Acta Academiae Medicinae Sinica

Objective To summarize the computed tomography (CT) findings of adrenal hemangioma. Method The CT findings of 9 patients with pathologically proved adrenal hemangioma from June 2008 to March 2011 were retrospectively reviewed. Results All the tumors were located unilaterally,with 4 in the left and 5 in the right. The tumors were 1.5-8.4 cm in size with complete capsule and well-defined contour. Among these nine tumors,six were round or ovoid,while the other three had irregular shapes. Plain scan showed mixed density in 8 and cystic change in 1. After contrast enhancement,six tumors manifested with inhomogeneous enhancement and the other three without enhancement. For three cases who underwent multi-phase enhanced CT scans,irregular enhancement at the periphery of the masses were showed in artery phase,and centripetal filling with contrast medium to the center of masses were showed in the portal and delayed phases.Conclusions Hemangioma is a rare benign tumor of the adrenal gland. CT findings are diverse,and the preoperative misdiagnosing rate can be high. Multi-phase enhanced CT scan may show characteristic features of adrenal hemangioma and help achieve correct preoperative diagnosis.

Objective To determine the effects of bisphenol-A (BPA) on blastocyst development and implantation. Methods According to completely randomized grouping method,90 pregnant mice were divided into 100, 300, and 600 mg/(kg·d)BPA groups and control group. BPA-treated pregnant mice were orally administered with BPA at concentrations of 100, 300 and 600 mg/(kg·d) from day 0.5 to day 3.5 of their pregnancy. Blastocyst implantation and development were studied. Results In the 300 mg/(kg·d) BPA group,the number of implantation sites and implantation rate were significantly decreased. In the 600 mg/(kg·d) group,no implantation sites were observed among pregnant mice and BPA inhibited embryo implantation. Blastocyst development on day 4 was examined,and findings showed that the development rate and total numbers of blastocysts in BPA treatment groups had no significant difference from the control group. However,BPA at 300 and 600 mg/(kg·d) significantly reduced blastocyst hatching rate and dramatically increased the number of blastocyst apoptotic cells when compared with those in the control group. Conclusion BPA at a high concentration damages the blastocyst development before implantation and inhibits embryo implantation.

Objective To establish a new animal model of osteonecrosis of the femoral head by local ethanol injection in emu. Methods Eight milliliter ethanol was injected slowly to the operated femoral head with customized probe in twenty adult male emus. Postoperatively,hip magnetic resonance imaging was performed at 1,4,8,12 weeks. After emus were sacrificed,the femurs were collected for micro-computed tomography and histological analysis. Results No emu demonstrated signs of infection or died unexpectedly. Magnetic resonance imaging examination showed broad edema at proximal femur at 1th week,and the edema decreased with time,till local edema at femoral head at the 12th week. Histological images showed human-like osteonecrotic changes with active bone repair. There were significant differences in trabecular structure and bone mineral density bet-ween the operated and intact femoral heads. No collapse was found 6 months after the operation. Conclusions This emu model of femoral head osteonecrosis by local ethanol injection can progress to early stage osteonecrosis. The different repair methods may have certain correlation with the results of osteonecrosis of the femoral heads.

Objective To assess the role of computed tomography angiography (CTA) using dual-source computed tomography in the preoperative evaluation of old patients scheduled for noncardiac surgery. Methods A retrospective review of the clinical data of patients who underwent CTA in our hospital between May 2011 and May 2013 was performed,and totally 111 old patients with risk factors of coronary artery diseases scheduled for noncardiac surgery were found to coronary CTA for preoperative evaluation. Prospectively electrocardiograph-triggered sequence scan protocol with dual-source computed tomography was performed. The imaging quality,coronary artery stenosis,the treatment before operation,and perioperative complications were assessed. Results For 1 779 coronary artery segments in 111 patients,the number of evaluable segments was 1 676 (97.4%). The mean effective dose of CTA was (2.7±0.9) mSv. Among them,71 patients with coronary artery stenosis <50% underwent surgery without cardiac complication and 17 patients with coronary artery stenosis ≥70% underwent conventional coronary angiography and coronary angioplasty or bypass surgery. The sensitivity and specificity of CTA in detecting ≥50% stenosis were 95% and 96%,and the sensitivity and specificity of CTA in detecting ≥70% stenosis were 97% and 98%. For 19 patients with coronary artery stenosis between 50% and 70%,the levels of myocardial enzyme were transiently higher for two patients,and no other cardiac complication occurred. Conclusion Coronary artery CTA is reliable in artery stenosis evaluation and can be used as cardiac risk stratification for old patients scheduled for noncardiac surgery.

