Table of Content

21 February 2014, Volume 35 Issue 1

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This study was awarded with The Second Grade National Prize for Science and Technology Progress—The application study on epidemiology, pathogenesis, diagnosis and treatment of mild cognitive impairment and dementia

Jia Jianping

2014, 35(1):  1-5.  doi:10.3969/j.issn.1006-7795.2014.01.001

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Dementia and mild cognitive impairment are the most common neurodegenerative disease and the leading cause of dementia in the elderly. Sponsored by over 40 national and provincial funds, we have obtained tremendous achievements through all these years hard work, which included: (1) A large complete system of clinical information and biological specimen dataset of dementia and mild cognitive impairment of Chinese population. (2) The study confirmed the genetic/susceptibility genes and major protein functions associated with Alzheimer's disease(AD) and reported for the first time the novel presenilin 1(V97L and A136G) mutation and SNPs in over 20 susceptibility genes associated with sporadic AD in Chinese population. (3) The study identified and confirmed the biomarkers and images for early diagnosis of AD. (4) The guidelines for the diagnosis and treatment of dementia and cognitive disorders. (5) New drugs for AD were developed and the technology platform for drug was constructed. This project improved the diagnostic and treatment skills for dementia and mild cognitive disorders and achieved significant social benefits.

This study was awarded with The Second Grade National Prize for Science and Technology Progress—Pathogenesis and treatment strategy of primary angle closure glaucoma

Wang Huaizhou, Wang Ningli

2014, 35(1):  6-9.  doi:10.3969/j.issn.1006-7795.2014.01.002

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Primary angle closure glaucoma(PACG) is the most prevalent and irreversible blindness disease in China and Asia and the blindness rate is as high as 37.5%~75.0%. We systemically investigated the structure of the anterior chamber angle and for the first time found the mechanism of angle closure of PACG. Then we established the new PACG classification system. We also launched a genetic research in Asia with 8 countries and areas and found 4 susceptibility genes which were related with the anatomical structure of the anterior chamber angle. We designed and developed the first panoramic ultrasound biomicroscopy (UBM) and early screening method and intervention technology. We found the new molecular mechanism of acute PACG and designed treatment route of acute PACG. We established a step by step treatment mode with drug, laser and surgery of PACG and improved the surgery technique. In a word,the serial study promoted recognition,diagnosis,and treatment of PACG. By the item we completed our nation's PACG prevention and treatment made a leap from following others to leading the area.

CT guided continuous radiofrequency thermocoagulation of spinal cord for treatment of refractory neuralgia after paraplegia caused by spinal cord injury

Lai Guanghui, Li Xuanying, Ni Jiaxiang

2014, 35(1):  10-12.  doi:10.3969/j.issn.1006-7795.2014.01.003

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Objective To investigate the feasibility, safety, and efficacy of spinal cord cross-sectional CT guided continuous radiofrequency thermocoagulation in treatment of refractory neuralgia after paraplegia caused by spinal cord injury. Methods Fourteen cases with refractory neuralgia caused by spinal cord injury were included in this study. The damage level of spinal cord injury was verified by magnetic resonance imaging (MRI) and physical examination. At 1-2 segments above the damage level, a puncture was performed trans-lamina to the spinal cord with CT guide and followed by continuous radiofrequency thermocoagulation therapy to the target. Results All treatments were successful. One patient's pain recurred 3 years after the treatment, and disappeared after another spinal cord radiofrequency thermocoagulation therapy. The remaining patients had no pain, the efficacy was 92.9%. Conclusion Spinal cord CT-guided continuous radiofrequency thermocoagulation therapy for refractory neuralgia after spinal cord injury is a safe, effective and accurate method and has clinical practical value.

Treatment of cervicogenic headache via upper cervical paravertebral injection combined with manipulative reduction guided by C-arm

He Mingwei, Zeng Qingwen, Liu Jing, Liu Changxin, Ni Jiaxiang

2014, 35(1):  13-17.  doi:10.3969/j.issn.1006-7795.2014.01.004

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Objective To study the effects of the upper cervical paravertebral injection combined with manipulative reduction guided by C-arm for the treatment of cervicogenic headache. Methods Sixty patients suffered from with cervicogenic headache, aged between 15 and 70 years were randomly divided into two groups(Group A 31patients; Group B 29patients), group A received C2 paravertebral injection combined with manipulative reduction guided by C-arm; B group only received upper cervical paravertebral injection. The efficacy and improvement of pain were compared.Results For group A, preoperation、1 week,1 month and 3 months postoperation, the pain scores on visual analogue scale(VAS)were 6.8±2.5、2.3±1.0、 2.4±1.0 and 3.0±1.3;the proportions of cases evaluated as"excellent" and "good" were 100%、93.5%、87.1%; respectively. For group B, the VAS scores were 6.5±2.3、2.0±1.2、3.2±1.5 and 4.6±2.0, the proportion of excellent and good was 96.5%、82.8% and 68.9% respectively. One month and 3 months after treatment,compared with group B, both the VAS and the proportions of cases with "excellent" and "good" were significantly different(P<0.05). Conclusion The effect of the treatment for cervicogenic headache, with upper cervical paravertebral injection combined with manipulative reduction guided by C-arm was better than that of the upper cervical paravertebral injection alone, but its long-term effect remains to be further explored.

