2006年 · 第119卷第03期

Abstract：Background Innovative advancements in ultrasound instrumentation present a number of imaging modalities for myocardial contrast echocardiography (MCE) in ischemic syndromes. How well they compare to each other in diagnostic accuracy in the detection of acute myocardial infarction is unclear. The purpose of this study was to assess the relative accuracy of 3 different imaging modes of MCE, low mechanical index (MI) real-time perfusion imaging (RTPI), triggered harmonic angio mode (HA), and ultraharmonic imaging mode (UH) in the detection of acute experimental myocardial infarction within the time frame suitable for potential reperfusion. Methods MCE was performed in 10 open-chest dogs using RTPI, triggered HA and triggered UH modes at baseline and one hour after occlusion of left anterior descending coronary artery. Presence or absence of perfusion defects, and the perfusion defect size when present, were analyzed and compared with the infarct size delineated by triphenyltetrazolium chloride(TTC)staining. Results The infarct area was (15.8±2.4)% by TTC staining; Perfusion defect area by MCE was similar to anatomic infarct area in all the three MCE approaches: (16.1±2.7)% by RTPI mode, (15.5±2.9)% by HA mode, and (15.5±3.0)% by UH mode. The sensitivity, specificity and overall diagnostic accuracy in the detection of myocardial infarction were 100%, 88%, and 94% for RTPI mode, 88%, 100%, and 94 % for HA mode, and 100%, 75%, and 88% for UH mode. Conclusion All modes of MCE, RTPI, triggered HA mode and triggered UH mode have excellent diagnostic accuracy in the immediate hour of acute coronary occlusion within the optimal time frame suitable for reperfusion therapy。

Abstract：Background Activation of signal transducer and activator of transcription 6 (STAT6 ) plays a critical role in the late phase of Th2-dependent allergy induction. STAT6 is essential to Th2 cell differentiation, recruitment, and effector function. Our previous study confirmed that DNA vaccination inhibited STAT6 expression of spleen cells induced by allergen. In the present study, we determined whether DNA vaccine encoding Dermatophagoides pteronyssinus group 2 (Der p2 ) could down-regulate the expression and activation of STAT6 in lung tissue from asthmatic mice.Methods After DNA vaccine immunization, BALB/c mice were sensitized by intraperitoneal injection and challenged by intranasal instillation of rDer p2. The levels of the cytokines IL-4 and IL-13 in BAL fluid were measured by enzyme-linked immunosorbent assay. The lung tissue was assessed by immunohistochemical staining with anti-STAT6. The protein expression of STAT6 was determined by Western blot. The activation of STAT6 binding ability was analyzed with electrophoretic mobility shift assay.Results DNA vaccine encoding Der p2 allergen effectively decreased the levels of IL-4 and IL-13 in the asthmatic mice. Histological evidence and Western blot showed that the expression of STAT6 in the DNA treated mice was markedly attenuated. STAT6 binding to specific DNA motif in lung tissue from the gene vaccinated mice was inhibited.Conclusion DNA vaccine encoding Der p2 prevents allergic pulmonary inflammation probably by inhibiting the STAT6 signaling pathway in mice with Der p2 allergen-induced allergic airway inflammation。

Abstract：Background Febrile seizure (FS) is the most common seizure disorders. Approximately one third of children with a febrile seizure have recurrent events. The mechanism of FS remains unclear. Heme oxygenase-1 (HO-1) is a member of the heat shock proteins family and can be induced in the brain by various stresses, including hyperthemia and seizure. This study aimed at investigating the changes of HO-1 in the cortex of rats after recurrent FS.Methods FS in rats was induced ten times, once every 2 days. In a bath of warm water, developing rats were randomly divided into two groups: control group (n=16) and warm water-treated group (n=50). The latter group was subdivided into hyperthermia group (n=19) and FS group (n=23). The expression and content of HO-1 mRNA in cortex were observed using in situ hybridization and quantitative reverse transcription-polymerase chain reaction (RT-PCR). The content of HO-1 protein in cortex was measured using Western blotting. Results HO-1 mRNA expression of cortex neurons in FS group was markedly increased in comparison with those in hyperthermia and control groups (P=0.00), however, there was no statistic difference between hyperthermia group and control group (P=0.16). The relative amount of HO-1 mRNA in cortex in FS group was increased by 53.13% and 96% in comparison with those in hyperthermia group and control group respectively (P=0.00), but there was no obvious difference between the later two groups (P=0.051). Western blotting analysis showed that the HO-1 protein content in cortex in FS group was increased by 198% and 246% in comparison with those in hyperthermia group and control group respectively (P=0.00). There was no obvious difference in HO-1 protein content between the later two groups ( P=0.09).Conclusions Recurrent FS in rats can cause the increase of HO-1 mRNA and protein in cortex which may be involved in the mechanism of FS. The short-time recurrent hyperthermia can not induce the increase of HO-1 mRNA and protein。

