Objective To assess the value of caval-atr ial venovenous bypass technique in resection of tumor thrombus for renal or adr enal carcinomas with inferior vena cava involvement. Methods From Mar.to Aug.of 2000,4 patients with renal or adrenal carcinoma extendi ng into inferior vena cava were admitted and evaluated.Radical nephrectomy and v ena cava thrombectomy were performed with the use of caval-atrial venovenous by pass technique. Results There was no significant change of hemodynamic parameters during vena cava thrombectomy.A part of tumor thrombu s in 1 case was left in situ because of its compact adhesion to the wall of infe rior vena cava.The tumor thrombus in inferior vena cava were completely removed in the other 3. Conclusions Caval-atrial venovenous byp ass technique is a simple and safe method during vena cava thrombectomy.

Objective To express the cytosolic superoxide dismutase(SOD)of Schistosoma japonicum and analyze its antigenicity.MethodsThe DNA sequence of Schistosoma japonicum gene of cytosolic SOD was amplified by reverse transcription polymerase chain reaction(RT-PCR)and subcloned into the expression vector pGEX-4T-3 to construct a recombinant plasmid Sj SOD-pGEX-4T-3.This recombinant plasmid was transformed into component cell of E.coli BL21(DE3).The fusion protein of GST-SOD was expressed by inducing with IPTG and purification by affinity chromatography.The specific antiserum was prepared by immunizing the BALB/c mouse with GST-SOD fusion protein,and the immnuogenicity of GST-SOD was investigated by Western blot analysis.ResultsThe gene of cytosolic SOD was amplified successfully and subcloned into expression vector pGEX-4T-3 forming the recombinant expression plasmid Sj SOD-pGEX-4T-3.The fusion protein GST-SOD was expressed after the recombinant containing Sj SOD-pGEX-4T-3 being induced by IPTG.Immunizing the BALB/c mouse with the fusion protein GST-SOD produced high titer specific antiserum of 1∶12800 and the fusion protein GST-SOD was recognized by sera of severe infection rabbits.ConclusionsThe cytosolic SOD has been expressed successfully and has a preferable immunogenicity.

Objective To synthesize and fusion express the predicted T-cell epitopes of Schistosoma japonicum, and analyze their immunogenicities. Methods The plus and minus oligo-nucleic acid strands of epitopes P7, P17, P18 were synthesized following their DNA sequence, respectively. The Nco I restriction enzyme sites were added to the 5′ end of epitope gene and the Xho I restriction enzyme sites were added to the 3′ end of epitope gene. The plus and minus strand of each epitope gene was annealed to form double strand DNA fragments. Then the double strand DNA fragments encoding epitope peptide were cloned into the site between Nco I and Xho I of plasmid pET32c(+) to construct recombinant plasmid which was transformed into E.coli DH5?. The recombinant plasmid containing P7, P17, P18 genes respectively was identified by PCR, restriction digestion and DNA sequencing, and then transformed into E.coli BL21 (DE3) for expressing the fusion protein. The fusion protein of peptide-thioredoxin(Trx) was expressed by inducing with IPTG and analyzed with SDS-PAGE. The fusion proteins were purified with Ni2+ column affinity chromatography. Meanwhile, the peptides P7, P17, P18 were synthesized artificially following their amino acid se-quence. By using the purified epitope peptide fusion proteins and synthesized epitope peptides, the splenic cells of C57BL/6J mice immunized with ultraviolet-attenuated cercaria of Schistosoma japonicum were stimulated respectively. The stimulation activity of fusion proteins and synthesized peptides were assayed by detecting the incorporation rate of 3 H-thymidine. Results The double strand DNA fragments of epitopes P7, P17, P18 were successfully cloned to form recombinant plasmids, all of which could express a 20 kDa fusion protein. Both the fusion protein and synthesized epitope peptides of P7 and P17 were able to stimulate the lymphocyte cells to proliferation effectively. Conclusion The peptide P7 and peptide P17 are testified as T-cell epitopes of Schistosoma japonicum.

