1998年 · 第111卷第07期

OBJECTIVE Systemic lupus erythematosus (SLE) is a multifactorial disease. Environmental factors such as viral infection(s) have been proposed as pathaetiological factors. There are particular interests in studying lymphotropic viruses such as the Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Although previous case reports and in vitro studies suggested that they may have a role, there is no direct evidence that onset of SLE or disease exacerbation is associated with active infection by these viruses. Using the very sensitive polymerase chain reaction (PCR) technique, we tried to find out evidence of active replication of these viruses in patients with SLE. METHODS Thirty-four patients with SLE were compared with matched normal controls. Eleven patients were newly diagnosed to have SLE and 18 of the 34 patients had active disease as determined by a SLE Disease Activity Index (SLEDAI) score of>or = 10 at the time of study. RESULTS Our results showed no evidence of active replication or reactivation of EBV in the leucocytes amongst the newly diagnosed SLE patients, established SLE patients, patients with SLEDAI>or = 10, patients with SLEDAI<10, and control subjects. There was no evidence of CMV infection in any of the subjects studied. The IgG and IgA responses against EBV early antigen (EA) and viral capsid antigen (VCA) were also studied. The IgG and IgA responses against VCA of EBV were increased in patients with SLE when compared with controls. However, there were no differences in these responses among different subgroups of patients. The mechanism of these responses was not apparent but may represent non-specific hyperimmune responses in these patients. There were no differences in the titre of IgG and IgA against EBV EA between the patient groups and controls. CONCLUSIONS There is no direct evidence that either EBV or CMV plays a direct role in the onset and/or exacerbation of SLE.

OBJECTIVE To study if visco-supplementation therapy is useful to the internal derangement (ID) of temporomandibular joint (TMJ). METHODS Sixty-three ID cases (69 TMJs) were studied by visco-supplementation therapy. The upper and/or lower articular cavities were irrigated with 5 ml normal saline and injected 0.3-1.0 ml 1% hyaluronate (HA) into articular cavity. If the symptoms of the disease still existed one week later, the therapy should be repeated for 1-2 times, once a week. The control group cases were injected 1 ml 2% lidocaine instead of HA. 8 other TMJs of 6 ID cases and 2 normal cadavers were studied with scanning electron microscopy (SEM) and light microscopy (LM). RESULTS The visco-supplement therapy was useful to ID patients. The difference between the test group and control group had statistical significance (χ2=6.6535, P<0.01). SEM and LM showed that the condyle, disc and bilaminar region in ID were degenerated or destroyed. CONCLUSIONS The friction between the articular surfaces in ID was increased and the bilaminar region could not retract the disc as in healthy TMJ. The visco-supplementation therapy can decrease the friction and resume the normal rheology of the diseased TMJs.

OBJECTIVE To determine the myocardial protective effect of crystalloid cardioplegic solution at different calcium concentration on immature myocardium. METHODS Isolated perfused neonatal rabbit hearts from three groups, arrested by intermittent infusion of St. Thomas Ⅱ cardioplegic solution with different concentration of calcium (in each group, only calcium concentration of cardioplegic solution was modified, Ⅰ. [Ca2+] 0.6 mmol/L; Ⅱ. [Ca2+] 1.2 mmol/L; Ⅲ. [Ca2+] 2.4 mmol/L), were kept ischemic globally at 20 ℃ for 90 minutes and then followed by 30 minutes of reperfusion in Langendorff mode. RESULTS Although the recovery of LVDP, +dp/dtmax at calcium content of 2.4 mmol/L after 10 minutes of reperfusion was significantly higher than those at 0.6 and 1.2 mmol/L calcium (P<0.05, P<0.01, respectively). The declined tendency of left ventricular hemodynamics after 20 minutes of reperfusion in this group was detected. By the end of reperfusion, the left ventricular functional recovery at 2.4 mmol/L calcium did not differ from those at 1.2 and 0.6 mmol/L calcium. Conversely, postischemic left ventricular functions at 0.6 and 1.2 mmol/L calcium were gradually improved during 30 minutes of reperfusion. In 2.4 mmol/L calcium group, the Ca2+-ATPase activity significantly increased (P<0.01, P<0.001) whereas myocardial ATP content was lower when compared with 1.2 mmol/L (P<0.001) and 0.6 mmol/L calcium groups. CONCLUSIONS Our research demonstrated that there were no statistical differences with respect to hemodynamic recovery in three groups after 30 minutes of reperfusion although left ventricular functional recovery at 2.4 mmol/L calcium accelerated early after reperfusion. In addition, with 2.4 mmol/L calcium, myocardial ATP content was decreased significantly. We conclude that, from the point of view of myocardial energy metabolism, St. Thomas Ⅱ cardioplegic solution at high concentration of calcium can not provide immature myocardium with optimal myocardial protection while with 1.2 mmol/L calcium, however, better high-energy store can be preserved.

