The discovery of microRNA (miRNA) has opened up a new train of thought for the diagnosis and treatment of esophagus cancer.let-7 is one of the most widely research of miRNA.In a variety of tumors,the expression of let-7 is down-regulated.let-7 can play the role of tumor suppressor gene by targeting to high mobility group A2 (HMGA2) and inhibit the cell proliferation.Recent studies have shown that the lower the degree of differentiation of cells,let-7 expression level is lower.It is expected as a symbol of poorly differentiated tumors.In addition,let-7 and esophagus cancer's radiation and chemotherapy sensitivity are closely related.

10.3969/j.issn.2095-4344.2013.23.015

Purpose:To improve the methads of approach in s urgery of esophageal cancer ,increase resection rate of esophagectomy, decrease the remnant cancer in margin and mortality after operation, enhance the postoper ative effect. Methods:From Jan.1999 to Dec. 2002,we adopted different surgica l approach as in esophagectomy in 297cases with esophageal cancer, such as left posterior thoracotomy(group I), left posterior thoracotomy with cervical incisi on (group Ⅱ),right anterior thoracotomy (group Ⅲ), right posterior thoracotomy (group Ⅳ). Results:The rate of operative resection was 98.7%(293/297)an d for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ they were 98.2%(86/87)、98.1%(52/53)、98.5%(133/135) 、100%(22/22) respectively;operation-related mortality was 1.7%(5/297) and fo r groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 2.3%(2/87)、1.9%(1/53)、0.75%(1/135)、4.5%(1/22) respectively;the occurrence of remnant cancer was 3.8%(11/293) and for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 4.7%(4/86)、3.8%(2/52)、2.6%(3/133)、9.1%(2/22) respective ly;the rate of postoperative complication was 12.8%(38/297) and for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 17.2%(15/87)、9.4%(5/53)、11.1%(15/135)、13.6%(3/22) respectiv ely. In the number of lymph node resected , there was statistical difference bet ween groups Ⅲ, Ⅳ and Ⅰ, Ⅱ(P0.05).Conclusions:Right anterior thoracotomy, right posterior thoraco tomy were more satisfactory operative approaches in radical total thoracic esop hagectomy of esophageal carcinoma. Through these two approaches,we not only can resect mediastinal and abdominal lymph nodes radically, but can also decrease t he cancer of at the margin and mortality after operation.

Objective To elevate accuracy of CT T4 staging diagnosis of esophageal carcinoma, we analysed relativity between CT diagnosis and postoperational pathology for the tracheal, bronchial, carinate early invasion. Methods From 1996 to 2002, 49 patients with cervical and middle-upper segment esophageal carcinoma proved by esophagectomy and pathology, whom were taken cervical or thoracic CT scaning before operation. Comparison was studied between postoperational pathology and CT diagnosis of tumor early invasion of the trachea, bronchus and carina. Results Of 49 patients with esophageal carcinoma, 21 lesions were in the cervical esophagus, out of 18 cases with tracheal early invasion performed by CT scaning, 14 cases comfirmed by postoperational pathology; 28 lesions in the middle-upper segment of thoracic esophagus, out of 17 cases with tracheal, bronchial or carinate early invasion diagnosed by CT scaning, 14 cases testified by postoperational pathology. Tracheal, bronchial and carinate early invasion of esophageal carcinoma proved by CT did not accord with postoperational pathology completely. The sensitivity, specificity, and accuracy of CT diagnosis for the tracheal, bronchial and carinate early invasion of esophageal carcinoma were 93.3 %, 33.3 %, 76.2 % in cervical esophageal and 82.4 %, 72.7 %, 78.6 % in thoracic esophageal respectively. The contingency coefficients of preoperational CT scaning comparison with postoperational pathology are 0.52, 0.77 respectively. Conclusion Early invasion to the trachea, bronchus and carina identified by conventional CT procedure for patients with esophageal cancer was more accurate and specific in thoracic than that in cervical. Esophageal tumor early invasion to the trachea, bronchus and carina performed with CT corresponded to postoperational pathology in some measure. Operatablity did not completely depend on the invasion of the trachea, bronchus and carina of esophageal carcinoma performed with CT.

