Table of Content

24 October 2007, Volume 28 Issue 5

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国家级奖项介绍

Surgical Resection of Giant Cerebral AVMs and Prevention of NPPB

Zhao Jizong;Shi Lihai

2007, 28(5):  551-554. 

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There are clearly cases of severe complications after giant AVMs resection, such as brain swelling and hemorrhage. In 1978, "normal perfusion pressure breakthrough, NPPB" has been termed by Dr. Spetzler. The incidence of NPPB is 1%～10%. The surgical management of giant AVMs previously has been associated with an unacceptably high incidence of complications. In the literature, the combined mortality and serious morbidity for resection has approached 50% in the literatures. In our study, that the combination of intraoperative embolization with surgical resection for treatment of giant cerebral AVMs. Pre-and postoperative changes of regional cortical cerebral blood flow in patients with cerebral AVMs. The embolization could block the arteniovenous shunts sufficiently to decrease the blood flow away from the normal areas of the brain, so as to prevent the incidence of intra-and postoperative rebleeding, especially in NPPB. Therefore, the combination of intraoperative embolization with surgical resection is an effective strategy in treatment of giant cerebral AVMs.

Critical Care Medicine——A Clinical Discipline in Rapid Development

Xi Xiuming

2007, 28(5):  555-557. 

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Critical care medicine provides life support techniques and effecient medical care for critically illed patients. During the last decade, it has been developed rapidly and exerted great infuence upon traditional clinical medicine. Today, critical care medicine includes a vast amount of knowledge. It also faces great challenges. It is necessary to have a multidisplinary and experienced ICU team in improveing the quality of intensive care service.

Comparison of Effects of Recruitment Maneuver on Acute Respiratory Distress Syndromes of Intra-and Extra-pulmonary Origins

Jiang Li;Xi Xiuming;Zhu Bo

2007, 28(5):  558-561. 

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Objective To compare the effects of recruitment maneuver in intra-and extra-pulmonary acute respiratory distress syndromes.Methods Fifty-three patients with ARDS who received recruitment maneuver(RM) were assigned into group ADRSp(n=25) and group ARDSexp(n=28) according to the causes of lung injury. All the patients were ventilated with tidal volume of 6 mL/kg of predicted body weight and limited plateau pressure less than 30 cmH₂O. RMs were conducted by applying CPAP of 40 cmH₂O for 40 s, repeated every 8 hours during the first 5 days. If the patient began weaning within the first 5 days, RMs were stopped . Both physiologic data and outcome measurements, including arterial blood gas(PaO₂, PaCO₂), airway pressure(peak pressure, plateau pressure), ventilator settings( tidal volume, PEEP, FiO₂) , hemodynamic parameters, ICU-free days by day 28, ventilator-free days by day 28 and rate of survival with unassisted breathing by day 28, ICU and 28-day mortality, were compared between 2 groups.Results The PaO₂/FiO₂ increased after RM on day 1 and day 2(144.9 mmHg vs 128.0 mmHg, P=0.007, 205.0 mmHg vs 175.0 mmHg, P=0.001, respectively), accomparied by significant decrease in FiO₂(0.58±0.16 vs 0.68±0.22, P=0.001;0.53±0.15 vs 0.54±0.15, P=0.017; respectively). But there was no significant difference in changes of PaO₂/FiO₂ and FiO₂ between two groups, so was also PaCO₂.During the first 5 days, no differences in peak pressure and plateau pressure between 2 groups were found. Each time when RM was conducted, no difference in heart rate and mean blood pressure before RM and 0.5, 1, 2, 4, 6-hours after RM were found. There were also no differences in ICU-free days, ventilator-free days, rate of survival with unassisted breathing, ICU and 28-day mortality between 2 groups. Only one patient was reported to suffer from low blood pressure when RM was performed. There were no incidence of barotraumas and other adverse effects.Conclusion RM is safe and effective in improving oxygenation in early ARDS. It has a beneficial impacts on the outcome. No significant differences are found in oxygenation, lung mechanics, hemodynamic parameters and prognosis between ARDSexp and ARDSp.

Negative Fluid Balance Predicts Prognosis in Patients With Septic Shock

Zhang Li;Xi Xiuming;Jiang Li

2007, 28(5):  562-565. 

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Objective To investigate the relationship between the negative fluid balance and outcomes in patients with septic shock.Methods This was a retrospective controled study. Medical records of 41 patients admitted to our medical ICU over a 5 year period(1999.1～2003.12) were examined. Patients with septic shock who had renal failure or required dialysis prior to hospitalization were not included. A number of demographic and physiology variables were collected from the medical records, including age, gender, MAP, heart rate, respiratory rate, temperature, electrolyte(K⁺, Na⁺, Cl^-), pH, PaO₂/F_iO₂, Cr, Hct, WBC, HCO₃^- and the intake liquid, fluid balance of the first 3 days, furosemide doses, and so on. From the variables admission APACHE Ⅱ(acute physiology and chronic health evaluation) and daily sequential organ failure assessment(SOFA) scores were computed from the collected data. Variables were compared between survivors and nonsurvivors, and also between the patients who achieved negative(<0 mL) fluid balance in ≥1 day of the first 3 days of management and those who did not achieve negative(<0 mL) fluid balance in ≥1 day of the first 3 days of management. The Logistic regression statistics was used to determine the relationship between negative fluid balance, age, APACHE Ⅱ, SOFA scores on the first and third day and survival.Results Of the 41 patients, 29 died(<28 days), so the mortality was 71%. There was no significant difference in terms of the APACHE Ⅱ, SOFA score, age, gender, furosemide doses between survivors and nonsurvivors: so was also between patients who achieved negative(<0 mL) fluid balance in ≥1 day of the first 3 days of management and those who did not ten of 21 patients who achieved a negative balance of <0 mL on ≥1 day of the first 3 days of treatment survived, only 2 of 16 patients who failed to achieved a negative fluid balance of on ≥1 day of the first 3 days of treatment survived(52.38% vs 87.50%, χ²=5.303, P=0.021).Conclusion At least 1 day of net negative fluid balance in the first 3 days of treatment may be a good independent predictor for survival in patients with septic shock.

The Therapeutic Efficacy of "Sepsis Bundle" in Patients with Septic Shock

Li jie;Xi Xiuming;Luo Xin;Jiang Li;Zhang Li

2007, 28(5):  566-570. 

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Objective The purpose of this study is to observe if the early bundle therapy can improve the outcome in patients with septic shock.Methods Thirty-three patients with septic shock in ICU of Fuxing Hospital from 2004 to 2007 have been enrolled, they were divided into two groups at the cut-point of Jan 1st 2006. The 15 patients from Jan 1st 2006 to Mar 1st 2007 were treated with the bundle therapy as a study group, the other 18 patients from Nov 1st 2004 to Jan 1st 2006 were given the routine therapy as a control group. According to the surviving sepsis campaign(SSC)guideline, the bundle therapy included the following: early goal-directed therapy (EGDT), early(within 1 hour after diagnosis) empirical use of broad-spectrum and effective antibiotics, blood glucose control, small-dose intravenous corticosteroid. The baseline data such as age, gender, acute physiology and chronic health evaluation(APACHE Ⅱ), sepsis-related organ failure assessment(SOFA), the initial central venous pressure(CVP), and CVP monitor changes before and after therapy, the changes in arterial serum lactate concentration, early volume intate, blood glucose changes, the length of ICU stay, 28-day hospital mortality, ICU mortality, in hospital mortality were recorded and compared with the control group.Results There were no differences in age, APACHEⅡand SOFA between two groups. Patients treated with the bundle therapy received more fluid within the first 6 hours(2 816.67±1 469.41 mL vs 1 882.22±1 024.63 mL, P=0.040〕. The CVP was significantly higher in the study group than that in the control group after the first 6 hours' treatment(11.2±4.74 mmHg vs 7.35±3.95 mmHg, P=0.018) and after 24 hours' treatment(10.53±2.67 mmHg vs 5.76±1.60 mmHg, P=0.000). The 28-day hospital mortality in the study group was significantly lower than that in the control group(33.7% vs 72.2%, P=0.038) . There were no significant differences in the first 3 day blood glucose between the two groups. There were no significant difference in ICU mortality and hospital mortality in the two groups.Conclusion Patients treated with early bundle therapy in the study group have given more active fluid resuscitation than those in the control group within the first 6 hours of septic shock, and 28-day hospital mortality in the study group is significantly decreased. Sepsis bundle may improve prognosis of patients with septic shock.

