2000年 · 第113卷第11期

Objective To assess the intravesical application of immunotoxin as adjuvant therapy to prevent recurrence after tumor resection in bladder cancer patients. Methods An anti-human immunotoxin against bladder carcinoma, BDI-1-RT, was prepared and its in vitro targeting cytotoxicity estimated. The immunoreactivity of BDI-1-RT with human bladder cancer tissue of different grades and stages was detected by immunohistochemical analysis. After safety test, intravesical administration of BDI-1-RT was performed in 31 patients while mitomycin C(MMC)was used in 36 patients serving as a control group. The recurrence rates and side effects in both groups were recorded. In addition, the development of human anti-mouse antibodies(HAMA)was determined by ELISA, to assess the potential safety of this immuotoxin. Results In our study, BDI-1-RT had immunoreactivity with 81.6% of bladder transitional cell carcinomas. The immunoreactivity of BDI-1-RT correlated with tumor grade. High-grade carcinoma had stronger staining than low-grade(P< 0.05). There was no significant difference between the BDI-1-RT group(10%)and MMC group(19.3%)in recurrence rate(P> 0.05). Side effects, including systemic and local, were more frequent in the MMC group(11 of 36 patients versus 2 of 31, P<0.05). HAMA was not detected in any of 7 patients. Conclusion Immunotoxin may have considerable potential in the prophylaxis of bladder transition cell carcinoma. Chin Med J 2000; 113(ll): 1002-1006

Objective To determine the sensitivity and specificity of using a computer-photoscreener and non-cycloplegic retinoscopy in the detection of amblyopiogenic factors in nine to fifty months old infants and children. Methods Three hundred children, nine to fifty months old, were screened with the computer-photoscreener and non-cycloplegic retinoscopy. With a blinded standardized clinical assessment as the standard, an overall comparison of the sensitivity of and specificity results obtained with the two techniques was made. Photoscreen images on the computer monitor screen were reviewed and analyzed immediately by two independent observers for indicators of amblyopiogenic risk factors. Simultaneously, the results were compared to the findings of a full ophthalmologic examination. Results The computer-photoscreener revealed a sensitivity of 94.6% and specificity of 90.1 %, and the non-cycloplegic retinocopy revealed a sensitivity of 85.7% and specificity of 81.0% for the detection of amblyopiogenic risk factors, including hyperopia(+2.75 D or more), myopia(-1.50 D or more), astigmatism(1.75 D or more), anisometropia(2.00 D or more), ocular misalignment(5 degrees or more), and media opacity(1.5 mm or more). Conclusions The computer-photoscreener offers an opportunity to identify problems that limit vision, and could provide a feasible and sufficiently reliable screening technique in infants and preschool children to be screened successfully for amblyopiogenic risk factors. Chin Med J 2000; 113(11): 1007-1010

Objective To clone and express EC1-2 and EC3-4 epitopes of PVA(pemphigus vulgaris antigen, desmoglein-3)in order to diagnose pemphigus and study the relationship between epitopes of PVA and anti-PVA antibody. Methods RNA was extracted from keratinocytes and the cDNA of epitopes EC1-2 and EC3-4 was synthesized by reverse transcription. Amplified genes of EC1-2 and EC3-4 were inserted into the expression plasmid, PGEX-4T-1, and transformed into E. coli BL21 by electric transduction. Recombinant fusion proteins of EC1-2 and EC3-4 epitopes were expressed by IPTG induction. These proteins were separated on SDS-PAGE gels and electroblotted to nitrocellulose to detect the anti-PVA antibody. Results The sequences of cloned EC1-2 and EC3-4 genes were identical to the sequence registered in PC/GENE. Expressed recombinant proteins reacted only to sera from patients with pemphigus vulgaris, not to sera from patients with bullous pemphigoid, systemic lupus erythematosus or normal persons. Conclusions These recombinant proteins are very specific in antigenicity. This may provide a new method for the diagnosis of pemphigus vulgaris(PV)or the differential diagnosis of other bullous cutaneous diseases via patient sera. It is also helpful in understanding the relationship between adhesion molecules and the pathogenic mechanism of pemphigus vulgaris. Chin Med J 2000; 113(11): 1011-1014

