Objective To investigate the application of video-mediastinoscopic biopsy and treatment for pleural effusion. Methods Thirty-two patients with pleural effusion received mediastinoscopic biopsy or treatment. The patients were maintained at a lateral decubitus. A 2 cm incision was made along the midaxillary line for introducing the mediastinoscope. The pleural fluid was drawn out and exploration with biopsy was conducted under mediastinoscope. For 25 patients with malignant hydrothorax, talcum powder was applied for pleurodesis. Results The operation time was 30~70 min (mean, 42 min). A confirmative diagnosis was obtained by video-mediastinoscopy in all the 32 patients, including adencarcinoma in 22 patients, poorly differentiated squamous cell carcinoma in 2, invasive thymoma in 1, tuberculosis in 5, and inflammation in 2. All the operations were successful and the patients recovered smoothly without severe postoperative complications. Conclusions Video-mediastinoscopy is one of effective methods for biopsy and treatment of pleural effusion.

Objective To compare the pre-existing mutations in reverse transcription region of HBV in patients with different HBV infection stages.Methods Totally 474 patients with chronic HBV infections,including 205 with chronic hepatitis B (CHB),153 with liver cirrhosis and 116 with hepatocellular carcinoma (HCC),were enrolled from the People' s Hospital of Shangyu and the First Affiliated Hospital of Zhejiang University during January 2011 and June 2013.All patients had not received nucleos (t)ide analogues treatment.HBV RT region mutations and genotypes were determined by PCR followed by sequencing.SPSS14.0 was used for statistical analysis.Results There were 387 (81.6％) patients with HBV genotype B,in which 156 were with CHB,124 were with liver cirrhosis,and 107 were with HCC.Nucleos(t)ide analogues-related mutations were observed in all the above 387 patients.rtS106C mutation was more popular in CHB and liver cirrhosis (14.1％ and 14.5％) patients than that in patients with HCC (4.7％) (x2 =6.126,6.207,P ＜0.05); And the positive rates of rtD134E/G/N/S mutations were also higher in CHB and cirrhotic patients (21.8％ and 20.2％) than that in HCC patients (10.3％,x2 =5.933,4.263,P ＜ 0.05).rtD134E/G/N/S and rtS106C mutations were correlated with HBeAg (P ＜0.01) and gender (P ＜ 0.05),but not with HBV virus load and age (P ＞ 0.05).The mutation frequencies in A-B interdomain were higher in CHB and cirrhotic patients (5.3％ and 5.6％) than that in HCC patients (3.5％,x2 =9.018,11.018,P ＜ 0.01).Conclusions Nucleos (t) ide analogues-related mutations exist in various HBV infection stages.rtSl06C and rtD134E/G/N/S mutations may be involved in necro-inflammation,and A-B interdomain mutations may be correlated with necro-inflammation,immune response and fibrosis in chronic liver diseases.

Objective:To clone the single chain variable Fv of anti-idiotype monoclonal antibody against vibrio alginolyticus.Methods:Total RNA was extracted from hybridoma cell 2F4 secreting MAb against vibrio alginolyticus and cDNA was amplified by retropolymerase chain reaction(RT-PCR),the expression vector pTAT-AL1 was constructed for the recombinant V_H-V_L expression.The transformed E.coli BL21 cells were propagated and induced by IPTG.Results:The V_H gene contained 369 base pairs and encoded 123 amine acid residues;The V_L gene contained 339 base pairs and encoded 113 amine acid residues;There were four FRs three CDRs and two characteristic cysteine residues in the V_H and V_L gene,respectively.ELISA results showed the ScFv retained almost the same antigen affinity and specificity as its parent monoclonal anitbody.Conclusion:The single chain variable Fv of anti-idiotype monoclonal antibody against vibrio alginolyticus was constructed successfully and expression products was found in the periplasmic space and inclusion bodies.This ScFv might be a new generation of gene engineering vaccine of the anti-idiotype monoclonal antibody against vibrio alginolyticus in fishery.