Effect of Intravenous Injection of Midazolam on SNAP Index

Wang Qian;Chen Guangqiang;Zhou Jianxin

2007, 28(5):  571-574. 

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Objective To determine the effect of intravenous injection of midazolam on SNAP index.Methods Ten post transsphenoidal hypophysectomy patients were enrolled in this study. All patients complained of sleeping difficult, midazolam was injected intravenously with a single bolus dose of 0.1 mg/kg. The SNAP index, Ramsay scale and Richmond Agitation and Sedation Scale(RASS) were monitored and documented before medication, and 1, 5, 15, 30, 45, 60, 90, 120 and 180 after medication. The SNAP index was compared at different time points, and was found to be correlated with the Ramsay scale or RASS.Results The baseline SNAP index was 89±6. After intravenous injection of midazolam, the SNAP index declined gradually and reached the lowest level(66±10) at 30 min after medication. After that, It rose gradually to the baseline level. The SNAP indices at 5 min to 90 min after medication were lower than the baseline level significantly(P<0.05). The SNAP index correlated significantly with the Ramsay scale and RASS, with respective Spearman correlation coefficient of-0.776 and 0.741(P<0.05).Conclusion The results of the present study indicats that the SNAP index correlates well the subjective evaluation and it might be a feasible method to monitor the depth of sedation after intravenous injection of midazolam.

Effect of Mechanical Ventilation on Lung Edema in Rabbits with Endotoxin-induced Acute Lung Injury

Qin Zhiqiang;Wang Chen;Pang Baosen;Sun Bing;Du Minjie;Niu Shujie;Long Shengze

2007, 28(5):  575-578. 

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Objective To investigate the effects of mechanical ventilation with different tidal volumes(VT) and positive end-expiratory pressure(PEEPs) on the lung edema in acute lung injury rabbit(ALI) models.Methods Thirty-six New Zealand rabbits were randomized into 6 groups(6 in each group). ①normal control group(NC), ② ALI group(Lipopolysaccharides 50 μg/kg intravenously), ③CVLP group(ALI + ventilation with V_T 15 mL/kg and 5 cmH₂O PEEP), ④ CVHP group(ALI + ventilation with VT 15 mL/kg and 10 cmH₂O PEEP), ⑤ LVLP group(ALI + ventilation with V_T 8 mL/kg and 5 cmH₂O PEEP), ⑥ LVHP group(ALI + ventilation with V_T 8 mL/kg and 10 cmH₂O PEEP). The ALI models receiving ventilation with different tidal volumes and PEEPs were ventilated for 4 h. Lung wet-to-dry weight(W/D) ratio was used to assay the lung edema.Results The W/D ratios in CVLP group(5.47±0.28), CVHP group(5.25±0.12), LVLP group(5.24±0.12) and LVHP group(5.12±0.10) decreased significantly(P<0.05) as compared with that of the ALI group(5.84±0.20), but increased(P<0.05) as compared with the NC group(4.81±0.19). The W/D in LVHP group was lower than that in CVLP group(P<0.05).Conclusion Ventilation attenuates lung edema in ALI models. Ventilation with both low V_T and high PEEP is more beneficial for lung edema in ALI.

Effect of Tight Glucose Control on Systemic Inflammatory Response and Immune Function during Critical Illness

Zhao Jingyang;Zhang Tongyan;Zhou Hua;He Wei;Li Tong;Zhao Dong;Wang Chao;Xu Yuan

2007, 28(5):  579-583. 

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Objective To investigate the correlation of stress hyperglycemia with serum levels of C reactive protein(CRP), interleukin-6(IL-6) and macrophage migration inhibiting factor(MIF) that reflect the inflammatory status and with the expression of human leucocyte antigen DR(HLA-DR) on peripheral monocytes in critically illed patients with trauma or infection; and to investigate the effect of intensive insulin therapy and glycemic control on inflammatory response and immune function in critical illness.Methods Thirty-three critically illed patients were randomly divided into the control group(maintenance blood glucose at a level between 9.99 and 11.10 mmol/L), glycemia controlling group 1(maintenance blood glucose at a level between 4.44 and 6.11 mmol/L), and glycemia controlling group 2(maintenance blood glucose at a level between 6.66 and 8.33 mmol/L). Critically illed patients with APACHEⅡscore≥10 after trauma or infection were enrolled. Patients with insulin-dependent diabetes mellitus, immune disease or history of long-term immunoregulating medicine taking were excluded; patients less than 18 years old were also excluded. Target glycemia was obtained by insulin infusion. The glycemia level was determined every one to two hours. The interval of glycemic measurement might prolong when target glycemia was achieved. The expression of human leucocyte antigen DR on peripheral monocytes was measured in all 33 patients with flow cytometry on 1, 4 and 7 of intensive care in parallel with C reactive protein. In the meantime, Enzyme-linked immunoadsorbent assay(ELISA) was used to determine the interleukin-6 and macrophage migration inhibiting factor. The same nutritional support was applied to all patients. Data were expressed as Mean±SD and analyzed by using Analysis of Variance and correlation and linear regression. A p value <0.05 was regarded as statistically significant in all the tests conducted in this study.Results 1) The incidence of stress hyperglycemia was very high, being 97% in this study. There was no hypoglycemia happened in these patients. 2) Compared with the control group and glycemia controlling group 2, glycemia controlling group 1 needed more insulin to achieve target glycemia. 3) There were much increase in serum levels of C reactive protein, interleukin-6 and macrophage migration inhibiting factor and decrease in the expression of human leucocyte antigen DR on peripheral monocytes in all 33 critically illed patients with trauma or infection. C reactive protein was positively correlated with the level of blood glucose, human leucocyte antigen DR was negatively correlated with the level of blood glucose. 4) The levels of C reactive protein, interleukin-6 and macrophage migration inhibiting factor decreased while the expression of human leucocyte antigen DR on peripheral monocytes gradually recovered with the patients improving. 5) Compared with the control group and glycemia controlling group 2, the human leucocyte antigen DR expression of peripheral monocytes in glycemia controlling group 1 increased. There were significant difference on 4 and 7 after admission in Surgical Intensive Care Unit(P<0.05). C reactive protein and interleukin-6 were much decreased on 7 d after intensive insulin therapy(P<0.05); macrophage migration inhibiting factor was also decreased, but the deference was not significant statistically(P>0.05).Conclusion 1) Serum inflammatory factors are much increased in critically ill patients with trauma or infection. Their immune functions are affected. Stress hyperglycemia happens at the same time. Some inflammatory factors are positively correlated with the level of blood glucose. Immune functions are negatively correlatied with the level of blood glucose. Inflammatory factors gradually decrease and immune functions recover with weakening of stress. 2) Tight glucose control with intensive insulin therapy can increase the human leucocyte antigen DR expression of peripheral monocytes. It also can attenuate the systemic inflammatory response in critically illed patients. 3) Control of glycemia to the normal range may have anti-inflammatory and immunoregulatory effect.

