Table of Content

21 February 2010, Volume 31 Issue 1

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The Second Grade National Prize for Science and Technology Progress——Studies on Pathogenesis and Treatment of Respiratory Failure

REN Yan-hong;ZHAN Qing-yuan

2010, 31(1):  1-3. 

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To improve the status of management in respiratory failure in China, the project of Studies on Pathogenesis and Treatment of Respiratory Failure was designed and conducted by three medical centers(Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Affiliate of Capital Medical University; Zhongshan HospitalFudan University; and Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical College) for more than ten years. This project focused on pathogenesis and treatment strategies of respiratory failure and achieved the following important innovations: (1) Pulmonary Infection Control Window(PIC Window) was firstly proposed and be used to determine the time switching point of sequential invasive-noninvasive ventilation; (2) The largest sample size of early use of noninvasive positive pressure ventilation(NPPV) for acute exacerbated COPD(AECOPD) on general ward provided the evidence-based data for expanding the indication of NPPV from treating respiratory failure to alleviating respiratory muscle fatigue; (3)Three new type masks with intellectual property for NPPV were developed; (4) By designing intrinsic expiratory end positive pressure(PEEPi) lung model with property of expiratory flow limitation, PEEPi was confirmed to be the most important factor to increase inspiratory difficulty; (5) The systematic measuring method of the diaphragm strength and endurance was established; (6) We firstly confirmed that aquaporin 1 (AQP1) was the key channel of fluid transportation in the lung; (7) A multicenter prospective cohort study provided objective data that depression has causal effect on COPD exacerbations and hospitalization; (8) The two guidelines for NPPV and mechanical ventilation of AECOPD were initiated by this group. This project has been acquired widespread use in clinical practice and promoted the research and treatment of respiratory failure in China.

The Second Grade National Prize for Science and Technology Progress——Studies on Diagnosis and Treatment for Obstructive Sleep Apnea and Hypopnea Syndrome

HAN De-min

2010, 31(1):  4-7. 

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This study was designed to improve diagnosis and the effectiveness of surgical treatment for obstructive sleep apnea and hypopnea syndrome. By establishing the concept of veli palatine, popularizing a revised uvulopalatopharyngoplasty(Han-UPPP), the surgical complications were reduced. Effectiveness of surgical treatment was improved from 53.3％ to 82.4％ by locating the obstructive sites in patients with sleep apnea and standardizing the indications of upper airway surgery. Death in perioperative period was diminished. The concept of "structure, function and symptom" was established. And endoscopic management of nasal obstruction was pushed to improve nasal breathing in patients with sleep apnea. The technologies were popularized in 17 provinces and over 30 hospitals in china. The guideline of diagnosis and treatment of sleep apnea in China was established. 196 related articles were published, including 20 in journals of scientific citation index. Seven patents were granted. The normalized techniques and basic studies about obstructive sleep apnea were enhanced, which resulted in the improvement of diagnosis and treatment level in China.

奖项介绍

The Second Grade National Prize for Science and Technology Progress

ZHAO Ji-zong;CAO Yong;TANG Ya-juan

2010, 31(1):  8-10. 

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In the last decade of the 20th century, the protection of both structure and function of brain in brain surgery had become a typical principle in the field of minimally invasive neurosurgery worldwide. However, brain surgery in China was still in the stage of micro-neurosurgery at that time. This study was to popularize the concept and technologies of minimally invasive neurosurgery in the treatment of brain surgery throughout the country. Based on the principle of “the least injury, the largest preservation of brain function”, traditional craniotomies were improved, and a set of both intraoperative monitoring and alerting system for brain protection were established as well. Meanwhile, the application of transitional medicine helped greatly to protect the basic visual, lingual and motor functions of the brain in neurosurgery. We are the first to verify the functional topology of the Chinese linguistic areas and the anterior region of the temporal lobe in the world, based on both scientific and clinical works. This study helped to improve the outcome of patients receiving minimally invasive neurosurgery in China, and lower the cost of the treatment of the diseases. Brain surgery in China has reached the international level in the field of minimally invasive neurosurgery.

眼科学基础及临床研究进展

The Handan Eye Study: A Review

WANG Ning-li;WANG Feng-hua;LIANG Yuan-bo

2010, 31(1):  11-17. 

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The Handan Eye Study is a population-based and epidemiological investigation of cross-sectional ophthalmopathy which included 6 830 Han people from 7 557 subjects at the age over 30 years in 13 villages of Yongnian County, Handan city, Hebei province in 2006-2007. The interviews covered demographic, behavioral, and ocular risk factors as well as healthrelated and vision-related quality of life. Ocular examination included measurement of visual acuity(VA), intraocular pressure, anterior and posterior segment examinations, visual field testing, fundus and optic disc photography. Physical examination included measurement of height and weight, blood pressure, electrocardiogram, fasting blood glucose, lipid levels, urea nitrogen and creatinine as well as tests of physical function including walking speed. Of the 7 557 individuals eligible for Handan Eye Study(HES), 6 830(90.4%) subjects participated the study. We present normative data for refractive error, frequency and causes of visual impairment and blindness, prevalence of epiretinal membranes, diabetic retinopathy and the normal OCT-measured macular thickness in healthy eyes of adult Chinese persons. These data from the HES will provide key information about the prevalence, risk factors, impact, and trends of ocular disease in rural regions of China and may be helpful for dealing with public health issues in China.

Role of Donor Bone Marrow Transplantation Induced Immune Tolerance in Prolonging the Survival Time of the Xeno-grafts in Swinemonkey Corneal Xenotransplantation

LIU Li-min;JIE Ying;PAN Zhi-qiang

2010, 31(1):  18-25. 