Objective To study the distribution and sequence analysis of gonadotropin releasing hormone (GnRH) gene in cultured gastric parietal cells of rats. Methods The distribution of GnRH molecule and GnRH mRNA were observed out through immunohistochemical ABC methods and in situ hybridization methods in cultured gastric parietal cells of rats. After isolation of the total RNA from the parietal cells, RT PCR was conducted to obtain GnRH cDNA. Then, the products of PCR was purified, digested by the restriction enzyme of Hind Ⅲ and EcoR Ⅰ, and DNA fragments interests were cloned into pUC19 vector. The products of PCR were analyzed by sequenceing with Sanger's method after identified by PCR and digestion of restriction enzyme. Results Gastric parietal cells showed GnRH immunoreactivity, positive material was located in cytoplasm with negative nuclei. GnRH mRNA hybridized signals were also detected in cytoplasm with negative nuclei. The specific amplified band of GnRH mRNA was detected through agarose gel electrophoresis and gene sequence is identical to the GnRH which has been reported in rat hypothalamus.Conclusion Our data suggest that GnRH could be produced by gastric parietal cells of rats and may modulate physiological function of gastric parietal cells of rats.\;[

Objective A retrospective cohort study was carried out to observe the long-term effect of ESD in treating early gastrointestinal cancer or precancerous lesions. Methods The clinical and follow-up data of 73 patients were collected. Kaplan-Meier, Log-rank and Breslow test and Cox's proportional hazards regression model were used to analyze the data. Results The median survival time in the gastric and colo-rectal early cancer or precancerous lesions is longer than 65 months in our study, respectively. For esophagus, the median survival time was 44.5 months; the disease free survival time (DFS) after ESD was significantly reduced in the esophagus, compared to the stomach and colo-rectum (χ2 = 12.61, P = 0.000; χ2 = 7.09, P = 0.008); the degree of atypia (or infiltration), and lesion size were considered to be two factors to influence the DFS after ESD (P = 0.027, OR^ =2.38, 95%CI:1.10 ~ 5.12, P = 0.074, 95%CI; OR^ =0.90, 95%CI: 0.80 ~ 1.01). Conclusion ESD is an effective curative treatment in the resection of early upper gastrointestinal cancer and precancerous lesions. The degree of atypia (or infiltration) was concluded as an independent risk factor for the DFS post-ESD, and the size of lesion was a valuable parameter with regard to the recurrence after ESD procedure.

Objective To evaluate the mid-term results of arthroscopic anterior cruciate ligament (ACL) reconstruction using Transfix technique.Methods From August 2002 to December 2003,38 patients (24 left knees and 14 right knees) with ACL ruptures underwent arthroscopic ACL reconstruction with hamstring tendon using Transfix femoral fixation and interference screws tibial fixation.There were 21 males and 17 females,aged from 19 to 48 years (average,28.4 years).The causes of injury included sports injury in 27 cases,traffic injury in 2 cases and fall injury in 2 cases,and 7 patients had no significant injury.There were 6 cases of acute injury and 32 cases of old injury.Anterior drawer test was positive in 35 cases,weak positive in 1 case and negative in 2 cases.Lachman test was positive in 37 cases,and weak positive in 1 case.The Lysholm score was used to evaluate the results.Moreover,X-rays and MRIs were used to observe the conditions of graft and bone tunnel.Results Thirty-six patients were followed up for 6.3 to 7.6 years (average,6.8 years).All patients had normal joint range of motion.The Lysholm score improved from preoperative 64.4±4.52 to postoperative 85.6±4.60,and the difference was statistically significant (P ＜ 0.05).The X-rays and MRIs showed femoral and tibial tunnel enlargement in 3 cases,femoral tunnel enlargement in 5 cases and tibial tunnel enlargement in 3 cases.No joint space narrowing was found in all patients.One patient underwent arthroscopic revision ACL reconstruction with allograft tendon using bioabsorbable interference screws fixation on both tibial and femoral sides for re-rupture of ACL 4 years after operation due to trauma.Conclusion Arthroscopic ACL reconstruction with hamstring tendon using Transfix femoral fixation and interference screws tibial fixation is an effective method,which can provide satisfactory joint range of motion and stability.

