2003年 · 第116卷第02期

Objective To investigate the biological behavior and proper management of myoepithelial carcinomas of salivary glands. Methods Twenty-seven cases of myoepithelial carcinoma of salivary glands were retrospectively studied and their detailed clinical and follow-up data were presented. Results The subjects consisted of 17 men and 10 women aged 16 to 73 years (mean age: 51 years). The parotid gland was the most common site (n = 14) of cancer. Clinical features included extensive local growth, invasion of the surrounding tissues, infrequent cervical lymph node metastasis but high rates of distant metastasis, frequent/multiple recurrences and poor prognosis. Conclusions Myoepithelial carcinomas of the salivary gland should be classified as high-grade malignancies. Early and radical surgery with close follow-up are essential for achieving favorable outcomes. Radiotherapy appears to be non-sensitive and elective neck dissection is generally unnecessary. Chin Med J 2003; 116(2): 163-165

Objective To clone the full-length cDNA of a gene responsible for vascular smooth muscle cell (v-SMC) proliferation in atherogenesis, and study its function. Methods Oxidized low density lipoprotein (ox-LDL) at optimal concentration was used as the stimulant to induce v-SMC proliferation in culture medium. A cDNA subtractive library of v-SMC proliferation specific to ox-LDL stimulation was established using subtractive hybridization technique. Methods, including blotting, Northern hybridization and gene sequencing, were used to clone new gene fragments. By using full-length cDNA screening and protein expression techniques, one full-length cDNA was cloned and its function was studied. Results One full-length cDNA was cloned. The new gene (Genbank AF 174647) expressed a 44 kDa protein, which might be associated with the activity of ox-LDL. Conclusion The new gene cloned may be associated with SMC proliferation in atherogenesis. Chin Med J 2003; 116(2): 166-170

Objectives To explore successful models of management of enterocutaneous fistulas and unresolved problems requiring further study. Method Analysis of therapeutic results of 1168 cases treated in one center from January 1971 to December 2000. Results In this group of patients, the recovery rate was 93% and 37% of fistulas healed spontaneously after non-operative treatment. The mortality rate was 5.5%, most of which occurred due to sepsis. Of 659 cases receiving definitive operations for enteric fistula, 98% recovered. Recovery, mortality and operational success rates (94.2%, 4.4%, 99.7%) of cases treated between January 1985 and December 2000 were significantly better than those (90.4%, 8.2%, 95.5%) of cases treated earlier (January 1971-December 1984) (P < 0.05). Conclusions The results from this study were better overall than those reported in previous literatures. The change in therapeutic strategy, improved technique in control of sepsis, rational nutritional support and careful monitoring of vital organs are the key reasons for improvement of managing enteric fistulas. However, increasing spontaneous closure of fistula, improving the therapeutic rate of specific enteric fistula (IBD or radiation enteritis) and performing definitive operations for enteric fistula at early stages are still problematic and require further study. Chin Med J 2003; 116(2): 171-175

Objectives To identify the cortical areas engaged during Chinese word processing using functional magnetic resonance imaging (fMRI) and to examine the reliability and reproducibility of fMRI for localization of functional areas in the human brain. Methods FMRI data were collected on 8 young, right-handed, native Chinese speakers during performance of Chinese synonym and homophone judgment tasks on two different clinical MRI systems (1.5 T GE Signa Horizon and 1.5 T Siemens Vision). A cross correlation analysis was used to statistically generate the activation map. Results Broca's area, Wernicke's area, bilateral extrastriate, and ventral temporal cortex were significantly activated during both the synonym and homophone activities. There was essentially no difference between results acquired on two different MRI systems. Conclusions FMRI can be used for localizing cortical areas critical to Chinese language processing in the human brain. The results are reliable and well reproducible across different clinical MRI systems. Chin Med J 2003; 116(2): 176-180