Computed tomography-guided spinal cord radiofrequency thermocoagulation for neuropathic pain following spinal cord injury

Wang Qi, Ni Jiaxiang

2014, 35(1):  18-22.  doi:10.3969/j.issn.1006-7795.2014.01.005

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Objective To evaluate the efficacy and safety of computed tomography-guided spinal cord radiofrequency thermocoagulation (SCRT) in treating neuropathic pain following spinal cord injury (NeP following SCI) and to investigate indications and contraindications of SCRT. Methods According to the preset inclusive and exclusive criteria, 43 patients with NeP following SCI accepted CT-guided SCRT. Visual analogue scale (VAS), VAS weighted value (VAS-WV) and simplified form of McGill Pain Questionnaire (SF-MPQ) were used to evaluate before and after SCRT; VAS and complications were followed up for 3, 6, 12, 24 and 36 months after SCRT respectively.Results VAS, total pain rating index (PRI-T) and present pain intensity (PPI) were significantly decreased after SCRT; postoperative relief rate was 97.7%; in follow-up period, relief rate was 97.7%, 97.5%, 94.3%, 92.9% and 90.5%, respectively; postoperative complications were post-dural puncture headache (18.6%) and stomachache (11.6%), all complications were completely relieved within 7 days after SCRT; no long-term complication was reported in follow-up period. Conclusion SCRT was effective and safe in treating NeP following SCI.

Comparison of inhibitory effect on breakthrough pain of regular intermittent epidural injection at different vertebra interspace during labor analgesia

He Liangliang, Ni Jiaxiang, Li Xuanying, Li Xiuhua, Zheng Shuyue, Li Na, Li Fang

2014, 35(1):  23-27.  doi:10.3969/j.issn.1006-7795.2014.01.006

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Objective To evaluate the inhibitory effect of regular intermittent epidural injection(RIEI)at different vertebra interspace during labor analgesia on breakthrough pain. Methods Ninety primiparas who requested labor analgesia were randomized into three groups: group of L_2-3(group A), group of L_3-4(group B)and group of L_4-5(group C). Epidural puncture procedure was performed at L_2-3, L_3-4, L_4-5, respectively for the 3 groups. After the catheter was inserted into epidural space, a test dose of 5 mL and loading dose of 10 mL was injected subsequently. All subjects were given pumps and received same parameter setting: manual bolus dose 8 mL+ lockout time 15 min+background continuous infusion dose 0+bolus dose 8 mL/h. RIEI started 60 min after test dose was injected. The blood pressure(BP), heart rate(HR), respiratory rate(RR), SpO₂, fetal heart rate(FHR), visual analog scale(VAS), modified Bromage score, the consumption of anesthetic, maximum blocked segment, breakthrough pain, stage of labor, delivery mode, amount of oxytocin, postpartum hemorrhage, the side-effects and Apgar score of neonates were recorded. Results The VAS obviously decreased in three groups since receiving labor analgesia(P <0.05), but no significant difference in VAS was found among the three groups(P>0.05). Compared with group A and group B,the maximum blocked segment in group C was significantly lower during labor analgesia(P <0.05), but the incidence of breakthrough pain was similar among the three groups(P>0.05). There was no significant difference in the other indexes among the three groups(P>0.05). Conclusion Similar clinical analgesic effect and incidence of breakthrough pain were acquired with regular intermittent epidural injection technique at L_2-3, L_3-4 or L_4-5, respectively. Therefore, the ideal choice of vertebral interspace should meet two standards: clear anatomic structure location and easy to perform the puncture.

Lidocaine mucilage topic anesthesia combined with propofol intravenous anesthesia in elderly patients for painless gastroscopy

Hua Jiang, Guo Yuna

2014, 35(1):  28-31.  doi:10.3969/j.issn.1006-7795.2014.01.007

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Objective To evaluate efficacy and safety of lidocaine mucilage topical anesthesia combined with propofol intravenous anesthesia in elderly patients for painless gastroscopy. Methods A total of 156 patients were allocated randomly into two groups: lidocaine mucilage and propofol anesthesia group (Group LP, n=78), merely propofol anesthesia group (Group P, n=78). Patients cardiovascular responses, including pulse oxygen saturation (SpO₂), blood pressure (BP), and heart rate (HR), were recorded before, during, and 30 min after gastroscopy. Swallowing reflex during the examination was observed, total dose of the propofol and patients number who would not receive the examination again were documented.Results All patients had finished the examination, without serious nausea and vomiting or obvious body moving. No respiratory depression happened during anesthesia. Cardiovascular responses to the anesthesia and examination were stable and there were no significant differences between both groups(P>0.05). The incidence of cough and throat discomfort were lower in Group LP, when compared with Group P(P<0.05). The total dose of propofol used was less in Group LP than in Group P(P < 0.05). More patients in Group LP would like to receive gastroscopy examination, when compared with Group P(P < 0.05). Conclusion Lidocaine mucilage topical anesthesia combined with intravenous propofol anesthesia is a safe, comfortable and suitable method for elderly patients undergoing painless gastroscopy examination.

