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A belated revelation: from gastroesophageal reflux
derived asthma to laryngotracheal irritation even spasm
WANG Zhonggao
Front. Med.. 2008, 2 (2): 127-129.
https://doi.org/10.1007/s11684-008-0023-0
The author has been inspired by the Global Evidence-Based Consensus for gastroesophageal reflux (GER), which put forward four extra-esophageal syndromes: reflux cough syndrome, reflux laryngitis syndrome, reflux dental erosion syndrome and the reflux asthma syndrome. The author himself happened to receive five emergency rescue treatments following apparent “bronchial asthma”, which was to be diagnosed as GER at his own insistence. PPI resulted in some relief. After being rescued again from suffocation, he had a fundaplication, which was performed at the Englewood Hospital & Medical Center, Englewood, USA in March 2006. The procedure immediately cleared up his “asthma”. A month later he brought forth a Center for GER in an army hospital in Beijing, China. Up to now, 601 patients with mainly respiratory distress (84%) were treated by Stretta Radiofrequency, 58 by surgery and more by PPI. The GER Center is now complete with a ward. GER patients with respiratory distresses turned out to fare better than those with acid regurgitation. A nozzle-shaped pharynx was found in patients with the reflux. Animal study revealed that the refluxate entered into trachea and even lungs. Gradually a hypothesis of a gastro-oesophago-laryngo-tracheal reflux took shape.Our modest effort to treat GER-derived respiratory distresses has got off to an encouraging start amid relative shortage of experience and facilities. We would like to share two thoughts with scholars and experts at home and abroad:1. The GER-derived asthma is not asthma, but GER pure and simple;2. The pathogenesis of “asthma” is not asthma, but laryngotracheal irritation/spasm and its sequence.
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Reducing biliary complications in adult-to-adult
living donor liver transplantation using right lobe graft: experience
of 124 cases
YAN Lunan, WEN Tianfu, WANG Wentao, YANG Jiayin, XU Mingqing, CHEN Zheyu, WU Hong
Front. Med.. 2008, 2 (2): 130-133.
https://doi.org/10.1007/s11684-008-0024-z
The aim of this paper is to summarize our experience of using right lobe liver grafts to reduce biliary complications in adult-to-adult (A-A) living donor liver transplantation (LDLT). From January 2002 to October 2007, 124 adult patients underwent living donor liver transplantation using right lobe grafts at the West China Hospital, Sichuan University Medical School, China. There was no death in all donors. Biliary reconstruction for 178 hepatic duct orifices from 124 donor grafts was performed which included 106 reconstructions of duct-to-duct anastomoses and 72 cholangiojejunostomy. Nine recipients had biliary complications including six bile leakages (four from the anastomotic site and two from the cut surface of the liver graft) and three biliary strictures. With the improved techniques for biliary reconstruction, we have achieved good results in 124 recipients of A-A LDLT. We ascribe our success to the introduction of microsurgical techniques and the use of fixed operators which help in decreasing the biliary complications of LDLT.
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Diagnosis and treatment for advanced hilar cholangiocarcinoma:
experience of 24 cases
ZHANG Zongming, ZHU Jianping, SU Yanming, GUO Jinxing, JIANG Nan, ZHANG Zichao, XING Hailin, LIU Kai, YUAN Haiming
Front. Med.. 2008, 2 (2): 134-138.
https://doi.org/10.1007/s11684-008-0025-y
The aim of this paper is to evaluate the efficacy of the surgical treatment for advanced hilar cholangiocarcinoma (CCA) in order to improve the resection rate and curative effect. A retrospective analysis was performed on the data of 24 patients who had undergone surgical treatment for advanced hilar CCA. According to the Bismuth classification, there were four cases of type IIIa, six cases of type IIIb, and 14 cases of type IV. Based on the treatment approaches, these patients were divided into three groups: $` Radical resection group: There were five cases (one type IIIa, three type IIIb, and one type IV). The tumor visible to the naked eyes was resected thoroughly and the cut margin was free of tumor by microscopic examination. Then, Roux-en-Y hepatico-jejunal anastomosis was performed to restore the bile flow. $a Palliative resection group: There were 11 cases. The bile flow was restored by Roux-en-Y hepatico-jejunal anastomosis directly in five cases (two type IIIa, three type IIIb) and by internal drainage through a hepatico-jejunal bridge in the other six cases (one type IIIa, five type IV). $b Simple internal biliary drainage group: There were eight cases of type IV, including three cases with the internal drainage through hepatico-jejunal bridge by laparotomy, three cases with endoscopic retrograde biliary drainage (ERBD), two cases with percutaneous transhepatic biliary drainage (PTBD). The rate of radical resection was 20.8% and the overall resection rate was 66.7%. All of the 24 patients were followed-up. The cumulative surviving rates were significantly different among these three groups (Log-rank ?2 = 17.56, P = 0.0002). For advanced hilar CCA, the best choice of treatment is radical resection. If radical resection is impractical, palliative resection combined with partial hepatectomy can significantly prolong the survival time. Internal drainage through a hepatico-jejunal bridge can enhance the surgical resection rate and decrease the occurrence rate of postoperative biliary leakage.
