2002年 · 第115卷第10期

Objective To study the resistance mechanism of clinical isolates of Ureaplasma urealyticum resistant to fluoroquinolones. Methods Thirteen isolates of Ureaplasma urealyticum resistant to six fluoroquinolones were selected out of 184 clinical isolates and their QRDRs (quinolone resistance-determining region) gyrA, gyrB, parC and parE were amplified by PCR. Sequencing results were compared to those susceptible reference strains and a comparison of deduced amino acid sequences were performed. Results Sequence comparison revealed a C to A change at 87nt of gyrA QRDR leading to the substitution of Asp95 with glutamic acid and a C to T change at 50nt of parC QRDR leading to the substitution of Ser80 with leucine. Conclusion These results suggest that a C to A change at 87nt of gyrA QRDR and a C to T change at 50nt of parC QRDR are associated with fluoroquinolone resistance of Ureaplasma urealyticum. Chin Med J 2002; 115(10): 1573-1575

Objective To evaluate the role of acyclovir in treatment and prevention of herpes simplex keratitis (HSK). Methods A total of 105 patients with HSK were divided into 4 groups. Group 1 consisted of 79 patients with HSV epithelial keratitis. Group 2 consisted of 20 patients with interstitial keratitis. Group 3 consisted of 6 patients with necrotizing keratitis. Group 4 consisted of 4 necrotizing keratitis patients with corneal perforation treated with conjunctival flap and corneal transplantation. All patients were treated with acyclovir systemically and topically. After full recovery, the patients with epithelial HSK and stromal HSK were randomly divided into two groups individually. One group was constantly treated with oral acyclovir at 300 mg/day for 1 year as a prophylaxis group. The other group was designated as control. Results During the one-year treatment and follow-up, 5 cases with epithelial HSK recurred in the prophylaxis group and 14 cases in the control group, showing a statistically significant difference. One case of stromal HSK recurred in the prophylaxis group and 4 recurred in the control group. Conclusion Long term and low dose oral acyclovir for prophylaxis of recurrent epithelial herpes simplex infection and therapeutic doses of oral acyclovir reduce both the rate and duration of recurrences of infectious herpes simplex keratitis. Chin Med J 2002; 115(10): 1569-1572

Objective To investigate the expression of cluster of differentiation 44 variant 6 (CD44V6) and proliferating cell nuclear antigen (PCNA) in ocular squamous cell carcinomas. Methods Streptavidin-biotin complex (SABC) immunohistochemistry was used to explore the expression of CD44V6 and PCNA in 35 cases of ocular squamous cell carcinomas, 20 cases of papillomas, and 11 cases of normal eyelid tissue. Results The CD44V6 positive rate was 62.9%(22/35) in ocular squamous cell carcinomas, 15.0%(3/20) in papillomas, but not detectable in the 11 cases of normal eyelid tissue. The positive expression rates of CD44v6 in ocular squamous cell carcinomas were significantly higher than in benign tumors (x2=11.57,P<0.01) or control tissue (P=0.001), and the positive expression rates of CD44V6 in metastasis were significantly higher than without metastasis (P=0.049) . PCNA labeling indexes (PI) in tumors with CD44V6 expression were significantly higher than those without (t=20. 21, P <0.01). Conclusions Overexpression of CD44V6 is correlated with the progress and metastasis of ocular squamous cell carcinomas. CD44V6 protein positive staining is associated with high PI. CD44V6 and PCNA are useful for evaluating prognosis. Chin Med J 2002; 115(10): 1564-1568

Objectives To explore the changes of multifocal electroretinograms (mfERG) before and after retinal detachment surgery and to evaluate its clinical significance. Methods Twenty-three patients (23 eyes) with rhegmatogenous retinal detachment underwent mfERG before and after surgery. The latencies and average response densities of N1,-wave and P1-wave of mfERGs in detached areas, attached areas, fovea and the entire tested area were compared before and after surgery. Results Preoperatively, the average response densities of N1 -wave and P1 -wave in the detached area were significantly smaller than those in attached areas (t=3.68, t=4.26, P <0.01), and the latencies of N1-wave and P1-wave in detached areas were significantly longer than those in attached areas (t=3.07, t=3.89, P <0.01) . Postoperatively, the average response densities of N1-wave and P1-wave in detached areas, fovea and the entire tested area increased, and there were significant differences pre- and postoperatively (P <0.05). However, the latencies of N1 -wave and P1 -wave before and after surgery showed no significant differences (P> 0.05). Conclusions The mfERG is a useful tool to evaluate the recovery of posterior retinal function after retinal detachment surgery. The response density is a more sensitive index than latency to evaluate retinal function of retinal detechment. Chin Med J 2002; 115(10): 1560-1563

