2003年 · 第116卷第09期

Objective To investigate the effects in vitro of 17 β-estradiol(E2)on the proliferation and metabolism of rabbit mandibular condylar cartilage cells. Methods Chondrocytes were derived from neonatal rabbit mandibular condylar cartilage using a modified enzyme method. 17p-estradiol was added to the culture medium in a variety of concentrations. Cell growth and DNA, collagen, and proteoglycan synthesis were used as indicators of proliferation and differentiation of condylar chondrocytes. These were measured by cell number, 3H-proline and 35S-incorporation, respectively. Results E2 increased cell number and 3H-thymidine incorporation at 10-8 to 10-10 mol/L, and 10-8 to 10-11 mol/L in a dose-dependent manner, peaking at 10-8 mol/L and 10-9 mol/L, respectively. However, further increase in the concentration of estradiol caused inhibition of both cell number and 3H-thymidine incorporation, and this was significant at 10-6 mol/L. The effect of E2 on proteglycan synthesis was similar; the maximum stimulating effect was at 10-8 mol/L, and inhibition was significant at 10-6 mol/L. There was no obvious stimulatory effect of E2 on 3H-thymidine incorporation observed. Conclusions Estradiol affects condylar chondrocyte cell growth, DNA, and proteoglycan synthesis in a biphasic manner depending on its concentration. This indicates that estrogen may be important in the proliferation and differentiation of mandibular condylar chondrocytes, and could be relevant to some aspects of certain tempormandibular joint diseases by modulating the function of the chondrocytes. Chin Med J 2003; 116(9): 1413-1417

Objective To investigate the expression of anaphylatoxin receptor C5aR(CD88)in synoviocytes from patients with rheumatoid arthritis(RA)and osteoarthritis(OA). Methods The expression of C5aR was assessed in synoviocytes isolated from 27 RA and 12 OA patients using reverse transcription-polymerase chain reactions(RT-PCR), flow cytometry, and immunofluorescence analysis. The effects of C5a on the release of tumor necrosis factor a(TNFα)from synoviocytes were assayed using enzyme-linked immunosorbent assays(ELISA). Results C5aR mRNA was detected in 24 of 27 samples from RA patients, and 10 of 12 samples from OA patients. Flow cytometric analysis and immunofluorescence study demonstrated the cell surface expression of C5aR in a significant proportion of synoviocytes from both RA and OA patients, and the level of C5aR expression in synoviocytes was significantly correlated with joint swelling, erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)in RA patients. Finally, interaction of C5aR with its ligand C5a was shown to enhance lipopolysaccharide(LPS)-induced TNFa release from synoviocytes. Conclusions The expression of C5aR in synoviocytes from inflammatory joint diseases and also the induction of TNFa release in activated synovicytes by the interaction of C5a and C5aR suggest that the C5a/C5aR system may play an important role in joint inflammation process. Chin Med J 2003; 116(9): 1408-1412

Objective To discuss treatment options for tonsillar squamous cell carcinoma. Methods A total of 108 patients with biopsy-proven tonsillar squamous cell carcinoma, treated between 1984 and 2000, were reviewed, including 82 men and 26 women, with ages ranging from 19 to 70 years. Treatments consisted of either radiotherapy and surgery reserved as salvage treatment(Salvage Surgery, 83 patients), or planned surgery with preoperative radiation(Planned Surgery, 25 patients). Radiotherapy was delivered primarily in a dosage of 60-70 Gy for Salvage Surgery patients and 40-50 Gy for Planned Surgery patients. Both salvage and planned surgeries were radical, with resection of the lateral oropharyngeal wall, segmental resection of the mandible and neck dissection. The pectoralis major myocutaneous flaps were used to repair surgical defects. Results The percentages of radical surgery used in the Salvage Surgery and Planned Surgery groups were 24. 1%(20/83)and 88. 0%(22/25), respectively(P = 0. 000). The local recurrence rates were 28. 9%(24/83)and 20. 0%(5/25)in the Salvage Surgery and Planned Surgery groups, respectively (P = 0. 378). The neck recurrence rates were 9. 6%(8/83)and 8. 0%(2/25)in the Salvage Surgery and Planned Surgery groups respectively (P= 0. 804). The 5-year survival rates were 59. 3 % and 55. 3 % in the Salvage Surgery and Planned Surgery groups, respectively (P= 0. 7056). Conclusions Although the two treatments had a similar survival rate, Salvage Surgery avoided 60%commando operations compared with the Planned Surgery group, which benefits to recovery of oral functions. Primary radiotherapy is recommended as the treatment of choice for tonsillar squamous cell carcinoma. After radical radiotherapy, salvage surgery should be undertaken in the case of tumor remnants or recurrenceS. Chin Med J 2003;116(9):1404-1407

