2003年 · 第116卷第01期

Objective To study the mechanism and feasibility of transurethral electrochemical therapy for the treatment of benign prostatic hyperplasia (BPH). Methods Between March 1998 and March 2000, specifically designed devices and catheters for electrochemical therapy were applied to 6 prostate specimens obtained by suprapubic prostatectomy in order to treat BPH patients with urinary retention for whom surgery was contraindicated. Sixteen patients (with a mean age of 77.3 years old) underwent electrical treatment totaling 160 - 220 coulombs under topical urethral anesthesia for 68 - 132 min. The catheters remained inside the patient for 7 - 10 d. Results Irreversible destructive changes occurred within cathodal tissue, while carbonization occurred within anodic tissue. The radius of tissue change was 7-8 mm and 1 - 2 mm, respectively. In vivo trial: 11 (69%) patients could be weaned off the catheters with satisfactory urination. Three months after therapy, the mean international prostate symptom score (IPSS) was 14.5, mean peak flow rate was 10.5 ml/s, and mean residual urine was 39 ml. No serious complications were observed. Conclusion Transurethral electrochemical treatment is potentially a minimally invasive alternative for treatment of BPH, especially for elderly patients at high risk. Chin Med J 2003; 116(1): 104-107

Objective To investigate whether pretreatment with repeated electroacupuncture (EA) at the Baihui acupoint could induce ischemic tolerance against transient focal cerebral ischemic injury in rats. Methods Thirty male Sprague-Dawley (SD) rats were randomly divided into 3 groups (n = 10 for each): the control group consisted of animals receiving no treatment, the isoflurane (ISO) group had animals that inhaled 1.5% isoflurane for 30 min a day for 5 days, and animals in the EA group received electroacupuncture at the Baihui acupoint for 30 min a day for 5 days under 1.5% isoflurane anesthesia. Twenty-four hours after the last treatment, the middle cerebral artery was occluded with No. 3 nylon monofilament for 120 min. The neurological outcomes were evaluated 24 h after reperfusion. The infarct volumes were then assessed using 2% triphenyltetrazolium chloride staining after the neurological outcome evaluation. Results The neurological deficit score (NDS) of the EA group [1(0-2)] was lower than that of the ISO group [2(1-3)] and the control group [2(1-4)], P < 0.05. The infarct volume of the EA group (38.3 ± 25.4 mm3) was significantly smaller than that of the control group (220.5 ± 66.0 mm3) and the ISO group (168.6 ± 57.6 mm3) 24 h after reperfusion. Conclusion Electroacupuncture at the Baihui acupoint 30 min a day for 5 days significantly reduces neurological injury induced by transient middle cerebral artery occlusion. Chin Med J 2003; 116(1): 108-111

Objectives To investigate the relationship between H. pylori infection, gastric cancer and other gastric diseases through the changes in gastric mucosa and the status of different gastric diseases within 5 years after H. pylori eradication in H. pylori-positive subjects in a high incidence region of gastric cancer. Methods One thousand and six adults were selected from the general population in Yantai, Shandong province, a high incidence region for gastric cancer in China. Gastroscopy and Campylobacter-like organism (CLO) testing were performed on all subjects. Biopsy samples from the gastric antrum and body were obtained for histology and assessment of H. pylori infection. All H. pylor-positive subjects were then randomly divided into two groups: treatment group receiving Omeprazole Amoxicillin Clarythromycin (OAC) triple therapy and placebo as controls. These subjects were endoscopically followed up in the second and fifth year. We compared the endoscopic appearance and histology of the biopsy specimens from the same site obtained at the first and last visits. Results All 552 H. pylor-positive subjects were randomly and evenly divided into treatment group or control group. During the five-year follow-up, the numbers of patients who continued to be negative or positive for H. pylori were 161 and 198, respectively. Statistical analysis revealed that: ① At the initial visit, there were no significant differences in the severity and activity of inflammation, atrophy and intestinal metaplasia between the biopsy specimens from the antrum and body respectively in both groups. ② The severity and activity of inflammation in both the antrum and body were markedly reduced after H. pylori eradication (P = 0.000) . ③Within five years after H. pylori eradication, intestinal metaplasia in the antrum either regressed or had no progression, while the proportion of intestinal metaplasia in the H. pylori-positive group increased significantly (P = 0.032). ④ After H. pylori eradication, the atrophy in both the antrum and body had no significant regression. The P value was 0.223 and 0.402, respectively. Conclusions H. pylori eradication results in remarkable reduction in the severity and activity of chronic gastritis, marked resolution of intestinal metaplasia in the antrum. On the other hand, continuous H. pylori infection leads to progressive aggravation of atrophy and intestinal metaplasia. Chin Med J 2003; 116(1): 11-14

