2002年 · 第115卷第09期

Objective To improve the therapeutic and preventive measure for elderly patients (75 years and over)with idiopathic Parkinson's disease (OEIPD). Methods Fifteen OEIPD patients were observed prospectively over a long period of time. Their diagnosis was confirmed by autopsy. Based on clinical and pathological data, the causes of death were analyzed. Results The mean clinical course in OEIPD patients was 6.2 ± 3.6 years. The majority of the 15 patients were the akinetic type and the akinetic type with tremor (80.0%). In the late stages of disease (4.8±3.5 year), choking occurred in 12 OEIPD patients who received nasal feeding for an average of 4 months after the occurrence of choking. The most common complication in 12 patients was repeated pulmonary infections with an average rate of 2.9 ± 1.9. The causes of death were bronchial pneumonia and shock induced by pulmonary infection (11 cases, accounted for 73.3%), acute myocardial infarction (2 cases),one case with cardiac rupture and one case with rupture of aortic aneurysm. Conclusions The clinical course was shorter in OEIPD patients. Levodopa therapy should be started early in OEIPD patients. Bronchial pneumonia and infectious shock constitute the major cause of death and choking was one of the main causes of aspiration pneumonia. Nasal feeding should be started as early as possible after the appearance of choking. Silent aspiration can be reduced by teaching the patient to protect the airway by 'supraglottic swallowing'. Chin Med J 2002; 115(9): 1409-1411

Objectives To investigate telomerase activity in esophageal squamous cell carcinoma (SCO and its preneoplasia lesions, and to study the relationships between telomerase activity and cancer differentiation,cancer invasiveness, and lymphatic metastasis. Methods Telomerase activity in esophageal SCC tissues, adjacent dysplasia tissues and normal epithelia from the surgical edge were assessed by microdissection-TRAP (telomeric repeat amplification protocol)-silver staining assay. Results Telomerase activity was detected in 37 (82.2%) of 45 esophageal tumors, 23 (79.3%) of 29 dysplasias, and 2 (5%) of 40 normal epithelia. There was a significant difference in activity between dysplasia and normal epithelium, as well as between tumor and normal epithelium. Twenty-six (92.9%) of 28 tumors with lymphatic metastasis had detectable telomerase activity compared to 11 (64.7%) of 17 non-lymphatic metastasis tumors. These relationships were statistically significant (P<0.05), but the one between telomerase activity and tumor grade was not. Conclusion Telomerase activity was high both in esophageal SCC and their preneoplasia lesions. The telomerase activity in SCC tissue was related to lymphatic metastasis, but not to cancer differentiation. Chin Med J 2002; 115(9): 1405-1408

Objectives To observe the expression of βig-h3 in normal cornea and keratoconus and to elucidate the role of extracellular matrix in keratoconus. Methods In situ hybridization was used to detect the expression of pig-h3 in the cornea. The cDNA library was screened with human pig-h3 cDNA probe to locate pig-h3 mRNA in cells. Results Expression of pig-h3 was found mainly in the stroma of the normal cornea and keratoconus, but decrease depending on the degree of keratopathy. In some serious cases, no expression signal was detected. The strongest expression was seen at the border of the normal region and keratoconus. Conclusions βig-h3, the structural component of the extracellular matrix, can affect cell adhensiveness in the development of corneal fibrous interstitial organization. During the development of keratoconus,decreasing levels of βig-h3 cause the diminution of corneal steadiness, which is related to formation of keratoconus. Chin Med J 2002; 115(9): 1401-1404

Objective To investigate in vivo survival of retinal ganglion cells (RGCs) after partial blockage of optic nerve (ON) axoplasmic flow by sub-retinal space or vitreous cavity injection of brain-derived neural factor(BDNF) produced by genetically modified neural progenitor cells (NPCs). Methods Adult Sprague-Dawley (SD) rat RGCs were labeled with granular blue (GB) applied to their main targets in the brain. Seven days later, the left ON was intra-obitally crushed with a 40 g power forceps to partially block ON axoplasmic flow. Animals were randomized to three groups. The left eye of each rat received a sham injection, NPCs injection or an injection of genetically modified neural progenitors producing BDNF (BDNF-NPCs) . Seven, 15 and 30 days after ON crush, retinas were examined under a fluorescence microscope. By calculating and comparing the average RGCs densities and RGC apoptosis density, RGC survival was estimated and the neuro-protective effect of transplanted cells was evaluated. Results Seven, 15 and 30 days after crush, in the intra-vitreous injection group, mean RGC densities had decreased to 1885 ±68, 1562±20, 1380 ±7 and 1837 ±46, 1561 ±58, 1370±16, respectively with sham injection or neural progenitors injection. However, RGCs density in the groups treated with intra-vitreous injection of BDNF-NPC was 2101 ±15, 1809 ±19 and 1625 ±34. Similar results were found in groups after sub-retinal injection. Higher densities were observed in groups treated with BDNF-NPCs. There were statistically significant differences among groups through nonparametric tests followed by the Mann-Whitely test. RGC apoptosis density in BDNF-NPC at each follow-up time was less than in other groups. Conclusions A continuous supply of neurotrophic factors by the injection of genetically modified neural progenitors presents a highly effective approach to counteract optic neuropathy and RGC degeneration after partial ON axoplasmic flow blockage. Chin Med J 2002; 115(9): 1394-1400

