2002年 · 第115卷第11期

Objective To investigate the specific cell-mediated immune efficacy of the an HPV16 prophylactic vaccine. Methods C57BL/6 mice were randomly divided into 3 groups: experimental group I (treated with pcDNA L1), control group Ⅱ (treated with pcDNA3.1) and control group Ⅲ (treated with PBS buffer). The mice were immunized three times during a three-week interval. Ten to fourteen days after the third inoculation, a footpad swelling test was used to detect delayed-type hypersensitivity (DTH) responses. Antigen-specific splenocyte proliferation assay and quantitation of IFN-γ cells in splenocytes were performed by FACS assay. Results In the experimental group, splenocytes actively proliferated after stimulation with HPV16 VLP, and had developed a markedly larger amount of CD8+ IFN-γ+ cells, which is an index for special CTL. Also, the footpad was significantly thickened upon inoculation with HPV16 VLP. Conclusion Naked DNA vaccine of HPV16 L1 can induce specific cell-mediated immune responses in mice, which should be considered for evaluation of HPV16 DNA vaccine feasibility. Chin Med J 2002; 115(11): 1697-1700

Objective To further characterize the differentiation inducing properties of EDRF1 and demonstrate its functional pathway involved in regulation of globin gene expression. Methods By transfecting EDRF1 sense and antisense constructs into HEL cells, we identified the expression of globin and erythropoietin receptor genes by Northern blot analysis. RT-PCR and EMSA (electrophoresis mobility shift assay) were performed to monitor the expression and DNA-binding activity of erythroid specific transcription factors GATA-1 and NF-E2. Results It was shown that when EDRF1 was overexpressed, production of α-globin increased. In antisense EDRF1, overexpression of HEL cells, significant loss of α-, γ-globin mRNA synthesis was observed. The transcription of endogenous GATA-1 and NF-E2 mRNA expression were maintained at the same levels compared with control experiments. However, the transcription activity of GATA-1 was severely impaired. Expression of erythropoietin receptor gene was not influenced by EDRF1 gene overexpression. Conclusion The results suggested that EDRF1 regulated α- and γ-globin gene synthesis by modulating DNA-binding activity of GATA-1 transcription factor. Chin Med J 2002 ; 115(11): 1701-1705

Objective To study the pharmacodynamics of vecuronium, atracurium, mivacurium and rocuronium in patients with end-stage renal failure. Methods Forty-six patients with end-stage renal failure scheduled for renal transplantation and 53 patients with normal renal function were given either vecuronium, atracurium, mivacurium or rocuronium. The neuromuscular effects were monitored by the evoked response of the adductor pollicis to train-of-four stimulation of the ulnar nerve. Results Onset of vecuronium, atracurium and mivacurium occurred faster or tended to be faster in patients with end-stage renal failure, but there was no significant difference in onset by rocuronium between the control patients and renal failure patients. Furthermore, the no-response period, duration of action and recovery of atracurium did not differ between the two groups. There was no significant difference in duration of action or recovery of mivacurium between the two groups, whereas its no-response period was significantly prolonged in the patients with end-stage renal failure. There was no difference in no-response period or duration of action after the initial dose of vecuronium or rocuronium between the two groups. However, no-response period and duration of effect by vecuronium and rocuronium were prolonged with increasing incremental doses in patients with end-stage renal failure. Conclusions All four muscle relaxants could be safely used in patients with end-stage renal failure. Onset of the relaxants were, in some cases, accelerated and no-response period of mivacurium was prolonged in patients with end-stage renal failure undergoing dialysis therapy. End-stage renal failure prolonged the no-response period and duration of action of vecuronium and rocuronium after repeated incremental doses, but did not alter those attributed to atracurium. Chin Med J 2002; 115(11): 1692-1696

Objective To evaluate the value of perfusion MR imaging and angiographic evidence of collateral circulation in symptomatic patients with ischemic cerebrovascular diseases (ICVD). Methods Cerebral angiography and perfusion MR were performed in 16 patients with symptoms of ICVD. Qualitative perfusion maps were calculated for regional cerebral blood volume (rCBV) and mean transit time (MTT). Results A total of 27 lesions were seen on the perfusion MR maps (6 infarcts and 21 ischemic lesions) and most of them (26/27) showed a prolonged MTT. MTT is sensitive to the presence of ischemic lesions, but not sufficient in distinguishing infarct from ischemia. All of the infarcts showed a decreased rCBV, while most of the ischemic lesions showed a normal or increased rCBV. When collateral circulation was identified on angiography, most ischemic lesions were not infarcts and had a normal or increased rCBV. The absence of angiographically identifiable cerebral collaterals may not always result in an infarct; 50% had decreased rCBV. Despite the absence of angiographic collaterals, the other half had normal or increased rCBV. Conclusion Cerebral angiographic evidence of collateral circulation is important in identifying a favorable outcome in patients with ICVD. However, a lesion with a normal or increased rCBV suggests a sufficient collateral circulation even without angiographic collaterals. Perfusion images may be a potentially useful adjunctive tool in the prediction of the outcome of ICVD, particularly where no apparent collateral macrocirculation is seen on CA. Chin Med J 2002 ; 115(11): 1687-1691

