A case of occult bowel perforation after a cycle of chemotherapy for advanced epithelial ovarian carcinoma

Occult bowel perforation is a rare complication in chemotherapy of advanced epithelial ovarian cancer (EOC). The authors present a case of a 75-year-old woman who had appendectomy due to suppurative appendicitis five years prior, that experienced an occult bowel perforation resulting in continuous decline of electrolytes after a single cycle of nedaplatin (NDP) and paclitaxel during neoadjuvant treatment of advanced EOC. To the authors' knowledge, this is the first reported case of an occult bowel perforation after neoadjuvant chemotherapy (NAC) for ovarian cancer. The complication was highly suggestive of a cell lysis mechanism for the perforation.

miR-135a contributes to paclitaxel resistance in tumor cells both in vitro and in vivo

Cancer cell resistance to paclitaxel continues to be a major clinical problem. In this study, we utilized microRNA (miRNA) arrays to screen for differentially expressed miRNAs in paclitaxel-resistant cell lines established in vitro. We observed concordant upregulation of miR-135a in paclitaxel-resistant cell lines representing three human malignancies. Subsequently, the role of miRNA-135a was evaluated in an in vivo model of paclitaxel resistance. In this model, mice were inoculated subcutaneously with a non-small cell lung carcinoma cell line and treated with paclitaxel for a prolonged period. In paclitaxel-resistant cell lines, established either in vitro or in vivo, blockage of miR-135a sensitized resistant cell lines to paclitaxel-induced cell death. We further demonstrated a correlation between paclitaxel response and miR-135a expression in paclitaxel-resistant subclones that were established in vivo. The paclitaxel-resistant phenotype of these subclones was maintained upon retransplantation in new mice, as shown by decreased tumor response upon paclitaxel treatment compared with controls. Upregulation of miR-135a was associated with reduced expression of the adenomatous polyposis coli gene (APC). APC knockdown increased paclitaxel resistance in parental cell lines. Our results indicate that paclitaxel resistance is associated with upregulation of miR-135a, both in vitro and in vivo, and is in part determined by miR-135a-mediated downregulation of APC.

Cinacalcet improves bone density in post-kidney transplant hyperparathyroidism

The recent availability of cinacalcet has provided a possible alternative to parathyroidectomy in kidney transplant patients with persistent hyperparathyroidism, but its effect on bone mass density (BMD) is unknown. From our database containing 163 kidney transplants performed at our center from 1999 to 2007, we compared recipients who received cinacalcet for persistent hypercalcemia and hyperparathyroidism following renal transplantation (n = 8) with up to two other posttransplant patients matched for age, sex, race, and graft function (n = 15). The outcome of the study was BMD changes from baseline to 12, 24, and 36 months post-renal transplantation. Repeated-measures mixed model was used to assess the difference of BMD change between two groups. Cinacalcet therapy was started at a median of 9 (range = 1 to 24) months posttransplant with a mean dose 56 ± 29 mg/d (mean duration = 1.6; range = 1 to 2.1 years). Cinacalcet therapy was associated with significant reduction of serum calcium compared to control. Cinacalcet therapy was associated with greater BMD increase at the hip over the 36-month posttransplant period. Cinacalcet was well tolerated. Our results suggest that cinacalcet may have a small but favorable effect on bone density following kidney transplantation.

Serological and virological surveillance of swine H1N1 and H3N2 influenza virus infection in two farms located in Hubei province, central China

Swine influenza viruses H1N1 and H3N2 have been reported in the swine population worldwide. From June 2008 to June 2009, we carried out serological and virological surveillance of swine influenza in the Hubei province in central China. The serological results indicated that antibodies to H1N1 swine influenza virus in the swine population were high with a 42.5% (204/480) positive rate, whereas antibodies to H3N2 swine influenza virus were low with a 7.9% (38/480) positive rate. Virological surveillance showed that only one sample from weanling pigs was positive by RT-PCR. Phylogenetic analysis of the hemagglutinin and neuraminidase genes revealed that the A/Sw/HB/S1/2009 isolate was closely related to avian-like H1N1 viruses and seemed to be derived from the European swine H1N1 viruses. In conclusion, H1N1 influenza viruses were more dominant in the pig population than H3N2 influenza viruses in central China, and infection with avian-like H1N1 viruses persistently emerged in the swine population in the area.

Comparative serum proteomic analysis of patients with acute-on-chronic liver failure: alpha-1-acid glycoprotein maybe a candidate marker for prognosis of hepatitis B virus infection

The acute-on-chronic liver failure (AoCLF) caused by hepatitis B virus (HBV) infection remains to be a challenge in clinics with a high mortality rate in China, and it is important to identify biomarkers to foresee the prognosis of patients with HBV. The current study analysed serum proteome changes of acute-on-chronic liver failure as a result of acute exacerbation of chronic hepatitis B infection. Serum samples were collected from normal subjects (NS, n = 8), patients with chronic hepatitis B (CHB, n = 12) and patients with AoCLF (n = 12). After removal of albumin/IgG and ultramembrane centrifugation, serum proteins were separated by two-dimensional gel electrophoresis. Differentially expressed spots were identified by matrix-associated laser desorption ionization time-of-flight tandem mass spectrometry. Through the removal of albumin/IgG and ultramembrane centrifugation, the well-resolved and reproducible two-dimensional gel electrophoresis (2-DE) profiles were obtained. A total of 23 proteins were identified on 2-DE profiles by their differential expression between the three cohorts. Mass spectrometry analysis resulted in the identification of 12 proteins unambiguously. Western blot analysis confirmed the proteomics results that the α1-acid glycoprotein (α1-AGP) levels decrease significantly in plasma of patients with AoCLF, but somewhat decreased in patients with chronic HBV. Further α1-AGP levels in bulk serum samples were measured by immune turbidimetry including normal subjects group (n = 25), acute hepatitis group (n = 36), chronic hepatitis group (n = 52) and AoCLF group (n = 48), the level of α1-AGP in AoCLF groups sharply decrease than other groups. Our study shows that α1-AGP may be a potential plasma biomarker for AoCLF diagnosis because of acute exacerbation of chronic hepatitis B infection.

