-1). CT perfusion imaging, free pressure of portal vein, oxygen content of portal vein and hepatic oxygen delivery, index of liver function (ALT, LDH and TB) were performed in succession and compared before and after I/R. Simultaneously, the morphology of liver samples were observed by light microscope and electron microscope.(1) The liver perfusion was markedly decreased in the CON group, and moderately decreased in IV group and mildly in SMA group. (2) There was no significant difference of CpvO(2) in group comparison (P0.05) before and after I/R, but there was an increasing tendency in SMA group after I/R. There was significant difference of HDO(2) in group comparison before and after I/R (P0.05), but mildly in SMA group. (3) FPP increased obviously after I/R in control group, but there were no significant differences in the other groups. (4) The serious injury of liver in CON group after I/R was detected under light microscope and electron microscope, and moderately improved in IV group and markedly improved in SMA group.The protective mechanisms of Lipo-PGE(1) on hepatic ischemia-reperfusion injury include: improving microcirculation, releasing FPP, increasing CpvO(2) and HDO(2), as well as alleviating parenchyma injury.

Laryngotracheal reconstruction requires a supportive structure with a mucosal lining, which needs a vascular supply in order to regenerate properly. We investigated the necessity of a vascular carrier and mucosal graft when using porous titanium for laryngotracheal reconstruction. Surgical defects of the laryngotracheal complex in 22 rabbits were reconstructed with: (a) porous titanium implanted on a vascularized fascia combined with a buccal mucosal graft (first stage) before transposing to the neck area (second stage); (b) porous titanium implanted on a vascularized fascia (first stage) combined with a mucosal graft (second stage); (c) porous titanium on a pedicled fascia flap; and (d) porous titanium alone. The grafts were tolerated well. Re-epithelialization occurred in all groups. Normal mucosa with a submucosal layer containing vital cells was noted using the titanium implants. Blood vessels were grown in the pores of the titanium scaffold to supply the overlying mucosa. The scaffold was well integrated in the adjacent tracheal cartilage and surrounding tissues, except in the two cases that showed titanium displacement. Inflammation and granulation formation were seen in most rabbits in groups III and IV, initiated probably by the use of buccal mucosal grafts. Reconstruction of a rabbit's trachea using composites of porous titanium, mucosal grafts and a fascia flap is feasible. Titanium seems to meet the requirements needed for closing a small defect of the tracheal wall and allows for re-epithelialization. For larger defects, a vascular carrier with a mucosal graft is probably indispensable to ensure the process of re-epithelialization. Copyright (C) 2010 John Wiley & Sons, Ltd.

The classical union-find algorithm is the basis for many graph algorithms and for dealing with equality. The easiest way to implement concurrent objects is by means of classical software solutions, but this leads to blocking when the process that holds exclusive access to the object is delayed or stops functioning. Thus we require our solutions to the data structure problem have the lock-free property. In this paper, we present an efficient lock-free algorithm for union-find with deletion, which promises more robust performance and reliability than conventional lock-based implementations.

We characterized the clinicopathological changes after transarterial chemoembolization for treatment of Wilms tumor.A total of 44 consecutive patients with Wilms tumor were randomized to undergo transarterial chemoembolization preoperatively or to undergo surgery only. We compared the clinicopathological findings of resected tumor from the 2 groups.Tumor-free survival at 2 years in the group undergoing transarterial chemoembolization was significantly higher compared to the control group (p0.01), and tumor related recurrence and deaths within 1 year were significantly lower in the study group than in controls (p0.01). Average tumor shrinkage was 48.2% in the study group. Average area of necrosis in tumor sections was 63.5% in the study group and 15% in controls (AUC 2.78, p0.01). Percentage of tumor with moderate to severe interstitial fibrosis was 64% (14 of 22 patients) in the study group and 18% (4 of 22) in controls (AUC 2.72, p0.01). Comparative rates of percentage of tumor demonstrating grade III to IV lymphocytic infiltration were 73% (16 of 22 patients) and 18% (4 of 22, chi-square 11.6, p0.01), median mitotic index in tissues 1.4 and 0.19 (AUC 55.7, p0.01), and median apoptotic index of tumor cells 28.1 and 12.8 per 10 microscopic fields (AUC 109.00, p0.05). Expression of p53 and Bcl-2 protein did not differ between the groups, but Bax protein expression was significantly higher in the study group (85% vs 40%, p0.05).Transarterial chemoembolization induces tumor cell necrosis, degeneration and apoptosis, while also boosting interstitial fibrous tissue hyperplasia and lymphocyte infiltration. These histopathological findings could help explain the basis of the better clinical outcome in patients with Wilms tumor who underwent preoperative transarterial chemoembolization.

