2002年 · 第115卷第06期

Objective To study the effect of retinoid X receptor alpha (RXRα) transfection plus treatment with the RXRa ligand, 9-cis-RA, on the proliferation and phenotype of platelet-derived growth factor (PDGF)-activated hepatic stellate cells (HSCs). Methods PDGF activated rat hepatic stellate cells were transfected with eukaryotic expression vector pcDNA3.1- human RXRα, and confirmed by Western blot. Proliferation of transfected HSC was assayed by bromodeoxyuridine (BrdU) incorporation as well as MTT, and the phenotype (α-smooth muscle actin,desmin) was observed by immunocytochemistry with image analysis. Results Transfection of the RXRa gene and treatment with ligand 9-cis-RA of PDGF-activated HSCs extended the increased expression of RXRa protein for at least 168 hours. Cell proliferation and expressions of alpha-smooth muscle actin (α-SMA) and desmin were blocked, compared with groups of shamtransfected, PDGF-activated, no transfection, no ligand treatment, and irrelevant ligand treated HSCs. Conclusion Transfection with the RXRa gene followed by 9-cis-RA ligand treatment will inhibit the proliferation and reverse the phenotype of activated HSC. Chin Med J 2002; 115(6): 928-932

Objective To identify genes associated with the chronic progression of renal disease and astragalus and angelica (A&A)'s renal protective effects. Methods The technique of silver staining mRNA differential display (DD) was used to investigate changes of gene expression in normal, sclerotic and A&A treated sclerotic kidneys. We isolated genes differentially expressed during the progression of renal disease which could be normalized by A&A. Results Several genes related to A&A's protective effects were isolated and one of them was confirmed by Northern blot. Conclusion Silver staining mRNA differential display is a simple and effective technique for isolating differentially expressed genes. The isolated new gene may be related to the progression of chronic renal disease and contribute to A&A's protective effects. Chin Med J 2002; 115(6): 923-927

Objective To evaluate the efficacy of endoscopic variceal sclerotherapy (EVS) for esophagogastric variceal bleeding. Methods A retrospective analysis was made on 1010 patients with esophagogastric variceal bleeding who underwent sclerotherapy, among whom there were 834 patients with cirrhosis, 160 with hepatocarcinoma,12 with Budd-Chiari syndrome and 4 with congenital liver fibrosis. Totally, 3203 sessions of sclerotherapy were performed, including 602 sessions of emergency sclerotherapy and 2601 of selective surgery. The average number of sessions of sclerotherapy for the initial treatment in 710 cirrhosis patients who received continuous sclerotherapy was 3.2 ±1.1 times. Follow-up was done in 579 cirrhosis patients for 3 - 157 months, with an average period of 42.5±32.8 months. Results The rate of emergency hemostasis in the whole group was 97.0%. The rate of complications was 13.4%, and the mortality rate was 1.8%. The rate of complete eradication and basically complete eradication of esophagogastric varices in cirrhosis patients was 84.1 %. The late rebleeding rate was 23.7%, and the survival rates were 95.8%± 0 . 8%, 86 . 1%± 1 . 6%, 74.5% ± 2.4%, 53.6% ± 3.8% at 1, 3, 5 and 10 years, respectively, according to Kaplan-Meier analysis. Conclusion EVS is an important method for the treatment of esophagogastric variceal bleeding. Chin Med J 2002; 115(6): 919-922

Objective To construct a retroviral vector carrying human vascular endothelial growth factor (hVEGF121)cDNA for evaluation of the possibility of VEGF gene therapy in ischemic bone disease. Methods hVEGF121 cDNA was obtained from the plasmid pCDI/VEGF121 and cloned into retroviral plasmid pLXSN. Recombinant plasmid was transferred to the retrovirus packaging cell, PT-67, by lipofectamine mediated gene transfer. Mouse bone marrow stromal cells (MSCs) were transfected by the retrovirus. The integration of the hVEGF121 cDNA into MSC genomic DNA and expression of the VEGF gene was detected. Proliferation assays of human umbilical vein endothelial cells (HUVECs) by VEGF121 in culture medium were performed. Results Recombinant pLXSN/VEGF121 was correctly constructed and confirmed by restriction endonuclease analysis and DNA sequencing analysis. hVEGF121 gene was integrated into MSC genomic DNA after transfection, and the VEGF121 protein was expressed. Proliferation assays showed VEGF121 in culture medium was a biologically active protein and had a mitogenic effect on HUVEC. Conclusions Recombinant retroviral vector carrying hVEGF121 cDNA was successfully constructed. VEGF121 protein expressed by MSCs had mitogenic effect biologically. This provides a further foundation for VEGF gene therapy for bone ischemic disease and bone tissue engineering. Chin Med J 2002; 115(6): 914-918