Objective To detect Mycoplasma genitalium(Mg) infection in high risk populations of sexually transmitted diseases(STDs)from several cities in China and to clarify the possible role of Mg in the pathogenesis of non-gonococcal urethritis. Methods Polymerase chain reaction(PCR)based on 2 pairs of primers, one for Mg-Pa(adhesion protein)and the other for 16S-rRNA(Mycoplasma genera)was used to detect Mg infection. Urogenital specimens of different high risk populations and urethritis patients, were collected from the Guangdong, Kunming, Shanghai, Nanjing, and Changzhou areas. Results The positive detection rate of Mg-DNA in high risk populations of STDs was significantly higher than that of the control group(χ2 = 7.82, P<0.01). The positive detection rates in Guangdong STD clinics and promiscuous persons from Kunming were higher than those from the Shanghai, Nanjing, and Changzhou areas(χ2 = 8.54, P < 0.01 and χ2 = 5.89, P < 0.05). Mg DNA could be detected in those patients without other relevant pathogens. Some patients were simultaneously infected with Mg and other microbes, such as Chlamydia trachomatis and/or Ureaplasma urelyticum. The positive Mg-DNA detection rate in patients with urethritis symptoms was higher than in patients without the symptoms(χ2 = 11.68, P<0.01). Conclusion Mg infection exists in high risk populations of STDs in China, and the Mg infection rate is different among different high risk groups. Chin Med J 2000; 113(11): 1015-1018

Objective To compare the characteristics of the dose-response relationship and the time course of action between atracurium and rocuronium in adult patients anesthetized with N20-02-fentanyl-thiopene. Methods Sixty patients, ASA grade I, aged 18-50 years, scheduled for elective plastic surgery were studied. All patients were randomly divided into either the atracurium or rocuronium group. General anesthesia was maintained with 60% nitrous oxide and 40% oxygen, thiopentone, and fentanyl. Neuromuscular function was assessed using an accelograph with train-of-four(TOF)stimulation at the wrist every 12 seconds. The percentage depression of the first twitch(T1)was used as the study parameter. The dose-response relationship of atracurium and rocuronium was determined by the cumulative dose-response technique. Results According to the dose-response curves established by a least squares linear regression, the potency ratio of atracurium to rocuronium was 1: 1.2. There were significant differences in the ED50, ED90, and ED95 between the two drugs. After the intravenous administration of equipotent doses of both drugs (1.5 ×ED95), the duration of peak effect, clinical duration, and total duration were significantly different between the two drugs, but their recovery indexes were similar. Conclusions Atracurium and rocuronium are low-potency nondepolarizing relaxants with intermediate duration. As compared to atracurium, the neuromuscular blocking effect of rocuronium was about 20% less potent and its duration of action was shorter. Chin Med J 2000; 113(11): 1019-1021

Objective To evaluate the imaging method and clinical application of CT virtual bronchoscopy(CTVB). Methods Fifty-two patients with bronchial and pulmonary diseases were studied with CTVB. All patients underwent fiberoptic bronchoscopy and patients with lung cancers were confirmed pathologically. Lung cancer of center type was found in 46 patients, postoperative lung cancer in 4, tracheal adenoidcystic carcinoma in 1, and bronchial diverticulum in 1. CTVB was performed using Navigator Smooth software on the workstation(Advantage Windows 3.1, GE Medical Systems). Source images included slice thickness of 3 mm or 5 mm, pitch of 1.0 or 1.5, 1.0 mm or 2.0 mm interval(overlap more than 60%)reconstruction. Results CTVB could reveal vividly the tracheobronchial lumens, the cartilage rings, the carina and the left and right main bronchi, down to the fourth order of bronchial orifices, mimicing fiberoptic bronchoscopy. Among 46 patients with lung cancers of center type, fiberoptic bronchoscopy showed the masses in 45 patients and CTVB displayed the masses in 42. The sensitivity of CTVB was 93.3% and its accuracy was 93.5％(x2 = 1.33, 0.10 < P < 0.25). The tumors appeared as masses or nodules, causing bronchial stenosis(n = 35)or occlusion(n = 7). The bronchial rings near the masses were blurred, smooth or absent in contrast to the findings of fiberoptic endoscopy. Postoperative bronchial stump(n = 4)appeared to be smooth. Bronchial diverticulum exhibited a local concavity on CTVB and local protrusion on surface shadow display(SSD). CTVB could pass through the stenotic bronchi and detect the occlusive bronchi from the distal end. Conclusions The sensitivity of CTVB in detecting bronchial masses was higher than that of fiberoptic bronchoscopy. Combined with multiplanar reconstruction(MPR)and CTVB can demonstrate the extraluminal extension of tumors. As a noninvasive examining method, however, CTVB is limited to observe mucosal abnormalities and to obtain histologic samples. Chin Med J 2000; 113(11):1022-1025

