2006年 · 第119卷第21期

Abstract：Background We compared the validity (evaluated by sensitivity and specificity), reliability (evaluated by reproducibility) and yield (evaluated by predictive value, examining complexity and cost) of individual and combined tests for bladder tumour antigen stat (BTAstat), nuclear matrix protein 22 (NMP22), hyaluronic acid (HA), survivin, CD44v6, vascular endothelial growth factor (VEGF), and voided urine cytology (VUC) in detecting bladder cancer. And at the same time we evaluated the clinical value of these seven detecting methods in the diagnosis of bladder cancer.Methods The six markers and VUC were detected in the urine of cancer group (151 patients with bladder cancer) and two control groups (50 patients with benign urological diseases and 50 healthy controls). The sensitivity, specificity, predictive value, reproducibility, examining complexity and checking cost of each marker and combined markers were calculated.Results There was a significant difference between bladder cancer group and the two control groups. The sensitivity, specificity and positive predictive value were as follows: VUC (36.4%, 100.0%, 100%), BTAstat (76.8%, 87.0%, 89.9%), NMP22 (77.5%, 81.0%, 86.0%), HA (82.8%, 83.0%, 88.0%), survivin (70.2%, 85.0%,87.6%), CD44v6 (50.3%, 79.0%, 78.4%), and VEGF (68.2%, 93.0%, 93.6%). The highest sensitivities were 91.4% for NMP22+BTAstat and HA+NMP22, whereas the combined marker with the lowest sensitivity (62.3%)was VUC+CD44v6. The highest specificity was 93.0% for the combined use of VUC+VEGF and HA+CD44v6 had the lowest specificity (73.0%). The most convenient examining method was the detection for BTAstat, the lowest cost was the detection for HA, and the best reproducibility were the detection for BTAstat and VUC.Conclusions All the markers have obvious clinical value in diagnosis of bladder cancer. The use of BTAstat+HA or NMP22+BTAstat are better examining methods in terms of validity, reliability, and yield。

Abstract：Background With the development of magnetic resonance (MR) technologies, whole-body 3D contrast-enhanced MR angiography (3D CE MRA) has become possible. The purpose of this study was to introduce and evaluate this technique in demonstration of various systemic arterial diseases.Methods Thirty-seven patients underwent whole-body 3D CE MRA using a 1.5T MR imager. The patients included were with clinically documented or suspected peripheral arterial occlusive disease (PAOD, n=19),Takayasu arteritis (n=8), polyarteritis nodosa (n=1), Type B dissection (n=4) and thoracic and/or abdominal aneurysm (n=5). Sixty-eight surface coil elements were employed to encompass the whole body. Four 3D CE MRA stations were acquired successively through automatic table moving. A total scan range of 188 cm,covering the arterial tree from carotid artery to trifurcation vessels, was acquired. Overall image quality of each arterial segment and venous overlay were assessed and rated. The depiction of various systemic arterial diseases was evaluated and compared with other imaging modalities if available, including digital subtraction angiography (DSA), CT angiography, dedicated mono-station MRA.Results Whole-body 3D CE MRA was well tolerated by all patients. It yielded a detailed display of the arterial system with a short examination time. The image quality was considered diagnostic in 99.3% of the arterial segments. The remaining 0.7% of the arterial segments were considered non-diagnostic. In 7 of 19 patients with PAOD, whole-body MRA showed additional vascular narrowing apart from peripheral arterial disease. In 9 patients with vasculitis, whole-body MRA depicted luminal irregularity, narrowing or occlusion, aneurysm and collateral circulation involving multiple vascular segments. Whole-body MRA also clearly revealed the severity and extent of dissection and aortic aneurysm. In 20 cases the vascular pathologies demonstrated on whole body MRA were confirmed by other imaging investigations.Conclusions The whole-body MRA technique was non-invasive, quick and easy to perform. It was valuable for a comprehensive evaluation of vascular involvement of various systemic arterial diseases。

