Journal of Capital Medical University

Brief summary on pathogenic mechanism of Ebola virus

Sheng Ziyang, Fan Dongying, An Jing

2014, 35(5): 529-532. doi:10.3969/j.issn.1006-7795.2014.05.001

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The Ebola virus (EBOV), a single strand negative RNA virus, belongs to Family Filoviridae. The infection can cause severe haemorrhagic fever (EHF). The virus distributes widely in Africa mainland and has caused continuous outbreaks because of its strong virulence and high infectivity. However, the pathogenesis of EHF remains unknown. This review will focus on recent progress of Ebola research to provide information for prevention and treatment of EBOV infection.

Lasker Awards 2014

Zhang Ting, Wang Xiaomin

2014, 35(5): 533-538. doi:10.3969/j.issn.1006-7795.2014.05.002

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In Sep. 8, 2014, Lasker Awards released. The 2014 Albert Lasker Basic Medical Research Award honors Kazutoshi Mori and Peter Walter for their discoveries concerning the unfolded protein response an intracellular quality control system that detects harmful misfolded proteins in the endoplasmic reticulum and signals the nucleus to carry out corrective measures. The 2014 Lasker~DeBakey Clinical Medical Research Award honors Alim-Louis Benabid and Mahlon DeLong for the development of deep brain stimulation of the subthalamic nucleus, a surgical technique that reduces tremors and restores motor function in patients with advanced Parkinson's disease. The 2014 Lasker~Koshland Award for Special Achievement in Medical Science honors Mary-Claire King for bold, imaginative, and diverse contributions to medical science and human rights: she discovered the BRCA1 gene locus that causes hereditary breast cancer and deployed DNA strategies that reunite missing persons or their remains with their families.

FOXP3 gene polymorphism may contribute to the onset and progress of children immune thrombocytopenia

Liu Fuhong, Chen Zhenping, Ma Jingyao, Wei Yunyun, Wu Runhui

2014, 35(5): 539-544. doi:10.3969/j.issn.1006-7795.2014.05.003

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Objective To investigate the association between FOXP3 gene polymorphism and the onset and progress of children immune thrombocytopenia (ITP), to explore the pathogenesis of childhood ITP. Methods A total of 328 patients of initial onset of ITP and 219 healthy individuals were enrolled into study group and controls group, respectively. FOXP3 polymorphisms: rs3761547, rs3761548 and rs2232365 were genotyped by the Sequenom SNP genotyping method. Patients were divided into two groups according to diagnosis and results of follow-up: "disease course exceeding 12 months"and "disease course within 12 months".Results The genotype rs2232365 AG was significantly higher in age-and sex-matched study group comparing to control group (P=0.013). Patients with rs2232365 G allele, rs3761547 GG genotype or G allele showed significantly higher in disease course exceeding 12 months sub-group than in disease course within 12 months sub-group (P=0.008, 0.001, 0.033 respectively).Conclusion The genotype rs2232365 polymorphism was associated with the pathogenesis of ITP; rs3761547 GG genotype and G alleles/ rs2232365 G allele may tend to have longer course and worse progress in children ITP. rs2232365 polymorphism was associated with progress of children ITP, which may play an important role in children ITP.

Mechanism of interferon gamma mediated hemophagocytic syndrome blood cell reduction

Tang Ran, Wang Yini, Zhang Jia, Li Shuo, Wang Zhao

2014, 35(5): 545-550. doi:10.3969/j.issn.1006-7795.2014.05.004

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Objective To explore whether there are differences between hemophagocytic syndrome patients and normal human bone marrow CD34⁺ cells' quality, study the effect and characteristics of interferon gamma differentiation to the bone marrow, and observe whether improved colony stimulating factor can restrain the inhibition of interferon gamma on bone marrow. Methods Separation and purification of bone marrow CD34⁺ hematopoietic stem cells were performed by immunomagnetic beads method. SCF, IL 3, GM-CSF, G-CSF, EPO colony stimulating factor on differentiation of bone marrow stem cells, the colony forming units (CFU) to evaluate the formation of bone marrow differentiation. Added different concentration gradient of interferon gamma in the system, observation the bone marrow colony formation the situation. Increase in the minimum concentrations interferon gamma inhibition of bone marrow in colony stimulating factor concentration to observe the bone marrow growth situation.Results This study demonstrated no difference in bone marrow CD34⁺ cells compared with normal quality (P> 0.05). The degree of inhibition of interferon gamma in different concentration on bone marrow is different, when interferon gamma concentration increased to more than 10ng/mL, the experimental group colony number difference compared to the control group without the addition of interferon gamma (P<0.05). To increase the training system of colony stimulating factors concentration can be made against the bone marrow suppression of interferon gamma.Conclusion There was no significant difference in bone marrow's quality between HPS patients and normal control. Interferon gamma may inhibit bone marrow's growth. Increased colony stimulating factor concentration may act against interferon gamma production.

