[Clinical characteristics and diagnosis of early hydatidiform mole].

Objective: To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole. Methods: A retrospective cohort study was conducted of 526 women with hydatidiform mole who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and ChildHealth Care Hospital from Feb. 2013 to Feb. 2018, including 484 women with gestational age less than or equal to 12 weeks (the early group) and 42 women with gestational age greater than 12 weeks (the late group). The clinical characteristics between the two groups were compared, and the pathological diagnosis and pre-evacuation ultrasound examination of the early group were further discussed. Results: Compared with the late group, the clinical characteristics of the early group tended to be atypical, and the incidence of vaginal bleeding, excessive uterine size, theca lutein cysts (>6 cm) and pregnancy complications decreased significantly (all P<0.05). The serum level of ß-hCG in the early group was significantly lower than that in the late group (Z=-2.382, P=0.017). While there was no significant difference in the pre-evacuation ultrasound detection rate between the two groups (53.5% vs 66.7%; χ(2)=2.697, P=0.101). Five hundred and fifteen patients completed the follow-up, and 38 patients with post-mole neoplasia were all cured. There was no significant difference in the malignant transformation rate of hydatidiform mole between the two groups (7.0% vs 11.9%; χ(2)=0.745, P=0.388). In the early group, 302 cases of complete hydatidiform mole (CHM), 179 cases of partial hydatidiform mole (PHM) and 3 cases of unclassified hydatidiform mole (UHM) were histologically diagnosed, according to pathological morphology combined with p57(KIP2) immunohistochemical staining. Compared with pathological diagnosis, the overall pre-evacuation ultrasound detection rate in the early hydatidiform mole was 53.5% (259/484), which was significantly better for complete (78.1%, 236/302) versus partial (11.7%, 21/179) hydatidiform moles (χ(2)=199.224, P<0.01). There was significantly weak negative correlation between the overall ultrasound detection rate and gestational age of hydatidiform mole (r=-0.211, P<0.01). The gestational age of early PHM was significantly longer than that of CHM (68.0 vs 58.5 days; Z=-8.048, P<0.01). Conclusions: The clinical presentations of early hydatidiform mole are not typical. Although ultrasound examination identifies only about half of hydatidiform moles, ultrasonography is still an important auxiliary examination method. Morphological examination combined with p57(K)IP2 immunohistochemical staining could effectively diagnose early hydatidiform mole, so as to reduce the missed diagnosis of hydatidiform mole.

Ulinastatin promotes T lymphocyte apoptosis in rats with severe acute pancreatitis via mitochondrial pathways.

We explored the influence of ulinastatin on apoptosis of T lymphocytes in rats with severe acute pancreatitis (SAP) and the effect of ulinastatin on mitochondrial apoptosis pathways in spleen lymphocytes. Thirty-six Wistar rats were randomly divided into three groups (N = 12): a sham operated group, a SAP group, and an ulinastatin-treated SAP group. The SAP model was established by injecting 5% sodium taurocholate into the intrapancreatobiliary duct. Study rats were sacrificed after 24 h, and splenic lymphocytes were then collected. CD4(+) and CD8(+) T lymphocytes were labeled by direct immune fluorescence assays; the percentage of apoptotic cells, mitochondrial membrane potential levels, and mitochondria permeability transition pore opening levels were measured by flow cytometry. In the ulinastatin-treated SAP group, the ratio of CD4(+)/CD8(+) T lymphocytes was significantly higher than that in the SAP group, and the apoptosis percentage of CD4(+) T lymphocytes was significantly decreased. The percentage of lymphocytes with an abnormal opening of the mitochondrial permeability transition pore and lymphocytes with decreased mitochondrial membrane potential in the ulinastatin-treated SAP group were significantly lower than that in the SAP group. Ulinastatin can directly enhance immunological function and attenuate immune suppression in SAP rats through inhibiting the apoptosis of CD4(+) T lymphocytes. These study findings demonstrate that therapeutic effects may occur through inhibiting the apoptosis induced by mitochondrial signaling pathways.

Evaluation of clinical significance of isoferritin by development of new monoclonal antibodies specific for acidic isoferritin.

