“Hepatic hilum area priority,liver posterior first”:An optimized strategy in laparoscopic resection for type Ⅲ-Ⅳ hilar cholangiocarcinoma

BACKGROUND In recent years,pure laparoscopic radical surgery for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma(HCCA)has been preliminarily explored and applied,but the surgical strategy and safety are still worthy of further improvement and attention.AIM To summarize and share the application experience of the emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types Ⅲ and IV.METHODS The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed.RESULTS Among the 6 patients,4 were males and 2 were females.The average age was 62.2±11.0 years,and the median body mass index was 20.7(19.2-24.1)kg/m^(2).The preoperative median total bilirubin was 57.7(16.0-155.7)μmol/L.One patient had Bismuth-Corlette type Ⅲa,4 patients had Bismuth-Corlette type Ⅲb,and 1 patient had Bismuth-Corlette type Ⅳ.All patients successfully underwent pure laparoscopic radical resection following the strategy of“hepatic hilum area dissection priority,liver posterior separation first”.The operation time was 358.3±85.0 minutes,and the intraoperative blood loss volume was 195.0±108.4 mL.None of the patients received blood transfusions during the perioperative period.The median length of stay was 8.3(7.0-10.0)days.Mild bile leakage occurred in 2 patients,and all patients were discharged without serious surgery-related complications.CONCLUSION The emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ.This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA,shortens the learning curve,and is worthy of further clinical application.

P92钢接头Ⅳ型开裂蠕变孔洞临界值的分析及应用

【目的】分析P92管道接头热影响区发生Ⅳ型开裂的蠕变孔洞临界值的影响因素,得到蠕变孔洞临界值计算方法,为评估接头开裂风险提供依据。【方法】收集服役后发生Ⅳ型开裂的P92接头,在未开裂处取样进行610℃下不同应力条件的高温持久蠕变试验,然后使用光学显微镜、电子显微镜观察服役开裂接头和持久断裂接头热影响区的蠕变孔洞分布形貌,并借助图像分析软件测量蠕变孔洞的面积分数,同时使用硬度仪测试热影响区软化情况,最后综合测试结果分析细晶区软化程度和接头应力水平对蠕变孔洞临界值的影响,并拟合应力、显微硬度、孔洞临界值三者之间的函数关系。【结果】研究发现,P92钢接头细晶区相比于接头其它区域软化速度更快,但软化作用并非其发生Ⅳ型开裂的必要条件,当应力水平较高时,细晶区没有发生明显软化时就可以触发蠕变开裂;得到接头轴向应力水平、蠕变孔洞面积分数临界值和显微硬度的函数关系式。【结论】引起Ⅳ型开裂的蠕变孔洞面积分数临界值与相对应力水平(轴向应力与硬度的比值)有关,相对应力水平越高,蠕变孔洞临界值越小,接头安全性就越低;通过测量接头细晶热影响区的蠕变孔洞面积分数和显微硬度,可以估算开裂接头的轴向应力水平,也可以评估在役未开裂接头的Ⅳ型开裂风险。

Antitumor activity of anti-type IV collagenase monoclonal antibody and its lidamycin conjugate against colon carcinoma