Objective To evaluate the safety and value of preoperative transarterial embolization of hypervascular vertebral tumors. Methods Sixteen patients with hypervascular vertebral tumors underwent transarterial embolization before surgery. The lesions were located between the middle cervical and lower lumbar spine. Forty-one arteries were embolized with permanent particles injected through a microcatheter, including polyvinyl alcohol (PVA) particles (150 - 500 μm) in 25 arteries and Dextran particles (150 -350 μm) in 16. Of these, 31 had pieces of gelatin sponge added for proximal pedicled embolization. The criteria for judging the effectiveness of embolization were completeness of tumor removal and estimated blood loss during surgery. Results The particles were injected into the tumor feeders through superselection in 17 arteries or flow control in 24. Tumor embolization was defined as "total" in five patients, "nearly total" in eight, "subtotal" in two, and "partial" in another. There were no symptomatic complications associated with embolization. Tumors were entirely removed in all patients. The average estimated blood loss during surgery was 1510 ml (range of 200-6000 ml) for all 16 patients. Conclusion Preoperative embolization of hypervascular vertebral tumors is safe and effective. It can make complete resection of a tumor possible and can make a previously unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and to avoid complications. Chin Med J 2002; 115(11): 1683-1686

Objective To evaluate the value of angiography and cholangiography on the diagnosis and interventional treatment of vascular and biliary complications after liver transplantation. Methods Sixteen of 46 patients (15 men and 1 woman, 17-60 years old) after orthotopic liver transplantation received angiography due to abnormal ultrasonography or edema of lower limbs, or cholangiography due to progressing jaundice. Percutaneous transluminal angioplasty or drainage was performed in some patients. Results Fifteen patients experienced vascular complications and 4 patients had biliary complications. Three of them appeared to have both vascular and biliary complications. Hepatic artery complications were the most common complications (9/16), including hepatic artery thrombosis or stenosis (6/9), bleeding (2/9) and hepatic artery-dissecting aneurysm (1/9). One patient with hepatic artery thrombosis received transcatheter thrombolysis and two patients with bleeding received coil embolization. Inferior vena cava and portal vein stenosis were observed in 6 and 2 patients, respectively. After balloon angioplasty or stent placement, clinical symptoms were alleviated. Biliary complications, including biliary stricture and anastomotic bile leak, occurred in 4 patients. Jaundice decreased after percutaneous transhepatic cholangiography and drainage. Conclusions Besides diagnosis, interventional methods include mini-invasive treatment for patients with vascular and biliary complications after liver transplantation. Balloon angiography and stent placement for venous stenosis are useful procedure for the treatment of these problems. Chin Med J 2002; 115(11): 1679-1682

Objective To investigate the variations of sensory evoked potentials (SEPs) in patients with affective disorders accompanying suicidal behavior. Methods 39 depressive patients, 22 manic patients and 33 normal controls were included in the study. Visual, auditory and somatosensory evoked potentials (VEP, AEP &amp; SSEP) were recorded from every subject using a Nicolet Spirit Instrument. Results Both the depressive and manic groups presented prolonged latencies and decreased amplitudes of major components of SEPs as compared to that of normal controls. Depressive patients with suicidal behavior had decreased P3 amplitude of VEP (P < 0.05), while maniacs with suicidal behavior had decreased P2 amplitudes of VEP &amp; AEP (P < 0.05 or 0.01). Compared with patients without suicidal behavior, patients with suicidal behavior had significantly decreased P3 amplitudes of VEP &amp; SSEP. Conclusions The variations of SEPs in patients with affective disorders is closely associated with a history of suicidal behavior. Their clinical significance and biological correlates with suicidal behavior need further study. Chin Med J 2002; 115(11): 1675-1678