Objective To introduce the applied anatomy of pedicled buccal fat pad (BFP) graft and a series of histological changes in the healing process of BFP as an uncovered pedicled graft. Methods The healing processes of BFP are demonstrated via uncovered pedicled grafts on rabbits in histological examination. Uncovered buccal fat pads were used to repair soft tissue defects in rabbit oral cavities. Results The uncovered buccal fat pads showed complete epithelialization of their oral surfaces at 6 to 8 weeks after surgery and were slowly replaced by fibrous tissue. Conclusions Advantages of the pedicled buccal fat pad graft include an anatomic region that is consistent and easy to excise. The operation can be performed in one incision, affecting neither appearance nor function of the area. Use of the buccal fat pad provides a good reconstruction of soft tissue defects in the mouth. Chin Med J 2002; 115(10): 1556-1559

Objective To examine serum levels of sICAM-1 from normal controls and patients with thyroid diseases(simple goitre, Graves' disease or Hashimoto's thyroiditis) with 125I -sICAM-1 RIA established in our lab. Methods Using 125I -sICAM-1 RIA, serum sICAM-1 levels of 400 healthy individuals as the normal group and 1020 patients with simple goitre (SG), Graves' disease (GD) or Hashimoto's thyroiditis (HT) were examined for a comporative chinical study. Results The serum level of sICAM-1 (±s) in the normal group was 168.43±36.23 μg/L- There was no significant difference between the normal and SG groups (P> 0.05), whereas the serum levels of sICAM-1 in autoimmune thyroid diseases (GD or HT) were higher than those in the normal or SG groups(P <0.05, respectively). After GD patients received one of three medical treatments, their serum sICAM-1 levels decreased (P <0.05). After GD patients were treated and their thyroid function decreased to normal, their serum sICAM-1 levels were lower than those in relapsed GD patients (P <0.05). Conclusions sICAM-1 RIA can be used to examine autoimmune thyroid diseases. Serum levels of sICAM-1 can be used as a parameter in diagnosing autoimmune thyroid disease and in evaluating the effects of therapy, drug administration or relapse in GD. Chin Med J 2002; 115(10): 1552-1555

Objective To analyze the efficacy of recurrence prophylaxis using radiation and chemotherapy following bladder conservation surgery for muscle invasive bladder cancer. Methods 23 patients with muscle invasive bladder cancer were treated with radiotherapy combined with bladder mitomycin infusion after bladder conservation surgery (study group). Radiotherapy was given using an external beam at an average dose of 5148 ±462 cGy with conventional fractionation. For comparison,29 similar patients treated with postoperative bladder mitomycin infusion without radiation served as control(control group). All patients were followed up for more than 3 years, an average of 41.6 months (36 - 60 months). Results The 3-year pelvic recurrent rate of muscle invasive bladder cancer was 17.4%in the study group and 44.8%(P=0.036) in the control group. The 3-year distant metastasis rates were 17.4%and 24 . 1 %, respectively (P=0 . 554). The 3-year overall survival rates were 81.8%and 86.2%, respectively(P=0.670). Two patients from the study group had their treatment interrupted, one for 3 days and the other for one week due to acute cystitis, while the rest of the patients were able to complete the treatment according to schedule. Conclusion Radiotherapy plus chemotherapy after bladder conservation surgery for muscle invasive bladder cancer can decrease the rate of pelvic recurrence effectively and be used as a realistic adjuvant treatment. Chin Med J 2002; 115(10): 1548-1551

Objective To assess the possibility of using spirometrically controlled computed tomography (CT) to test pulmonary ventilation function. Methods Spiral CT scans under the control of a spirometer were performed on 30 healthy adults. Spiral CT scan was performed at 50%vital capacity (VC) with an 8 mm slice thickness. Mean attenuation values and pixel index (PI) of lung regions were evaluated with semiautomatic evaluation software. Results There were significant differences in PI values between four pixel intervals. Conclusions Spirometrically controlled spiral CT with semiautomatic evaluation software is an accurate and reproducible method of measuring lung density and PI, which has the possibility of indicating pulmonary ventilation function. Chin Med J 2002; 115(10): 1548-1547

Objective To evaluate the influence of various clinicopathologic factors on the survival of patients with bile duct carcinoma after curative resection. Methods A retrospective analysis was performed on 86 cases of bile duct carcinoma treated from January 1981 to September 1995. Fifteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model. Results The overall cumulative survival rate was 73%for 1 year, 32%for 3 years and 19%for 5 years. The results of univariate analysis showed that the major significant prognostic factors for influencing survival of these patients were type of histological lesion, lymph node metastasis, pancreatic invasion, duodenal invasion, perineural invasion, macroscopic vessel involvement, resected surgical margin and depth of cancer invasion (P <0.05). Pancreatic invasion, perineural invasion and lymph node metastases were the three most important prognostic factors determined by multivariate analysis using the Cox Proportional Hazards Model. Conclusion Pancreatic invasion, perineural invasion and lymph node metastases are the most important prognostic factors for bile duct carcinoma after curative resection. Chin Med J 2002; 115(10): 1538-1541