Objective To investigate the possible effects of apolipoprotein A1 gene (APOA1) rs670 and rs5069 polymorphisms on plasma lipid profiles in healthy adolescents with different body mass index (BMI). Methods Totally 723 adolescents were divided into four groups according to their BMI：group 1[BMI=(17.80±0.75)kg/m2],group 2[BMI=(19.39±0.32) kg/m2],group 3[BMI=(20.68±0.43) kg/m2],and group 4[BMI=(23.40±2.05) kg/m2]. Height,weight,waist circumference,hip circumference,blood pressure,heart rate,plasma lipids,and blood glucose were determined,BMI and waist to hip ratio (W/H ratio) were calculated,and genome DNA was extracted for analyzing the genotypes of the APOA1 rs670 and rs5069 polymorphisms by polymerase chain reaction-restriction fragment length polymorphism. Results No significant differences in height,weight,BMI,waist circumference,hip circumference,W/H ratio,blood pressure,heart rate,plasma lipids,and blood glucose between APOA1 rs670 or rs5069 genotypes were observed among group 1,group 2,and group 3. In group 4,A carriers of the rs670 polymorphism had significantly higher systolic blood pressure (P=0.017) and blood glucose levels (P=0.009) than the adolescents with the GG genotype. T carriers of the rs5069 polymorphism had significantly higher height (P=0.013),weight (P=0.011),and hip circumference (P=0.026) than the adolescents with the CC genotype. Conclusions In healthy adolescents with higher BMI,APOA1 rs670 polymorphism is associated with systolic blood pressure and blood glucose levels. The elevation of systolic blood pressure and blood glucose levels in A carriers of APOA1 rs670 polymorphism may be favorably modulated by weight loss.

Objective To evaluate the diagnostic agreement of 3D pseudo-continuous arterial spin labeling (3D-pCASL) and 18F-fluorodeoxyglucose and 11C-Methionine positron emission tomography-computed tomography(PET/CT) for brain disorders. Method 3D-pCASL and PET/CT were performed on 7 patients with different brain disorders,and the diagnostic agreement was assessed by visual observation. Results Four tumor lesions presented hyperperfusion on 3D-pCASL,and hypermetabolism on PET/CT. One demyelinated lesion and one metabolic lesion showed hyperperfusion on 3D-pCASL,and one infected lesion showed hypoperfusion on 3D-pCASL；all these three lesions showed hypermetabolism on PET/CT. Conclusion 3D-pCASL can non-invasively evaluate the perfusion state of the brain disorder in vivo and have a good dignostic consistency with PET/CT.

Objective To analyze the correlation between analgesia in the postanesthesia care unit and intraoperative remifentanil. Methods The data of 5 594 patients in the postanesthesia care unit were retrospectively retrieved from the database of electronic medical record. The use of analgesic drugs in the postanesthesia care unit and intraoperative remifentanil was recorded,and case-control study was performed based on these enumeration data. Results A total of 205 (3.66%)patients out of 5 594 in the postanesthesia care unit were administered with analgesic drugs. In the grouped case-control study,remifentanil was intraoperatively used in 87 patients in the case group (n=205) and in 1 224 patients in the control group (n=5 389) (OR=2.51,95%CI=1.87-3.36,P=0.000). There were 205 “paired numbers” in the matched case-control study (OR=1.67,95%CI=1.12-2.80,P=0.011). Conclusion The analgesia in the postanesthesia care unit may be correlated with intraoperative remifentanil to a certain extent.