Determination of Concentration of Meropenem in Serum and Cerebrospinal Fluid during Continuous Intravenous Infusion

Xu Ming;Wang Qiang;Shi Zhonghua;Yang Li;Han Rong;Cheng Guangqiang;Zhou Jianxin

2007, 28(5):  584-586. 

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Objective To evaluate the pharmacokinetics of meropenem in serum and cerebrospinal fluid(CSF).Methods Eight post-craniostomy patients with ventricular drainage were enrolled in this study. Meropenem was infused intravenously after operation with 0.5 g continuously in the first 30 min and then 3.0 g continuously in the 24 h thereafter. Venous blood and CSF specimens were collected before, and 10, 20, 30 min, 1, 2, 3, 4, 6, 8, 10, 12 and 24 h after medication. Meropenem concentration in specimens were measured by high performance liquid chromatography.Results The peak meropenem concentrations in serum and CSF were (63.72±22.08)mg/L and (3.97±0.45)mg/L, respectively. The peak concentrations occurred at 30 min in serum and 3 h in CSF after medication. The respective steady state concentrations of meropenem in serum (21.44±3.36)mg/L and in CSF (2.65±0.06)mg/L were achieved in 3 h and 6 h after medication, which exceeded the 90% minimum inhibitory concentration of common pathogens in intracranial infection.Conclusion Results of the present study indicate that steady state concentration of meropenem is achieved early by continuously intravenous infusion.

Changes in Thyroid Function and Related Hormones in the Critically Ill Patients

Zhou Hua;Xu Yuan;He Wei

2007, 28(5):  587-591. 

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Objective Pronounced alterations in the hypothalamus-pituitary-thyroid axis occur during critical illness without any pathologic changes of the thyroid gland. It is referred to as non-thyroidal illness syndrome(NTIS) or euthyroid sick syndrome(ESS). And it is still controversy about whether reduction in circulating thyroid hormone is an adaptation resulting in a protection against catabolism or whether it is a maladaptation contributing to a worsening of the disease. So the aim of this study is: 1) to explore the profile of changes in thyroid function in the critically ill. 2) to explore the relationship between these endocrintic factors and metabolic states in critical illness with non-thyroidal illness syndrome.Methods Patients admitted to the ICU from September 2004 until December 2005 were eligible for enrollment in this study. Inclusion criteria were intensive care dependency with APACHE Ⅱ score over ten and with an expected stay in the ICU for at least another 48 h. Exclusion criteria were: ① age less than 18 yrs; ② preexisting neurological conditions; ③ hyperthyroidism hypothyroidism or other endocrine diseases; ④ intracranial lesions; ⑤ concomitant treatment with glucocorticoids and ⑥ pregnancy. A total of 38 patients with critical illness were investigated in this prospective clinical study, either with multiple organ dysfunction syndrome(MODS, n=13) or without MODS(n=25). Patients' age and APACHE Ⅱ scores were recorded at the first ICU-day and every 5th day. Serum T₃, T₄, thyrotropic-stimulating hormone(TSH), cortisol, growth hormone(GH) and insulin-like growth factor-1(IGF-1) were measured every 5-days; besides, the level of plasma albumin(ALB), prealbumin(PAB), transferrin(TRF) were measured at the same time. The data were analyzed by using T-test and bivariate correlations analysis. A P value <0.05 was regarded as statistically significant in all the tests conducted in this study. Data were expressed as Mean±S.Results Abnormality in circulating thyroid hormone was found in all patients in this study. The levels of serum thyroid hormone were declined markedly in patients with or without MODS(P<0.01). In MODS patients, recovery of declined of thyroid hormone wase slower than that in patients without MODS. A negati correlation was found between serum T₃ and cortisol and C reactive protein(P<0.05) in patients with acute critical illness, and a positive correlation was found between TSH and growth hormone(P<0.01) at the same time. No significant correlation was found between thyroid hormone and other hormones except cortisol in prolonged phase. Meanwhile, changes in blood levels of prealbumin and thyroid hormone were closely related(P<0.01).Conclusion Adjustments in the thyroid axis in critical illness include a rapid decrease in T3, the bioactive thyroid hormone. And there are no compelling data to administer thyroid hormone in the so-called non-thyroidal illness syndrome. Since non-thyroidal illness syndrome occurs in most patients with systemic illness, and because the morbidity and mortality rate of NTI is high, it becomes important to determine whether thyroid hormone administration is beneficial or detrimental. This clinical studyreveals that: 1) the hypothalamus-pituitary-thyroid axis is affected during critical illness. Thyroid hormone and TSH are decreased in critically ill patients and correlated with the severity of critical illness. 2) down-regulated function of the hypothalamus-pituitary axis is observed with decrease in TSH and growth hormone. 3) decrease in serum thyroid hormone is negatively associated with elevation in cortisol level negatively during prolonged critical illness. 4) changes in prealbumin relate positively to the level of thyroid hormone in prolonged ICU patients.

基础研究

Early and Late of Gene Expression Changes in Substantia Nigra and Striatum of MPTP Mice Model Employing Oligo Microarray

Cai Yanning;Wen Mei;Liu Shu;Chen Biao

2007, 28(5):  592-595. 

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Objective Parkinson's disease(PD) is a progressive neurodegenerative disorder characteriged by that results in degeneration of nigro-striatal dopamine neurons with the deficiency of dopamine in the striatum. The causes and underlying mechanism for the loss of dopaminergic neurons is still elusive but believed to be associated with alterations of gene expression in both substantia nigra and striatum. The aim of this study is to figure out differently expressed genes in substantia nigra and striatum in experimental parkinsonism, especially expression profiles at different time points post MPTP administration.Methods Sixteen C57BL/6J male mice were divided into 2 groups: MPTP group was administrated with one dose 30 mg/kg MPTP, which induced sub-acute animal model of parkinson's disease. Control group was treated with saline. Mice were separately sacrificed at 1 day post treatment, when acute response was obvious, and 2 months post treatment, when mice underwent a recovery. Total RNA was isolated from substantial nigra or striatum using Trizol reagent. It was then reversely transcribed into cDNA using Oligo dT primer, which served as template for the generation of cRNA. Consequently, cRNA was labeled using Klenow fragment. Then the probes were hybridized to MO₂ oligo chips representing 1 200 unique mouse genes. The chips were scanned with a ScanArray 4000. The acquired images were analyzed using GenePix Pro 4.0 software. Locally weighted scatterplot smoothing(LOWESS) normalization was carried out to reduce system biases.Results In substantia nigra, 13 genes expressed differently at day 1, and much less(6 genes) at 2 months. In addition, at acute stage (day 1), most genes with altered expression were stress protein or signal transducer or related to apoptosis, suggesting these pathways were associated with the initiation of loss of dopaminergic neurons in substantia nigra. In supporting this assumption, at recovery stage, most of these genes altered their expression reversely, indicating dopaminergic neurons in substania nigra undergoing a recovery. However, in striatum, 12 genes expressed differently at day 1, and similarly, 13 genes at 2 months. It was likely that differentially expressed genes at acute stage were related to the transient toxicity of MPTP, while those at recovery stage were regulated by the deficiency of dopamine in striatum.Conclusion Our results indicate that oxidative stress has a role in the mechanism of dopaminergic neuron degeneration. It is likely that both endotoxin and extrotoxin will cause the accumulation of reactive oxygen species and lipid oxidation in substantia nigra and then results in the cell loss in substantia nigra. However, the present gene expression analysis has clearly indicated that the process of dopaminergic neurodegeneration is a complex cascade of events that simple oxidative stress can not fully explain. It appears that multiple pathways are involved in the pathogenesis of PD. Gamma-aminobutyric acid pathway is altered in substantia nigra during MPTP treatment. Gamma-aminobutyric acid is a repressive neurotransmitter which is abundant in striatum and plays an important role in regulating function of basal ganglia. It appears that dopamine deficiency may modify the synthesis and secretion of gamma-aminobutyric acid in neurons in striatum and subsequently worsen the PD syndrome. Additionally, protein phosphorylation and proper folding may change dramatically in striatum of MPTP mice which might relate with the protein aggregation, a hallmarker of Parkinson's disease. These newly identified genes afford a quantitative view of the changes that accompany PD at the genomic level, and provid a deeper insight into the molecular basis of the disease.