We produced monoclonal antibodies (MAbs) against acidic isoferritin (AIF) of primary hepatic carcinoma (PHC) and human placental tissues. Competitive enzyme-linked immunosorbent assay (ELISA) revealed that each MAb bound to different antigenic determinants of AIF, but there is the same epitope between PHC AIF and placental AIF. Sandwich-type ELISA was developed to measure the concentration of serum AIF in the patients with PHC, chronic hepatitis, and cirrhosis. In most of cases of PHC, serum AIF levels were found to be significantly elevated, but were in low levels in almost all of the patients with chronic hepatitis and cirrhosis. On the other hand, we have studied the expression of AIF in liver tissue. Immunohistochemical study using MAb4c9 specific for PHC AIF and MAb7a9 specific for placental AIF has shown that AIF positive staining rates of hepatocytes with liver tissues of PHC, nonmalignant live diseases and normal control were 81.6, 6.7, 0%, and 73.7, 10, 0%, respectively. We also studied the p53 protein expression in those liver tissues (47.4, 0, 0% in PHC, nonmalignant liver diseases and normal liver, respectively). Our data indicated that there was significant correlation between AIF and p53 expression in liver tissues of PHC. Taken together, the results suggested that AIF is probably synthesized and secreted by the tumor cells of PHC and its production may reflect carcinogenesis of hepatocytes. Anti-PHC AIF MAb was clearly superior in diagnosis of PHC to antiplacental AIF MAb, and has potential application of immunotherapy.

[Effects of dachengqi decoction on gut hormones and intestinal movement after cholecystectomy].

In order to elucidate the mechanism of postoperative intestinal dysfunction and the effects of Dachengqui Decoction (DCQD) on it, somatostatin (SS), gastrin (GAS), vasoactive intestinal polypeptide (VIP), substance P (SP), motilin (MOT) and atrial natriuretic peptide (ANP) were determined, frequency and spectrum of peristaltic sound were simultaneously analyzed in 31 subjects undergoing cholecystectomy, the value of pre-, post-operation and post-medication were compared. Plasma SS and MOT decreased postoperatively (P < 0.05), DCQD elevated SS and MOT to higher level than preoperation, VIP, SP increased for half fold (P < 0.05). Gurgling sound diminished after operation, whereas DCQD normalized it. Peak frequency (Fmax) of gurgling ranging from 234.4 to 468.2 Hz preoperatively, mean frequency (FA) was 341.8 +/- 30.9 Hz postoperatively. FA reduced to 322.3 +/- 79.4, DCQD elevated it to 374.2 +/- 57.1 Hz. The result suggested that intestinal motility was disturbed after cholecystectomy, bowel was in dystonic status, accompanying with decreased plasma MOT, DCQD promoted intestinal peristalsis and enhanced it's tonus. The influence of gut peptides might be one of the important pathway that DCQD works.

Chronic tuberculous empyema: relationships between preoperative CT findings and postoperative improvement measured by pulmonary function testing.

AIMS: To evaluate whether preoperative computed tomography (CT) findings correlate with postoperative improvements in forced vital capacity (FVC) and forced expiratory volume during 1s (FEV1) in persons who have undergone unilateral decortication because of unilateral chronic tuberculous empyema. METHODS: A retrospective study was carried out of 67 individuals who had undergone decortication because of chronic tuberculous empyema between January 1996 and December 2000. Of these, 13 subjects who had had preoperative chest CT and preoperative and postoperative pulmonary function tests (PFTs) were included in the investigation. On preoperative CT, the degree of volume reduction of the affected side was compared with that of the contralateral normal lung. The relative volume of empyema was calculated by dividing the volume occupied by the empyema by the sum of the total volume of the ipsilateral lung and the empyema volume. The thicknesses of pleura and extrapleural fat in the involved hemithorax were measured by CT at their thickest points, and the degree of atelectasis adjacent to the empyema in the diseased lung was assessed and classified. These five CT parameters and the ages of the patients were compared with preoperative and postoperative FVC and FEV1 changes. RESULTS: A significant negative correlation was found between FVC changes and the relative volume of the affected lung (FVC: p = 0.039, RS = -0.58). FVC and FEV1 were found to be significantly and positively correlated with the relative volume of the empyema (FVC: p = 0.005, RS = 0.72; FEV1: p = 0.014, RS = 0.66) and the degree of atelectasis (FVC: p = 0.007, RS = 0.71; FEV1: p = 0.029, RS = 0.60) by Spearman's nonparametric correlation test. Other CT parameters and the ages of the patients were not found to be correlated with PFT changes. CONCLUSION: The relative volume of the affected side, the relative volume of empyema and the degree of atelectasis can predict improvements in FVC and FEV1 after decortication in patients with chronic tuberculous empyema.

