2002年 · 第115卷第07期

Objective To investigate the possibility of using melanoma antigen-1 (MAGE-1) peptide as a tumor vaccine to treat hepatocellular carcinoma (HCC). Methods The expressions of MAGE-1 in 8 HCC cell lines and in liver cancer tissue from a patient were detected using RT-PCR. The type of human leucocyte antigen I (HLA I) of both 8 HCC cell lines and peripheral blood mononuclear cells of the patient was detected using a microcytotoxicity method to screen out target cell lines for the cytotoxicity assay. Peripheral blood mononuclear cells from the HCC patient pulsed with an MAGE-1 peptide (NYKCRFPEI) were used as antigen presenting cells. Autogenous peripheral blood mononuclear cells were stimulated with antigen presenting cells every 7 days for 4 times to elicit cytotoxic T lymphocytes. The phenotype of effector cells was analyzed using flow cytometry. The cytotoxicity of effector cells was detected with a lactate dehydrogenase releasing assay. Results The expressions of both MAGE-1 and HLA-A24 were detected in BEL7405 cell line which were used as the positive target cell line in the cytotoxicity assay. The expression of MAGE-1 alone was detected in HLE, BEL7402, BEL7404, QGY7703 and SMMC7721 cell lines, and the expression of neither MAGE-1 nor HLA-A24 was shown in QGY 7701 and HpG2 cell lines. The last 7 cell lines could be used as negative target cell lines in the cytotoxicity assay. Peripheral blood mononuclear cells expanded 32 folds during 28-day culture. The ratio of CD3+ T cells increased by 16%(from 54%to 70%), and the ratio of CD8+ T cells increased by 20%(from 36%to 56%) during 28-day culture. When the ratio of effector cells to target cells was 10:1, effector cells exhibited 62.5%cytotoxicity against autogenous lymphoblasts pulsed with the peptide (NYKCRFPEI) of MAGE-1 antigen, 40.25%cytotoxicity against BEL7405 cells, compared with 17.88%cytolysis observed against autogenous lymphoblasts, 19.55%against HLE cells, and 1.6%against QGY7701 cells. When the ratio of effector cells to target cells was 3.3:1, the cytotoxicity of effector cells against the peptide pulsed autogenous lymphoblasts was 53.6%, which was much higher against autogenous lymphoblasts, HLE cells and QGY7701 cells at 15.6%. 13%and 1%, respectively. Conclusion The results demonstrate that cytotoxic T lymphocytes with the ability to specifically lyse target cells expressing both MAGE-1 and HLA-A24 could be successfully induced by the MAGE-1 peptide NYKCRFPEI in vitro. This indicates that a good result might be anticipated if this peptide is used as a tumor vaccine to treat HLA-A24 HCC patients. Chin Med J 2002; 115(7): 1002-1005

Objective To investigate the immune privilege induced by the Fas ligand (FasL) expressed by cotransplanted testicular Sertoli cells in islet allografts, and the effect of FasL gene transfection on islet cells in pancreatic islet allografts. Methods Allogeneic islets and testicular cells were cotransplanted into diabetic recipients. Pancreatic islets were infected with the recombinant adenovirus, AdV-FasL, and transplanted into diabetic recipients. Allograft survival, islet function, apoptosis of infiltrative lymphocytes in allografts and gene transfected islet allografts were analyzed. Results All animals receiving islet allograft alone returned to a diabetic state in a few days (mean survival time 6.3 ±0.6 days). When the quantity of testicular cells cotransplanted with islets increased to 1 x 107,all animals remained normoglycemic throughout the follow-up period (60 days) . FasL expression by cotransplanted Sertoli cells induced apoptosis of activated lymphocytes. Rejection of allografts in the FasL gene transfer group was accelerated and allograft survival was shortened to 3.4 ± 0.2 days (P<0.05). Pancreatic islets infected with AdV-FasL demonstrated positive staining for FasL at 24 h after transplantation, with increased intensity at 48 h. Apoptosis assays of pancreatic islet allografts at 24 h and 48 h revealed apoptosis of transfected islets. Conclusions FasL-expressing testicular Sertoli cells can induce apoptosis of activated lymphocytes. Cotransplantation of testicular cells allows long-term survival of allogeneic islets because of immune privilege, but the direct expression of FasL on islet allografts infected with AdV-FasL accelerates islet rejection via islet apoptosis and granulocyte infiltration. Chin Med J 2002; 115(7): 1006-1009

