Periprosthetic femoral fractures associated with contralateral hip disease

Femoral osteolysis associated with contralateral hip degenerative changes is a risk factor for ipsilateral periprosthetic femoral fracture. We report 5 comminuted proximal shaft fractures around loose femoral implants occurring in patients with both symptomatic femoral lysis and a painful hip on the other side. Our evolving strategy involves timely revision surgery once this pattern is recognized. Once fracture has occurred, emergent revision requires extensive medical evaluation, availability of long-stem revision implants, and appropriate instrumentation and allografts for fracture fixation.     

Risk Factors and Clinical Outcome for Anastomotic Leakage After Total Mesorectal Excision for Rectal Cancer

BACKGROUND: Anastomosis leakage is a major complication of rectal surgery. The aim of this study was to identify risk factors for anastomotic leakage after low anterior resection (LAR) in rectal cancer patients and study its impact on long-term prognosis and disease-free survival and overall survival in rectal cancer patients. METHODS: Consecutive patients who underwent rectal resection with primary anastomosis below the pelvic peritoneal reflexion for rectal cancer between October 1996 to February 2006 were included. RESULTS: Anastomosis leakage after LAR occurred in 51 patients (4.0%). The median time to leakage was 4 days (range = 2-30 days). In univariate analysis, gender, level of anastomosis less than 4 cm, preoperative concomitant chemoradiation (CCRT), and length of operation greater than 120 min were significantly associated with anastomosis leakage. In a multivariate analysis, gender (p = 0.041; relative risk = 2.007; 95% CI = 1.030-3.912) and preoperative CCRT (p = 0.003; relative risk = 2.861; 95% CI = 1.417-5.778) were identified as independent prognostic factors. The overall survival of the nonleakage group and the leakage group was 80.2% and 64.9%, respectively (p = 0.170). The 5-year disease-free survival rates were not significantly different between the nonleakage and leakage groups (78.1% vs. 65.9%, p = 0.166). CONCLUSIONS: The incidence of anastomotic leakage after low anterior resection is relatively low. Male gender and preoperative CCRT were associated with increased risk for anastomotic leakage after rectal cancer surgery. No effect of anastomosis leakage on local recurrence was found in this series.     

S腺苷蛋氨酸对肝癌细胞中GADD45β基因的表达诱导及其机制研究

目的 初步明确肝癌细胞中特异性表达缺失的GADD45β基因近端启动子活性调控中心,并探讨S腺苷蛋氨酸对肝癌细胞HepG2中GADD45β表达的影响及可能机制.方法 以30～50个碱基的间隔,于体外人工合成GADD45β近端启动子序列(-618～-520),分别插入pGL3 basic荧光素表达质粒的荧光基因上游,以电穿孔法转染HepG2,根据启动子活性强度结合TRANSFAC数据库,分析可能存在的转录调节因子结合位点;实时荧光定量PCR比较S腺苷蛋氨酸作用前后HepG2细胞GADD45β表达,并在此基础上进一步比较S腺苷蛋氨酸对GADD45β启动子活性的诱导作用,探讨其可能作用机制,并为GADD45β近端启动子研究提供功能性证据.结果 GADD45β近端启动子中含有3个NF-kB转录调节因子与启动子结合位点(-602/-593、-581/-572、-537/-528);S腺苷蛋氨酸能明显诱导HepG2中GADD45β的表达,并呈现出剂量一效应的正相关关系,同时其能相应明显诱导NF-kB的启动子活性.结论 S腺苷蛋氨酸能明显诱导肝癌细胞中特异性缺失的GADD45β基因表达,增强转录调节因子NF-kB的活性水平是其可能的作用机制,该研究为S腺苷蛋氨酸的肝脏保护作用提供了新的实验依据.     

