2008年·第121卷第13期

Abstract：Background Jaw osteonecrosis possibly associated with the administration of bisphosphonates is expected to be treated with a non-pharmacologic approach.This study aimed to determine whether noninvasive,mechanically mediated vibration would inhibit the decline in bone mineral density(BMD)that follows menopause,enhance the BMD of the Iumbar and femoral neck.and reduce chronic back pain in postmenopausal women with osteoporosis.Methods A total of 116 postmenopausal women with osteoporosis participated in this study,and they were divided into groups A(66 patients)and B(50).Group A received vibration treatment(Subjects vertically stand on the vibration platform,with a vibration frequency of 30 Hz,amplitude of 5 mm:they received the treatment five times per week,ten minutes each time and totally for six months),whereas women of group B served as controls without any treatment.L2-4 BMD,bilateral femoral neck BMD,and body mass index(BMI)were recorded before the treatment or at the third and sixth months of the treatment respectively.After the ending of the treatment,the change of BMD in each group was compared and analyzed.Chronic back pain was evaluated by visual analogue scale(VAS)at baseline and the third and sixth months of the treatment.Results Of the 116 women,94 including 51 women from group A((61.23±8.20)years)and 43 women from group B ((63.73±5.45)years),completed the study.There were no significant differences in baseline characteristics including age,BMI,menopausal years,lumbar BMD,femoral neck BMD,and VAS between the two groups.The lumbar BMD of the 51 women in group A increased by 1.3%(P=0.034)after vibration treatment for 3 months and by 4.3% at the sixth month (P=0.000).The lumbar BMD in group B was decreased at theird month,but there was not statistical significance(P＞0.05).At the sixth month,it was decreased bv 1.9%(P＜0.05).The femoral neck BMD of the 51 women in group A was slightly Increased after vibration treatment for 3 months,but without statistical significance(P＞0.05).At the sixth month,the BMD was increased by 3.2%(P＜0.05).In group B,the BMD was not decreased significantly(P=0.185)at the third month,but decreased significantly at the sixth month(1.7%)(P＜0.05)compared with the baseline.Chronic back pain(VAS)reduced more significantly in group A at the third and the sixth months(P＜0.05)after vibration therapy in comparison with the baseline.The BMI was not significantly changed in the two groups dunng the penod of follow-up.Conclusions Vibration therapy appears to be useful in reducing chronic back pain and increasing the femoral neck and lumbar BMD in postmenopausal women with osteoporosis。

Abstract：Background A new inhalable insulin aerosoI(Inh-Ins)was developed in China.The aim of this multicenter clinical study was to evaluate the efficacy and safety of this new Inh-Ins as a treatment of type 2 diabetes.Regular porcine insulin(RI)was used as a control.Methods This study is a prospective,randomized,open-label,parallel-group multicenter clinical trial in which 253 qualified patients with type 2 diabetes received the insulin Glargine daily at bedtime plus either a pre-meal Inh-Ins or a pre-meal subcutaneous RI for 12 weeks.HbA1c,fasting plasma glucose(FPG),the 1-hour-postprandial blood glucose(1hPBG)and the 2-hour-postprandial blood glucose(2hPBG)were measured.Events were monitored for adverse effects.Results After 12 weeks,the HbA1c decreased significantly from baseline in both treatment groups,with no significant difference between the two regimens.In the Inh-Ins group,FPG,both 1hPBG and 2hPBG significantly declined from baseline after the 8th-and 12th-weeks of treatment.The reduced values of FPG or 1hPBG between the two groups showed a more significant hypoglycemic effect with the Inh-Ins than the RI.After 12 weeks,the pulmonary carbon monoxide diffusing capacity(DLco)was significantly lower in Inh-Ins group than in the RI.The main side effects of Inh-Ins were coughing,excessive sputum,and hypoglycemia.Conclusions Inh-Ins was effective in decreasing HbA1c like the RI.It was better in lowering the FPG and the 1hPBG than the RI.Its main side effects were coughing,excessive sputum,and hypoglycemia.Also,Inh-Ins slightly impaired DLco。

