Volume 122  ·  Issue 05  ·  2009

Autoimmune disease represents a breakdown of natural tolerance to autoreactive antigens.Pemphigus and lupus erythematosus are common autoimmune diseases either skin-specific or with predominant skin involvement. During the past decades,much progress has been made in understanding the mechanism of autoimmune diseases and the immunological mechanism in some infectious diseases such as fungal infections. Various novel approaches have been developed in the treatment of these diseases。

Abstract：Background The presence of autoantibodies against multiple epidermal proteins is an important feature in paraneoplastic pemphigus (PNP). Circulating anti-desmoglein 3 autoantibody, the major pathogenic autoantibody in pemphigus vulgaris (PV), has been proved pathogenic in PNP. Because of many clinical differences between PNP and PV, we speculate about the involvement of other autoantibodies in the pathogenesis of PNP. Envoplakin (EPL) and periplakin (PPL) are recognized by most PNP sere. Their linker subdomains are highly homologous and necessary for the association of intermediate filaments.Methods We characterized the autoantibodies against the linker subdomains of EPL and PPL in PNP patients' sera and their associated tumors by enzyme-linked immunosorbent assay (ELISA) and immunofluorence. We also applied the purified autoantibodies against EPL and PPL from PNP sera to cultured human epidermal keratinocytes (HEK), to evaluate the changes of cell-cell adhesion.Results Autoantibodies against EPL and PPL were detected in most PNP patients by ELISA, and the decrease of these autoantibodies after removal of the tumors was roughly comparable to the improvement of clinical symptoms. Cultured tumor cells from PNP patients secreted these autoantibodies. Specific immunoglobulin receptors for EPL and PPL were found on B lymphocytes in tumors from PNP. Furthermore, purified anti-EPL and anti-PPL autoantibodies from PNP sere were capable of dissociating cultured human epidermal keratinocytes.Conclusion Autoantibodies against EPL and PPL may also be pathogenic in PNP。

Abstract：Background Antithrombotic and antiplatelet therapies have been proposed to treat non-ST elevation acute coronary syndrome (NSTEACS), yet limited information is available about their applications from a multicenter "real-world" clinical procedure, especially in China. This study was undertaken to characterize the use of antithrombotic and antiplatelet agents in relation to the risk levels of the NSTEACS patients who were enrolled in Sino-Global Registry of Acute Coronary Events (GRACEs) registry study.Methods We analyzed the data from 618 Chinese NSTEACS patients stratified into low-(n=151), intermediate-(n=233), and high-risk groups (n=234) based on GRACE risk scores. The baseline characteristics, clinical presentations,antithrombotic and antiplatelet agents were recorded and compared among the three groups.Results The administration rates of low-molecular-weight heparins (LMWHs) (86.08%) and thienopyridines (85.92%)were higher whereas the administration rate of glycoprotein Ⅱb/Ⅲa inhibitor (1.78%) was much lower than those reported previously. Meanwhile, within the first 24 hours of admission, the use of heparin/LMWHs in the high-risk group was more than that in the intermediate-and low-risk groups (73.50% vs 63.09% vs 55.63%, P=0.001). Furthermore, the combination of antithrombotic and antiplatelet medications showed no significant differences in all groups.Conclusions In the "real world" practice of China, the antithrombotic and antiplatelet therapies on NSTEACS are well adherent to the current guidelines except for several gaps, such as the very low use of glycoprotein Ⅱb/Ⅲa inhibitor.Moreover, these antithrombotic and antiplatelet treatments usually tend to be underused for the high-risk ones。