Effects of IGF-1 on Inhibitory Synaptic Transmission in Cultured Rat Hippocampal Neurons

Yin Yanling;Li Feng;Xing Changhong;Li Jingjin;Xie Zuoping

2007, 28(5):  596-599. 

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Objective To observe the effect of IGF-1 on inhibitory synaptic transmission in cultured rat hippocampal neurons and explore the possible mechanism.Methods Hippocampal neurons of rat were cultured with serum-free medium and used for experiment at 10～14 days. The cells were divided into 2 groups in the electrophysiology experiment: the control group and the IGF-treated group(in this group neurons were treated with 10 μmol/L IGF-1 24 h before experiment). While, 3 groups were included in the immunocytochemistry section: the control group, the IGF-treated group and PD98059 (10 μmol/ L) pretreated group(PD98059 was added to the medium 1 h before the addition of IGF-1). We observed the effects of IGF-1 on inhibitory postsynaptic current(IPSC) with the whole-cell patch clamp recording method and on the ratio of GABAergic neurons with immunocytochemical method. The patch-pipette solution contained (in mmol/L): 140 KCl, 10 HEPES, 10 EGTA, 2 MgCl₂, 2 Na₂ATP, 1 CaCl₂, pH 7.3. The typical resistance of glass electrodes was 3～7 MΩ when filled with intracellular pipette solution. The range of the whole-cell series resistance is 10～15 MΩ. During experiments, culture dishes were rinsed and perfused with extracellular solution containing (in mmol/L):140 NaCl, 5 KCl, 1 MgCl₂ , 10 HEPES, 10 Glucose, 3 CaCl₂, pH 7.4. Synaptically spontaneous IPSCs were isolated by the application of 20 M 6, 7-dinitroquinoxaline-2, 3-dione(DNQX) and 50 μmol/L aminophosphonobutyrate(APⅤ), the antagonist to the excitatory-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid(AMPA) and N-methy-d-aspartate(NMDA) receptors, respectively.Results IGF-1 remarkably reduced the frequency of IPSC, while had little effect on the mean amplitude. IGF-1 decreased the ratio of GABAergic neurons, which could be blocked by the inhibitor of mitogen-actived protein kinase(MAPK).Conclusion IGF-1 depressed inhibitory synaptic transmission,which may prevent induction long-term potentiation. IGF-1 reduces the ratio of GABAergic neurons. IGF-1 may influence inhibitory synaptic transmission through MAPK signal transduction pathway. As the activation of GABA receptor may depress the LTP, IGF-1 may modulate the function of learning and memory by disinhibition of hippocampal neurons. IGF-1 may be a promising target for learning and memory.

Arrhythmias Induced by Stretching the Left Ventricle of Rats

Huang Haixia;Wang Wei;Wei Hua;Fu Xiaosuo;Liu Ping;Niu Weizhen

2007, 28(5):  600-603. 

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Objective To examine whether stretching of rat left ventricles has any effect on the rat cardiac electric activity and to observe whether stretch-activated ion channels(SACs) play a role in this process by using the blocker in order to reveal the possible mechanisms of cardiac mechano-electric feedback(MEF).Methods Electrocardiogram(ECG) of rat was recorded. The pressure in the left ventricle was controlled by using pressure clamp technique. Extra-stretch was applied at the end of diastole by the pressure clamp to observe whether there would be any effect on the rat cardiac electric activity. Streptomycin(800 μmol/L), a non-specific blocker of stretch-activated non-selective cation channels(SACCs) was perfused for 30 min and the alterations of the effect of the mechanic stimulus were observed to identify the mechanism of cardiac MEF.Results There was no alteration in the cardiac electric activity when left ventricular pressure(LVP) was clamped at 0 mmHg or with a normal pressure waveform. Application of stretch(140 mmHg, 30 ms) at the end of diastole caused premature ventricular excitations (PVEs). After perfusion of streptomycin(800 μmol/L) for 30 min, the PVE caused by the extra-stretch disappeared.Conclusion Strong extra-stretch applied at the end of diastole can induce alterations of cardiac electric activity, which indicates that depolarization currents were activated by the stretch. Streptomycin can block this effect, which indicates stretch-activated non-selective cation channels are involved in cardiac MEF.

The Anti-tumor Immunity and Cultivation of the Fused Cells of Ovarian Cancer and Dendritic Cells Derived from Cord Blood——An In-vitro Study

Li Jinfeng;Zhang Zhenyu;Wang Shuzhen;Liu Jinwei

2007, 28(5):  604-608. 

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Objective To prepare hybrid cells(SKOV3/DC) by fusion of dendritic cells(DC) derived from cord blood and SKOV3 ovarian cancer cells; and analyze the biological characteristics and anti-tumor immunity of SKOV3/DC.Methods ① DC cells stained with PKH₂6 red fluorescence were fused with SKOV3 by means of polyethyleneglycol(PEG), and the fusion cells(SKOV3/DC) were selected with flow cytometry. ② Techniques of cell culture、flow cytometry and light microscopy were also used in characterization of growth, morphology and immunology of SKOV3/DC in vitro.Results ① The monocytes isolated from cord blood could be induced to DC. DC expressed CD1a, CD80, CD86, HLA-DR, MHC-Ⅰ molecules, but not CA125 antigen. ② SKOV3 cells expressed CA125 antigen and MHC-Ⅰ molecule but not CD1a, CD80, CD86 and HLA-DR molecules. ③ The DC were fused with SKOV3 cells at a ratio of 10∶1 and the fusion rate was about 8.5%.The morphological character of the SKOV3/DC was similar to its parental cells. SKOV3/DC express both CA125 antigen and high levels of CD1a, CD80, CD86, HLA-DR, MHC-Ⅰ molecules. SKOV3/DC could divide and proliferate in vitro, but the proliferative activity was significantly lower as compared with SKOV3 cells.Conclusion ① DC precursors in cord blood could be induced to differentiate and mature in media containing different cytokines. ② SKOV3/DC have some characteristics of both parental cells. The ability of dividsion and proliferation is significantly decreased as compared with SKOV3 cells, and the characteristic of malignant growth of parental SKOV3 cells has been lost. These data about SKOV3/DC vaccine found a basis for the study of the immunotherapy for ovarian cancer.

