Abstract:Objective To explore a novel animal model of physiological cardiac hypertrophy induced by long-term passive wheel running. Methods Forty male Sprague-Dawley rats were randomly divided into four groups (n=10): normal control group, passive wheel running(PWR) group, sham operation group, and transverse aortic constriction(TAC) group.PWR group received passive wheel movement training, TAC group received aortic arch narrow operation, sham operation group did not receive ligature thoracic aorta, and other treatments were similar to that of TAC group; no treatment was given to the normal control group. Five weeks after training or operation, a comparison was made between different groups. The modeling results of PWR were assessed by echocardiography, morphology, and molecular hypertrophic-markers for heart failure. Results Echocardiography findings showed that thickness of the left ventricle wall in PWR group was significantly increased compared with the normal control group, and that in the TAC group was significantly increased compared with the sham operation group (P<0.01); the stroke volume and ejection fraction were also significantly different between PWR and normal control group and between the TAC group and sham operation group(P<0.01). The left ventricle internal diameter at end-diastole was not significantly different from that of normal control group, but that in the TAC group was decreased by 38% compared with the sham operation group (P<0.01), indicating that the cardiac structures were significantly different between PWR and TAC groups. Compared with the normal control group, the heart weight/body weight ratio, left ventricular weight/body weight ratio and lung weight/body weight ratio were increased by 25.0%, 37.3% and 23.8% in PWR rats, respectively; compared with the sham group, the above indicators were increased by 31.6%, 38.8% and 56.6% in TAC rats, respectively(P<0.05 or P<0.01). Compared with the normal control group, the expression levels of atria natriuretic peptide (ANP)and brain natriuretic peptide (BNP)were 0.67-fold and 0.48-fold of those in PWR group(P<0.05), and those in the TAC group were 1.98-fold and 2.03-fold those of the sham operation group (P<0.05). Conclusion Long-term PWR training can induce physiological cardiac hypertrophy in rats, which may provide a novel way for establishing physiological cardiac hypertrophy animal models.

Abstract:【Abstract】Objective To investigate the protective effect of exogenous cardiotrophin-1(CT-1) on spinal cord injury and analyze the mRNA expression of CT-1 and its receptor. Methods: 90 male rats weight between 200 to 250g were randomly divided into 3 groups. The rats were crashed by Allen’s Weight-dropping Model. The different groups were treated by intraspinal injection of NS(normal saline), NGF, Recombinant human CT-1 (rhCT-1, 100 μg/kg/d),the survival rate and the number of nissl bodies of neurons were compared in HE and Nissl staining after damage 3d, 1w, 2w. Another 60 rats which were denervated for 1w, 4w, 12w by the same model in tow groups were taken to compare wet weight and total protein of surae triceps. Fluorescent quantitative PCR is available to conclude the mRNA expression of CT-1 and its receptor with 90 male rats that is composed by different time of sample in the same model. Results: All Section staining were observed by microscope in 200 magnified times. There is no obvious significant differences in the number of neurons and nissl bodies in CT-1 and NGF group upon HE or Nissl sections (P<0.05), but both were distinctly more than placebo group. The wet weight and total protein of surae triceps in CT-1 group is higher than placebo in 4w and 12w. The mRNA expression of CT-1 reduces progressively along with the duration of denervation after a transient increase. The mRNA expression of its receptors were appropriate increase. Conclusion: As an active cytokines that widely expressed in myocardial cell. Ct-1 also plays the part of potential protector in spinal cord injury.

Abstract:Abstract: Objective to investigate the effects of pirarubicin on proliferation and apoptosis of bladder cancer cells and its mechanism. Methods After treatment with THP, Flow cytometry was used to measure apoptosis of T24 and BIU-87 cells; The effects of pirarubicin on cell proliferation of T24 and BIU-87 cell lines were detected by MTT; QRT-PCR、RT-PCR were used to examine the mRNA expression of PLCε，BCL-2 in T24 and BIU-87 cell lines with or without pirarubicin treatment，the protein expression of PLCε in pirarubicin treatment cells was determined by western blot ; After combination treatment of THP with Ad-shPLCε in T24 and BIU-87 cells, MTT was used to evaluate cells proliferation and the protein expression of BCL-2 was detected by western blot in each group. Results Pirarubicin showed significantly dose- and time-dependent inhibitory effect on the proliferation of T24 and BIU-87 cell lines, and the inhibition ratios of 1.6 and 3.2 mg /L THP were higher than that of 0. 4 and 0.8 mg /L THP ( P ＜ 0. 05),in addition, the inhibition ratios of treatment with THP for 72h were higher than that of 24h and 48h THP( P ＜ 0. 05).Moreover , Cell apoptotic rate increased in cell with pirarubicin treatment（P<0.05）.The mRNA and protein expression of PLCε were suppressed in cell lines after treatment with THP. Meanwhile, the expression of BCL-2 at mRNA was repressed by Pirarubicin treatment. Combined treatment of THP with Ad-shPLCε exhibited synergistic inhibitory effects on cells proliferation and BCL-2 protein expression compared with THP treatment group (P<0.05). Conclusions Pirarubicin induced cell apoptosis and inhibited cell proliferation, which may be through suppress the expression of PLCε and BCL-2 in bladder cancer cell lines.