OBJECTIVE To summarize our experience in 22 patients who had attempted nonthoracotomy implantable cardioverter-defibrillators (ICD) for malignant ventricular arrhythmias (VA). METHODS Indications for implantation were ventricular fibrillation (VF) in 17 patients and refractory ventricular tachycardia in 5. Thirteen patients of them had underlying ischaemic heart disease. Seven had dilated cardiomyopathy and two had arrhythmogenic right ventricular dysplasia. RESULTS 20 out of 22 patients were successfully implanted nonthoracotomic ICD with defibrillating threshold of 16.7 J. The mean hospital stay was 7.8 days. The complications included chest wall haematoma and ventricular lead dislodgment requiring repositioning. In the follow-up period of 10.1±8 months, 6 patients with VA were treated successfully by ICD. CONCLUSIONS Nonthoracotomy ICD is possible in a vast majority of patients (91%) and should be considered in all patients requiring ICD without concomitant surgery.

OBJECTIVE To further investigate the mechanism of nasal secretion closely related to the innervation patterns in nasal mucosa with emphasis on the acetylcholinesterase (AChE)-positive fibers and peptidergic terminals in nasal mucosa as well as trigeminal ganglion (TG) cells. METHODS Histochemical demonstration of AChE-positive fibers, immunohistochemical study of the distribution patterns of multiple peptidergic terminals, double labelling of AChE and substance P (SP) and somatostatin (SOM) mRNA in situ hybridization were carried out in nasal mucosa and trigeminal ganglion (TG) in rats. RESULTS AChE-positive terminals were mainly distributed in the mid to posterior one third of septal nasal mucosa, with greater staining density on the walls of small vessels and glands. There were fewer such terminals in turbinate mucosa. Tachykinins-ergic terminals, including substance P (SP)-, neurokinin A (NKA)-, neurokinin B (NKB)- and calcitonin gene-related peptide (CGRP)-ergic terminals, had an extensive localizations in nasal mucosa, involving the following areas: between epithelial cells, submucosa, the walls of small vessels, glands and venous sinusoids in both septal and turbinate nasal mucosa. Septal mucosa had the greater density. There were overlaps in the distribution of these peptidergic terminals. There were also vasoactive intestinal peptide (VIP)-, neuropeptide Y (NPY)- and galanin (GAL)-ergic terminals in nasal mucosa. But no neurotensin (NT)- and somatostatin (SOM)-ergic terminals were found. In situ hybridization revealed SOMmRNA expression in TG cells. AChE and nine neuropeptides existed in the cytoplasms of TG cells. Besides, AChE and SP could exist simultaneously in cytoplasms of TG cells. CONCLUSIONS AChE-positive (corresponding to parasympathetic nerves) and peptidergic terminals have different distribution patterns in the nasal mucosa of rats, although an overlap does exist, indicative of their different physiological effects on the regulation of nasal secretion and other functions; AChE and multiple neuropeptides in the cytoplasm of TG cells might play a role in modulating the nasal secretion in response to stimuli in the nasal mucosa.

OBJECTIVE To determine if examination of mirror writing in the elderly could be used to assess the degradation of the brain function. METHODS The occurrence of mirror writing in 146 subjects was examined. Among them, 104 were males and 42 females. All subjects were university graduates. Age ranged from 40 to 85 years with an average of 62.7±13.4. These subjects were divided into two groups, a non-elderly group consisting of 60 subjects (41.1%) and an elderly group 86 subjects (58.9%). All 146 subjects were examined with 10 items for determination of handedness, mini-mental state examination and the written language of Chinese Aphasia Examination Scale (Draft) including spontaneous writing, writing from dictation and copying. The above mentioned performances of written language were done by left and right hand. RESULTS The results of examination revealed that in 146 subjects there were 7 subjects with mirror writing, which occurred only in the elderly group, accounting for 8.1%. In the elderly group, mirror writing was found in one subject of 70-79 years group and 6 subjects of age over 80 years. Mirror writing appeared in the elderly was of mild degree with an average percentage of 1.9±0.4. CONCLUSIONS It is suggested that examination of mirror writing in the elderly may be used to assess the degradation of the brain function in senile subjects.

OBJECTIVE To find out if the lesion in nucleus basalis of Meynert (nbM) can induce some morphological changes characteristic of Alzheimer's disease. METHODS Kainic acid was injected into nbM of the rats, and the behavioral deficiency and the morphological changes in the cortex and hippocampus were observed by methenamine silver staining and electron microscopical examination. RESULTS After 9-15 months of breeding following nbM-lesion, we observed many pathological changes in this animal model, which were characteristic of Alzheimer's disease in human, and especially we could find for the first time the formation of senile plagues after 15-month breeding. CONCLUSIONS It is proposed that the degeneration of nbM neurons might be primary and responsible for the pathological changes in other brain tissues in sporadic Alzheimer's disease.