Abstract：Background The lung functional status could be displayed on lung perfusion images. With the images, the radiotherapy plans of lung cancer could be guided to more optimized. This study aimed to assess quantitatively the impact of incorporating functional lung imaging into 3-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT) planning for non-small cell lung cancer (NSCLC).Methods Ten patients with NSCLC who had undergone radiotherapy were included in this study. Before radiotherapy,each patient underwent CT simulation and lung perfusion imaging with single photon emission computed tomography (SPECT). The SPECT images were registered with simulation planning CT and used to contour functional lung (lung-F) and non-functional lung (lung-NF). Two 3DCRT plans and two IMRT plans were designed and compared in each patient:two anatomic plans using simulation CT alone and two functional plans using SPECT-CT in addition to the simulation CT.Dosimetric parameters of the four types of plans were compared in terms of tumor coverage and avoidance of normal tissues. Total radiation dose was set at 66 Gy (2 Gy×33 fractions).Results In incorporating perfusion information in 3DCRT and IMRT planning, the reductions on average in the mean doses to the functional lung in the functional plan were 168 cGy and 89 cGy, respectively, compared with those in the anatomic plans. The median reductions in the percentage of volume irradiated with ＞5 Gy, ＞10 Gy, ＞20 Gy, ＞30 Gy and ＞40 Gy for functional lung in the functional plans were 6.50%, 10.21%, 14.02%, 22.30% and 23.46% in 3DCRT planning,respectively, and 3.05%, 15.52%, 14.16%, 4.87%, and 3.33% in IMRT planning, respectively. No greater degree of sparing of the functional lung was achieved in functional IMRT than in 3DCRT.Conclusion Function-guided 3DCRT and IMRT plannings both appear to be effective in preserving functional lung in NSCLC patients。

Abstract：Background Transcatheter bronchial artery embolization (BAE) is widely used for the treatment of hemoptysis and the immediate success rate is high, but there are still some hemorrhage recurrences. One of the common reasons for failure of BAE is collateral branches as blood supply. The inferior phrenic artery (IPA) is one of the most common collateral branches that is scarcely reported. Our purpose was to observe manifestations of IPA supplying to hemoptysis and evaluate the efficacy and safety of IPA embolization.Methods Angiography during interventional treatment of 178 hemoptysis patients in the past 7 years confirmed that IPA hemorrhage resulted in hemoptysis in 25 patients (26-67 years old) who had: lung cancer (11 patients), bronchiectasis (11 patients), chronic lung inflammation (2 patients), and pulmonary tuberculosis (1 patient). Among the 25 patients, 7 patients had twice interventional operations within one week and 6 patients still experienced intraoperative hemoptysis after conventional embolization of the bronchial artery, the internal thoracic artery, and the intercostal artery, then had the second interventional operation immediately. The total number of cases were 191. Selective embolization of the IPA was performed using polyvinyl alcohol microspheres, gelatin sponge particles, and microcoil. The safety and clinical significance of IPA embolization were evaluated. The Pearson χ2 test and Fisher's exact probability test were used in this study.Results Selective IPA angiography showed increased diameter of the IPA, disorganization of the branches, and varying degrees of angiogenesis. In 11 cases, contrast material was seen in vessels supplying the tumor and in the tumor. In 9 cases, contrast material had leaked into the area supplied by the IPA; in 8 cases, non-specific flake-like deposits of contrast material were seen; and in 14 cases, abnormal communication or shunt was visualized. Lesions were closely related to the pleura in 25 patients. Fifteen lesions were close to the diaphragmatic pleura, seven close to the mediastinal pleura, and three close to the lateral pleura of the lower lung. Eleven cases had inferior thoracic pleural thickening and adhesions. The IPA was embolized in 25 cases, and the success rate of hemostasis was 100%. The IPA was not embolized in the other 166 cases, and the success rate of hemostasis was 92.17 %. In the 25 cases with IPA embolization, the involvement of the IPA in the blood supply of the hemoptysis was correlated with the duration of the disease (P=0.0344). The involvement of IPA in the blood supply of the hemoptysis was not correlated with the characteristic of the lung lesions (benign or malignant) (P=1.0000). Duration of follow-up was 8 months to 5 years.Hemoptysis recurred in four patients 1,2, 3, and 6 months after interventional operation, respectively, and was controlled by conservative treatment. Twenty-one patients had no recurrence of hemoptysis.Conclusions Bleeding from the IPA can result in hemoptysis and failure of BAE in the treatment of hemoptysis. Lf IPA hemorrhage contributes to hemoptysis, supplementary IPA embolization may be a safe and effective treatment。