Abstract：Background Laparoscopy has been accepted for years as a management of benign ovarian tumors. The aim of this study was to estimate the feasibility and safety of laparoscopy in diagnosis and management of adnexal masses.Methods A total of 2083 patients with benign adnexal mass were treated by laparoscopy at Peking Union Medical College Hospital from January 2000 to December 2003. Their clinical data were reviewed retrospectively. All the adnexal masses suspicious of malignancy at the time of laparoscopy were sent for frozen section evaluation intraoperatively. The rates of unexpected intracystic vegetation and low malignant potential (LMP) tumor or malignancy were investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of laparoscopic diagnosis for LMP or ovarian malignancies were calculated. The ratios were compared by Chi-square test and the continuous variables were tested using two-tailed t test. Results Of the 2083 patients, 16 had LMP or invasive tumors (0.77%), among which 14 were diagnosed histologically intraoperatively and 2 postoperatively. Fifty-five (2.6%) of the 2083 patients had unexpected intracystic vegetations. Their frozen sections showed benign tumors in 41 (74.5%), LMP tumors in 8 (14.5%), and focal invasive ovarian cancers (stage Ic) in 6 (10.9%). The final pathological diagnosis were benign tumors in 41 (74.5%), LMP tumors 7 (12.7%), and focal invasive ovarian cancers (stage Ic) in 7 (12.7%). Laparoscopy achieved a sensitivity of 87.5%, specificity of 98%, positive predictive value of 25.5%, and negative predictive value of 99.9% in the diagnosis of ovarian malignancies. 2067 cases with benign adnexal masses underwent laparoscopy successfully. No conversion to laparotomy, or intra- and postoperative complications in this series. Of the 16 patients with LMP or invasive ovarian cancer, seven underwent laparoscopic surgery including immediate staging laparoscopy in 3. The mean follow-up was 17.3 months for the 16 patients. Among them, 1 developed a recurrent LMP tumor in the contralateral ovary 36 months after laparoscopic salpingo-oophorectomy, and received subsequent laparoscopic cystectomy and pelvic lymph node sampling; the others had no evidence of recurrent tumor during the follow-up. Conclusion Laparoscopy is feasible for diagnosis of adnexal masses, and the surgery is safe for patients with benign ovarian tumors。

Abstract：Background To repair late median nerve injury, many methods have been used in the past years. The aim of this study was to review a thirteen-year experience in restoration of thumb opposition by transposing flexor pollicis brevis muscle.Methods From July 1992 to August 2005, 63 patients without thumb opposition because of late median never injury were treated by transposing the flexor pollicis brevis muscle. All the patients had received primary nerve repair after the jnjury. The interval between the injury and the second operation was (1.87±2.31) years (6 months to 4.2 years). The patients were followed up for 3 to 48 [months mean (22.93±2.31) months]. A functional evaluation system designed in 1992 were used to estimate the outcomes of the patients. Results All the patients gained excellent functional results without complications and disabilities during follow-up.Conclusions Restoration of thumb opposition by transposing flexsor pollicis brevis muscle has the following advantages: 1. Operative trauma is minimal; 2. It is not necessary to transpose other tendons; 3. Except for the thumb in opposition, movements of other fingers and the wrist are not restricted postoperatively。

