1998年 · 第111卷第02期

Primary hepatocellular carcinoma (PHC) is a major cause of death in patients with chronic liver disease. One of the difficulties in the management of PHC is its extensive character: intrahepatic metastasis, venous invasion and distant metastasis. In the process of metastasis, tumor cells are scattered from the original site, spread hematogenously and arrested at small vessel. Thus, detection of tumor cells in the circulation might predict metastasis of the tumor. However, the number of cells in circulation could be much too small to be detected morphologically.

OBJECTIVE The critical role of infiltrating T cells in the pathogenesis of psoriasis is now well established. In order to determine whether circulating T cells from patients with psoriasis were also involved in the disease process, the authors investigated the biological behavior as studied by chemotactic activity of T cells in patients with psoriasis. METHODS A 48 microchemotaxis chamber was employed to determine T-cell chemotaxis activity. In addition, the expression of T cell activation markers such as HLA-DR and interleukin 2 receptor were analysed with fluorescence activated cell sorting technique and serum IL-8 level was measured with ELISA methods. Forty-five patients with psoriasis (23 patients with severe psoriasis and 22 with mild psoriasis) and 21 patients with atopic dermatitis were investigated. For comparison, T-lymphocytes from 20 healthy controls were tested equally. RESULTS T-cell chemotactic responses were significantly decreased in patients with severe psoriasis and atopic dermatitis as compared to healthy controls. Increased expression of activation markers such as HLA-DR and interleukin 2 receptor were demonstrated in circulating T cells from psoriatic patients and atopic dermatitis patients in comparison to healthy controls. Serum IL-8 level was significantly increased in patients with psoriasis and atopic dermatitis. CONCLUSIONS Circulating T cells in patients with severe psoriasis show abnormal in vitro chemotactic response to IL-8. Furthermore, the in vivo activation state of T lymphocytes in these patients and increased level of serum IL-8 seemed to be associated to their decreased in vitro T-cell chemotactic responses.

OBJECTIVE To explore the association of human leukocyte antigen (HLA) with pregnancy induced hypertension (PIH). METHODS We oligotyped HLA-DQA1, -DQB1 locus of 30 Chinese PIH families and 14 control families in Shanghai area by polymerase chain reaction-sequence specific oligonucleotide (PCR-SSO) hybridization method (probes labeled by nonradioactive technique). RESULTS Compared with the control group, the allelic frequency of HLA-DQB1 * 0502 was significantly higher in PIH couples, and the sharing of HLA-DQA1 increased in PIH couples as well. No difference was found in HLA-DQA1 allelic frequencies or HLA-DQB1 sharing between the two groups. Analysis of neither HLA-DQA1 nor HLA-DQB1 allelic frequencies in PIH patients and PIH mother-and-fetuses showed positive result. CONCLUSIONS HLA-DQB1 * 0502 may be a marker of susceptibility to PIH. DQB1 * 0502 itself or some gene(s) located in HLA class II region and in linkage disequilibrium with 0502 affect maternal T cell immunity during pregnancy. The increase of compatibility in HLA-D region causes the production of blocking antibody to decrease.

OBJECTIVE To investigate the gene mutation and the ratio of the spinocerebellar ataxia type 1 (SCA1) in Chinese patients with autosomal dominant spinocerebellar ataxia (ADSCA). METHODS The family material and DNA samples were collected from thirteen families with ADSCA. To determine the characteristics of the CAG trinucleotide repeats in SCA1 gene, the PCR products of the Rep1 and Rep2 primers were analyzed, and the bands with CAG repeat expansion were cloned by PCR2. 1 vector and sequenced. RESULTS One family was found to have an expanded CAG repeat in the 13 families with ADSCA. The clinically affected individual was heterozygous with one disease allele being 55 CAG repeats, whereas the mean size of the CAG repeats on 104 chromosomes generated from unrelated control Chinese individuals is 29.3 (ranging from 18 to 34). CONCLUSIONS The frequency of the SCA1 mutation is about 7% in the 13 Chinese families with ADSCA, suggesting that this type of genetic defect is not the main cause involved in the pathogenesis of ADSCA in China. Since the mutation has also been found in Caucasian, Japanese, Malaysian, and Bangladeshi kindreds, it is suggested that this genetic defect may well have multiple origins in different ethnic groups.