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Beneficial effects of preventive cholecystectomy
in patients with hepatic cancer
LIU Anzhong, LI Jun, HUA Huwei
Front. Med.. 2008, 2 (2): 139-142.
https://doi.org/10.1007/s11684-008-0026-x
There is no conclusive answer to the question whether excising gall bladder is helpful to the patient with hepatic cancer. The survival rate of patients with hepatic cancer for more than two years has been increased, and the incidence of complications of cholecystitis and gall stone are relatively higher among these patients, which may seriously complicate treatment of advanced hepatic cancer and decrease quality of life. The researchers conducted a prospective clinical investigation from 2002 to 2006 to assess the clinical significance of preventive cholecystectomy in patients with hepatic cancer. One hundred and eighteen cases of postoperative patients with hepatic cancer, who survived for more than two years, were followed up. Based on whether cholecystectomy was performed, the patients were divided into two groups including 48 cases with cholecystectomy and 70 cases with cholecyst reserved. The two-year morbidity of gall stone and morbidity of pain in the right upper abdomen of cholecyst reservation group were 54.29% and 68.57%, respectively, obviously higher than 0.00% and 20.83% of cholecystectomy group. Mainly for those treated with transcatheter arterial chemo-embolization, the morbidity of gall stone was 86.67% (P < 0.01). Therefore, preventive cholecystectomy is strongly recommended during hepatectomy to decrease the incidence of chronic cholecystitis and gall stone, especially for those whose chemotherapy and embolization will be carried out through hepatic artery and portal vein.
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Mechanisms of the spatial memory deficits induced
by injection of okadaic acid into the Meynert nucleus basalis of rats
TIAN Qing, LIU Bin, ZHOU Xinwen, TU Qian, LIU Rong, WANG Jianzhi
Front. Med.. 2008, 2 (2): 147-153.
https://doi.org/10.1007/s11684-008-0028-8
We previously reported that the injection of okadaic acid (OA) into the Meynert nucleus basalis of rats induced spatial memory deficits. The present study was designed to further explore the underlying mechanisms. We found that the level of acetylcholine (Ach) in the hippocampus significantly decreased 24 h after injection of OA into the Meynert nucleus basalis of rats. Simultaneously, spatial memory deficit, PP-2A inhibition and tau hyperphosphorylation at Ser-198/Ser-199/Ser-202 (Tau-1 epitope) and Ser-396/Ser-404 (PHF-1 epitope) were observed. With the restoration of hippocampus Ach to normal levels at 48 and 72 h after the injection, the spatial memory deficits, PP-2A inhibition and tau hyperphosphorylation were reversed. It is suggested that injection of OA into the Meynert nucleus basalis of rats may impair the hippocampus-dependent spatial memory through damaging the cholinergic projection between the Meynert nucleus basalis and the hippocampus and the selective inhibition of PP-2A and tau hyperphosphorylation may be at least part of the underlying mechanisms.
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Paeoniflorin prevents hepatic fibrosis of by inhibiting TGF-β1
production from macrophages in mice
CHU Deyong, LI Conglei, SHEN Jilong, WU Qiang
Front. Med.. 2008, 2 (2): 154-165.