Abstract：Background Appendicitis is the most common surgical problem in pregnancy, however the particular dangers of appendicitis in pregnancy lie in the varied presentation of symptoms and the higher chance of delayed diagnosis. The aim of this study was to determine the risk factors associated with prenatal outcome in acute appendicitis during second and third trimester pregnancies.Methods This was a retrospective single-center study that presented a descriptive analysis of the results. A total of 102 pregnant women who were diagnosed with acute appendicitis and operated upon in Peking University Third Hospital,China between January 1993 and December 2007 were presented. SPSS 12.0 for Windows was used for data analysis.Results Seventy-eight pregnant women who were diagnosed with acute appendicitis (sixteen patients had a perforated appendix, 62 patients had a non-perforated appendix) were operated upon during late pregnancy. The interval between symptom onset and surgery was the only predictive variable. A longer interval between symptom onset and surgery was associated with appendix perforation ((109.5±52.7) hours) than with no appendix perforation ((35.1±19.62) hours;P=0.007). There was a significant difference in the rate of preterm labor (5.1% vs 1.3%) and the rate of fetal mortality (25% vs 1.7%) between patients with and without a perforated appendix.Conclusions Delaying surgery correlates to more advanced disease with an increased risk of perforation. This contributes to an increased risk of further complications, including premature labor or abortion, and to higher maternal complication rates. Prompt diagnosis may improve the prenatal outcome。

Abstract：Background Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict.Methods Thirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province,were admitted 48 hours post-injury. All patients were male with a mean age of (22.4±8.7) years. The burn extent ranged from 4% to 75% ((13.6±12.9)%) total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition.Results These thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver,kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived.Conclusions A well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function。

Abstract：Background The immunological differences between children and adults with AIDS in China are not well documented.Th1/Th2 cytokines and chemokines are two types of immune factors intimately involved in disease progression of HIV-1 infection. This study aimed to identify changes in plasma levels of Th1/Th2 cytokines inerleukin (IL)-18, IL-16, IL-10 and chemokines regulated on activation, normal T cell expressed and secreted (RANTES), stromal cell-derived factor-1 (SDF-1) and monocyte chemoattractant protein-1 (MCP-1) in HIV-1-infected children and adults in China.Methods Seventy-five children with AIDS and 35 adult AIDS patients were recruited and clinical data were collected.CD4+ T lymphocyte counts were measured by flow cytometery and plasma HIV RNA levels were measured by quantitative RT-PCR. Plasma levels of IL-18, IL-10, IL-16, RANTES, MCP-1, SDF-1α and SDF-1β were quantified by enzyme-linked immunosorbent assay. The levels of β2-microglobulin (β2-MG) and soluble Fas (sFas) were measured to validate the level of humoral and cellular immune activation.Results The mean levels of all cytokines in pediatric and adult AIDS patients were significantly higher than in their healthy controls (P <0.01). The mean levels of these cytokines were higher in pediatric patients than in adult patients (P <0.05, except for SDF-1α and β2-MG). Some of the cytokine levels in patients younger than 6 years old was higher than in older children and adults with AIDS (IL-10, IL-18, SDF-1α, MCP, RANTES and sFas, P＜0.05). Levels of IL-18, IL-10,RANTES and β2-MG of pediatric patients increased as the levels of viral load increased (P ＜0.05).Conclusions Abnormal immune activation can be measured in Chinese pediatric and adult patients with AIDS, and is higher in children than in adult patients. The cytokines levels coincide with disease progression of AIDS, but have no direct relationship with total CD4+ T cell count。

