Absence of insulin receptor gene mutations in three insulin-resistant women with the polycystic ovary syndrome

Women with polycystic ovary syndrome (PCOS) are markedly insulin-resistant, but the molecular mechanisms of these changes and their relationship to the hyperandrogenic state remain to be clarified. Mutations have recently been identified in the insulin receptor gene of patients with extreme forms of insulin resistance associated with hyperandrogenism (eg, type A insulin resistance), and these mutations account for the insulin resistance in such patients. We performed this study to determine whether mutations in the coding portion of the insulin receptor gene were responsible for insulin resistance in PCOS. Insulin binding studies using cultured skin fibroblasts of three obese (body mass index > 27 kg/m²) women with PCOS (ie, mild hyperandrogenemia and chronic anovulation of unknown etiology) and documented insulin resistance showed no apprarent abnormalities in either the number or affinity of insulin binding sites. Direct sequencing of all 22 exons of the insulin receptor gene from two of the women with PCOS did not reveal any mutations. Furthermore, both alleles of the gene were expressed at equal levels. In a third insulin-resistant PCOS woman, there was no evidence for a mutation in the coding portion of the insulin receptor gene as determined by denaturing gradient gel electrophoresis (DGGE). We conclude that the insulin resistance in these PCOS women was caused by a defect extrinsic to the insulin receptor.     

经皮球囊扩张术治疗27例二尖瓣再狭窄效果研究

目的 探讨经皮球囊扩张术治疗二尖瓣再狭窄的临床效果。方法 对１９例闭式扩张术二尖瓣再狭窄（ＭＲＳ）。和经皮二尖瓣球囊扩张术（ＰＴＭＣ）后ＭＲＳ患者再次施行ＰＴＭＣ。结果 两组二尖瓣口面积（ＭＶＡ）分别增加７１％和７８％。闭式扩张术后经再次ＰＴＭＣ,ＭＶＡ从（１．３５±０．３４）ｃｍ＾２提高到（２．３１±０．３２）ｃｍ＾２,左房压（ＬＡＰ）由（２．３１±１．１０）ｋＰａ降至（１．２７±０．８７）ｋＰ     

中国广东籍汉族人细胞色素P450_2E_1基因5'侧翼区多态性

目的：探讨中国广东籍汉族人细胞色素Ｐ４５０２Ｅ１基因５′侧翼区的多态性分布规律。方法：利用聚合酶链反应和ＲｓａⅠ、ＰｓｔⅠ限制性片段长度多态性（ＰＣＲＲＦＬＰ）技术对８２名正常中国广东籍汉族人的细胞色素Ｐ４５０２Ｅ１基因５′侧翼区的多态性进行了检测。结果：８２名正常中国广东籍汉族人的细胞色素Ｐ４５０２Ｅ１基因５′侧翼区Ｃ１（ＲｓａⅠ＋,ＰｓｔⅠ）、Ｃ２（ＲｓａⅠ,ＰｓｔⅠ＋）等位基因频率分别为０８５４,０１４６;基因型Ｃ１Ｃ１、Ｃ１Ｃ２、Ｃ２Ｃ２的比率分别为０７３２、０２４４、００２４,符合ＨａｒｄｙＷｅｉｎｂｅｒｇ平衡分布。结论：中国广东籍汉族人细胞色素Ｐ４５０２Ｅ１基因５′侧翼区ＲｓａⅠ和ＰｓｔⅠ多态性分布规律与欧美人显著不同。     

Expression of p27 in Residual Rectal Cancer after Preoperative Chemoradiation Predicts Long-term Outcome