Objectives To study the status of cochlear mitochondrial DNA (mtDNA) and to determine the location of mtDNA deletion in aged mice. Methods We detected cochlear mtDNA in 2, 7-10 and 17-19 month old mice by nested polymerase chain reaction (PCR) and DNA sequencing. Results mtDNA3867bp deletions were found in the cochleae of aged mice. The deletion occurred within nt9103- nt12970 and were flanked by 15 base pair direct repeats. Comparing the incidence of mtDNA3867bp deletions, 17- 19 month old mice (7/8) were significantly higher than 7-10 month old mice(4/16). The deletion was not observed in 2 month old mice (0/7). The ratio of deleted mtDNA/total mtDNA in 17-19 month old mice was higher than in 7 -10 month old mice (P <0.001) . Conclusion Cochlear mtDNA 3867bp deletion in aged mice may be related to presbycusis. Chin Med J 2002; 115(9): 1390-1393

Objective To identify the changes in serum insulin like growth factor-1 (IGF-1) and IGF binding proteins(IGFBPs) in children with nephrotic syndrome (NS) and the effect of glucocorticoid on serum IGF-I and IGFBPs. Methods We measured serum IGF-I and IGFBPs levels by radioimmune assay and immune radiomagnetic assay in 36 children with NS, consisting of an active stage group (ANS, n=12), a remission stage group (RE, n=12), an active stage group with glucocorticoid treatment (GNS, n=12),and a normal control group (NC, n=10) . Results 1) Compared to NC, serum levels of IGF-I and IGFBP-3 were decreased (P <0.01); serum levels of IGFBP-I and IGFBP-2 were increased (P <0.01) in the ANS group. 2) Serum levels of IGF-I and IGFBP-3 were higher and IGFBP-1 and IGFBP-2 were lower in the RE Group than in theANS Group(P <0.01). 3) Compared to the ANS group, serum levels of IGF-I and IGFBP-3 were increased (P< 0.01) and serum levels of IGFBP-1 and IGFBP-2 were decreased (P <0.01) in the GNS group. 4) A correlation was found between serum levels of IGFBP-3 and albumin in the active stage group (r=0.76,P <0.01). There was also a correlation between serum levels of IGF-I and IGFBP-3 and an inverse correlation between the serum level of IGF-I and serum levels of IGFBP-1 and IGFBP-2 in the ANS group. No other correlations were observed. Conclusions The serum levels of IGF-I and IGFBPs are altered in children in the active stage of NS,but return to normal in the remission stage. GC treatment may influence serum IGF-I and IGFBPs in children with NS. Changes in IGF-I and IGFBPs levels may play a role in the growth retardation of NS children. Chin Med J 2002; 115(9): 1383-1385

Objective To study the effect and mechanism of the peripheral blood mononuclear cell (PBMC) invasion by HBV on artificial immunization in newborns. Methods Fifty-two newborns of HBsAg positive mothers were immunized with HBIG (hepatitis B immunoglobulin) and HBVac (hepatitis B vaccine) and were followed up for 7 months. The newborns' HBV-DNA in serum and in the PBMCs was detected with nested-PCR; anti-HBs was tested with solid phase radioimmunoassay (SP-RIA) . PBMCs isolated from newborn peripheral blood were incubated in the presence of PHA or purified HBsAg. Interleukin-2 (IL-2) level in culture supernatants of activated cells was detected by ELISA. Results The failure rate of immunization was higher in infants with positive HBV-DNA in PBMCs than those with negative HBV-DNA (P <0.05); IL-2 level in PBMC culture supernatants was lower in former than in the latter and in normal controls (P <0.05). The level of IL-2 in the immunization failure newborns was lower than that in the successfully immunized newborns and in normal controls (P <0.05). Conclusions Intrauterine invasion of PBMCs by HBV is one of the important reasons for immunization failure in newborns. IL-2 production is closely related to the invasion of PBMCs by HBV, which may contribute to the failure of artificial immunization in newborns. Chin Med J 2002; 115(9): 1380-1382