OBJECTIVE. In this article we report our experience with the diagnostic screening and management of children with melamine-induced nephrolithiasis. METHODS. A total of 1091 children younger than 4 years who had been exposed to melamine-contaminated formula from September 17 to October 12, 2008, were screened for nephrolithiasis at the department of pediatrics at Shenzhen Nanshan Hospital in China. During the clinical examination, each patient's demographic characteristics were recorded together with the details of his or her milk-consumption profile during the contamination scare and any clinical signs of poisoning. Urinary stones were detected by B-ultrasonography, and renal status was examined by a routine urine test panel and a renal function test. When urinary stones were detected, patients were ordered to cease consumption of the suspected formula, and a conservative treatment course was adopted, including infusion of fluids, urinary alkalinization, increased water consumption, and diuresis. RESULTS. Of the 1091 children screened, 12 (1.1%) were diagnosed with kidney stones. They had been exposed to the contaminated milk from 1 to 24 months. Eleven (91.7%) of these 12 patients had consumed milk with a high level of melamine content (955–2563 ppm); 1 patient (8.3%) had consumed milk with a low-level melamine content (6.2–17.0 ppm). Six patients exhibited dysuria; the remaining 6 patients were asymptomatic. All 12 patients had normal renal function, although 4 had proteinuria, and 1 had hematuria. The kidney stones were resolved within 3 to 5 days of commencing treatment in all 12 cases. CONCLUSIONS. Nephrolithiasis was associated with high melamine-exposure levels. A combination of B-ultrasonography and urinalysis is suitable for screening for pediatric nephrolithiasis caused by melamine poisoning. The condition can be resolved with a conservative treatment approach in patients without serious clinical symptoms who have normal kidney function.

To investigate the clinical value of digital subtraction angiography (DSA) and interventional treatment in gastrointestinal arterial hemorrhage.DSA data and experiences of interventional treatment of 78 cases with gastrointestinal arterial hemorrhage were retrospectively analyzed.The positive rate of DSA diagnosis was 74%(58/78). Contrast media overflow direct sign was found in 33%(26/78) patients. Contrast media overflow direct sign of postoperative anastomotic stoma was found in 83%(15/18) patients. Hemorrhage causes of 15 cases were duodenal ulcer, 5 stomach ulcer, 2 gastric cancer, 1 Dieulafoy disease, 9 vascular malformation and dysplasia, 8 in anastomotic stoma bleeding after gastrointestinal operation, 10 hepatic artery blow out and bleeding after operation of liver disease, 5 Crohn disease, 6 intestinal tract diverticulum hemorrhage, 6 enteritis or ulcer and 3 polyp of small intestine, 1 midrange malignant small intestinal interstitial tumor, 2 well differentiated small intestine leiomyosarcoma, 5 colon and rectal cancer. Fifteen cases received arterial drug infusion and 36 received arterial embolization. Twenty-seven cases underwent operation after DSA and interventional treatment, whose coincidence with pathology was 78%(21/27). Technical success rate of arterial embolization was 86%(31/36) and clinical success rate was 72%(26/36). Technical success rate of arterial drug perfusion was 60%(9/15) and clinical success rate was 40%(6/15). Rebleeding rate was 16%(8/51) after intervention treatment. During follow-up for 2-36 months, 1 rebleeding patient received gastroscope treatment after embolization, but failed and died later. There were no severe complications,such as ischemic necrosis,in all the cases.DSA is very important for the location and qualitation of gastrointestinal arterial hemorrhage. Transarterial drug infusion and embolization are safe and effective, and available to selective operation and complication handling.