OBJECTIVE To induce significant improvement of motor abnormalities and striatal dopamine (DA) levels in rat model of Parkinson's disease (PD), by intracerebral grafting of the genetically modified muscle cells expressing tyrosine hydroxylase (TH). METHODS Primary myoblasts and myotubes from the rat were prepared by cell culture and a plasmid, pCMVTH, containing TH gene and a promoter of cytomegalovirus (CMV) was constructed by DNA recombination technique. The primary muscle cells were transfected with newly constructed pCMVTH DNA vector, by using lipofection. These genetically modified muscle cells were grafted into the caudate- putamen of 6-OHDA-lesioned rats, representing PD models. Before and after grafting, the rotational behaviour and the striatal levels of DA and its metabolities were tested at different postoperative survival times. In addition, the immunocytochemistry for showing TH activity was done both in vitro and in vivo. RESULTS The newly constrcuted plasmid, pCMVTH was proved to contain TH gene and have correct direction of insertion. The cultured primary myoblasts and myotubes lipofected with pCMVTH were immunocytochemically shown to express TH activity in vitro. After grafting, these TH-expressing muscle cells showed to have a long-term survival cells in vivo and induced a marked decrease in abnormal locomotion and a increase in striatal DA levels for PD rat model. CONCLUSIONS In experimental gene therapy for PD, the pCMVTH is a useful vector for carrying TH gene. The lipofection is a practical technique for transferring a target gene into eukaryotes and primary cultured muscle cells should be a good vehicle for DNA transfer and intracerebral grafting.

OBJECTIVE To investigate human cardiac acidic isoferritin as a specific index of hepatic cancer. METHODS Acidic isoferritin was isolated and purified from human heart muscle. A radioimmunoassay for the acidic isoferritin in human serum has been developed, on the equilibrium method. The antiserum was obtained from rabbits immunized with purified acidic isoferritin. The 125I-acidic isoferritin was prepared by the chloramine-T method. The data were processed using the automated smoothed spline function data processing program. RESULTS The intra- and inter-assay CV of acidic isoferritin RIA were 1.65% and 9.71%, respectively, and the recovery rate was 102%. The antiserum provided a linear response from 7.0 to 369.6 micrograms/L with ED50 of 27.50 micrograms/L. The cross reactivity with AFP, CEA, lactoferrin and transferrin was negligible, and that with ferritin was 1.74%. The serum acidic isoferritin concentration showed a considerable variation in different sex and age groups. The serum acidic isoferritin was measured in liver diseases including hepatic cancer, hepatic cirrhosis and acute and chronic hepatitis. Its sensitivity for diagnosis of hepatic cancer was 73.05%, independent from the severity of hepatic injury. In 8 malignant tumors studied, acidic isoferritin appeared the most valuable in the diagnosis of hepatic cancer, with its positive, negative, false positive and false negative rates all being ideal. CONCLUSIONS Acidic isoferritin may turn to be a rather specific index of hepatic cancer. Combination of monitoring both acidic isoferritin and AFP would raise the positive detection and specificity in the diagnosis of hepatic cancer.

OBJECTIVE To assess the relationships between plasma and intracellular Ca2+, Mg2+ and blood cell membrane adenosine triphosphatase (ATPase) activity in normotensive and hypertensive subjects. METHODS Plasma and intracellular Ca2+, Mg2+ were measured with atomic absorption spectrophotometry, and red blood cell membrane Na+-K+ ATPase and Ca2+-ATPase activities were determined with colorimetric method in 55 patients with essential hypertension and 32 normotensive controls. RESULTS The results showed that the hypertensive group consistently demonstrated a significant decreased activity of ATPase studied, with significantly lower plasma Ca2+ and higher cytosolic Ca2+ levels when compared with those in normotensive group (P<0.01 or P<0.05, respectively). No significant differences were found in either plasma Mg2+ or intracellular Mg2+ level between the two groups. CONCLUSIONS This study suggests that patients with essential hypertension have widespread depression of cell membrane Na+-K+-ATPase and Ca2+-ATPase activities with plasma Ca2+ depletion and cytosolic Ca2+ overload, which may reflect an underlying membrane abnormality in essential hypertension. The cellular abnormalities may be related to the defective transport mechanisms that in turn may be aggravated by plasma Ca2+ depletion.