Objective To compare the efficacy and safety of two aminoglycoside antibiotics, etimicin and netilmicin, in the treatment of bacterial infections. Methods A randomized, open label, controlled clinical trial was conducted for the treatment of 65 patients hospitalized with respiratory tract infections, urinary tract infections, and skin and tissue infections. Thirty-four patients received etimicin and thirty-one patients received netilmicin at a dose of 100 mg every 12 hours by intravenous infusion. The duration of treatment was 7-10 days in both groups. Results 47 patients were enrolled in the etimicin group; 35 patients were assessable for safety and 34 patients were assessable for efficacy, 46 patients were enrolled in the netilmicin group; 32 patients were assessable for safety and 31 patients were assessable for efficacy. The results show that overall efficacy was 85.3% for the etimicin group and 83.9% for the netilmicin group, whereas bacterial clearance rates were 87.5% for the etimicin group and 89.7% for the netilmicin group. The incidence of adverse reactions was 8.6%(3/35)and 9.4%(3/32), respectively. Conclusion Etimicin and netilmicin were effective and safe for the treatment of respiratory tract infection, urinary tract infection, and skin and tissue infections. The results show there was no statistically significant difference between the two groups(P>0.05). Chin Med J 2000; 113(11): 1026-1030

Objective To investigate lymphangiogenesis in tumor tissues and 5'-Nase, Flt-4, Flk-1 expressions. Methods 5'-Nase and Aplase expressions and the morphology of lymphatics in gastric carcinoma tissues were observed with enzyme histochemistry. Flt-4 and Flk-1 expression in gastric carcinoma and sarcoma tissues was studied by immunohistochemistry. CNE-2z cells were implanted into the subdermal layer of nude mice and hyaluronic acid was injected at the same sites. After 4 or 5 weeks, nasopharyngeal carcinoma(NPC)xenograft tissues were cut for immunohistochemistry and enzyme histochemistry, and lymphangiogenesis, 5'-Nase, Alpase, Flt-4 and Flk-1 expression in NPC tissues was studied. Hyaluronic acid contents in sera of the patients with NPC and mice with NPC xenografts were measured by radioimmunoassay. Results There were a lot of lymphatics and solid strip-like tissues in gastric carcinoma and NPC xenograft treated with hyaluronic acid. The total number of lymphatics(26.±14.2/HP)increased significantly in gastric carcinoma tissues. Flt-4 and Flk-1 positive expression was found in gastric carcinoma, sarcoma tissues and NPC xenograft. Most of the vessels with positive Flt-4 were lymphatics. Flk-1 expression was only found in the walls of blood vessels. Hyaluronic acid content(363.52 ±98.15 ng/ml)in sera of patients with NPC was higher than that of the patients with chronic nasopharyngeal imflammation(306.29 ±27.15 ng/ml), with a significant difference(P = 0.039). The hyaluronic acid content in sera of nude mice with NPC(2120.59±490.22 ng/ml)was markedly higher than that in normal mice(1588.99 ± 502.12 ng/ml), with a significant difference between them(P = 0.007). Conclusion There are a lot of lymph capillaries with positive 5'-Nase in gastric carcinoma and NPC xenograft treated with hyaluronic acid. Flt-4 positive expression is shown in gastric carcinoma, sarcoma tissues and NPC xenografts. The results suggest there is lymphangiogenesis in these malignant tumor tissues. Hyaluronic acid contents in sera of patients with NPC and nude mice with NPC increase, which may promote the formation of lymphatics. Chin Med J 2000; 113(ll): 1031-1035

