Volume 85  ·   Issue 25  ·  2005

Angiotensin receptor antagonists (ARBs) have been established as effective antihypertensive agents in the past 5 to 10 years.

In recent years, it has been found that hyperexcitation of renin-angiotensin system (RAS) plays an important role in the pathogenesis of cardiovascular complications in chronic renal failure. Therefore, blocking RAS may be one of the measures to reduce such complications.

Objective to evaluate the clinical efficacy and side effects of late course conformal radiotherapy (3D-CRT) combined with chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Methods 96 cases of stage Ⅲ and Ⅳa nasopharyngeal carcinoma (NPC) were randomly divided into 46 cases of late course conformal radiotherapy combined with chemotherapy group (experimental group) and 50 cases of conventional radiotherapy combined with chemotherapy group (control group). The two groups were given cisplatin (DDP) + calcium leucovorin (CF) +5-fluorouracil (5-FU) regimen (CPF regimen) for 1 cycle before radiotherapy, and then 1 cycle after radiotherapy. The 1-year local control rate of nasopharyngeal carcinoma in the experimental group was significantly higher than that in the control group (97.83% and 78.00%, respectively, P =0.003); There was no significant difference in the distant metastasis rate between the two groups; The incidence of radiation-induced dental caries and radiation-induced otitis media in the experimental group was significantly lower than that in the control group (P =0.004,0.000); There was no significant difference in nausea and vomiting, hematotoxicity and oral mucosal reaction of degree Ⅲ ~ Ⅳ between the two groups. Conclusion Late course 3D-CRT combined with chemotherapy can improve the local control rate, reduce the distant metastasis, and reduce the radiation injury and radiation complications in locally advanced nasopharyngeal carcinoma.

Objective to compare the predictive ability of three different predictive systems, MELD, CTP and King's system, for chronic severe hepatitis; Methods All patients with chronic severe hepatitis who were admitted to Beijing You' an Hospital from February 2000 to February 2001 were divided into three groups: early stage (n =11), middle stage (n =14) and late stage (n =15) according to the criteria of 2000 National Academic Conference on Viral Hepatitis, and patients who could not be classified (n =26). The accuracy of each prediction model was evaluated according to the above three system scores and ROC curves; Kaplan-Meier Survival Curve Analysis of Different Forecasting Models; The MELD system was used to predict the effect of artificial liver treatment. The end point time of observation was 3 months. Results the MELD score at admission was very good in predicting the mortality of patients with severe hepatitis within 3 months. The c-statistic was 0.894 (sensitivity 100%, specificity 71%). The scores of MELD system in the early, middle and late stages of chronic severe hepatitis were 24.0±4.6, 31.1±2.9 and 41.4±10.0 (P<There was a significant correlation between the two (r =0.756, P<The effect of MELD scores on the therapeutic effect of artificial liver was obvious. The mortality of MELD scores ≤30, 31-39 and ≥40 were 10.7%, 47% and 60%, respectively. The Kaplan-Meier survival curve showed that the survival status of each MELD score was significantly different (Log-RanK test P<Conclusions (1) The predictive ability of MELD system is better than that of CTP and KCH. (2) If the MELD score is between 30 and 40 at the time of admission, the effect of artificial liver treatment is stronger than that of medical treatment; However, the mortality rate of patients with MELD score>40 was higher than 60%, and even artificial liver treatment could not improve the mortality rate, so patients should be mobilized to undergo liver transplantation as soon as possible; MELD score<30, and the mortality rate of KCH positive patients after artificial liver treatment in the past 3 months was only 9%.