Abstract：Backgroud Large vestibular aqueduct syndrome (LVAS) is a major cause of hearing loss in childhood. This study aimed at measuring external aperture of enlargement of the vestibular aqueduct (EVA) and analyzing relationship between the size of external aperture and hearing loss.Methods Diagnostic criteria of LVAS were based on hearing loss and CT images. CT images of temporal bone of 100 LVAS patients were collected and 60 control subjects were reviewed retrospectively in the past 10 years. A battery of audiometric and vestibular function tests were performed. The width of the vestibular aqueduct (VA) was measured on axial CT images of the temporal bone.Results One hundred patients (65 men, 35 women) were diagnosed as having the isolated EVA. Hearing loss mostly occurred in early childhood. The diagnosis age of LVAS was 7.7 years on average. The causes of hearing loss could not be confirmed by initial consult. Typically, audiometric curve is the high-frequency down-sloping configuration. 92% of the cases had severe or profound sonsorineural hearing loss (SNHL). The mean size of the external aperture was (7.5±1.2) mm in present LVAS. Statistical analysis showed that the degree of hearing loss is unrelated to the width of VA. Conclusions LVAS is a distinct clinical entity characterized by fluctuating, progressive SNHL. The degree of hearing loss is unrelated to the size of external aperture of VA. The protective management and hearing aid have become the main therapies. The cochlear implantation might be performed if the hearing loss affected learning at school。

Abstract：Background The highly polymorphic interleukin 10.G (IL10.G) microsatellite located in the promoter region of the interleukin-10 (IL-10) gene exerts a positive transcriptional regulatory effect on IL-10 gene expression and correlates with the in vitro IL-10 secretion. This study was conducted to investigate whether IL10.G microsatellite is associated with the incidence and /or the outcome of severe sepsis.Methods One hundred and fifteen patients with severe sepsis who had been treated at the intensive care unit of the university hospital were studied. One hundred and forty-one healthy individuals served as controls. IL10.G microsatellite genotyping was performed with the following two methods: fluorescent based polymerase chain reaction (PCR) techniques and silver staining of the amplified DNA fragment in polyacrylamide gel. Alleles were defined according to the size of the amplified DNA product.Results Ten alleles and 36 genotypes were detected both in the patients with severe sepsis and in the healthy controls. Allele IL10.G9 and allele IL10.G13 were the commonest alleles with the frequencies of 32.6% and 21.3% respectively in the patients with severe sepsis, and 34% and 27% respectively in the healthy controls. The allele frequencies of IL10.G microsatellite were neither different between the patients with severe sepsis and the healthy controls (P > 0.05), nor between survivors and non-survivors (P > 0.05). However, the frequency of one common allele IL10.G13 was slightly lower in the patients with severe sepsis than in the healthy controls (21.3% vs 27%, P > 0.05), and the frequency of allele IL10.G9 was slightly higher in the non-survivors than in the survivors (37.1% vs 28.1%, P > 0.05).Conclusion IL10.G microsatellite may neither contribute to the susceptibility to severe sepsis nor to the fatal outcome of severe sepsis。

Enterohaemorrhagic E. Coli (EHEC) has been isolated from human diarrhoeal disease, hemorrhagic colitis (HC), and haemolytic uremic syndrome (HUS). After 20 years since the first description of E. Coli O157: H7 in USA, EHEC has become an important public health problem worldwide.1,2 Given the magnitude and severity of recent outbreaks of E. Coli O157: H7 infection, there is an urgent need to reduce the human hazard caused by this pathogen. Cattle are considered as major reservoir of E. Coli O157:H7 because consumption of undercooked meat products from cattle has been often associated with many human infections。

Asthma is a chronic disease characterized by reversible airway obstruction, airway hyper- responsiveness, and inflammation of airways. Th2 cells, one sort of CD4+ T lymphocytes, are currently considered to play an important role in the chronic airway inflammation of asthma. Meanwhile, a number of laboratories have clearly established the importance of the Th2-derived cytokine interleukin-4 (IL-4) in mediating the airway inflammatory response. Anti-IL-4 therapy might be beneficial in treatment of chronic asthma。

Asthma and diabetes mellitus are common diseases and the concurrence is correspondingly expected to occur commonly. Several studies,1,2 however, indicate that the incidence of asthma in diabetic patients is less than that in the residual population. In the same individual, clinical asthma appears to be less severe when diabetes is superimposed.3 In addition, the onset of the diabetic state is accompanied by diminution of symptoms of previously existing bronchial asthma。