Effectiveness and safety evaluation of ultrasound guided stellate ganglion block

Yue Jianning, Wu Baishan, Wang Qi, Guo Yuna, Liu Jingjie, He Mingwei, Li Xuanying, Ni Jiaxiang

2014, 35(1):  32-34.  doi:10.3969/j.issn.1006-7795.2014.01.008

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To observe the safety and effectiveness of ultrasound-guided stellate ganglion block (SGB). Methods Seventy-six patients who required SGB treatment and had no contraindications, were divided into two groups using the random number table method, the ultrasound group (n= 38) and conventional group (n=38). The following indicators were observed: the total operation time, Horner's sign, patients with significant discomfort during the operation, the incidence of pain at the injection site, laryngeal recurrent nerve block, brachial plexus block, adverse reactions, such as local anesthetics poisoning.Results In the ultrasonic group SGB block horner's sign occurrence rate (98.5%) was higher than that in conventional group (81.1%; the incidence of discomfort in the ultrasound group (1.2%) was far lower than that in conventional group (23.5%); in the ultrasonic group, the incidence of pain after multiple block at the injection site (2.7%) was significantly lower than in conventional group (18.3%). The incidence of adverse reactions, such as laryngeal recurrent nerve block (0.6%), brachial plexus block (0.9%), local anesthetics poisoning (0.3%) were lower than those in conventional puncture group (5.6%, 5.6%, 7.7% respectively). The differences between the 2 groups were statistically significant (P<0.05). Conclusion Ultrasound-guided localization of SGB compared to traditional method, the success rate and safety were higher, with more advantages, therefore it is worthy of clinical use.

Research advances in radiofrequency treatment for cervicogenic headache

Li Yan, Ni Jiaxiang

2014, 35(1):  35-40.  doi:10.3969/j.issn.1006-7795.2014.01.009

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With the development of society and medicine, the pain attracts more and more attention of people, the methods for the treatment of pain are constantly emerging, and radiofrequency treatment technology has been widely used in the treatment of headache. Since 1983, Sjaastad firstly put forward the concept of "Cervicogenic Headache", it has drawn wide attention of both domestic and foreign scholars increasingly. The main clinical treatment included oral NSAIDs, massage, nerve block, and minimally invasive interventional treatment, especially radiofrequency treatment. This paper reviews recent literature at home and abroad about the radiofrequency treatment for cervicogenic headache, and summarizes the principle of the radiofrequency treatment, clinical application and existing problems.

Recent advances in studies on the role of sympathetic nerve in lumbar discogenic pain

Tang Yuanzhang, Bian Jingjing, Ni Jiaxiang

2014, 35(1):  41-44.  doi:10.3969/j.issn.1006-7795.2014.01.010

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Intervertebral disc disorder is a common cause for pain syndroms. Disc degeneration, annular tear, leakage of nucleus pulposus and the nerve ingrowth into the disc dominate the primary reason for discogenic pain. Recent studies on discogenic pain have provided new knowledge about this condition. The lumbar intervertebral disk may be innervated non-segmentally through the paravertebral sympathetic nerves. The exposure of the nucleus pulposus to the outer annulus fibrosus may induce nerve inflammation and ingrowth into the disc. Thus, sympathetic nerves irritation resulting from disc disorder has attached increasing attention to discogenic pain. This review focused on the sympathetic innervations into degenerated disc and the mechanisms of discogenic pain.

Effects of angiotensin-(1-7) on oxidative stress and adiponectin in adipocytes

Liu Chang, Cao Xi, Yang Fangyuan, Zhang Xuelian, Yuan Mingxia, Yang Jinkui

2014, 35(1):  45-50.  doi:10.3969/j.issn.1006-7795.2014.01.011

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Objective Although reactive oxygen species (ROS) contribute to glucose intolerance induced by the renin-angiotensin system (RAS) is well documented, the role of the newly discovered pathway of RAS, angiotensin Ang-(1-7)/Mas axis, in this process remains unknown. Here, we examined the effect of Ang-(1-7) on oxidative stress and adiponectin in adipocytes. Methods We treated fully differentiated 3T3-L1 cells with exogenous Ang-(1-7) to clarify its effects on ROS production. Intracellular ROS was measured by flow cytometry using dihydroethidium (DHE), and nitroblue tetrazolium assay. The cells were cultured in serum-free medium for 2 hours and added with glucose oxidase 50 mU/mL or 100 mU/mL for 12 hours to establish the oxidative stress model. We used these models to detect the role of Ang-(1-7) in oxidative stress of adipocytes. ROS production was slightly but significantly decreased in adipocytes treated with Ang-(1-7). Additionally, Mas receptor antagonist D-Ala7-Ang-(1-7) (A779) reversed the effect of Ang-(1-7) on oxidative stress. Furthermore, we also found that oxidative stress induced by glucose oxidase suppressed expression of adiponectin, an insulin-sensitive protein. However, the suppression of oxidative stress by Ang-(1-7) restored adiponectin expression, while A779 antagonize these changes induced by Ang-(1-7). Conclusion Ang-(1-7) can protect against oxidative stress and increase adiponectin expression in adipocytes. Ang-(1-7) may be a novel target for the improvement of insulin sensitivity by preventing oxidative stress.