Background: Compared with surgery alone, preoperative radiotherapy and 5-fluorouracil–based chemotherapy (combined-modality therapy; CMT) improves outcomes in patients with locally advanced rectal cancer. Although numerous studies have focused on identifying molecular markers of prognosis in the primary rectal cancer before CMT, our aim was to identify markers of prognosis in residual rectal cancer after preoperative CMT.Methods: Sixty-seven patients with locally advanced (T3–4 and/or N1) rectal cancer were treated with preoperative radiotherapy (median, 5040 cGy) with or without 5-fluorouracil–based chemotherapy. Residual tumor in the resected specimen, available for 52 patients, was analyzed for tumor-node-metastasis stage, lymphovascular and/or perineural invasion, and immunohistochemical expression of p27, p21, p53, Ki-67, retinoblastoma gene, cyclin D1, and bcl-2. Recurrence-free survival (RFS) was determined by the Kaplan-Meier method and compared by the log-rank test.Results: With a median follow-up of 69 months, the overall 5-year RFS was 74%. RFS was significantly worse for patients with positive p27 expression (P = .005), T3–4 tumors (P = .02), and positive lymph nodes (P = .04) in the irradiated specimen. On multivariate analysis, positive p27 expression remained an independent negative prognostic factor for RFS (P = .04). None of the other proteins was significantly associated with RFS.Conclusions: Our results indicate that positive p27 expression in rectal cancer after preoperative chemoradiation is an independent negative predictor of RFS. Expression of p27 in the residual rectal cancer may therefore identify patients with disease likely to be refractory to standard therapy and for whom investigational approaches should be strongly considered.the 56th Annual Cancer Symposium, Society of Surgical Oncology, Los Angeles, California, March 5–9, 2003.     

Metastatic Epithelioid Gastrointestinal Stromal Tumor: Yet Another Tumor with Anemone Cell Features

Since 1980 when Sibley and coworkers first described a nodal neoplasm of unknown histogenesis with striking surface microvilli for which they introduced the term "anemone cell," a series of reports have appeared in the literature illustrating tumors with similar ultrastructural features. While most reported cases showed differentiation along a particular line, rare cases remained histogenetically unclear. In this report a case is described of epithelioid gastric gastrointestinal stromal tumor metastatic to the liver, showing conspicuous long microvillus-type cell processes partially or circumferentially coating the cell surfaces, thus qualifying as yet another tumor type with anemone cell features.     

Peroxisome proliferator-activated receptor-gamma agonist rosiglitazone reduces clinical inflammatory responses in type 2 diabetes with coronary artery disease after coronary angioplasty

Rosiglitazone, an agonist of peroxisome proliferator-activated receptor-gamma (PPAR gamma ), is an insulin-sensitizing antidiabetic agent and inhibits restenosis in animal blood vessels. However, its benefit for patients with type 2 diabetes and coronary artery disease (CAD) after percutaneous coronary intervention is unknown. Patients with diabetes and CAD who had undergone percutaneous coronary intervention were randomized to either receive or not receive rosiglitazone (4 mg/d) for 6 months. After 6 months of rosiglitazone treatment, the plasma levels of fasting glucose and insulin and those of hemoglobin A1C and homeostasis model assessment of insulin resistance were significantly decreased in the rosiglitazone group as compared with baseline levels and those in the control group. After 2 and 6 months of rosiglitazone treatment, the plasma level of high-density lipoprotein was significantly increased in the rosiglitazone group. In addition, plasma levels of monocyte chemoattractant protein-1 and C-reactive protein and hyperresponsiveness of low-dose lipopolysaccharide-induced monocyte chemoattractant protein-1 secretion from monocytes were reduced. Furthermore, the occurrence of coronary events was significantly decreased in the rosiglitazone group at 6-month follow-up. Our data indicate that rosiglitazone may protect the vascular wall through not only improving the features of metabolic disorders but also reducing proinflammatory responses and the occurrence of coronary events in patients with diabetes and CAD after percutaneous coronary intervention.     