Effect of heat denaturation on labeled peripheral blood cell subsets

Ma Xiaocai, Sun Xuejing, Wang Yinying, Liu Congyan, Wan Suigui, Su Li, Sun Wanling

2014, 35(5): 551-554. doi:10.3969/j.issn.1006-7795.2014.05.005

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Objective To investigate the effect of heat denaturation on labeled peripheral blood cell subsets and establish a stable protocol of flow cytometry-Fluorescence in situ hybridization (Flow-FISH). Methods Heparinized fresh peripheral blood samples were taken from ten healthy persons. T lymphocytes, B lymphocytes and monocytes were labeled with Alexa Fluor^®647-CD3, CD19 and CD14 seperately, then denatured by high temperature. The expression of lineage-specific antigens were detected by flow cytometry, on cells with and without heat denaturation separately. T lymphocytes were labeled with Alexa Fluor^®647-CD3, and were allowed to react with four concentrations of crosslinker Bis[sulfosuccinimidyl] suberate (BS³) seperately, and the efficiency was evaluated by flow cytometry. Results After heat denaturation, the expression of CD3 and CD19 became weaker, while T lymphocytes and B lymphocytes could still be differentiated effectively; the expression of CD14 did not change, and monocytes could be differentiated clearly. After the reaction with BS³ in four concentrations, the percentages of Alexa Fluor^®647-CD3 labeled T lymphocytes were similar. The application of Alexa Fluor^®647 labeled anti-CD3, CD19 and CD14 antibodies might make the differentiation of blood cell subsets by Flow-FISH feasible, and the optimal final concentration of BS³ would be 2.5 mmol/L.

Expression of TGF-β₁ in hyperleukocytic acute myeloid leukemia and its clinical significance

Wang Min, Wang Liru, Cui Jianying, Zhou Hebing

2014, 35(5): 555-559. doi:10.3969/j.issn.1006-7795.2014.05.006

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Objective To investigate the role of transform growth factor β₁ (TGF-β₁) in pathogenesis of hyperleukocytic acute myeloid leukemia (AML).Methods The mRNA transcription levels of TGF-β₁ from bone marrow mononuclear cells (BMMNC) in 38 AML patients, protein expression levels of intracellular TGF-β₁ from BMMNC in 48 AML patients, and serum levels of TGF-β₁ from 40 AML patients were measured by real-time fluorescence quantitative polymerase chain reaction (RQ-PCR), flow cytometry, and double-antibody sandwich enzyme-linked immunosorbent assay (ELISA), respectively. Results The relative levels of the TGF-β₁ gene expression among hyperleukocytic AML patients, non-hyperleukocytic AML patients, and NC has no significant difference (P>0.05). The protein expression levels of TGF-β₁ in both hyperleukocytic AML and non-hyperleukocytic AML patients were significantly higher than that in NC (P<0.05), the plasma levels were significantly lower than that in NC (P<0.05). There was no significant difference in intracellular protein expression levels and plasma levels of TGF-β₁ between hyperleukocytic AML and non-hyperleukocytic AML patients (P>0.05). There was no significant difference in intracellular protein expression levels and plasma levels of TGF-β₁ between the FAB subtypes in hyperleukocytic and non-hyperleukocytic AML (P>0.05). Conclusion Decreased serum levels of TGF-β₁ may be involved in the pathogenesis of AML. However, decreased TGF-β₁ serum levels may not reflect reduced TGF-β₁ production by BMMNC. Our study showed that TGF-β₁ had no important impact on the pathogenesis of hyperleukocytic AML.

Clinical characteristics of 193 adult patients with immune thrombocytopenic purpura

Zhang Yong, Chen Wenming, Zhou Hebing

2014, 35(5): 560-565. doi:10.3969/j.issn.1006-7795.2014.05.007

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Objective To analyze the clinical manifestations and treatment effects of 193 adult patients with immune thrombocytopenic purpura(ITP). Methods Clinical features of 193 cases who suffered from ITP were retrospectively studied. Results Adult ITP patients were mostly(79.3%)in chronic course. Some of them had a history of infection(22.8%); 86.5% patients had a manifestation of hemorrhage. Petechiae and ecchymosis were the most common clinical symptoms in ITP patients(77.7%), 5 patients(2.6%)died of cerebral hemorrhage. The platelet count was lower in hemorrhage patients(P=0.000)0.86% patients received glucocorticosteroid or glucocorticosteroid based combination regimen, 69.3% patients achieved a response. Platelet count less than 20×10⁹/L, female, younger patients(15~40 years old)and the patients who had a manifestation of hemorrhage had a better response to the treatment (P=0.011, 0.029, 0.000 and 0.004, respectively). Bone marrow megakaryocytes and serum ANA had no correlation with therapeutic effect (P=0.054 and 0.179, respectively). 23.8% patients developed side effects related to treatment, 6.2% had liver toxicity, and 6.1% patients had an elevated blood glucose and 1 patient(0.52%)died from severe lung infection. Conclusion Most of adult ITP patients were in chronic course. Glucocorticosteroid is still the first line treatment in ITP patients. Sex, age and platelet count may predict the treatment effects. The disease in ANA positive patients may become autoimmune disease as seen during a long period follow up.