BACKGROUND: Human adipose tissue-derived stromal cells (ADSCs) possess exert proliferation and multi-directional ability. As a novel stem cell, it has been widely utilized in tissue engineering and plays an important role in biological and potential therapeutic applications.OBJECTIVE: To review the research progress, applications and existing problems of human ADSCs in tissue engineering and cell therapy by retrieving relevant publications. METHODS: PubMed and CNKI databases were undertaken to identify the relevant articles published from January 1960 to January 2009 with the key words of "human adipose tissue-derived mesenchymal cells, isolation, differentiation, immune phenotype, application" both in English and Chinese. The articles relate to biological characteristics and applications of ADSCs were selected. In the same field, the documents published earlier or in the authoritative journals were preferred, and the repetitive studies were excluded. RESULTS AND CONCLUSION: A total of 81 documents were searched by computer, and 57 references were included in the final analysis. The results demonstrated that, human ADSCs share many characteristics, including the high proliferative potential and exhibiting the exert ability to undergo multilineage differentiation under appropriate conditions. Human ADSCs can not only utilize for tissue repairing, but also for cell immune modulation and gene therapy. However, there are still problems in its application. With the development of research on human ADSCs, their biological characteristics will be revealed, and their application in tissue repairing, cell therapy, transplantation, as well as gene therapy must be hold a great promise.

Objective To investigate the FDG PET-CT image characteristics of bone metastases from lung cancer and the clinical value of 18F-fluorodeoxyglucose(FDG)PET-CT for diagnosis to bone metastases from lung cancer.Methods 32 cases of bone metastasis from lung cancer examined by FDG PET-CT had been studied.All of them were proved by pathology after operation or biopsy.Their FDG PET-CT diagnosis were analyzed by comparing with CT diagnosis. Results All of 115 lesions of 32 cases showed intense uptake of 18F-FDG. SUV mean was 7.47±3.48. 115 lesions located in 42 pieces of bones. Most importantly.16 lesions of occult bone metastases of 12 cases were found.The most related bone were ribs(26/115,22.61%),thoracic vertebral(21/115,18.26%),iliac bone(18/115,15.65%)and lumbar vertebral(16/115,13.91%).96 lesions(83.48%)showed lytic type on CT images,1 lesion(0.87%)showed sclerotic type,and 2 lesions(1.74%)showed mixture type.Conclusion The FDG PET-CT can early detect bone metastases from lung cancer.show their exact location,and have superiority in the screen of bone metastases from lung cancer.

Objective To investigate the diagnostic accuracy and the clinical usefulness of the combination of troponin I (cTnI) and copeptin detected in patients with suspected non-ST elevation myocardial infarction. Methods 176 patients presenting to the emergency departments with chest chocking or chest pain within 6 hours and without ST elevation on a 12-lead electrocardiogram (ECG) were enrolled in this study. The level of copeptin and cTnI was measured. The diagnosis was adjudicated by 2 independent experts.The diagnostic performance of them was assessed using ROC analysis , and the sensitivity and specificity of them were inferred based on the positive rate of two cardiac markers. Results (1)The levels of copeptin and cTnI in NSTEMI patients were markedly higher than other groups (P<0.05).(2)The AUCs of copeptin and cTnI were 0.846 and 0.683, and the 95%CI of two markers were 0.786 ~ 0.906 and 0.577 ~ 0.789, respectively. (3)Using 10.85 pmol/L as cut off value,the sensitivity and specificity of copeptin were 90% and 64%,and the positive predictive value and the negative predictive valueof NSTEMI diagnose were 42.4% and 95.6%,respectively.Using 0.05 ng/mL as cut off value,the sensitivity and specificity of cTnI were 42.5% and 94.1%,the positive predictive value and the negative predictive value were 68%and 84.8% for diagnosis of NSTEMI. (4)The copeptin level over 10.85 pmol/L in combination with cTnI could be used to detect NSTEMI with higher sensitivity than that of copeptin or cTnI alone (95% vs 90% vs 42.5%). The negative predictive value of the combination of copeptin and cTnI was increased , compared to that of copeptin or cTnI alone (97.7% vs 95.6% vs 85.7%). Conclusions Determination of copeptin in addition to cTnI can improves diagnostic performance , especially early after chest pain onset. It seems to allow a rapid and reliable rule out of NSTEMI.

BACKGROUND:With the development of minimal y invasive technique, more and more forearm fracture, especial y in children, was treated by elastic stable intramedul ary nailing. Recently, elastic stable intramedul ary nailing was also used in elder children, even adults. In particular, this technique has obtained good curative effects for open fracture and unstable fracture. OBJECTIVE:To evaluate the clinical effectiveness and safety of elastic intramedul ary nail and plate fixation for double fracture of forearm using evidence-based medicine. METHODS:We retrieved PubMed, Embase, Cochrane Library, China Biology Medicine, VIP, China National Knowledge Infrastructure, WanFang, and other electronic databases. The quality of the included studies was assessed using Cochrane Systematic Review. The analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION:A total of 7 randomized control ed trials involving 468 cases were included. The results of meta-analyses showed that compared with plate fixation group, effective rate was higher in the titanium elastic nail group (P<0.000 1), the time of fracture healing was shorter (P<0.000 01), and the hospitalization time was shorter (P<0.000 01). In the aspect of adverse reactions, incidence of refracture (P=0.03) and breakage of internal fixation (P=0.03) was significantly lower. These indicated that compared with plate fixation, titanium elastic nail can improve the total effective rate, shorten the time of fracture healing on X-ray and the hospitalization time, at the same time, can effectively reduce the complications of refracture and breakage of internal fixation.

