2001年 · 第114卷第07期

Objective To map the epitopes on Wegener's granulomatosis autoantigen proteinase 3. Methods Antigenicity of proteinase 3 was studied with Western blot analysis in which proteinase 3 was prepared under reducing and non-reducing conditions. Two anti-proteinase 3 monoclonal antibodies, HZ1F12 and HZ1H3, were used to inhibit each other and to inhibit 22 anti-proteinase 3 positive sera from patients with Wegener's granulomatosis in competitive inhibition enzyme-linked immunosorbent assays (ELISA) and Western blot analysis. Results All monoclonal antibodies and patient sera recognized proteinase 3 under non-reducing conditions in Western blot analysis. HZ1F12 was inhibited 74% by HZ1H3. 10/22 (46%) sera were completely or partially inhibited by HZ1F12; 9/22 (41%) sera were partially inhibited by HZ1H3; and 6/22 (27%) were inhibited by both monoclonal antibodies. In inhibition Western blot analysis, the binding of patient sera to proteinase 3 could be inhibited by HZ1F12. Conclusions The epitopes of Wegener's granulomatosis autoantigen were conformational. Anti-proteinase 3 monoclonal HZ1F12 and HZ1H3 recognized similar or overlapping epitopes on the proteinase 3 molecule. Epitopes of proteinase 3 recognized by anti-proteinase 3 positive sera were not restricted. Chin Med J 2001; 114(7):760-763

Objective To calculate the mean absorbed doses at the celluar and subcellular levels for uniformly and non-uniformly distributed Auger electron emitters. Methods The energy deposited in cells or nuclei by Auger electrons was analytically calculated using the polynomial representation of energy loss. S-values were subsequently computed for several target-source combinations. The absorbed dose and dose distribution were calculated for spherically symmetric radionuclide distributions depending linearly and exponentially on the radial position. The dose profile as a function of the source radial coordinate was also evaluated for typical cell sizes. The contributions of photon radiation to absorbed dose in cells were ignored. Results The mean absorbed dose and dose distribution depended largely on the size of the target cells, the radiation spectrum and the intracellular localization and distribution of radionuclides. The contribution of intranuclear radionuclides to mean absorbed dose was larger than that of extranuclear ones. Conclusion Auger electrons can produce high local energy deposition in cells because of their very low energies and extremely short ranges. Our dose calculation method is simple, and the results are reliable and can be used in many fields. Chin J Radiol Med Prot 2001; 21: 76-79

Objective To evaluate the clinical application of CT virtual endoscopy (CTVE) in the diagnosis and treatment of colonic carcinoma. Methods We collected 30 patients pathologically proven to have colonic carcinomas as examined by CTVE and electronic colonoscopy (EC), correlating the CTVE and EC images respectively with surgical pathology in three aspects: tumor morphological features, degree of circumferential bowel wall involvement and longitudinal extent of tumor. Results CTVE imaging of colonic carcinomas showed morphological features: polypoid pattern (11 patients), ulcerative pattern (11), and infiltrative pattern (8); degree of circumferential bowel wall involvement less than 1/2 (4 patients), from 1/2 to 3/4 (6), and more than 3/4 (20); and their longitudinal extent: 1.0-3.0 cm (7 patients), 31-5.0cm (10), and 5.1-11.0 cm (13). Correlation of CTVE and EC with surgical pathology was found. Comparison of CTVE with surgical pathology showed tumor morphological features: concordant (26 patients), and disconcordant (4); degree of circumferential bowel wall involvement: concordant (25), disconcordant (5); and longitudinal extent of the tumor: concordant (23), disconcordant (7). Comparison of EC with surgical pathology showed tumor morphological features: concordant (22 patients), disconcordant (8); degree of circumferential bowel wall involvement: concordant (28), disconcordant (2); and longitudinal extent of the tumor: concordant (14), disconcordant (3), and undefined by EC (13). Conclusions The images obtained by CTVE in colonic carcinoma are similar to those obtained by EC. CTVE is an excellent alternative to EC for patients who cannot tolerate EC and for cases with incomplete EC. Chin Med J 2001; 114(7):756-759