Objective To study the clinicopathologic features and immunoprofile of angiomyofibroblastoma(AMF)with emphasis on differential diagnosis. Methods Seven vulvar, two vaginal and one perineal angiomyofibroblastomas were evaluated by light microscopy and immunohistochemistry. The immunohistochemical studies were performed on paraffin-embedded sections using the standard ABC method with a panel of antibodies. Results Angiomyofibroblastoma predominantly occurred in middle-aged women in the genital region, especially in the superficial area of the vulva. Clinically, most of the tumors presented as slowly growing painless masses and were often diagnosed as Bartholin's gland cysts. Histologically, the tumors were all well-circumscribed and characterized by alternating hypocellular and hypercellular areas with abundant thin-walled blood vessels. The tumor cells were bland and spindle-shaped or epithelioid and tended to concentrate around the vessels or cluster in small nests. Immunohistochemically, the tumor cells expressed vimentin and estrogen receptor protein in all 10 cases and desmin in 9 cases. Three cases showed weak or focal immunoreactivity to alpha-smooth muscle actin and muscle specific actin. All ten patients were treated by local excision. Follow-up showed a benign course with no signs of recurrence. Conclusions Angiomyofibroblastoma is a distinctive neoplasm that has a propensity to occur in the female genital tract. Recognition of this entity is important to avoid misdiagnosis with other vulvar angiomyxoid neoplasms. Chin Med J 2000; 113(11): 1036-1039

Objective To determine whether cholinergic neurons in the basal nucleus magnocellularis(NBM)and the medial septum are affected in transgenic mice overexpressing human amyloid precursor protein 770 (APP770). Methods Eight age groups, from 3 months old to 10 months old, of either heterozygous transgenic or non-transgenic mice were used for choline acetyltransferase(ChAT)staining using immunohistochemistry. The number of ChAT-positive neurons was counted on the MCID Image Analysis System. Neurons in the cerebral cortex and area CA1 of hippocampus were also stained with cresyl violet and counted using optical dissector technique. Results There is no change in the number of forebrain cholinergic neurons in the transgenic mice up to 9 months of age. A loss of these cholinergic neurons starts in 9 months old transgenic mice, with a further decrease in the number of NBM and medial septum neurons in 10-month-old transgenic mice. On the other hand, the number of neurons in the cerebral cortex and hippocampal area CA1 remained unchanged. Conclusion These results demonstrate a selective loss of basal forebrain cholinergic neurons in APP770 transgenic mice. Chin Med J 2000; 113(11): 1040-1042

Objective To describe the etiologies, clinical features and diagnosis of cerebral venous sinus thrombosis. Methods We reviewed the records of 23 patients admitted with a documented diagnosis of cerebral venous sinus thrombosis from 1991 through 1999 in the Beijing Tiantan Hospital. Results Infection was the major condition associated with cerebral venous sinus thrombosis. Pseudotumor cerebri syndrome was the most common manifestation, while hemiplegia, seizure and unconsciousness may occur alone or in association. The diagnostic sensitivity of computed tomography(CT), magnetic resonance imaging(MRI)and digital subtract angiography(DSA)were 59%, 86% and 100%, respectively. The sensitivity of MRI with magnetic resonance angiography(MRA)reached 96%. Conclusion As the clinical findings were found to be nonspecific, CT combined with DSA, or MRI with MRA turns out to be valuable for the early diagnosis of cerebral venous sinus thrombosis. Chin Med J 2000; 113(11): 1043-1045

Objective To evaluate the role of p27Kip1 in tumorigenesis and the development of trophoblastic cell disease. Methods Using immunohistochemistry, the expression of p27-protein was investgated in 10 normal chorionic villi in the first trimester of pregnancy, 15 complete hydatidiform moles(HM), 7 invasive moles(IM)and 7 choriocarcinomas(CC). Results In all cases, immunohistochemical staining localized p27-protein in the plasma. Decreased expression of p27Kip1 was observed in malignant trophoblastic neoplasms with a positive rate of 21.43％, which is significantly less than that in normal chorionic villi(80%)and in complete HM(73.33%)(P < 0.05). The positive rate of p27Kip1 in those complete HM with large uterine size for gestational age was lower than that in those with normal or small uterus(42.86% vs 100%, P < 0.05). Conclusion p27Kip1 may be involved in the tumorigenesis of gestational trophoblastic neoplasm as a negative regulator of the cell cycle. The expression level of p27Kip1 in trophoblastic cells may be a prognostic factor for complete HM. Chin Med J 2000; 113(11): 1046-1048