Objective To investigate the diagnosis and surgical techniques of intramedullary hemangioblastoma of the cervical spinal cord. Methods MR imaging and the methods and results of surgery were analyzed in 21 patients. Results The tumors were divided into three types on MR imaging. ① Syringeal type, where the tumor varied in size and was accompanied by syringobulbia and syringomyelia; ② Cystic type, where the tumor presented as a cyst with a small mural node; and ③ Solid type, where the tumor was revealed as a huge solid mass. All tumors were totally removed and diagnosis was confirmed by histological study. Postoperative neurological status was improved in 20 patients and aggravated in 1. Conclusions The localization and the nature diagnosis of the tumor can be made by cervical MR imaging. Operative methods vary with tumor types. It is the most important that the tumor is dissected along the right interface and removed after devascularization. Chin Med J 2002; 115(7): 1010-1013

Objective To determine the combined effect of hypothermia and crystalloid hemodilution on blood solubility of volatile anesthetics. Methods Two hundred and thirty ml blood samples obtained from each of twelve healthy male volunteers were adjusted to a hematocrit of 40%and then diluted with normal saline to hematocrits of 36%, 32%,28%, 24%, and 20%. Blood/gas partition coefficients of desflurane, sevoflurane, isoflurane, enflurane and halothane were measured at 37℃, 33℃, 29℃, 25℃, 21℃and 17℃ using a two-stage headspace double equilibration method. Results As the temperature decreased, the logarithm of the blood/gas partition coefficient increased linearly (P <0.05) . As the hematocrit decreased, the logarithm of the blood/gas partition coefficient decreased linearly (P <0.05). The combined effect of hypothermia and crystalloid hemodilution on blood solubility of anesthetics was expressed by multiple linear regression equations as follows: Desflurane: logeλB/G=-0.0302 × T+0.0094 × HCT+0.119 R2=0.973 Sevoflurane: logeλB/G=-0.0295 ×T+0.0092 × HCT + 0. 306 R2=0.961 Isoflurane: logeλB/G=- 0 . 0382 × T +0 . 0154 x HCT+1 .120 R2=0 .997 Enflurane: logeλB/G=- 0 .0408 × T+0 . 0198 x HCT+1 . 408 R2=0 . 982 Halothane: logeλB/G=- 0 . 0417 × T+0 . 0218 × HCT+1 . 649 R2=0 . 994 WhereλB/G is the blood/gas partition coefficient, T is temperature (℃) and HCT is hematocrit (%). Conclusions Hypothermia increases, while crystalloid hemodilution decreases the blood solubility of volatile anesthetics. The combined effect of hypothermia and hemodilution on blood solubility at any cross point of temperature from 37℃ to 17℃ and hematocrit from 40%to 20%could be predicted by the multiple linear regression equations developed in this study. Chin Med J 2002; 1155(7): 1014-1019

Objective To investigate changes in renal function, urine N-acetyl-β-D-glucosaminidase enzyme (N-AG),liver function, myocardial enzymes, the pathology of renal damage and the mechanism of acute renal failure(ARF) associated with fish gall bladder poisoning. Methods Eleven patients with acute fish gall bladder poisoning were consecutively admitted to our hospital from September 1997 to October 1999. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were assayed before and after treatment. One patient consented to a kidney biopsy and the pathology of renal damage was observed under light and electron microscopes. Results All patients had multiple organ dysfunction syndrome (MODS) and 11 patients suffered from ARF. Ten patients had liver dysfunction, ten patients had poisonous myocarditis, and 8 patients had gastrointestinal dysfunction. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were significantly improved after treatment compared with those of before treatment (P <0.05). Kidney biopsy showed that the main damage site was the proximal renal tubule. All eleven patients recovered and were discharged from the hospital. Conclusions Ingestion of fish gall bladder leads to kidney damage, as well as liver, heart and gastrointestinal tract injury. The mechanism of acute renal function failure is the serious tubular damage,confirming the location of kidney damage. Necrosis of the proximal tubules plays an important role in the development of ARF. Immediate hemodialysis is the most effective treatment. Chin Med J 2002; 115(7): 1020-1022

Objectives To study the usefulness of CT virtual colonoscopy (CTVC) in patients with incomplete conventional colonoscopy (CO and assess the statistical differences between two methods of colorectal segment examination. Methods Sixty patients with incomplete CC underwent volume scanning using spiral CT. CTVC images were obtained using a navigator software in workstation. All patients were confirmed by surgical or CC biopsy histology. Statistical analysis was done using t test comparing two sample percentages. Results CTVC succeeded in 55/60 patients (91.7%) who had incomplete CC. Additional lesions were identified in the proximal colon in 15/55 patients (27.3%), including 1 primary carcinoma, 16 polyps in 13 patients and 1 ulcerative colonitis. The main cause of incomplete CC was occlusive mass; others were redundant tortuous colon loops, and excessive colonic spasm. There was a statistically significant difference between the two methods in colorectal segment examination. Conclusion CTVC is a feasible and effective adjunctive method for evaluating the entire colorectal segment following an incomplete CC procedure. It offers a new approach for colorectal examination. Chin Med J 2002; 115(7): 1023-1026

