2003年 · 第116卷第07期

Objective To investigate the clinical and imaging characteristics of severe acute respiratory syndrome(SARS), and to study their relationship. Methods Forty-six SARS confirmed patients were admitted to our hospital from February to April, 2003. X-ray examination documents were available in all cases and chest CT scanning was acquired in 6 cases, which were analyzed retrospectively, accompanied by their clinical features. Results Fever was found in 97. 8% of the patients. Clinical symptoms were mild, but X-ray and CT findings were distinct. CT scanning demonstrated ground glass like lesions and large patchy exudation and consolidation at the early stage in 6 cases. Different findings on radiography and CT were related to the different phases of the disease. After treatment, most lesions were absorbed completely, but slowly in patients with multi-lobe consolidation and/or extensive interstitial infiltration. Conclusion Special clinical and imaging findings could be found in SARS cases. The prognosis of SARS patients is related to the degree of lesions detected by radiography and CT. Chin Med J 2003; 116(7): 1104-1105

Objective To evaluate the advantages of image-guided system in transnasal endoscopic surgery. Methods Transnasal endoscopic surgery was performed with the aid of an image-guided system in 28 patients, supported with histopathologic diagnoses of chronic sinusitis with/without nasal polyps(10 cases), juvenile nasopharyngeal angiofibroma(4 cases), pituitary adenoma(6 cases), ethmoidal ossifying fibroma(3 cases), nasopharyngeal mixed tumor(2 cases), nasal leiomyoma(1 case), fungal sinusitis(1 case)and inverted nasal papilloma(1 case). Results For all the patients, the time periods from initialization to surgery ranged from 15 to 30 minutes(a mean of 26 minutes). The calibration coefficient ranged from 1. 3 to 2. 0. Accuracy of localization fell within 1 mm. Compared with traditional endoscopic surgery, operation times were not noticeably different. No complications occurred. Conclusions The image-guided system was able to identify borders and critical anatomical structures in real-time, especially of those with distorted anatomical markers. It provided a powerful means for a safer and less invasive endoscopic sinus surgery. Chin Med J 2003; 116(7): 1106-1107

Objective To study the relationship between pregnancy-induced hypertension(PIH)and catecholamine levels. Methods Catecholamines levels in maternal and fetal blood were determined in 116 patients with PIH and 40 normal control subjects using high performance liquid chromatography. The normal control subjects and PIH cases were selected from patients at term pregnancy receiving elective cesarean section. Results Plasma norepinephrine(NE)levels were significantly higher in patients with severe PIH than those in control subjects(P<0. 05). Both patients and control subjects had higher NE levels in the umbilical artery blood than in the umbilical vein blood(P<0. 05). NE levels in the umbilical artery blood were five times higher than those in the maternal blood. Conclusion The pathogenesis of PIH may relate to catecholamine concentrations in fetus. Chin Med J 2003; 116(7): 1108-1109

Objective To develop an efficient expression, purification system of recombinant Escherichia coli heat-labile enterotoxin B subunit(rLTB)and study its activity against mucosal immunoadjuvant by nasal immunization. Methods A recombinant, pMMB68-LTB was generated by cloning the LTB cDNA fragment into an expression vector(pMMB68)and transformed it into the host strain marine vibrio VSP60. The relevant target protein was identified using SDS-polyacrylamide gel electrophoresis(SDS-PAGE)and Western blot. Sephacryl S-100 gel filtration chromatography was carried out for purification of rLTB in engineering bacteria VSP60. BALB/c mice received hen egg lysozyme(HEL)alone or combined with rLTB by nasal administration. After three times immunization, IgG and IgA antibody levels in serum or small intestine wash samples were determined using ELISA. Results rLTB protein was highly expressed in VSP60. After gel filtration with Sephacryl S-100, the purity of rLTB reached 98. 1%, the yield rate was about 52%. After immunization, IgG and IgA antibody responses specific to HEL in system and mucosa of HEL + rLTB groups were significantly increased, compared with the HEL alone group(P <0. 001). Conclusions A set of protocols for large-scale rLTB preparation has been established, which is simple, efficient and applicable. The rLTB protein we prepared was proved to be a powerful mucocal adjuvant, which could greatly enhance systemic and mucosal immune responses to nasally coadministered antigen. Chin Med J 2003; 116(7): 1115-1117

