先天性食管闭锁和气管食管瘘麻醉及围手术期管理

目的:探讨先天性食管闭锁和气管食管瘘(EA/TEF)的麻醉及围手术期管理方法.方法:回顾性分析40例手术治疗的新生儿EA/TEF的临床资料.总结麻醉及围手术期管理及转归情况.结果:40例麻醉过程较平稳顺利完成手术,3例术后拔管,37例继续呼吸支持.术后死亡7例,其中4例术后死亡,3例术后监护人放弃治疗出院后死亡.活33例中重症肺炎7例,低体温8例,吻合口瘘5例,切口感染2例,均经治疗后痊愈出院.结论:良好的麻醉及围术期管理是EA/TEF手术治疗的重要组成部分,是手术顺利进行及术后成功的关键.     

食管癌遗传易感基因的研究进展

食管癌的发生发展是多个基因参与改变的过程,本文对近年来研究热点的遗传易感基因p53基因、FHIT基因、p16基因、错配修复基因、PLCE1基因在食管癌发生发展过程中的作用作了简要阐述,以期为食管癌的早期诊断、预后评估及基因治疗寻找一条可行的途径。     

食管腺癌、Barrett 食管活检粘膜中TGF-β1 的表达

目的:研究食管腺癌、Barret食管(Barrett esophagus,BE)和正常食管粘膜中转化生长因子β1(transforming growth factor-betal,TGF-β1)的表达。方法:采用免疫组化方法检测35例食管腺癌患者、40例BE患者及30例健康对照组食管组织中TGF-β1的表达水平。结果:未在健康对照组食管粘膜中发现TGF-β1的表达,食管腺癌组TGF-β1的表达水平>BE组>健康对照组(P<0.05)。食管腺癌组中,TGF-β1在中-高分化腺癌及低分化腺癌患者食管粘膜中的表达无明显差异(Z=1.07,P>0.05)。结论:食管腺癌、BE食管粘膜中TGF-β1表达水平升高,在食管腺癌中的表达与细胞分化程度无关。     

The impact of confounders on the test performance of natriuretic peptides for cardiac dysfunction in subjects aged 80 and older

The hypothesis that natriuretic peptides could be used to identify ‘pancardiac’ damage has been proposed. However, multiple factors are known to influence circulating levels of natriuretic peptides, especially in the very old. Therefore, the impact of confounders on the association between natriuretic peptide levels and cardiac dysfunction was further explored in subjects aged 80 and older. A diagnostic cross-sectional study embedded within the BELFRAIL study (n = 567) was performed. Baseline BNP and NT-proBNP levels were measured and echocardiograms were performed at the subject's home. Cardiac dysfunction was defined as systolic dysfunction, valvular heart disease or isolated severe diastolic dysfunction. Several functional and structural echocardiographic parameters were independently related to circulating levels of natriuretic peptides. Cystatin C, BMI, β blockers, diabetes, heart frequency, usCRP, age and sex were identified as confounders. The prevalence of cardiac dysfunction was 17.1% in the subjects without and 30.8% in the subjects with chronic atrial fibrillation (CAF) or pacemaker (PM). Only in subjects with CAF or PM the C statistic for cardiac dysfunction improved after correcting for confounders. The post-test probability for a negative test (PTP−) ranged from 3.7% to 12.2% and the PTP+ ranged from 21.9% to 62.2% in different strata of confounders. According to these data adjusting for identified confounders does not improve the diagnostic accuracy of the natriuretic peptides for cardiac dysfunction, except in subjects with CAF or PM. Stratifying for individual confounders showed that different cut-off values could be used to optimize the diagnostic characteristics of natriuretic peptides.     