Clinical application of leukapheresis in patients with hyperleukocytic acute leukemia

Meng Guangqiang, Wang Liru, Chen Yijuan, Zhang Jingjing, Wang Min, Guo Huixia, Wu Yue

2014, 35(5): 566-571. doi:10.3969/j.issn.1006-7795.2014.05.008

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Objective To determine whether leukapheresis has a favorable impact on hyperleukocytic acute leukemia (HAL) patients with leukostasis,and it has any effects on the disease outcomes of these patients.Methods Clinical data of 66 hyperleukocytic acute leukemia patients were collected. The impact of leukapheresis on leukostasis and peripheral white blood cell count were retrospectively analyzed. Clinical outcomes such as early mortality, complete remission (CR) rate and overall survival (OS) rate were also accessed. Results Leukapheresis can reduce the peripheral WBC count of HAL patients (P=0.000). The time to WBC count declined to 20×10⁹/L in the group with leukapheresis was significantly shorter than that in the group without leukapheresis (P=0.011). As to type I respiratory failure and central nervous system symptoms caused by leukostasis, a significant improvement was revealed in leukapheresis group (P<0.05). There was no significant difference in early mortality between the two groups (P=1.000). The differences in complete relief (CR) rate after the first cycle of induction chemotherapy, CR rate after the second cycle and overall survival between the two groups were not observed (P>0.05). Conclusion Leukapheresis and low-dose chemotherapy could quickly reduce the peripheral WBC counts of HAL patients, and improve type I respiratory failure and central nervous system symptoms due to leukostasis. Leukapheresis did not improve early mortality, CR rate after the first cycle of induction chemotherapy, CR rate after the second cycle and OS of HAL patients.

Isolation and culture of human osteoclasts from peripheral blood and the interaction between osteoclasts and myeloma cells

Zhang Jianhua, Dong Chunxia, Ren Fanggang, Tan Yanhong, Yang Linhua

2014, 35(5): 572-576. doi:10.3969/j.issn.1006-7795.2014.05.009

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Objective To evaluate the feasibility of isolation and culture of osteoclasts (OCs) in vitro, and investigate the interaction between OCs and myeloma cells.Methods Human OCs were isolated from peripheral blood mononuclear cells (PBMCs) in vitro according to the previously described procedures. The interaction between PBMC-OCs and MM cells was determined by coculture. Results In PBMC culture, after 4 days of incubation with osteoclastic medium, the nonadherent cells were removed, leaving most of the remaining adherent cells expressed (tartrate-resistant acid phosphatase) TRAP, were considered committed pOCs; 8226 cells actively attracted precursor OCs (pOCs) and induced OCs formation. When cultured for an additional 6-10 days in OC medium, pOCs differentiated into large, multinucleared OCs. When OCs were cocultured with myeloma cells, apparently all OCs remained alive after 7 days without addition of sRANKL and macrophage-colony stimulating factor (M-CSF). PBMC-OCs stimulated the proliferation of myeloma cells in cocultures and rescued MM cells death in serum-depleted cultures.Conclusion PBMC-OCs from healthy volunteers promoted MM cells growth and survival, MM cells actively attracted pOCs and induced OCs formation.

Chronic neutrophilic leukemia

Wu Xuebin

2014, 35(5): 577-580. doi:10.3969/j.issn.1006-7795.2014.05.010

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Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative neoplasm characterized by a proliferation mainly of mature neutrophils. The previous diagnostic criteria were not specific, the treatment was not effective and prognosis was poor. Recently, mutations in genes CSF3R and SETBP1 were identified which is expected to provide specific molecular markers for diagnosis and judgment of prognosis for CNL. And also, these novel molecular markers will likely facilitate therapeutic decision making, and further characterization of such mutations is anticipated.

Present status of studies on mechanism of thrombosis in multiple myeloma

Yang Yan, Yang Linhua

2014, 35(5): 581-584. doi:10.3969/j.issn.1006-7795.2014.05.011

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Multiple myeloma (MM) is a malignant tumor with abnormal proliferation of plasma cells. Individuals with MM have a higher risk of thrombosis than other solid tumors, and the development of thrombosis would impact the prognosis and long-term survival. The chemotherapy played an important role in thrombosis in MM except for the complications of the disease itself and the factors of tumor cells. Therefore, it is very important to understand the mechanisms and prevention of thrombosis in MM.