Objective To explore the protective effect of recombinant superoxide dismutase(SOD)fusion protein against the infection of Schistosoma japonicum Chinese strain.Methods The recombinant SOD fusion protein was expressed and purified with Glutathione sepharose 4B.C57BL/6J mice were immunized with the recombinant SOD fusion protein mixed with Freund adjuvant.Four weeks after the final immunization,the mice of the experiment and control groups were challenged with(45?2)S.japonicum cercariae.All the mice were sacrificed on the forty-fifth day after the challenge to calculate the worm reduction rate and egg reduction rate,and to observe the pathologic changes of liver tissue of the mice.Results The worm reduction rate was 35.63% and the egg reduction rate was 31.17% in the experiment group.The number of granuloma in the live tissue of the experiment group was less than that of the control group,and the mean diameter of single granuloma in the experiment group reduced by 22.32% compared with that of the control group.The IgG subclass levels of IgG1,IgG2a,IgG2b were higher than those of the control group.Conclusion The recombinant SOD fusion protein has a protective effect against Schistosoma japonicum infection.

Objective To clone and express a high mobility group box 1(HMGB1)protein of Schistosoma japonicum(Main-land strain)and analyze its function. Methods The DNA fragment of open reading frame encoding Sj HMGB1 protein was ampli-fied by RT-PCR from the mRNA of S. japonicum worms,then it was subcloned into the expression vector pET28a(+)to form the recombinant expression plasmid SjHMGB1-pET28a. The recombinant expression plasmid was transformed into the component E. coli BL21(DE3),and the tranformant containing recombinant expression plasmid was induced with IPTG to express the recombi-nant protein SjHMGB1. The recombinant SjHMGB1 protein was purified by affinity chromatography with nickel chelating affinity chromatography agarose gel. The Gel retard experiment and animal immunization were performed to analyze the DNA binding ca- pacity and the immunologic property of recombinant SjHMGB1. The expression levels of HMGB1 in different life cycle stages of S. japonicum were analyzed by Western bloting and RT-PCR. Female ICR mice were immunized with the recombinant SjHMGB1 pro-tein and infected with 45±2 cercariae of S. japonicum after three immunizations. Forty-two days post-infection,the worms and eggs of S. japonicum were recovered from the portal vein and liver tissue,respectively. The worm and egg reduction rates were calculat-ed respectively. Results A 530 bp of specific DNA fragment was amplified from mRNA of S. japonicum by RT-PCR,which was the open reading frame(ORF)encoding SjHMGB1protein confirmed by DNA sequencing analysis. The recombinant expression plasmid SjHMGB1-pET28a was constructed by cloning the ORF of SjHMGB1 into a expression vector pET28a(+). The bacterium transformants containing the recombinant plasmid expressed a soluble recombinant protein about 28 kDa after induced by IPTG, and the recombinant SjHMGB1 protein was purified by nickel chelating affinity chromatography. The gel retard experiment showed that the recombinant SjHMGB1 protein could bind to both supercoiled DNA and linear DNA,and the recombinant protein immu-nized mice produced high titers of antiserum IgG. Western bloting indicated that the recombinant SjHMGB1 protein was recognized specifically by the S. japonicum-infected mice serum. Above results showed that the recombinant SjHMGB1 protein possessed both functional activity and immunogenicity as the natural protein. RT-PCR and Western blot results showed that SjHMGB1 was abun-dantly expressed in the adult and egg stages whereas barely detectable in the cercaria stage. The immune protection experiment showed that the recombinant SjHMGB1 induced mice to produce high titers of specific antibody IgG but failed to conduct an effec-tive immune protection against S. japonicum. Conclusion The gene encoding HMGB1 from S. japonicum and the soluble recombi-nant SjHMGB1 protein with natural functional activity are obtained,and the recombinant SjHMGB1 has a high immunogenicity but is not able to induce an effective immune protection against S. japonicum.

