Objective The aim of this study was to measure quantitatively the TSP-4 mRNA expression and its significance in gastric carcinoma was evaluated by correlating its expression with clinicopathological features, microvessel density(MVD) and MMP-9.Methods Eighty-two patients with gastric carcinoma were recruited in this study. TSP-4 mRNA expression in gastric carcinoma and adjacent tissue was detected by real-time PCR. CD34 and MMP-9 protein expression were examined by immunohistochemistry. MVD was determined according to CD34-positive tubular structures. Results The expression level of TSP-4mRNA in gastric carcinoma was obviously higher than those of adjacent tissue(P=0.03) and it was associated with tumor size, histological type, lymph node metastasis, MVD and MMP-9(P=0.002, P=0.031, P=0.014,r＝0.67 P<0.01, P=0.008),but not sex, age and depth of invasion. (P=0.53,P=0.57,P=0.15).Conclusion TSP-4 may play an important role in occurrence and progression of gastric carcinoma and that the effect of TSP-4 on tumor growth and metastasis may be exerted through regulation of angiogenesis and MMP-9 expression in gastric carcinoma.

Objective To evaluate the impact of preoperative renal artery embolization in renal cell carcinoma patients with venous tumor thrombus.Methods A total of 249 RCC patients with venous tumor thrombus underwent radical nephrectomy and thrombectormy in our hospital.Seventy-four patients received preoperative renal artery embolization while other 175 patients did not.The related items were analyzed.The tumor thrombus level was divided into 5 groups with American Mayo clinic classification system.Considering the significant difference in tumor situation and treatment strategies, we took the hepatic vein as a cut-off line, dividing patients into two subgroups, the early and advanced tumor thrombus groups.There were 208 patients in the early tumor thrombus group and 41 patients in the advanced group.The related items were analyzed respectively.Results Patients in the embolization group tended to have larger tumors and higher percentage of advanced tumor thrombus.For all patients, the embolization group had longer operation time [(4.8 ±2.1) h vs.(4.1 ±2.2) h ,P <0.05] and greater median blood loss (900ml vs 500 ml,P <0.05), compared to the non-embolization patients, and RAE did not show benefits on perioperative outcomes seemingly.However, subgroup analysis of patients with advanced tumor thrombus ( above hepatic vein) , in spite of the larger size of tumor, preoperative RAE showed significant benefits on reducing operation time [(7.0 ±1.7)h vs.(8.2 ±1.8)h, P<0.05)] and intraoperative blood loss (2 000 ml vs.3 000 ml, P<0.05) and decreasing blood transfusion (1 525 ml vs.2 050 ml ,P>0.05).Conclusion Preoperative RAE may be more appropriate for patients with advanced tumor thrombus because of its benefits in reducing operation time, intraoperative blood loss and elevating the operative security.

BACKGROUND: Embryonic stem cells (ESCs), the seed cells of all mature cells in vivo, are useful tools for nerve transplantation and developmental gene function research. Notch1 signaling pathway is the key pathway to control the ordered neural development and differentiation of many kinds of neural cells, however, there is no report on the dynamic expression of Notch1 signal during the ESC differentiation to date. OBJECTIVE: To investigate the expression of Notch1 protein, transmembrane signal transduction molecule, during directional differentiation of embryonic stem cells into neural cells. DESIGN, TIME AND SETTING: Cell research was carried out between October 2003 and October 2004 at Zhongshan Ophthalmic Center, SUN Yat-sen University, Guangzhou, Guangdong Province, China. MATERIALS: BALB/C mouse embryonic stem cell line Ⅵ (passage 11)was obtained from experimental animal center of SUN Yat-sen University, provided by professor Huang Bing. ESC culture medium was high-glucose DMEM medium with 20% bovine serum and 106 IU/L mouse leukemia inhibitory factor. Induced differentiation medium was high-glucose DMEM medium with 20% fetal bovine.serum and 5×107 mol/L retinoid acid(RA). METHODS: Passage 11 ESCs were resuscitated and incubated by ESC culture medium in incubator at 37℃ with 5% CO2. Passage 11 ESCs were subcultured after 2 or 3 days and RA was added into medium to induce differentiation. Three time points for observation were established: induced for 1, 5 and 9 days. MAIN OUTCOME MEASURES: Morphological changes were observed under inverted phase contrast microscope, MAP-2 antigen expressed in differentiated cells was detected by immunofluorescence method. Immunocytochemistry, Western Blot, flow cytometry assay were used to investigate the Notch1 protein expression. RESULTS: ESCs presented clone-like growth. After induced by RA for 9 days, single neural network was achieved around most of the cell clusters. With the prolongation of induction, MAP-2 positive neural cells increased gradually. Almost all ESC clones expressed Notch1 protein strongly or positively, but Notehl protein expression decreased gradually after induced differentiation (P < 0.01). CONCLUSION: Notch1 signal shuts off progressively during induction of ESCs into neural cells, which suggests Notch1 may play an important role in the differentiation of ESCs into neural cells.