Objective To determine whether the synthesis of proteoglycan, collagen and associated ultrastructure are related to the adenovirus-mediated gene transferred to adult degenerative cells. Methods Adenovirus/cytomegalovirus human transforming growth fector-β1(Ad/CMV-hTGF-β1)was used to transfect degenerative cells. Antonopulos method, Miamine method and transmission electrion microscopy were conducted to study the synthesis of proteoglycan, collagen, and ultrastructure, respectively. Cell cultures were established from the nucleus pulpous and annulus fibrosus tissues, which were taken from surgery. Results Nucleus pulpous and annulus fibrosus cells were efficiently transduced by the adenoviral vector carrying hTGF-β1 gene. The synthesis of proteoglycan and collagen increased compared with the control group(P<0. 05). The metabolism of cells was slightly improved. No significant toxic effects were found. Conclusions Expression of hTGF-β1 gene is efficient to accelerates proteoglycan synthesis and thus1 accelerates the improvement of collagen. The function and structure of degenerative cells are improved. Ad/CMV-hTGF-β1 may be suitable for treating disc degeneration. Chin Med J 2003: 116(9): 1399-1403

Objectives To examine the anti-oncogenic effects of promyelocytic leukemia(PML)on bladder cancer and to explore its molecular mechanisms of growth suppression. Methods Wild-type PML was transfected into bladder cancer cells(5637 cell)and expressed in a replication-deficient adenovirus-mediated gene delivery system and introduced into human bladder cancer cells(5637 cell)in vitro and in vivo. The effect and mechanisms of the PML gene in cell growth, clonogenicity, and tumorigenicity of bladder cancer cells were studied using in vitro and in vivo growth assays, soft agar colony-forming assay, cell cycle analysis, apoptosis assay and in vivo tumorigenicity assay. Results Overexpression of PML in 5637 cells significantly reduced their growth rate and clonogenicity on soft agar. PML suppressed bladder cancer cell growth by inducing G1 cell cycle arrest and apoptosis. Adenovirus-mediated PML(Ad-PML)significantly suppressed the tumorigenicity and growth of bladder cancer cells. Intratumoral injection of Ad-PML into tumors induced by 5637 cells dramatically suppressed their growth. Conclusions The results indicated that overexpression of PML protein may promote efficient growth inhibition of human bladder cancer cells by inducing G1 cell cycle arrest and apoptosis, and adenovirus-mediated PML(Ad-PML)expression efficiently suppresses human bladder cancer growth. Chin Med J 2003;116(9): 1394-1398

Objective To assess the changes in constituents of genitourinary cancer inpatients in Beijing following the growing economy of China. Methods Urological inpatients treated from January 1951 to December 2000 at the Institute of Urology, Peking University were studied restrospectively. Results In the period of about 50 years 28 474 urological inpatients were reviewed. Cancer patients aged 0-25 years and 26-50 years comprised 19. 5% and 28. 2%, respectively. Since the 1970s the incidence rates of renal cancer and prostate cancer increased dramatically from 10. 4% to 28. 7% and from 3.3% to 13. 4%, respectively. Conclusion The introduction of new diagnostic instruments, the expansion of the aged population and a high fat diet are considered to be responsible for the change of constituents of genitourimary concer inpatients. Chin Med J 2003;116(9): 1391-1393

Objective To compare the efficacy and safety of remifentanil and fentanyl in patients undergoing a modified radical mastectomy or total hysterectomy. Methods Fifty-four patients were evenly randomised into remifentanil group and fentanyl group. Anesthesia was induced by propofol(1-2 mg/kg)and either remifentanil(2 μg/kg)or fentanyl(2. 5 μg/kg), and was maintained with inhalation of nitrous oxide in oxygen(2:1)and continuous infusion of either remifentanil(0. 2 μg · kg-1 · min-1)or fentanyl(0. 03 μg · kg-1 · min-1). Results The number of patients exhibiting light anesthesia responses in the remifentanil group during intubation and the maintenance of anesthesia was significantly less than that in the fentanyl group. Both systolic and diastolic blood pressures in the fentanyl group were significantly higher than those in the remifentanil group during intubation, skin incision, maintenance of anesthesia and extubation. The time to opening eyes on command and the time for extubation after surgery was comparable between the two groups. More patients in the remifentanil group(25 patients)required bolus injection of morphine for postoperative pain relief than those in the fentanyl group(5 patients, P<0. 05). There was no significant difference between the two groups in terms of side effects. Conclusions Under the condition of this study protocol, the anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability in comparison with fentanyl, and has no compromising recovery from anesthesia. Chin Med J 2003; 116(9): 1386-1390