Objective To describe a new noncontact balloon catheter mapping system and to assess the clinical utility of this system for guiding endocardial mapping and ablation of tachycardia. Methods Five patients with tachycardia underwent endocardial mapping and radiofrequency ablation using the noncontact balloon catheter mapping system. A 9 French, 64-electrode balloon catheter and a conventional 7 French electrode catheter for mapping and ablation were positioned in the same ventricular chamber. Ventricular three-dimensional geometry was established by the computerized mapping system. Using a boundary element inverse solution, 3360 virtual endocardial electrograms were computerized and used to derive isopotential maps. The earliest endocardial activation site, the exit site and the activation sequence of tachycardia or the critical isthmus of the reentry circuit were identified. Radiofrequency ablation with circular or linear lesion was performed at the target sites guided by the locator system. Results Six clinical types of tachycardia, 5 of which were ventricular tachycardia and one was concealed fasciculoventricular fiber mediated tachycardia, were induced by programmed stimulation. The mean cycle length of these tachycardias was 336.6 ±42.69 msec. The earliest activation site and the exit site of 5 mapped tachycardias were all identified using the system. One type of ventricular tachycardia was hemodynamically unstable and difficult to terminate, and could not be mapped. Among the 6 types of tachycardias, radiofrequency ablation was successful in 4. There was no complication during and after the procedure. During the mean follow-up of 6 months, no tachycardia recurred in the patients with a successful ablation. Conclusions The noncontact mapping system described in this study has advantage over conventional mapping techniques for refractory tachycardia. It is not only helpful for understanding the electrophysiologic mechanism of a complex case, but also suitable for mapping hemodynamically-intolerated and nonsustained ventricular tachycardia. Chin Med J 2002; 115(6): 909-913

Objective To study the clinical features of patients with primary biliary cirrhosis (PBC) in order to improve the doctors' awareness of the disease. Methods General status, clinical manifestations and laboratory findings of 40 patients with PBC were reviewed. Thirty-seven patients were females (37/40), and the mean age at diagnosis was 50.5 ± 7.8 years. The time interval from initial symptoms or preliminary diagnosis to final diagnosis was 24.0 ± 23.6 months. Results The most frequently reported symptoms were fatigue (67.5%, 27/40), jaundice (60%, 24/40)and pruritus (32.5%, 17/40). Eight patients (20%) had associated auto-immune diseases (Sjogren's syndrome and/or rheumatoid arthritis). Serum alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (γ-GT) levels were markedly elevated (520.3 ± 382.3 IU/L and 648.6 ± 529.1 IU/L,respectively) in all patients, while alanine aminotransferase (ALT) and aspartate aminotransferase (AST)levels were mildly elevated (82.6±54.5 IU/L and 100.7±47.2 IU/L, respectively). Twenty-four patients(60%) had a total bilirubin level ≥34.2 μmol/L. Thirty-five patients (87.5%) had elevated serum immunoglobin M, and 97.5% of patients (39/40) were anti-mitochondrial antibody (AMA)/AMA-M2 positive. Conclusion Elevated serum ALP and y-GT levels, together with a positive AMA/AMA-M2, can help the diagnosis of PBC. Liver biopsy is useful to confirm the diagnosis and to differentiate histopathological stages. Chin Med J 2002; 115(6): 904-908

Objective To investigate the relative effects of degree and distribution of body fat with several cardiovascular disease (CVD) risk factors in elderly Chinese subjects. Methods One-hundred and thirty-five elderly Chinese individuals (age range, 60 - 65 y) without any history of significant renal, hepatic or cardiac disease were recruited. Seated blood pressure,anthropometric and fasting plasma biochemical parameters were measured. Student's t-test was used to compare the differences in biochemical and anthropometric markers between cohorts. Results Males were heavier (64.6 ±8.6, 57.2 ±8.2 kg, P <0.001), taller (1.65 ± 0.06, 1.51 ± 0.05 m, P <0.001) and their greater body fat was predominantly deposited centrally (Waist-to-hip ratio,0.91 ± 0.06, 0.88 ± 0.07, P <0.05). Females were more generally obese with increased body mass index (BMI, 23.8 ± 4.6, 25.0 ±3.5 kg/m2, P <0.05) and percentage body fat [26.3%(24.5% -28.1 %) vs 37.2%(36.0%- 38.9%), P<0.001] than the males. However, despite an 11% higher proportion of body fat in females, no significant differences were identified in blood pressure, lipid profile,indices of insulin resistance or albumin-to-creatinine ratios. Conclusion It is likely that central adiposity contributes disproportionately to these metabolic disorders in males even though they are much leaner than elderly Chinese females. Chin Med J 2002; 115(6): 897-899

