2003年 · 第116卷第07期

Objective To study the relationship between pregnancy-induced hypertension(PIH)and catecholamine levels. Methods Catecholamines levels in maternal and fetal blood were determined in 116 patients with PIH and 40 normal control subjects using high performance liquid chromatography. The normal control subjects and PIH cases were selected from patients at term pregnancy receiving elective cesarean section. Results Plasma norepinephrine(NE)levels were significantly higher in patients with severe PIH than those in control subjects(P<0. 05). Both patients and control subjects had higher NE levels in the umbilical artery blood than in the umbilical vein blood(P<0. 05). NE levels in the umbilical artery blood were five times higher than those in the maternal blood. Conclusion The pathogenesis of PIH may relate to catecholamine concentrations in fetus. Chin Med J 2003; 116(7): 1108-1109

Objective To evaluate the advantages of image-guided system in transnasal endoscopic surgery. Methods Transnasal endoscopic surgery was performed with the aid of an image-guided system in 28 patients, supported with histopathologic diagnoses of chronic sinusitis with/without nasal polyps(10 cases), juvenile nasopharyngeal angiofibroma(4 cases), pituitary adenoma(6 cases), ethmoidal ossifying fibroma(3 cases), nasopharyngeal mixed tumor(2 cases), nasal leiomyoma(1 case), fungal sinusitis(1 case)and inverted nasal papilloma(1 case). Results For all the patients, the time periods from initialization to surgery ranged from 15 to 30 minutes(a mean of 26 minutes). The calibration coefficient ranged from 1. 3 to 2. 0. Accuracy of localization fell within 1 mm. Compared with traditional endoscopic surgery, operation times were not noticeably different. No complications occurred. Conclusions The image-guided system was able to identify borders and critical anatomical structures in real-time, especially of those with distorted anatomical markers. It provided a powerful means for a safer and less invasive endoscopic sinus surgery. Chin Med J 2003; 116(7): 1106-1107

Objective To investigate the clinical and imaging characteristics of severe acute respiratory syndrome(SARS), and to study their relationship. Methods Forty-six SARS confirmed patients were admitted to our hospital from February to April, 2003. X-ray examination documents were available in all cases and chest CT scanning was acquired in 6 cases, which were analyzed retrospectively, accompanied by their clinical features. Results Fever was found in 97. 8% of the patients. Clinical symptoms were mild, but X-ray and CT findings were distinct. CT scanning demonstrated ground glass like lesions and large patchy exudation and consolidation at the early stage in 6 cases. Different findings on radiography and CT were related to the different phases of the disease. After treatment, most lesions were absorbed completely, but slowly in patients with multi-lobe consolidation and/or extensive interstitial infiltration. Conclusion Special clinical and imaging findings could be found in SARS cases. The prognosis of SARS patients is related to the degree of lesions detected by radiography and CT. Chin Med J 2003; 116(7): 1104-1105

Objective To develop an efficient expression, purification system of recombinant Escherichia coli heat-labile enterotoxin B subunit(rLTB)and study its activity against mucosal immunoadjuvant by nasal immunization. Methods A recombinant, pMMB68-LTB was generated by cloning the LTB cDNA fragment into an expression vector(pMMB68)and transformed it into the host strain marine vibrio VSP60. The relevant target protein was identified using SDS-polyacrylamide gel electrophoresis(SDS-PAGE)and Western blot. Sephacryl S-100 gel filtration chromatography was carried out for purification of rLTB in engineering bacteria VSP60. BALB/c mice received hen egg lysozyme(HEL)alone or combined with rLTB by nasal administration. After three times immunization, IgG and IgA antibody levels in serum or small intestine wash samples were determined using ELISA. Results rLTB protein was highly expressed in VSP60. After gel filtration with Sephacryl S-100, the purity of rLTB reached 98. 1%, the yield rate was about 52%. After immunization, IgG and IgA antibody responses specific to HEL in system and mucosa of HEL + rLTB groups were significantly increased, compared with the HEL alone group(P <0. 001). Conclusions A set of protocols for large-scale rLTB preparation has been established, which is simple, efficient and applicable. The rLTB protein we prepared was proved to be a powerful mucocal adjuvant, which could greatly enhance systemic and mucosal immune responses to nasally coadministered antigen. Chin Med J 2003; 116(7): 1115-1117