Abstract：Background Tanis was repoded as a putative receptor for serum amyloid A(SAA)involving glucose regulated protein in insulin regulated resistance.It was found to be dysregulated in diabetic rats(Psammomys obesus,Israeli sand rat)and its homologue for humans is SelS/AD-015.The present study analyzed mRNA expression of SelS in omental adipose tissue biopsies from patients with type 2 diabetes mellitus (T2DM),and age-and weight-matched nondiabetic patients,the relationship of SelS mRNA with Homa-IR and serum SAA level.Methods Human omental adipose tissues from ten cases of type 2 diabetic patients and twelve cases of nondiabetic individuals were analyzed for the expression level of SelS mRNA by semiquantitative polymerase chain reaction(PCR),Homa-IR estimated by standard formula and SM level by enzyme-linked immunosorbent assay(ELISA).Results SelS mRNA expression.Homa-IR and serum SAA were higher in T2DM sufferers than in nondiabeUc control group.SelS mRNA level was positively correlated with Homa-IR and SAA level in each group.Conclusions SelS protein may be involved in insulin resistarice;in Chinese with T2DM by acting as the SAA receptor,thus playing an important role in the development of T2DM and atherosclerosis。

Abstract：Background An apnea test is essentialin the clinical determination of brain death.This study was conducted to analyse complications associated with the apnea test in the determination of the brain death.Methods On 93 adult patients In coma in Zhejiang Province of China from January 2003 to December 2006,179 apnea tests were performed as a part of the determination of brain death.Potential risk conditions and complications were analysed during apnea tests.Results During apnea,sedous cardiac arrhythmia did not occur in all patients.Complications occurred in 37 of 179 (21%)apnea tests.Hypotension occurred in 30 patients(17%)and it was obsewed in 8/94(9%)tests with baseline value of systolic arterial blood pressure not less than 120 mmHg,and 22/85(26%)lass than 120 mmHg(P＜0.05).Severe hypoxaemia occurred in 10 patients(6%)of which 3/138(2%)tests with baseline value of arterial oxygen pressure not less than 200 mmHg,and 7/41(17%)less than 200 mmHg(P＜0.05).Conclusions This study demonstrated that complications occurred mostly in patients with inadequate baseline systolic arterial blood pressure and preoxygenation.Adequate precautions during the apnea tests may reduce the risk of cardiovascular and oxygenation complication。

Abstract：Background Latanoprost,a prostaglandin F2a analog,has been shown to be an effective intraocular pressure lowering agent which acts by inducing ciliary muscle cells to synthesise matrix metalloproteinases.However,the response of ciliary melanocytes to latanoprost has never been reported.This research has investigated the ability of latanoprost to induce matrix metalloproteinase-1 expression in human ciliary melanocytes,and thereby advance the understanding of the mechanism of PGF2a in decreasing Intraocular pressure.Methods In vitro human ciliary melanocytes were treated for 48 hours with five different concentrations of latanoprost (100,150,200,500,and 1000 nmol/L).Ciliary melanocytes treated with 0.01% ethanel(vehicle)were used as a control.The expression of matrix metalloproteinase-1 in ciliary melanocytes was determined by Western blotting and immunofluorescent staining.Results Western blotting showed that the expression of matrix metalloproteinase-1 in ciliary melanocytes was induced by latanoprost,and the level of expression was dependent on the concentration of latanoprost in the culture medium.Immunofluorescent staining showed that matrix metalloproteinase-1 was confined to the ciliary melanocyte cytoplasm.Conclusions Latanoprost induced the expression of matrix metalloproteinase-1 in human ciliary melanocytes in a dose-dependent manner.Ciliary melanocytes,as well as ciliary muscle cells,may also play an important role in uveoscleral outflow modulation。