OBJECTIVE To evaluate the beneficial effects of early coronary reperfusion on left ventricular remodeling (LVRM) and systolic function in patients with acute myocardial infarction (AMI). METHODS Eighty-one patients with first AMI in the convalescent stage and having undergone left ventriculography (LVG) and coronary arteriography (CAG) were divided into four groups: the anterolateral wall (ALW) myocardial infarction (MI) non-reperfusion (n = 20) and reperfusion (n = 21), and inferoposterial wall (IPW) MI non-reperfusion (n = 20) and reperfusion (n = 20), according to infarct location and early treatment with or without successful coronary reperfusion therapy within 6 hours after onset of symptoms. By LVG, the parameters of LVRM and systolic function in the four MI groups were analyzed and compared with those in normal group (n = 25) and between the two reperfusion and non-reperfusion MI groups. RESULTS In both ALW and IPW MI non-reperfusion groups, the left ventricular (LV) end-diastolic volume (EDV), circumference (EDC), short-axis dimension (EDD), short to long axis ratio (ED-D/L), sphericity index (ED-SI) and end-systolic volume (ESV) were all significantly increased (P<0.01-0.001), while LV ejection fractions (LVEF) were significantly decreased (both P<0.001) when compared with those of normal group; and the increase in ESV and decrease in LVEF were both significantly greater in ALW than in IPW MI groups (both P<0.01). In both ALW and IPW MI reperfusion groups, however, the EDV, EDD, ESV, as well as the extent and severity of regional wall motion abnormality (RW-MA) were significantly smaller (P<0.05-0.001), while LVEF were significantly higher (P<0.01-0.001) when compared with those in the two non-reperfusion MI groups respectively. There were no longer significant differences in LVEF and ESV between ALW and IPW MI groups (both P>0.05). The EDC in IPW MI reperfusion group and the ED-D/L and ED-SI in ALW MI reperfusion group were also significantly reduced compared with those in the two non-reperfusion MI groups respectively (P<0.05-0.001). All the above parameters in the two reperfusion MI group were decreased to the normal in comparison with normal group except ESV and LVEF, and ED-D/L and ED-SI in IPW MI group. CONCLUSIONS It was indicated that in both ALW and IPW MI non-reperfusion groups, LVRM had occurred in convalescent stage of AMI with an increase in EDV and EDC, spherical change in LV shape, and accompanying reduction in LV systolic function; and early coronary reperfusion in AMI could reduce the extent and severity of RWMA, prevent from LV enlargement and remodeling, and preserve or improve LV systolic function with more prominence in ALW MI.

OBJECTIVE To assess the effects of long-term angiotensin-converting enzyme (ACE) inhibitor treatment with captopril on cardiac function in acute myocardial infarction (AMI). METHODS One hundred and one patients with AMI who were admitted to hospital within 72 hours of the onset of symptoms with no cardiogenic shock were randomly allocated to captopril (n = 52; group I) and conventional treatment (n = 49; group II). Left ventricular (LV) systolic performance and diastolic transmitral flow velocity profiles were assessed by Doppler echocardiography at admission (1.2±1.1 days), before discharge (27±10 days) and during follow-up (363±31 days). RESULTS At one year follow-up, in group I LV end-diastolic volume decreased, and ejection fraction increased due to a disproportionate decrease in end-systolic volume. The incidence of cardiac dilatation was reduced. LV early diastolic filling velocity (E) increased and late atrial filling velocity (A) decreased, resulting in an elevation of E/A ratio. However, the mean values of LV systolic and diastolic functional parameters were unchanged in group II. CONCLUSIONS Long-term treatment with captopril exerts a beneficial effect on cardiac protection for patients with AMI.

OBJECTIVE To obtain an objective assessment of the curative effectiveness of photodynamic therapy (PDT) for port wine stain (PWS), we investigate the relationship between the microvascular perfusion changes of PWS and the blanching of the lesions before and after PDT. METHODS Twenty-four patients (18 females and 6 males with a total of 28 lesions) suffering from PWS were treated with PDT. The lesions of various extents were located on the face and neck. After intravenous injection of photosensitizer hepatoporphyrin derivative (HpD), the copper vapor laser was adopted as light source and the lesions of PWS were irradiated. The laser Doppler perfusion imager (LDI) was used to measure the microcirculatory perfusion of PWS before and after PDT and comparison with the normal skin was done. RESULTS All the lesions showed remarkable decrease of tissue perfusion after PDT. It was shown that the mean, maximal and minimal values of tissue perfusion in the pre-treatment group were significantly higher than those in control group (P<0.01). Six months after PDT, the mean, maximal and minimal values of perfusion with the lesions were reduced, with significant difference from pre-treatment group (P<0.01), but no significant difference from control's. The colors of lesions were correlated with decrease of microcirculatory perfusion, which became lightened close to normal skin color without causing any scarring. CONCLUSIONS PDT is one of the most effective modalities for PWS. The microcirculation perfusion can reflect the degrees of PWS objectively. The curative effectiveness of PDT for PWS is due to tissue microcirculation response.