Abstract：Background Allograft meniscal transplantation is an increasingly popular treatment option for the symptomatic young patients with meniscus deficiency. However, many questions still surround it. In this research, we studied the anatomical location and histological structure of human meniscal horn bony insertions and to observe the anatomical morphology and histomorphology of peri-meniscal attachments based on meniscal allograft transplantation.Methods Twenty-two fresh-frozen adult cadaver knees were dissected. The locations of meniscal anterior and posterior horn bony insertions to tibia were measured. The anatomical morphology of peri-meniscal attachments was observed and the histological structure of meniscal horn bony insertions and peri-meniscal attachment were studied by HE staining.Results The anterior horn bony insertion of medial meniscus was (9.19±1.83) mm inferior to the corresponding anterior border of tibial plateau, and (7.81±2.25) mm lateral to the axial line of the medial intercondylar eminence. The posterior horn bony insertion of medial meniscus was in the posterior intercondylar fossa of tibia, located between the anterior fibers of the posterior cruciate ligament (PCL) tibial insertion and anterior border of the tibial posterior intercondylar fossa,and was (5.05±1.18) mm lateral to the axial line of the medial intercondylar eminence. The distance between anterior and posterior horn bony insertions of the lateral meniscus was (13.68±2.19) mm. Anterior horn bony insertion of the lateral meniscus was (3.99±1.27) mm medial to the axial line of the lateral intercondylar eminence, and the posterior horn bony insertion of the lateral meniscus was (5.80±1.36) mm medial to the axial line of the lateral intercondylar eminence. Except for the meniscal horn bony insertions, which is the typical enthesis, we call the attachment of the other parts of menisci as 'peri-meniscal attachment'. The morphological and histological study showed that the main peri-meniscal attachment was the meniscotibial ligament, through which the meniscus attached to the tibia with enthesis structure, and there was only loose connective tissue between menisci and capsule.Conclusions In meniscal allograft transplantation, the traditional meniscal size-matching method which take medial and lateral intercondylar eminences as references is not as accurate as expected. Attention should be taken to locate both anterior and posterior horn tunnels of medial meniscal allograft inferior to the tibia plateau, and to locate anterior and posterior horn tunnels of lateral meniscus close enough (mean 13.68 mm). The best way to reconstruct the peri-meniscal attachment is to suture the allograft to the preserved outer remnant of the original meniscus。

Abstract：Background The solitary pulmonary nodule (SPN) is one of the most common findings on chest radiographs. The objectives of clinical practice are to differentiate malignant nodules from benign nodules in the least invasive way and to make a specific diagnosis. This study was aimed to evaluate the correlation between perfusion imaging features and microvessel density (MVD) and vascular endothelial growth factors (VEGF) in SPNs using multi-slice computed tomography (MSCT); and to provide the theoretical basis for SPN blood flow pattern and blood flow quantitative features.Also, the study called for the discussion of the method's clinical application value in the differential diagnosis of benign and malignant SPNs.Methods Sixty-eight patients with SPN underwent multi-location dynamic contrast enhanced (nonionic contrast material was administrated via the antecubital vein at a rate of 4 ml/s) MSCT. Precontrast and postcontrast attenuations on every scan was studied. Perfusion, peak height, and the ratio of the peak height of the SPN to that of the aorta were analyzed. Perfusion was calculated using the maximum gradient of the time-density curves (TDC) and the peak height of the aorta. The quantitative parameters (perfusion, peak height, ratio of peak height of the SPN to that of the aorta) of the blood flow pattern were compared with MVD and the VEGF expression of immunohistochemistry.Results The perfusion peak heights of malignant ((96.15±11.55) HU) and inflammatory ((101.15±8.41) HU) SPNs were significantly higher than those of benign ((47.24±9.15) HU) SPNs (P＜0.05, P＜0.05). Ratios of SPN-to-aorta of malignant and inflammatory SPNs were significantly higher than those of benign SPNs (P＜0.05, P＜0.05). No significant differences were found between the peak height and SPN-to-aorta ratio of malignant SPNs and inflammatory SPNs (P＞0.05, P＞0.05). The precontrast densities of inflammatory SPNs were lower than those of malignant SPNs (P＜0.05).Perfusion values of malignant and inflammatory SPNs were significantly higher than those of the benign SPNs (P＜0.05,P＜0.05). The VEGF positive expressions appeared in 32 patients with malignant SPNs and 2 patients with benign SPNs,and the average value of the MVD was higher in patients with malignant SPNs (36.88±6.76) than in patients with either benign (4.51±0.60) or inflammatory (26.11±5.43) SPNs (P＜0.05, P＜0.05). There were statistically significant correlations between the CT perfusion feature and the MVD. The highest correlation was between the peak height of SPN and the MVD (r=0.657, P＜0.05).Conclusions Tumor microvessel density and VEGF expression facilitate the exploration of the pathophysiological basis of CT perfusion in SPNs. Multi-slice CT perfusion has shown strong positive correlations with angiogenesis in SPNs。

