Key factors for causing poplar Ice Nucleation Active bacterial canker and its control techniques

The isolation, culture and the active determination of poplar ice nucleation active (INA) bacteria and the inoculation tests in laboratory and field were conducted, and the varieties, distribution and number of poplar INA bacteria and its pathoge-nicity and freezing injury property were determined. The study results showed that the INA bacteria widely spread on poplar in Northeast China and caused the frozen injury for poplar under the frost condition in Spring or Autumn, which was the key factor to induce INA bacterial canker. Through evaluation and investigation of different poplar varieties and inoculation tests, fine dis-ease-resistant varieties and strains of poplar suitable for Northeast China were selected. Further tests for strong seedling showed that burying cuttings in sand and covering with plastic film could effectively avoid the frostbite, frozen and drought damage, reduce INA bacteria infection, and promote poplar growth. INA bacterial canker was detected early by highly special-ized antiserums of INA bacteria and the agglutinated test of ring-shaped boundary surface. The inducers such as streptomycin, phenylmercuric acetae, salicylic acid and heat-killed bacteria to immerse cuttings, have obvious induced disease-resistant effect. Before poplar sprouted in early spring, through spraying the solution of frostbite agent, the control effect also was obvious.

Hepatitis B virus taxonomy and hepatitis B virus genotypes

Hepatitis B virus(HBV) is a member of the hepadnavirus family.Hepadnaviruses can be found in both mammals(orthohepadnaviruses) and birds(avihepadnaviruses).The genetic variability of HBV is very high.There are eight genotypes of HBV and three clades of HBV isolates from apes that appear to be additional genotypes of HBV.Most genotypes are now divided into subgenotypes with distinct virological and epidemiological properties.In addition,recombination among HBV genotypes increases the variability of HBV.This review summarises current knowledge of the epidemiology of genetic variability in hepadnaviruses and,due to rapid progress in the field,updates several recent reviews on HBV genotypes and subgenotypes.

Gene therapy for gastric cancer:Is it promising?

Gastric cancer is one of the most common tumors worldwide. The therapeutic outcome of conventional therapies is inefficient. Thus, new therapeutic strategies are urgently needed. Gene therapy is a promising molecular alternative in the treatment of gastric cancer, including the replacement of defective tumor suppressor genes, the inactivation of oncogenes, the introduction of suicide genes, genetic immunotherapy, anti-angiogenetic gene therapy, and virotherapy. Improved molecular biological techniques and a better understanding of gastric carcinogenesis have allowed us to validate a variety of genes as molecular targets for gene therapy. This review provides an update of the new developments in cancer gene therapy, new principles, techniques, strategies and vector systems, and shows how they may be applied in the treatment of gastric cancer.

Esophageal rupture due to Sengstaken-Blakemore tube misplacement

The author presents three cases of esophageal rupture during the treatment of massive esophageal variceal bleeding with Sengstaken-Blakemore (SB) tube. In each case, simple auscultation was used to guide SB tube insertion, with chest radiograph obtained only after complete inflation of the gastric balloon. Two patients died of hemorrhagic shock and one died of mediastinitis.The author suggests that confirmation of SB tube placement by auscultation alone may not be adequate.Routine chest radiographs should be obtained before and after full inflation of the gastric balloon to confirm tube position and to detect tube dislocation.

Therapy of cancer by cytokines mediated by gene therapy approach

Gene therapy offers a new approach for treatment of cancer. Transfer of genes encoding immunostimulatory cytokines has been used with remarkable success to eliminate cancer in animals. However, clinical trials in patients with this strategy had limited efficacy. Therefore, improvement ofgene transfer vector system is necessary. A hybrid viral vector, consisting of SFV replicon with either murine IL-12 or reporter LacZ gene, was constructed. This hybrid vector showed specificity and high level of expression in HCC both in vitro and in vivo. In a rat orthotropic liver tumor model, treatment of established tumors by the hybrid vector with raiL- 12 gene resulted in a strong anti-tumor activity without accompanying toxicity. Subsequently, a helper-dependent adenovirus vectors containing a mifepristone （RU486） inducible system was constructed for controlled and liver-specific expression of human interleukin 12 （hIL- 12） （HD-Ad/RUhIL- 12） and mouse IL-12 （mIL-12） （HD-Ad/RUmIL-12）. Data showed that high and sustained serum levels of hlL-12 could be attained by continuing administration of RU486 every 12 or 24 h. Repetitive induction ofhlL-12 could be obtained over, at least, a period of 48 weeks after a single injection of HD-Ad/RUhlL-12. Treatment of liver metastases with of HD-Ad/RUmIL- 12 plus RU846 resulted in complete tumor regression in all animals. Then, different cytokine genes were inserted into conditional replicative adenoviruses vectors （also called oncolytic adenovirus）. Replication ofadenovirus in tumor cells would kill tumor cells and release viruses, which infect surrounding tumor cells. The combination of cytopathic effect by oncolytic adenovirus and biological effect of transgene would exert strong antitumor activity. These new types of vectors may provide a potent and safe tool for cancer gene therapy.