Objective To investigate the distribution, changes and a possible role for retinal dopamine transporter(DAT) in experimental myopia in chickens. Methods Two-day-old chickens were divided into four groups. Chicken eyes were fitted with lenses of -10D, -20D and translucent goggles unilaterally. Normal eyes were used as controls. After 3 wk, all chickens were given an intramuscular injection of 125I-β-CIT[2β-carbomethoxy-3β-(4-iodophenyl)tropane]and sacrificed two hours post injection. Retinal pigment epithelium (RPE) and the neural retina were obtained together or RPE was dissected out from the neural retina. Radioactive DAT from each specimen was assayed by γ-counter. Results Retinal DAT was detected in RPE specimens rather than in the neural retina in all eyes. Radioactive DAT in myopic eyes was higher, compared with control eyes. Conclusions Retinal DAT is mainly located in the RPE and may be involved in the formation of lens induced myopia (LIM) and form deprivation myopia (FDM). These methods may provide a new approach for further studying the role of the dopamine system in experimental myopia. Chin Med J 2002; 115(7): 1027-1030

Objective To study the relationship between severity of skeletal Class Ⅲ malocclusion and the patient's emotional status, as well as motivation for seeking surgical correction and satisfaction with the outcome of the surgery. Methods One hundred and forty consecutive Chinese patients with skeletal Class Ⅲ malocclusion who had been treated with a combined orthodontic and surgical approach were studied. Sixty-seven percent (40 males and 54 females) responded to a questionnaire. Fifty-four percent had two jaw deformities, 32%mandibular hyperplasia and 14%maxillary hypoplasia. Surgical procedures: 77%received two jaw surgeries, 15%maxillary advancement and 8%mandibular setback. This was a retrospective study based on questionnaires with numerical scale ranked answers (0: not at all; 1: a little; 2: moderately; 3: quite a bit; and 4: extremely). Results ANB angle was significantly negatively correlated with feelings about the nickname related to their facial problems (embarrassment: r= -0.30, P <0.01; worn out r = -0.32, P <0.01; angry r= -0.24, P <0.05). ANB angle also had a significant negative correlation with the reasons for having the surgery (pressure from their friends: r=- 0.21. P <0. 05, and referred by physician: r= - 0.24. P < 0.05). Changes in life style as a result of surgery were significantly negatively correlated with the ANB angle before treatment, positive influence on relationships with the opposite sex (r=-0.25, P<0.05). positive influence in social activiies (r=-0.22. P<0.05). Conclusion The psychological status before surgery and the outcome following orthognathic surgery in patients with skeletal Class Ⅲ malocclusion were closely related to severity of the malocclusion. Chin Med J 2002; 115(7): 1031-1034

Objective To study the effects of emodin on proliferation and differentiation of 3T3-L1 preadipocyte and the possible mechanism. Methods Cell proliferation was determined by MTT spectrophotometry, cell differentiation was determined by Oil Red O staining, and fatty acid synthase (FAS) activity was determined by spectrophotometry. Results Emodin promoted proliferation of 3T3-L1 preadipocyte at low concentration and inhibited the proliferation at high concentration in a dose-related manner. In contrast, it inhibited cell differentiation into adipocyte at low concentration in a dose-related manner. In vitro emodin inhibited the activity of FAS in a dose-related manner. Conclusions The effects of emodin on 3T3-L1 cell's proliferation and differentiation are dose dependent. Emodin inhibits the activity of FAS. Our results suggest that emodin should have a potential to serve as a fat-reducing drug. Chin Med J 2002; 115(7): 1035-1038

Objective To determine the karyotype of a cryptic structural abnormality and explore the mechanism of apparent chromosomal terminal deletion. Methods Fluorescence in situ hybridization(FISH) with a whole chromosome 7 painting probe and a 7q subterminal probe (7q36→qter), prepared by chromosome microdissection technique, was used to analyze a case with a history of spontaneous abortion and 7q terminal deletion detected by conventional G-banding technique. Results The case was a maternal cryptic insertional translocation between chromosome region lp32 and 7q32→q35. The region of chromosome 7q36→qter was not inserted into chromosome 1, and the abnormal chromosome 7 was not a terminal deletion but an interstitial deletion. Conclusions Chromosome insertion of the terminal region retains its telomere, which is consistent with the concept of a three-break rearrangement. Interstitial deletion may be regarded as another mechanism for terminal deletion in the chromosome banding level. Combined with chromosome microdissection, FISH technique could be a powerful diagnostic tool for detecting chromosome structural abnormalities. Chin Med J 2002; 115(7): 1039-1042