Effects of Almonds on DNA Damaged Peripheral Blood Lymphocytes in Rats Induced by H₂O₂

Wang Hui;Zhang Jie;Zhang Shuhua;Huang Peili;Guo Aimin

2007, 28(5):  609-612. 

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Objective To investigate the effects of almonds on DNA damaged peripheral blood lymphocytes in rats induced by H₂O₂.Methods 5.0 g almonds were ground into homogenate and diluted to 100 mL with redistilled water. Respectively extracted the homogenate 1.0, 2.0 and 3.0 mL then diluted them to 10 mL with redistilled water. The concentrations of almonds were 5.0, 10.0 and 15.0 g/L respectively. RPMI 1640 was used to separate the lymphocyte from 1 mL whole blood of a SD rat and adjusted the lymphocyte density to 1×10⁹/L. The lymphocytes were separated into 5 groups: ① control group; ② H₂O₂ group; ③ low dosage group: H₂O₂+50 mg/L almond; ④ moderate dosage group: H₂O₂+100 mg/L almond; ⑤ high dosage group: H₂O₂+150 mg/L almond. Except for control and H₂O₂ groups, different dosages of almonds(the final concentrations were 50, 100 and 150 mg/L) were added to the other groups. The lymphocytes of 5 groups were cultured in CO₂ incubator for 24 hours. Except for control group, H₂O₂(the final concentration was 50 μmol/L) was added to the other groups. PBS was used to rinse the lymphocytes of every group twice. Using trypsinase to digest the lymphocytes of every group for 1 minute, then blew the lymphocytes gently with sucker and adjusted the lymphocyte density to (1～10)10/L. The lymphocyte density was again adjusted to 109/L with agarose gel. DNA damaged peripheral blood lymphocytes of rats was measured by single-cell gel electrophoresis (SCGE) and laser scanning confocal microscopy. Taking two pictures of each group and observing 100 lymphocytes in each picture randomly. The number of DNA damaged peripheral blood lymphocytes of rats was counted and the tail length of comet measured. The data of the tail length of comets were treated with one-way ANOVA and the rates of DNA damaged peripheral blood lymphocytes were treated with Chi-Square test.Results The rates of DNA damage in control group, H₂O₂ group, low dosage group, moderate dosage group and high dosage group were 22.5%, 68.5%, 52.5%, 37.5% and 35% respectively. The tail length in control group, the H₂O₂ group, the low dosage group, moderate dosage group and high dosage group were (16.25±1.52)μm, (35.86±1.75)μm, (29.63±2.03)μm, (23.58±1.37)μm and (23.49±1.63)μm respectively. Compared with the control group, DNA damaged peripheral blood lymphocytes of rat in other groups increased remarkably(P<0.05). Compared with H₂O₂ group, DNA damage reduced notably when the doses of almond increased and it showed a dose-effect relationship(P<0.05).Conclusion It is indicative that almonds have effects of anti-oxidation to a certain extent.

Studies on the Variance of Oxidative Tolerance against Hydrogen Peroxide in Differentiated Neural Stem Cells of Rat

Tang Jie;Wang Hongyun;Sun Yilin;Zhang Yazhuo;Sun Meizhen;Wang Zhongcheng;

2007, 28(5):  613-616. 

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Objective To evaluate the variance of oxidative tolerance(OT) against hydrogen peroxide (H₂O₂) in differentiated neural stem cells (DNSC).Methods The DNSC of SD rat obtained after 8 days' differentiation, were cultured in media with H₂O₂(0.5 mmol/L) for 2 hours, followed by observation of their variance of oxidative tolerance. The survial was cultured for another 21 days, then observed the capability of proliferation and differentiation. The viability was assessed with fluorescent dye including Hoechst 33342 and PI. The antioxidant stress test included the expression of heat shock proteins (Hsps), catalase(CAT) and superoxide dismutase(SOD). The cellular types were determined by its markers, such as nestin, proliferating cell nuclear antigen(PCNA), MAP-2 and tubulin-β, GFAP, Gal-C. The transmission electron microscope(TEM) was used to study the ultrastructure of DNSC.Results After H₂O₂ attacks, DNSC at the periphery died and fell off from the cover glass, while those located at the central part survived and kept on differentiation and demonstrated positive staining by nestin(PCNA), MAP-2, tubulin-β, GFAP, and Gal-C, with no significant difference from the control group(P>0.05). TEM demonstrated the DNSC at the periphery with a relatively mature organelle and those at the central part with immature characteristics.Conclusion The relatively immature DNSC has a higher resistance against H₂O₂ than those relatively well-differentiated DNSC. DNSC surviving from H₂O₂ attack still keep the capability proliferate and differentiate.

临床研究

Analysis of Antihypertensive Drugs Used in Community Hospitals in Beijing

Sun Fei;Fang Xianghua;Li Ningyan;Ma Nan

2007, 28(5):  617-619. 

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Objective To assess the current status and trend of the use of antihypertensive drugs in community hospitals in Beijing.Methods The current status and percentages of different antihypertensive drugs commonly used in the clinic were investigated among community hypertensive patients by questionnaires.Results Seven hundred and nine hypertensive patients who were treated with antihypertensive drugs have been enrolled. Both compound formulations and calcium channel blockers were the most commonly used antihypertensive drugs with a utilization rate of 52.9% and 41.7%, respectively. The utilization rates of diuretic and compound formulae in patients who paid for themselves were higher than those in the patients covered by medical insurance, while the utilization rates of calcium channel blockers and ACEI in the former were lower than those in patients who had public health medical services free and medical insurance. Beijing getting on for years, the utilization rate of more expensive antihypertensive drugs reduced gradually.Conclusion The selection of antihypertensive drugs is not only dependent on the therapeutic effect, but also should on the individual difference and economic status of the patients.

The Impact of Anemia and Chronic Kidney Disease on Hospitalized Patients with Congestive Heart Failure

Wang Qing;Sun Xiaoqin;Yang Ming

2007, 28(5):  620-623. 

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Objective To investigate the prevalence of anemia and chronic kidney diseases(CKD) in hospitalized patients with congestive heart failure(CHF) and their impact on outcome of these patients.Methods In a retrospective study we analyzed 183 patients admitted with the diagnosis of CHF, NYHA classes Ⅱto Ⅳ.Patients were divided into anemic and non-anemic groups or CKD and non-CKD groups according to the definition of anemia and CKD. The prevalence of anemia and CKD was determined. An analysis of the relationship between anemia or CKD and hospital mortality was conducted.Results The prevalence of anemia and CKD was 37.7% and 55.74% respectively. The severity of CHF was associated with anemia and CKD. From classes Ⅱto Ⅳ CHF, the prevalence was 10.2%, 38.9% and 65.9% respectively for anemia and 34.7%, 53.3% and 84.1% respectively for CKD. Marked reductions in the level of Hb and eGFR followed the advance of NYHA classes(P<0.01). There was a positive association between anemia, CKD and the hospital mortality. Anemia was associated with CKD and NYAH classes.Conclusion Anemia and CKD are common in patients with CHF. Patients with severe CHF are likely to have anemia and CKD. Anemia or CKD is associated with hospital death in patients with CHF. CKD is one of probable causes of anemia in CHF.

Analysis of the Allergen Skin Prick Tests in 210 Patients with Bronchial Asthma

Lin Fang;He Zhengyi;Zhang Xiling

2007, 28(5):  624-626. 