Abstract：Background The advent of wavefront technology in the past five years has provided some insight into the optical outcomes of cataract surgery. The Tecnis Z9001 intraocular lens (Tecnis IOL, AMO) with a modified prolate anterior surface was claimed to reduce or even eliminate ocular spherical aberration to improve the visual quality. The purpose of this study was to determine whether Tecnis IOLs can improve the quality of vision as evaluated by measuring visual acuity, wavefront aberration, and contrast sensitivity.Methods In an intraindividual prospective study, 20 patients with bilateral cataract were randomly assigned to receive a modified prolate anterior surface IOL (Tecnis Z9001, AMO) in one eye and a biconvex spherical surface IOL (CeeOn 911A, AMO) in the other. After 3 months, the following were investigated: best corrected visual acuity, pupil diameter, photopic and mesopic contrast sensitivity, and wavefront aberration of the whole eye (ocular), cornea, and internal plane.Results The differences in the best corrected visual acuity and pupil diameter between the two groups were not statistically significant. Negative 4th-order spherical aberration (Z40) was found in the Tecnis group, whereas positive Z40 found in the CeeOn group for the internal and ocular plane. Statistically significant differences were found at the ocular higher-aberrations between the two IOLs. Contrast sensitivity testing showed significantly better results in the Tecnis group at visual angles higher than 1.0 degree under photopic conditions and at visual angles higher than 1.6 degree under mesopic conditions both without glare and with glare in comparison with the CeeOn group.Conclusions The Tecnis Z9001 IOL with a modified prolate anterior surface produces negative spherical aberration and consequently reduces the higher-order aberrations in pseudophakic eyes. This leads to enhanced contrast sensitivity and improved functional vision compared to conventional spherical IOLs。

Abstract：Background Hypertrophic cardiomyopathy (HCM) is a form of cardiomyopathy with an autosomal dominant inherited disease, which is caused by mutations in at least one of the sarcomeric protein genes. Mutations in the beta-myosin heavy chain (β-MHC) are the most common cause of HCM. This study was to reveal the disease-causing gene mutations in Chinese population with HCM, and to analyze the correlation between the genotype and phenotype.Methods The exons 3 to 26 of MYH7 were amplified by PCR, and the PCR products were sequenced in five non-kin HCM patients. A 17-year-old patient was detected to be an Arg723Gly mutation carrier. Then his family was gene-screened, and the correlation between genotype and phenotype was analyzed.Results The mutation of Arg723Gly in a Chinese family with HCM was detected for the first time. With a C-G transversion in nucleotide 13 619 of the MYH7 gene, located at the essential light chain interacting region in S1,the replacement of arginine by glycine took place at amino acid residue 723. A two-dimensional echocardiogram showed moderate asymmetrical septal hypertrophy with left atria enlargement. There was no obstruction in the left ventricular outflow tract. In his family, a total of 13 individuals were diagnosed HCM and 5 of them were dead of congestive heart failure at a mean age of 66-year-old. Eight living members were all detected to carry the mutation, in which 3 developed progressive heart failure. Moreover, the heart function of the people evidently deteriorates when their age are older than 50. The mutation and the disease show co-separated.Conclusion The Arg723Gly mutation is a malignant type. In Chinese the mutation has the similar characters to the former report but has low degree malignant。

Abstract：Background Vaginal myomectomy was firstly reported in 1994, however, it is a relatively new technique in China. The feasibility and safety of the procedure is still controversial in this country. The aim of this study was to analyze the outcomes of vaginal myomectomy in 90 patients and to investigate the feasibility and safety of the surgery.Methods From June 2001 to June 2004, 90 patients with uterine leiomyoma were treated with vaginal myomectomy in our hospital (vaginal group).. The indications, operative performance, postoperative complications, and recovery of the patients were analyzed and compared with those of 93 patients with uterine leiomyoma treated by laparotomic myomectomy from January 2000 to January 2001 (laparotomy group). The Student's t test was used to compare the continuous variables between the two groups, and the chi-square test was used to compare the categorical variables. The vaginal and laparotomy groups were followed up for 10-34 months (median, 21) and 15-24 months (median, 30), respectively.Results Vaginal myomectomy was performed successfully in 87 of the 90 patients (96.7%). In the other 3 patients, the procedure failed and laparotomy was carried out. In both groups, the uterus was enlarged to 8- 16 weeks gestational size (median, 10 gestational weeks). The number of resected tumors was 1-12 (median, 2) in the vaginal group and 1-15 (median, 4) in the laparotomy group, respectively (P＞0.05). The mean operating time, intraoperative blood loss, and postoperative hospital stay were (52 ± 21) minutes, (230± 44) ml, and (7.0 ±1.2) days in the vaginal group, and (65±32) minutes, (200±56) mi, and (7.0±1.5) days in the laparotomy group (P＞0.05). The mean top postoperative temperature was (38.4±1.1)℃ and (37.8±0.6)℃ in the two groups respectively (P＜0.05). Both groups had one recurrent case during the follow-up (P＞0.05).Conclusions Vaginal myomectomy is feasible and safe in treating uterine leiomyoma. To some extent, it is superior to laparotomic myomectomy by avoiding severe trauma during the surgery。