Abstract：Background The decrease of suffactant protein(SP)secreted by the alveolar type Ⅱ cell is one of the important causes of limiting air of pulmonary emphysema.However,the SP-A gene and protein changes in this disease are rarely studied.This study was undertaken to investigate alterations in SP-A gene activity and protein,and to explore their roles in the pathogenesis of emphysematous changes.Methods Twenty Wistar rats were divided randomly into a normal control group(n=10)and a cigarette smoking(CS)+lipopolysaccharide(LPS)group(n=10).Ultra-structural changes were obsewed under an electron microscope.The number of cells positive for SP-A was measured by immunohistochemistry.The mRNA expression and protein Ievel of SP-A in the lung tissues were determined by quantitative polymerase chain reaction(qPCR)and Western blot separately.The protein level of SP-A in lavage fluid was determined by Western blot.Results The number of cells positive for SP-A of the CS+LPS group(0.35±0.03)was lower than that of the blank control group(0.72±0.06,P＜0.05).The level of SP-A in the lung tissues of rats in the CS+LPS group(0.2765±0.0890)was lower than that in the blank controI group(0.6875±0.1578,P＜0.05).The level of SP-A in the lavage fluid of rats in the CS+LPS group(0.8567±0.1458)was lower than that in the blank controI group(1.3541±0.2475,P＜0.05).The lung tissues of rats in the CS+LPS group showed an approximate increase(0.4-fold)in SP-A mRNA levels relative to β-actin mRNA (P＜0.05).Conclusions The changes of SP-A may be related to emphysematous changes in the lung.And cigarette smoke and LPS alter lung SP-A gene activity and protein homeostasis。

Abstract：Background Diabetic gastroparesis is a disabling condition with no consistently effective treatment.In normal animals,both ghrelin and its synthetic peptide,growth hormone releasing peptide 6(GHRP-6),increase gastric emptying.Thus,we investigated the potential therapeutic significance of ghrelin and GHRP-6 in diabetic guinea pigs with gastric motility disorders.Methods A diabetic guinea pig model was produced by intraperitoneal(i.p.)injection of streptozotocin(STZ,280 mg/kg).Diabetic guinea pigs were injected i.p.with ghrelin or GHRP-6(10-100 pg/kg),and the effects on gastric emptying were measured after intragastric application of phenol red.The effect of atropine or a growth hormone secretagogue receptor(GHS-R)antagonist,D-Lys3-GHRP-6,on the gastroprokinetic effects of ghrelin or GHRP-6(100 μg/kg)was also investigated.Further,the in vitro effects of ghrelin or GHRP-6(0.01-10 μmol/L)on spontaneous or carbachol-induced contractile amplitude in gastric fundic circular strips taken from diabetic guinea pigs were examined.Growth hormone secretagogue receptor transcripts in the fundic strips of diabetic guinea pigs were detected by reverse transcriptase polymerase chain reaction(RT-PCR).Results We established a guinea pig model of delayed gastric emptying.Ghrelin(20,50,or 100 μg/kg)and GHRP-6 (20,50,or 1 00 μg/kg)accelerated gastric emptying in diabetic guinea pigs with gastroparesis(n=-6,P＜0.05).In the presence of atropine,which delayed gastric emptying,ghrelin and GHRP-6(100 μg/kg)failed to accelerate gastric emptying(n=6,P＜0.05).D-Lys3-GHRP-6 also delayed gastric emptying induced by the GHS-R agonist(n=6,P＜0.05).Ghrelin and GHRP-6 increased the carbachol-induced contractile amplitude in gastric fundic strips taken from diabetic guinea pigs(n=6,P＜0.05).RT-PCR confirmed the presence of GHS-R mRNA in the strip preparations.Conclusions Ghrelin and GHRP-6 increased gastric emptying in diabetic guinea pigs with gastroparesis,potentially,by activating the peripheral cholinergic pathways in the enteric nervous system。