Objectives To assess the value of non-invasive medical imaging for diagnosis of carotid artery stenosis and to study the relationship between carotid stenosis and brain infarction. Methods Thirty-one patients with a total of 62 carotid arteries were studied using Doppler ultrasound (DUS) and magnetic resonance angiography (MRA). Eleven of the 31 patients were studied using CT angiography (CTA). CT and MRI of the brain were also done in all patients. The imaging results in 5 patients were compared with those of digital subtraction angiography (DSA). Eight patients with severe stenosis received carotid endarterectomy. The comparisons between the imaging results and pathological data were conducted in 2 patients. Results Of the 62 carotid arteries, mild stenosis was seen in 11, moderate in 14, severe in 21, obstructed in 4 and normal in 12. In 25 patients with severe stenosis or occlusion of carotid arteries, there were a total of 35 focal or multifocal infarcts on the ipsilateral cerebral hemisphere, and 15 infarcts on the contrary side. Compared with the results of the operations, DUS correctly diagnosed 6 stenoses, while MRA identified 7 correctly and CTA 8. Agreement on location of stenosis as performed by endarterectomy, DUS, MRA and CTA occurred in all patients. Histologically, areas of calcification and fibrousness were related to high densities on CTA, strong echoes on DUS, and low signal intensities on MRA. Relatively large amounts of necrotic material and foam cells filled with lipolytic materials on the intimal surface of arteries were observed during pathologically, corresponding to low and iso-densities on CTA, low echoes on DUS, and inhomogeneous signal intensities on MRA. Conclusions A strong link exists between carotid stenosis and brain infarction. The combined use of DUS, MRA and CTA can improve diagnostic accuracy for the assessment of carotid artery stenosis, as well as assist in ascertaining the nature of the plaque. Chin Med J 2003; 116(1): 112-115

Objectives To reveal the relationship of brain motion and cerebrospinal fluid (CSF) flow by phase-contrast cine MRI, and to evaluate this technique in differentiating between arachnoid cysts and subarachnoid space enlargement. Methods Using a phase-contrast cine MRI pulse sequence, we measured brain motion and CSF flow during the cardiac cycle in 10 healthy volunteers and 10 patients with MRI-suspected arachnoid cyst or subarachnoid space enlargement. CSF stroke volume curve was illustrated according to flow quantification, and time-signal intensity curve was traced. The two curves were compared. Results This study showed that brain motion was due to the volume difference between arterial and venous blood flow during a cardiac cycle, and thus drives CSF pulsation. Arachnoid cysts and subarachnoid space enlargement carried different curve patterns, demonstrating that phase-contrast MRI and flow quantification can be a useful and reliable technique for non-invasive evaluation of brain motion and CSF flow. Conclusion Arachnoid cysts can be successfully differentiated using phase-contrast cine MRI from subarachnoid space enlargement. Chin Med J 2003; 116(1): 116-120