Monocyte infiltration and kidney allograft dysfunction during acute rejection

Multiple cell types infiltrate acutely rejecting renal allografts. Typically, monocytes and T cells predominate. Although T cells are known to be required for acute rejection, the degree to which monocytes influence this process remains incompletely defined. Specifically, it has not been established to what degree monocytes impact the clinical phenotype of rejection or how their influence compares to that of T cells. We therefore investigated the relative impact of T cells and monocytes by correlating their presence as measured by immunohistochemical staining with the magnitude of the acute change in renal function at the time of biopsy in 78 consecutive patients with histological acute rejection. We found that functional impairment was strongly associated with the degree of overall cellular infiltration as scored using Banff criteria. However, when cell types were considered, monocyte infiltration was quantitatively associated with renal dysfunction while T-cell infiltration was not. Similarly, renal tubular stress, as indicated by HLA-DR expression, increased with monocyte but not T-cell infiltration. These data suggest that acute allograft dysfunction is most closely related to monocyte infiltration and that isolated T-cell infiltration has less acute functional impact. This relationship may be useful in assigning acute clinical relevance to biopsy findings.

Mammography use in women age 80 and older with breast cancer

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Background: The guidelines for screening mammography use in patients age 80 years and older are not clear. The purpose of this study was to determine the effect of mammography use on stage and tumor size at breast cancer diagnosis. Methods: The study is a retrospective cohort using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. We evaluated 14,976 women aged 80 and older diagnosed with breast cancer between 1996–2002. Patients were divided into three cohorts based on screening mammography use in the 60 months prior to diagnosis: nonusers, non-regular users (1–2 mammograms), and regular users (3+). The effects of screening on tumor stage (0-I vs. II-IV) and size were determined by logistic regression and multivariate analysis of variance. Results: Regular mammography use for the age groups 80–84, 85–89, and >= 90 was 29%, 19%, and 9%, respectively. Among regular users of mammography, 26% presented with stage II or greater cancer while 64% of non-users presented with stage II or greater disease. On multivariate analysis, non-users were 4.7 (95% CI 4.26–5.14) times more likely to present with high-stage cancer. Non-users, non-regular users, and regular users had an adjusted mean tumor size of 5.08 (4.44–5.72), 3.26 (2.57–3.95), and 2.77 (2.02–3.51), respectively. Conclusions: Regular screening mammography among women aged 80 years and older is associated with earlier stage at presentation and smaller tumor size compared to mammography nonusers. Health care providers should consider discussing potential benefits of screening mammography with their older patients particularly for those without significant comorbidity.

No significant financial relationships to disclose.

Response of fetal heart rate to uterine contractions

The heart rate variability of fetuses under stress from maternal uterine contractions conveys critical information to clinicians and also provides theoretical clues about heart rate regulatory mechanisms. According to the polyvagal theory, the deceleration of fetal heart rate under stress is caused by the withdrawal of vagal tone. Recovery is mediated by its reestablishment. An implication of this mechanism is that the respiratory sinus arrhythmia (RSA) is elevated after the deceleration and subsequent recovery. Findings from our clinical data on fetuses support this theory. The data also indicate that in the instance of a late deceleration the RSA may not be elevated after recovery.

Evaluation of serial serum IL-6 levels in women with newly diagnosed ovarian cancer on a prospective clinical trial

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Background: Elevated levels of IL-6 in serum have been reported in patients (pts) with mullerian malignancies (MM) and have been associated with a poor prognosis. Little is know about the behavior of IL-6 during effective cytotoxic therapy and its correlation to various clinical parameters. Methods: Pts with surgically debulked FIGO Stage II, III, and IV MM were enrolled in the Modified Triple Doublets trial. 83 pts were assigned to a cohort in accordance with the extent of surgical debulking. Cohort I included women who had been optimally cytoreduced to <1cm of residual tumor. Cohort II consisted of pts who had either post-debulking residual disease >1cm or stage IV disease. Both cohorts were treated with 3 sequential chemotherapy doublets, gemcitabine/carboplatin, paclitaxel/carboplatin, and adriamycin/topotecan. Each doublet was delivered for 3 cycles. Serum was collected from pts prior to initiating each doublet at cycles 1, 4, 7 and at the end of study (post cycle 9). Serum IL-6 levels were measured in triplicate by sandwich ELISA. Results: Pts with MM had elevated levels of IL-6 following debulking surgery (mean = 12.7 pg/ml) as compared to normal controls (n = 11, mean IL-6 = 1.5 pg/ml, p =.01). While there was no significant correlation between IL-6 levels and stage of disease, the IL-6 serum concentrations did correlate with extent of surgical debulking (p = 0.0182). IL-6 concentrations dropped throughout all cycles of platinum based treatment with post platinum treatment mean concentration of 3.9pg/ml. IL-6 levels did not correlate with outcome of second look operation and there was no statistically significant correlation between IL-6 and CA-125 levels (p = 0.1612). Survival data is still immature with a median follow-up of 34 months, yet elevation of IL-6 levels following surgery demonstrates a trend towards inferior survival. Conclusions: IL-6 levels are elevated in ovarian cancer pts following surgical debulking and correlate with the volume of residual disease following surgical cytoreduction. Values decrease during cytoreductive platinum based chemotherapy although IL-6 was not as predictive of response as was CA-125. Data demonstrates a weak correlation betweenworse survival and elevated IL-6 levels. Supported by the Lana Vento Foundation.

No significant financial relationships to disclose.

Congestive heart failure (CHF) in older women treated with anthracycline (A) chemotherapy (C)

521

Background: There are little available data on the long-term cardiac safety of anthracycline chemotherapy in women over age 65, so we evaluated rates and predictors of CHF in this population of older women. Methods: We used data from the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database and included women aged 66–90 years who were diagnosed with breast cancer from 1992–1999, had no other cancers, and no history of CHF. Multivariable Cox regression analysis was used to estimate the 5- and 10-year cumulative rates of CHF and to determine the factors independently associated with the development of CHF. Results: A total of 34,621 women were included in this observational study: 28,640 who received no C, 3253 who received non-A C, and 2728 who received A C. Women who received A tended to be younger, have lower comorbidity scores, and have more advanced disease than women treated with non-A chemo or women who did not receive chemotherapy (p<0.001 for each). By multivariable Cox regression analysis, the 5- and 10-year rates of CHF in women aged 66–70 years were 19% and 47% for the A C cohort, 14% and 33% for the non-A C cohort, and 12% and 28% for the no C cohort. The adjusted hazard ratio was 1.45 (95% CI 1.19–1.76) for A C versus other C and was 0.97 (95% CI 0.82–1.14) for no C versus other C. The rates of CHF were not statistically different among women in the older age cohorts, although selection biases were likely stronger. Other significant predictors of CHF included black race (HR 1.28, 1.17–1.40), increasing comorbidity, and preceding diagnosis of hypertension (HR 1.40, 1.34–1.47), diabetes (HR 1.23, 1.16–1.30), and peripheral vascular disease (HR 1.26, 1.19–1.34). Conclusions: Although women ages 66–70 treated with A tended to be healthier than women treated with other types of chemotherapy, the rates of CHF among women treated with A were significantly higher. The difference in rates of CHF continued to increase through 10 years of follow-up.