Impact of severe hypertriglyceridemia in mice on female reproduction and the lipid and glucose metabolism of their offsprings

Ma Yahong, Abudula·Rexiti, Xie Beichen, Guo Xin, Yang Jinkui, Liu Guoqing

2014, 35(1):  51-55.  doi:10.3969/j.issn.1006-7795.2014.01.012

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Objective Severe hypertriglyceridemia (HTG) accompanied with pregnancy may induce acute pancreatitis, which could result in adverse outcomes of pregnancy. However, the effect of maternal HTG on the metabolism of lipids and glucose in offsprings remains unclear. Using apolipoprotein CⅢ (Apo CⅢ) transgenic mice with severe HTG as model system, this study sought to investigate the effects of severe HTG on the reproduction of the female mice as well as on the metabolism of lipids and glucose of the offsprings.Methods Female HTG Apo CⅢ transgenic and normal mice were mated with normal males to observe the effect of severe HTG on fertility and obtained three groups offsprings: maternal transgenic but normal offspring (maternal control, MC), maternal transgenic and transgenic offspring (maternal transgenic, MT) and maternal normal and normal offspring (normal control, NC). The three groups of mice were compared for litter size, birth weight and growth rate, plasma triglycerides (TG), total cholesterol (TC) and differences in glucose metabolism.Results Severe HTG from Apo CⅢ transgene in female mice did not affect the reproduction with unchanged pregnancy and litter size. The pups from the 3 groups had similar body weight and growth rate. Influenced by Apo CⅢ transgene expression, the plasma TG and TC levels at 14 and 28 days were much higher in MT mice than those of MC and NC groups (P<0.01). MT mice also had mildly impaired glucose tolerance, higher fasting insulin levels and hence higher homeostasis model assessment insulin resistance index (HOMA-IR), compared with the other two groups (P<0.05).Conclusion Severe HTG Apo CⅢ transgenic female mice had normal pregnancy, parturition and lactation. The maternally inherited Apo CⅢ severe HTG transgenic mice after weaning exhibited abnormal glucose tolerance and insulin resistance.

The prevalence of metabolic syndrome and its distribution characteristics in elderly people with type 2 diabetes mellitus in Beijing Wenquan community

Ma Namin, Yu Shilin, Geng Yahui, Dong Jianquan, Yuan Meiying

2014, 35(1):  56-59.  doi:10.3969/j.issn.1006-7795.2014.01.013

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Objective To investigate the prevalence of metabolic syndrome and its distribution characteristics in elderly people with type 2 diabetes mellitus in Beijing Wenquan community.Methods Data such as body weight, height, body mass index, blood glucose, and blood lipid were collected from 3 050 elderly patients who have been diagnosed with type 2 diabetes mellitus in Beijing Haidian Wenquan community by the method of random sampling,to analyze the prevalence of metabolic syndrome and relationship between each component and age and sex. Results 1 Among 3 050 type 2 diabetes mellitus patients, 156(5.1%)had isolated type 2 diabetes mellitus diabetes, 2 894 (94.9%) had type 2 diabetes mellitus with one or more metabolic abnormalities, 1 772(58.1%)had type 2 diabetes mellitus with hypertension,2 083(68.3%)had type 2 diabetes mellitus with hypertriglyceridemia,1 661(54.5%)had type 2 diabetes mellitus with low high-density lipoprotein cholesterol,2070 (67.9%)had type 2 diabetes mellitus with central obesity, 1 729(56.7%)had type 2 diabetes mellitus with metabolic syndrome. 2 With the growth of age, the prevalence of metabolic syndrome and its components in type 2 diabetes mellitus in elderly patients is increased year by year, the difference was statistically significant, but the prevalence of dyslipidemia and obesity has declined in the group of older than seventy years.3 Female type 2 diabetic patients with metabolic syndrome and its components had higher prevalence than that of males, especially in the low high-density lipoprotein cholesterol was most obvious. Conclusion Among the elderly patients with type 2 diabetes mellitus in Wenquan community of Beijing, 94.9% of them with other metabolic abnormalities,56.7% of them had metabolic syndrome. So, community diabetic management must be implemented in an all-round way, including control of blood pressure, blood lipids, body weight and so on, in addition to control of blood sugar. Age and gender differences are risk factors for type 2 diabetes mellitus combined with metabolic syndrome and its components prevalence, we should strengthen the prevention of metabolic syndrome in elderly and women patients.

Microalbuminuria on predicting end-stage renal disease in patients with type 2 diabetes

Guo Jing, Yang Jinkui

2014, 35(1):  60-66.  doi:10.3969/j.issn.1006-7795.2014.01.014

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Objective To analyze the value of microalbuminuria (MAU) on predicting end stage renal disease (ESRD) in patients with type 2 diabetes. Methods A total of 367 patients with type 2 diabetes were enrolled in this study. We analyzed clinical data, biochemical parameters, urinary albumin excretion rates (UAER) and estimated glomerular filtration rates (eGFR). According to the levels of UAER, the patients were divided into normal albuminuria (NAU) group and the MAU group. During an average of 5.2 years of follow-up, each time we measured the above parameters, including biochemical markers, UAER and eGFR. Results In NAU group, eGFR declined by 4.18% each year, with a total of 5.65% ESRD endpoint. In the MAU group, eGFR declined by 4.95% each year, with a total occurrence rate of ESRD of 14.29%. However, based on the survival analysis, no significant difference was found in the risk for ESRD. Based on the outcome of eGFR, all patients were divided into two groups: the renal function remaining group and ESRD group. Based on the Cox regression analysis, diastolic blood pressure was shown to be an independent risk factor for ESRD. Conclusion MAU cannot accurately predict the ESRD in patients with type 2 diabetes.