AIM： Type IV collagenase including MMP-2 and -9 plays an important role in cancer cell invasion and metastasis and is an attractive target for rnAb-directed therapy. The irnrnunoreactivity of rnAb 3G11, a rnAb directed against type Ⅳ collagenase in human colorectal carcinomas, was studied by irnrnuno-histochernical （IHC） staining, rnAb 3G11 was conjugated to an antiturnor antibiotic lidarnycin （LDM）. The antiturnor activity of 3G11-LDM conjugate against colon carcinoma was investigated in mice. METHODS： ELISA, gelatin zyrnography, and Western blot assay were used for the biological characterization of rnAb 3G11. The irnrnunoreactivity of rnAb 3G11 with human colorectal carcinomas was detected by IHC staining. The cytotoxicity of LDM and 3G11-LDM conjugate to human colon carcinoma HT-29 cells was examined by clonogenic assay and MTT assay. The therapeutic effect of conjugate 3G11-LDM was evaluated with colon carcinoma 26 in mice. RESULTS： As shown in ELISA, mAb 3Gll reacted specifically with type IV collagenase, while 3G11-LDM conjugate also recognized specifically its respective antigen. In IHC assay, mAb 3G11 showed positive irnrnunoreactivity in most cases of colorectal carcinoma, and negative irnrnunoreactivity in the adjacent non-malignant tissues. By gelatin zyrnography, the inhibition effect of rnAb 3G11 on the secretion activity of type IV collagenase was proved. In terms of IC50 values in MTT assay, the cytotoxicity of LDM to human colon carcinoma HT-29 cells was 10 000-fold more potent than that of rnitornycin C （MMC） and adriarnycin （ADM）. 3G11- LDM conjugate also displayed extremely potent cytotoxicity to human colon carcinoma HT-29 cells with an IC50 value of 5.6× 10^-19 mol/L. 3G11-LDM conjugate at the doses of 0.05 and 0.1 mg/kg inhibited the growth of colon carcinoma 26 in mice by 70.3 and 81.2%, respectively. CONCLUSION： mAb 3G11 is immunoreactive with human colorectal carcinoma and its conjugate with LDM is highly effective against colon carcinoma in mice.

肾组织石蜡切片Ⅳ型胶原α链免疫组织化学染色在诊断Alport综合征中的应用

目的对Alport综合征(AS)患者肾脏穿刺组织进行石蜡切片Ⅳ型胶原α链免疫组织化学检测,探讨其临床应用价值。方法选取2018年11月至2022年7月浙江大学医学院附属第一医院肾脏病中心确诊的10例AS患者(AS病例组)、10例心脏死亡器官捐献者(DCD)供肾及10例确诊为免疫球蛋白A肾病患者(对照组)的肾组织进行石蜡切片Ⅳ型胶原α1、α3、α5链全自动免疫组织化学染色,将其与冰冻切片免疫荧光染色结果进行比较。将对照组肾组织石蜡切片分别采用多种方法进行抗原修复,比较修复效果。结果对照组肾组织2种染色方法Ⅳ型胶原α1、α3、α5链染色在肾小球基底膜(GBM)中均为连续线状阳性表达。AS病例组肾组织2种染色方法Ⅳ型胶原α1链染色在GBM均呈连续线状阳性表达,α3、α5链染色在GBM为阴性或节段弱阳性表达。2种染色方法染色结果具有较高的一致性(Kappa=0.615,P=0.035)。结论石蜡切片全自动免疫组织化学检测Ⅳ型胶原α1、α3和α5能较好地用于AS的诊断,为AS的诊断和研究提供了一种可靠的技术手段。

基于上皮细胞-间充质细胞转分化(EMT)理论的艾灸配合化纤Ⅳ号方对实验大鼠Collagen Type Ⅲ和PDGF干预作用实验研究

目的:基于上皮细胞-间充质细胞转分化(EMT)学说观察化纤Ⅳ号方、艾灸以及二者相配合治疗肺纤维化大鼠Collagen TypeⅢ(Ⅲ-C)和PDGF的变化,探讨其治疗效应及生物学机制。方法:将鼠龄约为6周的SD大鼠随机分为空白组、模型组、化纤Ⅳ号方组、艾灸组、化纤Ⅳ号方与艾灸配合治疗组(简称为"灸药组"),治疗30 d后处死观察其肺组织病理改变,并检测其Collagen TypeⅢ、PDGF的基因和蛋白表达情况。结果:实时荧光定量结果显示:与空白组相比,各组Ⅲ-C和PDGF m RNA表达增高(P<0.05)。与模型组相比,各组的Ⅲ-C和PDGF m RNA表达有明显降低(P<0.01)。而各组中,灸药组疗效最明显,Ⅲ-C和PDGF的表达最低。蛋白免疫印迹法检测结果显示:与模型组相比各组的Ⅲ-C蛋白表达有差异。结论:1艾灸、化纤Ⅳ号方均可减轻博莱霉素诱导肺纤维化大鼠的肺纤维化程度。2艾灸配合化纤Ⅳ号方可减轻博莱霉素诱导肺纤维化大鼠的肺纤维化程度,且其效果优于单用艾灸或单用化纤Ⅳ号方。3艾灸、化纤Ⅳ号方及其二者配合使用不同程度阻抑博莱霉素诱导肺纤维化大鼠肺纤维化进程的效应机制,可能与通过调控其EMT过程中的Ⅲ-C和PDGF表达环节紧密相关。