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Objective To observe the survival of corneal xenograft of swine-rhesus monkey corneal xenotransplantation after the rhesus monkeys were preconditioned using cyclophosphamide(Cyc) and the following donor bone marrow transplantation(BMT), and discuss the mechanism of immune tolerance. Methods The donor corneas of 3 months old Wuzhishan pig(WZSP) were grafted orthotopically into rhesus recipients. Eighteen rhesus monkeys were divided into three groups randomly. Group 1 received BMT preconditioning using Cyc for one time, group 2 received BMT preconditioning using Cyc for two times and Group 3 received preconditioning with cyc without BMT. The survival status of the xeno-grafts were evaluated by slit-lamp microscopy. Mixed lymphocyte reactivity(MLR) was used to examine the specific immune reactivity of recipient to donor, the lymphocyte, the immunoglobulins and complements in the blood of the recipients were detected before and after keratoplasty at different time points. Two recipients in each group were sacrificed for corneal histopathological staining one month after transplantation. Results The mean survival time was(36.0±4.7 ) days in group 1, (32.8±6.4) days in group 2 and (17.7±3.2 ) days in group 3. MLR showed that the specific immune reactivity of group 1 and 2 was depressed to donor spleen cells after BMT, but there was no significant difference in group 3. The concentrations of immunoglobulins IgG, IgA, IgM and complement C3, C4 were increased 1~2 weeks after surgery in all groups. After corneal transplantation, the lymphocytes in the control group did not change significantly, while in groups 1 and 2, CD4⁺ T cells were gradually reduced and CD8⁺ T cells increased. Histopathological examination showed that corneal xenografts were infiltrated with inflammatory cells in group 3, the corneal endothelia were destroyed and exudative membranes were attached onto the endothelium of the grafts with acidophil infiltration. In groups 1 and group 2, there were only minimal inflammatory cells infiltration in the corneal xeno-grafts, the cornea was intact and no exudative membrane appeared, meanwhile no acidophil infiltration was found. Conclusion The survival time of the xenograft could be prolonged significantly in the recipient rhesus monkeys preconditioned using Cyc and following donor BM. The specific immune reactivity to donor was also depressed. The rejection of xenotransplantation was related to both cellular immunity and humoral immunity.

眼科学基础及临床研究进展

Quality of Vision in Patients with Refractive Multifocal Intraocular Lens Implantation

ZHANG Chun-fang;WANG Kai-jie;ZHU Si-quan;ZHAO Yang;LI Xue

2010, 31(1):  26-30. 

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Objective To observe the visual performance of patients with ReZoom refractive multifocal intraocular lens(IOL) compared with aspheric monofocal IOL. Methods This was a prospective nonrandomized controlled study. Totally 114 consecutive senile cataract patients(114 eyes) were enrolled into this study. Fifty-seven cataract patients(57 eyes ) were implanted with ReZoom refractive multifocal IOL (ReZoom group), and another 57 cataract patients (57 eyes ) were implanted with aspheric monofocal IOL(Tecnis ZA9003 group). All the patients were assessed at 3 months postoperatively in the aberrations of crystalline, the modulation transfer function, contrast sensitivity of 10/100 percent in three sorts short distance(40, 63, 100 cm), uncorrected distanced visual acuity, uncorrected near visual acuity, bestcorrected distance visual acuity, best-corrected near visual acuity, distance corrected near visual acuity, pseudo-accommodation and the rate of offnear glasses. Results At 3 months postoperatively, both uncorrected near visual acuity and distance corrected near visual acuity were significantly better in ReZoom group than that in monofocal IOL group(P＜0.05). The accommodative range was(3.29±0.33）D in ReZoom group and(1.55±0.27）D in TecnisZA9003 group(P＜0.05). In 3/5 mm pupil diameter, the difference of the higher-total aberration between TecnisZA9003 group and ReZoom group was significant(P＜0.05); in 3 mm pupil diameter, the difference of the coma aberration between TecnisZA9003 group and ReZoom group was significant(P＜0.05). At 40, 63 cm and 100 cm, VA scores were higher in ReZoom group than that in TecnisZA9003 group(P＜0.05). The rate of off-near glasses in ReZoom group was better than in the aspheric monofocal IOL group(P＜0.05). The modulation transfer function at the spatial frequencies of 5, 10, 15, 20 cpd in ReZoom group were lower than that in Tecnis ZA9003 group(P＜0.05). Conclusion Compared with aspheric monofocal IOL, the ReZoom refractive multifocal IOL increase the higher-order aberration, but it can provide certain pseudo-accommodation, better useful near and middle distance visual acuity than aspheric monofocal IOL, especially for the patients who want to get rid of spectacles.

Fundus Autofluorescence in Macular Dystrophy

MA Kai;JI Hai-xia;YAN Wei;XIONG Ying;ZHANG Feng;LIU Ning-pu

2010, 31(1):  31-35. 

