2007年 · 第120卷第11期

Abstract：Objective To review and assess the update studies regarding se lective serotonin reuptake inhibitors (SSRIs) in the treatment of premature ejaculation (PE) and then provide practical recommendations and possible mechanisms concerning state of the art knowledge for the use of SSRIs in alleviating PE.Data sources Using the Medline, 48 articles published from January 1st, 1996 to August 1st, 2006 concerning the use of SSRIs and their possible mechanisms in alleviating PE were found and reviewed.Study selection PE, rapid ejaculation, early ejaculation and SSRIs were employed as the keywords, and relevant articles about the use of SSRIs and their possible mechanisms in the treatment of PE were selected.Results Many kinds of SSRIs, such as fluoxetine, sertraline, paroxetine and citalopram, have widely been employed to treat PE. However, their effects are moderate and there is no a universal agreement about the kind, dose, protocol and duration. Dapoxetine, as the first prescription treatment of PE, may change this bottle-neck situation. SSRIs are suggested to be used in young men with lifelong PE, and acquired PE when etiological factors are removed but PE still exists. Phosphodiesterase 5 inhibitors (PDE5-Is) are suggested to be employed alone or combined with SSRIs when SSRIs fail to treat PE or sexual dysfunction associated with SSRIs occurs. The protocol of taking drugs on demand based on taking them daily for a suitable period is proposed to be chosen firstly. The possible mechanisms include increasing serotonergic neurotransmission and activating 5-hydroxytryptamine 2C (5-HT2C) receptors, then switching the ejaculatory threshold to a higher level, decreasing the penile sensitivity and their own effect of antidepression.Conclusion The efficacies of the current SSRIs are moderate in the treatment of PE and they have not been approved by the FDA, therefore new SSRI like dapoxetine needs to be further evaluated。

Radiofrequency (RF) ablation of the critical isthmus between the tricuspid annulus and the inferior vena cava is commonly used to treat typical atrial flutter (AFL).1 This has become the first line therapy in Europe and in the US due to its high success rate and significant improvement in quality of life compared with conventional medical therapy.2 Sizeable lesions are required to achieve persistent bidirectional conduction block (BCB), which is the best endpoint to ensurelong-term success.3,4 Cooling the ablation electrode by irrigation has been shown to prevent both overheating of the electrode-tissue interface and impedance rise during RF delivery, allowing greater power delivery and larger,deeper lesion.5 Recent studies showed that pain-free cryoablation was comparable to RF ablation regardingthe short and long-term clinical success rate and safety.6However, no studies have shown that cryoablation is superior to the irrigation RF ablation. In this study, we compared the efficacy and safety of cryoablation with the irrigation radiofrequency ablation technologies for typical AFL。

Pre-menopausal women are at risk for iron deficiency due to menstrual blood losses. The prevalence rates (PR) of iron depletion, iron deficiency anemia (IDA), and iron deficiency were 34.4%, 15.1% and 49.5% in pre-menopausal non-pregnant women respectively in China.1 Traditionally, the diagnosis of iron deficiency relies on the hematological markers (hemoglobin (HGB),mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), red cell distribution width (RDW))and biochemical markers (serum ferritin (SF), serum iron (SI), transferrin saturation (TS), total iron-binding capacity (TIBC)). Recently, the reticulocyte hemoglobin content (CHr) is considered to be used as a marker of iron deficiency.2 The aim of this study was to compare the diagnostic efficiency of CHr with the old markers in diagnosis of iron deficiency in Chinese pre-menopausal women。

Paraplegia is a rare but terrible complication following major spinal operation. Intraoperative monitoring should be used to detect the neurological complications early so that they can be surgically revised.1 The common procedures for spinal cord monitoring are intraoperative wake-up test and neurophysiological methods. The latter includes somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP). The wake-up test has been routinely used to monitor voluntary motor function of the lower limbs during corrective spinal surgery.During the wake-up procedure, the depth of anaesthesia should be lightened gradually to make patients respond to verbal commands。

The islet transcription factor pancreatic duodenal homeobox-1 (PDX-1, also known as insulin promoter factor-1 or IPF-1) is an orphan homeodomain protein that plays an important role in the development, proliferation,differentiation and maturation of pancreatic cells。