Effect of α-synuclein oligomer inhibit neurite outgrowth of rat primary cultured neuron

Wang Peng, Li Xin, Chen Yudong, Yang Weiwei, Li Xuran, Yu Shun

2014, 35(5): 587-591. doi:10.3969/j.issn.1006-7795.2014.05.013

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Objective To investigate the effect of oligomerization of α-synuclein on the neurite outgrowth of brain neurons and indicate its function, explore the mechanism of Parkinson's disease. Methods Neurons isolated from the neocortex of newborn SD rats were cultured and corresponding proteins were added into the culture medium to observe the effect of the protein on the neurite outgrowth of the neurons. Added α-Syn oligomer, α-synuclein monomer into the culture system of neural cells, and compared the different promoting effect of neurite outgrowth with that of control groups. Western blotting assays and immunofluorescence staining assay were used to confirm whether the result is special. Observed with inverted phase contrast microscope,and photographs were applied to analyze with software.Results The mean neurite length of the neurons treated by α-Syn oligomer was significantly shorter than that of the control group neurons (P<0.05). But the length of neurons treated by α-Syn monomer is longer than that of the control group (P<0.05). Increased concentration of α-synuclein oligomer can enhance this effect. The result of Western blotting and Immunofluorescence staining assay showed that α-synuclein oligomer can enter the neural cell and inhibit the neurite outgrowth. Conclusion α-Synuclein can inhibit neurite outgrowth of primary cultured neuron and this is a dose-dependent effect.

Differential expressions of oligomer α-synuclein in digestive tract in different ages of cynomolgus monkeys

Li Xin, Yang Weiwei, Li Xuran, Yu Shun

2014, 35(5): 592-595. doi:10.3969/j.issn.1006-7795.2014.05.014

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Objective To explore the expressions of oligomer α-synuclein (oligo-α-Syn) in digestive tract in different ages of cynomolgus monkeys. Methods Western blotting and ELISA was applied to measure the expressions of oligo-α-Syn in different ages of cynomolgus monkeys.Results The α-Syn oligomers increased significantly in the esophagus, stomach, duodenum, jejunum, ileum, colon of old monkeys compared with that of young and old monkey (P<0.01). Conclusion Oligo-α-Syn are the highest in digestive tract of old cynomolgus monkeys.

Alpha-synuclein promotes internalization of surface N-methyl-D-aspartate receptors in primary neurons and transgenic mice

Chen Yudong, Yang Weiwei, Li Xin, Wang Peng, Li Xuran, Yu Shun

2014, 35(5): 596-600. doi:10.3969/j.issn.1006-7795.2014.05.015

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Objective To investigate the effect of α-synuclein (α-Syn) on surface N-methyl-D-aspartate (NMDA) receptors on the primary neurons and transgenic mice.Methods Immunofluorescent labeling and Western blotting analysis were used to measure the alterations of NMDA receptors and Rab5B proteins. Rab5B antisense oligonucleotides were applied to suppress Rab5B expression. The primary neurons and transgenic mice were used as models to observe the effect of α-Syn on the surface NMDAR expression.Results α-Syn triggered a significant decrease of the surface NMDAR expression. This effect of α-Syn was blocked by suppression of Rab5B expression. Conclusion α-Syn promotes internalization of surface NMDA receptors by increasing Rab5B expression.

Effects of alpha-syn of N-methy-D-asparatic acid receptor in hippocampus neurons

Chen Yudong, Yang Weiwei, Li Xin, Yu Shun

2014, 35(5): 601-603. doi:10.3969/j.issn.1006-7795.2014.05.016

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Objective To elucidate the mechanisms of α-Syn inhibiting N-methy-D-asparatic acid(NMDA)receptors activities in hippocampal neurons.Methods Whole-cell patch-clamp recording was used to assess the effects of α-Syn on the NMDA currents in normally cultured hippocampal neurons. Results Peak amplitude of NMDA-evoked currents in cultured hippocampal neurons decreased significantly compared with that of NMDA currents in normally cultured hippocampal neurons. Conclusion These results suggest that α-Syn reduce the number of hippocampal neuron membrane NMDARs, and inhibit the activity of NMDARs.

Clinical features of 9 cases of sinusoidal obstruction syndrome

Wang Junyao, Zhang Guoyan, Zhu Yuanmin, Liu Yulan, Chen Ning

2014, 35(5): 604-607. doi:10.3969/j.issn.1006-7795.2014.05.017

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Objective Sinusoidal obstruction syndrome (SOS) is a clinical syndrome characterized by tender hepatomegaly, jaundice, and ascites, but not always easy to diagnose. This study aimed at summarizing several informative clinical presentations of SOS.Methods A total of 9 SOS cases seen from October 2009 to August 2014 were collected. Clinical materials including medical history, laboratory data, imaging features and outcomes were retrospectively analyzed.Results Majority of the 9 cases had a history of applying Chinese herbs before the onset of SOS. Most common clinical manifestations were bloating, right upper quadrant pain and weight gain. Biochemical tests revealed elevation of serum transaminase (especially AST>ALT) and hyperbilirubinemia. Serum-ascites albumin concentration gradient ≥11 g/L. Imaging examinations demonstrated hepatomegaly, inhomogeneous liver parenchyma and attenuated hepatic veins. Sinusoidal dilatation and hepatic cell necrosis were obvious in liver biopsy. Treatments were generally symptomatic and supportive. 2 cases of severe SOS died while the other 7 finally improved.Conclusion These 9 cases of SOS were mostly associated with Chinese herbs. Diagnosis was comprehensively based on clinical, laboratory, imaging and histological features. There were limited therapeutic options for SOS and severe cases had poor prognosis.

