1999年 · 第112卷第03期

OBJECTIVE To review the modern recognition of growth hormone deficiency (GHD) in adults and the beneficial effects of growth hormone (GH) treatment in such cases. DATA SOUCES AND METHODS Most published original articles about GH and GHD in recent domestic and world wide related literatures were available. STUDY SELECTION More than 65 originally identified articles were reviewed and 29 were selected that especially addressed the stated purpose. RESULTS Treatment of GHD in adult human beings became an option following the development of rhGH and the numerous reports on the effect of rhGH therapy in such patients. The syndrome of GH deficiency in adults principally comprises abnormalities in body composition, cardiovascular risk factor, and psychological well-being. In comparison with normal individuals, these patients have increased total-body fat mass (particularly visceral adiposity), reduced muscle mass, reduced muscle strength exercise performance, and reduced bone mass. The psychological dysfunction comprises self-reported reduction in energy, mood, and sleep, along with objective reductions in marital and socioeconomic performance. CONCLUSION The evidence that rhGH administration may be beneficial for the prevention, as well as treatment, of various clinical situations.

OBJECTIVE To investigate the cellular phenotype involved in corneal allograft rejection using wholemounts analysis. METHODS Corneal transplantation was performed between Sprague Dawley (SD) and Wistar rats. Corneal wholemounts were prepared from control rats and those after corneal transplantation on day 7 and 12. Immunohistochemical stain was performed on these wholemounts using monoclonal antibodies to transforming growth factor beta 1(TGF-beta 1), CD3, CD4, CD8, B lymphocytes, macrophages, dendritic cells and major histocompatibility complex (MHC) class II antigen. RESULTS Corneal allograft rejection started on day 7 and reached its maximum from 10 to 14 days after corneal transplantation. Presence of TGF-beta 1-, CD3-, CD4-, CD8-, MHC class II-positive cells, macrophages and dendritic cells were noted at the limbus of both SD rats and Wistar rats. No positive cell was present in the central cornea of normal rats. All positive cells but B lymphocyte were noted in large numbers in the cornea after corneal allograft transplantation. Marked staining for TGF-beta 1 was noted during graft rejection. CONCLUSIONS The corneal wholemounts technique provides a good visualization for the cellular phenotype involved in corneal allograft rejection. A variety of cells including TGF-beta 1, CD3, CD4, CD8, MHC class II antigen positive cells, macrophages and dendritic cells are involved in corneal allograft rejection. TGF-beta 1-positive cell might be an important immunosuppressive factor after corneal transplantation and also involved in the induction of fibrosis.

OBJECTIVE To search the method of culturing human trabecular cells (HTC) on a filter support so as to provide a model to study the hydraulic conductivity of HTC in vivo. METHODS The third passage of HTC was cultured on a nylon filter; after that we measured the rate of different irrigations through the filter with HTC [Lp, μl/(min·mm Hg·cm2)]. RESULTS HTC could continuously grow on the filters. The normal Lp was 10.45 μl/(min·mm Hg·cm2). Irrigated by the solution of epinephrine (EPI) or dexamethasone (DEX), Lp of HTC were higher than that in controls of the same cultural time, while after being exposed to DEX for a few days, Lp was significantly decreased. CONCLUSIONS (1) More information of hydraulic conductivity and effects of pharmacologic agents on HTC could be got from the dynamic filtery model; (2) EPI could improve the conductivity of HTC while DEX could have the same effect in early period.

OBJECTIVE To explore the methods of lens-sparing (without lensectomy), non-silicone oil tamponade and no scleral buckling for treatment of early giant retinal tears. METHODS Thirteen cases of early retinal detachment of proliferative vitreoretinopathy (PVR) grade C2-D1, with giant tear extending from 135 degrees to 270 degrees were chosen. Transscleral cryotherapy was first applied to treat each end of the giant tear up to the oral serrate. And then conventional three-port pars plana vitrectomy was performed. Perfluorodecalin liquid was injected to manipulate the flap of the retinal tear. The flap with no cryotherapy before was treated with endolaser or cryotherapy under optimal visual condition, then air-fluid was exchanged completely and C3F8 was injected properly. RESULTS With a mean follow-up of 8.2 months, the retina was reattached completely in 12 eyes. Success rate was 92.3%, and visual acuity improved. Most postoperative complications were slight. The retina failed to reattach only in 1 case with severe vitreous blood. CONCLUSIONS In treating early retinal giant tears without severe PVR, the lens-sparing, non-silicone oil tamponade and no scleral bucking are helpful to simplify operation and to improve the success rate of the retinal surgery and to yield satisfactory outcome of visual acuity. Besides, it can also avoid the initial side effects of silicone oil tamponade and diopter irregularity after lensectomy.