Effect of serum uric acid control on nephropathic end point in type 2 diabetes mellitus non-intervention

Sun Xiaomeng, Wang Yingying, Liu Chang, Feng Jianping, Xu Yuan, Yang Jinkui

2014, 35(1):  67-72.  doi:10.3969/j.issn.1006-7795.2014.01.015

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Objective To investigate the effect of serum uric acid on early function decline in type 2 diabetes mellitus. Methods Totally 512 inpatients with type 2 diabetes mellitus with urinary albumin excretion rate(UAER) under 200 μg/min were included in this study. The subjects were divided into groups base on the different levels of serum uric acid. Estimated glomerular filtration rate (eGFR) of both groups were compared, 466 Type 2 diabetes mellitus inpatients without renal function decline eGFR>70 mL/(min·1.73 m²) at the starting point participated in the 2-10 years follow up study. Terminal event was defined as eGFR <60 mL/(min·1.73 m²), and survival curves were made.Results The subjects were divided into 2 groups based on the level of serum uric acid. Low serum uric acid group had higher glomerular filtration rate with better renal function. Multivariate regression analysis showed that eGFR was negatively correlated with age, serum uric acid, disease duration, body mass index(BMI),and positively correlated with bedy mass index (HGB). In the follow up study, the subjects were divided into 2 groups based on the level of serum uric acid. The lower the serum uric acid of patients is, the lower the probability of a drop in kidney function, and survival time was longer. Conclusion In patients with type 2 diabetes mellitus, high uric acid will play a key role in the progression of diabetic nephropathy as an independent risk factor. Serum uric acid levels are a strong predictor of the development of early renal function decline in patients with type 2 diabetes mellitus.

Non-high density lipoprotein-cholesterol is an indicator to assess cardiovascular risk for subjects with dyslipidemia

Zhang Pengrui, Xu Yuan, Wang Guang, Yang Jinkui

2014, 35(1):  73-76.  doi:10.3969/j.issn.1006-7795.2014.01.016

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Objective To confirm that non-high density lipoprotein-cholesterol (non-HDL-C) is an effective clinical indicator to assess the cardiovascular disease (CVD) risk and lipid-lowering therapy regardless of glucose level. Methods A total of 6 341 subjects were selected from large-scale clinical survey of the Department of Endocrinology, Beijing Tongren Hospital in 2007. Fasting blood samples were collected from each subject and were tested for total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), HDL-C, triglyceride (TG) and non-HDL-C was calculated by subtracting TC from HDL-C. The subjects were divided into euglycemia group and hyperglycemia group according to fasting glucose level and the other parameters of the 2 groups were compared. Results TC, LDL-C, HDL-C, TG and non-HDL-C in hyperglycemia group were higher than that in euglycemia group. A linear positive correlation was found between non-HDL-C and LDL-C, non-HDL-C and TG. Conclusion non-HDL-C is an effective clinical indicator to assess the cardiovascular decease risk and lipid-lowering therapy.

Effects and possible mechanisms of pancreatic duct epithelial cells on insulin secretion of the islet β cells

Lyu Xiaohong, Wang Lei, Liu Chang, Wang Yingying, Yang Jinkui

2014, 35(1):  77-80.  doi:10.3969/j.issn.1006-7795.2014.01.017

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Whereas the endocrine and the exocrine pancreas have been generally regarded as independent entities in morphology and function, evidence for close interactions between the two glandular components has been obtained. A recent report has suggested that substance secreted into the pancreatic juice could exert an action on islet cells that directly face the duct lumina, and eventually bring a peculiar stimuli to a larger population of islet cells through gap junctions among them. Pancreatic duct epithelial cells secretc pancreatic juice rich in sodium bicarbonate which may have a functional effect on islet cells. It has long been recognized that cystic fibrosis transmembrane conductance regulator (CFTR) is abundant in small pancreatic duct epithelial cells and quite important for the secretion of bicarbonate. However, the expression of CFTR in pancreatic islet is not completely defined and few studies have reported about the role of CFTR expressed in islet cells. Further study on the influence and mechanism of pancreatic duct epithelial cells to the islet is needed, and it may be meaningful for the prevention, therapy of and perhaps the new drug for diabetes mellitus.

High levels of divergent HIV-1 quasispecies in neurological opportunistic infections in China

Liu Yuanzhi, Chen Binggang, Ding Wei, Qiao Luxin, Zhao Qingxia, Wu Hao, Chen Dexi, Zhang Yulin

2014, 35(1):  81-86.  doi:10.3969/j.issn.1006-7795.2014.01.018

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Objective To investigate virological characteristics of central nervous system (CNS) HIV-1 in AIDS patients with CNS opportunistic infection (OIs).Methods Totally 24 cases with CNS OIs and 16 non-CNS-OIs (control) cases were selected from AIDS patients who were infected with HIV-1 by paid blood donor in Henan province. HIV-1 loads of plasma and cerebrospinal fluid (CSF) were detected by reverse transcriptase polymerase chain reaction, and C2-V5 area of HIV-1 envelope region was amplified from viral quasispecies isolated from CSF by nest polymerase chain reaction. Results CSF HIV-1 load was significantly higher in cases with CNS OIs, but no high plasma HIV-1 load was found in these patients. CD4 counts were not significantly different between two groups. And, no straight linear correlations were found between CSF viral load and plasma viral load, CSF viral load and CD4 counts in either group. HIV-1 quasispecies isolated from the CSF of CNS OIs patients had a high diversity as the nucleotide sequence analysis of C2-V5 region.Conclusion These results suggest that high levels of divergent HIV-1 quasispecies in the CNS which probably contribute to opportunistic infections.