Collagen type Ⅳ对周围神经中再生轴突及非神经元细胞的作用和影响

本文用抗ｃｏｌｌａｇｅｎｔｙｐｅⅣ对抗体阻断ｃｏｌｌａｇｅｎｔｙｎｅⅣ的方法，研究了ｃｏｌｌａｇｅｎｔｙｐｅⅣ失活的移植神经段（长１０ｍｍ）植入大鼠坐骨神经后对再生轴突和非神经元细胞的作用和影响．实验结果显示：在移植神经段近端距近侧吻合口１ｍｍ处，术后１０ｄ抗ｃｏｌｌａｇｅｎｔｙｐｅⅣ组再生轴突数为对照组的５４％，术后１５ｄ增加到６６％，术后３０ｄ高达９４％．在移植神经段远侧距近侧吻合口９ｍｍ处，术后３０ｄ抗ｃｏｌｌａｇｅｎｔｙｐｅⅣ组再生轴突数为对照组的５８％。表明抗ｃｏｌｌａｇｅｎｔｙｐｅⅣ组再生轴突的生长启动和生长速度明显慢于对照组．巨噬细胞在移植神经段内的滞留数量抗ｃｏｌｌａｇｅｎｔｙｐｅⅣ组明显多于对照组．这些结果揭示ｃｏｌｌａｇｅｎｔｙｐｅⅣ在神经损伤和再生中对促进轴突的生长和维持神经微环境的平衡起着积极的作用．本文对ｃｏｌｌａｇｅｎｔｙｐｅⅣ在神经再生中的作用机制作了初步的分析和探讨。

Serum hyaluronic acid, procollagen type Ⅲ and Ⅳ in histological diagnosis of liver fibrosis

OBJECTIVE: To assess the significance of serum hyaluronic acid (HA), proeollagen type Ⅲ (PCⅢ), collagen type Ⅳ (CⅣ) in the histological diagnosis of liver fibrosis. METHODS: The concentrations of serum HA, PCⅢ, CⅣ in 253 patients with chronic liver diseases were measured by radioimmunoassay. Liver biopsies were performed in all patients at the same time. The liver was pathologically evaluated by a pathologist according to a scoring system. Combined with the results of liver pathological diagnosis, the accuracy of serum HA, PCⅢ, CⅣ in diagnosing patients with hepatic fibrosis (staging≥S_2) or cirrhosis (S_4) was assessed using the receiver operating curve (ROC). RESULTS: The cutoff values of serum HA, PCⅢ and CⅣ for identifying patients with hepatic fibrosis (≥S_2) or cirrhosis (S_4) were determined. The cutoff values of serum HA, PCⅢ and CⅣ for detecting patients with fibrosis (stage≥S_2) were 90μg/L, 90μg/L, 75μg/L, respectively; their sensitivity (Se) was 80.4%, 82%, 63.1%; their specificity (Spe) was 70.2%, 60.8%, 83.8%; their positive predictive values (PPV) were 86.7%, 83.5%, 90.4%; their negative predictive values (NPV) were 59.8%, 58.4%, 48.4%, respectively. The cutoff values for detecting patients with liver cirrhosis were 210μg/L for HA, 96.2% for Se, 85.3% for Spe, 65.4% for PPV, 98.8% for NPV; 150μg/L for PCⅢ, 76.4% for Se, 68.7% for Spe, 40.4% for PPV, 91.3% for NPV; 90μg/L for CⅣ, 80% for Se, 75.8% for Spe, 47.8% for PPV, 93.2% for NPV, respectively. CONCLUSIONS: Serum HA, PCⅢ and CⅣ can be determined for an accurate diagnosis of hepatic fibrosis in various stages. HA is the best for screening liver cirrhosis.