Objective To assess the value of percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava(IVC). Methods Twelve patients with renal or adrenal neoplasm extending into retrohepatic or subhepatic IVC were diagnosed by the investigations of CT, MR1, and Doppler ultrasound. There were 7 men and 5 women with a mean age of 51 years (range, 20 to 76 years). Of these patients, 11 had renal ne-oplasm and 1 had adrenal tumor; 11 in the right and 1 in the left; 11 with retrohepatic caval thrombus (level 2a) extension and 1 with extension into the subhepatic vena cava (level 1). On the operation day, all patients had a pereutaneous preset of the balloon catheter into the IVC, at the position be-tween hepatic vein and the tip of tumor thrombus. During surgical resection, the balloon was filled via the catheter to occlude the IVC prior to vena cavotomy. Results Radical nephrectomy and resection of vena cava thrombus was successfully performed with this technique on 12 patients. There were no operative or perioperative pulmonary embolisms or deaths, no any complication. The mean postopera-tive hospital stay was 12 d (range, 9 to 15 d). Pathological investigation revealed clear cell carcinoma in 6 patients, papillary renal cell carcinoma (RCC) in 3, metastatic hepatocellular carcinoma in 1, an-gioleiomyolipoma in 1 and adrenal leiomyosarcoma in 1. The pTNM stage in 9 patients with RCC was T3b N0 M0 in 8 patients, T3b Nx M1 in I patient. The mean followup was 21±10 months (median follow-up 24 months). Four patients died of lung or liver metastasis, and the recurrence of liver cancer at 6, 9, 15, and 22 months postoperatively. Eight patients have survived for 6 to 35 months (mean 26 months). The postoperative 1-, and 3-year cancer-specific survival rates in 9 patients with RCC were 78% and 67%. Conclusions Percutaneous balloon catheter occlusion technique is a feasible, safe, and effective method for tumor thrombectomy of low retrohepatic (level 2a) or subhepatic (level 1) type in patients with renal or adrenal neoplasm extending into the IVC. Additional experience and con-tinued investigation are warranted.

BACKGROUND:Acromion morphology is the most important external factor of degenerative rotator cuff tear,and studies on acromion morphology and acromion coverage have been continuing. OBJECTIVE:To investigate the coverage of acromion on rotator cuff tissue in three-dimensional space,measure coronal and sagittal parameters,and explore the relationship of acromial overhang,acromioglenoid angle and acromial coverage angle with degenerative full-thickness rotator cuff tears. METHODS:A total of 56 patients diagnosed with full-thickness rotator cuff tears by shoulder arthroscopic surgery or MRI in the Affiliated Hospital of Xuzhou Medical University from January 2022 to June 2023 were retrospectively collected as the tear group,while 48 patients with non-rotator cuff tear were included as the control group.Clinical data and chest CT data of the patients of the two groups were collected,and the shoulder blades of the patients were reconstructed using Mimics software.Acromial overhang,acromioglenoid angle and acromial coverage angle were measured in 3-matic software.The differences between the measurement parameters were compared between the two groups.Binary Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the ability of the measurement parameters to predict rotator cuff tear.It is generally believed that the parameter had good diagnostic value when the area under the receiver operating characteristic curve was greater than 0.8. RESULTS AND CONCLUSION:(1)The mean acromial overhang in patients with rotator cuff tears was greater than that in controls(P<0.001).The mean acromial coverage angle was also greater in patients with rotator cuff tears than in controls(P<0.001).There was no significant difference in the acromioglenoid angle between the two groups(P>0.05).(2)Binary Logistic regression analysis showed that acromial overhang and acromial coverage angle were both risk factors for rotator cuff tear(P<0.05).(3)Receiver operating characteristic curve analysis indicated that the areas under the curve of acromial overhang and acromial coverage angle were 0.725 and 0.865,respectively,and the optimal cutoff values were 36.15 mm and 60.65°.(4)The results showed that the acromial overhang and acromial coverage angle were greater in patients with rotator cuff tears than in patients without rotator cuff tears.Both were associated with degenerative full-thickness rotator cuff tears,and they could be used to predict rotator cuff tears,and the acromial coverage angle was more effective in predicting rotator cuff tears.

Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.