[Changes in vasoactive intestinal polypeptide levels in intestinal obstruction and the influence of da cheng qi decoction].

The role of vasoactive intestinal polypeptide (VIP) in small intestine obstructed rabbits and the therapeutic mechanism of Da Cheng Qi Decoction (DCQD) were studied. VIP concentrations of both blood and intestinal tissue were measured by specific radio-immunoassay in a rabbits' mechanical small intestinal obstruction model using fix of ileum to the right low abdominal wall, the influences of duodenal perfusion of DCQD on VIP levels were also investigated. 24 hours after ligating ileum, VIP of arterial plasma was elevated 7 fold, reaching 138.65 +/- 25.58 pmol/L, that of portal vein plasma was 4 times of the arterial value. VIP immunoactivity was detected in peritoneal fluid. VIP content of duodenal tissue in 16 intestine obstructed rabbits was 2 times high as that in 15 controls, whereas that of colonal tissue was inversed. DCQD caused a 50% decrease of elevated plasma VIP in experimental animals and a 65% increase in controls. The present work demonstrates that VIP might be released into the portal and peripheral circulation and mediate local and systemic pathophysiologic alterations accompanying small intestinal obstruction, such as hyperemia and edema of intestinal wall, accumulation of fluid in the lumen. VIP changes might account for the redistribution of blood flow in the obstructed segment of small intestine and the distal site of obstruction. DCQD has a therapeutic effect. The mechanism of dual modulate action of DCQD on VIP concentration is beyond our knowledge.

Evidence for the essential function of 2,4-dienoyl-coenzyme A reductase in the beta-oxidation of unsaturated fatty acids in vivo. Isolation and characterization of an Escherichia coli mutant with a defective 2,4-dienoyl-coenzyme A reductase.

For the purpose of assessing in vivo the importance of 2,4-dienoyl-CoA reductase (EC 1.3.1.34) in the beta-oxidation of unsaturated fatty acids, reductase mutants of Escherichia coli were isolated by selecting cells that were able to grow on oleate but not on petroselinic acid (6-cis-octadecenoic acid). One mutant (fadH) exhibited 12% of the 2,4-dienoyl-CoA reductase activity present in the parental strain with other beta-oxidation enzymes being essentially unaffected. Antireductase antibodies were used to show that the mutant contains a fadH gene product at a level similar to that observed in the parental strain. Thus, the mutation seems to have resulted in the synthesis of a fadH gene product with lower specific activity. The mutation was mapped in the 71-75-min region of the E. coli chromosome where no other gene for beta-oxidation enzymes has so far been located. Complementation of the mutation by F'141, which carries the 67-75.5-min region of the E. coli genome, resulted in an increase in the 2,4-dienoyl-CoA reductase activity to 80% of the level found in the parental strain. Measurements of respiration with petroselinic acid as the substrate showed rates to be linearly dependent on the 2,4-dienoyl-CoA reductase activity up to levels found in wild-type E. coli. 2,4-Dienoyl-CoA reductase, like other enzymes of beta-oxidation, was induced when E. coli was grown on a long chain fatty acid as the sole carbon source. It is concluded that 2,4-dienoyl-CoA reductase is required in vivo for the beta-oxidation of unsaturated fatty acids with double bonds extending from even-numbered carbon atoms.

Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty.