Clinical significance of joint detection of serum CEA,SCCA, and bFGF in the diagnosis of lung cancer

Lung cancer is a type of malignant tumor with highest morbidity and mortality. This study tested three tumor marker levels including CEA, SCCA, and bFGF to explore their value in lung cancer diagnosis and pathological type judgment. Venous blood was extracted from lung cancer patients, lung benign lesion patients and healthy control. Electrochemiluminescence immunoassay was applied to detect serum CEA and SCCA content. ELISA was used to test serum bFGF level. Serum CEA, SCCA, and bFGF levels and positive rates were significantly higher in lung cancer group than that of lung benign disease group and health control (P < 0.05). bFGF showed higher detection sensitivity than CEA in lung cancer (P < 0.05). Three joint detection sensitivity was higher than single test (P < 0.05), while its specificity was lower (P < 0.05), and the accuracy presented no significant difference. Serum CEA and SCCA levels and positive rates were obviously higher in non-small cell lung cancer patients when compared with small cell lung cancer patients (P < 0.05), while bFGF level was similar between small cell lung cancer and non-small cell lung cancer. bFGF showed higher detection rate than SCCA in small cell lung cancer (P < 0.05). Three joint detection exhibited higher positive rate in small cell lung cancer and non-small lung cancer than single test. Serum CEA, SCCA and bFGF joint detection improved detection sensitivity in lung cancer and had important reference value for pathological type deduction.     

加速康复外科模式对腹腔镜下胰十二指肠切除术后患者肠道黏膜屏障影响的研究

目的研究加速康复外科(ERAS)模式对腹腔镜下胰十二指肠切除术(LPD)术后患者的肠黏膜屏障功能的影响。方法回顾性分析2015年1月至2018年12月接受LPD术的患者145例,根据干预方案不同分为ERAS组78例及传统组67例。数据采用SPSS 24.0进行统计学分析,术后并发症发生率等计数资料采用χ^2检验;围术期各项指标、肠黏膜屏障功能指标以(±s)表示,独立t检验;P<0.05为差异有统计学意义。结果ERAS组术后恢复情况均优于传统组,其中首次排气时间、首次进食时间、引流管拔管时间及术后住院时间差异均有统计学意义(P<0.05);两组术后死亡率差异无统计学意义(P>0.05);ERAS组患者胃排空延迟的发生例数(3例,3.8%)明显少于传统组(5例,7.5%)(P<0.05),其余并发症比较差异无统计学意义(P>0.05);两组患者术后肠黏膜屏障功能指标ERAS组患者优于传统组,但差异无统计学意义(P>0.05)。结论加速康复外科能使LPD术获得更好的临床效果,并可促进LPD患者术后肠黏膜屏障功能的恢复。     

前磨牙邻面板固位全瓷粘接桥修复的应用研究

目的 探究IPS e.max Press玻璃基铸造陶瓷和WIELAND氧化锆陶瓷邻面板固位粘接桥修复下颌第二前磨牙缺失的抗折性能及模拟短期使用后的修复效果。方法 选取成人离体下颌第一前磨牙和第一磨牙各32颗,体外建立下颌第二前磨牙缺失模型。随机分为4组（n=8）,E0组:IPS e.max Press铸瓷粘接桥;E1组:IPS e.max Press铸瓷粘接桥+30万次机械循环加载;W0组:WIELAND氧化锆全瓷粘接桥;W1组:WIELAND氧化锆全瓷粘接桥+30万次机械循环加载。万能测试机测试各实验组的破坏载荷力值。结果 机械循环加载后试件均无松动或脱落,无明显裂纹。万能测试机测试结果:E0、E1、W0、W1组破坏载荷分别为（1 242.85±260.11）、（1 062.60±179.98）、（1 650.85±206.77）、（1 167.61±265.50） N,均大于下颌第二前磨牙所受最大力（360 N）,差异有统计学意义（P<0.001）。E0组破坏载荷小于W0组（P<0.05）。循环加载后,E1组和W1组间差异无统计学意义（P>0.05）。循环加载后,铸瓷组（E1、E0）破坏载荷变化不显著（P>0.05）,氧化锆组（W0、W1）明显降低（P<0.05）。结论 IPS e.max Press铸瓷和WIELAND氧化锆全瓷邻面板固位粘接桥修复下颌第二前磨牙缺失均能够获得良好的抗折性能,短期修复效果满意。