Abstract：Background The development and maintenance of spiral ganglion cells(SGCs)appear to be supported by neurotrophins.Removal of this support leads to their gradual degeneration.Intracochlear lnfusion with neurotrophins can provide trophic support to SGCs in animaJ deafness models if given shortly after deafening.However,it is not known whether delayed intervention will provide similar protection,which might be clinically relevant.The present research was conducted co determine the effects of brain-derived neurotrophic factor(BDNF)administration on the capacity of the peripheral processes to resprout.Methods The Ieft cochlea of 20 profoundly deafened rats.which were divided into 2 groups equally,was implanted with an electrode and drug-delivery system 30 days after deafening.Either BDNF or artificial perilymph(AP)was delivered continuously for 28 days.Electrically evoked auditory brainstem responses(EABRs)were recorded during the period.SGC body and peripheral process density were measured.Results The EABR thresholds of AP increase continually.Those of BDNF increase slowly at the beginning then decrease.and were significantly less than those of the AP group from day 14 to 28(P＜0.01).In terms of SGC and peripheral process density,the difference between the treated and control ears of BDNF group was clearly significant(P＜0.01),but not in AP group (P＞0.05).Analysis of the left cochlea between the two groups demonstrated that SGC/peripheral process density of the BDNF group was significantly greater than that of the AP group.Finally,a functional formula was developed telating the last EABR threshold and SGC density and process density,which was as follows:T=466.184-2.71(F.B.L).Conclusions Under the conditions of delayed intervention following 30 days after deafening in rats,it can be concluded that BDNF enhances SGC bodies and peripheral processes survival after differentiation and so improves auditory sensitivity.SGC peripheral processes influence the auditory sensitivity。

Abstract：Background This study investigated the inhibitory effect of berberine(BBR)on lipopolysaccharide(LPS)induced cyclooxygenase-2(COX-2)expression via the mitogen activated protein kinase(MAPK)signalling cascade pathways in human peripheral blood monocytes(PBMC).Methods PBMC from whole blood were isolated and cultured for uD 10 24 hours after division into 5 groups treated with LPS,LPS+BBR 25 μmol/L,LPS+BBR 50 μmol/L or LPS+BBR 100 μmol/L and untreated.Monocytes were extracted for RT-PCR and Western blot analyses to examine COX-2 mRNA and protein activated expression of p38 mitogen activated protein kinase(p38MAPK),Jun N-terminal kinase(JNK)and extracellular regulated kinases 1/2(ERK1/2)signalling pathways.Results COX-2 mRNA and protein expression decreased to a minimum at 12 hours after BBR treatment fP＜0.05).With the increasing concentration of BBR treatment,the COX-2 expression decreased progressively(P＜0.01).With BBR treatment for 6,12 or 24 hours at three doses,ERK1/2 protein expression was significantly inhibited.For the JNK pathway,only with the treatment of BBR at the concentration of 100 μmol/L was JNK protein expression inhibited compared with the LPS stimulation group(P＜0.01).Irrespective of the BBR concentration,no difference was shown between the BBR group and the LPS group for p38MAPK protein expression.Human monocytes COX-2 mRNA,by RT-PCR,and protein expression,by Western blot analysis,were inhibited when incubated with PD98059,SP6001 25 and SB203580 (P＜0.05).Conclusions Berberine inhibits COX-2 expression via the ERK1/2 signalling pathway and,possibly,at a high dosage via the JNK pathway.P38MAPK may have no relationship with the effect of BBR in PBMC.Berberine inhibited COX-2 mRNA and protein expression in a dose dependent manner and suppressed COX-2 expression to a minimal level after 12 hours of berberine treatment。

Abstract：Background Environmental toxins can destroy the physiological process of spermatogenesis and even lead to male infertility.Resveratrol(RES)is a natural phytoalexin with a wide range of biological activities.Some recent researches have demonstrated that RES can increase sperm output and protect sperm from apoptosis caused by physical damage.However,there is no evidence indicating that it can also exhibit a similar activity in testis injury caused by environmental toxins.This study was designed to evaluate the protective effect of resveratrol on testis damaged by environmental toxins and to elucidate the possible mechanism of its protective effect.Methods In this study 2,5-hexanedione(2,5-HD)was used as the injury agent.Forty male SD rats were randomly divided into 5 groups.During the first 5 weeks,group A was raised normally,groups B,C,D and E were exposed to 1% 2,5-HD;during the following 9 weeks,group C,D,E received intragastric administration of different concentrations of carboxymethylcellulose.Physical signs,body weight gain and testis weight were comparatively obsewed.Numbers and diameters of seminiferous tubules were analyzed following HE staining.In addition,expression of the c-kit protein and gene in spermatogenic cells jn every group was detected with immunohistochemistry,Western blot or RT-PCR.Results The 2,5-HD treatment resulted in physical signs that became worse and in emarciated testis.HE staining and immunohistochemistry showed that seminiferous tubules became emarcid,obsolete spermatogonia being stagnant and expression of c-kit protein being depressed.After oral administration of resveratrol,the 2,5-HD.induced physical signs were improved and close to the normal rats.The gain of body weight increased(P＜0.01).The recovery of testis weight was significant(P＜0.01).At the histological level,the seminiferous epithelia began to differentiate(P＜0.01):and even the physiological process of spermatogenesis restarted.Moreover,expression of c-kit protein and gene function resumed,although its expression remained different from the normal group.The diameter of and number of seminiferous tubules and the expression level of c-kit protein and gene activity were much closer to the normal group with increased doses of the resveratrol through oral administration.Conclusions Resveratrol could ameliorate markedly the dyszoospermia induced by 2,5-HD and induce spermatogenesis.The expression of c-kit,which is a specific marker protein of spermatogenic cell membranes,could be regulated by resveratrol。