Objective To explore the effect of high glucose on proliferation of bone marrow stromal stem cells through Wnt/β-catenin pathway. Methods Bone marrow stormal cells were obtained from the mandible of Wistar rats and stimulated with different concentrations of glucose (5.5 and 16.5 mmol/L). Cell proliferation was evaluated with methyl thiazolyl tetrazolium assay (1,3,5,and 7 d)and cell cycle analysis by flow cytometry (5 d). β-catenin and cyclin D1 protein levels were determined by Western blot. The mRNA expression of lymphoid enhancer binding factor-1 (LEF-1) and cyclin D1 were tested by real-time polymerase chain reaction.Results The results of methyl thiazolyl tetrazolium assay indicated that the optical density values of two different concentrations of the glucose had no statistical difference on day 1 (P=0.700). On days 3,5,and 7,the optical density values of the 16.5 mmol/L group were significantly lower than those in the 5.5 mmol/L group (P=0.006,P=0.002,and P=0.003). Cell cycle analysis indicated that high glucose concentration could reduced the progression from phase G1 to S,and the proliferation index values of the 16.5 mmol/L group were significantly lower than those of the 5.5 mmol/L group (P=0.014). The β-catenin and cyclin D1 levels were lower in the 16.5 mmol/L group when compared with the 5.5 mmol/L group. High glucose condition also reduced the mRNA expressions of LEF-1 and cyclin D1. Conclusion High glucose can inhibit the proliferation of bone marrow stormal cells by suppressing the expressions of β-catenin,LEF-1,and cyclin D1 in the Wnt/β-catenin pathway.

Objective To observe the hemodynamic change and reperfusion injury cause by transient hepatic venous occlusion and transient hepatic inflow occlusion in rats. Methods The rat liver was divided into 3 different areas：the ischemia reperfusion (IR) area：the inflow of the right superior lobe was clamped for half an hour；the non-isolated lobe congestive reperfusion (NIL-CR) area：the outflow of the right median lobe was clamped for half an hour；and the isolated lobe congestive reperfusion (IL-CR) area：the outflow of the left lobe was clamped for half an hour. The flux value and the oxygen saturation of microcirculation were monitored before at clamping for 30 minutes,and on 1 day,3 days,and 7 days after reperfusion. The hepatic damage and Suzuki’s score were evaluated. Results After clamping for 30 minutes,the flux value in the IR area was significantly higher than in NIL-CR area (P<0.01) and IL-CR area (P<0.01),the oxygen saturation in the IR area was significantly higher than in NIL-CR area (P<0.01) and IL-CR area (P<0.05). Compared with IR area,both NIL-CR area and IL-CR area were found having more severe liver damage in terms of Suzuki’s score in early postoperative period (at clamping for 30 minutes and on 1 day,P<0.01). However,there was no significant difference between NIL-CR area and IL-CR area in flux value,oxygen saturation,and Suzuki’s score (P>0.05). Conclusions Hepatic venous occlusion can more effectively decrease the blood perfrusion and oxygen saturation；thus,compared to the IR,CR can result in more severe liver damage. The presence of normal liver tissue around the congestion area can not influence liver damage in transient hepatic venous occlusion.

Objective To investigate the relationship between genetic polymorphisms of glucose transporter 4 (GLUT4) and hypoxia caused by obstructive sleep apnea syndrome (OSAS) as well as with related inflammatory factors. Methods Consecutive hypertension patients diagnosed at the People’s Hospital of Xinjiang Uygur Autonomous Region were selected from January to December 2010. A total of 859 subjects with possible OSAS base on their histories and physical examination findings udnerwent the polysomnography and inflammatory factor determination,of whom 616 (72%) were diagnosed with moderate and severe hypoxia with OSAS (case group) and 243(28%) without hypoxia or OASA (control group). Ninty-six patients from the case group underwent DNA sequencing at the functional domain of GLUT4 gene to screen for representative mutations. TaqMan PCR was used to genotyping then analyzed the relationship between locis of GLUT4 and hypoxia. Results GLUT4 genome sequencing was performed in 96 severe OSAS patients and 4 mutated sites were found,among which 3 mutated sites (rs5415,rs4517,and rs5435) were selected according to the principle of linkage disequilibrium (r2>0.8) and minimum gene allele frequency >5%. All of single nucleotide polymorphisms (SNP) satisfied Hardy-Weinberg equilibrium (P>0.05). A significant association of GLUT4 SNP rs5417 allele carried in control subjects,compared with moderate and severe hypoxia in OSAS patients (P<0.05)；AA+AC genotype relative to CC with low oxygen levels in subjects significantly reduced. The difference existed in overweight and obese patients,as well as in those aged more than 50 years (P<0.05). AA was still an independent protective factor for hypoxia caused by OSAS (OR=0.385,95%CI=0.210-0.704,P=0.002). Male (OR=1.635,95%CI=1.037-2.577,P=0.034)and total cholesterol(OR=1.600,95%CI=1.287-1.987,P<0.001) were independent risk factors associated with hypoxia. Normal weight(OR=0.059,95%CI=0.037-0.094,P<0.001) and high density lipoprotein cholesterol(OR=0.337,95%CI=0.171-0.666,P=0.002)were independent protective factors for hypoxia. The levels of monocyte chemoattractant protein-1 and C-reaction protein above CC were significantly higher than AA+AC (P<0.05). Conclusion Hypoxia caused by OSAS is associated with GLUT4 gene SNP rs5417.