https://doi.org/10.1007/s11684-008-0029-7
In order to investigate the effect of paeoniflorin (PAE) on hepatic fibrosis of mice with Schistosomiasis japonica in vivo and in vitro, a model of hepatic fibrosis caused by schistosomiasis was established in mice infected with cercariae of Schistosoma japonicum. Then, PAE was orally administered before and after praziquantel treatment and both therapeutics were given simultaneously at different time points after the infection. The concentration of serum hyaluronic acid (HA) was determined by radioimmunoassay (RIA). Hepatic granuloma and fibrosis were evaluated via HE and Masson staining. The expression of ?-smooth muscle actin (?-SMA), transforming growth factor ?1 (TGF-?1) and collagen I (Col I) protein was detected by immunohistochemistry. The effect of soluble egg antigen (SEA) and PAE on the production of TGF-?1 from mouse peritoneal macrophages (PM?s) was investigated by RT-PCR, Western blotting and ELISA. The effect of TGF-?1 in optimum macrophage-conditioned medium (OPMCM) on the proliferation of hepatic stellate cells (HSCs) and collagen secretion from HSCs with anti-TGF-?1 antibody was explored by MTT assay and ELISA. The results show that PAE could significantly reduce the concentration of serum HA, the size of egg granuloma, the severity of hepatic fibrosis and the expression of ?-SMA, TGF-?1 and Col I protein in the pre-treatment group. However, in sim- or post-treatment group, PAE did not have any significant therapeutic effect. TGF-?1 could be secreted from PM?s stimulated by SEA. Meanwhile, the production of TGF-?1 from PM?s could be depressed significantly by PAE in a concentration-dependent manner. TGF-?1 could promote the proliferation of HSCs and the secretion of collagens. In a word, PAE can prevent hepatic granuloma and fibrosis caused by schistosomiasis japonica through the inhibition of the secretion of TGF-?1 from PM?s, the proliferation and activation of HSCs and the secretion of collagens from HSCs.
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Relationship of endothelial nitric oxide synthase
gene polymorphism with blood pressure, lipid profile and blood glucose
level
TANG Zhongzhi, LI Junyao, YANG Jianhong
Front. Med.. 2008, 2 (2): 178-181.
https://doi.org/10.1007/s11684-008-0033-y
To study the relationship of the polymorphism of endothelial nitric oxide synthase (eNOS) gene and blood pressure, lipid profiles and blood glucose level. By using PCR-RFLP, the eNOS Glu298Asp gene polymorphism was detected in 184 patients with essential hypertension and 196 matched healthy individuals with normal blood pressure. Taking into account eNOS Glu298Asp polymorphisms, the relationship of blood pressure with triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL) and blood glucose level was analyzed. The distribution of eNOS Glu298Asp polymorphism had no significant difference between different blood pressure groups and gender groups, but there was a significant difference between different age groups, diastolic blood pressure groups or BMI groups (P < 0.05). Asp/Asp genotype significantly increased the risk of hypertension in individuals with serum TC above 5.4 mmol/L (P = 0.03, OR = 2.65). eNOS Glu298Asp polymorphism and serum lipid could synergistically modulate the blood pressure. eNOS Asp/Asp genotype could significantly increase the risk of hypertension in individuals with serum TC over 5.4 mmol/L. eNOS Glu298Asp in combination with serum TC could be used to predict the risk of hypertension.
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Protective effect of N-acetylcysteine against
lipopolysaccharide injury in hepatocytes of neonatal mice
WANG Lin, LIU Yalan, XU Jianbo, TIAN Yuan, WU Heshui
Front. Med.. 2008, 2 (2): 182-185.
https://doi.org/10.1007/s11684-008-0034-x
The present study provides supportive evidence for the effective prevention and treatment of lipopolysaccharide (LPS)-induced hepatocyte injury in neonatal mice by N-acetylcysteine (NAC). Hepatocytes of neonatal mice were obtained through collagenase digestion of the liver. The hepatocytes were treated either with LPS (10 ?g/mL) alone or with NAC (5 mmol/L) for 1 h before the addition of LPS (10 ?g/mL). After LPS treatment, 12 wells of the cultured hepatocytes and supernatants were harvested at 0, 6, and 12 h, respectively. Levels of alanine aminotransferase (ALT) and nitric oxide (NO) in the supernatant were biochemically quantified and reverse transcription-polymerase chain reaction (RT-PCR) was performed to detect the expression of inducible nitric oxide synthase (iNOS) mRNA after different treatments. At 0 h following the treatment of primary cultured hepatocytes with LPS, the levels of ALT, NO and iNOS mRNA in the supernatant were (21.1 ± 4.78) u/L, (1.6 ± 0.31) ?mol/L and 0.17 ± 0.023, respectively; at 6 h, (59.8 ± 8.59) u/L, (6.6 ± 0.81) ?mol/L, and 0.71 ± 0.091; and at 12 h, (89.6 ± 15.30) u/L, (7.8 ± 1.01) ?mol/L, and 0.71 ± 0.097. The levels of ALT, NO and iNOS mRNA at 6 and 12 h increased significantly, compared to those at 0 h (P < 0.01). In contrast to LPS treatment alone, pretreatment with NAC before LPS addition significantly reduced the levels of ALT, NO and iNOS mRNA in the supernatant at 6 h to (40.8 ± 7.30) u/L, (3.2 ± 0.71) ?mol/L, and 0.41 ± 0.060; and at 12 h to (55.4 ± 5.48) u/L, (4.0 ± 0.71) ?mol/L, and 0.40 ± 0.067, respectively (P < 0.01). However, the levels of ALT, NO and iNOS mRNA at 0 h did not change significantly with both treatment approaches. NAC has protective effects in hepatocytes of neonatal mice against LPS-induced injury as shown by the reduced levels of ALT, NO and iNOS mRNA when primary hepatocytes were treated with NAC prior to LPS stimulation. We postulate that NAC exhibits its protective function by inhibiting LPS-induced transcription of iNOS, resulting in decreased levels of NO.