Objective To evaluate the outcome of surgical treatment for congenital coronary artery fistulas (CAF) in 52 patients seen between May 1988 and July 1999. Methods Fifty-two patients ranging in age from 9 months to 58 years (mean 15.7 ± 16.4 years) were studied. Thirty-six patients had no other cardiac defects, 9 of those patients were more than 20 years old and presented with symptoms. Only one of 36 patients less than 20 years old had clinical findings before surgery. Sixteen patients had associated cardiac lesions. The site of fistula origin was the right coronary artery in 37 patients (71.2%), and the left coronary artery in 15 patients (28.8%). The sites of CAF drainage were the right ventricle, right atrium, left ventricle, left atrium and pulmonary artery in 22 (42.3%), 16 (30.8%), 6 (11.5%), 3 (5.8%), and 5 (9.6%) patients, respectively. The mean diameter of the fistula in 43 patients with single ostium was 7.34±4.12 mm. Results Cardiopulmonary bypass was used in all patients and no patient died. An arteriotomy was made on the anomalous coronary artery and the proximal opening of a fistula was closed within the vessel in 10 patients. Closure of the distal opening of a fistula draining into a cardiac chamber or pulmonary artery was performed in 26 patients. In 16 patients, both the proximal and distal opening were closed. Two and 3 distal opening of a fistula were found in 6 and 3 patients, respectively. No residual shunt was found before patients were discharged from the hospital. Forty patients were followed up for a mean period of 3.14 ± 1.84 years. The remaining 12 patients could not be contacted during follow-up. No clinical symptoms were found in those patients during follow-up but one patient still presented with ST-T change. Conclusion Early and properly surgical management is safe and effective for congenital coronary fistula. Chin Med J 2001; 114(7):752-755

Objective To investigate the characterization of death of human hematopoietic stem cells after irradiation. Methods Human fetal bone marrow mononuclear cells were irradiated with different doses of 60Co γ-rays at different high dose rates. Apoptosis and necrosis of CD34+ cells were analyzed by flow cytometry, following three-color labeling with PE-CD34/FTTC-Annexin V/7AAD at different times after irradiation. Results The death of CD34+ cells after 5 Gy and 8 Gy irradiation showed a continuous process of reproductive death during the first week, and the main death type was apoptosis. A majority of CD34+ cells died of necrosis during the first day after 10 Gy and 12 Gy irradiation, and all of them died within a week. Conclusion Niches were continuously vacated every day within a week following irradiation, and reproductive death of hematopoietic stem cells occurred. Chin J Radiol Med Prot 2001; 21: 73-75

Objective To detect the mutation frequency of the bcl 10 gene in the early and advanced stages of hepatocellular carcinoma (HCC). Methods Genome DNA samples were extracted from 46 cases of fresh HCC tumor tissues and their non-tumor adjacent tissues. Polymerase chain reaction-single strand conformation polymorphism method was used to detect point mutations of the three exons of the bcl 10 gene. For each individual exon, six random samples from those showing abnormal DNA bands were sequenced to verify those mutations. The relationship between serum alpha-fetoprotein (AFP) level and bcl 10 mutation, between the tumor size and bcl 10 mutation was also analyzed. Results Among the 46 samples, 26 cases (56.5%) were found to have mutations in exon 1, 5 out of the 6 cases were shown to have 5744 C→G mutation by sequencing; 25 cases (54.3%) were found to have mutations in exon 2, 4 out of the 6 cases were shown to have 11 311 T deletion mutation by sequencing. Twenty-one cases (45.7%) were found to have mutations in exon 3, all of the 6 cases selected for sequencing were shown to have 14 116 C→T mutation. Statistical analysis showed that neither serum alpha-fetoprotein level nor the size of hepatocellular carcinoma has a significant relationship with bcl 10 mutation. Conclusion The bcl 10 gene has a high mutation frequency in liver cancer. Chin Med J 2001; 114(7):747-751

Objective To evaluate the value of transvaginal ultrasonographic examination of the uterine cervix in predicting pretem delivery. Methods Transvaginal ultrasonography (TVS) was performed in 52 patients admitted with threatened preterm labor and with intact membranes. Cervical parameters of the ultrasonography were evaluated including endocervical length, the presence of funneling, funnel length, funnel width and cervical indices [ (Funnel length + 1)/Endocervical length]. Results The prevalence of preterm delivery was 26.92%(14/52) in 52 patients with threatened preterm labor despite routine tocolytic therapy. A significant relationship was indicated by logistic regression analysis between the occurrence of preterm delivery and ultrasonographic cervical parameters (P < 0.001 respectively). But of all ultrasonographic parameters, the cervical length was the best predictor of preterm delivery. Receiver operating characteristic curve analysis showed that a cervical length of 17 mm was the best cut-off point for predicting preterm delivery. The sensitivity and specificity were 78.57% and 86.84%, respectively. Conclusions It is suggested that transvaginal uitrasonographic examination of the uterine cervix is an objective and accurate method for the predication of the outcome of the patients with threatened preterm labor and intact membranes. Chin J Perinat Med 2001; 4: 10-12.