Objective To determine the efficacy and incidence of complications of extracorporeal shock-wave lithotripsy(ESWL)compared with pneumatic ureteroscopic lithotripsy(URSL)in the treatment of lower uretheral calculi. Methods From August 1997 to June 1999, 210 patients with lower ureteric calculi were treated with ESWL and the other 180 with URSL. The stones were fragmented with pneumatic lithotripter. The outcome was assessed by evacuation, retreatment and complication rates. Results ESWL for lower ureteric calculi resulted in a stone evacuation rate of 78. 1 %, compared with 93. 3% for URSL(P<0. 05). ESWL had a retreatment rate of 11. 9% and a perforation rate of 0, while URSL caused perforation of ureters in 3. 3% of patients and a retreatment of 2.2%. Conclusion For the management of lower ureteric calculi, ESWL provides a non-invasive, simple and safe option, and URSL has a higher stone evacuation rate but causes ureter perforation more frequently than ESWL does. Both ESWL and URSL have their respective advantages. It is recommended, however, that URSL be extensively developed for better treatment efficacy, given that the operator has an adequate technical background. Chin Med J 2003; 116(7):1001-1003

Objective Multiple subpial transection(MST)is one approach to the surgical treatment of intractable epilepsy with epileptogenic lesion located in functional areas. To verify the effect of MST, an experimental study was performed first, followed by clinical application. Methods On the basis of the experimental study, MST was performed in 200 intractable epileptic patients from 1991 to 2000. Of them, 80 cases underwent MST only while 120 others underwent MST combined with other techniques, such as corpus callosotomy, temporal lobectomy and focus resection. A series of modifications of the surgical techniques were made. Results The results of the experimental study indicated that MST could inhibit the formation and spreading of epileptic discharge and limit the damage to neurons in a minimal area on the epileptogenic agent injected cortex. MST does not impair major functions of the cortex. After the clinical application and modifications, 160 patients were followed up for 1 to 8 years. Complete control of seizure was obtained in 100 cases(62. 5%), significant reduction(more than 75%)in 32, reduction(more than 50%)in 20 and no change in 8. The total rate of effectiveness was 95. 0%, and the significant rate of effectiveness was 82. 5%. No functional defects were found in any patients. Conclusions The results indicate that MST is an effective approach to the surgical treatment of intractable epilepsy. MST can be combined with other approaches. The outcome of the subdivision of the MST only group indicates that MST on local epileptogenic lesion without structural changes is as effective as that of the combined operation group. To evade hemispheric disturbance, MST should be done first to avoid severe complications. Hemispherectomy should be performed only on poor effected cases of MST. Chin Med J 2003; 116(7): 1004-1007

Objective To introduce the technique of intrathoracic surgery performed through vertical transaxillary minithoracotomy. Methods From March 1989 to March 2001, 316 patients underwent intrathoracic surgery through a vertical transaxillary minithoracotomy. 285 patients suffered from patent ductus arteriosus(PDA), 10 congenital esophageal atresia, 8 congenital pulmonary cysts, 6 congenital emphysema, 1 pulmonary sequestration, 5 mediastinal tumor, and 1 eventration of the diaphragm. Results All of the patients were successfully treated under satisfactory exposure. No operative mortality and severe postoperative complications occurred. Conclusions Intrathoracic surgery performed through a vertical transaxillary minithoracotomy appears to be less invasive, and is a simple, safe, cosmetically acceptable and efficient approach. Chin Med J 2003; 116(7): 1008-1010

Objective To evaluate the effectiveness of a helium-oxygen mixture(79% He-21 % 02)as an aerosolizing compressed gas for β2-agonist therapy in patients with an asthma exacerbation. Methods Twenty-four patients in the outpatient department with a mild to moderate exacerbation of asthma were enrolled. The patients were randomly divided into an experimental group(13 cases)and a control group(11 cases). The experimental group inhaled Berotec with heliox-driven, and the control group inhaled Berotec with compressed air-driven. Eight hospitalized patients in the respiratory department with severe exacerbation of asthma were enrolled. The patients inhaled Berotec with heliox-driven or compressed air-driven in a random order. Results The results of spirometric parameters and arterial blood-gas analysis were measured. In the mild to moderate asthma patients, no statistical differences between the two groups for forced vital capacity(FVC), forced expired volume in one second(FEV1), and expiratory flow in 50% forced vital capacity(FEF50)were presented. But the severe patients showed significant differences between heliox-driven and compressed air-driven for FVC, FEV1, FEF50 and partial pressure of oxygen(Pa02). Conclusions Compared with the traditional inhalation of β2-agonist therapy using compressed air-driven, the method of inhaling β2-agonist with heliox-driven has more obvious benefits for those suffering from severe asthma. This is likely due to the cooperative effects between inhaling heliox on its physical gas properties and improving delivery of β2-agonist in the treatment of exacerbation of severe asthma. Chin Med J 2003; 116(7):1011-1015