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Objective To assess the value of autofluorescence photography in diagnosis and treatment of macular dystrophy by observing the characteristics of autofluorescence in such diseases. Methods Thirteen cases of macular dystrophy were enrolled, of whom 8 were male, and 5 were female. The routine clinical examinations included present history, family history, visual test, slitlamp examination, indirect funduscopy, color fundus image, fundus autofluorescence angiography(FFA) and autofluorescence photography. Some of the patients also did the examinations of electroretinogram(ERG), electro-oculogram(EOG) and ocular coherence tomography(OCT). By comparing the color fundus images, the FFA images with the autofluorescence images, we summarized the characteristics of autofluorescence in macular dystrophy. Results The central region of the disease presented hypo-autofluorescence(488 nm) corresponding to the disease region of color fundus image and FFA image. There were hyperfluorescence circles with different width around the central region in 7 cases, which may represent disease progression. We could see extensive hyper-autofluorescence out of the macula in 2 patients who denied night blindness. ERG showed serious cone dysfunction and small rod dysfunction, which may represent the early stage of cone-rod dystrophy. The disease image could also be seen by infrared autofluorescence(820 nm). Conclusion During the observation of macular dystrophy, correct interpretation of autofluorescence images can help to obtain many disease-related information. Autofluorescence photography can reflect the tissue metabolic activity, which becomes it's unique superiority in observing such disease. As a non-invasive examination, autofluorescence photography can be accepted more easily by follow-up patients, which is useful in clinic to some extent.

Experimental Research on One step Retinal Puncture Implantation of Subretinal Polyimide Film

LIU Wu;LIU Fang;MO Bin;LI Qian;WANG Dong-sheng;LU Qing-jun

2010, 31(1):  36-38. 

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Objective To investigate the feasibility of one-step retinal puncture for the implantation of sub-retinal artificial vision films. Methods Twenty-four adult healthy New Zealand white rabbits were randomly divided into two groups: the implantation group(12 rabbits) and the sham-implantation group(12 rabbits). A polyimide film was implanted into the subretinal space via direct retinal puncture after vitrectomy. The implanted film was removed half a minute later in the sham group. Fundus photography and optical coherence tomography were taken 15, 30 and 60 days postoperatively. Results The polyimide film was implanted successfully into the sub-retinal space in all eyes. During the operation and the fellow-up period, there were no any film shift and surgical complications such as retinal detachment and intraocular hemorrhages in both groups. The retina over the film thinned in the implantation group in the late period, while normal thickness was kept in the sham group. Conclusion One-step retinal puncture could implant the artificial vision film into the sub-retinal space safely and effectively. This new method may be suitable for the short-term research of sub-retinal artificial vision.

Establishment of Three dimensional Finite Element Model of Human Eye Based on Anatomical data

LU Hai;WAN Qian;WANG Guang-zhi

2010, 31(1):  39-43. 

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Objective To establish a three-dimentional(3D) finite element model of human eye based on the method of the computer aided design(CAD) and human anatomical data. Methods With an intense calculation of anatomical data of human eye, we obtained the geometry and dimension of eyeball, extraocular muscles and optic nerve. Based on the data, we accomplished the sketch, which followed by designing and assembling different sections of eye with UG NX2.0. The processed digital 3D model was input to and meshed by Hypermesh 8, and the 3D finite element model of human eye was constructed with ANSYS. Results A 3D finite element model of a unilateral eye was successfully constructed with 7 047 units and 5 642 nodes. Conclusion Based on the anatomical data, processed with CAD software and finite element analysis software, the 3D finite element model can be established which simulates the real anatomical structures of the human eye. The newly completed model can be used for further finite element analysis and might provide effective platform for biomechanical research of orbital fractures and eye injuries.

Analysis of Visual Electrophysiologic Tests in Patients with Retinitis Pigmentosa

LIU Yan;WEI Wen-bin;ZHAO Ming

2010, 31(1):  44-47. 

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Objective To analyze the results of visual electrophysiologic tests of patients with retinitis pigmentosa(RP) and further to reveal the pathogenesis of RPD. Methods Flash electroretinogram(F-ERG), pattern visual evoked potential(P-VEP) and flash visual evoked potential(F-VEP) of 43 patients(86 eyes) with RP were recorded using Roland RETIport visual electric system. Results Among patients scotopic rod response of F-ERG of overwhelming majority of eyes(83.7%) was non-detectable, while the maximum response, photopic response, flicker response and OPs were not recorded in 57%, 57%, 43% and 62.8% eyes respectively. No P-VEP waves were recorded from 26.7% eyes. F-VEP waves were detectable from all eyes. According to visual acuity all patients were divided into two groups and there were significant differences of ERG and VEP between them. Visual acuity was not correlated with any value of visual electrophysiologic tests. Conclusion ERG and VEP in patients with RP reveal characteristic changes.

Factors Related to Decreased Corneal Endothelial Cell Density in Patients Prior to Cataract Surgery

HOU Yan-li;WANG Yan-ling

2010, 31(1):  48-50. 

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Objective To explore the causes of decrease in corneal endothelial cells and the importance of examining the corneal endothelial cells in patients prior to cataract surgery. Methods The series comprised 336 male and 467 female patients. Their age ranged from 29 to 95 years, average 75 years. Decrease in corneal endothelial cell density was defined as reduction by twice the standard deviation from the known value for healthy persons in each age group. Results Eightytwo of the patients(10.2%) had decreased corneal endothelial cell density. The presumed underlying causes were diabetes mellitus(22.0%), glaucoma(7.3%), atopic dermatitis(2.4%) and others. No causes could be identified in 38 cases(46.3%). Conclusion Reduction in endothelial cells is present in about 10% of cases awaiting cataract surgery. We advocate evaluation of corneal endothelial cells as a routine procedure prior to intraocular surgery.

Searching for Susceptibility Genes in Age-related Macular Degeneration: An Evolutionary Process

WANG Jing-ying;CHEN Hao-yu;CHEN Li-jia;PANG Chi-pui;

2010, 31(1):  51-59. 