Objectives To provide reliable information concerning the presence or the absence of Histoplasma capsulatum (H. capsulatum) infection in China, and data concerning this respect. Methods Three hundred normal people and 435 hospitalized patients, who lived in Hunan and Jiangsu provinces, and the Xinjiang Autonomous Region, were tested with yeast-phase histoplasmin (ALK/Berkerley Biologicals Laboratories, USA) and human pure protein derivative of tuberculin (PPD) on the volar surface of the forearm. Any reaction to the antigens over 5.0 mm in diameter of induration at 48-72 hours was considered positive. Results A total of 138 subjects (18.8%) in 735 patients reacted to histoplasmin with 5.0-45.0 (9.1 ± 4.3) mm indurations. Significant differences of positive skin reaction rates in normal subjects were found in Hunan, Jiangsu and Xinjiang (8.9% vs 15.1% vs 2.1%). The overall positive rate of patients was 25.5%. Patients with tuberculosis [31.7% (78/246)] had a significantly higher positive skin reaction rate in comparison with those suffering from pneumonia [17.7% (11/62)], lung cancer [20.9% (9/43)], chronic obstructive pulmonary disease [17.3% (9/52 ] and other diseases [12.5% (4/32)] (P < 0.01). Of 562 cases, 292 cases (52.0%) reacted to PPD with indurations of 5-50 (13.7 ± 4.9)mm in diameter, 63 cases (11.2%) reacted to both histoplasmin and PPD, while 38 cases (6.9%) reacted to histoplasmin but not to PPD. Conclusions The data suggest that there is H. capsulatum herd infection in China. The infection rate in Southeast China is higher than that in the Northwest, and the infection rate of patients with pulmonary tuberculosis is higher than that of normal persons and other pneumonopathy patients. Chin Med J 2001; 114(7):743-746

Objective To determine the role of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), and evaluate the progress from SIRS to MODS and the therapeutic strategies for acute necrotizing pancreatitis (ANP). Methods Rat ANP models were made by retrograde injection of 3.5% sodium taurocholate 2.5 ml/kg into the pancreatic duct. Sermm interleukin-8 (IL-8), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNFα), amylase, endotoxin, and albumin were examined. The morphology and pathology of the pancreas, liver, lung, kidney and heart after ANP were observed. Finally, TNFα mRNA in the liver, lung, kidney and heart after ANP were observed by reverse transcriptase-polymerase chain reactions, and the efficiency of somatostatin and growth hormone were also observed in this experiment. Results ANP led to remarkable elevation of the inflammatory mediators which were positively correlated with the development of ANP and MODS. Somatostatin and growth hormone inhibited inflammatory mediators and TNFα mRNA overexpressions, reduced the risk of MODS, corrected hypoalbuminemia, reversed negative nitrogen balance, and controlled the reduction of cell groups with functions and reasonably intervened SIRS caused by ANP. Conclusion TNFα mRNA plays an important role in ANP progression. The amelioration of ANP by combination treatment with somatostatin and growth hormone leads to the reduction of complications and marked increase in survival. Chin Med J 2001; 114(7):738-742

Objective To explore the effects of liposome-C-erbB2 antisense phosphorothioate oligodeoxynucleotides (S-ODNs) on C-erbB2 proto-oncogene expression and cell proliferation in human ovarian cancer cells. Methods The effects of liposome-C-erbB2 S-ODNs on C-erbB2 protein expression, cell cycle and cell proliferation in human ovarian cancer cells were studied by means of flow cytometry and 3H-thymidine incorporation. Results Liposome-C-erbB2 S-ODNs can specifically reduce C-erbB2 protein expression in human ovarian cancer cells, accompanied by a 30% inhibition of cell proliferation. The effectiveness of liposome-C-erbB2 S-ODNs on the expression of C-erbB2 was about 40 times higher than that of C-erbB2 S-ODNs. Conclusions The data suggest that antisense therapy might be a useful method of gene therapy in ovarian cancer. The effectiveness of C-erbB2 S-ODNs could be greatly increased by adsorption of S-ODNs by liposomes. Chin Med J 2001; 114(7):735-737