Macroscopic appearance of TypeⅣand giant Type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with postoperative adjuvant chemotherapy

AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.

Serum type Ⅳ collagen level is predictive for esophageal varices in patients with severe alcoholic disease

AIM： To determine factors predictive for esophagea varices in severe alcoholic disease （SAD）. METHODS： Abdominal ultrasonography （US） was performed on 444 patients suffering from alcoholism. Forty-four patients found to have splenomegaly and/ or withering of the right liver lobe were defined as those with SAD. SAD patients were examined by upper gastrointestinal （UGI） endoscopy for the presence of esophageal varices. The existence of esophageal varices was then related to clinical variables. RESULTS： Twenty-five patients （56.8%） had esophageal varices. A univariate analysis revealed a significant difference in age and type Ⅳ collagen levels between patients with and without esophageal varices. A logistic regression analysis identified type Ⅳ collagen as the only independent variable predictive for esophageal varices （P = 0.017）. The area under the curve （AUC） for type Ⅳ collagen as determined by the receiver operating characteristic （ROC） for predicting esophageal varices was 0.78. CONCLUSION： This study suggests that the level of type Ⅳ collagen has a high diagnostic accuracy for the detection of esophageal varices in SAD.

Significance of regenerating islet-derived type Ⅳ gene expression in gastroenterological cancers

The regenerating islet-derived members （Reg）, a group of small secretory proteins, which are involved in cell proliferation or differentiation in digestive organs, are upregulated in several gastrointestinal cancers, functioning as trophic or antiapoptotic factors. Regenerat- ing islet-derived type Ⅳ （RegⅣ）, a member of the Reg gene family, has been reported to be overexpressed in gastroenterological cancers. RegIV overexpression in tumor cells has been associated with carcinogen- esis, cell growth, survival and resistance to apoptosis. Cancer tissue expressing RegIV is generally associated with more malignant characteristics than that with- out such expression, and RegⅣ is considered a novel prognostic factor as well as diagnostic marker in some gastroenterological cancers. We previously investigated the expression levels of RegⅣ mRNA of 202 surgical colorectal cancer specimens with quantitative real-time reverse-transcriptase polymerase chain reaction and reported that a higher level of RegⅣ gene expression was a significant independent predictor of colorec- tal cancer. The biologic functions of RegⅣ protein in cancer tissue, associated with carcinogenesis, anti- apoptosis and invasiveness, are being elucidated by molecular investigations using transfection techniques or neutralizing antibodies of RegIV, and the feasibility of antibody therapy targeting RegIV is being assessed. These studies may lead to novel therapeutic strate- gies for gastroenterological cancers expressing RegⅣ. This review article summarizes the current information related to biological functions as well as clinical impor- tance of RegⅣ gene to clarify the significance of Reg~ expression in gastroenterological cancers.

Genomic characteristics of Dickeya fangzhongdai isolates from pear and the function of type Ⅳ pili in the chromosome