BACKGROUND: The management of full thickness rectal prolapse remains controversial. Although abdominal approaches have a lower recurrence rate than do perineal operations, they are associated with a higher morbidity. The aim of this study was to compare the outcomes of perineal rectosigmoidectomy with and without levatorplasty. METHODS: Between 1989 and 1999, a total of 109 consecutive patients (10 men) underwent 120 perineal procedures. These patients were retrospectively evaluated in two groups on the basis of the type of surgery received: perineal rectosigmoidectomy (PRS) or perineal rectosigmoidectomy with levatorplasty (PRSL). Subsequent functional outcome and physiological parameters were assessed. RESULTS: The patients had a mean age of 75.7 years (range, 23.0-94.8 years) and they were followed for an overall mean (in both groups combined) of 28.0 months (range, 0.4-126.4 months) after surgery. Mean duration of surgery was 78.1 min (SD=25.9) and 97.6 min (SD=32.3) in PRS and PRSL, respectively ( p=0.002, unpaired t test). There was no significant difference between the two groups in terms of hospital stay, morbidity or mortality. Recurrence rates and mean time interval to recurrence were, respectively, 20.6% and 45.5 months in PRS compared to 7.7% and 13.3 months in PRSL ( p=0.049, chi-square test; p=0.001, unpaired t test). Both groups had significant improvements in postoperative incontinence score ( p<0.0001, Wilcoxon's matched-pairs signed-ranks test), however, there were no significant changes in anorectal manometric findings and pudendal nerve terminal motor latency assessment. CONCLUSIONS: Perineal rectosigmoidectomy with levatorplasty is associated with a lower recurrence rate and a longer time to recurrence than perineal rectosigmoidectomy alone. Levatorplasty should be offered to patients when a perineal approach for rectal prolapse is selected.

Colonic J-pouch function in rectal cancer patients: impact of adjuvant chemoradiotherapy.

PURPOSE: The colonic J-pouch technique of reconstruction optimizes functional outcome after proctectomy with coloanal anastomosis. However, the impact of adjuvant chemoradiation therapy on pouch function in rectal cancer patients has not been investigated. METHODS: From January 1994 to December 1999, 74 patients with midrectal or low rectal tumors (less than 10 cm from the anal verge) underwent a proctectomy with coloanal anastomosis with colonic J-pouch reconstruction. Chemoradiation was offered in patients with Stage II and III disease. Radiation therapy was administered using a four-field technique including the anal canal, for a total dose of 50.4 Gy (1.8 Gy/fraction/day). Fifteen patients (20 percent) died with metastatic disease, five (6.8 percent) died of other causes without evidence of recurrence, and five (6.8 percent) were lost to follow-up. In addition, two patients had local recurrence (2.7 percent) at the time of follow-up. Forty-five of 47 eligible patients (96 percent) responded to a questionnaire designed to evaluate specifically the degree of continence and pouch evacuation. RESULTS: The mean age of patients was 68.9 (range, 42-88) years and the mean duration of follow-up was 28.8 (range, 1-69) months. There were 28 patients in the surgery alone group and 17 patients who received either preoperative (13) or postoperative (4) adjuvant chemoradiation therapy. Patients in the surgery alone group had a significantly better degree of continence (mean +/- standard deviation continence score: 18.1 +/- 2.9 vs. 13.3 +/- 4.1, P < 0.001) and were less likely to experience evacuatory problems (mean +/- standard deviation evacuation score: 21.3 +/- 3.7 vs. 16.4 +/- 3.5, P < 0.001). Use of a pad was more frequent in the chemoradiation therapy than in the surgery alone group (53 vs. 18 percent, P = 0.02). The incidence after functional disorders was also more frequent in the irradiated group of patients: incontinence to gas (76 vs. 43 percent, P = 0.03), to liquid stool (64 vs. 25 percent, P = 0.01), and to solid stool (47 vs. 11 percent, P = 0.01). Moreover, irradiated patients reported more frequent pouch-related specific problems, such as clustering (82 vs. 32 percent, P = 0.001), and sensation of incomplete evacuation (82 vs. 32 percent, P = 0.001). Finally, regression analysis demonstrated that radiation-induced sphincter dysfunction was progressive over time. CONCLUSIONS: Both preoperative and postoperative chemoradiation therapy adversely affects continence and evacuation in patients with colonic J-pouch. Because radiation-induced damage to the normal tissues is known to be cumulative over time, long-term progressive dysfunction of the anal sphincter and neorectum are causes of concern. Consideration should be given to excluding the anal canal from the field of irradiation in patients with Stage II and III rectal cancer, whenever a sphincter-preserving procedure is planned.