Abstract:Objective To investigate the effect of acetyltransferase inhibitor Garcinol on estrogen-induced proliferation, cell cycle promotion and apoptosis inhibition of human breast cancer MCF-7 cells and the related mechanism. Methods The effect of Garcinol on 17β-estradiol (17β-E₂)-induced proliferation of MCF-7 cells was investigated using CCK-8 assay, and the optimal concentration of Garcinol was determine according to the inhibition rate. The cell cycle and apoptosis were analyzed by flow cytometry; the nuclear translocation of NF-κB/p65 was examined by immune cell fluorescence. RT-PCR was used to determine the expressions of cyclin D1, Bcl-2 and Bcl-x_L mRNA in MCF-7 cells; and the expressions of ac-H3, ac-H4, NF-κB/ac-p65, cyclin D1, Bcl-2, and Bcl-x_L protein were determined by Western blotting analysis. Results Acetyltransferase inhibitor Garcinol inhibited 17β-E₂-induced proliferation of MCF-7 cells, arrested MCF-7 cell cycle at G₀/G₁ phase, and increased the cell apoptosis(P<0.01). 17β-E₂ increased the expressions of ac-H3, ac-H4 and NF-κB/ac-p65 protein in MCF-7 cells(P<0.01, P<0.05, P<0.01), while Garcinol significantly inhibited the increase of ac-H3 and NF-κB/ac-p65 (P<0.01) but not ac-H4(P>0.05). 17β-E₂-induced nuclear translocation of NF-κB/p65 in MCF-7 cells was also significantly inhibited by Garcinol (P<0.01). Garcinol also significantly inhibited 17β-E₂-induced transcription and protein expression of cyclin D1, Bcl-2 and Bcl-x_L mRNA in MCF-7 cells (P<0.05). Conclusion 17β-E₂-induced proliferation and apoptosis inhibition of MCF-7 cells are associated with elevated acetylation level of histone and nonhistone NF-κB/p65, and acetyltransferase inhibitor Garcinol may inhibit the effect of 17β-E₂ by decreasing acetylation, probably through decreasing ac-p65 expression of NF-κB pathway, and subsequently down-regulating cyclin D1,Bcl-2,and Bcl-x_L.

Abstract:Objective To explore the effect of silent information regulator 1（SIRT1） on acetylation of nuclear factor-κB (NF-κB) p65 subunit and the expression of monocyte chemoattractant protein 1 (MCP-1) in rat mesangial cells (RMC) induced by high glucose. Methods Construct the lentiviral shRNA plasmid pTRC-shSIRT1 to interference SIRT1 gene and identification . The RMCs was classified into high glucose group (high glucose culture medium used), resveratrol high glucose group (with low glucose culture medium containing 1μmol / L SIRT1 activator resveratrol for 24 h and then switching to high glucose culture medium), SIRT1 RNAi group (4h after viral pTRC-shSIRT1 infection, and then switch to low-glucose culture medium), SIRT1 RNAi high glucose group (4h after viral pTRC-shSIRT1 infection, and then switch to high glucose culture medium) , While negative control group and the control group (hypertonic mannitol). The mRNA expression of SIRT1 and MCP-1 gene was analyzed by real-time quantitative PCR. The protein expression of SIRT1 and the acetylation of NF-κB p65 subunit were observed by Western Blot. The protein expression of MCP-1 was detected by ELISA. Results DNA sequencing demonstrated that the plasmid pTRC-shSIRT1 was successfully constructed. Viral produced by pTRC-shSIRT1 infected RMCs and knocked down SIRT1 expression both at mRNA and protein levels. The expression of SIRT1 was decreased and acetylation of NF-κB p65 subunit was significantly increased by high glucose. Resveratrol, as an activator of SIRT1 can decreases high glucose-induced acetylation of NF-κB p65, which results in the reduction of MCP-1 secretion. Conversely, Gene silencing of SIRT1 shows increased the acetylation of cellular p65 protein and secretion of MCP-1 when challenged with high glucose. Conclusion The plasmid pTRC-shSIRT1 was successfully constructed and can effectively down regulate SIRT1 mRNA and protein expression. SIRT1 activation can significantly inhibited high glucose mediated upregulation of MCP-1, This is probably attributable to the increasing SIRT1-mediated NF-κB p65 deacetylation.