Dickeya fangzhongdai, the causal agent of bleeding canker of pear, is a new member of the Dickeya genus and the only one that infects woody plants. Recent studies have reclassified several Dickeya isolates as D. fangzhongdai, which were isolated from various environments, including water, Phalaenopsis sp. and Aglaonema sp. To provide genomic characterization of D. fangzhongdai isolates from pear, the genomes of D. fangzhongdai strain JS5(=China General Microbiological Culture Collection Center, CGMCC 1.15464 ~T=DSM 101947 ~T), along with two other isolates, LN1 and QZH3, were sequenced and compared to those of other Dickeya spp. Homology greater than 99% was observed among three D. fangzhongdai strains. Plasmid, type IV secretion system(T4 SS) and type IV pili(TFPs) were found in genomes of D. fangzhongdai isolates. Comparative analysis of the type Ⅲ secretion systems(T3 SS), type Ⅲ secretion effectors(T3 SE), plant cell wall degradation enzymes(PCWDE) and membrane transport proteins of Dickeya spp. showed some differences which might reflect the variations of virulence, phylogenetic and phenotypic characteristics of Dickeya spp. In addition, deletion mutant of TFP in D. fangzhongdai JS5 showed no twitching motility and reduced virulence and biofilm formation. The fingdings of the distinctive plasmid, T4 SS and TFPs, as well as the differences of T3 SE, PCWDE and membrane transport proteins make D. fangzhongdai isolates unique. These results also suggested that acquisition of virulence genes by horizontal gene transfer might play some role in the genetic variation of D. fangzhongdai.

Pre-hepatectomy type Ⅳ collagen 7S predicts post-hepatectomy liver failure and recovery

BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve.When determining eligibility for hepatectomy,the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.METHODS This study was a retrospective cohort study.We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016.Early post-hepatectomy liver failure(PHLF)was defined using the International Study Group of Liver Surgery’s definition of PHLF.Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of<2 mg/dL and>2.8 g/dL,respectively,and the time taken for Child-Pugh score to return to Child-Pugh class A.RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function.Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S≤6 ng/mL than in those with type IV collagen 7S>6 ng/mL.In additional analyses,similar results were observed in patients without chronic viral hepatitis associated with fibrosis.CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and longterm postoperative liver function recovery.It can also be used in patients without chronic hepatitis virus.

Subtotal gastrectomy combined with chemotherapy: An effective therapy for patients with circumscribed Borrmann type Ⅳ gastric cancer

BACKGROUND Although Borrmann type Ⅳ(B-4) gastric cancer has a higher mortality rate and presents distant metastasis easily, especially peritoneal metastasis, when diagnosed, some B-4 patients were found to have no distant metastasis by preoperative detection and underwent curative surgery, which was defined as circumscribed B-4 in our study. In this study, we focused on the circumscribed B-4 patients without distant metastasis during surgery to identify factors related to prognosis and postoperative peritoneal cavity metastasis(PPCM), which is important for selecting an appropriate therapeutic strategy.AIM To identify factors related to the prognosis and PPCM of B-4 patients.METHODS A total of 117 B-4 patients who underwent gastrectomy between January 2005 and December 2012 were included in this study. Survival analysis was performed using Kaplan–Meier analysis and Cox multivariate models. Pearson correlation analyses were performed to identify the factors related to PPCM. All statistical analyses were performed using SPSS 20.0.RESULTS Lymph node status, gastrectomy type, and postoperative chemotherapy were independent prognostic factors in 117 circumscribed B-4 patients. Subtotal gastrectomy combined with chemotherapy could significantly improve the longterm survival time. Six patients who were diagnosed with pN0 and received the combination therapy had a 3-year survival rate of 100% and a median survival of 77.7 mo. Even for patients with metastatic lymph nodes(n = 13), the combination therapy also increased the 3-year overall survival rate to 57.1%. In addition, positive lymph node status was the only factor(P = 0.005) correlated with PPCM in certain B-4 patients, and chemotherapy was useful for suppressing PPCM in patients with subtotal gastrectomy but not in those with total gastrectomy.CONCLUSION Lymph node status is an independent prognostic factor for circumscribed B-4 patients. In addition, subtotal gastrectomy and postoperative chemotherapy could effectively improve prognosis and even suppress PPCM.