Objective To evaluate the efficacy of allo-UCBT in thalassemia children. Methods Five patients with β-thalassemia major (genotypes were homozygote of β41-42, β654 and double heterozygosities of β41-42/β654, β41-42/-28, β654/-28, respectively) were treated by allo-UCBT. The medican age was 3 year and ten month old (31/2 - 72/12). Four donor-recipient pairs were HLA-identical and one 1 locus mismatch. The patients received a median UCB nucleated cells (NC) of 5.5 × 107/kg body weight [ range (4.7 - 7.7) × 107/kg] and CD34+ CD38- cells 2.8 × 105/kg [range (0.6 - 4.5) × 105/kg] and CFU-GM 1.09 × 105/kg [range (0.24 - 230.00) × lO5/kg]. The conditioning regimen consisted of busalphan 16 - 20 mg/kg, cyclophosphamide 180 - 200 mg/kg) horse antithymocyte globulin (ATG) 90 mg/kg or rabbit anti-lymphocyte globulin (ALG) 25 mg/kg and melphalan of 90 mg/m2 was added to four cases. Cyclosporins A (CsA) alone was administered in 3 cases, and a combination of CsA and methotrexate in the other 2 Cases. Results Four cases were engrafted, but one rejected and recurred thalassemia state at day 60 past UCBT. One case had autologous reconstitution. The reconstitutions were found in all patients with neutrophils 0.5 × 109/L at day 19 (14 - 22), platelets > 20 × 109/L at day 37 (21-63). Two cases developed grade I and Ⅱ acute GVHD respectively. None developed chronic GVHD. Three patients survived disease-freely (survival with exthalassemia state). The median follow-up was 18 months, the probability of survival was 100%. Conclusion Allo-UCBT could reconstitute hematopoiesis with low frequency and mild grade of GVHD. It is an effective treatment for thalassemia. Chin J Hematol 2001; 22: 182-185.

Objective To study the pathogen of root surface caries in the elderly. Methods Plaque samples from the experimental group and the control group were collected. After culturing in selective and non-selective media, the different bacteria were isolated. The counts and the positive rates of total bacteria, porphyromonas group, pervotella group, streptococcus mutants group, actinomyces group and lactobacillus group were compared. Results The counts of total bacteria, streptococcus mutants, actinomyces and lactobacillus of the experimental group were higher than those of the control group. The positive rates of actinomyces and lactobacillus of the experimental group were significantly higher than those of the control group. Conclusion Actinomyces and lactobacillus are the main related pathogens of root surface caries in the elderly. Chin Med J 2001; 114(7):767-768

Objective To investigate the effect of intrathecal injection (IT) with methotrexate (MIX) plus dexamethasone (DXM) in treating central nervous system involvement in systemic lupus erythematosus (CNS lupus). Methods Twenty-four CNS lupus patients that were refractory to conventional steroid therapy were selected for IT with MTX 10-20 mg plus DXM 10 - 20 mg. The effects and side effects of IT were closely observed. Results The symptoms and signs of 22/24 (91.7%) CNS lupus patients receiving IT improved considerably. Cerebrospinal fluid pressure, protein and WBC levels declined from 201.5±155.4 mm H2O, 145.2±87.6 mg/dl and 25.1±14.3/mm3 to 128.7 ± 108.1 mm H2O, 60.8 ± 38.3 mg/dl and 6.8 ± 2.1/mm3 respectively. Transient side effects were observed in 4 patients: 1 with itching sensation of lower limbs, 2 with headache and 1 with incontinence. Conclusion IT with MTX plus DXM is a promising method for treating CNS lupus and deserves further investigation. Chin Med J 2001; 114(7):764-766

Objective To analyze the epidemic trend of the bacteria causing burn wound infection, and to explore the influencing factors. Methods Bacterial ecology on burn wounds was investigated in 210 burn patients admitted to our hospital from January 1999 to December 2000, and the results were compared to those done in the 1970s, 1980s and 1990s. Results Since 1999, G+ cocci increased significantly (52.17%) when compared with those of the past three decades (P < 0.01)> while G- bacilli decreased significantly (46.48%, P < 0.01). The ratio of Pseudomonas aeruginosa in the past two years was evidently lower than those in the early 1970s and 1990s (P < 0.01), while the ratio of staphylococcus aureus was much higher than those in the mid-1980s and 1990s (P < 0.01). Methacillin-resistant Staphylococcus aureus (MRSA) accounted for about 85%, significantly higher than its rate in the mid-1980s and the beginning of the 1990s (P < 0.01), with an increasing trend. Conclusion The increased incidence of Staphylococcus aureus in our unit in the past two years might be closely related to the preferential application of Imipenem in burn infection control. Furthermore, the ratio of MRSA in Staphylococcus aureus could not be lowered by vancomycin. Chin J Burns 2001; 17: 80-82