Objective To study the characteristics of low bone mass in amenorrhea patients with elevated follicular stimulating hormone (FSH). Methods Amenorrhea patients with elevated FSH: Primary amenorrhea 18 cases, secondary amenorrhea 171 cases and age matched controls with normal menstruation, 180 cases. The descriptive parameters were: estrogen, alkaline phosphatase, urinary excretion of calcium to creatine ratio, cortical bone mineral density at the right radius measured by single photon absorptiometry and trabecular bone mineral density at the lumbar vertebra body measured by quantitative computerized tomography. Results Average E2 levels in amenorrhea patients is under 150 pmol/L with significantly higher alkaline phosphatase and urine calcium to creatine ratio values than the normal menstruation group. Cortical bone mineral density in the secondary amenorrhea group (655 ±69 mg/cm2) was significantly lower than that of the normal menstruation group (677 ±56 mg/cm2, P <0.01). Trabecular bone mineral density in the secondary amenorrhea group (145 ±26 mg/cm3) was significantly lower than that of the NOR group (192 ± 28 mg/cm3, P <0.001). The disparity with the normal menstruation group is even greater in the primary amenorrhea group. Bone mineral density of the amenorrhea patients was negatively correlated with duration of the menopause. Conclusions Serum estradiol levels in amenorrhea patients was so low that bone turnover was accelerated. This led to insufficient bone accumulation and a dramatically drop in trabecular bone mineral density. The extent was closely related to age of onset of amenorrhea and the duration of ovarian failure. Chin Med J 2002; 115(9): 1376-1379

Objective To assess the possibility of using arterial pressure waveform or pulse oximetry plethysmographic waveform variation to estimate the pulmonary arterial wedge pressure (PAWP). Methods Fourteen American Society of Anesthesiologists grade I - Ⅱ patients aged 33 - 69 years and weighing 62.0 ± 9.5 kg scheduled for elective abdominal tumor surgery were studied. Their hemoglobin exceeded 120 g/L and hematocrit exceeded 35%. Pre-operative acute hypervolemic hemodilution was applied immediately after general anesthestic induction and tracheal intubation. PAWP, systolic pressure variation (SPV), delta down (dDown), SPVplet, dDownplet and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10 ml/kg and 20 ml/kg and again at the end of the operation. Central venous pressure was maintained at 10 -12 mm Hg during operation. Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 22 mm Hg) and the systolic pressure before the Valsalva manoeuvre during apnea were used to calculate arterial pressure ratio (APR). Results APR, SPV, dDown, SPVplet and dDownplet all correlated well with PAWP (r=0.717, -0.695,-0.680, -0.522 and - 0.624 respectively, P <0.01). There was a closer linear correlation between APR and PAWP than between the other parameters. The regression equation was PAWP (mm Hg)= 0.207xAPR (%)-0.382. Conclusion During positive pressure mechanical ventilation, APR, SPV, dDown, SPVplet and dDownplet can be used to estimate PAWP effectively. Chin Med J 2002; 115(9): 1372-1375

Objective To investigate role of exocrine cells in the pancreatic enhancement images at Manganese (Ⅱ)N, N' -dipyridoxylethlenediamine-N, N ' -diacetate 5, 5' -bisc (Mn-DPDP)-enhanced magnetic resonance(MR) imaging. Methods Artificial pancreatic leakage was constructed in six dogs using a fistula tube inserted into the duodenum papillae. Pancreatic juice was collected before and after intravenous infusion of 2 ml/kg of Mn-DPDP at a rate of 2-3 ml/min. The Mn content of pancreatic juice was measured by atomic absorption spectroscopy. T1-weighted spin-echo images and T1-weighted spoiled phase gradient-echo (SPGR)images were obtained prior and approximately 30 min after the administration of Mn-DPDP at 1.5T. Results The Mn content of pancreatic secretion increased 60.47 ±21 .83 μg/dl after the administration of Mn-DPDP (t=6.785, P <0.01). The signal/noise ratio (S/N) of the pancreas increased 53% ± 49%and 62% ± 44%on T1W spin echo images and SPGR images, respectively. Conclusions Exocrine cells of the pancreas can absorb manganese and excrete it through the pancreatic juice. Exocrine cells play an important role in the enhancement of the pancreas in MR imaging with Mn-DPDP. Chin Med J 2002; 115(9): 1363-1366

Objective To set up a rapid and simple method for identificating bacteria by 16S-23SrDNA intergenic spacer regions (ISRs). Methods Polymorphic products of PCR from ISRs were selected on agarose gel and sequenced directly using purified fragments by excising the gel without cloning. Nucleotide sequences were compared with GenBank databases and analyzed by DNAMAN program. Results There was only a single product in streptococcus genus after PCR amplification of 16S-23SrDNA ISRs. Five streptococcal species were obtained from 7 strains of streptococcus. Two major amplicons were consistently generated for 8 strains of Haemophilus influenzae (H. influenzae) . The sequence data showed that they all belonged to H. influenzae type b on GenBank databases. Conclusion PCR and direct sequencing of 16S-23SrDNA ISRs were very successful methods for bacterial species identification. Chin Med J 2002; 115(9): 1415-1417

Objective To study the clinical and pathological characteristics of solitary fibrous tumor (SFT). Methods Clinical pathological analysis and immunohistochemical studies were performed on ten patients with SFT. Results The SFTs located variously and showed different histological features. All cases showed positive staining for CD34, VM (vimentin) and Bcl-2, but negative staining for Desmin, S-100, CK (cytokeratin)and EMA (epithelial membrane antigen). Conclusions SFT is described as a " patternless " growth pattern. According to clinical pathological features and immunohistochemistry, it is different from other soft tissue tumors. Long-term clinical follow-up is necessary for this kind of tumor. Chin Med J 2002; 115(9): 1412-1414