Objective To investigate the effectiveness of using a medium molecular weight hydroxyethyl starch solution(HES)administered as a replacement for estimated blood loss(EBL)during cytoreductive surgery for ovarian cancer on splanchnic oxygenation. Methods Forty-two patients undergoing cytoreductive surgery for ovarian cancer were enrolled in this prospective randomized study. As soon as the EBL exceeded 10% but was less than 20% of the estimated blood volume, the patients were randomly assigned to receive either a volume of lactated Ringer's solution(LRS)equal to three times the EBL(LRS group, n =22)or a volume of 6% HES equal to the EBL(HES group, n = 20). Tissue oxygenation was assessed indirectly by measuring tonometric parameters, including the difference between gastric intramucosal PsC02 and arterial PaC02(Ps-a C02 gap), gastric intramucosal pH(pHi)and arterial lactate acid concentration at 30 min after induction of anesthesia(baseline value), 1 hour and 2 hours after skin incision, and at the end of surgery. Results At the end of surgery, the Ps-a C02 gap in the HES group(8. 7 ±1. 6 mmHg)was significantly lower than that of the LRS group(18. 74 ±4. 4 mmHg, P <0. 01), while the pHi(7.30 ± 0. 05 mmHg)in the HES group was significantly higher than that of the LRS group(7. 21 ±0.07 mmHg, P <0. 01). There was no significant difference between the two groups in terms of arterial lactate acid concentration. Conclusion In patients undergoing major surgery with relatively large blood losses, volume resuscitation with medium molecular weight hydroxyethyl starch solution may improve splanchnic blood flow and tissue oxygenation. Chin Med J 2003; 116(7):996-1000

Objective To assess the risk factors correlating to the likelihood for airflow obstruction among first-degree children of chronic obstructive pulmonary disease(COPD)patients and whether familial aggregation of pulmonary function abnormality exists. Methods Fifty-nine smokers with COPD and 28 smokers without COPD as control and all their children available were recruited into the study. Their history was recorded and a binary logistic regression analysis was carried out to ascertain the effects of their relationship to a proband with COPD, when other potential risk factors were controlled. Results Children with COPD probands showed increased risk of FEV1 below the 70% predicted(OR =1.987)after accounting for the effects of smoking, sex and clinical symptoms. The lower the pulmonary function of the COPD proband, the higher the risk to their children for FEV1 below the 70%predicted. Conclusions Our finding demonstrates the presence of a household aggregation inclination of COPD and pulmonary function impairment. Genetic factors might act as the basis of the familial aggregation. Chin Med J 2003; 116(7):991-995

Objective To establish a fluorescent polymerase chain reaction(F-PCR)method for detecting the coronavirus related to severe acute respiratory syndrome(SARS)and to evaluate its value for clinical application. Methods The primers and the fluorescence-labeled probe were designed and synthesized according to the published sequence of the SARS-associated coronavirus genes. A F-PCR diagnosis kit for detecting the coronavirus was developed, and 115 clinical nasopharyngeal gargling liquid samples were tested. Results The sequence of PGR amplified products completely matched the related sequence of the SARS-associated coronavirus genome. Forty-nine out of 67 samples from identified SARS patients and 8 of 18 samples from persons having close contact with SARS patients showed positive results. All 30 samples from healthy controls were negative. Conclusion The F-PCR method established may be a rapid, accurate and efficient way for screening and for the early diagnosis of SARS patients. Chin Med J 2003; 116(7):988-990

Objective To study the alteration of peripheral lymphocyte subsets in severe acute respiratory syndrome(SARS)patients and to help improve the early diagnosis of the disease. Methods Anti-coagulating blood samples from 98 SARS patients in the acute phase, 56 normal healthy blood donors, and from patients infected by HIV, CMV and EBV were collected. The T lymphocyte subsets were counted by flow cytometry using fluorescence-labeled specific monoclonal antibodies. Results A significant decrease was observed in all SARS patients in their peripheral CD4+ and CD8 + T lymphocyte absolute counts [256(104)x106/L and 256(117)x106/L, respectively], which were also lower than those of the patients infected with HIV, CMV and EBV. All patients infected with HIV, CMV and EBV had significantly higher CD8+ T lymphocyte counts in comparison with normal controls. Conclusions Decrease of both CD4 + and CD8 + T lymphocytes of patients is related to onset of SARS. T lymphocyte subset analysis would help improve the early diagnosis of the disease. Chin Med J 2003; 116(7):985-987