Contains fulltext : 81091.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To investigate whether porous titanium can provide a better support for revascularization of a mucosal graft ideal for tracheal reconstruction. In patients with laryngotracheal stenosis or tumor, the mucosa with supporting structures can be damaged, resulting in a defect that has to be reconstructed. Autologous tissues like cartilage and mucosa have been used for reconstruction. The main problem has been incomplete mucosal reepithelialization. DESIGN: In the first experiment, porous titanium or ear cartilage was combined with mucosa and implanted subcutaneously in athymic mice for different periods of time. In the second experiment, using rabbits, surgically created defects were reconstructed with porous titanium and mucosa on a pedicled fascia flap using a 2-stage procedure. The implants were analyzed with emphasis on angiogenesis and mucosal survival. SUBJECTS: Male New Zealand white rabbits and nude athymic mice (BALB-c nu/nu). RESULTS: Normal mucosa having a submucosal layer with vital cells was noted on top of the titanium. Multiple blood vessels were observed extending from the muscle layer through the titanium. Cytokeratin expression was detected in the suprabasal and basal layers of the mucosal epithelium. In contrast, the mucosa on cartilage showed no vital cells and no cytokeratin expression. In the rabbit experiment, all animals survived the reconstruction. The titanium was well integrated to the adjacent tracheal cartilage and surrounding tissues, supporting a fully vital mucosa. CONCLUSIONS: Porous titanium is an inert biomaterial that provides support and allows easy revascularization of a mucosal graft. Titanium, in combination with viable autologous tissues, is a good alternative for tracheal reconstruction.

To evaluate the early and midterm outcomes of endovascular repair of aortic dissection (AD).Between January 2001 and December 2006, 165 patients (145 male and 20 female) with AD were treated with endovascular repairing. The mean age of the patients was 52.8 years (range, 30-82 years). Among them, 36 patients had Stanford type A dissection, 121 had type B dissection and 8 had aortic ulcer. Among the dissection patients, 47 were acute AD (the interval between onset and surgery wasor = 7 days), 69 were subacute AD (the interval between onset and surgery was 8-30 days) and 41 were chronic AD (the interval between onset and surgery was30 days).The stents were placed technically successfully in 164 patients (99.4%). The rate of endoleak within 30 days after placement of stents was 7.3% (12/165) and neurologic complication rate was 2.5% (4/165). The mortality rate within 30 days was 6.1% (10/165), and the mortality of acute, subacute and chronic AD was 12.8%, 1.4% and 7.3%, respectively. One hundred and forty-five cases were followed up for 6 to 75 months (median, 28.2 months). Complete thrombosis in false lumen was achieved in 62 patients (42.8%), while partial thrombosis was achieved in 83 patients (57.2%). Nine patients died during fellow-up.It's indicated that endovascular repair of AD is a microinvasive, safe and effective methods for aortic dissection. However, the long-term efficacy needs to be evaluated further.

OBJECTIVE To evaluate the effects of endovascular stent-graft repair for Stanford type A aortic dissection combined with extra-anatomic bypass.To perform endovascular repair for Stanford type A aortic dissection, we tried to extend the landing zone by extra-anatomic bypass to reconstruct the innominate artery, the left common carotid artery or the left subclavian artery, and then achieved the process immediately or at a secondary stage via either the carotid or the femoral approach.Thirty-four patients with ascending aortic dissection (n=8) and aortic arch dissection (n=26) were treated with this technique. Thirty three patients were successfully done aortic endovascular repair, only one died during the operation. The thirty-day mortality rate was 8.8% (3/34), endoleak incidence rate was 11.8% (4/34) and incidence rate of cerebral infarction was 5.9% (2/34). Twenty-nine patients were followed-up for 6-70 months (mean, 24. 5 months). Complete (n=16) and partial (n=13) thrombosis of the false lumen were showed with CT angiography and/or vascular color Doppler ultrasound scanning.Endovascular stent-graft repair combined with extra-anatomic bypass can be a novel option for Stanford type A aortic dissection; it is safe, less invasive, and with fewer complications. Nevertheless, indications need further consideration.