Objectives To validate our revised syndromic algorithms of the management of sexually transmitted diseases and determine their sensitivity, specificity, positive predictive value and cost-effectiveness. Methods Patients with either urethral discharge, vaginal discharge or genital ulcer, were selected during their first visits to three urban sexually transmitted disease clinics in Fujian Province, China. They were managed syndromically according to our revised flowcharts. The etiology of the syndromes was detected by laboratory testing. The data were analyzed using EPI INFO V6.0 software. Results A total of 736 patients were enrolled into the study. In male patients with urethral discharge, the sensitivities for gonococcal and chlamydial infections were 96.7% and 100%. respectively, using the syndromic approach. The total positive predictive value was 73%. In female patients with vaginal discharge, the sensitivity was 90.8%, specificity 46.9%. positive predictive value 50.9%. and negative predictive value 89.3% for the diagnosis of gonorrhea and/or chlamydial infection by syndromic approach. In patients with genital ulcer, the sensitivities were 78.3% and 75.8%, specificities of 83.6% and 42.9%, and positive predictive values of 60.0% and 41.0% for the diagnosis of syphilis and genital herpes, respectively, using the syndromic approach. Cost-effectiveness analysis indicated that the average cost of treatment for a patient with urethral discharge was RMB 46.03 yuan using syndromic management, in comparison with RMB 149.19 yuan by etiological management. Conclusions The syndromic management of urethral discharge was relatively effective and suited clinical application. The specificity and positive predictive value for syndromic management of vaginal discharge are not satisfactory. The revised flowchart of genital ulcer syndrome could be suitable for use in clinical settings. Further validation and revision are needed for syndromic approaches of vaginal discharge and genital ulcer. Chin Med J 2003; 116(2): 181-186

Objective To discuss the prognosis of primary liver carcinoma treated with local resection and factors affecting prognosis. Methods The data of 130 patients who had been treated from October 1989 to October 1995 were analyzed retrospectively. We analyzed the concrete operating methods, the cause of postoperative complications and factors affecting prognosis. Results Curative local resection was performed in 130 patients. Operation-related mortality was 0.8%and the incidence of complication was 16. 1% (n = 18). The overall 1-, 3- and 5-year survival rates were 82.1%, 60.6% and 48.2%, respectively. Involvement of blood vessels or liver capsules and the elevation of AST before operation were the significant factors affecting prognosis (P < 0.05). Conclusion Local resection is a safe method characterized by little damage, rapid, less blood loss, low complication rate and good prognosis. Chin Med J 2003; 116(2): 187-190

Objective To analyze the urine of renal recipients for the presence of donor DNA in an attempt to establish an alternative diagnostic means of acute rejection. Methods Sixty-four renal transplant recipients were examined. Thirty-seven were normal after transplantation, while 22 others developed acute rejection, based on serum creatinine levels and/or needle biopsy findings of the graft. Five developed drug-induced renal dysfunction. In female recipients with a male graft, we examined urine for the presence of Y chromosome (SRY and DYZ-1) and in recipients receiving an HLA mismatched graft, we looked for HLA-DR gene (DRB1) using PCR. Results Among the 14 female recipients with male grafts demonstrating stable renal function, only one was positive for SRY and DYZ-1 on the Y chromosome. However, SRY and DYZ-1 were found in the urine of four female patients with acute rejection, but these DNA fragments were not detected in 3 of the 4 after anti-rejection therapy. The last patient was referred to hemodialysis. Of 23 recipients of a graft from HLA mismatch donors with stable renal function, DRB1 was negative in 21 (91%). Of 18 patients with acute rejection, DRB1 was positive in 16 (89%) and negative in 2. These DNA fragments were no longer found in 13 patients after anti-rejection therapy. In all patients with drug induced renal dysfunction, donor-derived DNA was negative. Conclusions Presence of door specific DNA in the urine of the recipient is strongly associated with acute rejection. Analysis of DNA derived from donor cells in urine was an effective and accurate method for the diagnosis of acute rejection of a renal transplant. Chin Med J 2003; 116(2): 191-194

Objective To study the effect of endoscopic-assisted keyhole operation (EAKO) on treating hypertensive intracranial hematomas and the value of our patent dissector applied during the operation. Methods A total of 25 patients with hypertensive intracranial hematomas underwent endoscopic-assisted keyhole evacuation, during which, the viewing dissector, which had recently achieved national patent, was connected to the tip of endoscope and used to help dissect hematomas. The outcome of this procedure were compared with those of 22 comparable cases undergone conventional surgical treatment (large or smaller craniotomy). The items for comparison included the volume of remaining hematoma, the duration of operation, postsurgical Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS). Results Remaining hematoma was ascertained 48 h after operation with the use of computerized tomography (CT) scans. In the case of EAKO, nearly complete evacuation (> 84%) was achieved in 21 cases; GCS was evaluated at 7 d postsurgery resulting in GCS > 12 in 9 patients, GCS 9-12 in 12 patients and GCS < 9 in 4 patients. The follow-up period ranged from 6 to 21 mon. GOS was estimated at half a year and good recovery rate as defined by GOS was assigned to 76% of the EAKO patients. There are significant differences in the volumes of remaining hematomas and the duration of operation between the EAKO and craniotomy group (P < 0.05). In addition, better clinical outcomes were obtained in EAKO. Conclusion EAKO has the advantage of being minimally invasive, improving surgical results and the prognosis of hypertensive intracranial hematoma patients. We conclude that keyhole operation is a safe, effective alternative for removal of hypertensive intracranial hematoma, particularly during acute stages. Chin Med J 2003; 116(2): 195-199