Abstract:Objective To observe the expression of CCL19 in colorectal carcinoma tissues and to investigate its effect on proliferation, migration and invasion of colorectal cancer cells. Methods The expression of CCL19 in 85 confirmed colorectal carcinoma tissues and the corresponding adjacent normal tissues was detected by quantitative real-time PCR (qRT-PCR) and immunohistochemistry of tissue microarray. SW620 cell line highly expressing CCR7(CCL19 receptor) as screened by qRT-PCR and Western blotting analysis was stimulated by different concentrations of rh-CCL19 (0, 10, and 100 ng/mL). Then the cell proliferation, migration and invasion capacity were examined by CCK-8, wound healing assay, and Transwell assay, respectively. Results Immunohistochemistry and qRT-PCR results demonstrated that CCL19 expression was significantly lower in the colorectal carcinoma tissues than in the normal tissues (P<0.05). CCL19 expression was associated with tumor size and invasion depth (P<0.01). Treatment with rh-CCL19 significantly decreased the proliferation, migration and invasion capacity of SW620 cells(P<0.05). Conclusion CCL19 expression in colorectal cancer tissues is lower than that in the adjacent normal tissues, and the expression is associated with tumor size and invasion depth. CCL19 can inhibit the proliferation, migration and invasion capacity of SW620 cells.

Abstract:Objective To investigate the value of transglutaminase 4 in diagnosis and prognosis prediction of prostate cancer. Methods Transglutaminase 4 immunostaining was performed with paraffin sections from 159 prostate cancer patients receiving radical prostatectomy, and the staining results were divided into 4 levels: negative staining, weak staining, moderate staining, and strong staining. The clinical and pathological information of the patients were obtained by reviewing the medical records. The follow-up data were collected by reviewing medical records, prostate cancer database of our department, and telephoning the patients or their family members. Expression of transglutaminase 4 and clinical, prognosis data of patients were subjected to statistical analysis. Results The expression of transglutaminase 4 in the prostatic cancer tissue was significantly higher than that in the adjacent normal tissue (P<0.001); and the expressions were significantly different in patients with different Gleason grades (P<0.001) and different prostate specific antigen levels(P=0.005). Univariate Cox regression analysis indicated that high transglutaminase 4 expression was a risk factor of biochemical recurrence of prostatic cancer (P=0.020), but multivariate Cox regression analysis did not support this finding (P=0.139). Conclusion Transglutaminase 4 expression is increased in prostate cancer tissues, and the expression is stronger in malignant tissues with higher Gleason grade and prostate specific antigen level.

Abstract:Backgroud: Currently, partial hepatectomy is the mainly treatment for early stage of primary hepatocellular carcinoma(HCC). Meanwhile, the most important factor affecting the long-term survival for patients with HCC is tumor recurrence after surgery. Variety of hemostatic agents were widely used in clinical to reduce the amount of bleeding during or after hepatectomy. However, there is lack of research whether tumor recurrence after hepatectomy is related to perioperative hemostatic agents used. Methods: 504 cases of patients underwent hepatectomy with diameter of HCC less than 5cm, stage of tumor on T1-2N0M0, liver function on Child-Pugh score A , B grade as well as pathological negative margins during 2005-2007 in our hospital were collected in this study. Cox model with stepwise regression analysis was used to find out the factors related to survival of patients and recurrence after surgery, and Kaplan-Meier analysis was used to clear whether the use of intravenous hemostatic agent is related to overall survival time (OS ) as well as recurrence - free survival time (RFS ). Results: The median follow-up time for all patients is 64 months ( 7-72 months). For all 504 patients, the perioperative intravenous hemostatic agents used was 326 cases and 178 cases did not receive any hemostatic agents during the perioperative period. Compared with patients recieved no hemostatic agents, 5-year OS rate is lower ( 61.04% vs 75.28%, P=0.002 ) as well as 5-year RFS rate is lower (49.08% vs 61.80%，P=0.001) on patients received perioperative intravenous hemostatic agents. Meanwhile, perioperative use of intravenous hemostatic agents is an independent risk factor on patients’ OS ( P = 0.002 relative risk 1.759,95 % CI :1.277 - 2 .521 ) and RFS ( P = 0.005 relative risk 1.523,95 % CI :1.136 -2 .043 ). Conclusion: Perioperative use of intravenous hemostatic agents reduce overall survival and recurrence-free survival time for patients after hepatectomy.