Objective To establish the method of enzyme-linked immunosorbent assay (ELISA) for measuring human IgM autoantibody to folate receptor. Methods Folate receptor was extracted and purified from the healthy woman placenta. The protein was coated on 96-well plates with a concentration of 5 ng/μl. Goat monoclonal antibody was used for detecting antibody. Pooled plasma from healthy donors was used to plot the standard curve and the IgM concentration of pooled plasma was defined as 1. We set up an ELISA procedure to measure human IgM autoantibody to folate receptor. The sensitivity,precision,and stability of the method were evaluated. Further,the folate receptor and bovine folate-binding protein were used as the antigen,respectively,to determine the autoantibody levels in 24 healthy individuals and 20 individuals once gave birth to baby with neural tube defects. Results The measuring range of the method was from 6.25×10-4 to 8.00×10-2. The lowest IgM level that can be detected was 3.12×10-4. The inter-assay coefficients of variations for samples with high,medium,and low IgM levels were 6.61%,3.50%,and 5.12%,respectively. The intra-assay coefficients of variations were 4.54%,5.49%,and 5.44%,respectively. The stability test results were considered within acceptable limits. The data from folate receptor-ELISA was significantly higher than that from bovine folate binding protein-ELISA,both in the healthy group (t=-11.9,P<0.001) and in the neural tube defect group(t=7.35,P<0.001). Conclusions The folate receptor-ELISA method for measuring human IgM autoantibody to folate receptor was successfully established. The method is sensitive,repeatable,and stable.

Objective To explore the impact of pedicle cortex perforation on the stability of internal fixation of the vertebral body fracture,and to compare the stability of the vertebrae with pedicle cortex perforation after the injured vertebra transpedicular screw fixation by different ways. Methods A total of 36 fresh thoracic and lumbarvertebrae samples of adult sheep (T13-L1) were equally divided into four groups (A,B,C and D) by using the random number table method. The vertebral compression fracture was performed in the L1 vertebral body of the four groups using the Chiba’s method. Four pedicle screws were fixed on the upper and lower injured vertebrae of four groups. In addition,the group C was fixed into a pedicle screw through the injured vertebrae；D group was set two pedicle screws through the injured vertebrae. Then the samples of group B,C,and D were removed a quarter of either side of lateral T14 thoracic pedicle,which was considered as the pedicle cortex perforation model. Four groups were performed fatigue test of 10 000 times by(300±105)N load. The drawing force of the screw and the stability of injured thoracolumbar vertebrae were measured and the differences in every group were compared. Results The axial compressive stiffness and maximum drawing force of screws in the other three groups were significantly higher than those in group B (all P=0.000). The maximum range of motion in four directions of group B were significantly larger than those of the other three groups (all P=0.000). The stiffness and the drawing force in groups C and D were significantly larger than those in the group A (all P=0.000),and the maximum range of motion in four directions of the two groups were lower than that of group A (P=0.002,P=0.005). Every testing indicator in group C had no significant difference when compared with group D (P>0.05). Conclusions The pedicle cortex perforation seriously affects the stability of the fractured vertebral body. The injured vertebra transpedicular screw can increase the stability of internal fixation.