Cardiovascular response of rats exposed to 60-Hz electric fields

Recently, it has been reported that exposure to high-strength electric fields can influence electrocardiogram (ECG) patterns, heart rates, and blood pressures in various species of animals. Our studies were designed to evaluate these reported effects and to help clarify some of the disagreement present in the literature. Various cardiovascular variables were measured in Sprague-Dawley rats exposed or sham-exposed to 60-Hz electric fields at 80 or 100 kV/m for periods up to four months. No significant differences in heart rates, ECG patterns, blood pressures, or vascular reactivity were observed between exposed and sham-exposed rats after 8 hours, 40 hours, 1 month, or 4 months of exposure. Blood pressure and heart rate measurements, made during exposure to a 100-kV/m electric field for one hour, revealed no significant differences between exposed and sham-exposed groups. In addition, physiologic reserve capacity, measured in rats subjected to low temperature after exposure to 100 kV/m for one month, showed that electric-field exposure had no significant effect on physiological response to cold stress. Our studies cannot be directly compared to the work of other investigators because of differences in animal species and electric-field characteristics. However, our failure to detect any cardiovascular changes may have been the result of 1) eliminating secondary field effects such as shocks, audible noise, corona, and ozone; 2) minimizing steady-state microcurrents between the mouth of the animal and watering devices; and 3) minimizing electric-field-induced vibration of the electrodes and animal cages.     

Multiple polymorphisms within the PLCE1 are associated with esophageal cancer via promoting the gene expression in a Chinese Kazakh population

Although recent genome-wide association studies of esophageal squamous cell carcinoma (ESCC) identified a susceptibility locus in phospholipase C epsilon 1 (PLCE1) in Chinese Han populations, few studies further confirmed these findings in pure Kazakh population in which there are higher incidence and mortality of ESCC. Here, we investigated the potential associations between 19 SNPs of PLCE1 and susceptibility to ESCC in 222 cases and 326 controls from a pure ethnic population of Kazakh. Real-time PCR and immunohistochemistry were performed to detect the PLCE1 expression levels and evaluate their association with PLCE1 polymorphism. We found that only 4 SNPs (rs753724, rs11187842, rs2274223, and rs12263737) with moderate linkage disequilibrium (LD) confer significantly increased risk of ESCC, with the ORs ranging from 1.43 to 2.04, and there was a risk allele dose-dependent increase in ESCC risk (P-trend = 0.043). Especially, the risk effects of rs2274223 were more evident in poor differentiation and advanced clinical stages of Kazakh ESCC. Additionally, the significantly lowest PLCE1 mRNA expression was found in the KYSE-150 cell line having no risk alleles compared with other three cell lines having risk alleles, and the normal tissues of both homozygous mutant type of PLCE1 rs12263737 and rs2274223 had a higher PLCE1 staining score than that of homozygous wild type. Our findings suggested that genetic variants in PLCE1 might serve as candidate markers for Kazakh ESCC susceptibility, and these LD variants might influence ESCC risk individually and jointly by promoting the messenger RNA and protein expression of the gene.     

β-tubulinIII在食管癌中的表达及在个体化化疗方案中的作用

目的：探讨β—tubulinIII在食管癌组织中的表达,分析其与食管癌生物学行为的关系,及根据其表达结果制定个体化化疗方案的疗效。方法：应用免疫组化（SP）法检测β-tubulinIII在55例食管癌组织中的阳性表达,采用X^2检验方法分析其阳性表达与肿瘤临床病理学特征之间的关系。依据低表达（阴性）对紫杉类抗微管药物相对敏感,选用紫杉醇联合顺铂方案;高表达（阳性）相对不敏感的原则,选择吉西他滨联合顺铂方案。对照组选用紫杉醇联合顺铂化疗方案。比较两组客观缓解率（ORR）及疾病控制率（DCR）的差异,及无进展生存时间（PFS）和中位生存期（MST）的差异。结果：B—tubulinIII在55例食管癌组织中阳性表达为16例（29．09％）,在肿瘤组织中的表达与食管癌的浸润深度、淋巴结转移及肿瘤分期相关（P〈0．05）,而与年龄、性别、组织学分化程度无关（P〉0．05）。实验组ORR为54．55％（30／55）优于对照组32．50％（13／40）,x^2=-4．543,P=0．033;DCR为69．09％（38／55）优于对照组47．50％（19／40）,xZ=-4．498,P=0．034。差异有统计学意义。实验组与对照组的PFS分别为5．2月和4．5月（x^2=4．215,P=0．040）,MST分别为8．9月和7．4月（x^2=6．146,P=0．013）,差异有统计学意义。结论：食管癌细胞存在β-mbulin III的表达,且与肿瘤细胞的浸润深度、淋巴结转移及临床分期相关。检肿瘤标本中13-tubulinⅢ表达,有助于为实施个体化化疗提供一种选择药物的方法。     