Objective To demonstrate the side effects of malariotherapy and to explore safe procedures in conduct of malariotherapy for human immunodeficiency virus(HIV)infected patients. Methods Twenty HIV/ acquired immunodeficiency syndrome(AIDS)patients were selected for the study of malariotherapy and were intravenously infected with Plasmodia vivax to induce therapeutic malaria. Malaria was terminated with chloroquine after 10-20 malarial febrile episodes. Clinical assessments were made before(baseline), during(malarial phase)and after(post)termination of malaria. The density of Plasmodia in peripheral blood from the HIV/AIDS patients were compared to that from HIV-negative naturally infected malarial patients who donated the blood for the therapeutically induced malaria. CD4 cell baseline levels were correlated to the severity of malarial symptoms and parasitemia. Results There were no significant differences of Plasmodium density between the HIV/AIDS patients injected with P. vivax and the HIV-negative blood donors. However, it was found that the HIV-positive patients had milder malarial symptoms and parasitemia with progressively lower CD4 cell baseline levels. All patients developed every day or every other day fever episodes with headache and shaking chill. These symptoms were well tolerated with the aid of anti-pyretic medications. Spleen and liver enlargement were seen in 15 of 20 and 4 of 20 patients respectively. Transitory liver effects with increase of serum glutamic-pyruvic transaminase were seen in 2 of 20 during malarial phase. Most patients experienced mild to medium anemia and 6 of 20 patients developed thrombocytopenia during malarial phase. All these side effects disappeared after termination of malaria or within one month thereafter. No complications occurred in these patients. Conclusions Therapeutically induced acute vivax malaria was well tolerated in 20 HIV-positive subjects who represented a range of CD4 cell levels from 1868/μl to 15/μl. Malariotherapy did not induce complications while increasing CD4 cell levels in most treated HIV/AIDS patients(results published elsewhere). Chin Med J 2003; 116(7): 1016-1021

Objectives To identify whether Epstein-Barr virus(EBV)encoded latent membrane protein 1(LMP1)can induce tumor necrosis factor receptor-associated factor 1(TRAF1)expression and promote its anti-apoptosis activity via the NF-κB signaling pathway, and assess that LMP1 suppresses apoptosis in nasopharyngeal carcinoma(NPC). Methods A stable transfected cell line HNE2-LMP1 was established by introducing LMP1 cDNA into HNE2 cells. Transactivation of TRAF1 was determined by luciferase reporter assay, while expression of TRAF1 mRNA was detected by RT-PCR and expression of TRAF1 protein and caspase 3 by Western blot analysis. Apoptosis activity was observed through fluorescence staining. Results LMP1 induced TRAF1 expression in NPC cells and caused a decrease in apoptosis. This induction could be blocked by antisense LMP1. Moreover, LMP1-mediated induction of a TRAF1 promoter-driven reporter gene was significantly impaired when the kB site kB1 or kB5 was disrupted, whereas mutation of kB3 had only a minor effect on LMP1 dependent up-regulation of the reporter gene. Conclusion LMP1 induces TRAF1 expression and promotes its anti-apoptosis activity via the NF-κB signaling pathway, which may be one of the mechanisms that LMP1 uses to suppress apoptosis in NPC cells. Chin Med J 2003; 116(7): 1022-1028

Objective To evaluate the effects of hepatocyte growth factor(HGF)on the prevention of scar formation and the promotion of wound healing by gene transfer. Methods A total of 12 female New Zealand rabbits were used in this study. Rabbits were anesthetized with an intravenous injection of sodium pentobarbital, and identical wounds were made over the ventral surface of each ear. Five circular wounds, 7 mm in diameter, were created in each ear by excision through the skin to the underlying cartilage using sterile technique. After the surgical procedures, 10 of the rabbits were randomly allocated to five groups, with 2 rabbits in each group: Ad-HGF group 1, Ad-HGF group 2, Ad-HGF group 3, Ad-GFP(a reporter gene)group and the solvent group. Immediately after surgery, 6 × 107 pfu Ad-HGF, 6 × 108 pfu Ad-HGF, 6 × 109 pfu of Ad-HGF, 6 × 109 pfu of Ad-GFP, or same volume of solvent(PBS, pH 7.2)was applied once to each wound in groups 1 to 5, respectively. One additional rabbit was used to evaluate the transfer efficiency of the adenovirus vector by transferring Ad-GFP(6 × 109 pfu)into its wounds. Ice slides of wounds from this animal were observed under fluorescence microscopy. Another additional rabbit was used to evaluate the expression of HGF and TGFβ1 after transferring Ad-HGF(6 × 109 pfu)into each of its wound. Immunohistochemistry was used for detection. Results The effect of HGF on reducing excessive dermal scarring was observed by adenovirus-mediated gene transfer. Transfection of the human HGF cDNA into skin wounds through an adenoviral vector suppressed the over-expression of TGFβ1, which plays an essential role in the progression of dermal fibrogenesis. Application of HGF to the wounds significantly enhanced wound healing and inhibited over scarring. Conclusion HGF gene therapy could be a new approach for preventing excessive dermal scarring in wound healing. Chin Med J 2003; 116(7):1029-1033