Objective To investigate the regulatory effects of hedgehog pathway on intestinal epithelial barrier function under hypoxia.Methods The IEC-6 cells of rats were divided into 3 groups:the normoxia group (21％ oxygen concentration),the hypoxia group (2％ oxygen concentration) and the hypoxia + cyclopamine group (cells pretreated by 5 mmol/L of cyclopamine,and then exposed in an atmosphere with 2％ oxygen concentration).The mRNA expressions of IHH,PTCH and GLI-1 were detected,and the transepithelial electrical resistance (TER) was determined.The protein expressions of tight junction proteins (ZO-1,Occludin,Claudin-1) and IHH were assayed by using the Western blot.All data were analyzed using the one-way analysis of variance or LSD-t test.Results The relative mRNA expressions of IHH,PTCH and GLI-1 were 0.056 ± 0.009,0.459 ± 0.087,0.142 ± 0.023 in the normoxia group,and 0.303 ± 0.052,0.678 ± 0.073,0.483 ± 0.061 in the hypoxia group,with significant difference between the 2 groups (t =-14.05,-11.85,-6.52,P ＜ 0.05).The relative protein expressions of IHH in the normoxia group and the hypoxia group were 0.39 ±0.06 and 0.91 ±0.15,with a significant difference between the 2 groups (t =-8.08,P ＜ 0.05).The TERs of the normoxia group,the hypoxia group and the hypoxia + cyclopamine group were (134 ± 5) Ohm/cm3,(100 ± 6) Ohm/cm3 and (118 ± 5) Ohm/cm3,with significant difference between the 3 groups (F =1.04,P ＜ 0.05).Compared with the normoxia group,the TER of the hypoxia group was decreased by 27.7％ (t =7.84,P ＜ 0.05) ; compared with the hypoxia group,the TER of the hypoxia + cyclopamine group were increased by 16.4％,but it was still significantly lower than the normoxia group (t =4.23,P ＜ 0.05).The expressions of ZO-1,Occludin and Claudin-1 were 1.18 ± 0.24,0.80 ±0.13 and 0.90 ±0.09 in the normoxia group,and 0.58 ±0.08,0.32 ±0.05 and 0.50 ±0.09 in the hypoxia group,and 0.92 ± 0.21,0.43 ± 0.10 and 0.82 ± 0.11 in the hypoxia + cyclopamine group,with significant difference between the 3 groups (F =4.95,2.88,10.09,P ＜0.05).The expressions of ZO-1,Occludin and Claudin-1 in hypoxia group were decreased by 48.7％,40.0％ and 55.6％ when compared with the normoxia group (t =12.86,9.35,18.90,P ＜0.05).The expressions of ZO-1,Occludin and Claudin-1 in the hypoxia + cyclopamine group were increased by 59.9％,35.2％ and 65.1％ when compared with the hypoxia group (t =5.63,2.92,6.66,P ＜ 0.05).Conclusion Hedgehog signal pathway could be activated under hypoxia,and then the expressions of tight junction proteins are decreased,which finally induces the injury of intestinal epithelial barrier function.

Objective:To evaluate the levels of interleukin 18(IL-18) mRNA in peripheral blood mononuclear cells(PBMCs),livers and spleens in monkey endotoxic shock models.Methods:Cynomolgus monkeys were injected i.v. with lipopolysaccharide(LPS) (2.8 mg/kg) to prepare the endotoxic shock models. The mRNA levels of IL-18 in PBMCs,livers and spleens were tested by fluorescence semi-quantitative realtime reverse transcription(RT)-PCR and compared with that of TNF-? and IL-1?.Results:IL-18 mRNA expression in PBMCs remarkably increased at 120 min after LPS administration, so did in livers and in spleens at the same time. mRNA levels of TNF-? in PBMCs peaked at 60 min after LPS injection, and also increased markedly at 120 min in livers and spleens. IL-1? mRNA levels peaked at 60 min in PBMCs, and did not change so much in livers and in spleens.Conclusion:IL-18 mRNA expression in PBMCs can be up-regulated by LPS, but changed latterly than TNF-? and IL-1? in endotoxic shock cynomolgus monkeys. It is presumed that IL-18 can be produced by PBMCs and liver Kupffer cells(maybe splenic macrophages),and TNF-? is produced by a variety of cells, but IL-1? in bloodstream mainly come from PBMCs after LPS challenge.