Isolation and identification of human adipose tissue-derived mesenchymal stem cells and differentiation into hepatocyte-like cells in vitro

Zhang Yunwei, Xu Lijuan, Wang Shufang, Yan Li

2014, 35(5): 608-616. doi:10.3969/j.issn.1006-7795.2014.05.018

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Objective To explore the method of isolation, culture and identification of human adipose-derived mesenchymal stem cells (hADSCs) and induce the hADSCs into hepatocyte-like cells in vitro.Methods hADSCs was obtained by collagenase I digestion centrifugation for primary culture and the stem cell surface antigens including CD13, CD73, CD34, CD45 and HLA-DR were determined by flow cytometry (FCM). The cells were induced into adipocytes and osteocytes by using induction medium. The hADSCs were induced by using the two-stage cytokine induction method and then the morphological changes were observed. The liver cell-related genes such as AFP, CK18, CK19 and so on were tested in the hepatocyte-like cells by RT-PCR. The expression of the above-mentioned molecules of the hepatocyte-like cells were tested by cell immunohisto- chemical method and glycogen synthesis function of the hepatocyte-like cells was tested by PAS staining. Results hADSCs obtained in the digestion centrifugation are of the uniform size and are fusiform fibroblast-like cells, their proliferation was good. Cells could survive and kept undifferentiated for a long time in vitro. Flow cytometry showed that cells highly expressed CD13, CD73, but the expression of CD34, CD45 and HLA-DR were low; hADSCs could be induced into adipocytes and osteocytes. After being induced into hepatocyte-like cells, the human adipose-derived cells, cellular morphology gradually became polygonal or round, showed high expression of liver cell-related gene, including alpha-fetal protein (AFP), albumin (ALB), and cytochrome CYP3A4. Besides, the obtained hepatocyte-like cells also expressed liver cell-related proteins incuding HepPar-1, AFP, CK18, CK19. PAS staining showed that the cytoplasm of hepatocyte-like cells were in red. Conclusion hADSCs could be isolated and obtained using digestion centrifugation, the obtained hADSCs could be repeatedly passaged and could survive for long time, and could be induced into functional hepatocyte-like cells in vitro, which provide experimental basis for ADSCs as seed cells of cell therapy, bioartificial liver and liver tissue engineering.

Symptoms and characteristics of gastroesophageal reflux disease during pregnancy and its effects on quality of life

Zhao Yuanyuan, Song Yang, Ma Hailian, Ji Ming, Li Peng, Zhang Shutian

2014, 35(5): 617-620. doi:10.3969/j.issn.1006-7795.2014.05.019

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Objective To explore the application of reflux symptoms questionnaire to evaluate the incidence of gastroesophageal reflux symptoms during pregnancy and its effects on quality of life.Methods Totally 120 women during different periods of pregnancy were chosen, and their frequency and degree of integration of 4 symptoms of regurgitation of food or nausea, heartburn, retrosternal pain and epigastric discomfort were recorded, and 40 non-pregnant women were enrolled as control, and statistics of the incidence and characteristics of gastroesophageal reflux symptoms during differernt periods of pregnancy were collected.Results 1There were significant differences among the three parameters of degree and frequency of acid regurgitation and frequency of heartburn of subjects during different periods of pregnancy (P<0.05). Among them, score of degree and frequency of reflux during early pregnancy were significantly higher than that of the other groups, and it was 8.70±6.49. However, degree and frequency of reflux gradually decreased with the increase of pregnancy. 2Through correlation analysis, vomiting of pregnancy was positively correlated with score of degree and frequency of reflux (r=0.69, P<0.01). 3Quality of life score of patients during each pregnancy had significant differences, and the results had statistical significance (P<0.05).Conclusion Gastroesophageal reflux symptoms during pregnancy were associated with vomiting of pregnancy. Quality of life was related to reflux during early pregnancy was the worst, and with the increase of gestational age, quality of life related to reflux improved to some extent.

Analysis of complications after placing fully covered self-expanding metal stent in patients with esophageal benign strictures

Yang Ling, Hao Xiaowen, Li Peng, Zhang Shutian

2014, 35(5): 621-625. doi:10.3969/j.issn.1006-7795.2014.05.020

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Objective To investigate the complications and prevention and control strategy after placing fully covered self-expanding metal stent for esophageal benign strictures. Methods A retrospective analysis was conducted in 40 patients with esophageal benign strictures after placing fully covered self-expanding metal stent. Results All cases with esophageal benign strictures had different levels of dysphasia, which was significantly improved after placing fully covered self-expanding metal stent. The main complications were: stent malapposition in 12 cases (malapposition frequency is 22), tissue overgrowth of stent in 9 cases (among them, 7 had difficult stent-removing), upper gastrointestinal bleeding in 2 cases (including one case who died of airway obstruction with esophageal arteries active bleeding), food obstruction in 2 cases in stent combined with dysphagia, 1 case failed to tolerate with the stent because of difficulty in breathing, and 1 case developed esophageal-tracheal fistula. Conclusion Complications are common in patients with esophageal benign strictures after placing fully covered self-expanding metal stent. Careful consideration is needed for this kind of diseases.