Objective To establish a stable cell line overexpression heme oxygenase-1(HO-1) mediated by a modified lentivirus system and identify its function. Methods The HO-1 gene was amplified by polymerase chain reaction and cloned into the modified pLentiLox3.7 expression vectors. The recombinant plasmids were transfected into HEK293T cells and the HO-1 was detected by Western blot. The recombinant plasmids were transfected into HEK293T cells to produce the viruses,with the helping plasmids including plp1,plp2,and VSVG. HEK293T cells were infected by the viruses and the cells that can express HO-1 were identified by Western blot. The reactive oxygen species were detected in the HO-1-overexpression HEK293T cells and the normal cells after the adding of hydrogen peroxide. The same experiment was performed with human umbilical vein endothelial cells. Results The stable cell line that can overexpress HO-1 was established,which was verified by Western blot. The reactive oxygen species in the HO-1-overexpression HEK293T cells and human umbilical vein endothelial cells decreased obviously after exposure to hydrogen peroxide. Conclusions The lentivirus-carrying HO-1 was successfully packaged and the stable cell line overexpression HO-1 was established. HO-1 can play a protective role in the course of oxidative damage.

Objective To investigate the effect of ischemia/reperfusion (I/R) on tumor metastasis in a experimental mouse model of hematogenous metastasis after I/R and to quantify expression of vascular cell adhesion molecule-1 (VCAM-1) during I/R. Methods An experimental mouse model of metastasis after partial hepatic I/R was designed to determine the effects of I/R on tumor metastasis to liver. Tumor loads were valued 14 days after operation. In addition,the expressions of alanine transaminase (ALT),aspartate transaminase (AST),and VCAM-1 were detected. Results Two hours after hepatic reperfusion,ALT and AST levels in ischemia 45-minute group and ischemia 30-minute group were significantly higher than in the sham group (all P<0.05). Also,the changes of ALT and AST were more obvious in the ischemia 45-minute group than in ischemia 30-minute group (all P<0.05). In the sham group,both ALT and AST slightly and transiently increased. ALT and AST in the ischemia 45-minute group and ischemia 30-minute group at 8 hours were both significantly higher than those at 2 hours reperfusion (P<0.05). The tumor load (valued by hepatic replacement area) and the expression of VCAM-1 in ischemic lobe were significantly larger in the ischemia 45-minute group than in the ischemia 30-minute group and sham group (P=0.013,P=0.007). However,there was no statistical difference on tumor load between the right lobe of sham operated mice and the right lobe (nonischemic lobes) of mice subjected to I/R (P=0.089). Mouse survivals were significantly longer in the sham group than in the ischemia 30-minute group (P=0.041) but were not significantly different between the ischemia 45-minute group and ischemia 30-minute group (P=0.055). VCAM-1 expression in ischemia 45-minute group was significantly higher than in ischemia 30-minute group and sham group(P=0.003,P<0.001),and it was positively correlated with the hepatic replacement area (r=0.491,P=0.045). Conclusion Hepatic I/R promotes liver hematogenic metastasis of hepatocellular carcinoma in mice and at least in part,through the induction of VCAM-1 expression.

Objective To explore the grey matter volume(GMV)changes in neuromyelitis optica(NMO)patients using a voxel-based morphometry method. Methods Whole brain structural images were acquired in 16 NMO patients and 16 gender-and age-matched healthy controls. Comparison of GMV between the two groups was analyzed by VBM8 toolbox of statistical parametric mapping 8. Result Compared with the controls,NMO patients showed decreased GMV in the frontal lobe,parietal lobe,temporal lobe,occipital lobe,limbic lobe,optic tract,caudate nucleus,thalamus,and cerebellum(all P<0.005). Conclusions Regional atrophy of grey matter is found in NMO patients. Voxel-based morphometry can reveal brain volume changes sensitively.