Objective To assess a new intervention for reestablishing the second hepatic hilum by means of puncturing and stenting the liver tissue between the intrahepatic vena cava and a hepatic vein for the treatment of Budd-Chiari syndrome (BCS). Methods Two patients with BCS, in which no second hepatic hilum structure was found in transhepatic venography, underwent an interventional procedure of canalizing and stenting the parenchyma tract between the intrahepatic vena cava and a hepatic vein. The procedures were performed in the percutaneous transhepatic and right jugular vein, respectively. A metallic stent with a 10 mm diameter was implanted to maintain tract patency. Results The free hepatic vein pressure (FHVP) of both patients decreased from 37 mm Hg to 5 mm Hg and from 28 mm Hg to 4 mm Hg, respectively, after the procedure. The complication of hemorrhage due to puncture was observed in one patient. Both patients maintained hepatic improvements in 3-year follow-up. Both clinical conditions and laboratory values were significantly improved after the procedure. Furthermore, the stented canals (the reestablished second hepatic hilum) maintained patent with normal FHVP, which was confirmed by control venography. Conclusion The new technique provides a simple, safe, effective, and relatively inexpensive treatment of Budd-Chiari syndrome. Long-lasting effectiveness is expected. Chin Med J 2003; 116(1): 121-124

Objective To evaluate transcervical removal of foreign bodies (TCRF) and to estimate the effectiveness of its monitoring methods. Methods One hundred and thirteen women were identified as having residual intrauterine devices (IUD), residual pregnancy products, unabsorbed strings and broken hooks, which were not removed during routine curettage or IUD removal. All patients were monitored using B ultrasonography while TCRF was performed. Four cases were monitored by laparoscopy simultaneously. One case was monitored by laparoscopic ultrasonography. Results Foreign bodies of one hundred and nine patients were taken out by TCRF. Uterine bleeding, amenorrhoea, discharge, abdominal pain, micturition and hematuria disappeared postoperatively. Fetal bones embedded into intramural uterin in four cases were not removed completely. Of these four, one became pregnant 4 months later after TCRF and term delivered. One case encountered uterine perforation that was sutured by laparoscopy. Conclusions TCRF is safe and efficient. Sufficient cervical canal distension, selection of equipment and methods to be used is important for successful TCRF. As a non-invasive and effective monitoring method, B ultrasonography is the first choice to monitor for TCRF. For patients with high risk factors for uterine perforation, laparoscopic monitoring should be done simultaneously. Laparoscopic ultrasonography monitoring has both the advantages of B ultrasonography and laparoscopy monitoring, but is invasive and expensive. Chin Med J 2003; 116(1): 125-128

Objective To establish the specific 16S-23S rRNA gene spacer regions in different bacteria using polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), DNA cloning and sequences analysis. Methods A pair of primers were selected from highly conserved sequences adjacent to the 16S-23S rRNA spacer region. Bacterial DNA from sixty-one strains of standard bacteria and corresponding clinical isolates representative of 20 genera and 26 species was amplified by PCR, and further analyzed by RFLP, DNA cloning and sequences analysis. Furthermore, all specimens were examined by bacterial culturing and PCR-RFLP analysis. The evaluation of these assays in practical clinic practice was also discussed. Results Restriction enzyme analysis revealed one, two or three bands or more observed among the 26 different standard strains. The sensitivity of PCR reached 2.5 colony-forming unit (CFU), and there was no cross reaction with human genomic DNA, fungus or virus. Fourteen species could be distinguished immediately by PCR, while another 10 species were further identified by Hinf I or Alu I digestion. The only difference between K. pneumoniae and E. durans was located at the site of the 779th nucleotide according to the sequence analysis and only Xma Ⅲ digestion could distinguish one from another. Of 42 specimens from septicemic neonates, 15 were identified as positive by blood culture at a rate of 35.7%. However, 27 specimens identified as positive by PCR, with a rate of 64.2%, a method significantly more effective than blood culture (P < 0.01). Of 6 cerebrospinal fluid (CSF) specimens, one tested positive for S. epidermidis was also positive by PCR, two culture negative were positive by PCR and diagnosed as S. epidermidis according to the DNA pattern. One positive for C. neoformans was negative by PCR. The other two specimens were negative by both PCR and culture. Conclusions The method of detecting bacterial 16S-23S rRNA spacer regions using PCR-RFLP techniques was specific, sensitive, rapid and accurate in providing a new technique for detecting pathogens in clinical bacterial infections. Chin Med J 2003; 116(1): 129-133