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Age-related macular degeneration(AMD) is a complex disease with multiple risk factors. Although the pathogenesis and etiology remain largely unclear, systematic investigation into the genetics of this disease has cumulated during the past two decades that leads to putative mechanisms and genes associated with AMD. In this review, the development of genetic studies on AMD was summarized. While we intend to perform a comprehensive citation of all published works on AMD genetics, we find that we have to filter out some reference papers and focus on those reports bearing more information and insight into AMD genetics and its molecular pathology. We have worked on a selection of observations and supporting references that illustrate a picture of the genetic processes that eventually lead to the development of AMD and related complications.

老年病的基础与临床研究

Effects of Shenwu Capsule and Its Effective Component Tetrahydroxystilbene Glucoside on Synaptophysin Expression in Hippocampal Neurons of Aged Rats

WANG Rong;ZHAO Zhi-wei;ZHANG Li;ZHANG Lan;LI Lin

2010, 31(1):  60-64. 

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Objective To observe the effects of Shen-wu capsule(SW) and its effective component tetrahydroxystilbene glucoside(TSG) on synaptophysin expression in hippocampal neurons of aged rats, and to elucidate the mechanisms of their effects in prevention and treatment in neurodegenerative diseases. Methods SW(0.8 g/kg, 1.6 g/kg) and TSG(0.03 g/kg, 0.06 g/kg) were intragastrically administered to aged Sprague-Dawley rats which were 21 to 24 months old for 3 months. Six-month-old rats were used as young control group, and vehicle-treated 24-month-old rats as aged control group. The straight-channel water maze test was used to evaluate the learning and memory ability in rats. Electron microscopy was used to observe neuronal ultrastructure in hippocampus CA1 area especially the synaptic structure. The expression of synaptophysin(SYP) in hippocampus was detected by immunohistochemical staining. Results Compared with 6-month-old young control group, the number of errors in the water maze test increased in aged control rats at the age of 24 months(P<0.01); and administration of high dose of SW and TSG significantly reduced the number of errors in aged rats(P<0.01). Electron microscopy displayed that the number of synapses in the hippocampus CA1 area clearly diminished in aged control rats, while high dose of TSG administration significantly increased the number of synapses, even formed “synapticglobes”. Immunohistochemical staining showed that the expression of SYP in the hippocampus decreased markedly in aged control rats(P<0.01), but significantly elevated in aged rats treated with SW(low and high doses) and TSG(high dose)(P<0.01). Conclusion SW and TSG protected neuronal synaptic structures and enhanced synaptic protein expression in aged rats, which provided the experimental data for elucidating the anti-aging mechanisms of SW capsule and TSG.

Effect of Analog P165 of APP 5 mer Peptide and Rosiglitazone on Change of Spatial Reference Learning and Memory Ability in Type 3 Diabetes Mellitus(T3DM) Rats

MENG Xiang-hong;ZHAO Zhi-wei;JI Zhi-juan;ZHANG Jing-yan;WANG Rong

2010, 31(1):  65-68. 

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Objective To investigate the effect of analog P165 of APP5-mer peptide and rosiglitazone on change of spatial reference learning and memory ability in type 3 diabetes mellitus rats. Methods Healthy adult male rats of Sprague Dawley(SD) strain were randomly divided into 4 groups: Control group, type 3 diabetes mellitus(T3DM) group, T3DM P165 treatment group, and T3DM rosiglitazone treatment group. T3DM models were induced by intracerebroventricular injection of Streptozotocin(STZ, 3 mg/kg) bilaterally. P165 groups were treated with gastric P165(355 μg/kg) and rosiglitazone group was treated with gastric rosiglitazone(2 mg/kg) for 4 weeks, whereas the model group and control group were given 0.9% normal saline. Then,learning and memory ability was detected by Morris water maze test. Body weight and serum glucose level were recorded. The rat serum insulin, glucagon, insulinlike growth factor-1(IFG-1) was detected by ELISA method. Results In the Morris water maze test, compared with control group, the escape latency increased significantly(P<0.01) in model group. Compared with model group, the escape latency decreased significantly(P<0.05) in the groups treated with P165 and rosiglitazone. The serum IGF-1 level decreased significantly in the model group(P<0.05) than the control group. The serum IGF-1 level increased significantly in P165 treated group(P<0.01). The body weight and the serum glucose, insulin, and glucagon had no significant difference among the groups in the period of experiment. Conclusion There is learning and memory impairment in the T3DM rats. P165 could raise the rats blood serum IGF-1 level, ameliorate learning and memory ability but did not influence the serum glucose.

Protective Effect of Insulin Sensitizer Rosiglitazone on SH-SY5Y Cell against Streptozotocin-induced Injury

ZHANG Jing-yan;WANG Rong;SHENG Shu-li;JI Zhi-juan;MENG Xiang-hong;ZHAO Zhi-wei

2010, 31(1):  69-71. 

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Objective To investigate the effect of insulin sensitizer rosiglitazone on streptozotocin(STZ)induced insulin signal transduction pathway injury in SH-SY5Y cells. Methods Cells from human neuroblastoma cell line SH-SY5Y were divided into control group, STZ 0.8 mmol/L group, STZ 0.8 mmol/L+rosiglitazone 20 μmol/L group. The cells were counted, MTT(MTT) metabolic rate, lactate dehydrogenase(LDH) leakage rate in each group were measured, and the effect of rosiglitazone on SH-SY5Y cells was observed. Results Compared with the control group, cell count and MTT metabolic rate of STZ model decreased(P<0.01), and LDH leakage rate increased(P<0.01). After rosiglitazone protection, these indicators were significantly improved, cell count and MTT metabolic rate were higher than that in STZ injury group(P<0.01), LDH leakage rate was lower(P<0.01). Conclusion Rosiglitazone can reduce STZ-induced nerve cell toxicity, to improve cell survival, though its mechanism still need to be further explored.