Objectives To observe the changes of serum interleukins(IL), T-lymphocyte subsets, and white blood cell(WBC)count in patients with severe acute respiratory syndrome(SARS), and to investigate the relationship between injured immune function, immune response and disturbed immune adjustment in SARS patients. Methods The levels of serum IL-2, IL-10, IL-12 and T-lymphocyte subset counts were measured in 35 clinically diagnosed SARS patients by using enzyme linked immunosorbant assay(ELISA). The relationship between the measured results and WBC count was further analyzed. Results The level of serum IL was increased to a great extent in the 35 SARS patients, and the levels of serum IL-2, IL-10 and IL-12 were 242. 53(92. 69)pg/ml, 77. 43(63. 37)pg/ml and 65. 94(43. 21)pg/ml, respectively. The level of serum IL-2 increased markedly(P <0. 01). The peripheral blood CD3+, CD4+ and CD8+ counts were lower than normal in 23 patients(67. 7%), 26 patients(74. 3%)and 15 patients(42. 9%), respectively. The peripheral blood WBC counts were lower than 4. 0 × 109/L in 10 patients, and their CD3 +, CD4+ and CD8+ counts were 583. 90(315. 58)x106/L, 272. 00(94. 13)x 106/L and 209. 00(72. 21)x 106/L, respectively. The peripheral blood WBC counts were(4. 0-10.0)x 109/L in 20 patients, and their CD3 +, CD4+ and CD8+ counts were 700. 00(502. 96)x 106/L, 347. 00(247. 58)x 106/L and 322. 05(228. 47)x 106/L, respectively. The peripheral blood WBC counts were higher than 10. 0 × 109/L in 5 patients, and their CD3 +, CD4 + and CD8 + counts were 1466. 00(630. 86)x106 /L, 783. 00(311. 14)x106/L and 640. 00(294. 40)x 106/L, respectively. The decreased CD3 +, CD4+ and CD8 + counts were consistent with the decreased WBC counts. The level of IL in SARS patients was significantly higher than that in patients with chronic hepatitis B(P <0. 01). Conclusions The level of serum IL is closely related to cell immunity in SARS patients. The level of serum IL is increased evidently while CD3 +, CD4 + and CD8 + counts decrease. Both serum IL and CD are associated with injury of immune function, and thus they could be regarded as a monitoring index for judging the condition of SARS patients and prescribing immune therapy. Chin Med J 2003; 116(7):981-984

Objective To study the pathological characteristics of severe acute respiratory syndrome(SARS)and its relationship to clinical manifestation. Methods Tissue specimens from 3 autopsies of probable SARS cases were studied by microscope, and the clinical data was reviewed. Results The typical pathological changes of lungs were diffuse hemorrhaging on the surface. A combination of serous, fibrinous and hemorrhagic inflammation was seen in most of the pulmonary alveoli with the engorgement of capillaries and detection of micro-thrombosis in some of these capillaries. Pulmonary alveoli thickened with interstitial mononuclear inflammatory infiltrates, suffered diffuse alveolar damage, experienced desquamation of pneumocytes and had hyaline-membrane formation, fibrinoid materials, and erythrocytes in alveolar spaces. There were thromboembolisms in some bronchial arteries. Furthermore, hemorrhagic necrosis was also evident in lymph nodes and spleen with the attenuation of lymphocytes. Other atypical pathological changes, such as hydropic degeneration, fatty degeneration, interstitial cell proliferation and lesions having existed before hospitalization were observed in the liver, heart, kidney and pancreas. Conclusion Severe damage to the pulmonary and immunological systems is responsible for the clinical features of SARS and may lead to the death of patients. Chin Med J 2003; 116(7):976-980