Abstract：Background Estrogen might play an important role in type 2 diabetes mellitus pathogenesis. A number of polymorphisms have been reported in the estrogen receptor alpha (ERα) gene (also named ESR1), including the XbaI and PvuⅡ restriction enzyme polymorphisms of ESR1, which may be involved in disease pathogenesis. The aim of this study was to determine whether ERα gene polymorphisms are associated with type 2 diabetes mellitus and serum lipid level.Methods Two hundred and ninety-nine patients with type 2 diabetes mellitus were compared with three hundred and forty-one health controls of Guangzhou in China, both were male and postmenopausal female residents at 51-70 years. ESR1 genotyping was performed using polymerase chain reaction (PCR) and PvuⅡ and XbaI restriction fragment length polymorphism (PCR-RFLP) analysis.Results ESR1 allelic frequencies of P, p and X, x alleles were 0.408, 0.592; 0.360, 0.640 in the type 2 diabetes mellitus group and 0.318, 0.682; 0.328, 0.672 in the control group, respectively. In case-control study, there was significant difference in PvuⅡ, but not XbaI, allele frequency between the type 2 diabetes mellitus and control groups (P=0.001 and P=0.122). When the group was separated into men and women, the difference was significant in women (P＜0.001) but not in men (P=0.854) with the PvuⅡ genotype, and the effect of PvuⅡ variant on the development of type 2 diabetes mellitus was improved with aging. In addition, PvuⅡ genotype was associated with blood glucose [fasting blood glucose (FBG), postprandial blood glucose (PBG)] and serum lipid [total cholesterol (TC) and low density lipoprotein (LDL)-c] concentration in healthy women.Conclusions PvuⅡ polymorphism of ESR1 increases susceptibility to type 2 diabetes mellitus in Chinese Guangzhou women. ESR1 variants may also impact serum lipid metabolism, which might provide a mechanism connecting ESR1 to type 2 diabetes。

Abstract：Background Although dopamine transporter (DAT) is essential for addiction, the effect of additive drugs on DAT function is still controversial, especially for opiates. We investigated the functional changes of dopamine transporter in striatum of rhesus monkeys during acute morphine injection and its abstinence.Methods Four rhesus monkeys, 6 to 9 years old, two male and two female, were examined for 12 days. Single photon emission computed tomography (SPECT) was performed with 99Tcm-TRODAT-1 as the radiopharmaceutical dopamine transporter agent during different stages of acute morphine injection and its abstinence. The ratios of SPECT signal between striatum and cerebellum (ST/CB) were calculated.Results The ST/CB ratio declined significantly on the first day of morphine injection and continued declining with more morphine injections. After abstinence, the ratio increased with time, but was still significantly lower on the 5th day of abstinence than the normal level.Conclusions In rhesus monkey, acute morphine injection has both rapid and lasting effects on DAT by downregulating its function. The decline was partially reversible following morphine abstinence. The results suggest that striatum is one effective target of morphine and that the DAT function in striatum is one indicator for morphine addiction。

Abstract：Background Atherosclerosis is a complex vascular inflammatory disease. Aspirin is a mainstay in the prevention of vascular complications of atherosclerosis. In this study, the effectiveness of aspirin in suppressing atherosclerosis and the inflammation process was evaluated in rabbits fed with a high fat diet.Methods Eighteen male New Zealand rabbits were randomly divided into 3 groups: control group, untreated cholesterol-fed group, aspirin treated cholesterol-fed group, which were fed for 12 weeks. After 12 weeks, the aorta was harvested for pathologic morphology observation. Immunohistochemical analysis of cyclooxygenase-2 (COX-2), macrophage and vascular smooth muscle cell (VSMC) was performed. The statistical analysis was performed by the statistical program SPSS 10.0.Results The aorta plaque/intima size (P/I) by pathologic morphology observation was 0%, (59.6± 13.7)% and (36.3± 16.5)% in the control, untreated cholesterol-fed group and aspirin treated group, respectively. The maximum plaque thickness, the degree of artery stenosis and the proportion of the intimal circumference occupied by atheroma of the 3 groups were significantly different from each other (P＜0.01). The expression of COX-2 and macrophage in plaque of the aspirin treated group were decreased compared with that in untreated cholesterol-fed group. However, no difference was found in the expression of VSMC between the aspirin treated and the untreated cholesterol-fed group.Conclusion The mechanism of atherosclerosis suppression by aspirin in cholesterol-fed rabbits is related to the inhibition of COX-2 expression together with the reduced inflammation followed by, but not related to the hypolipidemic effects。