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Objective To investigate the common allergens of bronchial asthma in Beijing area.Methods Twenty four different allergens produced by Allergopharma Merck Pharmaceutical Co. were used for skin prick tests with saline as negative comparison and histamine as positive control.Results Among the 210 patients studied, the positive rates of the Dermatophagoides farinae and pterongssinus were 57.14% and 58.57% respectively. Positive rate of the dermatophagoides farinae and pterongssinus were 50.51% and 57.73% respectively in the asthma group complicate with allergic rhinitis, while in the uncomplicated asthma group, the Dermatophagoides farinae and pterongssinus were 62.83% and 59.29% respectively. The positive rate of mugwort pollen was 30.95%, and that giant ragweed was 28.5%, Inhalant allergens of next importance were moulds and animal denders. Shrimps, milk and eggs were common food allergens.Conclusion Dermatophagoides farinae and pterongssinus are the most common allergens in Beijing area, however, the allergens of mugwort and giant ragweed have becoming increasingly important in recent years. Allergen skin prick tests provide a significant basis for the diagnosis and management of asthma. It is safe and easy to operate and can be used for detecting multiply allergens simultaneously.

The Abnormalities of Coagulating and Fibrinolytic System and the Effects of Pentoxifylline on Coagulating and Fibrinolytic Function in Experimental Obstructive Pulmonary Emphysema in Rats

Li Yuanhong;Zhang Hongyu;Pang Baosen;Chen Yangyu;Mao Yanling;Ma Li;Huang Xiuxia;Xin Ping;Zhang Haiyan

2007, 28(5):  627-631. 

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Objective To investigate the abnormalities of coagulation and fibrinolytic system in experimental pulmonary emphysema in rats and evaluate the effects of pentoxyfylline(PTX) on inhibiting the pathogenesis of emphysema in rats.Methods Thirty-six Wistar rats were randomly divided into three groups, the normal control group, the model group and the PTX group. Rats in the model group and PTX group were injecting endotoxin(3 mg/kg) into vena caudalia on the 1^st、14^th、28^th days and exposed to the smoke from 12 pieces of cigarettes for 30 minutes in days 2～45(excluding the 14^th and 28^th days), two times a day with the intervals about 4 hours. The PTX group were treated with PTX, 15 mg/(kg·d^-1), by intraperitoneal injection before passive smoking from 1～30^th days. Observation began on the second day. Pumonary function tests were performed to evaluate the following indices including FEV_0.2, FEV_0.2/FVC, Ri, Re. After which rats of all three groups were sacrificed. The blood serum levels of TNF-α, IL-10 and the plasma levels of tPA, PAI-1, TFPI: Ag were measured by ELISA method, the blood AT-Ⅲ activity were measured by chromogenic assay,and the lung histopathological changes of all rats were observed with morphometric method with HE stain.Results Rats of the model group shared many features of human chronic obstructive pulmonary emphysema, such as infiltration of lymphocytes, monocytes and neutrophils in airways wall, distorted alveolar structure and enlarged alveoli. The extent of emphysematous damage of PTX group such as infiltration of lymphocyte in airways wall and enlarged alveoli were milder than those of the model group. Pulmonary function tests showed that the FEV_0.2/FVC of model group was greatly lower than those of the normal control group(P<0.01), but FEV_0.2/FVC of PTX group was increasingly higher than the model group(P<0.01). Compared with the normal group, the model group presented significant differences in the plasma levels of AT-Ⅲ activity, TFPI:Ag, tPA and PAI-1〔(56.04±14.81)vs(85.46±18.03), (1.39±0.26)μg/L vs(1.05±0.17)μg/L, (F=29.42,0.35,P<0.01);(2.1±0.73)μg/L vs (1.45±0.43)μg/L,(0.54±0.07)μg/L vs (0.80±0.24)μg/L, (F=0.79,0.26,P<0.05) respectively〕; there were negative correlations between AT-Ⅲ activity and TNF-α(r=-0.87,P<0.01);In comparison with the model group, TNF-α and AT-Ⅲ in the PTX group〔(10.69±2.54)pg/ml vs (21.32±5.71)pg/ml,(76.83±9.03)vs(56.04±14.81) respectively〕were also markedly improved(F=11.35, 8.84, 20.80, P<0.01).Conclusion The experimental pulmonary emphysema model in rat could be successfully established by exposing to cigarette smoke and repeated injecting endotoxin into vena caudalia. The abnormalities of coagulation and fibrinolytic system is induced by the pulmonary vascular endothelial injury. AT-Ⅲ , TFPI, tPA and PAI-1 might be involved in the process. PTX can inhibit the release of TNF-a and relieve the airway inflammation, and also enhance AT-Ⅲ and improve hypercoagulative state. It suggests that PTX can inhibit the development of pulmonary emphysema in rat.

Studies on the Reference Range of Urinary Formed Elements with UF-100 in Beijing Area

Yue Xiuling;Li Yuwen;Zhou Jin;Ma Junlong;Zhang Shimin;Cong Yulong

2007, 28(5):  632-635. 

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Objective To investigate the normal reference range of urinary formed elements with UF-100 in Beijing Area.Methods The same methods were used to count the red blood cells(RBC), white blood cells(WBC), epithelic cells(EC) and casts of urine from 6 587 healthy people(3 243 males and 3 344 females) aged 1～92 years in Beijing. The examinations were completed within the same period of two hours under strict in laboratory quality control.Results The levels of RBC(expect for the group of 1～12 years)、 WBC and EC showed significant differences between males and females(P<0.05).There was no significant difference in WBC among the groups over 13 years(P>0.05), as compared with the groups aged 1～12 years in males. There was no significant difference in WBC among the groups of over 13 years(P>0.05)in females. There was no significant difference in RBC among groups aged 1～12 and the groups aged >19 years(P>0.05) in males, which were lower than those in groups aged 13～19 years. In females, The levels of RBC were not significantly different among the groups aged >13 years(P>0.05) which were higher than those in the groups aged 1～12(P<0.05). There were no significant differences in EC in all groups(P>0.05)in males, In females, EC did not show significant differences among the groups of 13 ～55 years(P>0.05), but there were significant differences among the groups aged 1～12 years and >56 years(P<0.05). In terms of casts, there were no significant differences among the different age and sex groups(P>0.05).Conclusion There were differences in urinary formed elements among groups of different sexes and ages(expect for cast).

Arteriosclerosis in Lower Extremity Complicated with Type 2 Diabetes Mellitus-Risk Factors and the Therapeutic Effect

Liu Wei;Fu Hanjing;Yang Jinkui;Du Yanfang

2007, 28(5):  636-639. 

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Objective To investigate the effect of metabolic control and different risk factors of arteriosclerosis in lower extremity complicated with type 2 diabetes mellitus, and the therapeutic efficacy of PGE1.Methods One hundred and sixty-eight hospitalized patients with type 2 diabetes mellitus in the recent two years were enrolled in our study. We observed the ABI level through the Hunt Leigh Doppler manometry, and compared the risk factors such as the function of pancreatic island, metabolic control etc. Among the diabetics with macro-vascular complications, a therapy of Lipo prostaglandin E₁(PGE1) was installed in all patients whose ABI were lower than 1 for 10 to 14 days, and then the ABI levels were observed again. All subjects in our study were divided into three sub-groups based on their ABI, they are group A: ABI>1, group B: 1>ABI>0.5, group C: ABI<0.5.Results The results of 24 h monitoring of blood pressure showed that the Min-DBP in group C was significantly lower than that in group A and B, the P-values were 0.047 and 0.010 respectively. In UCG, the level of EF in group B was significantly higher than those in group A and C, the P-values were 0.006 respectively and 0.005 respectively. The level of UAER in group B was significantly higher than that in group A, P=0.22. Univariate analyses showed that in all lower ABI patients, age at examination, duration of diabetes, C-peptide level, total cholesterol and LDL cholesterol, glycosylated hemoglobin A1c, urinary albumin excretion rate(UAER) were higher than those who had normal ABI, although the difference was not significant. Multivariate analyses showed that UAER was positively related to ABI. After the PGE₁ therapy for 10 or 14 days, the ABI levels were all higher than the baseline, but difference was not significant.Conclusion ABI level is effective in evaluatin g the arteriosclerosis in lower extremity in type 2 diabetes. We can deduce the ABI level by HDL cholesterol. PGE1 can improve the ABI level of chronic arterial ischemia of legs.