Objective to observe the expression of amyloid β 1-40 (A β 1-40) and its amyloid β precursor (β-APP) in hippocampal CA1 neurons after cerebral ischemia.Methods 43 necropsy samples of infarction due to cerebral ischemia were collected and divided into ischemic 2-6 h, 7-24 h, 25-48 h, 49-72 h, 73-96 h, 97-144 h and 145-168 h groups according to the ischemic time (time from onset to death). The expression of A β 1-40 and β-APP in hippocampal CA1 neurons was detected by immunohistochemical staining, and the positive cells were counted under microscope by SPSS 11.5 statistical software. Results Compared with the control group (2.88 ± 0.18/high power field), the expression of A β 1-40 increased (22.44 ± 2.79/high power field) in the ischemic group at 2-6 h, reached a peak (36.30 ± 2.67/high power field) at 73-96 h, and then decreased, but still higher than that in the control group. The number of β-APP positive cells in the ischemic group at 7-24 h (28.11 ± 2.03/high power field) was significantly lower than that in the 2-6 h group (33.30 ± 0.42/high power field), and the number of positive cells increased after 24 h, reached a peak (32.32 ± 1.36/high power field) at 73-96 h, and decreased after 96 h, but still higher than that in the control group (25.90 ± 1.55/high power field). The increase of β-APP and the increase of A β 1-40 were significantly positive after 24 h

Objective to investigate the molecular mechanism of apoptosis induced by growth inhibitory factor (PML) in bladder tumor cells. Methods Lipofectamine2000 was used to transfect recombinant eukaryotic expression vector PMEP4/PML and empty control PMEP4 into bladder tumor cell line UM-UC-2. Resistant clones stably expressing PML were screened by 300 μ g/ml hygromycin B. The expression of PML protein was detected by laser confocal method. Apoptosis of tumor cells was detected by DNA ladder method. The expression of apoptosis-related proteins was detected by Western blot method. Results After the expression was induced by 5 μ mol/L CdSO4, laser confocal microscopy showed that there were scattered yellow-green fluorescent spots in the nucleus of the cells transfected with PMEP4/PML, but no specific fluorescent spots were observed in the cells transfected with empty vector PMEP4. The DNA gradient method showed that the cells transfected with PML appeared ladder-like apoptosis band 24 h after induction of PML expression. Conclusion PML-induced apoptosis of bladder tumor cells may be related to the upregulation of cysteine hydrolase 3, the activation of PARP protein and the inhibition of the expression of survivin.

Objective to investigate the mechanism of photodynamic therapy of bladder cancer with CDHS801. Methods T24 cells were incubated with CDHS801, and the subcellular localization of CDHS801 was analyzed by using MitoTracker RED CMXRose and MitoTracker Green FM with laser confocal microscope. The survival rate after photodynamic therapy was detected by MTT assay. T24 staining was observed by acridine orange/ethidium bromide staining with laser confocal microscope. The ultrastructure changes of the cells were detected by electron microscope, and the apoptosis was judged by flow cytometry. Results Under laser confocal microscope, the fluorescence emitted by CDHS801 and mitochondrial fluorescent probe was located in the cytoplasm and distributed in dots around the nucleus. After PDT, the cell survival rate of the experimental group was significantly reduced, the loss of cell membrane integrity was stained yellow, and the apoptosis peak appeared in sub-G1 phase by flow cytometry PI staining. Under transmission electron microscope, the chromatin of the cells concentrated under the nucleus membrane to form crescent body, and the cells underwent apoptosis, but the control group did not have these manifestations. Conclusion Distributed in cytoplasm, mainly in mitochondria, bladder cancer cells underwent apoptosis after laser irradiation.

Objective to establish an oligonucleotide chip for the detection of cytokines tumor necrosis factor (TNF) -α, interleukin (IL) -10, transforming growth factor (TGF) -β 1, IL-4, IL-6 and their receptor single nucleotide polymorphism, and evaluate its performance by sequencing and other methods. Methods According to relevant literature, SNP database of NCBI and SNP 500 Cancer database of NCI, 59 oligonucleotide probes were selected and designed. The genomic DNA was amplified by multiplex polymerase chain reaction (PCR), labeled with Cy5. The labeled products were hybridized with the probes on the chip, and the genotypes of each locus were judged by laser scanning and fluorescence signal analysis, and verified by sequencing. Results 130 peripheral blood samples were detected successfully, except 10 samples without PCR products due to long time, and the remaining 120 samples were detected successfully. There was no difference in three repeated tests, and there was no locus error in sequencing. Conclusion Detection of cytokines by oligonucleotide chip technology It has the advantages of high specificity, high sensitivity, good repeatability, high throughput and simple operation. It is an ideal method.

