2001年 · 第114卷第05期

Objective To assess the effect of transcatheter closure of patent ductus arteriosus (PDA) by comparing five different devices. Methods 354 patients (135 males, 219 females) underwent transcatheter closure of PDA using the Porstmann Ivalon plug, Rashkind double umbrella, Sideris button device, Coils and Amplatzer occluders. The mean PDA diameter at its narrowest segment was 3.1 ± 1.3 mm. Qp/Qs was 2.2±0.5. Follow-up evaluation was performed with color flow mapping of the main pulmonary artery at 24 h and 6 months after closure. Results Successful occlusion was observed in 92%(23/25) for the Porstmann device, 98.7%(77/78)for the Rashkind device, 100%(43/43) for the Sideris device, 100%(69/69) for the Coil and 100%(139/139) for the Amplatzer device. No residual shunts were needed for the Porstmann, while 1.4%-15%of patients who received the Rashkind, Sideris, Coils or Amplatzer needed residual shunts during follow-up. There were complications of 24%(6/25) for the Porstmann, 3.8%(3/78) for the Rashkind, 1.4%(1/69) for Coils and 1.4%(2/139) for the Amplatzer. No complications were found in patients with the Sideris device. Conclusion The results showed that the Sideris device, Coils and the Amplatzer device are more effective and safer than the others for the occlusion of PDA in children. Chin Med J 2001; 114(5): 456-458

Objective To analyze the relationship of waist circumference (WC) as an index of central obestiy to cardiovascular (CVD) risk factors and their clustering and explore the optimal cut-off point of WC for Chinese populations. Methods Data were collected from surveys of 14 groups of middle-aged (35 - 59 years) random samples undertaken during 1993 - 1994, including factory workers, farmers, city residents and fishermen, from northeast, north, east, south, southwest and the middle part of China. The survey methods were internationally standardized. All the local investigators were trained, certified and quality was controlled by the Coordinating Center available for analysis. Results The measures of WC of both male and female Chinese were smaller than those of farmers. Stratifying WC by every 5 cm from <65 cm to ≥100 cm, we found that the prevalence rates of high blood pressure, high serum total cholesterol, low HDL-C, high fasting glucose and clustering rate (≥2 risk factors) were all increased significantly with higher levels of WC. The age-adjusted OR for clustering of risk factore increased by 7.8 and 8.5 times for men and women, respectively. For men with WC≥ 85 cm, the sensitivity and specificity were 59,8% and 70.3%, respectively. Both were better than other cut-off points. Conclusions The extent of central obesity correlates closely with the elevation of cardiovascular risk factors and their clustering, thus the prevention and control of central obesity should be emphasized in Chinese populations. It is better to keep the waist circumference under 85 cm in men and under 80 cm in women.

Objective To evaluate the efficiency of percutaneous balloon angioplasty of coarctation of the aorta in children and discuss its risk factors that can lead to poor long-term results. Methods From September 1987 to August 1999, 24 patients underwent 27 balloon angioplasty procedures for native or recurrent coarctation of the aorta at our institution. There were 19 patients with discrete(membranous) coarctation, 4 patients with long-segment and aortic arch hypoplasia, and 1 patient with postoperative recurrence. The balloon diameter was chosen not to exceed the diameter of the aorta proximal to the stenotic site (11.06 ± 2.80 mm vs 11.78 ± 3.18 mm), with the chosen diameter two to four times that of the stenotic segment (2.57 ± 0.68 times). The patients have been followed up for half to twelve years (mean 6.2 ± 2.8 years). Satisfactory result was defined as a reduction in the pressure gradient across the site of coarctation to ≤ 20 mm Hg. Results The systolic pressure gradient across the coarctation site decreased from 48.17±14.68 mm Hg to 14.96±13.12 mm Hg (P <0.01) and the diameter of the coarctation site increased from 4.66±2.43mm to 8.80±3.32 mm (P<0.01). Immediate satisfactory results were obtained in 19 patients (79%), Of the 5 patients with unsatisfactory results, 4 had aortic arch hypoplasia and 1 had membranous coarctation. Of the 19 patients with satisfactory results, 18 patients had membranous coarctation and 1 patient had recurrent postoperative coarctation. No aneurysm and other complications had occurred in any patients at the follow-ups. Conclusion Percutaneous balloon angioplasty is an effective treatment alternative to surgery in most patients with recurrent postoperative or native membranous coarctation of the aorta. It should not be recommended for the coarctation of aortic arch hypoplasia. Chin Med J 2001;114(5): 459-461