Cardiac channelopathies: Genetic and molecular mechanisms

Channelopathies are diseases caused by dysfunctional ion channels, due to either genetic or acquired pathological factors. Inherited cardiac arrhythmic syndromes are among the most studied human disorders involving ion channels. Since seminal observations made in 1995, thousands of mutations have been found in many of the different genes that code for cardiac ion channel subunits and proteins that regulate the cardiac ion channels. The main phenotypes observed in patients carrying these mutations are congenital long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), short QT syndrome (SQTS) and variable types of conduction defects (CD). The goal of this review is to present an update of the main genetic and molecular mechanisms, as well as the associated phenotypes of cardiac channelopathies as of 2012.     

CYFRA21-1 and CEA are useful markers for predicting the sensitivity to chemoradiotherapy of esophageal squamous cell carcinoma

Background: Chemoradiotherapy (CRT) is currently performed for patients with advanced esophageal carcinoma. Sensitivity of tumours to CRT differs from one case to another and may be influenced by the expression of biological molecules. The aim of this study was to identify biological markers which could predict sensitivities of esophageal squamous cell carcinoma (ESCC) to CRT.

Methods: A total of 84 patients with stage I–IV ESCC were evaluated. The cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) and carcinoembryonic antigen (CEA) levels were measured before CRT by enzyme-linked immunosorbent assays in patients with primary ESCCs using 3.4?ng ml^?1 and 3.3?ng ml^?1, respectively, as cut-off values. The relationships between pretreatment expression of CYFRA 21-1 and CEA and the effectiveness of CRT were analysed.

Results: The complete response (CR) rates of the primary tumours estimated by computed tomography in patients with high levels of CYFRA21-1 and CEA were 10% (3/30) and 4.2% (1/24), while in cases with low CYFRA21-1 and CEA the CR rates were 50% (27/54) and 48.3% (29/60), respectively (p?=?0.002 and 0.003). The effective rates (CR+PR) in CYFRA21-1 high and low groups were 60% (18/30) and 96.3% (52/54), while in CEA high and low groups they were 58.3% (14/24) and 93.3% (56/60), respectively (p?=?0.013 and 0.013).

Conclusion: CYFRA21-1 and CEA may be helpful in predicting the responsiveness in ESCC of primary lesions to CRT, although the results should be confirmed in larger, more homogeneous studies.     

Differential expression of miR-195 in esophageal squamous cell carcinoma and miR-195 expression inhibits tumor cell proliferation and invasion by targeting of Cdc42

MicroRNAs (miRNA) have played an important role in carcinogenesis. In this study, Agilent miRNA microarray was used to identify differentially expressed miRNAs in esophageal squamous cell carcinoma (ESCC) tissues and miR-195 was downregulated in ESCC compared with normal esophageal tissues. Moreover, Cdc42 was confirmed as target gene of miR-195. Ectopic expression of miR-195 in ESCC cells significantly downregulated Cdc42 by directly binding its 3′ untranslated regions, and induced G1 cell cycle arrest, leading to a significant decrease in cell growth, migration, and invasion in vitro. Therefore, our findings demonstrated that miR-195 may act as a tumor suppressor in ESCC by targeting Cdc42.