Analysis on Clinical Data of 50 Elderly Patients with Elevated Fibrinogen

YAO Jie;WANG Li;WU Xiao-guang;XIANG Yan-hong;KOU Gui-ping;WANG Pei-chang

2010, 31(1):  72-74. 

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Objective To explore the causes of elevated fibrinogen(Fib) and factors associated with clinical features in elderly patients. Methods The clinical and laboratory data of 50 elderly patients with high Fib(high Fib group) and 45 elderly patients with normal Fib(control group) were analyzed and compared. Results As compared with the control group, the patients in the high Fib group had significantly higher activated partial thromboplastin(APTT), erythrocyte sedimentation rate(ESR), and blood platelet(PLT) while their total cholesterol(TC ) was significantly reduced. Analysis of clinical diagnosis indicated that high Fib group of elderly patients had significantly more acute severe disease and higher incidence of thrombosis than those in the control group of elderly patients. Conclusion Increased fibrinogen in elderly patients may suggest higher risks for severe acute disease and the occurrence of thrombotic disorders.

Significance of the Changes in Blood Lipid, Serum Uric Acid, Fibrinogen and Platelet Levels in Patients with Cerebral Infarction and Myocardial Infarction

ZHAO Qi-yan;WANG Li;WANG Pei-chang

2010, 31(1):  75-78. 

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Objective To investigate the changes in blood lipid, serum uric acid, fibrinogen, platelet level in patients with cerebral infarction and myocardial infarction. Methods A total of 206 patients were divided into 3 groups: myocardial infarction group(n=69), cerebral infarction group(n=72), cerebral infarction complicated with myocardial infarction group(n=65), and 76 healthy persons were enrolled into control group. Triglyceride(TG), total cholesterol(TCH), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C ), apolipoprotein A1 (Apo-A1), apolipoprotein B(ApoB), serum uric acid(UA), fibrinogen(Fib), plateletcrit(PCT), mean platelet volume(MPV) and platelet volume distribution width(PDW) were examined for all subjects. ResultsIn cerebral infarction group and myocardial infarction group, the UA, Fib level was higher than that of control group(P<0.01, P<0.05); the MPV, LDL-C level was higher than that of control group(P<0.05), and cerebral infarction and myocardial infarction had no interactive effect on the changes of UA, Fib, MPV, and LDL-C. The PDW level in cerebral infarction group and myocardial infarction group was higher than that of control group, PCT level was lower than that of control group(P<0.05); TG, TCH and APOB were higher than those of control group(P<0.05); HDL and APOA1 level were lower than that of control group(P<0.01). Cerebral infarction and myocardial infarction had interactive effects on the changes in PDW and PCT(P<0.01) and on TG, TCH, APOB, APOA1, and HDL-C(P<0.05). Conclusion Monitoring of blood lipid, serum uric acid, fibrinogen, and platelet levels is helpful in diagnosis and predicting the prognosis in patients with cerebral infarction and myocardial infarction.

Model of Middle Cerebral Artery Occlusion in New Zealand Rabbits

YAN Feng;JI Xun-ming;XUAN Yun;TIAN Xin;ZHANG Chen-cheng;LUO Yu-min;

2010, 31(1):  79-83. 

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Objective To establish a modified middle cerebral artery occlusion(MCAO) model in the rabbit through a novel hollow filament based on the intraluminal suture method, to provide a new modal for studying the cerebrovascular disease. Methods The rabbit was anesthetized and fixed and the distal common carotid artery(CCA), internal carotid artery(ICA), and external carotid artery(ECA) of the rabbit were exposed. A modified PE-50 catheter(a novel hollow filament) had been introduced into the ICA through the incision of ECA and the filament was lodged in the narrow proximal anterior cerebral artery(ACA) and blocked the MCA at its origin. The neurological functional scores were evaluated at 24 h after the operation. Then the rabbits were sacrificed and 2, 3, 5-triphenyltetrazolium chloride(TTC) staining was used to determine the infarct volume. Results The pH values, PO₂, PCO₂, mean arterial blood pressure(MABP), and glucose were not affected by the operation. The cerebral blood flow(CBF) decreased by 45.8%±16.2 after ischemia. The neurological functional scores varied in each rabbit. The percentage of the infarct volume was 9.43%±5.37%. The rate of success was 54.3% for the model. Most rabbits died of the subarachnoid hemorrhage. Conclusion The model can be used for the study of cerebral ischemia by monitoring the cerebral blood flow and careful operation although the ratio of success was not very high.

老年病的基础与临床研究

Postsynaptic Dense Area and Synaptic Plasticity

FENG Bo;HU Peng;WANG Rong

2010, 31(1):  84-87. 

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Synapses are connections between neurons, biological signals are transferred from the presynaptic membrane by the synaptic transmission to the postsynaptic membrane. Changes in the number and function of synapsis can cause changes in synaptic plasticity, thereby can affect learning and memory. Postsynaptic dense area and the close relationship between synaptic plasticity are essential for the maintenance of synaptic function properly. In this article, we make a brief overview on the research of postsynaptic dense area including its discovery and composition, participation in a major neurotransmitter in synaptic plasticity, as well as the relationship between postsynaptic dense area and the synaptic plasticity.

Improvement of a PCRbased Method for Vector Construction of Multisitedirected Mutations in GC-rich Promoter

JIANG Luan;SHAO Lei;HU Yang;DONG Ling-yue

2010, 31(1):  88-92. 