Objective To investigate the incidence,pathogens,and clinical features of infection in consecutive cases from 2010 to 2012 in Peking Union Medical College Hospital. Method The incidence,pathogen,treatment,and outcomes of patients with hematological diseases who had positive findings of bacterium in their samples from 2010 to 2012 were retrospectively analyzed. Results There were 449 positive samples (5.8%) from 4 890 patients during this period,among which 388 were proved to be with pathogenic bacteria. Samples separated from patients with community-aquired infections accounted for 8.4% of all positive samples. Most community-aquired infections were caused by Gram-negative bacteria (75%),although no multidrug-resistant bacteria was observed. Samples separated from patients with nosocomial infections accounted for 91.6% of all positive samples. Respiratory tract (49.4%) and peripheral blood (32.6%) were the most common samples with positive results. Skin soft tissues (10.4%),and urine (3.7%) were less common samples. Most of the pathogenic bacteria of the nosocomial infections were Gram-negative (66.9%). The most common Gram-negative bacteria included Escherichia coli (13.8%),Pseudomonas aeruginosa (12.1%),and Klebsiella pneumonia (12.1%),while Staphylococcus aureus (10.4%),Enterococcus faecium (7.0%),and Staphylococcus epidermidis (5.1%) were the most common Gram-positive bacteria. Gram-negative bacteria consisted of most of sputum samples and peripheral blood samples. Samples from the surface of skin wound and anal swab were composed largely by Gram-positive bacteria (63.8%). The detection rates of extended-spectrum beta-lactamase-producing Klebsiella pneumonia/Klebsiella oxytoca,Escherichia coli,and Proteus mirabilis were 24.0%,87.9% and 38.4%,respectively. The resistance to Acinetobacter baumannii was serious. Multidrug-resistant,extensive drug resistant and pan drug resistant A. baumannii acountted for 74% of all A. Baumannii infections. Stenotrophomonas maltophilia showed low resistance to sulfamethoxazole/trimethoprim,levofloxacin and minocycline. Also,22 methicillin-resistant Staphylococcus aureus and 9 methicillin-resistant Staphylococcus Epidermidis were detected,which were only sensitive to vancomycin,teicoplanin,and linezolid. All patients were treated in the haematology wards and most of them were under agranulocytosis or immunosuppression. Finally,22 patients reached clinical recovery through anti-infective therapy,whereas 49 patients died. Among those deaths,42 patients attributed to severe infections and infection-associated complications. Fourteen of all the deaths might be infected with drug-resistance bacteria. There were 61 samples proved to be bacteria colonization. Nonfermenters such as Acinetobacter baumannii and Stenotrophomonas maltophilia made up for a large amount of bacteria colonization. Conclusions The pathogens of nosocomial infections in the hematology ward are mainly Gram-negative bacteria. The incidences and pathogens vary from different infection sites. Nosocomial infection still has a higher mortality rate. Once nonfermenters are detected positive,the pathogenic or colonial bacteria should be distinguished.

The incidence of lymphoma has increased annually. The nutrition status of lymphoma patients influences their quality of life and even the tolerance to treatment. This review summarizes the resting energy expenditure of untreated lymphoma patients,influence of chemotherapy and bone marrow transplantation on nutrition status,and individualized nutrition support for these patients.

Since 2006,tyrosine kinase inhibitors and anti-angiogenic drugs have revolutionized the treatment of metastatic renal cell carcinoma by improving progression-free survival and overall survival. The prognostic factors in metastatic renal cell carcinoma treated by targeted therapy include anatomical,histological,clinical,biological,and molecular parameters. The accuracy of these prognostic factors are not high when applied alone. A renal cancer prognostic system that combines all these prognostic factors can improve the risk assessment of renal cancer and prognosis prediction,and thus guide clinical decision-making.

Histidine triad nucleotide-binding protein 1 (HINT1) is a member of a superfamily of histidine triad proteins named by the conserved nucleotide-binding motif histidine-x-histidine-x-histidine-xx,in which x represents hydrophobic amino acid. HINT1 is implicated in pathological progress of many human diseases including cancer and schizophrenia；however,little is known about the essential role and pathological consequences of HINT1 in cellular physiology and diseases. Therefore,we summarize the structure,distribution,and physiological function of HINT1 in cells and tissues as well as the correlation between HINT1 and human diseases.