Abstract：Background The increased use of ail-ceramic crown provides a rationale for tooth-colored core. Due to superior mechanicai properties, Vita Celay infiltration ceramic developed for crown and bridge works presents the potential for fabricating ail-ceramic posts and cores in one piece. This study was conducted to compare the fracture strength of endodontically treated teeth which were thereafter given different types of posts and cores and crowns restoration, respectively. The evaluated post-and-core systems are: custom-fabricated Celay ail-ceramic post-core, custom cast metal post-core, and prefabricated stainless steel post (Parapost) with and without 2.0 mm dentine ferrule.Methods Sixty freshly extracted human maxillary central incisors were endodonticaily treated and randomly divided into five groups with 12 samples each. Group A: Celay ceramic post-cores restored teeth with 2.0 mm dentine ferrule. Group B: Celay ceramic post-cores restored teeth with no dentine ferrule. Group C: cast metal post-cores restored teeth with 2.0 mm dentine ferrule. Group D: cast metal post-cores restored teeth with no dentine ferrule. Group E: prefabricated post and composite cores restored teeth with 2.0 mm dentine ferrule. All teeth were restored with Celay ceramic crowns. Each specimen was subjected to a load at a 45-degree angle to the long axis on MTS 810 material testing machine until failure, at crosshead speed of 0.02 em/minute. Analysis of variance followed by the Newman-Keuls pairwise multiple comparison tests were used to compare the results of the groups tested.Results There was a statistically significant difference among the five groups (P＜0.01). Celay ceramic post-cores restored teeth with 2.0 mm dentine ferrule [(758.35±119.26) N] and cast metal post-cores restored teeth with 2.0 mm dentine ferrule [(756.63 ±166.22) N] had a significantly greater mean fracture strength than the other three groups in which no significant difference was observed. The 2.0 mm dentine ferrule could cause significant fracture resistance alteration of Celay post-core restored teeth.Conclusions When covered with Celay ceramic crowns, Celay post-cores restored teeth with 2.0 mm dentine ferrule and cast metal post-cores restored teeth with 2.0 mm dentine ferrule have similar fracture strength. There was a statistically significant difference between the fracture resistance of Celay post-core restored teeth with and without 2.0 mm dentine ferrule。

Abstract：Background Previous studies showed that the prognostic factors for superficial transitional cell carcinoma of the bladder varied with the findings of different cohorts. Few multivariate analyses of prognostic factors for superficial bladder tumors have been reported in China and bladder preservation as a prognostic index of superficial bladder tumors is limited and scarce in Chinese patients. This study was conducted to analyze a group of risk factors for prognostic outcomes for patients with primary superficial transitional cell carcinoma of the bladder.Methods Between January 1980 to December 2000, 198 patients [172 men and 26 women; mean age (52.98±11.28) years] with primary superficial transitional cell carcinoma who were pathologically classified as Ta or T1 in Hunan Provincial Tumor Hospital (Changsha, China) were enrolled in this study. Surgical methods included local resection and electric coagulation of bladder tumors, transurethral resection of bladder tumors and partial cystectomy. After initial surgical treatment, patients were followed through a cystoscopy every three months during the first two years and every six months thereafter in the design of retrospective cohort. Survival analysis was performed to analyze risk factors of the prognostic outcomes for transitional cell carcinoma of the bladder.Canonical correlation analysis was conducted to present and interpret synthetically the multi-correlation between all kinds of prognostic outcomes and risk factor in multiply dimensions.Results The average follow-up period was (6.65±4.74) years. Assessments at three, five, and 10 years showed recurrence rates, respectively, of (28.32 ± 3.45)%, (35.31 ± 3.83)%, and (42.48 ± 4.40)%; progression rates of (8.89±2.14)%, (15.16±2.94)%, and (23.88±4.19)%; bladder-preservation rates of (94.68± 1.74)%, (93.87±1.91)%, and (91.51±2.49)%; metastasis rates of (8.25±2.05)%, (11.24±2.47)%, and (28.94±4.93)%; and cancer-related survival rates of (95.02 ±1.62)%, (90.70 ± 2.45)%, and (77.14± 4.88)%. The main risk factors for recurrence were histological grade, blood transfusion during surgery and the duration of symptoms. Progression was affected by blood transfusion during surgery, histological grade, the number of re-examinations, and the length of the recurrence-free period. Metastasis was associated with tumor multifocality, hydronephrosis,microscopic growth pattern, and the recurrence-free period. Cancer-related survival was influenced by microscopic growth pattern and the recurrence-free period. Bladder preservation involved only the recurrence-free period. The comprehensive results from canonical correlation analysis showed that the main prognostic outcomes were cancer-related survival, metastasis and progression respectively, while the dominate risk factors were histological grade, tumor multifocality and blood transfusion.Conclusions The risk factors were different for each prognostic outcome of transitional cell carcinoma of the bladder. This is helpful for predicting the prognosis of transitional cell carcinoma of the bladder and designing therapeutic and follow-up strategies for this cancer。