Abstract:Objective To investigate the etiology of aortic valve diseases and their shifts, as well as the in-hospital mortality of the adults undergoing aortic valve replacement. Methods We carried out a retrospective statistical analysis on a total of 927 patients, who were identified as adults having aortic valve replacement in Changhai hospital, during the 20-year study period. Results In the past few years, the major cause of the aortic valve disease included congenital disease and degenerative condition . There was a decrease in the proportion of patients with rheumatic or infectious etiology, while an increase in degenerative or congenital etiology. During the last decade, duration of postoperative ventilation, time in the intensive care unit (ICU) and length of postoperative hospital stay reduced significantly compare with those of the first decade (P <0.05). The overall in-hospital mortality was 4.7% (44 of 927 patients). No gender difference was found in operative mortality. The in-hospital mortality have greatly decreased in the past 15 years,lower than that of the first 5 years (P<0.05)。Conclusions There was a shift in the causes of aortic valve disease. With improved cardiopulmonary bypass and surgical techniques , as well as better intensive care treatment , the in-hospital mortality of aortic valve replacement in adults decreased to a lower level than before.

Abstract:Objective To evaluate the prevalence and risk factors of microalbuminuria (MAU) in hospitalized patients. Methods 1259 hospitalized patients with detected urinary microalbumin in the year of 2012 were recruited in Tongji Hospital of Tongji University . They were divided into two groups according to the level of urinary microalbumin. 907 cases were included in normal albuminuria (NAU) group , 352 cases were in microalbuminuria group. Statistical analysis of clinical data was made in the two groups. Results Microalbuminuria prevalence of hospitalized patients was 27.9%. The age in MAU group was elder than NAU group (P<0.01), and the prevalence of diabetes mellitus and hypertension in MAU group was higher than NAU group (P<0.01). The age, gender, TG, TC, LDL-C, HDL-C, diabetes, hypertension and diabetes hypertension served as independent variables, and MAU as a dependent variable for univariate analysis. Results showed age, diabetes , hypertension and diabetes hypertension were closely related to MAU. Further multivariate analysis with logistic regression revealed that age and diabeteswere independent risk factors of MAU. Advanced age (>80 years old，OR 1.668，95% CI 1.185~2.348) and diabetes mellitus (OR 1.718，95% CI 1.334~2.211) increased the risk for MAU. Conclusions MAU is closely related to age and diabetes mellitus in hospitalized patients. Strict control of blood glucose and timely treatment are helpful to slow down the development and progression of diabetic nephropathy and cardiovascular disease.

Abstract:Objective To evaluate the pharmacokinetics of curcumin phospholipid complex (CCPC) in rats following oral administration. Methods Blood samples were collected from the retinal venous plexus of SD rats after oral administration of CCPC or curcumin (CC), and the blood concentration of curcumin was determined by high-performance liquid chromatography (HPLC). Results The solubility and cumulative dissolution of CCPC (0.150 g/L and 68.04%, respectively) were higher than those of CC (0.057 g/L and 50.68%, respectively). The pharmacokinetic parameter of CCPC and CC were calculated as follows: C_max (74.34±5.57) μg/L and (61.64±4.29) μg/L, T_max (0.17±0) h and (0.25±0) h, AUC_0-t (637.38±30.04) μg·h·L^-1 and (172.41±31.66) μg·h·L^-1, and AUC_0-∞ (857.80±223.69) μg·h·L^-1 and (191.08±43.27) μg·h·L^-1, respectively. The intra-day, inter-day precision, and recovery rate met the criteria for content determination. Conclusion Compared with curcumin, CCPC can be absorbed more rapidly and eliminated more slowly.