Diagnostic value of endoscopic retrograde cholangiopancreatography(ERCP) related techniques combined with serum CEA and CA199 for obstruction of bile duct

Fang Long, Fan Yanhua, Du Shiyu, Gao Chun, Liao Junxian

2014, 35(5): 626-629. doi:10.3969/j.issn.1006-7795.2014.05.021

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Objective To explore the diagnostic value of endoscopic retrograde cholangiopancreatography(ERCP)related techniques combined with serum CEA and CA199 for obstruction of bile duct.Methods A total of 155 patients with bile duct obstruction who were admitted to our hospital between June 2010 and December 2013 were included in this study. Serum tumor markers (CEA and CA199)were tested before ERCP. Bile cytology,bile duct brush cytology and bile duct biopsy were conducted during ERCP. We expressed the diagnostic value as the sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Youden index and Kappa value.Results Of the 155 patients, 56 had benign biliary obstruction and 99 had malignant biliary obstruction.Significant differences were found for serum CEA and CA199 between benign and malignant obstruction group patients [2.55(1.70-3.11)ng/mL vs. 3.26(1.95-7.00)ng/mL,P=0.002;46.91(13.24-115.90)U/mL vs 258.20(74.80-1000.00)U/mL,P=0.000].The 3 ng/mL and 150 U/mL were selected as the cutoff values for CEA and CA199,respectively.Based on the sensitivity and specificity,CA199 had a greater significance than CEA for bile duct obstruction. Bile duct brush cytology had a greater significance than bile cytology and bile duct biopsy.For bile cytology,bile duct brush cytology and bile duct biopsy,the sensitivity was 23.0%,72.0% and 69.1%,respectively,the specificity all were 100%,the positive predictive values all were 100%,the negative predictive values were 16.3%,34.4%,10.5%,the accuracy was 33.0%,75.6%,70.2%,the Youden index was 0.23,0.72,0.69,and the Kappa values were 0.072,0.397,0.136,respectively.Combined with one and more ERCP-related techniques,the combination of bile duct brush cytology with bile duct biopsy had the greatest significance than others.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Youden index,and Kappa value were 82.2%,100%,100%,40.7%,84.2%,0.822 and 0.502,respectively. For patients with serum CEA≥3ng/mL or CA199≥150U/mL,combined with bile duct brush cytology with bile duct biopsy,the sensitivity was 89.4%,83.0%,specificity all were 100%,positive predictive values all were 100%,negative predictive values were 50.0%,35.7%,accuracy was 90.4%,84.5%,Youden index were 0.894,0.830,and Kappa values were 0.618,0.457,respectively.The diagnostic values were increased.Conclusion The combination of bile duct brush cytology,bile duct biopsy during ERCP,and serum CEA,CA199 levels before ERCP had definite value for the diagnosis of bile duct obstruction.Serum CEA≥3 ng/mL could be used for the selection of patients with high risk before ERCP,bile duct brush cytology combined with bile duct biopsy was recommended for patients with bile duct obstruction and baseline serum CEA≥3 ng/mL.

Application of holmium laser in gastroscopy

Song Yang, Li Peng, Ji Ming, WuYongdong, Zhang Shutian

2014, 35(5): 630-633. doi:10.3969/j.issn.1006-7795.2014.05.022

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Holmium is a late-mode of solid pulsed laser. It has favorable effect in cutting soft tissues, vaporization, hemostasis and coagulation. It has a good ability in cutting tissue and its penetration is superficial therefore it is accurate to control. Holmium laser causes little thermal injury, it can be used to make precise incision, and is good in directivity. It can be transmitted by soft optical fiber and is highly suitable for gastroscopy. This article summarized the application of holmium laser in digestive system diseases, such as gastric bezoar, early digestive system cancer, esophageal stenosis, upper gastrointestinal polyps and so on.

CCAAT/enhancer binding protein has a negative role in human hepatic stimulator substant expression in HepG2 cells

Wu Yuan, Dong Lingyue, An Wei

2014, 35(5): 634-639. doi:10.3969/j.issn.1006-7795.2014.05.023

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Objective To study the site of a negative role of CCAAT/enhancer binding protein α (C/EBPα) in human hepatic stimulator substant(hHSS) expression and the affect of the regulation mechanism of EGF. Methods EMSAs were carried on to examine whether candidate transcription factor binds to the hHSS promoter. mRNA levels of hHSS expression were measured by real-time PCR. Protein levels of hHSS expression were measured by Western blot.Results Down-regulation of C/EBP expression significantly enhanced hHSS mRNA expression, yet did not affect EGF inhibition of hHSS mRNA expression. The results from EMSAs clearly demonstrate that C/EBP binds the C/EBP1 site. Conclusion C/EBP does not participate in EGF inhibition of hHSS mRNA, whereas it has a negative role in hHSS expression by binding the C/EBP1 site.