Superior mesenteric artery syndrome following scoliosis surgery: Its risk indicators and treatment strategy

AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patients with adolescent scoliosis who had undergone surgical treatment were evaluated prospectively, and among them seven patients suffered from SMAS after operation. Each patient was assigned a percentile for weight and a percentile for height. Values of the 5th、 10th、 25th、 50th、 75th、 and 95thpercentiles were selected to divide the observations. The sagittal Cobb angle was used to quantify thoracic or thoracolumbar kyphosis. All the seven patients presented with nausea and intermittent vomiting about 5 d after operation.An upper gastrointestinal barium contrast study showed a straight-line cutoff at the third portion of the duodenum representing extrinsic compression by the superior mesenteric artery (SMA).RESULTS: The value of height in the seven patients with SMAS was above the mean of sex- and age-matchednormal population, and the height percentile ranged from 5% to 50%. On the contrary, the value of weight was below the mean of normal population with the weight percentile ranging from 5% to 25%. Among the seven patients, four had a thoracic hyperkyphosis ranging from 55° to 88°(average 72°), two had a thoracolumbar kyphosis of 25° and 32° respectively. The seven patients were treated with fasting, antiemetic medication, and intravenous fluids infusion. Reduction or suspense of traction was adopted in three patients with SMAS during halo-femoral traction after anterior release of scoliosis. All the patients recovered completely with no sequelae. No one required operative intervention with a laparotomy.CONCLUSION: Height percentile＜50% , weight percentile ＜25%, sagittal kyphosis, heavy and quick halo-femoral traction after spinal anterior release are the potential risk indicators for SMAS in patients undergoing correction surgery for adolescent scoliosis.

Antiviral treatment of hepatitis B virus-transgenic mice by a marine organism, Styela plicata

AIM： To evaluate the antiviral effect of the effective ingredient of Styela plicata in a murine model of hepatitis B virus carrier. METHODS： HBV-transgenic mice were divided into 3 groups （control group, lamivudine treatment group and the effective ingredient of Styela plicata treatment group） and assigned to receive normal diet, lamivudine or the effective ingredient of Styela plicata for consecutive weeks. Serum hepatitis B surface antigen was detected by enzyme-linked immunosorbent assay （ELISA） method. Serum HBV DNA was detected by real-time polymerase chain reaction （RT-PCR）. Serum T helper （h） 1 cytokine interleukin （IL）-2 and Th2 cytokine IL-6 were detected by the quantitative sandwich enzyme immunoassay technique. Another group of HBV-transgenic mice was assigned to receive the effective ingredient of Styela plicata for consecutive weeks. The histology of liver tissue was evaluated before and after treatment. RESULTS： Twelve weeks after starting the therapy, serum hepatitis B surface antigen was significantly lowered in Styela plicata -treated mice and lamivudine-treated mice compared with the mice receiving normal diet （F12wk = 88.81, P12wk = 0.000 〈 0.01）. Serum HBV DNA was significantly lowered in Styela plicata -treated mice and lamivudine-treated mice compared with the mice receiving normal diet （F12wk = 20.71, P12wk = 0.000 〈 0.01）. However, like lamivudine, the effective ingredient of Styela plicata could not inhibit the replication of HBV completely. A rebound phenomenon of hepatitis B surface antigen and HBV DNA in sera could be found 4 wk after withdrawal of medication. Eight weeks after starting the therapy, serum levels before and after Styela plicata treatment of IL-2 were 2.41 ± 0.38 and 10.56 ± 0.78 ng/L, respectively （t8wk = -16.51, P8wk = 0.000 〈 0.01）. Compared with the serum levels of IL-2 in the normal diet-treated mice （2.48 ± 0.17 ng/L; t8wk = 13.23, P8wk = 0.000 〈 0.01）. Serum levels before and after Styela plicata treatment of IL-6 were 63.62 ± 6.31 and 54.52 ± 6.22 ng/L, respectively, compared with the serum levels of IL-6 in the normal diet-treated mice （60.84 ± 4.21 ng/L）. Histological analysis of liver from Styela plicata-treated HBV-transgenic mice also showed catabatic status in inflammation and hepatitis B surface antigen. CONCLUSION： Styela plicata may be an effective anviral medicine in treating chronic hepatitis B.