Abstract:Objective To investigate the changes of the amino acid receptors in solitary tract nucleus(NTS)of rats after spinal cord injury (SCI). Methods The rat model of T₄ spinal cord transection was used in this study. The study was divided into SCI group(n=5)and Control group(n=5). Changes in mean arterial pressure (MAP) and heart rate (HR) were observed at 1,2,3,4, and 6 weeks after SCI; and the protein expression of the glutamate N-methyl-D-aspartate receptor 1 (NMDA-R1) and gamma-aminobutyric acid receptor A α1 (GABAA-α1) in the NTS were detected by Western blotting analysis at different time points. Results The MAP level was significantly decreased at 1-3 weeks after SCI (P<0.05), and it gradually recovered 4 weeks after SCI; the HR was significantly increased 1-4 weeks after SCI (P<0.05) and recovered at the 6^th week. The results of Western blotting analysis showed that the protein expression of GABAA-α1 was significantly increased 2 weeks after SCI and significantly reduced at 4 and 6 weeks after SCI (P<0.05). Moreover, the ratio of NMDA-R1 to GABAA-α1 expression in NTS was significantly elevated after SCI(P<0.05). Conclusion The adaptable changes of important receptors in the NTS following SCI may improve SCI-induced cardiovascular dysfunction.

Abstract:Objective To report the first clinical case of robotic-assisted laparoscopic nephrectomy(right) combined with inferior vena caval thrombectomy for level Ⅱ tumor thrombus in China. Methods A 73-year-old female patient presented with "gross hematuria and flank discomfort for 4 months" was admitted to our hospital. Preoperative CT scans revealed a 4.9 cm×4.7 cm right renal cancer, grossly extending into the inferior vena cava (IVC, length of the IVC tumor thrombus: 4.6 cm). After three months of neoadjuvant targeted molecular therapies (TKIs), the tumor size reduced to 4.3 cm×4.4 cm on CT and the IVC tumor thrombus length reduced to 3.3 cm. IVC filter was placed cephalad 2 days before surgery under DSA intervention. The patient was placed in recumbent position during the operation; a 12-mm optical port was placed to the right of the rectus abdominis at 2 cm above the umbilicus. Two 8-mm robotic ports and three 12-mm assistant ports were placed percutaneously under direct visualization through a stab incision. The robotic system was then docked, with the colon reflected medially and the duodenum kocherized. The IVC sheath was opened, and the IVC was dissected circumferentially above and below the insertion of the right renal vein to the extent dictated by the length of the thrombus. With the right renal artery dissected and transected, the vessel loops were used to create modified-Rummel tourniquets. The vena cava below and above tumor thrombus, and the left renal vein were cross-clamped. With the vessel loops cinched down completely and secured by hem-o-lok clips, the wall of the IVC was then incised longitudinally for approximately 5 cm. The tumor thrombus was delivered intact along with the invaded IVC wall. The IVC was closed and tourniquet was loosened. After adequate hemostasis was achieved, the specimen was placed into an entrapment sac and incisions were closed by layers. Results The procedure was smoothly completed. The total operating time was 363 min and the total IVC cross-clamp time was 47 min. The estimated blood loss was 1 200 mL. The amount of intraoperative transfusion was 1 200 mL and 1 000 mL postoperative blood transfusion was required for a low level of hemoglobin. The bowel function recovered at day 3 after operation and drainage was maintained for 3 days. The patient was discharged 16 days after operation. Conclusion We successfully completed the first clinical case of robotic-assisted laparoscopic nephrectomy combined with inferior vena caval thrombectomy for level Ⅱ tumor thrombus in China; it is a safe and feasible procedure, but has great technical difficulty, so the patients should be chosen with great care.

Abstract:Objective To use transperitoneal laparoendoscopic single-site (LESS) partial nephrectomy combined with flexible 3-D laparoscope for partial nephrectomy in pigs, and to introduce our experience on LESS training in a pig model for partial nephrectomy. Methods A male pig was given general anesthesia and was put in a supine position. A 3.5 cm incision was made through the right abdominal rectus. A multi-channel QuadPort(Olympus^TM) was established. Artificial pneumoperitoneum was created by 14 mmHg(1 mmHg=0.133 kPa); the lower pole and the kidney pedicle of the right kidney were isolated. The lower pole of the right kidney was resected after the renal artery was blocked. Figure-8 sutures were used to close the wound, with no notable bleeding noticed after opening the blood. The specimen was enclosed in an endoscopic pouch and pulled out from the incision. Results The procedure was smoothly completed without any extra incision. The operating time was 47 min; the period of renal artery occlusion was 21 min (5 min for resection, 16 min for stitching); and the intraoperative blood loss was 20 mL. There was no complication during the operation. Conclusion Our initial experience shows that 3D-LESS partial nephrectomy procedure is technically difficult, but it is safe, feasible and effective. Flexible 3D laparoscopy can provide clear 3D visualization, improving the operating accuracy and reducing the fighting of instruments. The pig model used in this study can help surgeons to obtain experience on 3D-LESS partial nephrectomy.