Abstract：Background Cell-based vascular therapies of endothelial progenitor cells (EPCs) mediated neovascularization is still a novel but promising approach for the treatment of ischemic disease. The present study was designed to investigate the therapeutic potentials of human umbilical cord blood-derived EPCs (hUCB-EPCs) in rat with acute myocardial infarction.Methods Human umbilical cord blood (hUCB) mononuclear cells were isolated using density gradient centrifugation from the fresh human umbilical cord in healthy delivery woman, and cultured in M199 medium for 7 days. The EPCs were identified by double-positive staining with 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine percholorate-labeled acetylated low-density lipoprotein (Dil-Ac-LDL) and fluorescein isothiocyanate-conjugated Ulex europaeus lectin (FITC-UEA-I). The rat acute myocardial infarction model was established by the ligation of the left anterior descending artery. The hUCB-EPCs were intramyocardially injected into the peri-infarct area. Four weeks later, left ventricular function was assessed by a pressure-volume catheter. The average capillary density (CAD) was evaluated by anti-VⅢ immunohistochemistry staining to reflect the development of neovascularization at the peri-infarct area. The graft cells were identified by double immunofluorescence staining with human nuclear antigen (HNA) and CD31 antibody,representing human origin of EPCs and vascular endothelium, respectively. Expressions of cytokines, proliferating cell nuclear angigen (PCNA), platelet endothelial cell adhesion molecule (PECAM) and vascular endothelial growth factor (VEGF) were detected to investigate the underlying mechanisms of cell differentiation and revascularization.Results The donor EPCs were detectable and integrated into the host myocardium as confirmed by double-positive immunofluorescence staining with HNA and CD31. And the anti-VⅢ staining demonstrated a higher degree of microvessel formation in EPCs transplanted rats, associated with a significant improvement of global heart function in terms of the increase of left ventricular end-systolic pressure (LVESP),+dp/dtmax and -dp/dtmax as well as the decrease of LVEDP in rats with EPCs therapy comparing to the control rats (P＜0.05). Moreover, the expression of the rat PCNA mRNA and PECAM were both enhanced in the EPCs group compared with that of the control group.Conclusions The human umbilical cord blood-derived EPCs could incorporate into new-born capillaries in rat myocardium, induce revascularization and improve the proliferation activity in the peri-infarct area, resulting in the improvement of global heart function. This may indicate a promising stem cell resource in cell-based therapy for ischaemic diseases。

Abstract：Background β-glucan is the major structure component of Candida albicans (C. albicans) cell wall. It has been demonstrated that Dectin-1 as the principal C-type lectin pattern-recognition receptor (PRR) can recognize fungal β-glucan and induce immune responses. In this study, we sought to clarify whether insoluble β-glucan from the cell wall of C. albicans (CalG) could induce immune responses in human THP-1 monocytes (a human acute monocytic leukemia cell line) and to determine the underlying mechanisms.Methods Human THP-1 monocytes were challenged with CalG in vitro. The mRNA expression of Dectin-1, Toll-like receptors (TLR2), proinflammatory cytokine (TNF-α) and chemokine (IL-8) was assayed by real-time reverse transcription polymerase chain reaction (RT-PCR). The secretion of TNF-α and IL-8 were measured by enzyme-linked immunosorbent assay (ELISA). H2O2 release was determined by microplate fluorescent assay. Western blotting was used to analyze IkB-α phosphorylation and degradation.Results Exposure of THP-1 monocytes to CalG led to increased gene expression and secretion of TNF-α and IL-8.CalG induced H2O2 release in a time-dependent manner. CalG hydrolyzed with zymolyase failed to induce gene expression and secretion of TNF-α, IL-8 and H2O2 release. CalG up-regulated the mRNA of Dectin-1, whereas the mRNA level of TLR2 was not altered. THP-1 monocytes challenged with CalG resulted in the activation of NF-KB in a time-dependent manner. Dectin-1 inhibitor laminarin blocked the CalG-induced production of TNF-α and H2O2 in THP-1 monocytes, but no such effect was observed in pretreatment with anti-TLR2 neutralizing antibody and the LPS inhibitor (polymyxin B).Conclusion CalG may play a role in activation of immune responses in human THP-1 cells through Dectin-1, not TLR2.This work was supported by a grant from National Natural ScienceFoundation of China (No. 30671893)。