Decision for salvage treatment after transanal endoscopic microsurgery

BACKGROUND: Transanal endoscopic microsurgery (TEM) has emerged as an alternative to classic radical operation for early rectal cancer. Early rectal cancer can be treated by adequate local excision such as TEM. If there are adverse risk factors, especially poor cellular differentiation, close resection margin, or positive lymphovascular invasion or incomplete excision, a radical resection is indicated. This study aimed to clarify the factors related to recurrence for patients required to undergo a salvage operation after TEM. METHODS: This retrospective study analyzed 167 patients who underwent TEM for rectal cancer between 1994 and 2004. Of these patients, 36 with poor differentiation, mucinous carcinoma, proper muscle invasion, lymphovascular invasion, and positive resection margin were included in the analysis. RESULTS: Of the 36 patients, 12 underwent a salvage operation, and the remaining 24 did not because of poor physical condition or refusal of radical surgery. There were a total of 6 (16.7%) recurrences. One (8.3%) of the 12 patients who underwent salvage surgery had systemic recurrence. Five (20.8%) of the 24 patients who did not receive surgery had recurrence (3 local recurrences, 2 distant recurrences). Analysis of the subgroups showed that 2 (28.6%) of 7 patients with lymphovascular invasion had recurrence, and that 1 patient (100%) had a T3 lesion. Three (17.6%) of 17 patients had T2 lesions. CONCLUSIONS: For high-risk patients, TEM followed by radical surgery is the most beneficial in preventing local recurrence. Radical salvage surgery is strongly recommended if pathologic results after TEM show T3 lesion or lymphovascular invasion.     

羟基脲对肝癌细胞HepG2中GADD45β表达影响及其可能机制

目的 初步明确肝癌细胞中GADD45β基因近端启动子序列,探索羟基脲对人肝癌细胞HepG2的GADD45β表达影响及可能机制.方法 体外合成GADD45β近端启动子序列群(-618～-314),构建荧光素表达质粒,转染肝癌细胞株HepG2,根据启动子活性强度结合数据库分析存在的转录调节因子结合位点;以实时荧光定量PCR比较羟基脲作用前后HepG2细胞GADD45β表达,并进一步比较羟基脲对GADD45β启动子活性的调控作用、分析羟基脲对HepG2的抑制效应,并通过Caspase-8、Caspase-9和Caspase-3的表达变化测定凋亡的发生和发展.结果 GADD4518近端启动子中含有3个NF-кB(-602/-593、-581/-572、-537/-528)和1个E2F-1(-470/-436)转录调节因子与启动子结合位点;羟基脲能明显诱导HepG2中GADD45β的表达,并呈现出剂量-效应的正相关关系,同时NF-кB和E2F-1启动子均明显增强.羟基脲能够明显抑制HepG2的DNA合成能力和细胞克隆形成能力,同时羟基脲能迅速启动HepG2凋亡的发生和发展.结论 羟基脲能明显诱导肝癌细胞中特异性缺失的GADD45β基因表达,增强转录调节因子的表达水平是其可能的作用机制.     

Family history of diabetes and risk of atherosclerotic cardiovascular disease in Korean men and women

The importance of family history of type 2 diabetes (FHD) as a risk factor for atherosclerotic cardiovascular disease (ASCVD) remains controversial. A report of diabetes in parents and siblings was used to establish FHD in a cohort of 1,005,230 Koreans aged 30-95 years insured by the National Health Insurance Corporation who had a biennial medical evaluation during 1992-1995. ASCVD morbidity and mortality from 1993 to 2005 were examined in relation to FHD and other ASCVD risk factors. The risk of ischemic heart disease (IHD) increased significantly (19%) in men with FHD but not in women. A strong interaction was observed between FHD and personal history of diabetes for the occurrence of ASCVD; men with both diabetes and FHD were at significantly increased risk of developing IHD, cerebrovascular disease and ASCVD with hazard ratios (HR) of 2.28, 2.07, and 2.12, respectively, compared to those who had neither FHD nor type 2 diabetes. Corresponding risks were 2.64, 2.03, and 2.10 in women, respectively. This study demonstrates that risk of ASCVD is increased among those with diabetes and a family history of diabetes; suggesting that genetic factors associated with occurrence of familial diabetes may increase risk of ASCVD beyond the risk among people without FHD.     