Objective To summarize the clinical presentation, pathology features, and treat-ment principle for primary testicular non-Hodgkin's lymphoma. Methods Twelve patients were di-agnosed with primary testicular lymphoma. The mean age was 62 years (36-78). Of the patients, unilateral primary testicular tumors were found in 11 cases and bilateral tumors were found in 1 case. All cases had swollen testes, 3 cases had mild pain and 1 had low-grade fever. Ultrasonic examination detected solid mass in all 12 cases. CT scan revealed retroperitoneal enlarged lymph nodes in 3 cases. Nine patients were diagnosed with disease of stage Ⅰ E, 2 of stage Ⅱ E, and 1 of stage Ⅲ E. All of the patients underwent radical orchiectomies. Postoperative treatment included: CHOP chemotherapy for 10 cases, radiotherapy after chemotherapy for 5 cases, and surgery alone for 2 cases. Results Post-operative pathology results were non-Hodgkin's lymphoma in all cases. One patient lost in follow up, one died within 2 years because of other disease. The 1, 3 and 5 year actual survival rates were 82% (9/11) ,40%(4/10),20% (2/10), respectively. The relapsed organs included contralateral testis(3/ 11), central nervous system(3/11), liver(1/11)and retroperitoneal lymph node(1/11). Conclusions The prognosis of the primary testicular non-Hodgkin's lymphoma is very poor. Chemotherapy must be used after surgery for any stage. Stage Ⅰ E and Ⅱ E patient should be treated by surgery combined with radiotherapy and chemotherapy. Contralateral testis should be irradiated prophylactically. Pa-tients beyond stage Ⅱ E should accept chemotherapy after surgery and radiotherapy according to the patient's status.

Objective: To examine the alteration of pathologic structure and endogenous hydrogen sulfide pathway in rats with pulmonary hypertension induced by high pulmonary blood flow. Methods: Sixteen SD rats were randomly divided into shunting group and control group. An 11 week aortocaval shunting was produced in rats of shunting group, and pulmonary artery mean pressure (mPAP) was evaluated using right cardiac catheterization. The ratios of right ventricular mass to body weight (RV/BW) and right ventricular mass to left ventricular plus septal mass[RV/(LV+S)] were also detected. Pulmonary vascular micro and ultra structures were examined. Meanwhile the concentration of plasma hydrogen sulfide (H 2S) was measured by spectrophotography. The gene expression of cystathionine ? lyase (CSE)was detected by in situ hybridization, and the activity of CSE in lung tissues was measured by H 2S production according to chemical analysis. Results: After 11 weeks of aortocaval shunting, pulmonary artery mean pressure was significantly increased. Muscularization of small pulmonary vessels and relative medial thickness of pulmonary arteries were obviously increased in shunting rats compared with controls. Ultrastructure of intrapulmonary arteries changed obviously in shunting rats. Meanwhile, plasma H 2S concentration was decreased and the activity of CSE (according to H 2S production) in lung tissues decreased in shunting rats. CSEmRNA expression by pulmonary arteries was significantly suppressed. Conclusion: Pulmonary vascular structural remodeling is the important pathologic basis for pulmonary hypertension induced by high pulmonary blood flow. The down regula tion of endogenous H 2S pathway might play an im portant role in the development of high pulmonary blood flow induced pulmonary hypertension.