Objective to observe the dynamic changes of cerebral primary motor cortex after total brachial plexus injury by functional magnetic resonance method, and to explore the possible mechanisms. Methods 5 patients with total brachial plexus injury confirmed by clinical examination and surgery, 4 patients underwent nerve translocation to partially restore the function of elbow and shoulder joints. According to whether the patients had undergone MR examination before surgery, the patients were divided into two groups: Group A, 4 patients undergone fMRI examination before surgery (Cases 1, 3, 4, 5), and Group B, 4 patients undergone fMRI follow-up after surgery (Cases 2, 3, 4, 5). The fMRI examination was done by oxygen saturation dependent (BOLD) method, and the motor task included simple palm movement of both hands, and the hand movement of the affected side required to be completed in "simulation" state. Then, the size and location of excitation pixels in the activation area were recorded, and the signal intensity was observed. A single subject was compared with the activation area of cerebral cortex when the healthy limb moved as a reference, and the observation results of normal volunteers were used as a reference, In Group A, when the affected hand simulated "movement", 2 cases observed scattered and punctate excitation area in the contralateral primary motor cortex, and the signal intensity was significantly weaker than that in the representative area of the healthy hand, and 2 cases did not see activation area, and all cases had nerve activity in the auxiliary motor area. In Group B, with the prolongation of time, the activation area appeared in the contralateral primary motor cortex of the affected limb and showed a gradual increase trend. Conclusion After peripheral nerve injury, the primary motor cortex can change significantly, and functional magnetic resonance is an effective non-invasive method to evaluate the plasticity change of motor cortex after peripheral nerve injury.

Objective to investigate the effect of hypoxia on the expression of cyclooxygenase 2 (COX-2) in human temporomandibular joint synovial fibroblasts, and to explore its biological role in temporomandibular joint disorders (TMD). Methods the expression levels of COX-2 gene and protein in synovial fibroblasts during different periods of hypoxia were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot. The changes of prostaglandin E2 (PGE2) and metallomatrix proteinase 2, 9 (MMP-2, MMP-9) secretion in the hypoxia group and the combination of hypoxia and COX-2 inhibitor celecoxib were determined by ELISA and gelatin zymography, respectively. Results (1) The mRNA of COX-2 in the hypoxia group and the normoxic group were 1.51±0.34 and 1.39±0.57 respectively by RT-PCR and 0.65±0.24 and 0.71±0.15 respectively (all P<(2) The expression of COX-2 protein was determined by Western blot, and the expression of COX-2 protein was 0.29±0.06 at 6 h, 0.51±0.09 at 12 h, and 0.68±0.11 at 24 h after hypoxia, but the expression of COX-2 protein was not detectable in the normoxic group (all P<The expression of COX-2 protein increased in a time-dependent manner. (3) The release of PGE2 (7.6 ng/ml ± 0.8 ng/ml) was significantly higher than that in the normoxic group (2.5 ng/ml ± 0.4 ng/ml, P<0.01); The combined drug treatment group (4.3 ng/ml ± 0.4 ng/ml) was also significantly lower than that in the hypoxia group (P<(4) After 12 h hypoxia, the secretion of MMP-2 and MMP-9 was higher than that in the normoxic group, but the secretion capacity was weakened under the combined action of drugs. Conclusion Tissue hypoxia is an important factor leading to TMD; Under hypoxia, human synovial fibroblasts may influence the progression of temporomandibular joint lesions caused by hypoxia by increasing the expression of COX-2.