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Objective To construct several vectors in which multi-site mutation occurs within a GC-rich hHSS promoter. Methods An interested genomic region of human hepatic stimulator substance(hHSS) was multi-site-directly mutated and amplified. During amplification, the melting temperature was reduced by adding certain concentration of DMSO and the concentration of the enzyme-digested products was increased through ethanol precipitation. Results The results showed that five different hHSS promoter vectors containing multipoint mutations were effectively constructed and confirmed by DNA sequencing. Conclusion This improved method for PCR amplification of GC-rich promoter was efficient, which provides a rapid, simple and economic approach to analysis of genomic DNA.

Effect of Serum Containing Components of Liang Xue Huo Xue Capsules on the Angiogenesis

CHEN Zhao-xia;ZHAO Jing-xia;LI Ping;LIU Xin;WANG Yan;LIANG Dai-ying

2010, 31(1):  93-98. 

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Objective This study aimed to explore the possible effect on angiogenesis of Liang Xue Huo Xue(LXHX) Capsules, derived from a clinical effective decoction and to understand the mechanism in treating psoriasis. Methods The chorioallantoic membrane(CAM) model was established to investigate the effect of drug serum with LXHX Capsules on the angiogenesis. Abnormal hyperplasia models of human dermal microvascular endothelial cells(HDMEC) stimulated by basic fibroblast growth factor(bFGF) and phorbol-12-myristate-13-acetate(PMA) were used to survey HDMEC proliferation by the cck-8 assay, cells migration by Transwell assay and lumen formation by lumenforming assay. Results As compared with the same serum concentration of serum that did not contain LXHX, the 5%,10% and 15% serum containing LXHX capsule components significantly inhibited angiogenesis of the CAM(P<0.05, P<0.01, respectively) and HDMEC proliferation(P<0.05, P<0.01, respectively), as well as significantly inhibited HDMEC migration(P<0.01) and lumenformation(P<0.01). Conclusion The contained LXHX capsules components inhabited CAM angiogenesis, HDMEC proliferation, migration and lumenformation which indicated that LXHX capsules affect on angiogenesis and it may be one of the mechanisms of treating psoriasis with LXHX capsule.

Effect of Autologous Mononuclear Bone Marrow Cell Implantation on the Plasm Level of Urotensin-Ⅱ and Endothelin-1 in Patients with Acute Myocardial Infarction

XU Hong-tao;GAO Lian-ru;ZHANG Ning-kun;ZHU Zhi-ming;FEI Yu-xing;YANG Ye;WANG Zhao-jun;LIU Ying-ming;CAO Yi;CHEN Yu;LI Xian-feng

2010, 31(1):  99-102. 

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Objective To study the effect of intracoronary implantation of autologous mononuclear bone marrow cell(MBMC) on the plasma level of urotensin-Ⅱ(U-Ⅱ) and endothelin-1(ET-1) in patient with acute myocardial infarction(AMI). Methods Twenty-three patients with AMI who underwent intracoronary implantation of autologous MBMC were enrolled in this study. UⅡ and ET-1 levels were measured by radioimmunoassay. Results The U-Ⅱ level in AMI patients was lower than that of control group〔(0.223±0.043)mg/L, vs (0.462±0.115)mg/L, P<0.05〕. After MBMC implantation, U-Ⅱ levels increased to 129% on day one compared to pre-transplantation. Whereas ET-1 levels decreased to 61%(compared with pre-transplantation) one day after cell infusion. And both U-Ⅱ and ET-1 slightly increased again 7 days after transplantation compared with 1 day after transplantation. Conclusion The therapeutic effect of MBMC transplantation may be related to the changes of ET-1 and UⅡ plasma level.

Comparison of Five Different Disease Activity Scoring Scales for ANCAassociated Vasculitis

ZHANG Li-min;WU Qing-jun;FENG Sheng;ZENG Xiao-feng

2010, 31(1):  103-105. 

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Objective Several different scales were devised to assess disease activity in anti-neutrophil cytoplasmic autoantibody(ANCA)-associated vasculitis(AAV). To investigate the reliability and correlation of these instruments, five disease activity scales were compared. Methods Totally 45 cases of AAV including 30 Wegener granulomatosis and 15 microscopic polyangitis were scored using the five disease assessment scales: the Birmingham Vasculitis Activity Score(BVAS1994), the BVAS for Wegener granulomatosis(BVAS/WG), BVAS2003, the Disease Extent Index(DEI) and the Five Factor Score(FFS). Twenty cases were rescored by the raters. All data were analyzed by SPSS statistical software. Results Reliability of the scales was high(intraclass correlations for each measure range=0.93 to 0.98).Test/retest reliability was also high for each scale(range=0.97 to 0.98). The scores by different activity assessing scales correlated significantly well, BVAS1994 and BVAS2003(rs=0.96, P<0.001), BVAS1994 and BVAS/WG(rs=0.87, P<0.001), BVAS1994 and DEI(rs=0.82, P<0.001), BVAS2003 and BVAS/WG(rs=0.87, P<0.001), BVAS2003 and DEI(rs=0.83, P<0.001), BVAS/WG and DEI(rs=0.78, P<0.001). Conclusion The scales for measuring disease activity in AAV are highly correlated and reliable. The different trial data could be compared with one another.

Relationship between Highsensitivity C-reactive Protein and Severity of Coronary Artery Lesions in Unstable Angina Patients

XU ji;HAO Heng-jian;HU Shao-dong;YIN Chun-lin

2010, 31(1):  106-108. 