OBJECTIVE To evaluate the corneal surface changes and visual quality after excimer photorefractive keratectomy (PRK) for myopia. METHODS Corneal topographic analysis was performed on 23 patients (38 eyes) with myopia after PRK at the 1-, 3-, 6- month postoperative follow-up visits. RESULTS The corneal sphericity was changed after excimer PRK. As time went on, the mean surface regularity index (SRI) and the surface asymmetry index (SAI) decreased gradually, and the corneal surface became more smooth; mean simulated keratoscope readings (SimK) showed a gradual restoration. At the 6-month postoperative examination, corneal topography showed four main patterns of ablation: round or oblong (50%), collar-button (23.68%), semicircular (18.42%) and central island (7.9%). Patterns of ablation were correlated with visual acuity. CONCLUSIONS The quantitative analysis of corneal topography is essential for evaluating corneal surface changes after PRK and helpful in the surgical design of PRK and in predicting the refractive outcome with greater precision.

OBJECTIVE To observe the changes of the ocular anterior segment structure and the relationship between the intraocular pressure (IOP) and these changes after the topical application of cycloplegia using ultrasound biomicroscope (UBM), especially to observe the changes of ciliary body thickness, ciliary process thickness and ciliary process-lens distance. METHODS The quantitative measurement with UBM and the measurement of IOP were performed before and after the topical application of 2% homatropine solution in 48 normal eyes. The results were statistically analyzed. RESULTS In the parameters showing the changes of the anterior chamber angle after topical use of 2% homatropine solution, both the trabecular iris angle and the angle opening distance 250 decreased. The iris thickness 1 increased. The anterior chamber became deeper and the iris-lens contact distance became shorter. All these differences were statistically significant (P<0.05). In the parameters showing the changes of ciliary body, the ciliary body thickness and the ciliary process thickness decreased. The scleral ciliary body angle increased. The iris-zonule distance decreased and the ciliary process-lens distance increased. All these differences were statistically significant (P<0.05). The IOP increased from 17.63±3.45 mm Hg to 18.23±3.53 mm Hg after topical use of 2% homatropine solution, but the difference was not statistically significant (P>0.05). CONCLUSIONS After the topical use of cycloplegia, the anterior chamber becomes deeper. The anterior chamber angle becomes narrower, and the ciliary body becomes thinner and moves backward and the ciliary process-lens distance increases. By using UBM the structures of the ocular anterior segment in the living state can be observed and measured quantitatively. The ultrasound biomicroscopic imaging has its advantages in the morphological study of the ocular anterior segment.

OBJECTIVE To study the structure of alleles in the 3' end of the apoB gene in Han, Mongolian and Tibetan populations in China as well as the roles in the regulation of gene expression. METHODS DNA were obtained from human leukocytes by phenol-chloroform extraction and ethanol precipitation. PCR were carried out in a 50 microliters volume containing 50 ng genomic DNA as template. The Ssp1-digested products were loaded on a gradient acrylamide gel and run for 3 hours. The constructs containing alleles were tested in cultured HepG2 and HeLa cells using transient assays. RESULTS Sixteen alleles with different repeat number were characterized. All of the alleles varying from HVE22 to HVE52, allele HVE34 was the most common (58.4%), followed by allele HVE36 (13.8%) and HVE32 (10.5%). 258 PCR products were digested with Ssp1 and run in 4-12% PAGE. We detected the fragments of 266bp, 91 bp, 61 bp and 39 bp in almost all samples. The small alleles (including HVE22, HVE24, HVE26 and HVE36) decreased the expressive activity of the luciferase reporter, in contrary, the large alleles (including HVE44, HVE46 and HVE48) elevated obviously the expressive activity of the luciferase reporter. CONCLUSIONS More alleles with different number of tandem repeats in 3' end of apoB gene exist in the Chinese populations. The alleles in 3' end minisatellite of human apoB gene could control the expression of the gene itself.