Objective To observe the influence of glucose on the expression of glucose transporters (GluTs) in peritoneal tissues. Methods Mesothelial cells (MsCs) from Sprague-Dawley (SD) rats were cultured in medium with glucose 214.4 mmol/L or 75.5 mmol/L. The normal medium with glucose 17.5 mmol/L was used as control. Total RNA was extracted from each sample after 24 hours incubation. Reverse transcript polymerase chain reaction (RT-PCR) was performed with primers corresponding to sodium-glucose transporter (SGIT1) and GluT1 -GluT4. mRNA expression of the above GluTs from each sample was measured with quantitative PCR. Results GluT1 and GluT2 mRNA can be detected in MsCs from SD rats, while no positive bands can be found specificaly for GluT3, GluT4 and SGIT1. Quantitating the amount of PCR products indicated that the levels of QluT1 mRNA in MsCs cultured 24 h in both 214.4 mmol/L glucose and 75.5 mmol/L glucose medium decreased dramatically compared with that in normal medium (P≤0.01). While under the same conditions, the levels of GluT2 mRNA in MsCs cultured 24 h in 214.4 mmol/L and 75.5 mmol/L glucose medium both increased significantly (P<0.01). Conclusions GluT1 is strongly expressed in MsCs under normal glucose levels and decreased dramatically under high glucose conditions, while GluT2 expressed at a low level in normal medium and increased greatly after incubation in high glucose conditions. This may play a great role in glucose absorportion during peritoneal dialysis and have some connection with ultrafiltration failure due to the alteration of glucose absorption after long-term dialysis. Chin Med J 2001; 114(5): 477-480

Objective To determine the expression and function of the c-kit receptor in bone marrow mononuclear cells (BMMNC) of patients with myelodysplastic syndromes (MDS). Methods Direct immunofluorescence assay and reverse transcriptase-polymerase chain reaction (RT-PCR) were used to detect c-kit protein and c-kit mRNA expressions in the BMMNC of 29 MDS patients and 10 normal controls. Cell culture was used to detect the function of the c-kit receptor. Results c-kit protein expression in the MDS group was significantly higher than that in the control group(8.58%±5.28% vs 3.04%± 1.49%, P<0.05). c-kit protien expression in the refractory anemia (RA)group was significantly lower than that in the RA with an excess of blasts (RAEB)/RAEB in transformation(RAEB-t) group (5.12%±2.13%vs 10.01%±5.07%, P<0.05). The rate of c-kit protein expression was 32.43%in aoute myeloblastic leukemia (AML) cases transformed from MDS (t-AML). c-kit mRNA expression in the MDS group was correlated with c-klt protein expression, Interleukin-3 (IL-3) and erythropoietin (Epo), with or without stem cell factor (SCF), upregulated c-kit protein and its mRNA expression. In the presence of IL-3 and Epo, SCF showed significant stimulating effects on the formation of CFU-GM and BFU-E in semi-solid cultures of normal BMMNC, but had no effects on those of the MDS patients. Conclusion The protein and mRNA expression of the c-kit receptor in the BMMNC of MDS patients were higher than those of normal controls, and the function of this receptor in MDS BMMNC was abnormal. Chin Med J 2001; 114(5): 481-485

Objective To evaluate quantitatively the current status of major cardiovascular risk factors in different populations of China and their trends in the past two decades. Methods In the autumn of 1998, with international standardized examination and measurement, cross-sectional sampling surveys were conducted in 15 research groups including southern and northern, urban and rural, residents, manual workers, farmers and fishermen in different parts of China. 15 395 participants, aged 35 to 59years, about 1000 for each group, were recruited, half of whom were males. Prevalences of major CVD risk factors were standardized to the WHO world standard population. Comparisons were made for 9 groups of samples with comparable data in the early 1980s and 1990s to observe the trends in the past two decades. Results The current status of major risk, factors showed the following characteristics. (1) Prevalence differed greatly between population samples for all risk factors; (2)Prevalence of hypertension was generally higher in the north than in the south, higher in urban areas than in rural, and higher in males than in females, with the rate being over 40% for some populations; (3) The difference in prevalence of dislipidemia was prominent between populations in areas with well-developed and relatively undeveloped economies, and for some populations, the prevalence was over 30%;(4) Prevalence of overweight subjects was significantly higher in the north than in the south, and higher in populations in areas with a well-developed economy than in areas with a relatively undeveloped economy, and the rate was over 50% for some populations; (5) Smoking and alcohol drinking were still a behavior of male. Comparable data from 9 groups showed that in the past two decades, there were great changes in all CVD risk factors. Prevalence of being overweight and hypercholesterolemia increased steadily and significantly, by 137% and 88% for males and by 95% and 65% for females, respectively. Prevalence of hypertension increased 43% for males and 36% for females from early 1980s to early 1990s. Prevalence of alcohol drinking in males increased by 10%. Prevalence of smoking decreased significantly, but was still over 60% in males. Conclusion The current status and trends of CVD risk factors in the middle-aged Chinese population suggest that the incidence of cardiovascular diseases will be increasing in China in the early 21st century, if CVD prevention and control are not reinforced.