10.3969/j.issn.1007-3969.2013.05.003

Objective To observe the expression of the IGF-1 on the auditory cortex as well as the hippo-campus of rats which underwent longterm exposure to white noise to explore its effects for the repairment of the noise induced damage in the central nervous system.Methods 16 healthy Wistar rats were randomly grouped as chronic noise exposure group(group A)which underwent the longterm noise exposure(100 dB SPL white noise,4 hours per day for 28 days)and control group(group B).The expression of IGF-1 both on the auditory cortex and hippocampus was measured and the ABR waveforms were recorded.ResuIts Compared with the group A,the num-ber of IGF-1 positive neurons as well as the expression of IGF-1 both in the auditory cortex and the hippocampus of the group B increased(P<0.05),the ABR threshold was significantly higher(P<0.05 )after long-term noise exposure.ConcIusion Chronic noise exposure induced the changes of the IGF-1 system which may play a part in the protection for the noise-induced damage of the central nervous system.

Objective To compare the 2-year efficacy of de novo combination therapy with lamivudine (LAM) and adefovir dipivoxil (ADV) to that of entecavir (ETV) monotherapy in treatment of patients with hepatitis B virus ( HBV )-related decompensated cirrhosis.Methods A total of 120 naive patients with HBV-related decompensated cirrhosis admitted to Shangyu People's Hospital and the First Affiliated Hospital of Zhejiang University from January 2007 to April 2008 were enrolled,in which 60 were treated with LAM and ADV combination therapy,and other 60 patients were treated with ETV monotherapy.Tests for liver and kidney function,alpha-fetoprotein,HBV serum markers,HBV DNA load,prothrombin time (PT),and ultrasonography or CT scan of liver were performed every 1-3 months.Repeated measure ANOVA and x2test were used to compare the efficacy,side effects and accumulated survival rates at 12 and 24 month in two groups.Results Forty-five patients in each group were followed-up for 24 months.There was no significant difference in HBV DNA negative rates and ALT normalization rates at month 12 (x2 =2.12 and 2.88,P ＞0.05 ) and month 24 between two groups (x2 =3.21 and 3.24,P ＞ 0.05); while HBeAg seroconversion rate in LAM + ADV group at month 24 was significantly higher than that in ETV group (43.5％ vs.36.4％,x2 =4.09,P＜0.05).Viral breakthrough occurred in 2 cases (4.4％) by month 12 and 3 cases (6.7％) by month 24 in LAM + ADV group,and no viral mutation was observed; while in ETV group,viral breakthrough occurred in 1 case ( 2.2％ ) by month 12 and 2 cases (4.4％) by month 24,and viral mutation was observed in 1 case (2.2％) by month 24.At the end of month 24,increase of AIb (F=18.9 and 17.3,P＜0.05),decrease of TBil and ALT (F=16.5,17.1 and 23.7,24.8,P ＜0.05 ),shortening of PT ( F =22.7 and 24.5,P ＜ 0.05 ),and the improvements of CTP and MELD scores (F=18.5,17.8 and 24.2,23.8,P＜0.05) were observed in both groups.The accumulative rates of mortality or liver transplantation were 16.7％ ( 10/60 ) and 18.3％ ( 11/60 ) in LAM + ADV and ETV groups,respectively.No blood creatinine increased above the normal upper limit was observed in both groups.Conclusion Both LAM + ADV combination therapy and ETV monotherapy can effectively inhibit HBV replication,improve liver function,decrease mortality and viral resistance,but the 24-month HBeAg seroconversion rate in combination therapy group is higher than that in monotherapy group.

OBJECTIVE: To evaluate the efficacy and safety of Pravastatin versus Simvastatin in downregulating low density lipoprotein cholesterol(LDL-C) and upregulating high density lipoprotein cholesterol(HDL-C).METHODS: A total of 66 patients with hypercholesterolemia were enrolled: 33 were randomly assigned to receive Pravastatin(40 mg) for 6 weeks,and another 33 to receive Simvastatin(40 mg) for 6 weeks.Serum lipid levels at baseline and 6 weeks after medication were measured.The primary effective indicator was LDL-C as compared with baseline value and the secondary effective indicator was HDL-C.Safety was evaluated based on laboratory data and clinical adverse reactions.RESULTS: Both Pravastatin and Simvastatin significantly decreased LDL-C level,showing significant differences as compared with before medication(P0.05).Less adverse drug reactions were noted in both groups.CONCLUSION: Pravastatin and Simvastatin were equivalent in lipid-regulatory effect and both were well-tolerated.