Distinct sensitivity of different arterial baroreceptors on ruthenium red

Zhao Haiyan, Huang Haixia, Liu Ping, Zhang Sitao, Niu Weizhen, Wang Wei

2014, 35(5): 640-645. doi:10.3969/j.issn.1006-7795.2014.05.024

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Objective To investigate if ruthenium red (RR) possesses differentiating effects on baroreceptors and to understand the relationship between these different effects and types of the baroreceptors. Methods Carotid sinus-nerve preparation of the rabbit was perfused intrasinusally and extrasinusally in vitro. Baroreceptor discharges were recorded from nerve filaments containing 2-5 fibers while the intrasinusal pressure was clamped with pulsatile or ramp waves. Single fiber discharges were obtained by sorting the few-fiber discharge using software Spike 2. Results According to the response to RR (20 μmol /L), baroreceptor fibers can be distinguished into two types: RR sensitive and insensitive fibers. To further analyze electrophysiological characteristics of the two types, we found that the RR sensitive and insensitive fibers correspond with C- and A-fibers, respectively.Conclusion Carotid sinus fibers can be classified into two types according to the response to RR (20 μmol /L). The two types of baroreceptors might belong to A- and C-fibers, respectively. The results suggested that the mechanisms for mechano-electrical transduction in the two types of baroreceptor fibers might not be the same.

About safety assessment of acer truncatum bunge leaves extract in vitro and in vivo

Gao Lifang, Cao Lige, Tian Mi, Hu Zijing, Gao Wen

2014, 35(5): 646-652. doi:10.3969/j.issn.1006-7795.2014.05.025

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Objective To determine the safety of acer truncatum bunge leaves extract (AT). Methods Acute oral toxicity testing of AT was performed in mice. Genotoxicity of AT was assessed by bone marrow micronucleus, mice sperm abnormality and bacterial reverse mutation tests. The subchronic toxicity study of AT was used via ninety days feeding test. Results The oral maximum tolerated dose of AT was more than 10g/kg, which belonged to an actual non-toxicity substance. The results of genotoxicity profiles were all negative. There was no significant difference in toxicity between control and AT treated animals with respect to general condition, body weight, food efficiency, food consumption and clinical chemistry parameters throughout the treatment at dose 1-2g/kg. But compared with the control group, body weight and food consumption were significantly lower in 6g/kg group male rats. And compared with the control group, hypoglycemic effect was indicated in 6g/kg group male rats after 45 days treatment. Conclusion The AT is safe and shows no evidence of observed adverse effect up to the 2g/kg dose.

Polysomnographic characteristics of obstructive sleep apnea syndrome complicated with rapid eye movement (REM) sleep behavior disorder

Chang Yi, Nie Xiuhong, Zhan Shuqin, Zhao Xin, Wu Siqi, Gu Zhuqin, Chen Biao

2014, 35(5): 653-656. doi:10.3969/j.issn.1006-7795.2014.05.026

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Objective To explore the relationship between REM sleep behavior disorder(RBD) and obstructive sleep apnea syndrome(OSAS).Methods Totally 76 OSAS subjects defined by AHI apnea-hypopnea index>10/h were enrolled from sleep disease center of Xuanwu Hospital from 2012 to 2013(28 RBD-OSAS cases and 48 OSAS controls). All subjects were undergone by one night video-polysomnography(vPSG) and the sleep apnea related parameters were compared between the two groups. Results Compared to OSAS group, RBD-OSAS patients had lower AHI index and hypopnea index, more severity of oxygen desaturation(baseline SpO₂ and minimum SpO₂) and longer maximum hypopnea time and <90% O₂ saturation duration(P<0.05).Conclusion RBD is capable of protecting against OSAS by increasing EMG activity of upper airway muscle tone during both REM and NREM sleep in RBD with OSAS patients. This result may provide a new direction for the treatment of OSAS.

Clinical application of total parenteral nutrition in patients with postoperative alimentary tract malignant tumor

Zhao Jingyang, Gu Mei, Zhu Changyu, Dang Shoutao

2014, 35(5): 657-659. doi:10.3969/j.issn.1006-7795.2014.05.027

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Objective To evaluate safety and efficacy of total parenteral nutrition(TPN) in patients with postoperative alimentary malignant tract tumor. Methods Twenty-seven patients with alimentary tract malignant tumor were treated with total parenteral nutrition after operation in oncological department of Beijing Tongren Hospital. Serum levels of albumin, prealbumin and transferrin were compared. Complications of total parenteral nutrition and serum levels of CEA and CA199 in 3 months after operation were observed. Results Serum levels of albumin and prealbumin were higher on the 4^th and 7^th day. And serum level of transferrin was higher on the 7^th day. Only one patient with catheter-related bloodstream infection was observed. Serum levels of CEA and CA199 in 3 months after operation were not elevated.Conclusion Total parenteral nutrition in patients with postoperative alimentary tract tumor is safe and effective.