Objective To assess the prevalence of colorectal cancer (CRC) in Beijing and the reliability of the sequential fecal occult blood test (SFOBT) for CRC screening. Methods Of the natural population (48 100 persons) in several Beijing communities, we screened 26 827 persons with age over 30 using the SFOBT screening program, Guaiacum Fecal Occult Blood Test (GFOBT), Immuno Fecal Occult Blood Test (IFOBT), and colonoscopies. Results The screening rate of the population was 74% . The positive rate of SFOBT was 5.6%. The prevalence of CRC in the entire population of Beijing was therefore calculated to be 36.57/105. Of 12 CRC detected patients, 4 cases were in stage Dukes A (33.33%), 7 cases in stage Dukes B (58.33%), only 1 case (8.34%) in stage Dukes C. Conclusions The prevalence of CRC in Beijing is one of the highest in China. Individuals at high risk for CRC or those over 50 years of age should be considered as primary candidates for screening. SFOBT screening is a cost-effective and reliable method for early detection of CRC. Chin Med J 2003; 116(2): 200-202

Objective To evaluate the effect of preoperative transcatheter arterial chemoembolization (TACE) on apoptosis of hepatocellular carcinoma (HCC) cells. Methods A total of 136 patients with HCC underwent liver resection. One to five courses of TACE prior to liver resection were performed in 79 patients (TACE group), in which one to four courses of chemotherapy alone were performed in 11 patients (group A), one to five courses of chemotherapy combined with iodized oil were performed in 33 patients (group B), one to three courses of chemotherapy combined with iodized oil and gelatin sponge were performed in 23 patients group C) and one to three courses of chemotherapy combined with iodized oil, ethanol and gelatin sponge were performed in 12 patients (group D). The other 57 patients only received liver resection (non-TACE group). The extent of apoptosis was analyzed by transferase -mediated dUTP nick end labeling (TUNEL) staining. The expressions of Bcl-2 and Bax protein were detected by immunohistochemical method. Results The apoptotic index(AI) and level of Bax protein in HCC cells were significantly higher in groups A, B, C and D than those in the non-TACE group (P < 0.05). The level of Bcl-2 protein and ratio of Bcl-2 to Bax protein of HCC cells were significantly lower in Groups A, B, C and D than those in the non-TACE group (P < 0.05). Conclusion Preoperative TACE regimens may enhance apoptosis of HCC cells by up-regulating the expression of Bax protein and down-regulating the expression of Bcl-2 protein and ratio of Bcl-2 to Bax protein expression. Chin Med J 2003; 116(2): 203-207

Objective To assess the role of oxidative metabolism and nitric oxide synthesis for elucidating their pathophysiological mechanisms in a Tibetan patient with essential hypertension. Methods The serum levels of total superoxide dismutase (T-SOD), malondialdehyde (MDA), total antioxidant capacity (T-AOC), nitric oxide (NO) and nitric oxide synthase (NOS) were assayed in sixty native Tibetans (thirty hypertensive patients and thirty healthy volunteers as control). Results The levels of T-SOD, T-AOC, NO and NOS were significantly lower in the patient group than in the control group (P < 0.01 ); MDA was significantly higher in the patient group than in the control group (P < 0.01). The level of MDA had a strong negative correlation with T-SOD, T-AOC, NO and NOS (r = -0.82, - 0.76, - 0.79, - 0.73, respectively, P < 0.001 for all). Conclusion Tibetan patients with essential hypertension (EH) may have underlying oxidative metabolism dysfunction and depressed NO synthesis, both responsible for the hypertensive process. Chin Med J 2003; 116(2): 309-311

Objective To ascertain whether a coding mutation (Ile93Met) in ubiquitin carboxy-terminal hydrolase (UCH-L1) gene plays a role in idiopathic Parkinson's disease (IPD). Methods Polymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP) was used to distinguish the wild-type (two DNA fragments of 34 and 126 bp) from the variant allele (three fragments of 34, 60 and 66 bp) because the mutation created a new site for restriction endonuclease BsmF1. DNA was isolated from various blood samples using a phenolchloroform extraction. Results Ile93Met substitution was found neither in PD patients nor in controls. Conclusions Our study suggested that Ile93Met of UCH-L1 gene did not influence risk of IPD. Chin Med J 2003; 116(2): 312-313