Both diabetes mellitus (DM) and hypertension are common in the aged population. The incidence of angiopathies and calcification in pulp vessels is more frequent in DM patients than nondiabetics.1 Some evidences have suggested an interaction between control of blood pressure and pain regulation. Zamir and Shuber 2found that hypertensive patients had a higher threshold for sensation of pain than normotensive controls in the tooth-pulp electricity test。

Polydactyly, one of the fairly common congenital deformities of the hands and/or feet, occurs as an isolated disorder or as part of a syndrome. It is not only observed sporadically, but also inherited with a mainly autosomal dominant inheritance. However, postaxial polydactyly in both hands and feet with 24 digits in total was rarely reported in China。

Fat-forming variant of solitary fibrous tumor (fat-forming variant of SFT), previously called lipomatous hemangiopericytoma (L-HPC), is a recently recognized rare variant of solitary fibrous tumor (SFT)with unpredictable biologic behavior. Fat-forming variant of SFT occurs predominately in the deep soft tissues of the lower extremities. Histologically, it is composed of an admixture of benign hemangiopericytomatous and lipomatous components. Up to now, only 37 cases have been reported in the English literature worldwide1-7 and the molecular analyses are sparse. Reported herein is the first Chinese case of fat-forming variant of SFT. Although one case of fat-forming variant of SFT in the mediastinum was briefly reported, this is the first case in the region with detailed histologic, immunohistochemical features and flow cytometric DNA analysis。

Abstract：Background It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor liver transplantation (LDLT) without the middle hepatic vein (MHV). Excessive perfusion of the portal vein and venous outflow obstruction will lead to acute congestion of the graft, ultimately resulting in primary nonfunction. Although various reconstruction patterns have been explored in many countries, there is currently no clear consensus. In this study we describe a technique to prevent "chocking" of the graft at the outflow anastomosis with the inferior vena cava (IVC) in LDLT using right lobe graft without the MHV.Methods A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobe grafts without the MHV or reconstruction of hepatic venous outflow. The donor's right hepatic vein (RHV) was anastomosed with a triangular opening of the recipient IVC; the inferior right hepatic vein (IRHV), if large enough, was anastomosed directly to the IVC. The great saphenous vein (GSV) was used for reconstruction of significant MHV tributaries.Results No deaths occurred in any of the donors. Of the 55 recipients, complications occurred in 6, including hepaticvein stricture (1 case), small-for-size syndrome (1), hepatic artery thrombosis (1), intestinal bleeding (1), bile leakage (1),left subphrenic abscess and pulmonary infection (1). A total of three patients died, one from small-for-size syndrome and two from multiple system organ failure.Conclusions The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow. This technique alleviates surgical risk of living donors, ensures excellent venous drainage, and prevents vascular thromboses and primary nonfunction。

Abstract：Background Dopamine exerts its effects mainly in nervous system through D1, D2 or D3 receptors. There are few reports dealing with the effects of dopamine on leukaemia cells. However, some dopamine agonists or antagonists do show biological effects on some types of leukaemia cells. Here, we report the effects of dopamine on the proliferation,differentiation and apoptosis of K562 leukaemia cells.Methods Proliferation was determined by MTT assay and cell counting both in liquid and semisolid cultures.Differentiation was verified by morphology, benzidine staining and flow cytometry. Apoptosis was checked by Hoechst 33258 staining and flow cytometry. The two groups were untreated group and treated group (dopamine 10-9 mol/L-10-4mol/L).Results In liquid culture, MTT assay and colony assay, dopamine inhibited proliferation of K562 cells. Inhibition rate was 29.28% at 10-6 mol/L and 36.10% at 10-5 mol/L after culture for 5 days in MTT assay. In benzidine staining and CD71 expression, dopamine induced K562 cells toward erythroid differentiation by increased 155% at 10-6 mol/L and by 171% at 10-5 mol/L after culture for 5 days in benzidine staining. In Hoechst 33258 staining and flow cytometry,dopamine induced K562 cells toward apoptosis. The sub G1 peak stained by PI was 14.23% at 10-4 mol/L dopamine after culture for 3 days compared with the control (0.81%) in flow cytometry.Conclusion Dopamine inhibites proliferation and induces both differentiation and apoptosis of K562 leukaemia cells。

Abstract：Background The methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF-s) - simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome.Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.Methods To treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization.Results All iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4-46 days (mean (15±10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6-24 months (mean (11.8±3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed.Conclusion The results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure。