No significant financial relationships to disclose.

Acute myeloid leukemia (AML) in older women after adjuvant breast cancer therapy

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Background: Adjuvant chemotherapy for breast cancer is associated with the development of secondary AML, but this risk in an older population has not been previously quantified. Methods: We queried data from the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database for women who were diagnosed with nonmetastatic breast cancer from 1992–1999. We compared the risk of AML in patients with and without adjuvant chemotherapy (C), and by differing C regimens. The primary endpoint was a claim with an inpatient or outpatient diagnosis of AML (ICD-09 codes 205–208). Risk of AML was estimated using the method of Kaplan-Meier. Cox proportional hazards models were used to determine factors independently associated with AML. Results: 36,904 patients were included in this observational study, 4,572 who had received adjuvant C and 32,332 who had not. The median patient age was 75.3 (66.0–103.3). The median follow up was 63 months (13–132). Patients who received C were significantly younger, had more advanced stage disease, and had lower comorbidity scores (p<0.001). The unadjusted risk of developing AML at 10 years after any adjuvant C for breast cancer was 1.6% versus 1.1% for women who had not received C. The adjusted HR for AML with adjuvant C was 1.72 (1.16–2.54) compared to women who did not receive C. HR for radiation was 1.21 (0.86–1.70). HR was higher with increasing age but p>0.05. An analysis was performed among women who received C. When compared to other C regimens, anthracycline-based therapy (A) conveyed a significantly higher hazard for AML HR 2.17 (1.08–4.38), while patients who received A plus taxanes (T) did not have a significant increase in risk HR1.29 (0.44–3.82) nor did patients who received T with some other C HR 1.50 (0.34–6.67). Another significant independent predictor of AML included GCSF use HR 2.21 (1.14–4.25). In addition, increasing A dose was associated with higher risk of AML (p<0.05). Conclusions: There is a small but real increase in AML after adjuvant chemotherapy for breast cancer in older women. The risk appears to be highest from A-based regimens, most of which also contained cyclophosphamide, and may be dose-dependent. T do not appear to increase risk. The role of GCSF should be further explored.

No significant financial relationships to disclose.

Biphasic metaplastic sarcomatoid carcinoma of the breast

BACKGROUND

Breast biphasic metaplastic sarcomatoid carcinoma (MSC) is rare and aggressive. We analyzed 100 patients treated at M. D. Anderson Cancer Center (MDACC) with 213 MSC and 98 carcinosarcoma patients identified through the Surveillance, Epidemiology and End-Results (SEER) database to describe clinical and pathologic characteristics.

PATIENTS AND METHODS

We searched the MDACC (1985-2001) and SEER databases (1988-2001) for breast MSC and carcinosarcoma patients.

RESULTS

We identified 100 MDACC MSC patients: 66% had node-negative disease and 6% distant metastases at presentation. Median recurrence-free survival (RFS) of 94 patients with stages I-III disease was 74 months (range 3-74), with 52% 5-year RFS [95% confidence interval (CI) 0.42-0.63]. Median overall survival in these patients was not reached, with 64% 5-year survival (95% CI 0.54-0.75). The initial stage of the tumor, but not use of adjuvant chemo- or radiotherapy, had a strong association with outcome. The pathologic complete response rate to neoadjuvant chemotherapy was 10%. Median survival from the time of recurrent disease was 14 months (range 1-55). Tumors were usually hormone receptor- and HER2/neu-negative. SEER data were consistent with MDACC findings.

CONCLUSIONS

Breast MSC and carcinosarcoma are aggressive, treatment-refractory tumors with shared clinical features and outcome similar to poorly differentiated receptor-negative adenocarcinomas. New therapeutic agents are needed.

Paclitaxel resistance: molecular mechanisms and pharmacologic manipulation

It has been approximately ten years since the Food and Drug Administration (FDA) approved paclitaxel for the treatment of platinum resistant epithelial ovarian carcinoma. Since the approval, the drug has found therapeutic applications in a variety of schedules and in a wide variety of epithelial malignancies. Its novel mechanism of action provided the hope that it would demonstrate anti-neoplastic activity in multidrug resistant tumor cells. Unfortunately, as with other chemotherapeutic drugs, resistance is commonly seen. Laboratory investigation has defined a wide variety of resistance mechanisms including overexpression of multidrug resistance (MDR-1) gene, molecular changes in the target molecule (betatubulin), changes in apoptotic regulatory and mitosis checkpoint proteins, and more recently changes in lipid composition and potentially the overexpression of interleukin 6 (IL-6). This review describes the in vitro molecular data that define and support the various mechanisms of resistance and critically evaluates the evidence for the participation of these mechanisms in clinically relevant paclitaxel resistance. This review also explores pharmacologic attempts to modulate paclitaxel resistance, principally through inhibition of the MDR-1 drug efflux pump. Future avenues for drug resistance research and its pharmacologic manipulation in the clinic are discussed.

Overexpression of human phosphoglycerate kinase 1 (PGK1) induces a multidrug resistance phenotype

BACKGROUND

Multidrug resistance is a significant barrier to the development of successful cancer treatment. To identify genetic alterations that are directly involved in paclitaxel resistance, a functional cloning strategy was developed.

MATERIALS AND METHODS

Using mRNA from paclitaxel resistant human ovarian cancer cell line SW626TR, a cDNA library was established in a pCMV-Script vector that permits expression of cDNA inserts in mammalian cells. Transfection of the pCMV-Script/SW626TR cDNA library into the paclitaxel-sensitive human osteogenic sarcoma cell line, U-20S, resulted in several paclitaxel-resistant clones.

RESULTS

DNA sequencing of clone C16 demonstrates complete homology to human phosphoglycerate kinase 1 (PGK1). Retransfection of the PGK1 insert into U-20S confers a multidrug resistant phenotype, characterized by a 30-fold increase in paclitaxel resistance, and cross-resistance to vincristine; adriamycin and mitoxantrone, but not methotrexate or cisplatin. Enzymatic analysis of the PGK1 transfectants demonstrates an increase in PGK1 activity as compared to the parental cell line, U-20S. Northern and Western analysis of PGK1 transfectants reveals no change in MDR-1 expression compared with the parental cell line. In addition, co-culture of PGK1 transfectants with verapamil only partially reverses the multidrug resistant phenotype. Rhodamine 123 studies are also consistent with an MDR-1 independent mechanism of increased drug efflux.