Neurotoxicity of HIV-1 envelope protein gp120 V3 loop

Zhang Zhili, Chen Binggang, Jiang Taiyi, Qiao Luxin, Wu Hao, Chen Dexi, Zhang Yulin

2014, 35(1):  87-91.  doi:10.3969/j.issn.1006-7795.2014.01.019

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Objective To investigate the neurotoxicity of human immunodeficiency virus-1(HIV-1) envelope protein gp120 in vitro. Methods Primary mouse cortical neuronal cultures were firstly established for neurotoxicity analysis. Terminal dUTP nick end-labeling (TUNEL) assay and lactate dehydrogenase (LDH) leakage assay were used to analyze neuronal apoptosis induced by recombinant gp120 V3 loop polypeptide. Further, Western blotting was used to detect the levels of apoptosis associated proteins bcl-2 and bax under gp120 V3 loop exposure. Results Recombinant gp120 V3 loop polypeptide was found to induce neuronal apoptosis and inhibit neurite outgrowth in a concentration dependent manner, which was associated with low expression of bcl-2 proteins. Conclusion HIV-1 envelope protein gp120 has neurotoxicity.

Analysis of T cell activation in early HIV-infected individuals from MSM population

Li Zhen, Wu Hao, Zhang Tong

2014, 35(1):  92-95.  doi:10.3969/j.issn.1006-7795.2014.01.020

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Objective To evaluate the immune activation of T cells in early human immunodeficiency virus (HIV)-infected individuals, to find out the predictors for disease progression of early HIV-infected individuals. Methods Twenty-five early HIV-infected individuals, screened from the cohort of men who have sex with men (MSM) of Beijing YouAn Hospital were enrolled in this study. Frozen peripheral blood mononuclear cells (PBMCs) from early HIV-infected and uninfected individuals were obtained. The expression of activation markers CD38 and human leukocyte antigen DR (HLA-DR) on T cells were detected by flow cytometry. Correlations between T cell activation and CD4 T cell count or plasma viral load in early HIV-infected individuals were analyzed by Pearson test.Results Compared with uninfected individuals, the frequencies of HLA-DR⁺CD4⁺T cells and CD38⁺HLA-DR⁺CD4⁺T cells were significantly increased in early HIV-infected individuals (P<0.05), but no significant difference in the frequency of HLA-DR⁺CD4⁺T cells was observed. Moreover, the frequencies of CD38⁺CD8⁺T cells, HLA-DR⁺CD8⁺T cells and CD38⁺HLA-DR+CD8⁺T cells were significantly elevated in early HIV-infected individuals compared to uninfected individuals(P<0.05). However, no significant differences in CD38 and HLA-DR expression on T cell were observed between early HIV-infected individuals with different infection time. Furthermore, the frequencies of CD38⁺ CD8⁺T cells and CD38⁺HLA-DR+CD8⁺T cells were negatively correlated with CD4 cell count, and positively correlated with plasma viral load. Conclusion The frequencies of CD38⁺ CD8⁺T cells and CD38⁺HLA-DR+CD8⁺T cells may be used as the predictor for disease progression in early HIV-infected individuals.

Prevalence of and associated factors for HIV and HBV infections among men who have sex with men in Beijing, China

Xu Yuanlong, Yang Xiansan, Liu Kaiyan, Yi Yin, Li Qunhui, Huang Xiaojie, Guo Caiping, Wu Hao

2014, 35(1):  96-100.  doi:10.3969/j.issn.1006-7795.2014.01.021

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Objective To investigate the prevalence of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection among men who have sex with men (MSM) population in Beijing and related high risk factors, and provide scientific evidence for disease prevention.Methods A cross-sectional survey was conducted in Beijing. A questionnaire was used to collect demographic information and potential correlated factors, and blood specimens were collected and tested for serologic markers of HBV, HIV and syphilis infections. Questionnaire-based data and serological testing results were recorded with EpiData 3.0 software. Statistical analyses were performed using SPSS 13.0.Results The prevalence of HIV and HBsAg were 11.6% and 9.0%, respectively. There are 26.5% had serologic markers of HBV infection. In multivariate analyses, two variables were independently associated with HBV infection: not having fixed male sex partners in the past 12 months, reported a diagnosis of a sexually transmitted disease (STD). Multivariate analysis using forward stepwise Logistic regression confirmed that age, native place, not having fixed male sex partners in the past 12 months, unprotected anal intercourse in the past 12 months, syphilis rapid plasma regain (RPR) results were independent predictors of HIV infection. Conclusion High prevalence of HIV and HBV infection were observed among MSM. Comprehensive preventive measures for HIV and HBV and targeted health education campaigns should be developed among MSM population. The prevention and control of HIV and syphilis should be carried out simultaneously.