Abstract：Background Sjǒgren syndrome (SS) is a systematic autoimmune disease, on which traditional therapeutic agents show limited effect. More effective agents with longer-lasting and fewer side effects are needed in the clinic. The aim of this study was to investigate the effects of Ganoderma lucindurn spores (GLS) on sialoadenitis of nonobese diabetic (NOD) mice.Methods Thirty-two female NOD mice were assigned randomly into 4 groups: low-dose GLS-treated (L-GLS) group and high-dose GLS-treated (H-GLS) group, a dexamethasone group, and a normal saline (NS) control group. Stimulated total saliva flow rate (STFR), area of lymphocytic infiltration in submandibular glands and ratios of CD4+ and CD8+ T lymphocytes and B lymphocytes in peripheral blood as well as apoptosis of these subsets and serum IgG level were tested after 10 weeks of treatments. Differences among the groups were analyzed by one-way analysis of variance (ANOVA), Student-Newman-Keuls Test (SNK) was used between each two groups and a P＜0.05 was considered statistically significant.Results STFR of the high-dose GLS group increased significantly after a 10-week treatment compared with those of the NS control group (P＜0.05). The incidence of sialoadenitis in GLS-treated NOD mice groups showed no significant difference compared with the control group (P＞0.05), but the area of lymphocytic foci in both the H-GLS and L-GLS groups decreased significantly to 50% of the NS control group (P＜0.05); the ratio of CD4+/CD8+ T lymphocytes and apoptosis of B lymphocytes of NOD mice with sialoadenitis were less and apoptosis of CD4+ and CD8+ T lymphocytes were significantly increased compared with the control group (P＜0.05). After pretreatment with H-GLS before sialoadenitis onset, the ratio of CD4+/CD8+ T lymphocyte and the serum IgG levels of NOD mice decreased significantly (P＜0.05).Conclusions Pretreatment with H-GLS can relieve symptoms of sialoadenitis in NOD mice. GLS has some protective effects on sialoadenitis in NOD mice through increasing STFR and decreasing the area of lymphocytic loci by regulating the ratio of CD4+/CD8+ T and apoptosis of B lymphocytes。

Abstract：Background Tumor necrosis factor α receptor 1 (TNFαR1) plays an important role in the signal pathway of apoptosis.The objective of this study was to investigate the effects of TNFaR1 knockout on the up-regulation of erythropoietin receptor (Epo-R) and the coordinated anti-apoptosis functions during myocardial ischemia-reperfusion injury in mice.Methods The ischemia-reperfusion injury model for cardiomyocytes was performed by ligating the left circumflex branch artery of TNFαR1 knockout (P55-/-) C17 B6 mice, as well as wild-type (P55+/+) C17 B6 mice. Triphenyltetrazolium chloride (TTC) staining was performed to observe the damaged area of the heart. TUNEL staining and DNA fragmentation were used to identify apoptosis. Mitochondrial Bcl-2 and Bax as well as expression of Epo-R and its downstream genes (Jak-2, slat-5, Akt, IkB-α, HIF-1α) were measured by Western blotting. The gene knockout mice were assigned into those undergoing the apoptosis surgical model group (KO group), and those subjected to sham operation (Kos group). Similarly, wild-type mice were either exposed to the surgical model (WT group) or subject to a sham operation (WTs group).Results The myocardial damage ratio of the wild-type group after the operation was significantly higher than that of the knockout group, (50.5±6.4)% vs (36.9±6.9)%, P＜0.01. Similarly, TUNEL positive ratio of the wild-type group was significantly higher than that of the knockout group, (63.1±5.6)% vs (42.1±4.7)%, P＜0.01. The gray value ratios of Epo-R,Jak-2, stat-5, Akt, IkB-α, HIF-1 and mitochondrial Bcl-2 in the KO group were significantly higher than those of the WT group, P＜0.05; however, mitochondrial Bax was significantly lower than that of the WT group significantly (P＜0.05).Conclusions Using the ischemia-reperfusion injury model in mice, cardiomyocytes of TNFαR1 knockouts exhibited anti-apoptotic characteristics. This information could be used to coordinate the prevention of myocardial apoptosis by up-regulating and activating the Epo-R pathway。

Stress urinary incontinence is one of the most common diseases in urology. The main treatments for stress urinary incontinence are pharmacotherapy, physico-behavioral therapy and surgery.1 However, the results of present methods are not satisfactory. Tissue engineering is a newly emerging technology that may provide a novel method for the treatment of stress urinary incontinence.2