Relationship between Baseline White Blood Cell Count and In-hospital Mortality in Patients with Acute Myocardial Infarction——The Value for Prediction of Prognosis

Li Jing;Hua Qi

2007, 28(5):  640-643. 

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Objective To study the relationship between the white blood cell(WBC) count of peripheral blood at the early stage of acute myocardial infarction(AMI) and the prognosis.Methods One thousand and fifty-six cases of AMI were divided into normal WBC counting and elevated WBC counting groups(≤10×10⁹/L or >10×10⁹/L). Clinical characteristics of the two groups and in-hospital mortality were compared.Results The mean age of patients with leukocytosis was lower than that of the control〔(61.3±12.7) years and (64.3±11.3) years respectively, P<0.001〕; the peak value of MB isoenzyme of creatine kinase was higher in the group with elevated WBC count〔(2 137.6±1 543.4) IU/L and (1 410.1±1 183.9) respectively, P<0.001〕; the incidence of cardiogenic shock(6.0% and 2.3% respectively, P<0.01) and arrhythmias(41.5% and 29.4% respectively, P<0.001) were also higher in the WBC elevated group. WBC count was an independent predictor for in-hospital mortality by logistic regression analysis.Conclusion The WBC count is a valuable short-term predictor for in-hospital mortality patients with AMI.

Relationship between Pathophysiological Changes and Memory Function in Patients with Obstructive Sleep Apnea/ Hypopnea Syndrome

Kong Feng;Yang Peijie;Lui Chunhong

2007, 28(5):  644-645. 

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Objective To investigate the relationship between the pathophysiological changes and memory function in patients with obstructive sleep apnea/ hypopnea syndrome(OSAHS).Methods Twenty-one patients with OSAHS were monitored for sleep efficiency, apnea/hyponea index, minimal oxygen saturation(SaO₂) during sleep, average oxygen saturation during sleep and total sleep time of SaO₂<90% by polysomnography tests. Their memory functions were measured by neuropsychological tests. The Epworth sleepiness scale was used to assess the degree of patients' daytime somnolence.Results Memory function of patients with OSAHS was significantly associated with total sleep time of SaO₂<90%(standardized coefficients=-0.643, P<0.01); but memory function of patients with OSAHS was not associated with sleep efficiency, apnea/hypopnea index(AHI), average oxygen saturation(SaO₂) during sleep, minimal SaO₂ during sleep and excessive daytime somnolence(EDS).Conclusion Memory function in patient with OSAHS correlates with hypoxia. AHI and SaO₂ are not sensitive for assessment of the memory dysfunction in those patients.

Determination of Telmisartan Concentration in Human Plasma by Means of RP-HPLC with Fluorescence Detector

Chen Huaying;Lin Yang;Wen Shaojun;Han Min;Zhou Zijie

2007, 28(5):  646-648. 

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Objective A RP-HPLC method with fluorescence detector was established to determine telmisartan in human plasma.Methods Internal standard method quantifying telmisartan concentration in plasma was performed and valsartan was used as the internal standard. Plasma samples containing drug were extracted with benzene under acidic condition, followed by drying with nitrogen. The residual products were redissolved with mobile phase prior to analysis. Separation was performed on a reverse phase ZORBAX Eclipse XDB-C18 column(4.6×150 mm,5 μm), equipped with a pre-column of the same material(4.6×12.5 mm, 5 μm). The mobile phase contained methanol-acetonitrile-10 mmol/L potassium dihydrogen phosphate buffer, pH 3.2(5∶40∶55, v/v/v). The flow rate was set at 1.0 mL/min and the injection volume was 20 μL. The excitation and emission wavelengths were 250 nm and 375 nm, respectively. The column temperature was 25 ℃.Results No intrinsic substances interfered with analysis of telmisartan. The retention times were 8.8 min for telmisartan and 10.7 min for valsartan. The good linear relationship was obtained over the range(1～180)μg/L and the equations were determined by least squares linear regression analysis. The linear equation was A=0.2769R+0.03788. The linearity of the relationship between peak area ratio and amount ratio was demonstrated that the correlation coefficient was 0.9995. The limit quantification(LOQ) was set at 1 μg/L of telmisartan in human plasma. The average recovery rates were 97.53%, 104.6% and 105.1 % for plasma quality control(QC) samples at 2.0, 30, 70 μg/L, respectively. The RSDs of inter-and intra-day were all less than 7% for low, medium, high plasma QC samples. The intra and inter-assay precision and accuracy of the quality control and limit of quantification were satisfactory in all cases. Plasma samples were stable in the chromatographic rack for 24 h at room temperature, but we recommended storing processed plasma samples at 4 ℃ until the analysis.Conclusion The developed method was validated with respect to selectivity, linearity, accuracy, LOQ and stability. The experimental datum has proved that the above described method would provide accurate, rapid, simple and sensitive measurements of telmisartan in plasma. It is more suitable to determine telmisartan concentration in plasma and study the pharmacokinetics of telmisartan.

The Diagnostic of Combination Measurement of Pregnancy-associated Plasma Protein A and Progesterone in Diagnosis of Early Pregnancy

Wen Jing;Ren Haiying;Zhai Jianjun

2007, 28(5):  649-651. 

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Objective Ectopic pregnancy and abortion are the most common abnormal gestation in early pregnancy, they seriously affecting the physical and mental health of women, and both of their morbidities are rising year by year. Although the widely used ultrasound and detection of human chorionic gonadotrophin can diagnose most cases of early abnormal pregnancy, there are still some that couldn't be diagnosed correctly through above the mentioned methods. This study was designed to provide new method for early diagnosis of normal and ectopic pregnancy and abortion through detection of the levels of progesterone and pregnancy-associated plasma protein A(PAPP-A).Methods One hundred and twenty-six patients with early pregnancy who visit clinic or need further treatment in hospital from January 2006 were enrolled. Prior to treatment, the levels of serum progesterone and PAPP-A were measured by ELISA. One-way analysis of variance in SPSS 11.5 was used in statistics; P value<0.05 was considered statistically significant.Results The mean levels of P and PAPP-A in normal pregnancy, missed abortion and ectopic pregnancy all showed a tendency to decrease. The blood progesterone and PAPP-A levels showed statistically significant difference(P<0.05) between normal and abnormal(missed abortion and ectopic pregnancy) pregnancies, but no difference between missed abortion and ectopic pregnancy.Conclusion P and PAPP-A can be considered as early diagnostic methods of abnormal pregnancy. Missed abortion and ectopia pregnancy can't be distinguished by these manoeuvres, and final diagnosis need to be combine with other auxiliary examinations.

Clinical Analysis of the Therapeutic Effects of Norethindrone on Simple Endometrial Hyperplasia

Jin Qiaofeng;Lai Ailuan;Zhang Lisong;Du Qiang;Feng Xiangdong

2007, 28(5):  652-654. 