5-fluarouracil-based chemotherapy has become a standard regimen for the treatment of advanced colorectal cancer (ACRC).1 Defined as the second line therapy for ACRC with 5-fluarouracil (5-Fu) plus leucovorin (LV) combined with oxaliplatin (OXA), the response rate (RR), progression-free survival (PFS)and overall survival (OS) were 21.2%, at 4.7 and 11.5 months, whereas RR, PFS and OS with 5-Fu plus LV combined with irinotecan (CPT-11) were 11.4%, at 3.2 and 12.2 months. There were no statistical difference between the two protocals.2,3 Those results may well suggest that some of these patients were resistant to 5-Fu. Therefore it is necessary to find a more effective regimen without 5-Fu to treat recurrent ACRC patients that were initially treated with 5-Fu. Our previous study showed that OXA can enhance the function of hydroxycamptothecine (HCPT) in inducing the apoptosis of a human colorectal cell line in vivo.4 So we chose OXA plus HCPT (OH) regimen to treat 28 patients with ACRC and compared RR, one-year survival rate, PFS, OS and main toxicities with a 5-Fu plus LV combined with OXA (OFL) regimen。

Diabetic nephropathy, one of the major causes of death of diabetes patients, is diagnosed as the thickening of glomerular basement membrane and progressive expansion of the glomerular mesangium and tubulointerstitium. Intensive studies have shown that hyperglycemia is the key factor for renal sclerosis which can lead to end-stage renal disease for diabetic patients.1,2 Our previous studies demonstrated that Xiaoke granule can inhibit the progression of diabetic nephropathy. However, its mechanisms remain unknown.3,4 In this study, we found that Xiaoke granule coincidently depresses transforming growth factor-beta1 (TGF-β1)expression and inhibits the effect of high glucose on mesangial cell proliferation. This might suggest that the effect of Xiaoke granule on inhibiting progression of diabetic nephropathy through down-regulating TGF-β1 expression。

Traumatic brain injury (TBI), which is an important reason of human mortality and morbidity in industrialized countries, still cannot be treated effectively. Since the self-repair capacity of brain is limited, cellular transplantation in TBI may be a therapeutic option。

Leukotrienes (LTs) are synthesized from membrane derived arachidonic acid.Downstream of 5-lipoxygenase in the arachidonic acid cascade, leukotriene C4 synthase (LTC4S)catalyses the conjugation of leukotriene A4 (LTA4)with reduced glutathione to form LTC4, then LTC4 convert to active metabolites LTD4 and LTE4. LTC4, LTD4 and LTE4, which are called cysteinyl leukotrienes (CysLTs), are potent proinflammatory mediators of asthma. LTC4S is the key enzyme involved in the formation of CysLTs. There is a polymorphism of adenine (A) to cytosine (C) transversion at -444 locus in the promoter region of the LTC4S gene, A-444C. This allelic variant results in an extra recognition site for the Ap-2 transcription factor and is associated with an increased LTC4S transcription rate. Some studies in other countries suggest that LTC4S A-444C polymorphism is associated with asthmatic severity and clinical response to leukotriene receptor antagonist.

AIthough recurrent traumatic carotid-cavernous fistula (CCF) and its treatment have been reported sporadically,1 a complex cavernous sinus dural arteriovenous fistula (DAVF) secondary to balloon embolization of a direct traumatic CCF is rare. In 2005, we treated such a case via transvenous approach using coils and N-buty-2-cyanoacrylate (NBCA). The causes of recurrent cavernous sinus DAVF and its endovascular approach are discussed。