In this study, sonography video urodynamic studies (SVUDS), which combined synchronically urodynamic studies with trans-perineal and trans-abdominal sonography, were used to detect female bladder outlet obstruction (FBOO). The dynamic changes of urethra and surrounding pelvic floor structure during storage and voiding phase were observed by SVUDS and the causes of FBOO were analyzed. And the findings were as follows: 13 patients showed organ prolapse, there was an urethral angulation deformity during urination; 5 cases had abnormal urination as the urethral opening was not good in the middle of urination period; 4 cases had urethral stricture, as the proximal end of the obstruction dilated during urination, and the obstruction site showed no relaxation; 1 case had primary bladder neck obstruction with an incomplete opening of the bladder neck during urination; 3 cases had idiopathic bladder outlet obstruction and the sphincter of bladder neck and urethra opened well during urination.

Objective To evaluate the clinical efficacy and safety of Holmium laser in the treat ment of calyceal stricture and atresia through antegrade percutaneous nephrostomy. Methods Ante grade percutaneous nephrostomy was performed in 68 patients with calyceal stricture and atresiathrough a rigid 8/9.8 F ureteroscope. The stricture and atresia was incised in a linear fashion by theHolmium laser with a 550 mm fiber. After completion of the incision,a double J ureteral stent wasplaced for 6-8 weeks and nephrostomy tube was kept for 7 days thereafter. Patients were then fol lowed up with IVU and/or ultrasound at 3-6 month intervals. Results The mean operative timewas 90 min,ranged from 80 to 120 min. The mean postoperative hospital stay was 8 d(7-9d). Hy dronephrosis was significantly improved in 38 cases in an average follow up of 9 months (4-26 months). Repeated laser incision was performed to 4 treatment failures and all turned out to be suc cessful. Conclusions The Holmium laser treatment through antegrade percutaneous nephrostomyfor calyceal stricture and atresia has characteristics of minimal invasion,short hospital stay,good effi cacy in short term and repeated cases. This procedure to be used as the first choice for patients withgood renal function and mild hydronephrosis,especially accompanied with renal calculus.

Objective To explore the change of Brain natriuretic peptide(BNP) and endothelin-1 (ET-1) levels in artial septal defect(ASD) patients and the relationship among BNP,ET-1 and pulmonary pressure.Methods 105 final diagnosed ASD patients were divide into non-pulmonary hypertension group (nPH group) and pulmonary hypertension group(PH group),and the PH group were divided into two subgroup:slight PH group,moderate and sever PH group.According to the altitude of habitation,105 ASD patients also were divided into 3 groups:＜ 2 500 m group,2 501-3 500 m group and ＞ 3 500 m group.Plasma BNP were measured by radioimmunity method and ET-1 were measured by ELISA.The data analysis used single factor analysis and Fisher least singnificant difference t test.Results Both the plasma BNP levels (152.34 ± 40.61) pg/ml and ET-1 level (137.69 ± 37.17) pg/ml of the ASD-PH group were significantly higher than those [BNP (126.70 ± 32.27) pg/ml,ET-1 (92.92 ± 32.3) pg/ml] of ASD-nPH group.There were strong difference in plasma BNP levels and ET-1 levels among different degree PH groups(F =6.782,P ＜ 0.05 ; F =8.475,P ＜ 0.05).Statistical difference were also shown in BNP(F =6.846,P ＜ 0.05) and ET-1 (F =9.327,P ＜ 0.05) levels by compared difference altitude groups.The BNP levels are positively correlated with mean pulmonary artery pressure (r =0.326,P ＜ 0.05),size of defect (r=0.301,P＜0.05) and the altitude of habitation (r =0.252,P＜0.05).Conclusion Plasma BNPand ET-1 levelsof ASD-PH group significantly higher than those of ASD-nPH group.By the increasing of the altitude and PH degree,the plasma BNP and ET-1 levels are increasing,which suggest that BNP and ET-1 play an important role on the proceeding and development of the PH and hypoxia promoted secretion of BNP and ET-1.