Recent progress in the gene therapies against HIV-1

Tian Yaru, Jiao Yanmei, Zhang Tong, Wu Hao

2014, 35(1):  101-107.  doi:10.3969/j.issn.1006-7795.2014.01.022

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Highly active antiretroviral therapy (HAART) has achieved significant success, but anti-HIV drug treatment still has its limitation,such as causing drug toxicity and viral-escape mutants. Gene therapy has better ability of anti-HIV in theory. It offers the promise of preventing progressive HIV infection by sustained interference with viral replication. Gene-targeting strategies are being developed with RNA-based agents, such as ribozyme, antisense, RNA aptamers and small interfering RNA, and protein-based agents, such as the mutant HIV Rev protein M10, fusion inhibitors and zinc-finger nucleases. This review mainly discusses the various gene therapy strategies and recent progress. Many of these strategies are being tested in ongoing and planned clinical trials.

Long-term model, administration pattern and efficacy description of rats in acute ischemic stroke condition

Jiang Xueyun, Zhang Yingjie, Zhao Ming

2014, 35(1):  108-112.  doi:10.3969/j.issn.1006-7795.2014.01.023

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Objective To establish rat model of acute ischemic stroke of long-term symptom onset, as well as to evaluate therapeutic efficacy and side effects. Methods Individually neurological ratings were scored and self-contrast was performed, as well as continues administration were given for 6 consecutive days. Results In vivo 1 μmol/kg JXY(Gly-Arg-Pro-Ala-Lys-Arg-Gly-Asp-Val) treated rats of acute ischemic stroke immediately, or 4, 6 and 24 h after symptom onset were cured. This advantage was further enhanced by continuously administered JXY with 1 μmol/kg initial dose. In contrast, 3 mg/kg t-PA had no such therapeutic efficacy. Conclusion Improving efficacy and limiting the neurotoxicity of t-PA are of clinical importance to thrombolytic therapy in the treatment of acute ischemic stroke over 3 h symptom onset. The rat models of acute ischemic stroke of 4, 6 and 24 h symptom onset have broad utility. On the model 1 μmol/kg JXY is capable of treating acute ischemic stroke rats immediately, 4, 6 and 24 h after symptom onset.

Determination of total flavonoid in leaves of acer truncatum Bunge by spectrofluorimetry

Ma Denglei, Shao Jianqun, He Shenzhi, Zhang Feng

2014, 35(1):  113-117.  doi:10.3969/j.issn.1006-7795.2014.01.024

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Objective To propose a method to determine the total flavonoid in leaves of Acer truncatum Bunge by Spectrofluorimetry. Methods Based on fluorescent property that flavonoids can make a stable complexation with Al³⁺, the excitation and emission wavelengths were selected at 470 nm and 547 nm respectively with rutin as the standard sample to research effects of solvent, the dosage of 5%Al(NO₃)₃ solution, pH, standing time and chlorogenic acid. Results The optimum conditions were 60% ethanol as solvent, added 1 mL of 5%Al(NO₃)₃ solution and made pH=5 in 10 mL volumetric flask. The fluorescence intensity had a good linear relationship with rutin concentration in the range of 6.55×10^-6mol/L~3.20×10^-5mol/L. The regression equation was found to be y=1.147 7x + 0.430 4,R²=0.999 1. Conclusion This method could lower the influence of chlorogenic acid for determination total flavonoid by changing the excitation wavelength with fluorescence analysis and the work provided a reference for quantitative analysis of total flavonoid in the leaves of Acer truncatum Bunge.

Effects of Gubentongluo decoction on TGF-β₁、MMP-9 and TIMP-1 expression in diabetic nephropathy rats

Li Fengting, Li Meng, Wang Xinyao, Geng Jianguo

2014, 35(1):  118-121.  doi:10.3969/j.issn.1006-7795.2014.01.025

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Objective To study the effects of Gubentongluo decoction on transforming growth factor(TGF-β₁)、matrix metalloproteinase-9 (MMP-9) and tissue inhibitors of metalloproteinases-1(TIMP-1) expression in diabetic nephropathy rats. Methods The model of diabetic nephropathy rats was established by unnephrectomized and intraperitoneal injection of streptozotocin(STZ).The rats were divided into six groups randomly, including normal group, model group,western medicine group, Gubentongluo decoction (high, middle, low dosage) groups. The immunohistochemical method was applied to detect the expression of TGF-β₁、MMP-9 and TIMP-1. Results Compared with the model group, the high and middle groups of Gubentongluo decoction significantly lowered the expression of TGF-β₁ and TIMP-1(P<0.05), increased the expression of MMP-9(P<0.01).Conclusion Gubentongluo decoction could significantly inhibit the expression of TGF-β₁,regulating the balance of MMP-9 and TIMP-9, delaying the process of renal pathology in DN rats,having a protective effect on kidney.

