Atherosclerosis ; Endothelial Cells ; Humans ; Nitric Oxide Synthase Type III ; Stem Cells

Objective To study the diagnosis and treatment of malignant renal angiomyolipoma with metastases. Methods Three cases of advanced malignant renal angiomyolipoma with metasta-ses were retrospectively reviewed. Case 1 was a 55-year-old woman presenting with recurrent low-grade fever and aching pain in left flank. Ultrasound showed solid mass in the left kidney. Left radical nephrectomy was then performed. The right pulmonary lobectomy of the inferior lobe and wedge ex-section of superior lobe was performed 7 years later because of multiple pulmonary metastases. Case 2 was a 37-year-old woman. Left nephrectomy was performed because Ultrasound and CT showed left kidney solid mass. Six years later, multi-site metastases were found in liver and retroperitoneum and mestastasis tumors were resected. At 10 years after the primary diagnosis, CT showed multi-metasta-ses in liver and retroperitoneum. The retroperitoneal masses were resected and liver lesions were trea-ted by radiofrequency ablation. Case 3 was a 34-year-old man presenting with swelling pain in right flank. CT scan showed a lesion in the right kidney and right radical nephrectomy was performed. Four months after the surgery, MRI revealed multiple liver and retroperitoneal nodules. All the 3 cases had not been diagnosed with tuberous sclerosis and did not accept chemotherapy. Results The cut sur-face of the lesions was red-brown and yellow and the texture was tender. Under microscopic examina-tion, the tumors of case 1 and case 3 were composed of sheets or nests of large polygonal epithelioid cells. It revealed that occasionally clear cytoplasm with abundant eosinophilic, prominent nucleoli, and multinucleated and markedly pleomorphic form. Necrosis was presented as well. Large areas of case 2 tumor were made up of spindle smooth-muscle cells, adipose tissue, thick-wall blood vessels and some areas merged with a proliferation of epithelioid which was consistent with typical angiomyolipoma. Im-munohistochemical study showed that the epithelioid cells and spindle smooth-muscle cells were posi-tive for VM, HMB45, Melan-A and negative for S100, CK. Case 1 and case 3 were diagnosed with malignant epithelioid angiomyolipoma, while case 2 was diagnosed with malignant classic angiomyoli-poma and epithelioid in part of the tumor. Case 1 was well alive. Case 2 was alive with tumor 12 years after the diagnosis. And case 3 was missed in the follow-up 3 months after metastasis resection. Conclusions Malignant renal angiomyolipoma is a rare disease. The diagnosis depends on histopatho-logic, immunohistochemieal study and clinical follow-up. Radical resection of the primary, recurrent and metastatic tumors is the main therapy. It needs more research to clarify if metastasis has any effect on prognosis.

Adenocarcinoma ; metabolism ; pathology ; Adult ; Combined Modality Therapy ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Keratins ; metabolism ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prostate-Specific Antigen ; metabolism ; Prostatectomy ; Prostatic Neoplasms ; metabolism ; pathology ; secondary ; surgery ; Sarcoma, Synovial ; metabolism ; pathology ; surgery ; Vimentin ; metabolism

Objective To explore the diagnosis and treatment of lower limb deep venous thrombosis (DVT) after severe craniocerebral trauma. Methods Thirty-seven cases of DVT in the lower limbs following severe craniocerebral trauma treated in our hospital between December 2003 and December 2008 were reviewed. Results All the 37 patients received anticoagnlation therapy. Thrombolytic agents were administered in 18 patients, and 14 patients underwent implantation of inferior vena cava filter. Except for one fatal case, all the cases showed relief of lower limb swelling and pain after the treatments. Eleven patients were cured, 21 showed significant improvement, and 4 had moderate improvement. Conclusions Patients sustaining craniocerebral injury are at high risk of DVT in the lower limbs, for which vascular color Doppler ultrasonography, venography, and digital subtraction angiography are effective diagnostic modalities. Anticoagulation therapy remains the primary treatment of DVT in the lower limb, and implantation of inferior vena cava filter proves valuable for preventing pulmonary embolism. Early prevention of lower limb DVT can be of vital importance.

