2003年 · 第116卷第05期

Objective To determine a network solution to meet the network requirements of the heavy data flow, load balance, and potential network storms from expansion of picture archiving and communication system(PACS)application. Methods Intel Netstructure 480T Giga Switch was used as the main switch and connected to each building by fiber channel at 1 Giga speed to archive 100 MB/s to each port. At the same time, the independence of the original network construction was physically kept. The layer 3 and 4 switchers were used as load balance to reduce the heavy load of the network, and all the cabling for PACS used the super CAT5 along with the Intel Netstructure 1520 to prepare for potential network storms. Results An advanced intranet was set up to fully meet the high standard requirement of the PACS. The foundation for upgrading the whole network system to 1 Giga application was built to achieve sharing and transmission of images, information, and patient data within the hospital. The base was established for the standardized management of the hospital. Conclusion Good planning is the first step in setting up PACS, and the equipment forms the necessary platform to run PACS and all kinds of hospital information system(HIS). The networking construction is the foundation of e-hospital. Chin Med J 2003; 116(5): 645-649

Objective According to the characteristics of digital medicine and the demands of digitalized management in hospitals, we established a storage system that is affordable, highly expandable, and reliable. Methods The multi personal computer storage system(MPCSS)was constructed using hardware and software. The image data were archived from major servers to storage personal computers(PCs)by using Neusoft-picture archiving and communication system(PACS)and backed up on storage PCs. We simulated data loss on storage PCs and then restored the data. We also expanded the storage system to enlarge its capacity. Results The average transfer rate from MPCSS was 27. 7 MB/s, and the average cost for this system was ¥74/GB. In the testing stage, only 6 of 187 instances of data retrieval(from 100 patients)failed. Conclusion The MPCSS is much less expensive than other high capacity systems or devices. It is feasible and suitable for digital image storage. Chin Med J 2003; 116(5): 650-653

Objective To discuss the scheme and implementation of workstation configuration for medical imaging information systems suitable to the practical situation in China. Methods The workstations were logically divided into picture archiving and communication system(PACS)workstations and radiology information system(RIS)workstations. The former applied to three kinds of diagnostic practice: the small matrix images, large matrix images and high resolution grayscale display applications. The latter consisted many different models defined by the usage and function processes. Results A dual-screen configuration for image interpretation workstations integrated the image-viewing and reporting procedures physically. Small matrix images as CT or MR were operated on 17 inch(1 inch =2. 54 cm)color monitors, while conventional X-ray interpretation was performed on 21 inch color monitors or portrait format grayscale 2 k by 2. 5 k monitors. All other RIS workstations not involved in imaging process were set up with a common PC configuration. Conclusion Workstation schemes for medical imaging information systems should satisfy the basic requirements of medical imaging and investment budget. Chin Med J 2003; 116(5): 654-657

Objective To investigate the set-up and preliminary performance of a digital radiology conference system and its characteristics. Methods The imaging system included a dual-screen image-text workstation with a Matrox G450 demonstration dual-head card, two multimedia projectors, a large screen, and a line-pair and grey scale test card. Patient information on radiology information system(RIS)and images on picture archiving and communication system(PACS)were fetched with GE Radworks software based on Intranet and PACS. The fetching velocity and resolution and grey scale of the images were measured. Results Patient information in the form of texts and images were demonstrated successfully on two screens with Matrox G450 demonstration dual-head card and switched rapidly between text-image two-screen and image two-screen. The image fetching velocity was fast, the resolution was high, and the grey scale was good. Conclusion The digital conference radiology system is good, and should be popularized. Chin Med J 2003; 116(5): 658-660

Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas(CSdAVFs), including its indications, complications and efficacy. Methods Eight patients with symptomatic CSdAVFs were treated by endovascular embolization with platinum coils, via the inferior petrosal sinus(IPS)in 6 patients, and via the Sylvian vein after surgical exposure in other 2 patients. Results Complete angiographic resolution of the fistula was obtained in six patients immediately after the procedures, and a complete resolution of symptoms and signs was achieved in all patients. The residual fistulas in two patients disappeared completely in the follow-up angiography. Conclusion Transvenous embolization is a useful and safe approach in the management of CSdAVFs. Chin Med J 2003; 116(5): 661-664