Objective To investigate the prevalence of functional dyspepsia (FD) and the psychological disorders in Chinese population and their relation. Methods A total of 1016 apparently healthy people (study population) randomly selected from population were interviewed. A general questionnaire, Zung self-rating depression scales (SDS), and anxiety scales(SAS) were given to each subject. Seventy-two inpatients with confirmed diagnosis of FD, 84 with organic dyspepsia, and 197 with other organic diseases were also studied. Results Among the study population, 23.5% had FD and 9.1% had disturbances of depression and/or anxiety. The prevalence of psychological disturbances in FD group (15.5%) differed significantly from that in non-FD group (7.1%, P <0.01). In the survey of inpatients, the rate of depression/anxiety in FD group (54.2%) was greater than that in organic dyspepsia group (19.0%) and other organic diseases group (28.9%), P <0.05, and was also significantly higher than that of the FD cases in the study population (15.5%), P <0.01. Further analysis showed that some psychosocial disturbances were risk factors of FD. Conclusion Both FD and depression/anxiety disturbances are common in China, and there is a link between them. Chin Med J 2002; 115(7): 1082-1084

Objective To explore the relationship between genetic polymorphisms of the ethanol metabolizing enzymes and the occurrence of alcoholic liver disease (ALD). Methods Sixty-five healthy male controls and 165 alcoholisms (including 122 ALD patients and 43 male alcohol abusers without liver complications defined as alcohol-dependent) were analyzed by polymerase chain reaction and hybridized with oligonucleotide microarray to detect the polymorphisms of the ethanol metabolizing enzymes genes. Results The frequencies of alcohol dehydrogenase gene 2 * 1 (ADH2 * 1) allele were shown as 37.69%, 46.51 %and 59.02%in control, alcohol-dependent and ALD groups respectively; while those of ADH2 * 2 allele were shown as 62.31%, 53.49% and 40.98% respectively. No ADH2 * 3 was detected in any of the subjects. The frequency of ADH2 * 1 was significantly higher in alcoholisms (ALD group and alcohol-dependent group) than in healthy controls (P <0.01), and significantly higher in ALD group than in alcohol-dependent group (P <0.05) . The frequency of ADH3 * 2 was significantly higher in alcohol-dependents than in healthy controls (P <0.05) . The frequencies of ALDH2 * 2 allele mutation were significantly lower in alcoholisms than that in the healthy controls, and the deference between ALD group and alcohol-dependent group was significant. No homozygotes for the mutant ALDH2 * 2 allele were found in either alcoholic groups. Conclusions Polymorphic ADH2, ADH3 and ALDH2 genes can affect the propensity for alcohol drinking in Chinese. The alleles of ADH2 * 2, ADH3 * 1 and ALDH2 * 2 are most likely to play a protective role against excessive consumption. ADH2 * 2 and ALDH2 * 2 may contribute to susceptibility for ALD. Chin Med J 2002; 115(7): 1085-1087

Objective To determine whether the transfusion-transmitted virus (TTV) is hepatotropic. Methods Total DNA was extracted from various tissues of 5 experimentally infected Rhesus monkeys during the viremic period. A dot hybridization was done with viral double stranded DNA probes or single antisense probes. Results The double-stranded probe was hybridized with DNA from the liver, bone marrow, spleen,stomach, small intestine and colon. The single-stranded antisense probe was hybridized with DNA from the liver, small intestine and bone marrow of all 5 monkeys, but not with that from other tissues. Conclusions As the viral genome was of negative polarity, the plus-stranded fragment identified in our study might be a replicative intermediate, and was only demonstrated in the liver, small intestine, and bone marrow by dot blot hybridization with single-stranded antisense probes. It is suggested that the TTV replicates in the liver, bone marrow and small intestine, and TTV might be hepatotropic. Chin Med J 2002; 115(7): 1088-1090