Abstract：Objective To review HIV/AIDS epidemic history,current situation and prevention policy in China.Data sources Information included in this article was identified by searching PUBMED(1997-2006)online resources using the key terms"HIV/AIDS","epidemic","prevention",and"China".Study selection Original milestone articles and critical reviews written by major pioneer investigators of the field were selected.Results The key issues related to the HIV/AIDS epidemic situation in China and Chinese government prevention policy were summarized.HIV/AIDS epidemic groups and trends for HIV transmission were discussed.Conclusion In January 2006,650 000 people were estimated to be living with HIV in China.The overall HIV/AIDS epidemic is at a low level(0.05%)and concentrated in several at risk populations.However,the data show that new cases of HIV infection are growing every year and spreading from at risk populations to the general population.Premier WEN Jia-bao announced the"Four frees and one care"policy and the Chinese government has developed a series of programs with strong policy measures to stop the spread of HIV/AIDS in China。

Posttransplant lymphoproliferative disorder(PTLD)is a well-known complication of both solid organ and bone marrow transplantation,with a prevalence estimated to be between 1% to 20% depending on the type of organ transplanted.1,2 PTLD includes a wide spectrum of proliferative changes ranging from reactive hyperplasia,borderline lesions.to malignant lymphomas.Several factors,such as the clinical immunosuppressive regimen,infection of the Epstein-Barr virus,and underlying disease in the patient are believed to contribute to the development of PTLD.3-5 In this report.we reviewed a consecutive series of 164 patients who underwent their first liver transplantation in our center.Three cases of PTLD were diagnosed on the basis of histological examination.All three patients had a background of hepatitis B virus(HBV)infcction,and developed PTLD after an episode of HBV reactivation.Herein,we describe the clinical features of these three cases of PTLD,with particular reference to the potential association of HBV reactivation and development of PTLD。

Human coagulation factor Ⅻ(FⅫ),also called Hageman factor,is a plasma plycoprotein that is functionally deficient in individuals with Hageman trait:which is an inhefited trait discovered by chance during preoperative blood coagulation screening tests.FⅫ is a single-chain 596-amino-acid zymogen of a serine protease with an approximate molecular weight of 80 000。

Malignant infantile osteopetrosis (MIOP) is characterized by a lack of osteoclastic function,with disturbed bone building and remodeling.1 Most children with this disease die within the first decade of life of secondary consequence of bone marrow failure.Hematopoietic stem cell transplantation(HSCT)is the only curative therapy for MIOP,an otherwise fatal disease.2 We present a girl wim MIOP who underwent a successful unrelated cord blood transplantation(CBT)in Taiwan,China.She was the first case from the mainland of Chinawho has come to Taiwan province for HSCT。

To the editor:With great interest,we read the recent article by Zhao et al,1 in which the authors performed a genome-wide screen for genes that are associated with multi-drug resistance development.The authors concluded that construction of a chemoresistance prediction rule,based on gene expression patterns,is practical and that their results may be useful for the detection and treatment of MDR in pancreatic cancer patients。

To Dr.Xie:First,thank you for your questions and suggestions.I wish my following clarifications would provide sufficient answers to your questions。