OBJECTIVE To investigate the effects of combined radiation and thermal burn injury on the survival of skin allografts and to analyze the relationship between the prolongation of allograft survival and the changes of immune functions of the thymocytes and splenocytes in rats. METHODS Wistar rats were irradiated with 3, 4, 5, 6 and 8 Gy of gamma rays. Thirty minutes after radiation, 15% TBSA III-degree burn was inflicted to the rats. Twenty-four hours after the burn injury, allografts were used to cover the burn wounds. In the 8 Gy group, 1 hour before skin grafting, the bone marrow cells (4×108) from the same donor were also transplanted. All rats were carefully observed after injury. The rats with single radiation injury of 5 Gy gamma rays, with single burn injury and with combined radiation-burn injury were killed 3, 7, 10, 15 and 30 days after skin grafting for immunological assay and pathological study. RESULTS All the allografts in the single burn group were rejected in 10 days. In the combined injury groups, the survival rates of the allografts in rats undergoing 3 and 4 Gy radiation were 20% and 30%, respectively. In the combined injury groups undergoing 5, 6 and 8 Gy radiation, the 10-day survival rates of the allografts were 69%, 88% and 100% respectively, and the 30-day survival rates in the three groups were 36%, 42% and 100% separately. The grafted allogenic skin, with normal epithelial cells and good vascularity, healed well with the recipient's skin. Hairs grew well from the allografts 30 days after grafting. Three, 7 and 15 days after allografting, in the single burn group, the proliferative activities of the thymocytes were 90%, 185% and 130% of the preinjury level, and the antibody forming capacities of the splenocytes were 200%, 171% and 300% of the preinjury level, respectively; in the combined injury groups, the proliferative activities were 6%, 99% and 91% of the preinjury level, and the forming capacities were 2%, 36% and 90% of the preinjury level. CONCLUSIONS The survival rate of allograft in rats undergoing combined radiation and thermal burn injury rises with the increase in radiation dosage. The allograft covering single bun injury is severely rejected by immune reaction. The prolongation of the survival of allograft in combined injury group mainly results from radiation that suppresses immune functions.

OBJECTIVE To explore the clinical significance of the resection of the cardia and fundus for patients suffering from cardiac cancer of the gastric stump. METHODS Twenty-five patients suffering from cardiac cancer with a mean period of 13 years and 3 months after subtotal gastrectomy were included in this study. Their average age was 59.1 years. Among them, 19 patients got exploratory thoracotomy. RESULTS Of the 19 patients, 1 was inoperable, 1 underwent resection of the gastric stump and esophagojejunostomy because of his huge tumor, 17 underwent resection of the cardia and fundus of the gastric stump and accepted gastroesophagostomy (9 were subjected to tunnel gastroesophagostomy and 8 to end-to-end esophagogastrostomy). The largest tumor was 5 cm × 4 cm in size. Except for a death resulting from intestinal obstruction following operation, the others attained a good recovery. The longest period of survival was 4.5 years. CONCLUSIONS Resection of the cardia and fundus and gastroesophagostomy can be carried out for patients suffering from cardiac cancer of the gastric stump. The method is in line with the principle of the conservation surgery.

OBJECTIVE To observe the anti-injury role of recombinant human augmenter of liver regeneration. METHODS To establish liver injury models induced by CCl4 in vivo and in vitro, cell survival rates and LDH release rates served as observing index in experiments in vitro. Survival rates of liver failure animals, serum concentration of ALT, LDH, DNA and pathological examination were selected as parameters in experiment in vivo. RESULTS rhALR could increase the survival rates and decrease the LDH release rates of injured hepatocytes in vitro. rhALR could also increase the survival rates of liver failure animal, promote hepatocyte proliferation and decrease the serum level of ALT and LDH in vivo. CONCLUSIONS ALR is an important stimulator for liver regeneration and may play important role in liver damage repair.

Conscious sedation is a technique in which drugs are used to depress the central nervous system to allow treatment or examination to be performed, while verbal contact with the patient is maintained throughout sedation. A lack of response from the patient may indicate the transition from sedation to the state of general anaesthesia.

OBJECTIVE To introduce a common but not well-recognized acute abdominal disease in children. METHODS Thirty-eight children with spasm of the internal anal sphincter were reviewed. RESULTS The main symptom was the sudden onset of continuous pain in the lower abdomen with paroxysmal exacerbation. The typical sign was the dilation of the sigmoid colon with tenderness aggravated by pressure. Plain X-ray films showed dilation of the sigmoid colon and rectum. The symptoms could be relieved by digital rectal examination or a glycerin suppository. CONCLUSIONS It is the temporary achalasia of the internal anal sphincter that causes acute abdominal pain.

The interventional radiology in China took off in the early 80's. Even with a late start, it has nevertheless made a tremendous progress in the past 15 years in areas such as basic research, diagnostic technology as well as the related equipment and devices. Interventional therapy, more significantly has gained national and international recognition due to its successful treatment of multi-large series of cases with excellent to good results.