Ⅳ类石英玻璃光学均匀性影响因素研究

Ⅳ类石英玻璃是一种重要的特种玻璃材料,在光学探测、惯性导航等领域内具有重要作用。光学均匀性是表征光学玻璃结构均匀性的一种重要方法,Ⅳ类石英玻璃的光学均匀性与硅氧网络结构分布一致性密切相关。本文通过四步法光学均匀性测试、紫外-可见-近红外光谱、红外反射光谱等方法,研究了羟基、金属杂质及氧缺陷的径向分布特点和硅氧键键角的径向变化,采用相关性分析研究了各影响因素对样品光学均匀性的影响。结果表明:表示玻璃光学均匀性的波前畸变t_(0)Δn沿玻璃半径先降低后升高;羟基的径向分布整体上与t_(0)Δn的径向变化相反,200 nm处透过率径向变化、硅氧键键角径向变化与t_(0)Δn的径向变化相近;羟基对Ⅳ类石英玻璃光学均匀性的影响较小,金属杂质、氧缺陷及硅氧键键角的径向变化是影响Ⅳ类石英玻璃光学均匀性的主要因素。

Hypertension, type Ⅳ cardiorenal syndrome and chronic kidney disease: Pathophysiological and therapeutical approach

Hypertension represent one of the most important comorbid factors in chronic kidney disease(CKD) patients and its prevalence increases from 65% to 95% according to glomerular filtration rate decline. CKD patients need to maintain their blood pressure levels into 130/80 mm Hg according to most recent guidelines. Despite of many therapeutic agents, achievement of ideal blood pressure levels remains so far from the ideal ones. Hypertensive disease represent most important risk factor to develop a type Ⅳ cardiorenal syndrome, while prevalence of end stage renal disease is still raising and it represents worldwide epidemiological challenge. Correct management of hypertensive disease can obtain better control on CKD progression.

Conservative management of small bowel perforation in Ehlers-Danlos syndrome type Ⅳ

Ehlers-Danlos syndrome (EDS) is a group of inherited connective tissue disorders caused by collagen synthesis defects. EDS type Ⅳ, or vascular EDS, is caused by loss-of-function mutations in the type Ⅲ pro-collagen gene (COL3A1 ). Common complications of EDS type IV include gastrointestinal bleeding and bowel perforations, posing diagnostic and therapeutic dilemmas for both surgeons and gastroenterologists. Here, we describe a complicated case of EDS type Ⅳ in a 35-year-old caucasian female who presented with overt gastro-intestinal bleeding. The patient had a prior history of spontaneous colonic perforation, and an uncomplicated upper endoscopy was performed. A careful ileoscopy was terminated early due to tachycardia and severe ab-dominal pain, and a subsequent computed tomography scan confirmed the diagnosis of ileal perforation. The patient was managed conservatively, and demonstrated daily improvement. At the time of hospital discharge, no further episodes of gastrointestinal blood loss had occurred. This case highlights the benefit of conservative management for EDS patients with gastrointestinal hemorrhage. It is recommended that surgical treatmentshould be reserved for patients who fail conservative treatment or in cases of hemodynamic instability. Finally, this case demonstrates the necessity for a higher threshold of operative or endoscopic interventions in EDS type Ⅳ patients.

金荞麦提取物抑制肿瘤细胞侵袭、转移和HT-1080细胞产生Ⅳ型胶原酶的研究

目的探讨金荞麦提取物对肿瘤细胞侵袭和转移的影响。方法以人工重组基底膜及小鼠黑色素瘤高转移株自发性肺转移模型观察了金荞麦提取物对Ｂ１６－ＢＬ６细胞的体外抗侵袭活性和体内抗转移作用；用聚丙烯酰胺凝胶电泳法进一步观察了其对人纤维肉瘤ＨＴ－１０８０细胞Ⅳ型胶原酶的产生及活性的影响；同时用ＷＳＴ法观察了该药的细胞毒性。结果金荞麦提取物在１００ｍｇＬ－１剂量下能明显抑制Ｂ１６－ＢＬ６细胞侵袭；在２００ｍｇｋｇ－１剂量下能有效抑制Ｂ１６－ＢＬ６黑色素瘤细胞在Ｃ５７／ＢＬ６小鼠体内自发性肺转移。该药对Ｂ１６－ＢＬ６和ＨＴ－１０８０细胞无明显细胞毒作用。该药能抑制ＨＴ－１０８０细胞Ⅳ胶原酶的产生，但对酶的活性无明显影响。结论金荞麦提取物具有明显的抗癌侵袭和转移的作用。