Objective To investigate the chest X-ray manifestations of SARS cases. Methods A retrospective study was conducted among 52 clinically confirmed SARS patients from February 9 to May 10, 2003. Chest X-ray scanning was performed at a interval of 1-3 days according to the requirements. The manifestations and special features of SARS in X-ray were analyzed. Results Small or large patchy shadows with intensive density in both lungs were observed in 31 cases, ground-glass like opacification in 16, small patchy shadows in one lung lobe or one lung segment in 18, nodular shadows in one lung segment in 1, and increased lung marking in lung interstitial tissues in 2. Rapidly changing consolidations revealed in chest X-ray images were found to be associated with SARS infections, and they were not affected by treatment with antibiotics. Conclusion Chest X-ray provides a sensitive and specific method for the diagnosis and treatment of SARS, and those present with symptoms and signs should undergo chest X-ray scanning every 1-3 days. Chin Med J 2003; 116(7):972-975

Objective To study the chest X-ray image features of patients with severe SARS. Methods Chest X-ray image features in 36 patients with severe SARS were retrospectively analyzed. The image characteristics were compared with those of 224 patients with common SARS. Results The important chest X-ray imaging features of 36 patients with severe SARS included small patch of infiltration(n =27, 75. 0%), large patch of infiltration(n =22, 61. 1%), large area of lung consolidation(n =10, 27. 3%), interstitial lung lesion(n =26, 72. 2%), ground-glass shadow(n = 28, 77. 8%), irregular linear opacity(n = 15, 41. 7%), diffuse lung lesion(n = 12, 33. 3%), with single lung involved(n =9, 25. 0%), and both lungs involved(n =32, 88. 9%). The rates of large patch of infiltration, large area of lung consolidation, ground-glass shadow, diffuse lung lesion and involvement of both lungs in patients with severe SARS were significantly higher than those in patients with common type of SARS(all P <0. 01). Out of the 11 severe SARS patients who died, nine had large area of ground-glass shadow with air bronchogram in both lungs before death. Conclusions Large patch of infiltration, large area of consolidation, ground-glass shadow, diffuse lung lesion and involvement of both lungs were the main X-ray image characteristics of patients with severe SARS. Large area of ground-glass shadow with air bronchogram in both lungs indicated a bad prognosis. Chin Med J 2003; 116(7): 968-971

Objective To investigate the effects of treatment with ursodeoxycholic acid(UDCA)on intrahepatic cholestasis in rats, and to explore its mechanism. Method Rats suffering from intrahepatic cholestasis were treated with UDCA. Their serum alanine transaminase(ALT), alkaline phosphatase(ALP), total bilirubin(TBIL), direct bilirubin(DBIL), γ-glutamyl transpeptidase(γ-GT), total cholesterol(TCH), bile flow, total bile acid excretion, total Na+ and TCH of bile were measured before and after treatment. In addition, the changes of liver tissue under microscrope were observed and recorded. Results Compared with the control group, serum ALT, ALP, TBIL, DBIL, y-GT and TCH of rats in the treatment group decreased, while bile flow, total bile acid excretion, total Na+ and TCH decreased significantly. Degeneration of hepatocytes, infiltration of inflamed cells and proliferation of small bile ducts in the treatment group were improved under microscope. Conclusion UDCA may have therapeutic effects on cholestatic hepatitis. The mechanism may involve in its hydrophilicity, choleretic effect and immune modulation. Chin Med J 2003; 116(7): 1099-1103

Objective To investigate a 272 base pair section of the 5 '-non-coding region of genomic DNA from the peripheral blood monounuclear cells of healthy hepatitis virus C(HCV)-negative human subjects(not patients). Methods This sequence section bears interest because ① it harbors several potential methylation(Cp-rich)sites, and ② it represents the largest part of its internal ribosomal entry site. A pre-PCR digestion protocol was established making consistent use of four restriction endonucleases selected for certain features: Smal, XmaCI, Mspl, and Hpall are inhibited if methylation(s)are present at certain cytosines within their cutting sequences. Results The suspected HCV-specific sequence was found in the DNA of each subject tested. The pre-PCR digestion assay reveals individual differences in their pattern of methylation, which may be due to possible epigenetic phenomena. Conclusions The results provide formal proof that these HCV-specific sequences are contained in the genomic or extra chromosomal target DNA, and probably belong to a new class of endogenous sequences. Chin Med J 2003; 116(7)11092-1098