Objiective To evaluate the effect of pearventricular device closure of non-muscular ventricular defercts(VSDs) in infants.Methods From April 2007 to February 2008,39 patients with non-muscular VSDs were received off pump surgical treatment,perventricular device closure were for all the patients.There were 16 males and 23 females with mean age of(14.5±7.8) months(12 to 36 months and mean weight of(12.4±2.3)kg(8.5 to 18.0 kg).There were 34 perimembranous and 5 subateria VSD.The diameter of defects were 3.0 to 11 mm[mean(6.1±2.0)mm].Results Thirty-seven(94.9%)VSDs ere successfully closed,while two were repaired under cardiopulmonary bypass(CPB)instead of device closure because of the complication of moderat aortic reurgitation.The diameter of occluders were 4 to 12mm[mean(8.2±2.0)mm].The tricuspid regurgitations decareasded after operation in 3 patients with perimenmbranous VSDs,while the closure caused new mild or trace tricuspid regurgitations in 8 patients.Six patients with perimembranours VSDs acquired the incomplete right bundle branch blocks affter device closure.The length of hospital stay was 3 to 5 days[mean(3.4±0.4)]after operation and no petient had blood transfusion.Conclustion Perventricular device closure is probably an effective and safe treatment for non-muscular VSDs in unfants.

Objective To evaluate the effectiveness of occlusive wrapping with plastic film in the delivery room to prevent heat loss and reduce the occurrence of hypothermia on admission to the Neonatal Intensive Care Unit (NICU) in very low birth weight infants.Methods A total of 209 very low birth weight infants (birth weight＜1 500 g and gestational age＜33 weeks),born in the Second Hospital of Wenzhou Medical University (Yuying Children's Hospital) and admitted to the NICU immediately after birth from June 1,2009 to December 1,2010,were randomized to the wrap group or non-wrap group.Infants randomized to the wrap group were dried and then wrapped with polyethylene film up to their necks immediately after delivery.They were then covered with warmed blankets and transported to the NICU by the neonatal team.The non-wrap group received routine care in the delivery room following the guidelines of the Neonatal Resuscitation Program.The t test and Chi-square test were used for statistical analysis.Results The mean rectal temperature on admission to the NICU was significantly higher in infants of wrap group compared with those of non-wrap group [(36.1 ± 0.8) ℃ vs (35.5 ± 1.0) ℃,t=4.707,P＜0.01],and the incidence of hypothermia was 41.0％ (43/105) in the wrap group which was lower than that in the non-wrap group (66.3％,69/104) (x2=13.547,P＜0.01).In infants ＜29 weeks of gestation,the mean rectal temperature on admission to the NICU was higher in the wrap group than in the non-wrap group [(36.1 ± 0.8) ℃ vs (35.4 ± 1.1) ℃,t=3.051,P＜0.01].In infants ≥ 29 weeks of gestation,the mean rectal temperature on admission to the NICU was higher in the wrap group than in the non wrap group [(36.0±0.9) ℃ vs (35.5±0.9) ℃,t=3.698,P＜0.01].The arterial blood gas base excess in the wrap group and non-wrap group was-(2.9±2.7) mmol/L and-(5.0±4.2) mmol/L,respectively (t=4.473,P＜0.01).The rate of endotracheal intubation was 20.0％ (21/105) in the wrap group and 27.9％ (29/104) in the non-wrap group,(x2=1.785,P=0.182).The duration of hospitalization was (49.2± 10.7) d in the wrap group and (45.8±9.1) d in the non-wrap group,and the difference was not statistically significant (t=1.152,P=0.251).Conclusions Wrapping very low birth weight infants with plastic film in the delivery room can reduce the occurrence of hypothermia.