Management of Crohn’s disease in smokers:Is an alternative approach necessary?

Inflammatory bowel disease(IBD) is a chronic condition with a pathogenic background that involves both genetic and environmental factors.Although important progress has been made regarding the former in the last decade,scarce knowledge is available for the latter.In this sense,smoking remains the most important environmental factor in IBD.Active smoking increases the risk of developing Crohn's disease(CD).Moreover,CD patients who start or continue smoking after disease diagnosis are at risk for poorer outcomes such as higher therapeutic requirements and disease-related complications,as compared to those patients who quit smoking or who never smoked.However,the harmful effect of active smoking is not uniform in all patients or in all clinical scenarios.Interventions designed to facilitate smoking cessation may impact the course of the disease.In this article,the available evidence of the deleterious effects of smoking on CD is reviewed in detail,and alternative therapeutic approaches to CD in smokers are proposed.

Current understanding of coronary artery calcification

Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven- tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD pa- tients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.

Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy's lesion

AIM： To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding. METHODS： Retrospective study of patients with gas- trointestinal bleeding secondary to Dieulafoy＇s lesion （DL） from 2005 to 2011. We analyzed the demographic characteristics of the patients, risk factors for gastro- intestinal bleeding, endoscopic findings, characteristics of the endoscopic treatment, and the recurrence of bleeding. We included cases in which endoscopy de- scribed a lesion compatible with Dieulafoy. We exclud- ed patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures. RESULTS： Twenty-nine patients with DL were identi- fied. Most of them were men with an average age of 71.5 years. Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy. The most common location for DL was the stomach （51.7%）. The main type of bleeding was oozing in 65.5% of cases. In 27.6% of cases, there was arterial （spurting） bleeding, and 6.9% of the patients presented with an adherent clot. A single endoscopic treatment was ap- plied to nine patients （31%）, eight of them with adren- aline and one with argon, while 69% of the patients received combined treatment. Six patients （20.7%） presented with recurrent bleeding at a median of 4 d after endoscopy （interquartile range = 97.75）. Within these six patients, the new endoscopic treatment ob- tained a therapeutic success of 100%. The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding （50% vs 33.3% for other type of bleeding） rP = 0.024, odds ratio （OR） = 8.5, 95% CI = 1.13-63.87]. The use of combined en- doscopic treatment prevented the recurrence of bleed- ing （10% vs 44.4% of single treatment） （P = 0.034, OR = 0.14, 95% CI = 0.19-0.99）. CONCLUSION： Endoscopic treatment of DL is safe and effective. Adrenaline monotherapy and arterial （spurting） bleeding are associated with a high rate of bleeding recurrence.

Bio-feedback treatment of fecal incontinence: Where are we, and where are we going?

Fecal incontinence is a disabling disease, often observed in young subjects, that may have devastating psycho-social consequences. In the last years, numerous evidences have been reported on the efficacy of bio-feedback techniques for the treatment of this disorder. Overall, the literature data claim a success rate in more than 70% of cases in the short term. However, recent controlled trials have not confirmed this optimistic view, thus emphasizing the role of standard care. Nonetheless, many authors believe that this should be the first therapeutic approach for fecal incontinence due to the efficacy, lack of side-effects,and scarce invasiveness. Well-designed randomized,controlled trial are eagerly awaited to solve this therapeutic dilemma.

Influence of HLA-DRB1 alleles and HBV genotypes on interferon-α therapy for chronic hepatitis B

AIM. To investigate the influence of HLA-DRB1 alleles and HBV genotypes on inberferon-α therapy for chronic hepatitis B. METHODS： HLA-DRBI＊03, ＊07, ＊09,＊12, ＊15 alleles were determined using polymerase chain reaction/sequence specific primer （PCR/SSP） technique in 126 patients with chronic hepatitis B and 76 normal control subjects in Shandong Province, and HBV genotypes were determined by nested-PCR analysis using type-specific primers in 126 patients. RESULTS： The positivity of HLA-DRB1＊07 allele in chronic hepatitis B group was significantly higher than that in normal control group （X^2 = 6.33, P〈0.025, RR = 2.37）. Among the 126 patients, genotype B was found in 38 （30.2%）, genotype C in 69 （54.8%）, and mixed genotype （B＋C） in 19 （15.0%）, genotypes D-F were not found. Among the 46 DRB1＊07（＋） patients, 7 were responders and 39 were non-responders among them （X^2 = 6.71, P〈0.05）. The positivity of HLADRB1＊07 and prevalence of HBV genotype C were significantly higher in non-responders than in responders. CONCLUSION： High positivities of HLA-DRB1 ＊07 allele and HBV genotype C are closely associated with the lower response to interferon-α therapy for chronic hepatitis B.

Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

AIM:To evaluate the incidence of contrast-induced nephropathy(CIN)in cirrhotic patients and to identify risk factors for the development of CIN.METHODS:We performed a retrospective review of 216 consecutive patients with cirrhosis who underwent computed tomography(CT)with intravenous contrast at the University of Rochester between the years 2000-2005.We retrospectively examined factors associated with a high risk for CIN,defined as a decrease in creatinine clearance of 25%or greater within one week after receiving contrast.RESULTS:Twenty-five percent of our patients developed CIN,and 74%of these patients had ascites seen on CT.Of the 75%of patients who did not develop CIN,only 46%had ascites.The presence of ascites was a significant risk factor for the development of CIN(P=0.0009,OR 3.38,95%CI 1.55-7.34)in multivariate analysis.Patient age,serum sodium,Model for End-stage Liver Disease score,diuretic use,and the presence of diabetes were not found to be significant risk factors for the development of CIN.Of the patients who developed CIN,11%developed chronic renal insufficiency,defined as a creatinine clearance less than baseline for 6 wk.CONCLUSION:Our results suggest that in hospitalized cirrhotic patients,especially those with ascites,the risk of CIN is substantial.

Expression liver-directed genes by employing synthetic transcriptional control units

AIM： To generate and characcerize the synthetic transoiptional control units for transcriptional targeting of the liver, thereby compensating for the lack of specificity of currently available gene therapeutic vector systems. METHODS： Synthetic transcriptional control unit constructs were generated and analyzed for transcriptional activities in different cell types by FACS quantification, semi-quantitative RT-PCR, and Western blotting. RESULTS： A new bifunctionally-enhanced green fluorescent protein （EGFP）/neor fusion gene cassette was generated, and could flexibly be used both for transcript quantification and for selection of stable cell clones. Then, numerous synthetic transcriptional control units consisting of a minimal promoter linked to “naturally” derived composite enhancer elements from liver-specific expressed genes or binding sites of liver-specific transcription factors were inserted upstream of this reporter cassette. Following liposome-mediated transfection, EGFP reporter protein quantification by FACS analysis identified constructs encoding multimerized composite elements of the apolipoprotein B100 （APOB） promoter or the ornithin transcarbamoylase （OTC） enhancer to exhibit maximum transcriptional activities in liver originating cell lines, but only background levels in non-liver originating cell lines. In contrast, constructs encoding only singular binding sites of liver-specific transcription factors, namely hepatocyte nuclear factor （HNF）, HNF3, HNF4, HNF5, or CAAT/enhancer binding protein （C/EBP） only achieved background levels of EGFP expression. Finally, both semi-quantitative RT-PCR and Western blotting analysis of Hep3B cells demonstrated maximum transcriptional activities for a multimeric 4xAPOB cassette construct, which fully complied with the dataobtained by initial FACS analysis CONCLUSION： Synthetic transcriptional control unit constructs not only exhibit a superb degree of structural compactness, but also provide new means for liver-directed expression of therapeutic genes.

The effects of CIK cells on the treatment of renal cell carcinoma

Objective： To observe the effects of cytokine-induced killer （CIK） cells on the treatment of renal cell carcinoma. Methods： Twenty-eight postoperative cases with stage Ⅰ or stage Ⅱrenal cell carcinoma were admitted in our hospital from January 2002 to June 2006, all cases were pathologically confirmed, and were divided into group A （18 cases） and group B （10 cases）. Group A was administrated 3-12 periods of CIK cells treatment combined with 5-7 cycles of IL-2 and INFα-2b, together with 4 cycles of chemotherapy （5-Fu ＋ CF）. Group B was given 4 cycles of chemotherapy （5-Fu ＋ CF） and 5-7 cycles of IL-2 and INFa-2b. Results： Three cases in group A had metastatic masses in two lungs within 1 year and died within 2 years postoperatively. The other 15 cases are still alive and in good health. Six cases in group B had metastatic masses in two lungs or/and in abdominal cavity within 1 year, and 4 of them died within 2 years. All the 6 cases died within 3 years. The other 4 cases are still alive and in good health. Conclusion： CIK cells are safe and effective for the treatment of stage I or stage II renal cell carcinoma, which should be further widely used.