Objective To evaluate the clinical outcome of craniofacial resection for advanced malignant tumors in oral and maxillofacial regions. Methods Forty-six patients who underwent craniofacial resection for malignancies involving the anterior and middle cranial fossa over a 20-year period between June 1978 and December 1997 at our department were evaluated. Twenty patients received radiation therapy and an adjuvant therapy after the operation. Eleven patients received chemotherapy of various types as an adjuvant therapy. Results The 3- and 5-year survival rates were 48.8% (20/41) and 35.1% (13/37), respectively, while the 10-year survival rate was 20% (4/20). Conclusions Our results revealed good prospects of using craniofacial resection on patients with advanced malignancies in the oral and maxillofacial regions. Chin Med J 2003; 116(l): 134-137

Objective To obtain peptide mimicking epitopes of Schistosoma japonicum (S. japonicum) through screening of a phage peptide library and to test their potential for induction of protection. Methods S. japonicum infected sera from Microtus fortis (IMFS) and normal sera from Microtus fortis (NMFS) were used respectively to screen a 12-mers random peptide library by testing the reactivity of anti-S. japonicum serum with the phagotopes. After three rounds of biopanning, the pooled phages were used to immunize mice, after which challenge infection was performed. Results Of 12 randomly picked clones, 10 clones selected using IMFS and 7 clones selected using NMFS were shown to be antigenic. Significant reduction in adult worms (22.6%) and a high reduction (68.9%) in liver eggs were achieved following immunization with phages screened with IMFS. However, no protection was elicited by those selected with NMFS. Conclusion The results show that the phagotopes are both antigenic and immunogenic, suggesting a potential use of phage displayed peptide as novel vaccines against S. japonicum. Chin Med J 2003; 116(l): 138-141

Objective To compare the efficacy of low dose recombinant tissue-type plasminogen activator (rt-PA) thrombolysis with primary coronary stenting after acute myocardial infarction. Methods Of 261 patients with first acute myocardial infarction, 131 were given low dose rt-PA intravenous thrombolysis, and 130 primary coronary stenting. Results The age, time from onset of chest pain to hospital presentation and infarct location between these two groups were comparable. The patency rate of the infarct-related artery (IRA) in patients in the thrombolysis group was significantly lower than that of patients in the primary stenting group (P < 0.001). Recurrent myocardial infarction, and selective coronary stenting of patients with thrombolytic therapy were higher than that of patients in the primary stenting group (7.6% vs 1.5%, P < 0.05; 20.6% vs 0, P < 0.001, respectively). Left ventricular ejection fraction (LVEF) in patients in the thrombolysis group was lower than that of the stent group (55.6% ± 13.4% vs 65.8% ± 9.2%, P < 0.001). Total hospitalization time of the thrombolysis group was longer than that of the stent group (16 ± 7 d vs 11 ± 4 d, P < 0.001). Mortality in the thrombolysis group was higher than that of the stent group, but this difference was not significant (6.1% vs 3.1%, P > 0.05). Conclusion Comparing with low dose rt-PA thrombolytic therapy after acute myocardial infarction, primary coronary stenting has a higher patency rate of the IRA, better cardiac function and shorter hospitalization time. Chin Med J 2003; 116(1): 142-144

Objective To evaluate the role of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and plasma homocysteine levels in patients with type 2 diabetes mellitus and diabetic retinopathy (DR). Methods Total of 208 patients with type 2 diabetes mellitus and 57 controls were recruited into the study. MTHFR genetic C677T polymorphisms were determined by PCR-RFLP. Plasma total homocysteine levels were measured using high-performance liquid chromatography (HPLC) with fluorescence detection. Results The frequencies of MTHFR TT homogeneous type, CT heterogeneous type and allele T (28.18%. 41.82%, 49.09%) were significantly higher in the type 2 diabetes mellitus with diabetic retinopathy group than those without retinopathy (18.37%, 29.59%, 33.16%) and those of controls (17.54%, 28.07%, 31.58%). The presence of the T allele appeared to have a strong association with the development of diabetic retinopathy. The odds ratio was 1.94 with a 95% confidence interval of 1.31 -2.88. Moreover, plasma homocysteine levels were remarkably higher in patients with TT or CT genotype than in patients with the CC genotype. Conclusion MTHFR gene C677T mutation associated with a predisposition to increased plasma homocysteine levels may be considered as a genetic risk factor for diabetic microangiopathy (such as DR) in Chinese patients with type 2 diabetes mellitus. Chin Med J 2003; 116(l): 145-147