Allergic asthma has been defined as a disease of immunodysregulation, where the pathology is a direct consequence of excessive T-helper type 2 immune responses (Th2) to allergens in the lungs. Disease is associated with increased secretion of type-2 cytokines such as interleukin (IL)-4, IL-5 and IL-13 which, among other things, promotes enhanced IgE levels, induces pulmonary eosinophilic inflammation and increased mucus production in the airways.1 The prevalence of allergic asthma and other atopic disorders has increased dramatically to almost epidemic proportions in the past few decades, especially in lndustnahzed countries.2 An attractive explanation for this increase is offered by the "hygiene hypothesis", which states that the relative lack of infections early in life could promote the development of allergic diseases in genetically predisposed individuals.3Mycobacterium bovis (M. Bovis) Bacillus of T-helper type 1 immune responses (Th1)4-11and modulates the development of asthma both in animal models and human beings, as we previously described in a review.12

Neisseria meningitidis (N. Meningitidis) is classified into 13 serogroups based on the immunological reactivity of the capsular polysaccharide.1 Serogourps A,B and C are responsible for over 90% of meningococcal disease.2In developed countries, endemic disease is generally caused by serogroups B and C. Epidemics due to serogroup B have also occurred in Brazil, Chile, Cuba,Norway and, more recently, in New Zealand.2 In China,serogroup A is the most common cause of epidemics. In recent years, the number of meningococcal meningitis cases in China attributed to serogroups B and C has substantially increased.3,4

In pemphigus vegetans, intertriginous areas are more commonly involved, and verrucous vegetations develop easily in these areas. In this article, we report a case of Hallopeau type of pemphigus vegetans confined to the right foot。

Lichen sclerosus et atrophicus (LSA) of the male genitalia was a chronic, sclerosing, atrophic process of the glans and foreskin. Atrophy and scarring in the penis can lead to urethral stricture, acquired phimosis,even a significant reduction of physiological function.Though its prognosis is usually benign, the risk of penile carcinoma in patients with LSA remains uncertain. We report a 36-year-old patient of aggressive penile squamous cell carcinoma (SCC) arising on LSA of the penis within a short period。

Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common types of paroxysmal supraventricular tachycardia. The mechanism of AVNRT is reentry associated with dual or multiple atrioventricular nodal (AVN) pathways. Typical AVNRT pathways,including fast and slow pathways, are confined in the right atrium. Radiofrequency catheter ablation of the slow pathway, and occasionally the fast pathway, has become the definitive treatment of choice for most symptomatic patients. Besides typical AVNRT, there exists some atypical AVNRT with various manifestations. Several groups have reported successful ablation of the leftward dual AVN pathway from the left side of the heart.1-3 We present one case of left-sided AVN as well as dual AVN pathway. The tachycardia was successfully eliminated by ablation of the slow pathway deep in the coronary sinus。

The first laparoscopic hepatectomy case was reportedby Reich et al1 in 1991. Initially the laparoscope was utilized diagnostically for resection and biopsy of superficial liver lesions. Recently due to the technological advancement and instrumental improvement, the laparoscopic hepatic resection procedures have evolved significantly. Among them, the caudate lobectomy is considered to be one of the most challenging surgeries on account of its unique anatomic location in the core of the liver within the abdomen. So far, there are only a few reported laparoscopic caudate lobectomy cases in the literature and the most cases were performed utilizing a traditional procedure.2,3

To the Editor: Management of a difficult airway remains one of the major challenges to the anesthetists in clinical practice.1 Lightwand-guided nasal intubation has been shown to be a useful technique in the patients with known difficult airways.2-4 Also the preformed nasotracheal tubes (PNTs) are commonly selected for nasal intubation in the patients undergoing head and neck surgery because they are easy to secure,provide convenient surgical access and help to reduce nasal damage.5 However, the anesthetists must be faced with a problem that the PNT is significantly longer than the wand of the Trachlight TM (Laerdal Medical Corporation, New York, USA). For example, the lengths of the sizes 6.0-7.5 Portex Polar cuffed nasal tubes (Portex Lmited Hythe, England) range from 43 to 46 cm,whereas the wand of the Trachlight TM is only 33 cm long.After the wand of the TrachlightTM is inserted into the PNT, therefore, its distal light bulb is not able to protrude beyond the distal end of the PNT. We have adapted a simple method to solve this problem。