Hepatitis C virus induced insulin resistance impairs response to anti viral therapy

Hepatitis C virus (HCV) infection is an important risk factor for insulin resistance (IR). The latter is the pathogenic foundation underlying metabolic syndrome, steatosis and cirrhosis, and possibly hepatocellular carcinoma (HCC). The interplay between genetic and environmental risk factors ultimately leads to the development of IR. Obesity is considered a major risk factor, with dysregulation of levels of secreted adipokines from distended adipose tissue playing a major role in IR. HCV-induced IR may be due to the HCV core protein inducing proteasomal degradation of insulin receptor substrates 1 and 2, blocking intracellular insulin signaling. The latter is mediated by increased levels of both tumour necrosis factor-α (TNF-α) and suppressor of cytokine signaling 3 (SOC-3). IR, through different mechanisms, plays a role in the development of steatosis and its progression to steatohepatitis, cirrhosis and even HCC. In addition, IR has a role in impairing TNF signaling cascade, which in turn blocks STAT-1 translocation and interferon stimulated genes production avoiding the antiviral effect of interferon.

Retrospective study on Professor Zhongying Zhou's experience in Traditional Chinese Medicine treatment on diabetic nephropathy

OBJECTIVE:To study and analyze the etiology and pathogenesis,diagnosis and prescription for cases of diabetic nephropathy(DN) treated by Professor Zhongying Zhou(Prof.Zhou) with the help of dada mining technique,so as to inherit his clinical experience and academic thoughts.METHODS:After pretreatment of the medical record information,statistical software SPSS 13.0 was used to analyze and process the standardized data using the descriptive analysis,cluster analysis and association rules.RESULTS:Ninety-four entries derived from Traditional Chinese Medicine(TCM) four-diagnostic information were selected.Through data mining,the highest frequency was yellow-thin-greasy tongue coating,followed by dark tongue,and then by thready-slippery pulse.The main self-conscious symptoms were limb numbness,dry mouth,frequent micturition,etc.With respect to pathogenesis,the etiology related to kidney reached 73.46%.The frequency of pathological factors for deficiency,blood stasis,heat,dampness,phlegm and dryness were 137.65%,80.25%,78.40%,48.77%,21.60%,and 14.20% respectively.A total of 236 kinds of herbs were used 2913 person times,averaging 17.98 herbs per prescription.CONCLUSION:The pathological location of DN is in the kidney.The pathogenesis of the disease is deficiency in origin and excess in superficiality,the former of which include deficiency of the liver and kidney,and deficiency of both Qi and Yin.The main pathological factors are blood stasis,heat,dampness,phlegm,and dryness;and they act upon each other to form the complex pathogenesis in terms of blood stasis-heat,dampness-heat,phlegm-heat,and dryness-heat.All the above factors are always crucial in the aggravation of DN throughout the whole course of its pathological evolution.

First rib fractures： not always a hallmark of severe trauma a report of three cases

According to medical literature, fracture of the first rib is quite rare and the bilateral condition is especially rare. This type of fracture is usually associated with severe intrathoracic trauma and other bony or neurovascular injuries, thus can be considered as a harbinger of major trauma. However here we present three cases of low velocity first rib fractures without any major trauma or multisystem injuries. All the three patients were treated conservatively and did well on simple analgesics and rest and had no early or late complications. It can be seen that not all the first rib fractures are associated with major trauma or multisystem injuries. There is a variant of first rib fracture with low velocity injuries which is not associated with any major complications in contrast to majority of first rib fractures associated with high velocity injuries. Causative factor of such injuries may be violent muscular contraction of scalenus anterior or serratus anterior, but not direct trauma.

Simultaneous bilateral trochanteric fracturesma report of four cases

Simultaneous bilateral intertrochanteric fractures are very rare. There is a paucity of data in current literature documenting patients with such kind of hip fractures. It is severe and potentially life-threatening, associated with a high morbidity. The major determinants of successful outcome are high vigilance, early single stage stabilization and mobilization as well as management of associated comorbid conditions that may influence the longterm rehabilitation of patients. Here we reported 4 cases of concurrent bilateral trochanteric fractures along with review of the literature. Our study aimed to discover its frequency, identify the injury mechanisms as well as factors present in the pathogenesis of these fractures, and outline the available treatment modalities.