Objective To investigate the distribution and clonality of the T-cell receptor (TCR) Vβ repertoire in chronic graft versus host disease (cGVHD). Methods The complementarity determining region 3 (CDR3) of the TCRβ gene with 24 variable regions was amplified in peripheral blood mononuclear cells drawn from one cGVHD patient after allogenic bone marrow transplantation (allo-BMT) 35, 39, 43 or 45 months respectively, using RT-PCR, to observe the expression of TCR Vβ repertoire T cells. The PCR products were further analyzed by genescan to evaluate clonality of T cells. Results Fourteen or 16 TCR Vβ subfamily T cells were detected in each sample of cGVHD case. Oligoclonal T cells were identified in TCR Vβ 6, 16, 17, 19 and 21 subfamilies. The stable clonal T cells in all samples were identified in Vβ6, Vβ17 and Vβ21 subfamilies. Conclusion Skewing distribution and stable clonal expansion of T cells can be found in cGVHD cases and it may be related to the initiation of cGVHD. Chin Med J 2001; 114(5): 489-492

Objective To evaluate the clinical usefulness of the pulsatile bidirectional Glenn shunt operation. Methods Between June 1994 and January 2000, pulsatile bidirectional Glenn shunt was performed on 41 patients, 31males and 10 females, aged 5 ±4 years (7 months ~6years), with a body surface area of 0.64 ±0.25 m2(0.35 ~1.48 m2) . Thirty-five operations were performed under hypothermia with cardiopulmonary bypass, and the other 6operations were performed at ordinary temperatures without cardiopulmonary bypass. The SaO2 before operation was 70%±11%(25%-89%) . The pulmonary pressure measured during operation was 12.5 mm Hg±2.7 mm Hg (8~17 mm Hg). Results One patients died in the early postoperative period, three experienced chylothorax, and the others made uneventful recovery. This operation provides excellent early palliation of cyanosis. The average SaO2 was 90%±4%(77%- 96%) on discharge. The duration of postoperative respirator usage was shorter in those patients who underwent operation at ordinary temperatures without cardiopulmonary bypass. Conclusion The pulsatile bidirectional Glenn shunt, easy to perform and with good early postoperative effects, is a useful procedure in the early management of patients with a functional univentricular heart.

Objective To investigate the incidence of pregnancy induced hypertention (PIH) in Shanghai during 1989 -1998. Methods Data were analyzed retrospectively from three municipal general hospitals and five special hospitals of obstetrics and gynecology. Results There were 158 790 deliveries during the ten years. The total number of PIH was 8852 cases. The incidence of PIH was 5.57%. The rates of mild, moderate and severe PIH were 55.83%, 29.39%, and 14.78%, respectively. There were 114 cases (1.29%) complicated with eclampsia. The rate of cesarean section was 66.97%in PIH patients. The complications of PIH were as follows: abruption of Placenta 0.52%, heart failure 0.34%, renal failure 0.20%, DIC 0.07%, hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome 0.03%, and one case of maternal death. There were 9197births in 8852 cases of PIH (twins 343 cases, triplets one case). Perinatal death occurred in 66 cases (7.18‰), of which fetal death accounted for 48 cases, stillbirth 12 cases and neonatal death 6 cases. Conclusion The incidence of PIH and the rate of perinatal infant death can be reduced by strengthening antenatal monitoring, prevention, early diagnosis and treatment of PIH.

Objective To observe engraftment kinetics, the incidence and severity of graft-versus-host disease(GVHD), and clinical outcome on 40 recipients undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Methods From June 1997 to May 1999, forty leukemia patients with a median age of 35 years underwent allo-PBSCT. PBSC were mobilized with G-CSF at a dose of 5 μg/kg s.c. every 12 hours for 5 days. A median of 7.7 (2.0 - 16.8) × 106 CD34+ cells/kg was infused into the recipients. Busulfan-cyclophosphamide (BU-CY) was used as the conditioning regimen. All patients received cyclosporine A and either methotrexate (n=34) or methylprednisolone (n=6) for GVHD prophylaxis. Results Engraftment of neutrophils and platelets was achieved at a median of 13 days (9 - 28 days) and 12 days (7-60 days) respectively. Patients receiving ≥4×106 CD34+ cells/kg or given G-CSF post transplant had significantly accelerated neutrophil and platelet engraftment. Acute GVHD occurred in 17 of 40 patients (42.5%), with grade II-IV acute GVHD in 10 patients (25%). Chronic GVHD developed in 21(9 extensive, 12 limited) out of 30 evaluable patients (21/30, 70%) with a median follow up of 380 days(180 - 900 days). Transplant related mortality was 17.5%and the relapse rate was 10%. The probability of leukemia free survival at 3 years was 72.5%. Conclusion Allo-PBSCT can provide rapid hematopoietic reconstitution without an increased incidence of acute GVHD, but may be associated with a high risk of chronic GVHD. Chin Med J 2001; 114(5): 493-496