Objective To explore the relationship between receptor of advanced glycaton end products(RAGE)gene Gly82Ser polymorphism and patients with transient ischemia attack(TIA).Methods The Gly82Ser gene at the position of RAGE gene exon 3 was identified by a polymerase chain reaction- restriction fragment length polymorphism(PCR-RFLP)method in 70 cases of TIA & Diabetes(DM), 60 of simply TIA and 66 healthy control subjects.Results The genotypes of RAGE gene Gly82Ser identified were GG, GS and SS.The frequencies of RAGE gene Gly82Ser GS heterozygous genotype of TIA & DM and control were respectively 62.9% and 43.9%, significantly higher in TIA & DM patients than in control subjects(OR 2.036, 95% CI 1.021--4.062, P=0.042), however no significant difference was found between simply TIA and control(53.3% vs 43.9%, OR 1.299,95% CI O.644--2.618, P=0.465). Significant difference of the frequency of S allele was found neither between TIA & control and control(being 34.3% and 26.5%, respectively, OR 1.446,95% CI 0.859--2.434, P=0.164), nor between simple TIA and control(28.3% vs 26.5%, OR 1.096,95%CI 0.630--1.907, P=0.746).Conclusions RAGE gene Gly82Ser GS heterozygous genotype may be associated with TIA & DM patients.RAGE gene Gly82Ser polymorphism is a risky factor for TIA & DM patients, but not for TIA patients.

Objective To compare maternal and neonatal outcomes after induction,elective cesarean section and spontaneous onset of labor in uncomplicated term nulliparous women.Methods A total of 3751 uncomplicated term nullipara who delivered in Peking Union Medical College Hospital from Sept 2002 to April 2007 were retrospectively analyzed.They were divided into three groups:the induction group, the elective cesarean section group,and the spontaneous onset of labor group.Their general conditions (such as age,weeks of pregnancy,hospital days and cost),postpartum complications(such as postpartum hemorrhage,puerperal morbidity,urinary retention,blood transfusion,delayed healing,and trauma),and Apgar score were compared by statistic methods.Results(1)Among 3751 women,501(13.3%)of them underwent induction(the induction group),1634(43.6%)delivered by cesarean section(cesarean section group),the other 1616(43.1%)women underwent spontaneous onset of labor(the spontaneous onset of labor group).(2)Results of general conditions:the spontaneous onset of labor group had the shortest hospital days,which was longer in the induction group,and the longest in the selective cesarean section group(P

Erythroderma with complicated etiology is one of the severe skin diseases and has high mortality,of which the incidence was 0.5％-1.5％ in skin diseases.Erythrodermic psoriasis (EP) is the commonest type of erythroderma.In addition,there are drug-induced erythroderma,erythroderma secondary to preexisting dermatoses,malignancy-related erythroderma,and idiopathic erythroderma of unknown etiology.Erythroderma of different etiologies has various clinical manifestations,resulting in relevant curative effects and outcomes.In this article,we retrospectively investigated 205 erythroderma patients about clinical symptoms,auxiliary examination and treatments,and evaluated the efficacy and prognosis.There were 84 cases of EP among 205 patients,10 cases of erythroderma caused by specific drugs,77 cases of erythroderma secondary to preexisting dermatoses (excluding psoriasis),7 cases of erythroderma patients suffering from malignancy and 27 cases with unknown causes.We concluded that the etiology of male patients in different age groups had significant difference.The incidence of EP was the highest among all types.The EP was commonly accompanied with hypoproteinemia,and changed into psoriasis vulgaris after treatment.Drug-induced erythroderma was commonly accompanied with fever,and mostly cured by systematic steroid therapy.For erythroderma secondary to preexisting der matoses,the original dermatoses must be actively treated to achieve a satisfying prognosis.Erythroderma with malignancy or unknown causes had long-term duration,poor response to the treatment,and high potential to relapse.Therefore,clarifying the etiology,providing an appropiate and individual regimen,and regular follow-up are crucial for the successful treatment of erythroderma with unknown causes.