To evaluate effects of sirolimus on collagen synthesis and collagen type I and type III mRNA expression in vascular smooth muscle cells (VSMCs).Rat VSMCs from thoracic aorta were cultured and added with sirolimus of the concentrations of 0, 0.1, 1.0, 10, and 100 ng/ml respectively for 24 h, then co-cultured with L-(3)H-proline for 12 h. L-(3)H-proline incorporation was monitored by liquid scintillation counting. RT-PCR was used to detect the mRNA expression of collagen type I and collagen type III. Logarithmic phase VSMC were treated with sirolimus by 0 ng/ml, 0.1 ng/ml, 1 ng/ml, 10 ng/ml and 100 ng/ml respectively for 24 h prior to 12 h exposure to L-(3)H-proline.The proline incorporation values were 1369 +/- 186, 1211 +/- 157, 1037 +/- 139, 910 +/- 144, and 741 +/- 160 cpm respectively of the 0, 0.1, 1, 10, and 100 ng/ml sirolimus groups. Paired t-test analysis showed that the proline incorporation value of the group with higher sirolimus concentration was significantly lower than that of the group with lower sirolimus concentration (F = 18.936, P0.001), except between the 0.1 ng/ml group and 0 ng/ml group (control group) and between the 1 ng/ml group and 10 ng/ml group (P = 0.057, P = 0.12). RT-PCR showed that the collagen I levels were 112 +/- 23, 140 +/- 23, 152 +/- 12, 166 +/- 22, and 179 +/- 18 respectively in the groups of sirolimus of the concentrations of 100, 10, 1, 0.1, and 0 ng/ml respectively, the higher the concentration of sirolimus the lower the collagen I level (all P0.05), however, there was no significant difference in the collagen I level between the 0.1 mg/ml group and the control group (P = 0.236). There was no significant difference in the collagen III level among the groups of sirolimus of different concentrations (F = 2.409, P = 0.070).Sirolimus inhibits the collagen synthesis in the VSMCs and attenuates the mRNA expression of type I collagen concentration-dependently.

To evaluate the changes in hepatic perfusion after interventional obliteration in patients with cirrhosis and portal hypertension by means of spiral CT perfusion imaging.Twenty-three patients who suffered from cirrhosis and portal hypertension were selected to undergo interventional disconnection. Partial spleen embolization (PSE) was performed in 15 patients and PSE combined with percutaneous transhepatic obliteration (PTO) was carried out in 8 patients. Hepatic perfusion was carried out pre- and post-operation. The density-time curve was obtained from the interest region of liver, abdominal artery, portal vein. The parameters of perfusion were calculated by the means of deconvolution simultaneously.The portal vein perfusion (PVP) decreased in patients with PSE, but total hepatic blood perfusion was not statistically different from that of pre-operation. After treatment, the hepatic artery perfusion increased obviously. PVP decreased from 0.862 to 0.722 ml x min(-1) x ml(-1) but was not statistically different from that of pre-operation. Hepatic arterial perfusion and total hepatic blood perfusion increased from 0.128, 0.990 ml x min(-1)x ml(-1) pre-operatively to 0.290, 1.021 ml x min(-1) x ml(-1) postoperatively in patients with PSE combined with PTO.Spiral CT perfusion could objectively reflect the hemodynamic change in hepatic parenchyma after the interventional vascular obliteration.