Objective To investigate the role of caspase-3 and its inhibitor Ac-DEVD-CHO in rat lens epithelial cell apoptosis induced by hydrogen peroxide(H202)in vitro. Methods Rat lenses were incubated in modified Eagle's medium containing 2 mmol/L H202 to induce apoptosis in vitro. Apoptosis in lens epithelial cells was assessed by transmission electron microscopy and annexin V-propidium iodide(PI)double staining flow cytometry after 12, 24 and 48 h of incubation. The activity of caspase-3 was analyzed by western blotting. Results Observations under transmission electron microscopy revealed that 2 mmol/L H202 could effectively induce lens epithelial cell apoptosis in vitro. Caspase-3 activity increased during cell apoptosis and the peak measurement occurred at 24 h after treatment with H202. Cell apoptosis was blocked by caspase-3 inhibitor Ac-DEVD-CHO. Conclusions The activation of caspase-3 plays an important role in executing apoptosis in H202-treated lens epithelial cells and in the formation of cataract. The caspase-3 inhibitor Ac-DEVD-CHO may effectively prevent lens epithelial cell apoptosis caused by oxidative injury. Chin Med J 2003; 116(7): 1034-1038

Objective To localize the language cortex associated with Chinese word processing by magnetic source imaging(MSI). Methods Eight right-handed and one left-handed healthy native Chinese subjects were examined by magnetoencephalography(MEG)and a 1. 5T magnetic resonance imaging(MRI)unit. All subjects were given pure tone stimuli 50 times, 150 pairs of Chinese words(meaning related or unrelated)auditory stimuli, and pure tone stimuli subsequently 50 times. Evoked response fields time locked to the pure tone and Chinese words were recorded using a whole-head neuromagnetometer in real-time. The acquired data were averaged by the acquisition computer according to the response to the pure tone, related pairs of words and unrelated pairs of words. The data obtained by MEG were superimposed on MRI, using a GE Signa 1. 5T system. Results MEG, showed there were two obviously higher magnetic waves named M50 and M100, which were localized in the bilateral transverse temporal gyri in all subjects. The responses to the pairs of Chinese words(meaning related or unrelated)were similar in the same hemisphere of the same subjects. There was a higher peak during 300-600 ms in the right hemisphere of one left handed subject, but no peak in the left hemisphere, indicating that the language dominant hemisphere was localized in the right hemisphere. Superimposing the MEG data on MRI, the language area was localized in the Wernicke's areas. A 300-600 ms response peak was obsarved in each hemisphere(the amplitude of the 300-600 ms response peak in each hemisphere was almost the same)in two right-handed subjects, showing that the language area was localized in the 2 hemispheres in the two subjects. There was one peak in each hemisphere(300-600 ms response)in 6 subjects, but the amplitude of the wave in the left hemisphere in the 6 subjects was much higher than that in the right hemisphere. By choosing randomly from the later component(300-600 ms response)several time points and superimposing them on MRI, all time points were localized in the posterior part of the superior temporal gyri, which is the Wernicke's areas. Conclusions Comparing with the later component of the bilateral hemispheres, the wave amplitude in the language dominant hemisphere was much higher than that in the non-language dominant hemisphere. The language areas could be identified by judging whether meanings of pairs of Chinese words were related or not. Chin Med J 2003; 116(7): 1039-1042

Objectives To analyze the FBN1 mutations in Chinese patients with Marfan syndrome(MFS)and to make a genetic diagnosis based on haplotype linkage analysis for MFS. Methods Nine MFS families(17 patients)were analyzed with single strand conformation polymorphism(SSCP)and sequencing. Four primers were designed for the flanking sequences of FBN1 gene and used for haplotype-segregation analysis of MFS(B). Results SSCP band alteration was detected in the PCR products for exon 25 in MFS(A)Ⅱ: 1. Direct sequencing revealed a small 13 bp deletion; the deleted sequence is gccTc∧Tgcaccca at bases 3243-3456 of the cDNA in exon 25. This mutation was novel. MFS(B)families were analyzed using the haplotype linkage technique. The data suggested that MFS(B)families were linked to the FBN1 gene. The proband ' s daughter was an asymptomatic patient. Conclusion The combination of mutation detection and chromosome haplotype analysis can provide better evidence for a genetic diagnosis of MFS. Chin Med J 2003; 116(7): 1043-1046