Objective To investigate best diagnosing methods and therapy for patients with biliary tract complications after liver transplantation and analyze related factors. Methods A review was made of data collected from 96 patients, and confirmed by retrospective case notes examination. Results A total of 94 patients (97 grafts) survived more than 2 days after transplantation; of whom, 92 had an end-to-end biliary anastomosis with a T tube. The average follow-up was 5.8 months (range: 0.3 -10.2 months). Among the 94 patients, eight (8.5%, 8/94) had complications: leakage during T-tube removal (2 patients), leakage at an earlier stage (2), simultaneous stricture and leak (2) and just stricture(2). Six patients with biliary tract complications had predisposing factors including hepatic artery stenosis (2 patients, including one hepatic artery stenosis combined with severe rejection, hepatic artery thrombosis (3), and donor-recipient bile duct mismatch (1). There was no difference in cold ischemic time. With hepatic artery thrombosis and/or stenosis> 50%, five patients were re-transplanted; without hepatic artery thrombosis and/or stenosis <50%, three patients required endoscopic stenting and radiological percutaneous drainage of bile collection with or without balloon dilation. All patients survived. Conclusions Biliary strictures occur later than leaks after surgery. Without hepatic artery thrombosis and/or stricture, there is no need for surgery; with hepatic artery thrombosis and/or stricture> 50%, re-transplantation is needed as early as possible. Chin Med J 2002; 115(10): 1533-1537

Objective To investigate the cross-reactivity between glutamic acid decarboxylase (GAD)-I-A97 and I-Ad tetramer in diabetes-prone non-obese diabetic (NOD) mice (I-A97) and diabetes-free Balb/c mice (I-Ad). Methods Two GAD peptide I-A97 and I-Ad tetramers were generated and compared for phenotype and function of sorted GAD peptide I-A97 and I-Ad tetramer-positive (tet+) T cells. Results The cross-reactivity is shown in either tetramer positive percentage or tetramer staining intensity. The NOD and Balb/c derived-tet+ T cells were able to be cross-stained by GAD peptide I-A97 and I-Ad tetramers, and responded to both irradiated NOD and Balb/c splenotyes under stimulation by synthetic and recombinant GAD peptides. Conclusion Although I-A97 and I-Ad are closely related in biochemical and biological aspects, their most notable difference is the presence or absence of a negatively charged residue at position β57 that links to insulin-dependent diabetes mellitus. Chin Med J 2002; 115(10): 1579-1581

Objective To evaluate the efficacy of a novel compound derived from Traditional Chinese Medicine (TCM)for treatment of alveolar echinococcosis in the Kuming mouse. Methods The compound was extracted from TCM by serial procedures including amalgamation of TCM drugs, boiling in a beaker, cold condensation using a reflux instrument, evaporation by mild heating and finally, formation of a deep brown powder. An animal model of alveolar echinococcosis was established concurrently. A bit of alveococcus tissue derived from alveolar echinococcosis in the mouse was transplanted into the peritoneal cavity of the musculus of a Kuming mouse. The duration of infection after inoculation was classified as either 1 week or 10 weeks; the animals were again divided into treated groups and control groups. Estimation of the alveococcus inhibitory rate and electron microscopic observation served as the main methods for assessment of efficacy. The infected mice in the treated groups were intra-gastrically administered once per day with the TCM extractive powder at doses of 20 mg • kg-1 for three months continuously. All the animals were sacrificed and examined half a month after the end of TCM treatment. Results Total wet weight of alveococcus collected from the 9 mice in the treated group after one week of infection was 37.8 g (±s, 4.196±2.090 g), which was markedly lower than the amount collected from 10 mice of the control group (121 .3 g, ±s, 12.1 ±4.3 g) . Therefore, the inhibitory rate of the alveococcus was 65.7%(P <0.01). Similarly, the total wet weight of alveococcus from 7 mice of the treated group after 10 weeks of infection was 4.3 g (±s, 0.62 ±1.21 g), which was much lower than the amount collected from 6 mice of the control group (17.85 g, ±s, 2.93±3.28 g). The inhibitory rate of alveococcus was 80.6%(P <0.01) . Furthermore, the ultrastructural appearances of alveococcus showed obvious differences between the two groups. Conclusion TCM extractive powder for treatment of murine alveococcosis is considered to be a hopeful anti-echinococcus compound it is a topic for further study. Chin Med J 2002; 115(10): 1576-1578

Purpose To review 54 cases of human myiasis in China reported from 1995 - 2001 in order to characterize the current epidemic situation. Date sources All reference data originated from some Chinese literature in Chinese medical journals. Twenty-four short reports published from 1995-2001 were selected according to the stated purpose. Due to the varied outcomes of myiasis at different sites in the body, the present paper is divided into 7 types of infection: ocular, nasal cavity, external auricular, cutaneous, gastrointestinal, urogenital, and traumatic myiasis . Results Of these 54 selected cases of myiasis in China from 1995 - 2001, hypodermic myiasis (31 patients) and ocular myiasis (12 patients) were the most common, comprising 43 cases (80%). The cases were equally distributed amongst both genders. Furthermore, most of the infected were children and infants, totaling 39 cases, or 72%. The regional distribution of myiasis was widespread throughout the sixteen provinces and autonomous regions in question. Conclusions Although not always reported, myiasis is a common zoonotic parasitosis occurring in most of China's territories. Due to its prevalence, preventive measures for myiasis are urgently needed. Chin Med J 2002; 115(10): 1445-1447