CONCLUSION

Together this data suggests that PGK1 can induce a multidrug resistant phenotype through an MDR-1 independent mechanism.

Overexpression of IL-6 but not IL-8 increases paclitaxel resistance of U-2OS human osteosarcoma cells

The cytokines IL-6, initially recognized as a regulator of immune and inflammatory response and IL-8, a potential regulator of angiogenesis, also regulate the growth of many tumor cells. Human cancer cells selected for multidrug resistance to common chemotherapeutic agents demonstrate increased expression of IL-6 and IL-8. To determine whether IL-6 or IL-8 overexpression contributes directly to the drug resistant phenotype, IL-6 or IL-8 cDNA were introduced into the paclitaxel sensitive human osteosarcoma cell line U-2OS using the pIRESneo bicistronic expression vector. Interleukin-6 and IL-8 transfectants were selected for either high IL-6 or IL-8 secretion and evaluated in drug resistance assays. Two IL-6 and two IL-8 secreting clones express IL-6 or IL-8 levels of 10 ng/ml and 1 ng/ml in culture, while parental U-2OS and pIRESneo vector transfected control cells express IL-6 and IL-8 levels of 0.005 ng/ml and 0.1 ng/ml, respectively. MTT cytotoxicity with IL-6 transfected cells demonstrates a five-fold increase in resistance to paclitaxel and a four-fold increase in resistance to doxorubicin as compared to U-2OS. There are no changes in mitoxantrone or topotecan resistance in the IL-6 transfectants as compared to parental U-2OS. Northern analysis of IL-6 transfectants demonstrates that the resistant phenotype is not related to increased levels of MDR-1, MRP-1, or LRP. Western analysis also confirms that P-glycoprotein levels are not altered in IL-6 transfectants. Further supporting an MDR-1 independent mechanism of drug resistance, verapamil cannot reverse paclitaxel resistance in transfected cells, findings further supported by rhodamine 123 exclusion data. Treatment of IL-6 transfected cells with paclitaxel, compared with drug-sensitive parental U-2OS, shows U-2OS(IL-6) are significantly more resistant to apoptosis induced by paclitaxel and exhibit decreased proteolytic activation of caspase-3. In contrast U-2OS(IL-8) transfectants demonstrate no appreciable increase in paclitaxel resistance when compared with parental cells. In summary, while both IL-6 and IL-8 are overexpressed in paclitaxel resistant cell lines, only IL-6 has the potential to contribute directly to paclitaxel and doxorubicin resistance in U-2OS. This resistance is through a non-MDR-1 pathway.

Naphthalene formation by allylation of zirconaindenes in the ZnX2-Pd(PPh3)4 system

Zirconaindenes reacted with allyl halides in the presence of ZnX2 (X = Cl or Br) and a catalytic amount of Pd(PPh3)4 to give naphthalene derivatives in good yield.

Role of NF-Y in in vivo regulation of the gamma-globin gene

The duplicated CCAAT box is required for gamma gene expression. We report here that the transcriptional factor NF-Y is recruited to the duplicated CCAAT box in vivo. A mutation of the duplicated CCAAT box that severely disrupts the NF-Y binding also reduces the accessibility level of the gamma gene promoter, affects the assembly of basal transcriptional machinery, and increases the recruitment of GATA-1 to the locus control region (LCR) and the proximal promoter and the recruitment of transcription cofactor CBP/p300 to the LCR. These findings suggest that recruitment of NF-Y to the duplicated CCAAT box plays a role in the chromatin opening of the gamma gene promoter as well as in the communication between the gamma gene promoter and the LCR.

[Chlamydia pneumoniae infection in patients with chronic obstructive pulmonary disease]

OBJECTIVE

To investigate the association of chlamydia pneumoniae infection with chronic obstructive pulmonary disease (COPD).

METHODS

61 patients with acute exacerbations of COPD, 35 patients with stable COPD and 26 healthy subjects were selected. Chlamydia pneumoniae-specific serum IgG, IgA, IgM antibodies were measured by microimmunofluorescence method. Chlamydia pneumoniae DNA in sputum were detected by nested polymerase chain reaction.

RESULTS

The prevalence of acute chlamydia pneumoniae infection in COPD patients with acute exacerbation was significantly higher (31.1%) than that in patients with stable COPD (P < 0.05) and in healthy subjects (P < 0.01). The prevalences of chronic chlamydia pneumoniae infection in COPD patients with acute exacerbations (21.3%) and stable COPD patients (31.4%) were higher than that in healthy subjects (P < 0.05) The level of geometric mean titer of the serum IgA antibodies was the highest in COPD patients with acute exacerbations (20.5), intermediately elevated in stable COPD patients (10.8) and lowest in healthy subjects (3.6).

CONCLUSION

Acute chlamydia pneumoniae infection is a rather frequent event in acute exacerbation of COPD, and chronic chlamydia pneumoniae infection may be involved in pathogenesis of COPD.

[Profile of telomerase and telomerase RNA expression in nasopharyngeal carcinogenesis of rats induced by N, N'dinitrosopiperazine (DNP)]

OBJECTIVE

To investigate the profile of telomerase and telomerase RNA expression in nasopharyngeal carcinogenesis (NPC) induced by N, N'dinitrosopiperazine (DNP) and examined histolofically.

METHODS

Nasopharyngeal carcinomas of rats were induced by DNP and examined histologically. PCR-ELISA and nested RT-PCR were used to assay telomerase and telomerase RNA expression at different stages in the nasopharyngeal tissues of rats.

RESULTS

During the carcinogenesis process, telomerase activity increased along with the formation of a nasopharyngeal carcinoma. Telomerase expression was positively related with nasopharyngeal carcinogenesis. Telomerase RNA expression was present and did not change during the NPC process. Expression of telomease RNA was earlier than telomerase activation. Telomerase activation and telomerase RNA expressin were also detected in the pre-cancerous nasopharyngeal lesions.

CONCLUSION

Telomerase activation may participate in the onset and progression of NPC, and is an early step in NPC.