The purpose of this study was to evaluate the clinical feasibility and efficacy of transcatheter selective arterial chemoembolization (TACE) for unresectable hepatoblastoma in infants and children. The study was performed with the approval of our institutional review board. Sixteen patients (13 boys, 3 girls) with unresectable hepatoblastoma were treated one to three times with preoperative TACE in an effort to improve the surgical and clinical outcome. Their ages ranged from 50 days to 60 months, with a mean age of 20.4 months. All cases were pathologically proved hepatoblastoma by fine-needle biopsy. After an intra-arterial catheter was selectively inserted into the main feeding artery of the tumor, cycles of cisplatin (40 to 50 mg/m(2)) and adriamycin (20 to 30 mg/m(2)) mixed with lipiodol were given, followed by gelatin foam particles or stainless-steel coils. Tumor response was evaluated according to tumor shrinkage, alpha-fetoprotein (AFP) levels, and pathological findings. TACE procedure was performed one to three times, depending on the patient's response. Surgical resection was carried out when the tumor volume appeared sufficiently reduced to allow safe resection by either lobectomy or extended lobectomy. A marked reduction in tumor size associated with decreased AFP level occurred after treatment. According to paired-samples test, tumor shrinkage ranged from 19.0% to 82.0%, with a mean value of 59.2%. AFP levels decreased 99.0% to 29.0% from initial levels, with a mean decrease of 60.0%. TACE allowed subsequent complete surgical resection in 13 cases and the other 3 cases underwent partial resection. One patient underwent successful orthotopic liver transplantation after receiving TACE therapy. Pathological examination showed that the mean percentage of necrotic area in the surgical specimens was 87%. Overall survival rate at 1, 3, and 5 years was 87.5%, 68.7%, and 50%, respectively. Correspondingly, event-free survival rate was 75%, 62.5%, and 43.7%, respectively. In addition, there was no marked chemotherapeutic agent-induced toxicity noted during the observation period. We conclude that TACE is feasible, well tolerated, and effective in inducing surgical resectability of hepatoblastoma in pediatric patients, which has become an independent palliative or curative therapeutic option, especially for patients without distant metastasis.

OBJECTIVE To assess the ability of three-dimensional power Doppler imaging to depict vascularity in hepatocellular carcinoma. METHODS Forty-three patients with hepatocellular carcinomas were subjected to two- and three-dimensional power Doppler imaging, and 14 of them also underwent angiography. The delineated amounts of intratumoral Doppler signals were compared between 2 methods of power Doppler imaging in 43 patients. In the 14 patients who also underwent angiography, the patterns of blood supply depicted by 2 methods of power Doppler imaging were compared with that depicted by angiography, and the intratumoral vascularity on three-dimensional projection images and angiograms was also quantitatively assessed by calculating the vascularity-area ratio with graphics software. RESULTS In comparison with two-dimensional power Doppler imaging, three-dimensional power Doppler imaging was subjectively determined as showing more intratumoral Doppler signals in 32 (74.4%) of the 43 lesions. The accuracies in depicting vascular patterns were 64.3% (9 of 14) for three-dimensional projection images and 14.3% (2 of 14) for two-dimensional slices compared with the results of angiography. The vascularity-area ratios on three-dimensional power Doppler imaging projections and angiograms were 46.0% +/- 25.6% and 48.5% +/- 22.5% (mean +/- SD), respectively (P > .05). Three-dimensional projection images correlated significantly with angiograms in quantifying the vascularity (gamma = 0.87; P < .001). CONCLUSIONS A three-dimensional power Doppler projection image gives a better overall picture of vascular distribution than a two-dimensional slice and correlates with angiography significantly for delineating vascularity in hepatocellular carcinoma.

In this study, we examined the expression of osteopontin (OPN), αvβ3 and Pim-1 in non-small cell lung cancer (NSCLC) and investigated the potential clinical implications of their expression patterns in NSCLC. Immunohistochemical assays were used to examine the protein expression of OPN, αvβ3 and Pim-1 in 208 NSCLC samples and their adjacent normal lung tissue specimens. Statistical analyses were performed to evaluate the relationships between OPN, αvβ3 and Pim-1 expression patterns, and their association with the clinical-pathological parameters of NSCLC patients. In NSCLC tissues, the positive rates of OPN, αvβ3 and Pim-1 expression were 67.8% (141/208), 76.0% (158/208) and 58.7% (122/208), respectively. However, in the adjacent normal lung tissues, the positive rates of OPN, αvβ3 and Pim-1 were 20.2% (42/208), 24.0% (50/208) and 14.9% (31/208), respectively. The differences in the positive expression rates of OPN, αvβ3 and Pim-1 between NSCLCs and the adjacent normal lung tissues were all significant (P