Objective To study the prevalence of skin positivity to purified protein derivative (PPD) in human immunodeficiency virus (HlV)-infected patients in Hong Kong. Methods Consecutive clients of an HIV clinic were administered the PPD test and 2 units of PPD-RT23 were used. The area of induration was then measured in 48 to 72 h. Results were related to patient characteristics and HIV-related parameters. Results Eight (17.0%) out of 47 clients tested positive to the administration of 2 units of PPD-RT23. If the cutoff were raised to 10 mm according to current practice, only two (4.3%) would test positive. Conclusion The prevalence of PPD positivity in HIV-infected patients in Hong Kong is 17%, when a cutoff of 5 mm is used. This figure may form the basis for further studies on the utility of isoniazid preventive therapy in this group of patients. Chin Med J 2002; 115(7): 1091-1092

Objective To study the factors that affect the prognosis of the patients with benign prostatic hypertrophy(BPH) after prostatectomy. Methods Using urodynamic methods, we studied 50 BPH patients with embarrassing outcomes after prostatectomy. Results Detrusor instability (DI) appeared in 20 (40%) patients. Twelve (24%) patients suffered from weak contractility of the detrusor and 18 (36%) patients had bladder outlet obstruction. Conclusions DI, weak contractility of the detrusor and bladder outlet obstruction are the most frequent causes affecting the prognosis of BPH patients after prostatectomy. Urodynamics may play a significant role in the identification of the causes of unsatisfied prognosis of BPH patients. Chin Med J 2002; 115(7): 1093-1095

Objective To evaluate the measurement of Samarium-153 ethylenediaminetetramethylene phosphonic acid(153Sm-EDTMP) bone uptake rate using whole-body scintigraphy and analyze the relationship between bone uptake rate and therapeutic effect. Methods Sixty-six patients with painful bony metastases from prostate (n=15), lung (n=20), breast (n =18), nasopharyngeal carcinoma (NPC) (n=5), colon (n=2), kidney (n=2) and unknown cause (n= 4) carcinoma were examined with whole-body scintigraphy 10 min and 5 h post administration of 153Sm-EDTMP. Bone uptake rate was then calculated. (1) Complete response (CR): disappearance of > 2 metastases, Karnofsky Performance Score (KPS) increase >20, moderate or complete remission of bone pain 7 d post injection of 153Sm-EDTMP. (2) Partial response (PR): disappearance of 1 -2 metastases,KPS increase 10 - 20, moderate remission of bone pain in 3 wk. (3) Non-response (NR): no disappearance or shrinkage of metastases, KPS increase <10, no or slight remission of bone pain. Results The range of bone uptake rate in 66 patients was 31.9%- 86.6%(mean=56.0%). The bone uptake rate in the CR group (17 cases, 25.7%), PR group (24 cases, 36.4%). and NR group (25 cases, 37.9%) was 52.4% - 86.6%(mean=68.7%), 43.7%- 70.4%(mean=58.3%), and 31.9%-51.5%(mean=41.0%) respectively. Statistical analysis showed that there was a significant difference between the CR and PR groups (t=4.258, P=0.001) as well as between PR and NR groups (t=8.48,P=0.001). Conclusions Using a simple and reliable whole-body scintigraphic technique to calculate prospectively the bone uptake rate, we have, for the first time in China, reported the relationship between bone uptake rate and therapeutic effect. This allows nuclear medicine physicians to calculate a safe and effective dose of 153Sm-EDTMP in individual patients to palliate bone cancer pain without myelotoxicity. Chin Med J 2002; 115(7): 1096-1098

Objectives To review the identified deafness genes related to nonsyndromic hearing loss (NSHL) and summarize their expressions and functions in the cochlea and to introduce the current studies of molecular genetics on NSHL in China. Methods The presented data are based on a review of the literature as well as the author's experience with NSHL and communications with other researchers in China over the past 3 years. Results Currently, 23 deafness genes related to NSHL have been cloned and identified. Some genes are associated with both NSHL and syndromic hearing loss (SHL), in both dominant and recessive deafness. Deafness genes have a highly specific expression pattern in the inner ear. Some functional categories are starting to emerge from a characterization of deafness genes. There are interacting genes in the genetic background that influence the extent of hearing impairment. The GJB3 gene, which is associated with high-frequency hearing impairment, was cloned in a Chinese laboratory. Mutations in some genes, such as GJB2 and mitochondrial 12S rRNA, have been screened in Chinese patients with NSHL. Mapping new deafness gene loci as well as identifying new genes and their functions is an active area of study in China. Conclusions It is challenging for us to continue identifying new deafness genes and analyze gene functions. By identifying genes responsible for monogenic hearing impairment, more insight may be gained into the molecular process of hearing and the pathology of hearing loss. Chin Med J 2002; 115(7): 1078-1081