Cloning and characterization of a potential transcriptional activator of human gamma-globin genes

Hybrids produced by fusing human fetal erythroblasts (HFE) with mouse erythroleukemia (MEL) cells initially produce predominantly or exclusively human gamma-globin and switch to human beta globin expression as time in culture advances. One explanation for the initially predominant expression of gamma-globin gene in these hybrids is the presence of trans-acting factors that activate gamma-globin gene transcription. We used differential display of hybrids before and after the gamma to beta switch as well as fetal liver and adult erythroblasts to identify cDNAs that could be candidates for potential gamma gene activators. Identically sized amplicons which were present in fetal liver erythroblasts and in the hybrids expressing only gamma-globin but were absent in the adult erythroblasts and in the same hybrids after they had switched to beta globin expression were cloned and sequenced. Fifty pairs of cDNAs fitting these criteria were chosen for further analysis. The sequences of the two members of 48 pairs differed from each other, revealing the low efficiency of this experimental approach. One clone pair coded for human proteosome subunit X. The second pair coded for a protein containing an acidic domain in the N-terminus and three consecutive CDC10/SW16/ankyrin repeats in the C-terminus. Transactivation assays in the yeast hybrid system and transient transfection assays in COS cells showed that a potent trans-activating domain resides in the N-terminus of this protein. Northern blot and RT-PCR assays showed that this gene is expressed in several fetal tissues but not in adult tissues. Stable transfection assays provided evidence that the product of this gene may increase the level of gamma mRNA in HFE x MEL cell hybrids that undergo the gamma to beta switch, suggesting that this new gene encodes a protein that may function as gamma gene activator.

TRAG-3, a novel cancer/testis antigen, is overexpressed in the majority of melanoma cell lines and malignant melanoma

BACKGROUND

We have identified a novel cancer/testis antigen, TRAG-3, (Taxol Resistance Associated Gene-3) that was initially discovered in search for new genes involved in drug resistance by differential display. Early study of TRAG-3 revealed minimal to absent expression in various normal tissues and over-expression in many carcinoma cell lines including several melanoma lines.

MATERIALS AND METHODS

Northern and RT-PCR technologies were used to evaluate TRAG-3 expression in numerous cell lines and tumor tissue.

RESULTS

Analysis of a wider panel of normal tissues, 32 melanoma cell lines and 4 malignant melanomas demonstrates TRAG-3 expression in 25 of the 32 melanoma cell lines (78%) and four of four of the malignant melanoma tumors (100%). Of the additional eight normal tissues screened, expression was present in normal testis but absent in all other tissues. RT-PCR evaluation of TRAG-3 reveals two transcripts in many carcinoma cell lines with sequencing of these products demonstrating the 799 bp TRAG-3 transcript and a second alternatively spliced transcript, TRAG-3long TRAG-3 maps to band Xq28 within a MAGE gene complex, however sequence analysis demonstrates that TRAG-3 is not homologous to other known cancer/testis antigens.

CONCLUSION

TRAG-3 appears to be a novel cancer/testis antigen.

[Time course of TGF beta 1 and VEGF expression in experimental vein grafts]

OBJECTIVE

To investigate time course of TGF beta(1) and VEGF expression and their role in intimal hyperplasia.

METHODS

In situ hybridization and immunohistochemical technique were used to detect the time course of intimal hyperplasia, time course of TGF beta(1) mRNA and protein expression of TGF beta(1) and VEGF.

RESULTS

After autogenous vein replacement, the obvious neointima was seen at 2 weeks, and peaked at 8 weeks. The expression of TGF beta(1) mRNA peaked at 1 week and decreased gradually, but at 10 weeks, its positive cell percentage was still 10.1%. Both protein expression of TGF beta(1) and VEGF in VSMCs increased from 24 hours after grafting and peaked at 2 weeks. Their positive cell percentages were 40.6% and 36.6% respectively. After 4 weeks, their expression decreased at 8 weeks, the positive cell percentages were 8.9% and 13.8% respectively.

CONCLUSIONS

TGF beta(1) plays an important part in ECM accumulation by promoting ECM synthesis and decreasing ECM degradation. VEGF plays the key role in reendothelialization. They may affect each other and cooperated in the formation of intimal hyperplasia.

[Summary of 42 patients with acute aortic occlusion]

OBJECTIVE

To summarize the experience of diagnosis and treatment in 42 patients with acute aortic occlusion.

METHODS

Clinic data were analyzed. The emergency surgery of retrograde catheter thrombolectomy of transaortic thromboembolism were done, and the propathy and complications were treated simultaneously.

RESULTS

Normal blood flow were restored just after operation. Four patients died of myonephropathic metabolic syndrome and heart failure. 38 patients were followed up for 0.5 to 4 years. Among them, 36 were followed for more than 1 year. A better effectiveness was achieved in 28 patients. Two patients died of recurrence accompanied with heart failure.

CONCLUSION

Early diagnosis and treatment may increase the curative ratio and decrease the mortality in patients with acute aortic occlusion.

A logic for biological systems

This paper proposes a specification language, hybrid projection temporal logic of modelling, analyzing and verifying biological systems which can be considered, in general, to be hybrid systems consisting of a non-trivial mixture of discrete and continuous components. The syntax and semantics of the logic are presented, and some examples of hybrid systems are modelled to illustrate the formalism.

Observation of Coriolis Coupling between nu(2) + 4nu(4) and 7nu(4) in Acetylene &Xtilde;(1)Sigma(+)(g) by Stimulated Emission Pumping Spectroscopy

Stimulated emission pumping (SEP) spectroscopy has been used to examine a low energy region (E(vib) approximately 4400 cm(-1)) of &Xtilde;(1)Sigma(+)(g) acetylene at higher resolution than was possible in previous dispersed fluorescence studies. The expected bright state, nu(2) + 4nu(4), is observed to be coupled to the nearly degenerate 7nu(4) state by a Coriolis mechanism. A least-squares analysis yields values for zero-order vibrational energies, rotational constants, and a Coriolis-coupling coefficient that are all consistent with expectations. Calculated relative intensities of SEP transitions, accounting for interference due to axis-switching effects, are also consistent with observations. Implications of the observed Coriolis resonance with regard to global acetylene vibrational dynamics are also discussed. Copyright 2000 Academic Press.