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Objective To observe the relationship between high-sensitivity C-reactive protein and severity of coronary artery lesions in unstable angina patients. Methods Totally 1 528 patients(954 males and 574 females) with unstable angina pectoris seen in our hospital were enrolled into this study. High-sensitivity C-reactive protein(CRP) levels were measured in all patients. Coronary angiography was performed in every patient, and the severity of coronary stenosis was evaluated by using the Gensini scoring system. The patients were divided into three groups which were mild, moderate and severe, according to the Gensini score. The data were analyzed by SPSS software. We studied the relationship between high-sensitivity C-reactive protein and severity of coronary artery lesions in unstable angina patients.Results The CRP levels were significantly correlated with the severity of coronary stenosis(P<0.01). Conclusion The high-sensitivity CRP levels might be an important risk factor related with the severity of coronary stenosis.

Evaluation of the Effects of Multi-modality Analgesia for Headache Occurred after Aneurismal Subarachnoid Hemorrhage

LU Jing-jing;YANG Zhong-hua;ZHAO Xing-quan

2010, 31(1):  109-112. 

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Objective This prospective study was designed to explore the etiology of headache occurred after aneurismal subarachnoid hemorrhage(aSAH) and evaluate the effects of the multi-modality analgesia with compound tablet of oxycodone and acetaminophen in treatment of this kind of headache. Methods All of the 107 patients had angiographic demonstration of the presence of intracranial aneurysm and SAH was diagnosed upon CT studies within 24 hours of onset. Assessment of headache was made on the numeric rating scales(NRS) on days 1, 2, 3, 5, 7, 10 and 14 after SAH. Patients suffered from moderate-severe headache were examined by cranial CT scan and transcranial doppler(TCD) to find the reason, and their diversities were analyzed. Patients without etiological findings were divided to compound tablet of oxycodone and acetaminophen in a regimen of 1 tablet tid or Rotundine tablet in a regimen of 2 tablets tid for 3 days. Results Of the 107 patients, 93(86.9%) patients with SAH suffered from moderate-severe headache; in 9.7%(9/93) of them the headache was caused by rebleeding of untreated aneurysm, CT scan found hydrocephalus in 16.1%(15/93) patients with headache, TCD found intracranial vasospasm in 12.9%(12/93) of patients, 61.3%(57/93) of patients had negative results. There was a significant difference(P<0.01) between the actively treated group and control group in analgesic effects. Conclusion Majority of aSAH patients suffered from moderate to severe headache Multi-modality analgesia with compound tablet of oxycodone and acetaminophen was effective in treatment of moderate to severe headache occurred after aSAH without any pathological changes.

Analysis of Risk Factors for Autogenous Arterio-venous Fistulas Thrombosis in Chronic Hemodialysis Patients

DING Jia-xiang;ZHANG Dong-liang;DAI Wen-di;JI Dan-ying;ZHANG Li;LIU Wen-hu

2010, 31(1):  113-116. 

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Objective Autogenous arterio-venous fistulas(AVF) are regarded as the optimal vascular access for chronic hemodialysis(CHD) patients. This study was conducted to investigate the association of clinical indexes and vascular access thrombosis in chronic hemodialysis patients. Methods Fifty-six CHD patients with AVF were followed up for over 6 months. Vascular access blood flow was measured by the ultrasound dilution technique. Their clinical indexes were collected. Thrombotic events were recorded during follow-up. Results A total of 11 thrombotic events in 56 accesses were documented throughout this study duration. Patients were divided into two groups: thrombotic group and non-thrombotic group. They were comparable in age, gender, and weight index. It was found that the access blood flow was much more decreased in the thrombotic group than in nonthrombotic patients at the beginning of this study〔(337.3±236.9)mL/min vs (748.5±386.7)mL/min; P=0.001〕. However, there was no statistically significant difference in the blood pressure, hemoglobin concentration, blood plaque, clotting time and blood lipids. The dialysis adequacy(KT/v) was reduced in the thrombotic group compared to the other group(1.3±0.3 vs 1.5±0.3, P=0.038). The AVF cumulative survival rate was about 65.2%, when their access flow was less than 500 mL/min. There was a 4.5 fold increase in the relative risk of thrombosis for patients with an access blood flow less than 500 mL/min compared to those with more than 500 ml/min. Conclusion In CHD patients with AVF, the less access blood flow was, the more possible the vascular access thrombosis. When vascular access blood flow was blow 500 mL/min, it was a strong predictive factor for thrombosis. It was necessary to correct the reduced flow to improve the dialysis adequacy.

Relationship between Diabetic Retinopathy and Serum Bilirubin Level

SU Zhi-yan;YANG Jin-kui;ZHANG Lin

2010, 31(1):  117-119. 

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Objective To investigate the relationship between diabetic retinopathy and serum bilirubin level. Methods Six hundreds and sixty-four hospitalized patients with type 2 diabetes mellitus from June 2005 to May 2008 were enrolled in this study. All subjects in this study were divided into two groups based on the results of fundus examination: non-diabetic retinopathy(NDR) group and diabetic retinopathy(DR) group. Serum bilirubin levels of two groups were determined and compared. Multivariate Logistic regression analysis was performed to estimate the odd ratios of all risk factors. Results The serum bilirubin level of DR group is lower NDR group(P<0.01). Logistic regression analysis showed that the duration(OR=1.011), LDLC level(OR=1.450) and systolic blood pressure(OR=1.011) were independent risk factors of incidence of diabetic retinopathy, and serum bilirubin was a protective factor(OR=0.909). Conclusion Bilirubin level and diabetic retinopathy have some relationship. Attention should be paid to the antioxidant role of bilirubin.