Objective To investigate the effects of injecting Shenfu, an extract of traditional Chinese herbal medicines, on the central nervous system(CNS)and the cardiac toxicity of bupivacaine in rats. Methods Sixteen male Sprague-Dawley rats, weighing form 280 to 320 g, were randomly assigned to two groups(n= 8 in each group). Animals in the control group received a saline injection 10 ml/kg while animals in the Shenfu group received an injection of Shenfu 10 ml/kg intraperitoneally 30 minutes before intravenous infusion of bupivacaine. Lead Ⅱ of an electrocardiogram(EEG)was continuously monitored after 3 needles were inserted into the skin of both forelimbs and the left hind-leg of each rat. The femoral artery was cannulated for measurement of arterial blood pressure and blood sampling. The femoral vein was cannulated for the infusion of bupivacaine. After baseline measurement(arterial blood pressure, heart rate and arterial blood gas), 0. 5% bupivacaine was infused intravenously at a rate of 2 mg · kg-1 · min-1 to all animals until asystole occurred. The time of bupivacaine-induced convulsions, arrhythmia and asystole were determined. The dose of bupivacaine was then calculated at the corresponding time point. Results The doses of bupivacaine that induced convulsions, arrhythmia and cardiac arrest were remarkably larger in Shenfu injection-treated animals than in saline-treated rats [convulsions,(10. 5± 1. 9)mg/kg vs(7. 2± 1. 5)mg/kg; arrhythmia(10. 5±2. 0)mg/kg vs(7. 2± 1. 9)mg/kg; asystole,(32. 8 ± 8. 5)mg/kg vs(25. 0±5. 0)mg/kg; P = 0. 006, 0. 009 and 0. 044, respectively]. Conclusion The Shenfu injection is able to reduce the toxicity of bupiralaine to CNS and cardiac system in rats. Chin Med J 2003; 116(9): 1382-1385

Objective To analysis the pathological demography in Chinese patients undergoing renal biopsy from our niphrology center. Methods Between January 1979 and October 2000 in Jinling Hospital, Nanjing, China, 10 002 attempts of percutaneous renal were performed in patients with renal disease from 33 provinces of China. The pathological classifications were made according to the WHO criteria of 1982 for renal pathology or the modified WHO criteria of 1995 by a panel of pathologists and nephrologists during routine clinical-pathological rounds. The pathological demography between those specimens collected from 1979-1989 and those from 1990-1999 was compared. Results The mean age of the 10 002 subjects undergoing renal biopsy was 31. 4 ± 13. 0 years(ranging from 1 to 78 years), with a male to female ratio of 1. 3:1; for the 592 renal transplant recipients, the mean age was 37. 5±9. 1 years(ranging from 16 to 66 years), with a male to female ratio of 2. 36:1. Primary glomerular diseases(PGD)accounted for 71 % of the total patients undergoing renal biopsies, secondary glomerular nephritis(SGN)23%, tubular-interstitial diseases 3. 2%, unclassified renal diseases 1. 3%, hereditary and congenital renal diseases 1.0%, end stage renal diseases 0. 96%, and recently realized or rare renal diseases 0. 15%. IgA nephropathy(IgAN)was the most frequent pathological pattern(40%)of PGD, followed by mesangial proliferative lesion(MsPL)(30%), membranous nephropathy(MN)(10%), and focal segmental glomerulosclerosis(FSGS)(6%). Lupus nephritis(LN)was the most pathology common seen(74%)in SGN. During the 22 years of the study period, there was a steady increase in patients with SGN discovered during pathological evaluation of renal disorders. A rise in prevalence was found in IgA nephropathy, MN(both P<0. 001), crescentic glomerulonephritis(P<0. 0001), anti-GBM disease, and hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura related renal damages(both P<0. 001). There was a decrease in endocapillary proliferative glomerulonephritis(P<0. 001)and IgM nephropathy(IgMN)(P<0. 01)from 1990-1999 as compared to 1979-1989. Infrequent renal pathological entities were also diagnosed in this group, including Niemann Pick disease, Fabry's disease, POEMS syndrome, and lipoprotein glomerulonephropathy. Conclusions This is the largest series of renal biopsy data in China, and therefore may reflect the demographic picture of renal diseases in this country. Changes in prevalence of renal pathological entities were reflected in this group of patients over the last 22 years. In primary glomerular diseases, IgA nephropathy is still the most frequently observed pathological pattern. In SGN, LN appeared the most often. Increased prevalence was found in anti-GBM nephritis and HUS/TTP. Chin Med J 2003; 116(9): 1377-1381