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Objective To study the effects of Norethindrone on biological features of estrogen receptor(ER), progesterone receptor(PR)and proliferative cell nuclear antigen(PCNA) in patients with simple endometrial hyperplasia(EH).Methods Thirty cases diagnosed by curettage and pathological examination were given Norethindrone 5 mg everyday for 22 days from the 5 day after curettage and 5th days from onset of second and third mentrual periods. The pathology of endometrium was examined at the 25～28 days of the third periad. ER, PR, PCNA expressions were examined with immunohistochemical methods pre-and after-treament by Norethindrone for 3 monthes.Results After three periods of treatment by Norethindrone, the menstrual durations were shortened obviously, the amount of flow and clots were decreased. The expressions of ER, PR and PCNA in simple endometrial hyperplasia before treatment were 3.33±1.92, 4.13±1.55 and 4.40±1.54 respectively. After three periods of treatment, expressions of ER, PR and PCNA were 1.97±1.87, 1.80±1.75 and 1.83±1.00 respectively, which were significantly lower than those of the pretreatment ones(P<0.05).Conclusion Norethindrone is effective in the treatment of simple endometrial hyperplasia.

Clinical Significance of Antithrombin-Ⅲ and P-selectin Changes in Normal Pregnancy

Wang Qi;Zheng Yuanyuan;Zhang Weiyuan

2007, 28(5):  655-657. 

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Objective A variety of maternal physiological changes occur during pregnancy, including coagulation systems. There is a hypercoagulability state in normal pregnancy, which is beneficial in preventing excessive blood loss at the time of delivery; which can also induce during pregnancy the risk of pre-DIC state. The aim of this study is to explore the dynamic changes and clinical significance of plasma antithrombin-Ⅲ(AT-Ⅲ) and P-selectin(GMP-140) during different stages of normal pregnancy.Methods A prospective case controlled study was carried out. Eighty-five healthy pregnant women were investigated at first, second and third trimesters respectively as experimental groups and fifty healthy age-matched non-pregnant women as a control group were also investigated. Antithrombin-Ⅲ was determined by chromogenic substrate method. P-selectin was detected by enzyme linked immunoadsorbent assay(ELISA).Results The AT-Ⅲ level was higher in pregnant women in the first trimester(146.37±27.44)μg/L than that in the control group(122.43±31.81)μg/L(P<0.001), while the activities of AT-Ⅲ was obviously decreased in pregnant women in the second(26.02±30.39)μg/L and third trimesters(125.43±21.89)μg/L as compared with that in the first trimester(P<0.05). GMP-140 levels of first, second and third trimester groups were (93.36±38.66)μg/L, (71.01±64.69)μg/L and (123.32±75.36)μg/L respectively. The level of GMP-140 was lower in pregnant women in the first trimester than that in the control group(97.76±45.83)μg/L, being significantly lower in the second group(P<0.05). While, the activities of GMP-140 had an obviously higher level in the third trimester than those in other groups(P<0.01).Conclusion Hypercoagulability has been observed in the pregnant women since the second trimester, and the changes are more significant with the progress of pregnancy.

Clinical Value of Liquid Based Cytology Test in Comparison with Vaginoscopy Histology in the Diagnosis of Cervical Lesions

Yin Xiuqin;Wang Xiaoju;Zhao Junying;Liu Yan

2007, 28(5):  658-660. 

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Objective To study the clinical value of liquid based cytology test compared with vaginoscopy histology in the diagnosis of cervical lesion.Methods Retrospective analysis was carried out in 6 621 females(age range from 21 to 73 years old) from a single centre(Beijing Friendship Hospital) admitted from May, 2006 to October, 2006. All the patients received liquid based cytology test(Thin Prep Pap Test, TCT) and the result was reported in terms of the Bethesda system(TBS system). Among all the patients, 253 of them were diagnosed as atypical squamous cells of undetermined significance(ASC-US) or above and should receive further vaginoscopy biopsy test.Results Among the 253 patients with abnormal TCT results, 180 cases were diagnosed as ASC-US, 7 cases as atypical gland cells of undetermined significance(AGUS), 46 cases as low grade squamous intraepithelial lesions(LSIL), 17 cases as atypical squamous cells cannot exclude high grade intraepithelial lesion(ASC-H) and 3 cases as high grade squamous intraepithelial lesions(HSIL). All the TCT results of the above 253 patients were compared with the histological results from vaginoscopy biopsy. 1) Among the 180 ASC-S cases, after biopsy test, 37 cases were diagnosed as stage one cervical intraepithelial neoplasia(CIN Ⅰ), 13 cases as CIN Ⅱ and 1 case as CIN Ⅲ. 2) Among the 7 cases of AGUS, one case was confirmed as CIN Ⅰ after biopsy. 3) Among the 46 cases of LSIL, further biopsy test showed that 18 cases of them were CIN Ⅰ, 1 case was CIN Ⅱ, 1 case was CIN Ⅲ and 2 cases were invasive squamous cancer. 4) Among the 17 cases of ASC-H, 2 cases were diagnosed as CIN Ⅱ, 3 cases as CIN Ⅲ and 2 cases of in-situ squamous cancer after biopsy. 5) All the 3 cases who were diagnosed as HSIL by TCT were confirmed to have cancer after histological exam by vaginoscopy biopsy. Two of them were invasive squamous cancer and the other one was well-differentiated adenocarcinoma. Human papilloma virus(HPV) DNA was detected in both samples obtained by the 2 methods of TCT and vaginoscopy biopsy. Sixty patients showed HPV-DNA positive from TCT(27.7%) but 82 patients showed HPV-DNA positive from the biopsy(32.4%). The positive screening rate of HPV by the above 2 methods was compared by means of χ² exam and statistical difference was found between the 2 methods(P=0.03).Conclusion Adjunctive TCT can enhance the sensitivity and accuracy of the diagnosis of cervical leision by vaginoscopy and biopsy. In clinical practice, ASCUS usually need to recheck after 3～6 months.However this reseach shows: that carrying out vaginoscopy and biopsy as early as possible can earn much opportunity to diagnose cervical cancer early.

Clinical Analysis of the Diagnostic Value of Mammography and Ultrasonography in Invasive Tubular Breast Carcinoma

Yin Ziyi;Song Maomin;Wang Pilin;Zhi Yinghui;Zhang Tie

2007, 28(5):  661-663. 

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Objective To investigate the diagnostic value of mammography and ultrasonography in patients with invasive tubular breast carcinoma.Methods One hundred and ninetyseven patients with breast diseases were reviewed retrospectively. They were divided into premenopausal group and postmenopausal group. Pathologic result were chosen as gold standard. The diagnostic accuracy of mammography and ultrasonography was compared.Results In the premenopausal group: sensitivity, specificity and accuracy rates of ultrasonography were 87.7%, 90.7% and 89.4% respectively; sensitivity, specificity and accuracy rates of mammography were 63.2%, 89.3% and 78.0% respectively. In the postmenopausal group: sensitivity, specificity and accuracy rate of ultrasonography were 90.0%, 93.4% and 91.9% respectively; sensitivity, specificity and accuracy rate of mammography were 86.7%, 90.8% and 90.0% respectively.Conclusion Ultrasonography has greater value clinically in diagnosing invasive tubular breast carcinoma. Sensitivity of mammography in premenopausal group is obviously lower than that in postmenopausal group. In premenopausal group, sensitivity and accuracy rate of ultrasonography are obviously higher than those of mammography.