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Autologous peripheral hematopoietic stem-cell
transplantation in a patient with refractory pemphigus
SUN Ledong, SUN Jing, ZENG Kang, MENG Fanyi, DIAO Youtao, XU Dan, HUANG Liang, ZHAO Jie, Liu Qifa
Front. Med.. 2008, 2 (2): 191-194.
https://doi.org/10.1007/s11684-008-0036-8
The aim of this study is to explore the effectiveness of autologous peripheral hematopoietic stem-cell transplantation in the treatment of refractory pemphigus. A 35-year-old male patient presented with a 4-year history of recurrent bullae on his trunk and extremities. The diagnosis of pemphigus was made on the basis of the clinical, histologic and immunofluorescence findings. The patient had shown resistance to conventional therapy with glucocorticoid and immunosuppressive agents. Two months before admission, he complained of hip joint pain. X-ray and CT scan revealed aseptic necrosis of the femoral head. Stem-cell mobilization was achieved by treatment with cyclophosphamide, granulocyte colony-stimulating factor (G-CSF) and rituximab. Peripheral blood stem cells were collected via leukapheresis and cryopreserved for later use. Immunoablation was accomplished by using cyclophosphamide (200 mg/kg; divided into 50 mg/kg on days -5, -4, -3, and -2), antithymocyte globulin (ATG; 10 mg/kg; divided into 2.5 mg/kg on days -6, -5, -4, and -3), and rituximab (1200 mg/d; divided into 600 mg/d on days 0 and 7). Autologous peripheral hematopoietic stem cell transplantation was followed by reconstitution of the immune system which was monitored by flow cytometry. The glucocorticoid was withdrawn immediately after transplantation. The pemphigus titer turned negative 6 weeks after transplantation and remained negative. The patient was in complete drug-free remission with no evidence of residual clinical or serological activity of pemphigus during 1 year of follow-up. The patient’s response suggests that autologous peripheral hematopoietic stem cell transplantation may be a potential “cure” for refractory pemphigus. However, further studies are needed to evaluate the risk-benefit ratio of this approach in patients with pemphigus showing resistance to conventional therapy.
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Chemotactic effect of urokinase-type plasminogen
activator on mouse spermatozoa
DING Xiaofang, LI Honggang, XIONG Chengliang
Front. Med.. 2008, 2 (2): 195-199.
https://doi.org/10.1007/s11684-008-0037-7
The aim of this study is to investigate the chemotactic effect of urokinase-type plasminogen activator (uPA) on mouse spermatozoa. Capillary assays were applied to study the chemotactic activity of ascending and descending gradients of uPA. Firstly, the chemotactic effect of an ascending gradient of uPA on mouse spermatozoa was observed by counting the number of spermatozoa that migrated into the capillary after incubation with uPA for 5, 10, 20, and 30 min, respectively, compared with that after incubation with F10. Twenty minutes was a suitable incubation time to obtain a plateau of sperm accumulation. Meanwhile, to confirm the specific effect of uPA on mouse sperm chemotaxis, uPA inhibitor (PAI-1) and anti-uPAR rabbit IgG were added to the test solution containing 20 U/mL uPA, respectively. To exclude the possibility that PAI-1 and anti-uPAR rabbit IgG may affect sperm accumulation nonspecifically, PAI-1 and anti-uPAR rabbit IgG were added to F10, respectively. It was found that the chemotactic effect of uPA was neutralized completely by PAI-1 and anti-uPAR rabbit IgG. PAI-1 and anti-uPAR rabbit IgG had no neutralizing effect on the sperm chemotactic effect. Lastly, the sperm chemotaxis response to a descending gradient of uPA was also observed. Taken together, the results suggest that uPA can induce sperm chemotaxis in vitro by binding to its receptor on the sperm membrane and may act as a chemoattractant in precontacting sperm-egg communication thereby increasing the chance encounter of spermatozoa and eggs.