OBJECTIVE To investigate the function and characteristics of histamine receptors on the hemopoietic progenitor cells. METHODS BDF1 mice (both male and female), inbred at our university, aged 8-12 weeks, weighing 20-24 g, were used in this study. Bone marrow cells were incubated for 1 hour at 37 ℃ with 2-AT (H1 receptor agonist) or impromidine (H2 receptor agonist) alone, or in combination with the antagonists pyrilamine or cimetidine respectively. Control experiment was performed in Dulbecco's modified Eagle's Medium (DMEM) alone. Cells treated with different drugs were performed by colony forming unit-granulocyte-macrophage (CFU-GM) and colony forming unit-megakaryocyte (CFU-Meg) assay. RESULTS When bone marrow cells were treated with 10-8 mol/L to 10-5 mol/L of 2-thiazolylethylamine (2-AT) which had no influence on CFU-GM and CFU-Meg proliferation, 10-8 mol/L to 10-5 mol/L of impromidine could increase the number of CFU-GM and CFU-Meg colonies. The effects of H2 receptor agonists on CFU-GM, CFU-Meg could be antagonized by H 1 receptor agonist. CONCLUSIONS Our findings suggest the existence of histamine H1 and H2 receptors on the hemopoietic progenitor cells and the antagonism between two different histamine receptor subtypes on the proliferation of CFU-GM and CFU-Meg.

As the relative nosetilogy of tumors, sexual hormone receptors have gained much attention of scholars. To investigate whether the estrogen receptors (ER) and progesterone receptors (PR) are present and how they are distributed in transitional cell carcinoma (TCC) of bladder, 38 patients with TCC of the bladder were studied by enzyme linked histochemical stain method.

Since Hall described a method of valvular excision through microvenotomies and reported the use of in situ saphenous vein grafts in 1962, the technique has been taken to treat lower limb ischemia. In this paper, we presented the results of 28 patients with 30 ischemic legs treated by in situ saphenous vein bypass during the last 60 months.

Traumatic brain injury (TBI) is a major public health problem throughout the world. More than 400 000 patients with TBI in the United States of America and estimately more than a million patients with TBI in China are admitted to hospital every year. The outcome of patients with TBI has been significantly improved in the decade all over the world, especially in China. Because of both laboratory and clinical advances in TBI, the mortality of severe TBI patients with Glasgow coma scale (GCS) <8 decreases to less than 30%. This paper summarized the main progress of TBI research in China.

OBJECTIVE To present some new concepts in the treatment of fractures and bone defects of long bones with internal fixation. METHODS Animal experiments, mechanical tests and clinical analyses were done. RESULTS AND CONCLUSIONS Reduction of fracture should be perfect, bone defect can be reconstructed by intramedullary and extramedullary bone graft. Relatively rigid fixation at the early stage and elastic fixation at the later stage are beneficial not only for fracture healing, but also for bone remodeling. In order to avoid complications including non-union, immobilization syndrome of the bone and joint, and implant failure, radiographs should be taken periodically; if there is any bone resorption, weight-bearing should be restricted.

OBJECTIVE To review the application of trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT) in the outcome evaluation of trauma care and their research advances. Data Sources Both Chinese- and English-language literature searched by using MEDLINE/CD-ROM (1985-1996) and Index of Chinese-Language Literature (1985-1996). Study Selection Over fifty papers and reviews published over the past ten years were selected. Results and Conclusion TRISS can be employed for different purposes, that is, preliminary outcome-based evaluation (PRE) and definitive outcome-based evaluation (DEF). TRISS is a method which is now the most extensively used for the outcome evaluation of trauma. Even so, it still has some shortcomings, e.g., trauma can not be given the weights that should be given, and the section of age is too simple. ASCOT is also a physiologic and anatomic combined method for the evaluation of injury severity and outcome. To some extent, this method obviates the shortcomings of TRISS in the calculation of probability of survival (Ps) with injury severity score (ISS). Therefore, ASCOT is considered to be superior to TRISS in the evaluation of Ps. However, TRISS is still now more extensively used than ASCOT just because ASCOT was recently developed.

Treatment of multiple system organ failure (MSOF) after severe polytrauma is one of the difficult problems in clinical work. One patient with severe polytrauma by falling from 36 m high was admitted to the Surgery Intensive Care Unit of Beijing Emergency Medical Center in September 1993. Then the patient developed MSOF, which affected the function of the heart, lungs, gastrointestinal (GI) tracts, Kidneys, brain and liver, with injury severity score (ISS) of 41, and acute physiology and chronic health evaluation II (APACHE-II) of 44, After 71 days of intensive treatment, the patient was discharged uneventfully with normal treatment, the patient was discharged uneventfully with normal function of all the six organs. The purpose of our paper is too report the treatment course of the case.

Trauma is one of the oldest subjects in medical sciences, because it appeared just as early as human being came to the earth. At the same time, trauma is also a novel subject, because trauma has been strikingly increasing with the high-speed development of economical construction, traffic transport and sharp increase of vehieles in number.