Abstract:Multiple sclerosis (MS) is a classic neuroimmunologic and neurodegenerative disease. A growing body of evidence suggests that epigenetic changes are associated with the development of MS. Epigenetic modifications can influence the expression of genes, but will not change the sequence of DNA. DNA methylation, histone modification and microRNA-associated post-transcriptional gene silencing are three key epigenetic mechanisms that influence gene expression. Epigenetic mechanisms may regulate MS onset by affecting the genetic susceptibility and environmental risk factors, and by influencing the inflammatory demyelination and neurodegeneration involved in MS pathology. In this review we summarized recent studies on the role of epigenetic changes in the pathophysiology and treatment of MS.

Abstract:Cervical spondylotic myelopathy (CSM), commonly seen in the elderly, is caused by the chronic compression of the spinal cord induced by cervical disc degradation. Magnetic resonance imaging (MRI) can clearly reveal spinal canal stenosis, morphology and signal changes of compressed spinal cord, but it falls short in demonstrating the slight changes and microstructure of the spinal cord and is not capable of quantitative analysis. Diffusion tensor imaging (DTI) is a new MRI technique which can display the water molecule diffusion characteristics in the nerve fiber cells, with the evaluation parameters mainly including the apparent diffusion coefficient (ADC) and the fractional anisotropy (FA). Moreover, it can clearly display the fiber bundle of the spinal cord with the diffusion tensor tractography (DTT), making it currently the only non-invasive way to trace the white matter fiber bundle. Studies have reported that DTI parameters compared with routine MRI is more sensitive in early diagnosis, neuronal function evaluation, and prognosis prediction of CSM. DTT can clearly display the morphology and dynamic changes of spinal nerve bundles, evaluate the neuronal function and predict the post-operation prognosis. There are still limitations for spinal DTI, such as lack of standard method for measuring and analyzing DTI parameters, and whether DTT can reflect the true pathological status of spinal cord. Here we reviewed the development of DTI technology and its role in CSM.

Abstract:Objective To investigate the relationship and clinical significance between the expressions of RegIV and EGFR, PI3K proteins in gastric adenocarcinoma. Methods S-P Immunohistochemistry was used to detect the expression of RegIV and EGFR, PI3K proteins in pathological tissue with 63 cases with e gastric adenocarcinoma and tumor-adjacent normal esophageal tissue. Results The positive expression rates of RegIV and EGFR, PI3K proteins in 63 cases with gastric adenocarcinoma tissue 50.7% (32/63)、68.3% (43/63) 、60.3% (38/63) respectively, were significantly different from the positive expression rates of tumor-adjacent normal esophageal tissues 19.0% (12/63)、20.6% (13/63)、9.5% (6/63)respectively(P<0.05); The expression of RegIV was significantly correlated to differentiation degree (P<0.05)and the expression of PI3K protein was significantly correlated to differentiation degree, infiltrative depth, TNM stage and lymph node metastasis(P<0.05). The expression of Akt protein was significantly correlated to lymph node metastasis (P<0.05). There was positive correlation between the expression of RegIV/PI3K, RegIV/Akt and PI3K/Akt proteins in esophageal squamous cell carcinoma and the value of Spearman coefficient correlation were 0.284,0.305 and 0.423 (P<0.05)． Conclusions RegIV may play an important role in tumorigenesis and tumor progression by activating PI3K/Akt signaling pathway.