Objective To investigate the relationship between heart rate variability(HRV)and prostaglandin E2(PGE2)in patients with renal insufficiencies. Methods HRV blood and 24-hour urine prostagladin E2(PGE2)detection were detected in the following 4 groups of people: group A was a control group comprised of 20 normal individuals; group B had 20 patients with renal disease but exhibiting normal renal function; group C contained 20 patients with renal disease and compensatory renal function; group D had 20 patients demonstrating renal insufficiencies. The indices standard deviation of all NN intervals(SDNN), index of standard deviation of the averages of NN intervals(SDANN), mean of the standard deviation of all NN intervals performed on all 5-minute segments of the entire recording(SDNNindex), square root of the mean of the sum of the squares of differences between adjacent NN intervals(rMSSD)and NN50 count divided by the total number of all NN intervals(PNN50)were used to evaluate HRV, blood and 24-hour urine were determined by specific radioimmunoassay(RIA). Results PGE2 in blood and urine and HRV exactly within 24 hours in patients with renal insufficiencies, negatively correlated with worsening damage to renal function. There was a slight or moderate correlation between blood and urine PGE2 and the SDNNindex, SDANNindex, SDNN, rMSSD and PNN50 indices (P< 0. 05). Conclusions HRV and cardiac autonomic regulatory functions are decreased in the patients with renal insufficiencies, while lower levels of PGE2 may be a related factor. Chin Med J 2003; 116(9): 1374-1376

Purpose To review the characteristics and evolution of the fungal spectrum, and the risk factors causing fungal infection, and to make progress in diagnosing fungal infection after organ transplantation. Data sources An English-language literature search(MEDLINE 1990-2000)and bibliographic review of textbooks and review articles. Study selection Twenty-three articles were selected from the literature that specifically addressed the stated purpose. Results Fungal infections in organ transplant patients were generally divided into two types: ①disseminated primary or reactivation infection with one of the geographically restricted systemic mycoses; ② opportunistic infection by fungal species that rarely cause invasive infection in normal hosts. The risk factors of fungal infection after a transplant can be evaluated and predicted according to the organ recipient's conditions before, during and after the transplant. Progress in early diagnostic methods during the past 10 years has mainly revolved around two aspects, culture and non-culture. Conclusions It is important to undertake a systemic evaluation on the condition of the organ recipient before, during and after a transplant; should any risk factor for fungal infection be suspected, diagnosis should be made as early as possible by employing mycological techniques including culture and non-culture methods. Chin Med J 2003; 116(9): 1421-1425

Objectives To characterize the prethrombotic state(PTS)in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome(OSAHS)and the effect of nasal continuous positive airway pressure(nCPAP)ventilation on their PTS. Methods Forty-one elderly patients with moderate and severe OSAHS were enrolled into the OSAHS group and underwent nCPAP treatment. Their blood samples were drawn at 6:00 am and 4:00 pm before and during nCPAP treatment, respectively, to test hemocrit, platelet aggregation(PAG), whole blood viscosity(WBV), plasma fibrinogen(fng), prothrombin time(PT)and activated partial thromboplastin time(APTT). All blood factors were also tested in a control group consisting of 32 healthy elderly Chinese with neither OSAHS nor cerebrocardiac vascular disease. Results In the OSAHS group there was a significantly higher hemocrit, WBV, fng, and a significantly shorter PT and APTT at 6: 00 am compared to 4: 00 pm before nCPAP treatment, while there was no significant difference among all blood test factors between 6:00 am and 4:00 pm on day 30 of the nCPAP treatment. In the OSAHS group, the hemocrit, WBV, PAG and plasma fng were significantly lower and the PT and APTT were significantly longer at 6: 00 am on day 30 of the nCPAP treatment compared to 6: 00 am before the nCPAP treatment. A significantly lower hemocrit, but a much longer PT and APTT were observed at 4:00 pm on day 30 of the treatment, compared with 4:00 pm before the treatment. No significant difference among the blood test factors was found between 6:00 am and 4:00 pm blood in the control group or between the control and OSAHS groups after 30 days of nCPAP treatment. Conclusion In elderly Chinese OSAHS patients, PTS could be effectively eliminated by nCPAP treatment. Chin Med J 2003; 116(9): 1426-1428