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Expression of heat shock protein gp96 in osteosarcoma
and its clinical significance
GUO Weichun, CHEN Anmin
Front. Med.. 2008, 2 (2): 200-203.
https://doi.org/10.1007/s11684-008-0038-6
This study aims to detect the expression of heat shock protein gp96 (HSPgp96) in osteosarcoma and explore its role in anti-tumor immunity. Expression of HSPgp96 in 45 cases of osteosarcoma, including 24 cases of the osteoblast type, 21 cases of chondroblast type and 5 cases of normal bone tissue were detected by immunohistochemistry (IHC). The expression rate of HSPgp96 was 100% (45/45) in osteosarcoma, compared with 20% (1/5) in normal bone tissue. The average positive cell rates were 97.23% and 0.48% in osteosarcoma and normal bone tissue, respectively, and the difference between them was significant (P < 0.01). The positive cell rates in osteoblast type and chondroblast type were 97.78% and 96.56%, respectively, and the difference had no statistical significance (P > 0.05). The expression degree of HSPgp96 in osteosarcoma had a clear correlation with the pathologic degree (P < 0.05), while it had no relationship with the clinical stage (P > 0.05). The expression of HSPgp96 is high in osteosarcoma and it may be a significant index for judgment of malignancy degree and an important target site of anti-tumor immunity.
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Effects of 3-aminobenzamide on poly (ADP-ribose)
polymerase expression, apoptosis and cell cycle progression of HeLa
cells after X-ray irradiation
DU Xiang, ZHAO Hongguang, GUO Wei, GONG Shouliang, WANG Wen
Front. Med.. 2008, 2 (2): 204-206.
https://doi.org/10.1007/s11684-008-0039-5
The aim of this paper is to study the changes of apoptosis and cell cycle progression in HeLa cells after the poly (ADP-ribose) polymerase (PARP) was inhibited by its inhibitor 3-aminobenzamide (3-AB) and the mechanisms of PARP action on HeLa cells damaged by irradiation. Flow cytometry (FCM) was used to examine the PARP expression and the percentage of apoptotic cells and cell cycle progression. The percentage of HeLa cells with positive expression of PARP protein 2, 4, 8 and 12 h after administrated with 3-AB was significantly lower than that of the control (P < 0.01). The percentages of apoptotic cells in the 3-AB plus irradiation group at the time points of 2, 8, 12 and 24 h after 2 Gy irradiation were higher than that in the irradiation group (P < 0.01 or P < 0.05) and the percentage of G2 cells decreased significantly (P < 0.01 or P < 0.05). It indicates that 3-AB can rapidly inhibit PARP expression of HeLa cells, promote cell apoptosis and block G2 arrest induced by irradiation.
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Concentrations of toxic heavy metals in ambient
particulate matter in an industrial area of northeastern China
PIAO Fengyuan, SUN Xiance, LIU Shuang, YAMAUCHI Toru
Front. Med.. 2008, 2 (2): 207-210.
https://doi.org/10.1007/s11684-008-0040-z
This paper investigates concentrations of various heavy metals in ambient particulate matter (PM) and provide evidence for prevention from air pollution. The concentrations of heavy metal components in the PM were determined by inductively coupled plasma/Mass spectrometry (ICP/MS) from September 2000 to August 2002 in a northeast industrial city in China. Concentrations of Cd, Mn, Pb, Ni, Cr and As in the PM were 9.3, 461.9, 588.7, 69.5, 205.7 and 57.4 ng/m3 in the industrial area, and 5.7, 245.5, 305.0, 31.4, 58.8 and 32.5 ng/m3 in the main road, respectively. Concentrations of these heavy metals except Cd were significantly higher in the industrial area and main road than those in the suburban area (P < 0.05 or P < 0.01). The change curves of the six heavy metal concentrations show their concentrations increased in the winter and spring, but decreased in the summer and autumn. The results indicate that concentrations of the metals in the PM are relatively high in the industrial area and main road.
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