Objective To investigate the effects of red orpiment on cell morphology, expression of promyelocytic leukemia (PML) mRNA and its protein localization in NB4 and HL-60 cell lines. Methods Cell morphology was assayed by Wright's staining and fluorescence staining, while PML mRNA expression was determined by RT-PCR. PML protein localization by evaluated by immunofluorescence staining. Results The typical apoptosis was found in NB4 and HL-60 cells after treatment with red orpiment. The fusion protein was no longer observed in NB4 cells, PML protein was relocated, and then degraded. In HL-60 cells, PML protein underwent a similar progress. The expression of promyelocytic leukemia (PML) mRNA was not changed in the treated cells. Conclusion Red orpiment inhibits the proliferation of leukemia cells by inducing them to undergo apoptosis. Chin Med J 2003; 116(1): 148-150

Objective To labele MESPU35, a embryonic stem (ES) cell line derived from C57BL/6j mouse, with enhanced green fluorescent protein (EGFP) for further application. Methods The EGFP gene was controlled by the hybrid CA promoter/enhancer (CMV enhancer/ chicken beta-actin promoter/ beta-actin intron) to construct the vector of the transgene, pCA-EGFP. The vector was transfected into MESPU35 by electroporation. Results We generated EGFP expressing ES cells demonstrating normal properties. The green fluorescence of EGFP expressing cells was maintained in propagation of the ES cells for more than 30 passages as well as in differentiated cells. Cultured in suspension, the "green" ES cells aggregated, and formed embryoid bodies maintaining the green fluorescence at varying developmental stages. The "green" embryoid bodies could expand and differentiate into various types of cells, exhibiting ubiquitous green fluorescence. Conclusions The hybrid CA promoter/enhancer used to control the EGFP expressing ES cells, resulted in more intense and ubiquitous activity. The EGFP transfected cells yield bright green fluorescence, which can be visualized in real time and in situ. In addition, the ES cells, MESPU35, are derived from C57BL/6j mice, which are the most widely used in oncology, physiology and genetics. Compared to 129 substrains, C57BL/6j mice avoid a number of potential problems apparent in the other strains. Chin Med J 2003; 116(l): 151-153

Objective To improve the closure rate of large nasal septal perforations. Methods Using an endoscope, complex mucoperichondrial/mucoperiosteal flaps on one side and free tissue graft on the other, we designed a procedure to repair large nasal septal perforations. Results In our series, 8 patients were operated on with this procedure, resulting in complete closure of the perforation and subsequent relief of symptoms. Conclusion This technique may be used as an alternative for the repair of large nasal septal perforations. Chin Med J 2003; 116(1): 157-158

The development of gastric cancer is a multi-factor process. In addition to genetic factors, environmental factors including smoking, low gastric acidity, excessive intake of salt or salty food and low consumption of fresh fruits and vegetables all contribute to the development of gastric cancer. Of particular interest, epidemiological and experimental studies have demonstrated that Helicobacter pylori (H. pylori) infection is causally linked to gastric cancer. Most studies using micronutrient supplementation have failed to demonstrate any preventive effect against the development of gastric cancer. The use of non-steroidal antiinflammatory drugs has been consistently observed to protect against the development of gastric cancer. Recently, eradication of H. pylori infection by a chemopreventative approach is being studied in a number of trials. Studies using precancerous lesions as an end point of the treatment have produced conflicting and mostly negative results. Trials using cancer as an end point are being cautiously carried out in high-risk populations, and will provide the definitive answer to this important question. In the end, vaccination may be proven to be the optimal strategy in human for the management of H. pylori infection and prevention of gastric cancer. Chin Med J 2003; 116(1): 5-10