Objective To use infrared thermography to take cat cerebral cortical temperature in order to visualize the temperature of its entire cerebral cortex as an image. Methods After performing craniotomy for exposure of cerebral hemispheres in 52 cats, their cortical temperatures were displayed and analyzed by computerized infrared thermovision. Results The temperature distribution of the cerebral cortex was uneven, with a maximum difference of 2.3℃ among different cortical areas. The temperature in the cortical anterior-inferior area (including the Ant. Ectosylvian, the lower section of Mid. Ectosylvian and the Ant. Sylvian) was higher compared to the temperature in the posterior-super-parts (Post. Suprasylvian, Mid. Suprasylvian, Post. Lateral and Ant. Lateral). Locations with higher or lower temperatures showed little change within three days after craniotomy, and the cortical temperature held steady. Conclusion The use of cortical infrared thermo-images for display of cat cortical temperature is possible and has many advantages over traditional methods. This new neuroimaging method has a practical value in neurological research. Chin Med J 2002; 115(11): 1670-1674

Objective To explore the inhibitory effect of human endostatin gene mediated by retroviral vector on the growth of human liver carcinoma. Methods A recombinant retroviral plasmid containing human endostatin gene and signal peptide was engineered and transferred into PA317 cells to produce retrovirus. Human liver carcinoma cells (SMMC7721) were infected with the above retrovirus to build a stable endostatin-transfected liver carcinoma cell line (SMMC-endo). The control liver carcinoma cell line (SMMC-pLncx) was developed in a similar way except that the plasmid was replaced by an empty retroviral vector. Immunohistochemistry and Western blot were used to test the expression and secretion of human endostatin. The biological activity of the expressed human endostatin was assessed by endothelial cell proliferation assay. The growth rates of SMMC-endo and control SMMC-pLncx cells in vivo and in vitro were also observed. Results The expression and secretion of human endostatin by endostatin-transfected SMMC-endo cells were confirmed by immunohistochemistry and Western blot. Compared with the control group, concentrated supernatant of SMMC-endo cells remarkably inhibited the proliferation of human umbilical vein endothelial cells by 48%, significantly higher than the inhibition by the control (10.2%; P < 0.01). The endostatin-transfected SMMC-endo cells had similar in vitro growth rates to SMMC-pLncx cells. The in vivo experiment showed that the growth rate of SMMC-endo cells was slowed. Only in 3 out of 5 mice were tumors formed and flank tumors of SMMC-endo cells were 94.5% smaller than those of control cells 22 days after inoculation into nude mice (P < 0.001). Conclusions Gene transfer of human endostatin mediated by retroviral vector is an effective form of cancer therapy. Chin Med J 2002 ; 115(11): 1664-1669

Objective To study the psychology and the treatment during the process of hand allograft. Methods The patients were interviewed to evaluate their states of mind and their abilities to manage stress during the selection of patients. The psychology of the two patients were trained before the operation and managed accordingly afterwards. Results One of 12 candidates was found to be unsuitable for the transplantation because of psychiatric problems. One week postoperatively, the two patients were anxious, lacked patience and were afraid of seeing the long-awaited grafted hand. After 1 week, the patients began to accept the new hand, with full acceptance of the hand 1 month later. With the recovery of hand sensation 4 to 5 months after the operation, the patients regarded the hand as their own. Conclusion Psychological problems exist during preoperative selection of patients and postoperative rehabilitation, requiring psychologists in the hand transplantation team. Chin Med J 2002; 115(11): 1660-1663

Objective To study the esthetic and long-term effectiveness of cerinate porcelain laminate veneers. Methods A total of 736 front teeth were restored with cerinate porcelain laminate veneers, which were then tested at different time points by clinical tracking observation and appraisal. Results The short and long term rates of effectiveness were 96.6% and 96.2%, respectively. There was no relationship between clinical effectiveness and the length of restoration time. The failure rate was higher in 18 - 30 years old patients and those with discolored teeth. The major clinical performance was fold fissure and deciduous of porcelain laminate veneers. Conclusions Cerinate porcelain laminate veneers are an ideal choice for dental esthetic restorations because they are unnoticeable, stable, strong and require no excessive dental preparation. Chin Med J 2002; 115(11): 1739-1740

Objective To investigate a non-invasive, effective and rapid mode of detecting the recurrence of bladder cancer during follow-up. Methods Ninety patients following transurethral resection of bladder tumor (TURBt) surgery were recruited from January 1998 to March 2000. Standard ELISA was used to determine the quantity of nuclear matrix protein (NMP-22) in urine of all bladder cancer patients during their follow-up periods. Urine bladder tumor antigen (BTA) stat test was simultaneously performed and followed by cystoscopy. Results The total positive rates of urinary NMP-22 and BTA stat test were 76.7% (33/43) and 67.4%(29/43), respectively. Comparatively, this positive rate would increase to 93.0% (40/43) when the combination of both urine NMP-22 and BTA test were adopted. Conclusion Examination of NMP-22 in urine is a rapid and effective way to detect the recurrence of bladder cancer. If combined with BTA test, NMP-22 may be used as a non-invasive method in surveillance of recurring of bladder cancer, which may reduce the frequency of patients needing to undergo conventional invasive cystoscopy. Chin Med J 2002; 115(11): 1736-1738