Abstract:Objective To compare the difference between the target volume delineated by CT and that delineated by positron emission tomography and computer tomography(PET-CT)in locally advanced pancreatic carcinoma (LAPC), and observe the impact of PET-CT on planning of three-dimensional conformal radiotherapy (3D- CRT). Methods Thirteen patients with locally advanced pancreatic carcinoma referred for radical radiation therapy, underwent PET-CT scanning. GTV was delineated on the CT imaging and PET-CT fused imaging respectively. The two images were used to develop the radiotherapy planning.Dose-volume histograms (DVH) parameters were selected to be paralleled to compare the quality of the two plans and the impact of PET-CT on radiation plan (RP) was further analyzed. Results (1) PET-CT image altered GTV and PTV: For all patients, the GTV_CT versus GTV_PET-CT was 57.3±22.9cm₃ versus 68.4±31.7cm₃,the CTV_CT versus CTV_PET-CT was 119.9±38.7cm₃ versus 132.7±47.5cm₃,the PTV_CT versus PTV_PET-CT was 288.6±52.1cm₃ versus 312.4±79.4cm₃.The difference was statistically significant. In 6 patients, changes were obvious. The average increase was 36.5%(22.15cm₃), due to the extension of the primary tumor beyond that defined by CT and additional lymph node metastases. (2) PET-CT image changed the parameters of DVH: to deliver the same target dose of 60 Gy in 30 fractions, all dose-volume characteristics altered in treatment planning, but there was no significant difference. Conclusions PET-CT image can reflect the relationship of the tumor and normal tissue more accurately. The application of PET-CT fused imaging on target volume delineation not only can provide a satisfactory the parameters of DVH, but also more precise on target volume delineation and planning of three-dimensional conformal radiotherapy for LAPC.

Abstract:Objective To investigate the image quality and radiation dose of low heart rate for coronary CT angiography obtained with a prospectively-gated technique volume scan versus a prospectively-gated technique helical scan. Methods Coronary CT angiography obtained with 320-row CT were evaluated in 128 patients. These patients were assigned into two groups: Group 1(n=72), patients undergoing prospectively gated technique volume scan; Group 2(n=56), patients undergoing helical scan. The main branches of coronary arteries were divided into 9 segments. Meanwhile, the image quality was evaluated with a four-point grading scale. The student t test was performed to evaluate the difference between the two groups, which include image noise, excellent rate and pass rate of image, and effective radiation dose. Results The ascending aorta root CT value of group 1 and group 2 were respectively (492.08 ± 58.51) HU and (522.72 ±56.91) HU, and the image noise of the two groups were respectively (19.64 ± 3.51)HU and (22.66 ± 5.33)HU. Coronary artery image quality of group 1 and group 2 both satisfy the diagnosis. Excellent rate were respectively 97.5% (632/648), and 96.8% (488/504), and pass rate were respectively 99.7% (646/648), and 99.2% (500/504), There was no significant difference (p > 0.05)in image noise, excellent rate of image, and pass rate of image between group1 and group2. Effective radiation dose of group 1 and group 2 were respectively (3.21 ± 0.23) mSv, and (13.27 ± 2.39) mSv, The difference in effective radiation dose between the two groups was significant (p = 0.000).Conclusion Image quality of coronary CT angiography obtained with a prospectively-gated technique volume scan and a prospectively-gated technique helical scan can meet clinical diagnosis. As compared with helical scan, radiation dose was much lower when the patient underwent the volume scan. Conclusively, it is a kind of good method of assessment of coronary artery.

Abstract:Objective To evaluate the safety, feasibility and efficacy of da Vinci robot-assisted laparoscopic partial nephrectomy in the treatment of renal tumors with PADUA score of ≥10, and assess its clinical role. Methods Between May 2012 and September 2013, 37 cases of da Vinci robot-assisted laparoscopic partial nephrectomy for renal tumors with PADUA score of ≥10 were performed a single urologist at our institution. Patient age 52.3±10.1(32-72)years; Body mass index 24.9±3.88(17.1-34.3) kg/m2; Charlson Co-morbidity Index (Age-weighted) 0.5±0.84(0-3); Tumor laterality (L/R) 20/17; all tumors were unilateral and solitary lesions with a mean diameter of 4.2±1.19(2.1-7.2)cm and PADUA score of 10.8±0.87(10-13); Preoperative eGFR (mL/min•1.73m2) 101.2±25.58(46.6-198.7). The renal pedicle, involved kidney, tumor exposure, tumor excision and renorrhaphy were conducted with da Vinci robot-assisted laparoscopic techniques. Results All 37 cases were smoothly finished without any surgical conversion, intraoperative complications or transfusion. Operative time was 241±50.0(120-330) min, estimated blood loss was 185±169.9(50-1000) ml, renal ischemia time was 26.7±9.90(0-50) min. The mean postoperative stay was 11.4±3.44(8-19) days with an overall complication rate of 13.5%(5/37). Pathological examination revealed none of positive surgical margin, 28 cases of renal clear cell carcinoma, 3 papillary cell carcinoma, and 5 different types of benign lesions. At a mean follow-up of 5.9±4.64(1-12) months, all patients are alive and no local recurrence or distant metastasis were detected. Nevertheless, the estimated glomerular filtration rate decreased at a mean percentage of 8 and before-after comparison revealed significant difference(Z=-2.883, p=0.004). Conclusion da Vinci robot-assisted laparoscopic partial nephrectomy provides a meticulous alternative in the surgical management of high PADUA score renal tumors with minimally invasiveness, improved safety, and renal function preservation, although the cancer control outcomes are awaited further follow-up.