Lichtenstein technique advantages compared to the traditional surgical treatment of inguinal hernia

Liu Housheng, Liao Qiu, Zhao Yong

2014, 35(5): 660-662. doi:10.3969/j.issn.1006-7795.2014.05.028

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Objective Reveals Lichtenstein technique advantages compared to the traditional surgical treatment of inguinal hernia. Methods Select our hospital 118 cases diagnosed from January 2011 to December 2013 surgical admitted for inguinal hernia. Press the number randomly divided into a control group and the observation group, 59 cases in each group. The control group received traditional hernia repair treatment. Observation group performed surgical Lichtenstein hernia repair. Two groups were compared operative time, hospital stay, postoperative ambulation and postoperative urinary retention, wound hematoma, scrotal fluid and edema, hematoma and other complications were observed. Results Through comparative analysis, the observation group surgery time, hospital stay, postoperative ambulation time, postoperative urinary retention, wound hematoma, scrotal effusion and edema, hematoma and other complications were lower than the control group, the difference was statistically significance (P<0.01). Conclusion Using Lichtenstein inguinal hernia surgical treatment has advantages over traditional hernia repair.

A follow up investigation of long-term prognosis of women who suffered from preeclampsia

Sang Cuiqin, Wang Shuzhen, Zhang Zhenyu

2014, 35(5): 663-666. doi:10.3969/j.issn.1006-7795.2014.05.029

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Objective To know about long-term prognosis of the babies and the women who suffered from preeclampsia before.Methods A total of 40 patients with preeclampsia who subject to inpatient delivery in our hospital 5 years before were reviewed retrospectively,the long term of maternal and fetal outcomes was followed up.Results 1 Perinatal infant dead rate was as high as 31.8%. Live fetus have normal growth and development,aslo have normal intelligence.The earlier the disease attacked, the higher perinatal infants dead rate was. 2Three mother dead after puerperium. Nine people left chronic hypertension should be long-term antihypertensive therapy. 3There was a high recurrent risk in subsequent pregnancy,but illness severity reduced.Conclusion To improve maternal health care network, pregnancy should be banned or induced earlier in those women who are suffering from so serious illness that is not suitable for pregnancy. Those who have already suffered from severe preeclampsia, should terminate pregnancy as soon as possible in order to keep mother safe. Expectant treatment cases must be strictly selected. Management should be stricted after delivery, in order to prevent the occurrence of heart cerebrovascular accident. The next pregnancy should be expected.

Application of integrated visual and auditory continuous performance test to evaluate the curative effect of EEG biofeedback on attention deficit hyperactivity disorder(ADHD)

Ren Lingmin, Zhang Yun, He Huili, Chen Jingjing

2014, 35(5): 667-670. doi:10.3969/j.issn.1006-7795.2014.05.030

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Objective Apply Integrated Visual and Auditory Continuous Performance Test to evaluate the curative effect of electroencephalographic(EEG) biofeedback treatment on Attention Deficit Hyperactivity Disorder(ADHD). Methods Fifty cases of ADHD children in Psychology Department of our hospital from January 2013 to March 2014 were selected to accept EEG biofeedback training ( five times a week, 30 minutes per time, 20 times as a course).All patients accepted two continuous courses of EEG biofeedback training. Integrated Visual and Auditory Continuous Performance Test(IVA-CPT) was applied to detect visual-auditory control and Visual-Auditory attention before and after the treatment. We will compare the changes of the relative quotients, to evaluate comprehensively of the curative effect of EEG biofeedback.Results After the training, integrated control and integrated attention of children were significantly improved(P<0.001). Except willpower quotient and speed quotient, the differences were statistically significant. Conclusion EEG biofeedback training is an effective method for ADHD which is worth being popularized clinically.

"Inner GPS" in the brain——introduction of Nobel Prize in Physiology or Medicine 2014

Wang Ke, Zhang Ting, Wang Xiaomin

2014, 35(5): 671-675. doi:10.3969/j.issn.1006-7795.2014.05.031

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The Nobel Prize in Physiology or Medicine 2014 was divided, one half awarded to John O'Keefe, the other half jointly to May-Britt Moser and Edvard I. Moser for their discoveries of cells that constitute a positioning system in the brain.

Consideration of editorial work In the clinical medical certification environmental

Mu Meng, Zhang Junmin, Sun Chaoyuan, Chen Ruifang

2014, 35(5): 676-678. doi:10.3969/j.issn.1006-7795.2014.05.032

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In October 2014, Capital Medical University would meet Clinical Medicine Professional Certification. According to the requirements of the school, from several aspects including the guarantee of quality, providing good services to the Capital Medical University discipline construction, personnel training and opening up thinking seriously about humanities characteristic columns, Editorial Office of Journal of Capital Medical summarized the related work and prepared for the certification.

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