Objective Wolff-Parkinson-White syndrome (WPW) is considered to be an autosomal dominant hereditary disease, but the gene is not identified. The objective of this study was to localize the genetic loci of Wolff-Parkinson-White syndrome. Methods Linkage analysis between the disease of Wolff-Parkinson-White syndrome and 3 STR (short tandem repeats) markers on 7q3 (D7S505, D7S688, and D7S483) was tested in 3 kindreds of the Wolff-Parkinson-White syndrome (101 numbers in total) by genotyping. Results Wolff-Parkinson-White syndrome was linked to the loci above. The maximum two-point Lod score detected at D7S505 was 6.4 at a recombination fraction (0) of 0.1; the Lod score of D7S688, D7S483 was 5.3 vs 2.5. Conclusion The gene of Wolff-Parkinson-White syndrome is located at 7q3. Chin Med J 2002; 115(11): 1733-1735

Objective To approach the sequential release of antitumor drugs and promote the effect of chemotherapy. Methods Adriamycin (ADM) and carboplatin (CBP) were respectively microcapsulated with ethylcellulose by organic phase separation. The morphology and sizes of the microcapsules were observed and measured with light microscope and scanning electromicroscope. The contents and the release rates of ADM and CBP in microcapsules were measured with fluorescence spectrophotometer and high-efficiency phantom chromatic (HPC) spectrum respectively. The antitumor sensitivity test in vitro was devised with MTT assay. Results The microcapsules of ADM and CBP were spherical in shape with diameters of 196 ± 64 μm and 214 ± 48 μm respectively. The contents of one-layer and two-layer CBP and ADM microcapsules were 51.4%, 35.7% and 39.8% respectively, with the release rates in vitro of 62.4%/day, 54.8%/day and 48.2% /8h. The results of drug sensitivity test in vitro demonstrated that the current preparation has never affected the stability and antitumor activity of CBP and ADM. Conclusion Microcapsules with different drugs and different thickness of material have different release rate. Combined arterial chemoembolization with different microcapsules could approach the sequential release and promote the effect of chemotherapy. Chin Med J 2002; 115(11): 1730-1732

Objective To review the major progress in primary angle closure glaucoma (PACG). Methods Contents of this article were selected from the original papers or reviews related to primary angle closure glaucoma published in Chinese and foreign journals. A total of 76 articles were selected from several hundred original articles or reviews. The content of selected articles is in accordance with our purpose and the authors are authorized scientists in the study of glaucoma. Results Primary angle closure glaucoma is the most common type of glaucoma in the Sino-Mongoloid population. PACG in Chinese can be classified into three types depending on the mechanism of angle closure: 1. Multimechanism: 54.8% of Chinese PACG is caused by co-existing factors. The pattern of angle closure appears to mainly be creeping closure. After iridectomy, almost 40% of the cases still manifest a positive response to the darkroom provocative test and progressive synechial closure or recurrent angle closure may occur. Several mechanisms are involved in this form of PACG such as pupillary blocking component, iris crowding component and anterior positioned ciliary body. These factors can coexist in the follow patterns: pupillary blocking and iris crowding coexist; pupillary blocking and anterior positioned ciliary body coexist or three of them co-exist. 2. Pupillary block: (38.1% of Chinese PACG) is caused by iris bombe due to pupillary block with acute or subacute attack. It responds well to iridectomy or laser iridotomy. 3. Non-pupillary blocking: (7.8% of Chinese PACG). They usually have a deeper anterior chamber, and tend to be younger (below 40 years of age). Angle closure in this form of PACG is caused by: iris crowding mechanism or/and anteriorly positioned ciliary body against iris root to angle. It is critical to distinguish multi-mechanism PACG from other types. The initial treatment for this type of PACG is also iridectomy, but after the pupillary block component is eliminated by iridectomy, the residual non-pupillary blocking components should be highlighted by a diagnostic treatment procedure or by a ultrasound biomicroscopy (UBM) provocative test. Finally, the role of UBM in the observation and evaluation of the mechanism of angle closure is discussed and future research directions on PACG in Asians are proposed. Conclusion Chinese eyes have been recognized to be prone to the development of creeping angle closure. There is some direct evidence that creeping angle closure is caused by multiple mechanisms. Further study on this topic is needed. Chin Med J 2002; 115(11): 1706-1715