Abstract:Objective To compare the effects of target-controlled infusion (TCI) between propofol/remifentanil and sevoflurane/remifentanil during anesthesia on cerebral oxygen metabolism in patients undergoing brain tumor surgery, so as to provide references for clinical practice. Methods A double-blind randomized, controlled trial was conducted with sixty participants, which were equally assigned to two groups. Patients in the PR Group were induced by TCI of propofol/remifentanil combination and those in the SR Group were anesthetized with sevoflurane/remifentanil combination. Blood samples were collected at different time points to measure jugular bulb venous oxygen saturation (SjvO₂) and generate arteriovenous oxygen content difference (Da-jvO₂). The hemodynamic parameters and duration of surgery or anesthesia of each participant were also monitored and recorded. Results No significant difference was found regarding to the hemodynamic parameters or duration of surgery/anesthesia between the two groups. SjvO₂ was found significantly higher and Da-jvO₂ was significantly lower in the SR group than those in the PR group(P<0.01). Conclusion Combined anesthesia with propofol/remifentanil vs sevoflurane/remifentanil are both safe for patients undergoing cerebral tumor operation; and sevoflurane/remifentanil seems to provide better oxygen supply and has more rapid post-operation recovery; however, sevoflurane/remifentanil can improve cerebral oxygenation.

Abstract:Objective Evaluation the effect of intraoperative intravenous magnesium sulfate on propofol , fentanyl dose and postoperative adverse events. Methods Sixty ASA I orⅡ patients of either sex，aged18-60 yrs.，undergoing craniocerebral surgery with general anesthesia were randomly divided into 2 groups(n=30 each)：control group(group C)and magnesium sulfate group(group T)．T group received intravenous 50 mg/kg magnesium sulfate after the induction, while C group received normal saline. Blood concentration of magnesium was measured before and after operation. The dose of intraoperative propofol and fentanyl, and the incidence of postoperative pain, nausea and vomiting, muscle tension and tendon reflex and other adverse events at different time were recorded. Results Intraoperative intravenous magnesium sulfate can effectively reduce the intraoperative propofol and fentanyl dosage（P<0.05）, and alleviate postoperation pain（P<0.05）. While, there was no obvious change in adverse events, such as Nausea and vomiting, muscle tension and tendon reflex, and postoperative blood concentration of magnesium（P>0.05）. Conclusion Intraoperative intravenous magnesium sulfate (50 mg/kg) can effectively reduce the intraoperative propofol and fentanyl dosage, and can effectively alleviate postoperative pain, while had no obvious effect on postoperative adverse events.

Abstract:Objective: To study the clinical features, imaging findings and prognosis of hepatic epithelioid hemangioendothelioma(HEHE)in Eastern Hepatobiliary Surgical Hospital, and to improve the level of recognition and preoperative diagnosis of HEHE. Methods: Clinical data of 15 pathology-confirmed HEHE patients, admitted in our hospital from 1999 to 2010 were collected and analyzed retrospectively. Results: Besides 7 cases of abdominal discomfort, this cohort of HEHE patients does not show common typical manifestations. Laboratory examinations found 8 low ALB/GLB (A/G) cases, 3 mild anemia cases, and 1 high alanine aminotransferase (ALT) case, but no abnormal AFP, CEA or CA19-9 cases. Plain computed tomography (CT) scanning found uneven multiple low-density lesions in most cases, and dynamic enhanced CT scanning demonstrated peripheral enhancement in hepatic arterial (HA) phase and more peripheral enhancement in portal vein (PV) phase, and ring enhancement were detected in delayed phase. Magnetic resonance imaging (MRI) demonstrated low signal intensity and even lower lesion centers in T1-weighted images (T1WI), but slightly high signal intensity lesions and higher lesion centers in T2-weighted images (T2WI). Enhanced MRI scanning showed ring enhancements but no obvious enhanced centers. Lesions were further enhanced in delayed MRI scanning. Prognosis of this cohort: ten of these 15 patients alive nowadays including four cases alive with the tumor. Conclusions: Comprehending the clinical and radiological characteristics of HEHE facilitates the level of recognition and preoperative diagnosis of this disease and promotes surgeons to take active and appropriate surgeries.