Preparation of lentivirus silencing PHF8 and its effects on human esophageal squamous-cell carcinoma cells

Sun Xiujing, Yuan Biao, Zhu Shengtao, Li Peng, Xu Youqing

2014, 35(1):  122-128.  doi:10.3969/j.issn.1006-7795.2014.01.026

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Objective To construct a recombinant lentivirus for RNA interference of PHF8 gene, establish a human esophageal squamous-cell carcinoma cell lines with PHF8 gene knockdown and observe its effect on cell proliferation. Methods The PHF8 or Nonsilencing shRNA and packaging vectors were cotransfected to 293T cells to produce the recombinant lentivirus, which were further ultra-centrifuged, tittered and used to infect the human esophageal squamous-cell carcinoma cell lines. The infection efficiency was evaluated with fluorescence microscope and flow cytometry and stable cell lines were constructed using puromycin selection assay. Real-time PCR and Western Blotting were used to confirm the silencing of PHF8. Research on the effect of PHF8 on cell proliferation was performed using MTS asssy. Results We successfully prepared the recombinant lentivirus for RNA interference of PHF8 gene. The expression of PHF8 mRNA and protein in expremental group were lower than that of the control group (P<0.05). The proliferation of expremental group cells were reduced than that of control group (P<0.05). Conclusion Lentivirus mediated shRNA effectively inhibited the expression of PHF8 in human esophageal squamous-cell carcinoma cell lines and the cell proliferation ability.

The traditional Chinese medical syndrome study on 155 patients with non-alcoholic fatty liver disease

Wang Weijian, Hu Jun

2014, 35(1):  129-131.  doi:10.3969/j.issn.1006-7795.2014.01.027

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Objective To study the characteristics of the traditional Chinese medicial (TCM) syndrome of non-alcoholic fatty liver disease (NAFLD), laying the foundation for further study its pathogenesis. Methods The clinical symptom questionnaire was developed and the cross-sectional research method was adopted. The comprehensive clinical data of patients with NAFLD was collected and TCM symptom data were collected for statistical analysis. Results In all age groups of patients with NAFLD have occurred to the 40-50 age group the largest proportion of the total number of cases 34.2%; the ratio of male to female NAFLD patients was 3.07：1. The incidence of TCM syndrome was liver-stagnation and spleen-deficiency (39.4%), phlegm-damp accumulating (24.5%), phlegm and blood knot (18.7%), deficiency of liver and kidney (9.8%), and dampness-heat accumulating (7.6%). Conclusion Liver-stagnation and spleen-deficiency is the most common TCM syndrome in NAFLD patients, and phlegm is an important factor in its incidence.

A clinical observation of etomidate or propofol combined with sufentanil for artificial abortion

Hu Zhenfa, Dong Peng, Tian Ming

2014, 35(1):  132-135.  doi:10.3969/j.issn.1006-7795.2014.01.028

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Objective To compare the anesthesia effect of the etomidate or propofol combined with sufentanil used for artificial abortion. Methods Ninety-four cases of women in early pregnancy for induced abortion were randomly divided into two groups (Group E and Group B),with 47 patients in each group. After receiving 0.1 μg/kg sufentanil, patients in group E received 0.3 mg/kg etomidate and patients in group B received 2.0 mg/kg propofol.Blood pressure, heart rate and SPO₂ were monitored in the course of anesthesia. Operation time, wake-up time, recovery time of orientation, incidence of adverse reactions were observed in both groups. Results There was no significant difference between the two groups in age, weight, falling asleep time,operation time and wake up time. After injection, blood pressure was decreased significantly in group B (P<0.05) and it was stable in group E.The incidence of injection pain was 25.5% and 2.1% in group B and E respectively(P<0.01), The incidence of nausea was 2.1% in group B and 8.5% in group E. Conclusion Both etomidate and propofol can be used for artificial abortion anesthesia. Propofol induced a significant decrease of blood pressure and a higher incidence of injection pain. Etomidate maintained a stable blood pressure, but induced a higher incidence of myoclonus, nausea and nettle rash.

Interventional treatment of stent restenosis or occlusion after transjugular intrahepatic portosystemic shunt

Wang Lei, Liu Fuquan, Yue Zhendong, Zhao Hongwei

2014, 35(1):  136-139.  doi:10.3969/j.issn.1006-7795.2014.01.029

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Objective To summarize the interventional treatment strategy of stent restenosis or occlusion after transjugular intrahepatic portosystemic shunt (TIPS). Methods The data collected from 20 patients (10 males and 5 females, aged 27-58 years, averaged 48 years) with stent restenosis or occlusion after TIPS from Jan.2009 to Dec.2011 were retrospectively analyzed. 12 patients with stent restenosis and 8 patients with stent occlusion were confirmed by ultrasonography before surgery and intraoperative DSA. All patients were used bare metal stent. 4 patients were performed ballon dilation,11 patients were re-stented after ballon dilation, and 5 patients accepted the second Tips to reconstruct the shut. Results Free portal pressure (FPP) was reduced from(3.94±0.52)kPa to(2.55±0.46)kPa (P<0.05), 3 patients with hepatic coma improved after drug treatment within one week postoperatively. All patients underwent warfarin anticoagulation after intervention. There was no stent restenosis or occlusion during follow-up of 1.5 years. Conclusion The shunt stent has a certain rate of restenosis or occlusion after TIPS, but the prior stent can be expended and the shunt can be reconstructed with interventional techniques, it has the extremely application value in reducing portal pressure and extending the survival of patients.