Cytokines IL-1beta, IL-2, IL-6, IL-8, MCP-1, GM-CSF and TNFalpha in patients with epithelial ovarian cancer and their relationship to treatment with paclitaxel

In vitro work suggests that cytokines may be important modulators of the cytotoxic effects of paclitaxel and subsequent drug resistance. This has been investigated in vivo in patients with ovarian cancer by ELISA. There was consistently elevated expression of IL-6 and IL-8 but not MCP-1, IL-1beta, IL-2, GM-CSF or TNFalpha. Peritoneal fluid concentrations of IL-6, IL-8 and MCP-1 were two to three logs greater than serum concentrations. Elevated concentrations of IL-6 correlated with a poor final outcome (P = 0.039), and increased IL-6 and IL-8 correlated with a poor initial response to chemotherapy (P = 0.041 and P = 0.041, respectively). There was a relatively clear pattern of change in all three cytokines. In serum, IL-6, IL-8 and MCP-1 decreased with the administration of steroids prior to paclitaxel, and increased in the 24 h after paclitaxel. Postoperative drainage fluid was relatively acellular, preventing flow-cytometric analysis of epithelial cells for apoptosis, but suggested activation of T cells by paclitaxel. IL-6 and IL-8 appear to be of prognostic importance in epithelial ovarian cancer. Treatment with paclitaxel is associated with an increase in expression of a limited number of cytokines in patients with ovarian cancer, notably IL-6, IL-8 and MCP-1.

Discovery of differentially expressed genes associated with paclitaxel resistance using cDNA array technology: analysis of interleukin (IL) 6, IL-8, and monocyte chemotactic protein 1 in the paclitaxel-resistant phenotype

In an attempt to define the molecular changes associated with the paclitaxel-resistant phenotype in human cancer, a paclitaxel-resistant ovarian cancer cell line, SKOV-3TR, was established through stepwise selection in increasing paclitaxel concentrations. SKOV-3TR was cross- resistant to doxorubicin and vincristine and overexpressed multidrug resistance gene 1 but not multidrug resistance associated protein. SKOV-3TR and the paclitaxel-sensitive SKOV-3 parent line were characterized using human cDNA array technology that examined expression of a wide variety of genes involved in cell growth, signal transduction, cell death, and immune function. cDNA probes from reverse transcribed mRNAs of both paclitaxel-resistant and parent cells were compared to identify genes differentially expressed in the paclitaxel-resistant cells. Of 588 different human cDNA transcripts compared, 6 genes were found to be markedly decreased, and 12 genes increased in the resistant subline. Northern analysis and/or reverse transcription-PCR confirmed that 12 of these 18 genes were over- or underexpressed in SKOV-3TR. In addition, at least eight of the genes were found differentially expressed in several other paclitaxel- and/or doxorubicin-resistant cell lines, both those with increased multidrug resistance expression and those without. Included in the set of overexpressed genes were the cytokines/chemokines interleukin 6, interleukin 8, and monocyte chemotactic protein 1. ELISA assays confirm that mRNA overexpression of these cytokine/chemokines was associated with the increased secretion of these molecules in the tissue culture supernatant. Evaluation of supernatants from an expanded collection of paclitaxel- and Adriamycin-resistant cell lines demonstrated that all of the resistant lines had significant overexpression of at least one cytokine/chemokine as compared with their drug-sensitive parent line. The overexpression of these cytokines seemed to be stable and associated with a drug-resistant phenotype with only a modest induction of cytokine expression in the parent line with short-term paclitaxel exposure. These findings suggest that the development of paclitaxel resistance is accompanied by multiple changes in gene expression including stable alterations in selective chemokine and cytokine expression. The role these associated genetic changes have in the drug-resistant phenotype is discussed.

Structural analysis and mapping of DNase I hypersensitivity of HS5 of the beta-globin locus control region

The beta-globin locus control region (LCR) is a cis regulatory element that is located in the 5' part of the locus and confers high-level erythroid lineage-specific and position-independent expression of the globin genes. The LCR is composed of five DNase I hypersensitive sites (HSs), four of which are formed in erythroid cells. The function of the 5'-most site, HS5, remains unknown. To gain insights into its function, mouse HS5 was cloned and sequenced. Comparison of the HS5 sequences of mouse, human, and galago revealed two extensively conserved regions, designated HS5A and HS5B. DNase I hypersensitivity mapping revealed that two hypersensitive sites are located within the HS5A region (designated HS5A(major) and HS5A(minor)), and two are located within the HS5B region (HS5B(major), HS5B(minor)). The positions of each of these HSs colocalize with either GATA-1 or Ap1/NF-E2 motifs, suggesting that these protein binding sites are implicated in the formation of HS5. Gel retardation assays indicated that the Ap1/NF-E2 motifs identified in murine HS5A and HS5B interact with NF-E2 or similar proteins. Studies of primary murine cells showed that HS5 is formed in all hemopoietic tissues tested (fetal liver, adult thymus, and spleen), indicating that this HS is not erythroid lineage specific. HS5 was detected in murine brain but not in murine kidney or adult liver, suggesting that this site is not ubiquitous. The presence of GATA-1 and NF-E2 motifs (which are common features of the DNase I hypersensitive sites of the LCR) suggests that the HS5 is organized in a manner similar to that of the other HSs. Taken together, our results suggest that HS5 is an inherent component of the beta-globin locus control region.

Structure-based ligand design by dynamically assembling molecular building blocks at binding site

A structure-based ligand design method is proposed and tested. The method is based on stochastic dynamics simulation of multiple copies of molecular building blocks in the presence of a receptor molecule. The molecular building blocks are assembled into candidate compounds "on the fly" at given intervals during the simulation. In the algorithm, a special effort is made to explore different possible combinations of building blocks and to select an optimum combination. By repeating the cycle of deconstruction and reconstruction in a single simulation, a set of candidate compounds that can be built from the building blocks evolves and is dynamically optimized. The method was tested by breaking two known flexible human immunodeficiency virus type 1 protease inhibitors into building blocks and reassembling them in the active site of the enzyme. For the inhibitor L700417, a set of conformations was generated by the calculation. Among these, the original compound was recovered with the lowest energy at the experimentally observed binding site and in the correct conformation. For pepstatin, the experimentally observed binding mode of the backbone of the inhibitor was reproduced by a calculation in which the building blocks corresponding to the side-chain groups were omitted. Proteins 1999;36:462-470.

TRAG-3, a novel gene, isolated from a taxol-resistant ovarian carcinoma cell line

The mechanisms responsible for the development of the taxol resistance phenotype are unclear, and are likely explained by multiple mechanisms. To understand the molecular changes associated with drug resistance more fully, a taxol-resistant subline, derived from the human ovarian cancer cell line SKOV-3, was established through selection by culture in incrementally increasing taxol concentrations. Comparison of SKOV-3 to SKOV-3TR by differential display identifies a new gene, TRAG-3 (Taxol Resistance Associated Gene- 3). In comparison to the parental line, SKOV-3, TRAG-3 mRNA is overexpressed in the taxol-resistant cell line SKOV-3TR. The nucleotide sequence of the TRAG-3 cDNA contains an open reading frame of 333bp that predicts for a protein product of 110 amino acids. A GenBank search identifies a cosmid clone containing a genomic sequence corresponding to that of TRAG-3. DNA and protein analysis reveals that TRAG-3 has no homology to any known cDNAs or proteins. Northern analysis demonstrates that TRAG-3 is overexpressed in the taxol-resistant breast cancer cell line MDA 435TR as well as the doxorubicin-resistant multiple myeloma cell lines 8226/DOX40 and 8226/MDR10V. A survey of normal tissue shows minimal or absent TRAG-3 mRNA expression. Screening of a wide variety of cancer cell lines demonstrates TRAG-3 expression in many cell lines derived from different tissue types. In summary, TRAG-3 is a novel gene whose expression is associated with the chemotherapy-resistant and neoplastic phenotype.