表位九肽库的构建及人Ⅳ型胶原酶特异结合肽的筛选

将人工合成的编码九肽的随机序列ＤＮＡ片段克隆进丝状噬菌体表达载体ｆＵＳＥ５，经多次电击转化和表达，获得肽段与噬菌体ｐⅢ蛋白融合并展示在噬菌体表面的随机序列九肽表位肽库。库容量达１０１０个克隆。以Ⅳ型胶原酶为靶蛋白，采用亲和纯化筛选模式，从中筛选出Ⅳ型胶原酶结合肽。进一步ＥＬＩＳＡ检测筛选出与Ⅳ型胶原酶特异结合的２０个阳性克隆。序列分析发现一组肽含有ＷＤＸＸＤ的共同序列，一组含有ＷＶＧＸＸＲ的共同序列。其中ＷＤＸＸＤ的序列与Ⅳ型胶原酶单链抗体可变区序列同源。结果表明，多肽库是筛选蛋白特异结合肽的有力工具，表位九肽库的构建和筛选方法的建立为进一步应用筛选具有高亲和力的特异结合肽奠定了基础。

抗Ⅳ型胶原酶单链抗体scFv(3G11)在大肠杆菌的表达及其抗肿瘤活性

目的制备抗IV型胶原酶单链抗体(scFv),用于构建小型化抗肿瘤抗体靶向药物。方法构建重组表达质粒pET-scFv,并在大肠杆菌进行诱导表达。SDS-PAGE和Western-blot法对表达蛋白进行鉴定,分步透析复性。ELISA法、免疫细胞化学染色法检测scFv对靶抗原和肿瘤细胞的结合活性,明胶酶谱法检测对IV型胶原酶活性的抑制作用。Boyden Chamber法测定对肿瘤细胞侵袭的影响。动物试验肿瘤模型检测在小鼠体内的抗肿瘤活性。结果表达的单链抗体scFv(3G11)以包涵体的形式存在,经变性和复性后,对抗原IV型胶原酶和肿瘤细胞的免疫反应呈阳性,抗体亲和常数为6×107/mol/L。不仅可以抑制HT-29细胞和HT-1080细胞分泌的Ⅳ型胶原酶活性,还可以体外抑制肿瘤细胞的侵袭,抑制程度与浓度呈剂量依赖关系。scFv(3G11)4mg/kg对小鼠移植性肝癌H22的抑瘤率为49.4%(P<0.01)。结论scFv(3G11)保留了完整抗体的抗原结合和抑制活性,能够与肿瘤细胞特异性结合,并在小鼠体内有中度抑瘤效果。scFv(3G11)的相对分子质量远小于完整抗体,可作为肿瘤靶向药物的理想载体。

Ⅳ型胶原及Ⅳ型胶原酶与涎腺腺样囊性癌生物学特性的关系研究

用免疫组织化学ＡＢＣ法，观察２５例涎腺腺样囊性癌（ＡＣＣ）患者的癌组织中Ⅳ型胶原以及Ⅳ型胶原酶的表达与分布，探讨其与ＡＣＣ侵袭和转移的关系。结果显示，Ⅳ型胶原主要分布在基底膜上以及部分筛状假囊、腺管和肿瘤细胞浆内，Ⅳ型胶原酶分布在肿瘤细胞浆内及周围。经统计学检验，发现筛状－管状型ＡＣＣ，ＴＮＭ早期和无转移者，Ⅳ型胶原多阳性表达，Ⅳ型胶原酶多阴性表达；而实体型ＡＣＣ，ＴＮＭ晚期和转移者，Ⅳ型胶原多阴性表达，Ⅳ型胶原酶多阳性表达。本研究结果表明，Ⅳ型胶原低表达和Ⅳ型胶原酶的高表达可作为判定ＡＣＣ临床恶性程度的指征，是ＡＣＣ侵袭和转移的关键因素之一。