Objective To investigate the relationship among-75 bp/ +83 bp polymorphism in apolipoprotein A1(apo A1)gene, lipids levels and the occurrence of coronary atherosclerosis disease(CAD). Methods We determined distributions of two Mspl polymorphisms of the apo A1 gene at-75 bp and + 83 bp, and blood lipids levels among 137 Chinese patients(92 with CAD and 45 in the control group)in relation to circulating lipids and coronary angiography. Results The demographic information for 137 subjects showed that subjects with CAD tended to have more unfavorable lipoprotein variables. Genotype distributions at both sites were different between the CAD and control groups. Furthermore, the control group had higher M1-/M2-frequencies than the CAD group(M1: P<0. 005; M2: P<0. 05)and the"M1-"(A)and"M2-"alleles were associated with increased high-density lipoprotein cholesterol(HDL-C)(M1-: P < 0. 0001; M2-: P<0. 05)and apo A1(M1-: P<0. 0001; M2-: P < 0. 05)levels."M1-"and"M2-"were significantly negatively correlated with CAD(P <0. 01 and P <0. 05, respectively). Conclusions Our results suggest that changes from G to A at the-75 bp site and from C to T or G to A at the +83 bp site do increase circulating levels of apo A1 and HDL-C. And those individuals with these changes are likely to have a lower risk of developing CAD. Chin Med J 2003; 116(5): 665-668

Objective To explore adverse effects of combined treatment of interleukin-12(IL-12)and interleukin-18(IL-18)against cryptococcosis in a murine model. Methods Infected mice were treated with a combination of IL-12 and IL-18. Their body weight and intake of water and food were observed and recorded. Serum levels of leptin were detected with an enzyme-linked immuno sorbent assay(ELISA). Results In the combined treatment group, the intake volume of water and food were reduced, leading to weight loss and undetectable levels of leptin in the serum. These adverse effects were more profound in mice that had received higher doses of cytokines, which sometimes led to a fatal outcome. There was a significant difference compared with the control group. Neutralization of endogenous tumor necrosis factor-a(TNF-α)by its specific mAb did not alter the wasting effect of this treatment. Conclusions The combined IL-112/IL-18 treatment may cause a number of adverse effects independent of TNF-α and leptin synthesis. Further investigations for resolving these adverse effects are required before clinical application of these cytokines. Chin Med J 2003; 116(5): 669-672

Objective To establish a means for prenatal prediction of spinal muscular atrophy(SMA)through survival motor neuron(SMN)gene deletion analysis and genetic counseling in families with a child affected with SMA. Methods Genetic analysis for prenatal prediction of Werdnig-Hoffmann disease was performed in a at risk Chinese family by polymerase chain reaction(PCR)-single-strand conformation polymorphism(SSCP)in SMN gene exons 7 and 8. Results The pregnancy was positive for the homozygous deletion of the SMN gene, thus the fetus was diagnosed as being affected and the pregnancy was terminated. Conclusion This approach is fast and reliable for DNA-based prenatal diagnosis of Werdnig-Hoffmann disease. Chin Med J 2003; 116(5): 673-675

Objective To investigate the efficacy of allogeneic peripheral blood stem cell transplantation(PBSCT)in the treatment of severe aplastic anemia(SAA)and severe infection. Methods A patient with SAA and pseudomonas aeruginosa septicemia was treated with PBSCT from an HLA-identical sibling with cyclophosphamide(CY)and total body irradiation(TBI)for conditioning. The patient was infused with 20. 3 × 108/kg mononuclear cells including 61. 0 × 106 /kg CD34+ cells following the conditioning regimen. Results Twelve days after PBSCT, the absolute neutrophil count(ANC)of 1. 0 × 109/L was achieved, with platelet count > 50 × 109/L at twenty days. The donor origin of engraftment was confirmed by polymerase chain reaction(PCR)analysis of short tandem repeats at the end of the first, sixth and twelfth month. The patient's body temperature dropped to normal level when her ANC reached 0. 5 × 109/L on day 10, and the bacterial culture of blood sample became negative subsequently. Symptoms and signs of acute or chronic graft versus host disease(GVHD)were not observed in 30 months after PBSCT. Conclusions Hematopoiesis was reconstituted shortly after PBSCT. The combination of CY and TBI and the infusion of sufficient peripheral blood stem cells may contribute to the successful engraftment. PBSCT may be considered as the first choice when hematopoietic stem cell transplantation is needed for SAA patients complicated with severe infection. Chin Med J 2003; 116(5): 676-678