Objective： The aim of this study was to evaluate the expression of E-cadherin,α -catenin,β -catenin,and γ -catenin in gastric carcinoma and dysplasia and to determine the relationship with tumorigenesis and biological behavior of gastric cancer. Methods： The expression of E-cadherin, α -catenin, β -catenin, and γ -catenin in 43 patients with gastric carcinoma and gastric biopsy specimens from 22 patients with dysplasia and 10 healthy controls were determined using immunohistochemistry. Results： Membranous staining was observed in control biopsy specimens for all components of the complex. Abnormal expressive rates of E-cadherin,α -catenin,β -catenin in gastric carcinomas (53.5％ ,55.8％ ,51.2％ ,respectively) were significantly higher than that in gastric mucosal dysplasials （ 22.7％ ,22.7％ , 18.2％ , respectively P<0.05） ,and the rates in advanced gastric carcinomas were also significantly higher than that in early gastric carcinoma（ P< 0.01, P< 0.05, P< 0.01,respectively） . Tumors with a decrease in E cadherin occurred significantly more frequently in undifferentiated gastric carcinoma (P< 0.05). There were higher abnormal expressive rates of E-cadherin and β  catenin in the patients with tumor infiltrating out of serosa and with lymph nodes metastasis （ P<0.01 or P< 0.05） . Up to 50.0％ of gastric dysplasials and 76.7％ of tumors stained abnormally for one or more components of the cadherin catenin complex (P< 0.05), and the lymph nodes metastasis rates for one or more components of the E cadherin complex was significantly higher than that for no one components of the E cadherin complex (P< 0.01). Conclusion： The decreased expression of E cadherin and part of the catenins correlate with tumor stage, poor differentiation, infiltrative tumor growth, and lymph nodes metastasis, which suggests that E cadherin complex play a critical role in the course of chang from gastric mucosal dysplasials to gastric carcinoma. Thus, study of all the components of E cadherin catenin complex may be more valuable than single component of the complex for the detection of patients with gastric carcinoma.

Objective To investigate homografting vascular endothelial progenitor cells(EPCs)for preventing restenosis formation of carotid artery in New Zealand white rabbit models.Methods EPCs of New Zealand white rabbits were isolated,confirmed and expanded though the injured carotid arterial endothelium of rabbit model induced by dilatation with a 2.5 F balloon;and then EPCs were transplanted into the injured endothelium of the cells transplantation group(n=13,3 of them were transplanted with fluorencently-labeled- EPCs),while equal volume of saline without EPCs was injected into the injured endothelium in the control group(n=8).Histopathology was performed at 4 days after transplantation for the 2 rabbits,with fluorencently-labeled-EPCs.All of the rest remained rabbits were killed 4 weeks later for histological examinations.Results The histopathological slides showed that the fluorescence-positive expression existed in the injured endothelium 4 days after transplantation.At 4 weeks after the EPCs transplantation,there were less restenosis and less vascular wall thickening in the rabbits of cells transplantation group than those of the control group(P＜0.01).Conclusion The local interventional homografting heterogeneous endothelial progenitor cells can prevent restenosis after the carotid artery angioplasty in New Zealand White rabbit model. (J Intervent Radiol,2007,16:95-98)

OBJECTIVETo investigate the plasma Big endothelin-1 levels in patients with gastric carcinoma before and after radical gastrectomy, and explore its clinical significance.

METHODSOne hundred and six patients with gastric carcinoma and 20 controls were enrolled. The Big ET-1 plasma levels were examined by enzyme-linked immuno absorbent assay before and on the 1st, 3rd, and 10th day after curative surgery, and then were tested every 3 months in the patients with advanced gastric cancer.

RESULTSAll patients, except those with stage I gastric cancer, had significantly higher mean plasma Big ET-1 levels compared with normal controls (P=0.000). Higher plasma Big ET-1 levels were associated with lymph node metastasis (P=0.020) and serosal infiltration (P=0.035). The plasma Big Endothelin-1 levels were markedly increased on the first post-operative day (1st POD) in all patients,but decreased on the 3rd POD with no significant difference compared to the preoperative levels. On the 10th POD, the patients with stage I and II gastric cancer showed marked reduction in plasma Big ET-1 levels (P=0.010 and P=0.000, respectively), whereas no significant difference was observed in stage III and IV patients. During the follow-up, the plasma Big ET-1 levels just before recurrence in stage II patients were significantly higher compared with the levels on the 10th POD (P=0.011).

CONCLUSIONSPlasma Big ET-1 might be a reliable marker to determine the severity of gastric carcinoma. Monitoring plasma Big ET-1 levels after curative resection in stage II gastric cancer patients is valuable to predict recurrence.

Adult ; Aged ; Case-Control Studies ; Endothelin-1 ; blood ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; pathology ; Neoplasm Staging ; Stomach Neoplasms ; blood ; pathology ; surgery