Objective To discuss the diagnostic accuracy of the preliminary clinical use of stereotactically guided wire localization biopsy for nonpalpable breast lesions and its value in the early detection of breast carcinomas. Methods Stereotactically guided wire localization biopsy was performed on 26 lesions. The distance between the needle tip and disease center (D) was calculated and compared to that directly obtained from measurement of the localization between the wire tip and center of the lesion. Localization was rated as excellent, good or bad when D values were ≤2.5 mm, =2.6- 2.9 mm, and ≥5.0 mm, respectively. Results Excellent, good, or bad localization results were achieved in 20, 5, and 1 procedure, respectively. These data correlated well with the direct measurements of the localization between the wire tip and center of the lesion. Resection of 26 lesions by a single operation was achieved,and the median volume of the resected specimens was 10.5 cm3. The breast carcinoma detection rate of 6/26 was achieved. Conclusion Our initial application of the technique showed that stereotactically guided wire localization biopsy of nonpalpable breast lesions is an effective tool for the localization and specification of breast lesions. It could avoid false negativity and help excise the entire lesion without excessive excision of the surrounding normal tissue. The technique is worthy of wider application for the preoperative diagnosis of nonpalpable breast lesions.

Objective To evaluate the diagnosis and management of bronchial rupture from blunt thoracic trauma. Methods A group of 31 patients with bronchial rupture was involved. Chest roentgenography, tomography and bronchoscopy were performed on all patients. The surgical technique and complications were described. Results Diagnosis was confirmed by tomography and bronchoscopy in all the patients. End to end anastomosis was used in 26 patients. Four patients were operated with total pneumonectomy. One patient was repaired with an intercostal muscle and rib flap with blood supply. Of the 31 patients, one died of adult respiratory distress syndrome after operation. Most patients had excellent surgical outcomes. 81 %(25/31)of the bronchial rupture were delayed in diagnosis and treatment. The classic symptoms and signs of bronchial rupture included subcutaneous emphysema, dyspnea and an intermediate coma interval. The roentgenogram showed mediastinal emphysema, pneumothorax, "drop lung" sign and marked radiodensity of hilum widened mediastinum. Conclusion Bronchoscopy is a useful and accurate method to diagnose and treat the bronchial rupture, with which surgeons can easily locate the rupture site during surgery. Surgical treatment could restore pulmonary function in most patients. Chin Med J 2001, 114(5): 540-541

Objective To investigate the clinical effects of cordotomy on bilateral cord abductal paralysis. Methods With unilateral cordotomy, we treated 4 patients with bilateral cord paralysis whose glottis size was about 2.0 mm to 2.5mm. They were followed up for over one year. Results One week after surgery, the tracheotomy tubes of all 4 patients were plugged and no dyspnea occurred during rest and mild action. Their voices were more hoarse than before surgery. After 3 months, the tracheotomy tubes were successfully decannulated, and in the following one year, their respiration was normal and then speech was clear, although their voices were still a little hoarse. Conclusion We suggest that cordotomy be one option in the treatment of bilateral cord abductal paralysis. Chin Med J 2001; 114(5): 542-543

Objective To investigate the expression of the Fas antigen and the induction of apoptosis in eosinophils (EOS) by anti Fas antibody in vitro. Methods The purified EOS from healthy donors were cultured for 72 h in the presence of human IL-5 with or without anti-Fas monoclonal antibody (MoAb) at various concentrations (1- 1000 ng/ml). The changes of eosinophil viability, percentage of apoptosis, and fragmented DNA electrophoresis were observed. The eosinophils treated by Fas MoAb for 24 h, 48 h, 72 h were cultured with monocyte-derived macrophages. The positive percentage of macrophages which engulfed EOS was calculated. Results The anti-Fas MoAb suppressed IL-5-mediated EOS survival in a dose- and time-dependant manner. High concentration of IL-5 (106 U/L) could not inhibit anti-Fas MoAb-mediated apoptosis. The percentage of apoptosis was 35% ± 6% after 24 h treatment with Fas MoAb (P <0.01(, and increased to 96% ± 3% after 72 h (P < 0.01), The percentage of macrophages which engulfed eosinophils was significantly higher than that of control (P < 0.01). Conclusion The anti-Fas MoAb can efficiently induce eosinophil apoptosis, and apoptotic EOS induced by anti-Fax MoAb could be engulfed by macrophages.