Analysis and Intervention of Psychological Problem for the Out-patients Treated by Multiwavelength Laser

ZHAO Yan;LIU Shu-xian;SUN Li

2010, 31(1):  120-122. 

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Objective To analyze the emotional situation of outpatients received multiwavelength laser treatment and provide effective emotional management.
Methods Totally 110 outpatients who received multiwavelength laser treatment were randomized into 2 groups, 55 patients into intervened group, 55 patients into control group. Different emotional situations were analyzed and emotional managements were given to the patients in intervened group.Results Forty-eight out of 55 patients in the intervened group had steady mood, they initially cooperated with doctors for the multiwavelength laser treatment. Conclusion It is of great significance to understand the psychological condition of patients who have received the clinical use of multiwavelength laser and give them effective intervention, which not only provides the patients the most favorable psychological and physical condition to cooperate with doctors in the clinical use of multiwavelength laser for a satisfactory curative effect, but also greatly increases the working efficiency.

Early Diagnosis of Type Ⅰ Diabetic Nephropathy

ZHANG Gui-ju;SHEN Ying;ZHU Cheng;LIU Min;BAI Guang-hui

2010, 31(1):  123-125. 

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Objective To clarify whether the urinary excretion of n-acetyl-β-d-glucosaminidasen(NAG), Retinolbinding protein(RBP) andβ2-microglobulin(β2-MG) can be used as indicators for the early diagnosis of type Ⅰ diabetic nephropathy. Methods A total of 47 selected patients with type Ⅰ diabetes admitted to Beijing Children's Hospital and 30 healthy controls were recruited in this study. Urine levels of albumin were measured by the radioimmunoassay; NAG, RBP, β2-MG, and IgG were determined by enzyme-linked immunosorbent assay(ELISA). Results The 47 patients were divided into two groups based on the rate of urinary excretion of albumin, group 1 patients had normal albuminuria(UAE<20 μg/min); group two had microalbuminuria(UAE 20~200 μg/min); group three was normal control. The urinary level of RBP was significantly higher in patients with microalbuminuria than in the patients with normal albuminuria(P=0.046) and normal control(P=0.039). The urinary level of albumin was positively correlated with the RBP(r=0.24, P=0.032). Conclusion The urinary RBP can be a marker in diagnosis of early DN, but it is not more sensitive than UAE.

Treatment of Pilon Fractures Caused by Great Power with Limited Internal Fixation Combined External Fixator

LIU Feng-qi;LU Ying

2010, 31(1):  126-128. 

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Objective To study the application of limited internal fixation combined external fixators in treating Pilon fractures caused by great power and observe its effect. Methods From January 1997 to August 2005, 23 cases of Pilon fractures caused by great power were treated with limited internal fixation combined with external fixators. Results Twenty-three cases were followed up for periods of ten months to five years and three months. According to the standards set by Mazur, et al, 83% of followed-up cases achieved excellent results when the function of the ankle joints was evaluated.Conclusion It was proved that limited internal fixation combined with external fixators is a safe and effective method in treating Pilon fractures caused by great power.

Individualized Anesthesia for Epileptogenic Foci Resection by Precise Localization

TIAN Zhao-long;LI Jing-sheng;LAN Fei;WANG Tian-long

2010, 31(1):  129-133. 

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Objective To explore individualized anesthesia management for patients undergoing epileptogenic foci resection and decrease the effects of narcotics and anesthetic management on electrocorticography(ECoG) monitoring during epilepsy surgery and to study the awake testing during general anesthesia(GA) and anesthesia management for electrophysiological stimulation of cortex during the operation. Methods The data of 127 patients undergoing epilepsy surgery from 20052007 were reviewed and analyzed. The patients were divided into 3 groups: Group A(GA), Group B(GA+awake testing) and Group C(local anesthesia+intravenous anesthesia) with 105,16,and 6 patients, respectively. In Group A, propofol,remifentanil and vecuronium were infused continuously with(2.69±0.48)mg/(kg·h^-1), (0.09±0.02)μg/(kg·min^-1) and (0.05±0.06)mg/(kg·h^-1) respectively after intubation. And some inhaled 0.4%~0.6% isoflurane to maintain anesthesia. The infusion doses of propofol and remifentanil were increased in Group B, not using isoflurane. In group C, patients received scalp nerve block with 0.5% lidocaine mixed with 0.25% ropivacaine, and continuous infusion of propofol and remifentanil with 1~2 mg/(kg·h^-1) and 0.03~0.05 μg/(kg·min^-1). Results Both group A and B stopped infusing 15 minutes before ECoG. 94.8% of patients could be detected abnormal brain waves in ECoG 15~30 minutes later in Group A; 100% patients in group B waked up quickly when infusion was stopped, but complained more painful, especially in patients receiving electrical stimulation of cortex, and two of them refused cooperation. Conclusion TIVA and combined intravenousinhaled anesthesia are suitable for epilepsy surgery. We should control the timing and dosage seriously, and decide when to stop infusing or deep anesthesia. BIS monitoring is helpful.

医学前沿

Breakthrough of the 2009 Year of 《Science》 in Life Science

ZHANG Ting;WANG Xiao-min

2010, 31(1):  136-141. 

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This year's runners-up for Breakthrough of the Year of 《Science》were released on Dec. 18, 2009. The two out of the ten findings are in life science: Rapamycin and calorie restriction stretched the mammal's life span; Gene therapy successes in treating several devastating diseases. The above two findings are reviewed in this article.