Objective To use virtual endoscopy to obtain detailed three-dimensional images of bone, soft tissue and paranasal sinus damage as well as images of adjacent unaffected areas for optimum surgical planning. Methods A spiral CT scanner was used to examine 46 cases of facial bone fractures, maxillary cysts, obstructive sleep apnea syndrome(OSAS)and maxillary bone tumours. Data were input into a navigator workstation to create images similar to those displayed by a fiberoptic endoscope. Various 3-D images were obtained when probe sites were changed. Results Virtual endoscopy can clearly display the anatomic structure of the paranasal sinuses, nasopharyngeal cavity and upper respiratory tract, revealing damage to the sinus wall caused by a bone tumor or fracture. In addition, the technique can be used to indicate volume changes of the upper respiratory tract in OSAS patients. These results were similar to those obtained through actual operations. Conclusions Virtual endoscopy is a new method which produces very clear images. It is reliable to provide detailed information for optimal operative planning. Chin Med J 2003; 116(5): 679-681

Objective We designed a multi-center, double-blind, randomized, parallel, with metformin controlled clinical trial to evaluate the efficacy and safety of low dose rosiglitazone combined with sulphonylurea therapy in type 2 diabetic patients who were inadequately controlled with sulphonylurea alone. Methods Patients were treated with 4 mg rosiglitazone once daily plus sulphonylurea(test group)or 0. 5 g metformin twice daily plus sulphonylurea(control group)for 12 weeks. The mean levels of HbA1c, fasting and postprandial plasma glucose were recorded and compared between the two groups. Results The mean levels of HbA1c decreased by 1. 09% and 0. 95% in the test group(n = 102)and control group(n =96)respectively. Fasting and postprandial plasma glucose levels in the test group decreased by 25. 0% and 35. 6%, and in the control group, decreased by 17. 7% and 23.8% as compared with the baseline(both P<0. 01). No liver damage was found. Conclusion Combination treatment of rosiglitazone and sulphonylurea can effectively improve glycemic control in type 2 diabetic patients inadequately controlled with sulphonylurea alone. Chin Med J 2003; 116(5): 785-787

Objective To investigate the effects of fresh and preserved amniotic membrane on polymorphonuclear neutrophils(PMNs)so as to understand the anti-inflammatory mechanism of amniotic membrane transplantation. Methods Conditioned medium was collected 48 hours after fresh or preserved amnions were cultured in DMEM and 5% C02 at 37℃. Then, polymorphonuclear cells were cultured in conditioned culture or DMEM. Fluorescent microscopy with 4', 6-diamidino-2-phenylindole(DAPI)staining and cytometry were performed 6, 9, 12, and 15 hours later. Results Apoptotic neutrophils were found in each group at different time points. The percentage of apoptotic cells at 6, 9, 12, and 15 hours after culture in the fresh and preserved amnion groups and the control group was 17. 3%, 24. 4%, 29.8%, 37.1 %, and 16. 2%, 20.1 %, 23. 7%, 27.7%, and 10. 2%, 13. 7%, 21.1%, 26. 4%, respectively(t test, P1 <0. 01, P2 <0. 01 and P3 <0. 01). Conclusion Amniotic membrane can accelerate apoptosis of polymorphonuclear neutrophils, reduce inflammation, and prevent ocular surface collagen from resolution, indicating that fresh amnion might have a stronger effect than preserved amnion. Chin Med J 2003; 116(5): 788-790

Objective To explore low density lipoprotein(LDL)oxidation by macrophage myeloperoxidase(MPO)at molecular level. Methods Using a mouse macrophage model, we examined the relationship between LDL oxidation and macrophage MPO by measuring macrophage MPO activity, LDL oxidation products, MPO gene expression and cellular orientation of LDL oxidation. Results MPO gene expression increased to its maximum gradually when the concentration of LDL was increased, and then maintained at that level. NaN3 inhibied the elevation of MPO activity and LDL oxidation, which was LDL concentration-dependent. After the composition of macrophage membrane was roughly analyzed, it was determined that the contents of MPO and LDL in 5% sucrose were 7. 667 and 21 times higher than those in 10% sucrose, respectively. Conclusion LDL is attached to the "microdomain"of the macrophage membrane in which LDL is oxidized by MPO. Chin Med J 2003; 116(5): 791-793