[Effects of inflammatory infiltration on the formation of abdominal aortic aneurysm]

OBJECTIVE

To explore inflammatory infiltration and its effects on the formation of abdominal aortic aneurysm (AAA).

METHODS

Immunohistochemical technique was used to detect lymphocyte (CD45 positive) and macrophage (CD68 positive) infiltration while in situ hybridization was applied to investigate the mRNA expression of Matrix Metalloproteinase-9 (MMP-9) in 20 cases of human AAA and 4 cases of normal human abdominal aortas.

RESULTS

Inflammatory infiltration occurred in every case of AAA with various degree, and there was a parallel tendency between the degree of injury of abdominal aortic elastin and that of inflammatory infiltration in AAA. Inflammatory infiltration was not found in normal aortas. MMP-9 mRNA was detected in macrophages and lymphocytes in all 20 cases, in smooth muscle cells in 13, and not in normal abdominal aortas.

CONCLUSIONS

Inflammatory infiltration attended and enhanced the formation of AAA through a complex of sequence of biochemical, cellular and immune events.

[Relationship between PDGF-A, bFGF and proliferation of smooth muscle cells in vein grafts]

OBJECTIVE

To detect the relationship between platelet-derived growth factor-A (PDGF-A), basic fibroblast growth factor (bFGF), and proliferation of smooth muscle cells in vein grafts.

METHODS

An animal model of autogenous vein graft was established by transplanting internal branch of the jugular vein to the common iliac artery by end-to-end anastomosis. 25 rats were used. The grafted veins were harvested at 6 h, 2 d, 1 w, 2 w and 4 w respectively after the operation. The expression of PDGF-A and bFGF in different stages after grafting procedure was observed immunohistochemically.

RESULTS

The expression of PDGF-A peaked at 1 w, paralleled with proliferation of SMC, and was significantly higher than that at 6 h (P < 0.01). The expression of PDGF-A diminished gradually. At 4 w, it was significantly lower than that at 1 w (P < 0.01). bFGF demonstrated bimodal pattern of the expression: the first peak of expression occurred by 2 d and the second peak by 2 w. The difference was significantly compared with other stages.

CONCLUSIONS

The expression of PDGF-A 1 contributed to migration and proliferation of SMC. Except for contributing to proliferation of SMC, bFGF perhaps took part in endothelization.

[The relation-ship between apoptosis, apoptosis related-gene expression and proliferative activity in smooth muscle cell after autogenous vein grafting]

OBJECTIVE

To study the mechanism of graft vein stenosis.

METHODS

A rat experimental model of autogenous vein graft was established by transplanting the right external jungular vein into the infrarenal abdominal aorta in 100 Wister rats. Electric microscope, TUNEL and immunohistochemical S-P technique were used to detect the apoptosis, the expression of apoptosis related-gene bcl-2 and bax and proliferation cell nuclear antigen (PCNA) of smooth muscle cells(SMCs) in vein graft.

RESULTS

From 1 to 8 weeks after replacement, the expression of apoptosis and PCNA of SMCs was continuously higher than the control group (P < 0.01). From 1 to 2 weeks, the expression of TUNEL and PCNA showed peak value. From 1 to 2 weeks, the positive rate of apoptosis was lower than that of PCNA, but from 4 to 8 weeks, the positive rate of TUNEL was higher than that of PCNA. There was obvious positive correlation between the expression of TUNEL and PCNA (r = 0.813 P < 0.05). One to 2 weeks after vein grafting, bcl-2 positive rate increased and was more different than the control group and the group of 4 to 8 weeks after vein grafting (P < 0.010).

CONCLUSIONS

The imbalance of proliferation and apoptosis may be related to the vessel remodeling and vein graft stenosis, and bcl-2 and bax protein may involve in the regulation of apoptosis of VSMC. Adopting the mixed strategy to regulate the balance between proliferation and apoptosis may be useful to prevent vein graft stenosis.

[Reconstruction of esophagus by microsurgical technique in forty-five cases]

Reconstruction and repair of atresia or defect of the upper portion of esophagus is difficult. From November 1980 to December 1997, forth-five cases, consisting 35 males and 10 females, were treated with microsurgical technique. The 45 patients fell into the following groups as esophageal atresia of various causes in 21 cases, anastomotic fistula or stenosis following reconstruction of esophagus in 7 cases and late carcinoma of esophagus in 17 cases. The types of reconstruction consisted of transfer of free jejunum with its lower portion carrying a vascular pedicle in 24 cases, free transfer of jejunal graft in 15 cases, free vascularized jejunal graft in 2 cases and free vascularized tubular skin graft in 4 cases. After a follow-up of 6-19 months besides eight cases died from late esophageal carcinoma, thirty-seven cases were survived and could take food by mouth. All of the benign cases could return to work. In patients having late esophageal carcinoma, the operative procedure could improve the life quality and facilitate chemotherapy and radiotherapy.

[Management of true extremity aneurysms: experience in 23 patients]

OBJECTIVE

To explore the etiologic feature and specificity of diagnosis and treatment in true aneurysms of the extremities.

METHOD

23 patients with true aneurysms of the extremities from January 1984 to September 1997 were retrospectively reviewed.

RESULT

Of 30 true aneurysms of the extremities, multiple aneurysms were found in 7 patients (30.4%). The multiple aneurysms were diagnosed in the same time or in different time. 21 patients were treated by exclusion of aneurysm and replacement with autogenous saphenous vein or graft.

CONCLUSION

Early diagnosis and treatment are recommended to prevent complications which can cause limb loss, and multiple aneurysms must be taken into account. Importance of arteriography should be stressed in the diagnosis of multiple aneurysms. Exclusion of aneurysm and autogenous saphenous vein reconstruction is the first choice of treatment, circulation of the operated extremities should be noticed and close follow-up is imperative to pay attention to the development of new aneurysms.