The situation of tuberculosis and M. tuberculosis (MTB) drug resistance is severe in China. Among the MTB isolates, 27.8% were resistant to one primary antituberculosis drug at least. Isoniazid (INH) is one of the first-line anti-TB drugs. The rates of primary resistance and acquired resistance to INH were 11.0% and 31.0%, respectively.1 MTB strains resistance to INH is mainly caused by the alterations in several genes encoding the molecular targets as follows: catalase peroxidase (katG), the enoyl-acyl carrier protein reductase (inhA), the alkyl hydroperoxide reductase (ahpC), beta-ketoacyl-acyl carrier protein synthase (kasA), and NADH dehydrogenase (ndh).2-4 However, the mutations of katG and inhA promoter region, especially in codon 315 of katG, were found in the majority of INH-resistant clinical isolates。

Pneumocystis jiroveci pneumonia (PCP) is one of the most serious and potentially fatal infections encountered in immonosuppressed patients. It remains the most common cause of pulmonary morbidity and mortality in patients infected with human immunodeficiency virus (HIV). 1

PBC-AIH overlap syndrome is an autoimmune liver disease between AIH (autoimmune hepatitis) and PBC (primary biliary cirrhosis). To investigate the characteristic of the PBC-AIH overlap syndrome, we have conducted a retros- pective study of 12 diagnosed overlap syndrome patients and compared them with typical PBC and AIH on the basis of clinical, biochemical, serological and histopathological findings。

It is well-known that risk for endometrial adenocar- cinoma increases in patients with high level of estrogen that is unopposed by progestin. And activation of extracellular signal-regulated kinase (ERK)1 and phosphatidylinositol 3 kinase/protein kinase B (PI3K/PKB) pathway are responsible for hormone-dependent cell growth in endometrial carcinoma.2-4 PI3K produces phosphatidylinositol- 3-phosphates by phosphory- lating the D3 hydroxyl of phosphoinositides, leading to membrane translocation of PKB, on which PKB is phosphorylated and activated. Then the activated PKB can stimulate antiapoptotic cellular responses and block apoptotic functions of the cells, thus regulate the apoptosis and proliferation of cell, cell cycle progression, glucose usage, and angiogenesis。

Transcoronary ablation of septal hypertrophy (TASH) has been recommended as an option for patients with drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). However, its outcome is varied, and some factors are attributed to the diversity results.1 Up to now, there is no study on the influence of the ablated myocardium's condition on the outcome. We retrospectively analyzed the myocardial perfusion imaging (MPI) obtained before and early after TASH in our patients to explore the relationship between the ablated myocardium's condition and the clinical outcome。

With continuing advanced research into pleural fluid turnover, the majority of scientists hold the view that pleural fluid is derived from the microvessels in parietal pleura and drained via parietal lymphatic vessels which empty into systemic veins. The lymphatic vessels that contribute to the pulmonary lymphatic circulation originate in the subpleural connective tissue, not directly from the visceral mesothelium.1 Therefore, according to the current point of view, pleural effusion absorption through the visceral pleural is normally negligible and visceral pleura, is not involved in the pleural fluid turnover.2 Our study explored the origins of pulmonary lymphatic tissues in humans and the possible effect of visceral pleural on pleural fluid turnover. We compared the incidence of pleural fluid between patients with left and right heart failure, and detected the origin and distribution of lymphatic tissues in pulmonary lymphangiopathy。

Subclavian steal syndrome is cerebral or brain stem ischemia resulting from diversion of blood flow from the basilar artery to the subclavian artery, which is caused by occlusive disease of either the subclavian artery or the innominate artery before they branch off at the vertebral artery. In the patients with subclavian steal syndrome the subclavian artery is fed by retrograde flow from the vertebral artery via the carotids and the circle of Willis。

Hemangiomas are abnormally dense collections of dilated capillary vessels which are difficult to diagnose being short of characteristic symptoms and signs. We present a patient with hemangioma who demonstrated many of the difficulties in diagnosis and led to misdiagnosis, which highlighted the importance of the modern computed tomography (CT) scan technique and bron- choscopic treatment. To our knowledge, this is the first report of hemangiomas with a long pedicel connected to the bronchial wall in the callan that was diagnosed and treated using bronchoscope。

Chronic eosinophilic pneumonia (CEP), a rare eosinophilic lung disease of unknown etiology, is characterized by peripheral blood eosinophilia, chest radiograph infiltrates, and prompt response to corticosteroid therapy.1 The first detailed description of CEP was described by Carrington et al 2 in 1969. The usual symptoms are cough, dyspnea, fever, and weight loss. It is most often seen in middle aged woman and has a subacute onset.1 We report a case of CEP presenting with right lower lung infiltrates and mucus plugging that causing bronchus obstruction。