OBJECTIVE To investigate the association between apolipoprotein E (apoE) gene polymorphism and coronary heart disease(CHD) in Han Chinese. METHODS Apo E genotype was examined with the methods of hot start polymerase chain reaction (PCR) and restriction isotyping in samples of 113 unrelated Chinese healthy individuals and 93 patients with CHD. The relation of the gene polymorphism of apoE and levels of serum lipids, lipoproteins, and apolipoproteins was also studied. RESULTS The results showed that the epsilon 4/3 genotype was more frequent in CHD cases than in control subjects (31.2% vs. 11.5%, P<0.01). The frequency of the epsilon 4 allele in CHD cases was significantly higher than in control subjects (17.2% vs 7.5%, P<0.01). The epsilon 4 allele was associated with high concentrations of serum TC (r = 0.265, P<0.05), LDL-C (r = 0.266, P<0.05), and apoB (r = 0.360, P<0.01). CONCLUSIONS Hot start PCR assay is considered a rapid and simple technique for apoE genotyping. This method is suitable for routine laboratories and large scale population studies. Genetic polymorphism of the apoE gene might contribute to the determination of serum lipid profile and the development of CHD among Han Chinese.

OBJECTIVE To study the hematopoietic enhancing effects of recombinant human macrophage colony-stimulating factor (rhM-CSF) expressed in silkworm. METHODS Balb/c mice were irradiated with sublethal dose of 60Co γ-rays and then administered intraperitoneally with silkworm expressed rhM-CSF (1000 U per individual for 7 days) in treatment group or with normal saline (for 7 days as well) in control group. The hematopoietic recovery of irradiation mice was observed by comparing peripheral white blood cell (WBC) counts, differential counts of WBC and bone marrow hematopoietic progenitor cell colony forming assay in soft agar at different time after irradiation. RESULTS The total WBC counts (×109/L) of treatment group at day 15 and 20 after irradiation(3.42±1.20, 5.56±2.50, respectively) were significantly higher than those of control group (2.03±0.90, 3.72±2.30; both P<0.05). On days 10, 15, 20, 25 and 30 after irradiation, the monocyte counts (×109/L) of treatment group (0.08±0.06, 0.16±0.10, 0.48±0.35, 0.47±0.21 and 0.33±0.17, respectively) were all significantly higher than those of control group (0.025±0.016, 0.05±0.04, 0.23±0.16, 0.33±0.19 and 0.17±0.13; all P<0.05). On days 15, 20 and 25, the granulocyte count (×109/L) of treatment group (1.03±0.61, 2.18±1.19 and 3.28±1.09) were also higher than those of control group (0.62±0.37, 1.40±0.99 and 2.20±0.74; all P<0.05). On day 9 after irradiation, the bone marrow CFU-GM yield of control group (19±11/106 cells) was significantly lower than that of treatment group (78±30/106 cells, P<0.05). CONCLUSIONS rhM-CSF expressed in silkworm could accelerate hematopoietic recovery in irradiated mice.

OBJECTIVE Artificial neural network is first used in the measurement study of brain of Alzheimer's disease using MRI, and a completely new pattern discriminating method is adopted, so as to take advantage of MRI to diagnose and identify AD patients. METHODS 12 patients with probable AD (aged 65.33±8.62 years) and 36 normal controls matched with age and gender (aged 65.81±74.37 years) were studied. MRI are performed on Siemens Magnetom IMPACT 1.0 T; eight interesting brain structures including sixteen regions (left and right) indices are measured and studied; SPSS software and BP network software made by authors respectively were used to process and analyze the measured data. RESULTS Using artificial neural network to the same regions and data, both the sensitivity and accuracy were found higher than using the traditional discrimination function analysis method; the indices of amygdala, hippocampus, parahippocampal gyrus, temporal lobe, and temporal horn, these five structures could completely differentiate AD from normal controls; new cases were successfully diagnosed. CONCLUSIONS Artificial neural network combining with MRI is probable to become a useful and reliable clinical tool to diagnose AD patients.

OBJECTIVE To study clinicopathologically 17 cases of cerebral amyloid angiopathy (CAA) with dementia and to investigate the possible neuropathology of this disorder. METHODS Of 362 autopsy cases, 17 who had had dementia with proved CAA were studied. Hematoxylin and eosin, Congo red, Bodian and beta/A4 protein immunohistochemical stain were used. Brain sections were observed under light microscopy and polarized light microscopy. The amyloid was confirmed by positive Congo red stain with apple-green birefringence under polarized light and positive beta/A4 immunohistochemical stain. The severity of amyloid deposit was graded as slight, moderate and severe. RESULTS In the 17 cases of CAA associated with dementia, Alzheimer's disease was found in 3 cases, Pick's disease in 1, multi-infarct dementia in 6, multi-hemorrhage dementia in 4, and pure CAA in 3. CONCLUSIONS CAA not only is closely related to Alzheimer's disease, but also causes cortical multiple small infarcts and hemorrhagic lesions, which lead to dementia. Moreover, pure CAA may produce dementia through hypoperfusion of the cortex by CAA-related hyalinization and stenosis of the arteries, which lead to the loss of cortical neurons.