[Surgical treatment of extracranial carotid artery aneurysm]

OBJECTIVE

To study the experience in the treatment of extracranial carotid aneurysm.

METHODS

67 cases of extracranial carotid artery aneurysm(ECAA) were treated surgically from January 1986 to June 1997.

RESULTS

There were a mortality rate of 1.5% and a hemiparalysis rate of 4.5%.

CONCLUSION

Clinical examinations are important for diagnosis of ECAA. Angiography plays a significant role in understanding the morphology, function, pathophysiology of ECAA. To decrease postoperative cerebral ischemia, collateral circulation of cerebral vessels should be evaluated and matas test done. Correct operative method is a key factor for successfull treatment.

[Ultrasonic angiography in therapeutic decision-making in peripheral occlusive vascular diseases]

OBJECTIVE

To study quickscan (QS) in different therapeutic decision-making in 55 patients with peripheral occlusive vascular diseases.

METHODS

Based on QS results, 30 patients were treated conservatively. The disease progress and therapeutic effects were assessed by QS in every three months. Percutaneous transluminal angioplasty was performed successfully in 5 patients without prior diagnostic angiography. 20 patients were scheduled for surgery. Operation of eleven patients was guided by information obtained from QS findings only, which was confirmed during operation. Angiography was necessary in 9 patients except one to formulate a therapeutic strategy.

RESULTS

The accuracy of QS was 92%(23/25).

CONCLUSION

QS is of value in deciding the access route of angiography and PTA, and can replace preoperative angiography, Quickscan is time-saving, inexpensive, objective and accurate. It can be used in therapeutic decision making in peripheral occlusive vascular diseases and bypass grafting.

The accuracy of color Doppler flow imaging for the detection of symptomatic deep venous thrombosis in Chinese patients

To evaluate the ability of color Doppler flow imaging (CDFI) to detect deep venous thrombosis (DVT), which is difficult to diagnose clinically, 67 limbs of 60 patients who presented with clinical signs strongly indicative of DVT during the period between June 1988 and June 1992, were examined. The iliac, common femoral, and superficial femoral veins were assessed with the patient in the supine position, and the popliteal vein was examined with the patient prone. Gentle but firm compression with the transducer probe was used to test for the presence of DVT. Ascending contrast venograms were also obtained within 24 h after the ultrasound procedure, with venography being used as the standard for comparison with CDFI. DVT was identified in 63 limbs by contrast venography and in 62 limbs by CDFI. The sensitivity and specificity of CDFI were 98.4% and 100%, respectively, while the positive and negative predictive values were 100% and 80%, respectively. The thromboses were classified into three patterns: the filling type, the local type, and mural thrombus, detected in 63%, 27%, and 10%, of the limbs respectively, with the filling type being the most common in this series. The results of our study illustrated that CDFI is highly sensitive and specific for detecting symptomatic DVT and that it should be gradually substituted for venography in such patients.

Experience in prevention of serious complications of laparoscopic cholecystectomy

OBJECTIVE

To study the causes and prevention of the complications of laparoscopic cholecystectomy (LC).

PATIENTS AND METHODS

Based on experience with 2 428 cases, the following should be paid attention to when dissecting and separating adhesions around the gallbladder and of the Calot's triangle. The best method for the prevention of mistaking the common bile duct (CBD) for the cystic duct is to find the junction of the cystic infundibulum and duct, separate the gallbladder wall along the infundibulum, and transect the cystic duct at the junction with the infundibulum. If dense adhesions around the gallbladder or of the Calot's triangle are met with, LC should be abandoned and open the cholecystectomy (OC) should be used instead. In separating the Calot's triangle, blunt dissection should be used to avoid burning the extrahepatic bile duct (EHBD), and blind hemostasis should be avoided. If the cystic artery lies in the upper part and the back of the cystic duct, the cystic duct should be dissected out, clipped and cut first, then the cystic artery be dealt with. If the cystic artery is in the front part of the pedicle of the gallbladder, the artery should be separated, clipped and cut first. Injury to the adjacent organs may be avoided by using electric coagulating hook correctly and avoiding accidental damage to the viscera, and keeping from viscera injury due to current chemotaxis in the closed cavity of the body.

RESULTS

A total of 2427 patients were cured. One patient died of frequent episodes of supraventricular tachycardia and pneumonia on the 21st day after LC.

CONCLUSION

If LC surgeons follow the above said principles of LC technique. LC is very safe for patients with benign diseases of the gallbladder.

[Ultrasonic angiography in diagnosis of peripheral vascular disease]

The ability of Quickscan (QS) was studied to assess haemodynamically significant lesions in the iliac and femoro-popliteal arteries. Quickscan was prospectively and independently compared to digital subtraction angiography (DSA) of the iliac and femoro-poplited arteries. In 155 patients, 631 arterial segments were evaluated. A QS frequency ratio of greater than 1:3 had a sensitivity of 93% and a specificity of 85% in detecting stenosis > 50% diameter (75% area) reduction in the iliac artery as shown on DSA. The sensitivity and specificity for stenosis in the femoral and popliteal arteries were 85%, 96%, 82%, 98% respectively. In the detection of occlusion, QS had a sensitivity of 84% and a specifity of 98% in the iliac artery; 94%, 97%, in the femoral; and 94%, 85% in the popliteal arteries respectively. There was a significant correlation between the area reduction found by QS and the calf/brachial pressure index (CBI) (r = -0.77 P < 0.01). 35 patients underwent successfully angioplasty based on QS findings. We conclude that quickscan can provide an inexpensive, quick and noninvasive screening technique for the routine initial assessment of peripheral vascular disease.

A two-year experience with laparoscopic cholecystectomy--a report of 1475 cases from Kunming, China

Over a 2-year period, from 12 September 1991 to 11 September 1993, laparoscopic cholecystectomy was performed on 1475 patients with benign gallbladder disease in Kunming General Hospital, Yunnan, China. Of these, 28 cases (1.9%) were converted to open surgery. Various complications were documented in 27 instances including extrahepatic bile duct injury in 4 cases (0.3%), postoperative haemorrhage requiring laparotomy in 3 cases (0.2%) and bile leak from cystic duct stump in 1 case (0.07%). There was 1 (0.07%) death in the series. The junction between the gallbladder infundibulum and the cystic duct is an important landmark which laparoscopic surgeons must identify in the course of the procedure. Because the junction remains a comparatively constant landmark, in difficult laparoscopic cholecystectomy, excessive dissection of the bile duct would be unnecessary. During dissection of the hepatic hilus, blund dissection is recommended and the blind use of cautery and haemostasis should be avoided.