Abstract：Background Pulmonary-vein isolation (PVI) is currently used for the treatment of chronic and paroxysmal atrial fibrillation and a major risk of PVI is thromboembolism. The purpose of this study was to observe embolic event rate in patients with persistent or paroxysmal atrial fibrillation (AF) undergone PVI.Methods Circumferential PVI (CPVI) was performed in 64 consecutive patients with persistent AF (42 men, aged (60.0±9.1) years) and in 84 consecutive patients with paroxysmal AF (53 men, aged (61.4±9.3) years). Warfarin was administrated in all patients before ablation for at least 3 weeks ((5.2±2.6) weeks) and continued for at least 3 months post ablation with international normalized ratio (INR) of 2.0-3.0. During CPVI, intravenous heparin was given at a dose of 5000-8000 U or 75-100 U/kg, followed by 1000 U or 12 U/kg per hour.Results In patients with persistent AF, 1 patient developed embolic event during ablation and 3 patients developed embolic events after ablation. In contrast, no thromboembolic event was observed in patients with paroxysmal AF (4/64vs 0/84, P=0. 033).Conclusion Thromboembolic event rate related to CPVI is significantly higher in patients with persistent AF than that in patients with paroxysmal AF。

Abstract：Background 11C-4-N-(3-bromoanilino)-6,7-dimethoxyquinazoline (11C-PD153035) has been reported as a tracer for imaging human tumors that overexpress epidermal growth factor receptor (EGFR). However it is still unclear whether 11C-PD153035 uptake correlates with EGFR expression levels. The objective of this study was to investigate the relationship between 11C-PD153035 accumulation and EGFR expression levels.Methods Synthesis of 11C-PD153035 was performed in the Tracerlab FXc system. Accumulation of 11C-PD153035 by MDA-MB-468, A549 and MDA-MB-231 cells was measured in vitro. There were six tumor-bearing mice in each group.11C-PD153035 uptake in tumors was determined by positron emission tomography/computed tomography (PET/CT).Tumor/normal muscle tissue (T/NT) analysis in PET images was applied to quantify the PET data. Sixty minutes after PET/CT scanning, the nude mice were sacrificed and the tumors were excised. The 11C-PD153035 accumulation in different tumors was determined by a gamma counter.Results Close correlation existed between the uptake and the level of EGFR expression both in vitro and ex vivo (r2=0.72, P＜0.001; r2=0.63, P=0.003). When the static T/NT analysis method was applied to analyze the PET data, the observed correlation was again excellent (r2=0.70, P=0.001).Conclusions The uptake of PET tracer 11C-PD153035 closely correlates with the EGFR expression levels in tumor cells. 11C-PD153035 has the potential to yield useful information for both cancer diagnosis and therapy。

Abstract：Background Promoter analysis is currently applied to detect the expression of the targeted gene in studies of signal transduction and transcriptional regulation. As a reporter gene, luciferase plays an important role and has been used widely in the promoter assay.Methods Human embryonic lung fibroblast cells (2BS), HeLa cells and MCF-7 cells were transfected with various genes embedded by lipofectamine. This study determined various factors that affect promoter activity determination,such as the selection of the reporter genes and internal references, the dose and the type of the vectors carrying the transcription factors, the host cells and the instruments.Results The sensitivity of the luciferase assay was much higher than that of enhanced green fluorescence protein (EGFP). Moreover, promoter activity is increased in a dose-related manner only in certain ranges outside of which the results may be reversed and the promoter activity is related to the expression vector which is carrying the cDNA.Otherwise, the length of the promoter, internal references and the host cell can also influence the promoter activity.Conclusions To detect the promoter activity accurately, a few factors including dose, vector, length and host cell which influence reporter gene assay aforementioned should be considered。

Achondroplasia (ACH) is the most common form of skeletal dysplasia characterized by disproportionately short stature, lumbar lordosis, relative macrocephaly and other skeletal anomalies resulting from a defect in the maturation of the chondrocytes in the growth plate of the cartilage. The combined frequency of the disease has been estimated to be 1 in 15 000 live births.1 ACH is inherited in autosomal dominant fashion with a complete penetrance, more than 80% of affected individuals have de novo mutations associated with increased paternal age。