Up-regulation and co-expression of fibroblast growth factor receptors in human gastric cancer

Fibroblast growth factor (FGF), a key regulatory factor of cell growth and differentiation, is involved in embryonic development, angiogenesis, and tumorigenesis. To date, four different FGF receptors (FGFRs) have been cloned and characterized. We examined the expression of four FGFRs in human gastric cancer tissues and cell lines using Northern analysis, ribonuclease protection assay, and immunohistochemistry. The mRNAs of FGFR-1 (10/14), FGFR-2 (9/14), and FGFR-4 (9/14) were up-regulated in cancer compared with normal tissues. FGFR-3 mRNAs were barely detectable in both normal and cancer tissues. These FGFR mRNAs were co-expressed in various combinations of two or three in the same tissue. Immunohistochemistry confirmed specific staining of multiple FGFRs, except FGFR-3, in the cancer specimens. To investigate the functional significance of FGFR co-expression we examined the invasive property of SNU-16 cells, which exhibited gene amplification of FGFR-2, -3, and -4 as well as over-expression of keratinocyte growth factor receptor (KGFR), a splice variant of FGFR-2, and FGFR-4 mRNA. KGF plus acidic FGF (aFGF), KGF, and aFGF treatment enhanced the invasive potential of SNU-16 cells over the control by 100%, 107%, and 47%, respectively, indicating that neither additive nor synergistic effect was induced by stimulation with aFGF plus KGF. These results suggest that co-expression of FGFRs in various combinations may cause subtle changes in the progression of gastric cancer. Received: 16 February 1999 / Accepted: 6 March 2000     

Adult patients with t(8;21) acute myeloid leukemia had no superior treatment outcome to those without t(8;21): a single institution’s experience

Clinical features and treatment outcome of 31 patients over 16 years of age with t(8;21) acute myeloid leukemia (AML) were compared with 60 patients without t(8;21). Among 31 patients with t(8;21), 15 patients were classified as AML-M2 and 11 and 5 patients as AML-M4 and M1, respectively. Of these patients, 28 patients (90.3%) achieved complete remission and 22 patients received consolidative treatment: intermediate-dose cytarabine (IDAC) 11, high-dose cytarabine (HDAC) 6, and allogeneic bone marrow transplantation (BMT) 5. When compared with patients without t(8;21), we could not demonstrate better treatment outcome for t(8;21) AML [median event-free survival (EFS) and overall survival (OS) 10.3 and 12.5 months in AML with t(8;21) vs 11.5 and 15.6 months in AML without t(8;21)]. In the t(8;21) AML group, patients who received HDAC consolidation did not show superior treatment outcome to those who received other consolidative treatment [median EFS: IDAC 11.9 months vs HDAC 9.2 months vs allogeneic BMT 38.1 months (P=NS) and median OS: IDAC 17.8 months vs HDAC 12.0 months vs allogeneic BMT 47.3 months (P=NS)]. Similar treatment outcome between patients with and without t(8;21) and non-superior treatment outcome of HDAC consolidative chemotherapy in the t(8;21) AML group in our study is contradictory to previous reports.These two authors equally contributed to this study: K.-W. Lee and I. S. ChoiSupported by a grant CRI-01-07 from the Cancer Research Institute, Seoul National University College of Medicine, and a grant 05-2001-002 from the S.N.U.H. Research Fund     

腹腔灌洗液中CK20m RNA水平与结直肠癌不同术式的研究

目的探讨腹腔灌洗液中CK20m RNA的临床意义以及腹腔镜直肠癌根治术的临床应用价值。方法选择49例直肠癌手术患者,利用RT-PCR技术分别检测以上患者腹腔灌洗液中CK20m RNA表达,从而探究CK20m RNA的临床价值以及评价腹腔镜直肠癌根治术的临床实用性。结果 10例良性病变腹部手术组患者腹腔灌洗液中CK20m RNA无明显表达。39例结直肠癌患者腹腔灌洗液中可见CK20m RNA表达,术前、术中以及术后的总表达率为40.2%(47/117),且术前、术中以及术后CK20m RNA的表达率比较差异无显著性(P0.05)。17例开腹手术组和22例腹腔手术组术前、术中以及术后CK20m RNA阳性表达率的比较差异无显著性(P0.05)。结论腹腔镜结直肠癌根治术治疗结直肠癌安全有效,与开腹手术相比并不增加癌细胞局部种植的风险。