Objective To study the surgical technique and results of laryngeal function preservation in treatment of hypopharyngeal carcinoma. Methods A retrospective review of 305 patients with malignant neoplasms of the hypopharynx (279 males, 26 females, age ranging from 14 to 77 years) was performed from 1978 to 1996. In the 305 patients (stage I, n=6; stage Ⅱ, n=12; stage Ⅲ, n=82; stage Ⅳ, n=205), the sites of origin were pyriform sinus (n=234), postcricoid (n=21), posterior pharyngeal wall (n=35) and superior hypopharynx (n=15) . Of the 305 patients, 206 (67.54%, stage I, n=6; stage Ⅱ, n=12; stage Ⅲ,n=65; stage Ⅳ, n=123) were surgically treated with laryngeal function preserved and 99 (32.46%. stage Ⅲ, n=17; stage Ⅳ, n=82) had no laryngeal function preserved. All had 55 - 75 Gy radiotherapy according to their need. Results A total of 206 patients (67.54%) were surgically treated with laryngeal function preserved, totally(voice, respiration and deglutition) in 139 (67.5%) and partially (voice and deglutition) in 67 (32.5%). 99 patients (32.46%) had no laryngeal function preserved. The overall 5-year survival rate of the 305 patients was 44.8%, which segregated to 83%(stage Ⅰ), 71 %(stage Ⅱ), 58%(stage Ⅲ), and 36%(stage Ⅳ). The 5-year survival of the laryngeal function preserved group was 48%(n=66), the rate of complications 28%(n=58) and the rate of residual tumor 5.8%(n=12), compared with the no laryngeal function preserved group 37%(n=20), 31.3%(n=31), and 6%(n=6) (P>0.05). Conclution Only a small proportion of patients (31/305, 10%) with hypopharyngeal carcinoma who require total laryngectomy and preservation of the laryngeal function is feasible for eradication of tumor and preservation of laryngeal function. Chin Med J 2002; 115(6): 892-896

Objective To report our experience of 200 endoscopic totally extraperitoneal inguinal hernioplasties utilizing reusable instruments. Methods Between August 1999 and June 2000, 200 endoscopic totally extraperitoneal hernioplasties were performed on 163 patients. The mean age of the study population was 63 years with a male to female ratio of 157:6. Perioperative details and postoperative outcomes were prospectively evaluated and analyzed. Results A total of 196 (98%) endoscopic extraperitoneal inguinal hernioplasties were successfully performed. Conversion rates to transabdominal preperitoneal and open repairs were 1 .5%(n=3) and 0.5%(n=1), respectively. There were no other intraoperative complications. Postoperative morbidity included retention of urine (n=7), wound bruising (n=2), atelectasis (n=2) and gouty arthritis (n=1) . The mean visual analogue pain scores at rest were 2.3, 1.6 and 1 .9 on postoperative days 0, 1 and 2,respectively. The mean length of hospital stay was 1.9 days. 113 patients (69%) returned to normal activities within one week. Of the 35 patients who experienced both open and laparoscopic repair, 80%expressed preference for endoscopic hernioplasty in the event of future recurrence. Conclusions Endoscopic extraperitoneal inguinal hernioplasty can be safely performed utilizing reusable trocars. Substantial reduction of operative cost could be achieved by the elimination of disposable instruments. Deficiencies of the reusable metallic trocar, namely peri-cannula air-leak and sliding movements of the trocar, can be overcome by purse-string suture of the fascial opening. Chin Med J 2002; 115(6): 888-891

Objective To reconstitute an Alzheimer's disease model by administering bradykinin (BK) or cyclosporine A (CSA) to the rat hippocampus. Methods BK or CSA was administered to the rat hippocampus using a stereotaxic apparatus. The behavior of the rats was observed with an electronic attack-jump platform. The phosphorylation of Tau protein was examined through immunohistochemical assay. Results Behavior studies showed that an obvious disturbance in learning and memory was seen in BK injected rats. No obvious dysfunction was observed in CSA injected rats. The results obtained by immunohistochemical assay indicated that the staining of M4, 12E8, paired helical filament-1 (PHF-1) and calcium/calmodulin-dependent protein kinase Ⅱ (CaMK Ⅱ) was stronger, and that of Tau-1 was weaker in BK injected rats compared with the control group. We also found that the binding of M4 and PHF-1 but not 12E8 to Tau was significantly increased in CSA injected rats. As for BK injection, binding of Tau-1 to Tau was decreased after CSA injection. Conclusion To our knowledge, this is the first data showing in vivo that the activation of CaMK Ⅱ induces both Alzheimer-like Tau phosphorylation and behavioral disturbances. Chin Med J 2002; 115(6): 884-887