Objective to investigate the application value of radiofrequency ablation (RFA) standardized treatment and comprehensive measures in improving the curative effect of liver tumors.Methods 302 cases of 476 liver malignant tumors were treated with RFA, and the standardized treatment plan and additional treatment methods were applied to summarize the curative effects.181 cases of primary liver cancer (HCC), 282 tumor foci, with an average tumor size of 4.2 cm, and 121 cases of liver metastatic cancer (MLC), 194 tumor foci, with an average tumor size of 3.9 cm. According to the tumor size, shape and adjacent to diaphragm, gallbladder, gastrointestinal and other different locations, the corresponding standardized and individualized protocols were used. Attach importance to the method and operation skill of ablation needle in adjacent important structural areas; Results the tumor inactivation rate was 95.7% (270/282) for HCC and 94.8% (184/194) for MLC after 1 month after RFA. 91.1% (51/56) of adjacent intestinal tumors, 88.5% (69/78) of adjacent diaphragm tumors and 94.3% (49/52) of adjacent gallbladder tumors were observed. The local recurrence rate of HCC was 10.3% (29/282) and MLC was 14.4% (28/194) after 3-57 months follow-up. The survival rate of 1, 2 and 3 years was 87.6%, 67.4% and 58.6%; The survival rates of 50 patients with stage Ⅰ ~ Ⅱ hepatocellular carcinoma were 90.7%, 85.9% and 73.7% respectively, MLC was 87.4%, 48.2% and 25.3%, and complications accounted for 2.2% (13/583); Five cases of hemorrhage were treated with local ablation and systemic medication. One case of intestinal perforation was prevented by prolonging fasting time after treatment for adjacent intestinal tumor. The remaining 7 cases were mild injury of adjacent organ structure, and there was no death related to radiofrequency therapy. Conclusion Standardized RFA treatment plan and appropriate individualized treatment plan, emphasizing the application of additional methods, can help to improve the inactivation rate of liver tumor; To master the types of major complications and the corresponding preventive measures is an important link to improve the curative effect and promote the treatment of RFA.

Objective to investigate the effects of different doses of angiotensin converting enzyme inhibitor (ACEI) on brain natriuretic peptide and norepinephrine (NE) in patients with chronic heart failure, and to investigate the feasibility and safety of higher doses of ACEI. Methods Sixty-six patients with chronic heart failure were randomly divided into perindopril small dose group (33 cases, 2~4 mg/d) and higher dose group (33 cases, 8~10 mg/d) for 12 weeks. All indexes [NE, brain natriuretic peptide concentration, left ventricular end-diastolic diameter (LVED), left ventricular ejection fraction (LVEF), etc.] were measured before and after treatment. There was a significant positive correlation between brain natriuretic peptide and LVED and NE (r =0.42, P =0.015; r =0.402, P =0.002). After 12 weeks of treatment, 7 patients withdrew due to intolerable cough reaction (3 cases in the smaller dose group and 4 cases in the larger dose group), and the other 59 patients completed the study. The concentrations of brain natriuretic peptide and NE in the smaller dose group were 8 μ g/L ± 4 μ g/L and 387 ng/L ± 211 ng/L after treatment, and the concentrations of brain natriuretic peptide and NE in the larger dose group were 6 μ g/L ± 4 μ g/L and 250 ng/L ± 63 ng/L after treatment. The concentrations of brain natriuretic peptide and NE in the larger dose group were significantly lower than those in the smaller dose group after treatment (all P<Conclusion Plasma brain natriuretic peptide concentration is closely correlated with the severity of heart failure, and is positively correlated with NE concentration in patients with chronic heart failure. Perindopril can significantly reduce brain natriuretic peptide and NE in patients with chronic heart failure by administering small dose gradually increasing dose, and it is well tolerated.

Nosocomial infection is not only a serious medical problem, but also a problem that has plagued the management workers of medical institutions for a long time. The harm caused by nosocomial infection is manifested in many aspects, the direct victims are patients and their families, which are physical, mental and economic damage and loss, and may even pay the price of life. As the birthplace of infection, the hospital that treats patients seems to be both the perpetrator and the indirect victim, including the disruption of normal hospital order, extra increase of workload, economic loss and so on.

A 49-year-old female was admitted to hospital on July 28, 2004 due to the discovery of skin ecchyma in both upper limbs and hematoma in left buttock for more than 2 months.

There are two ways of embryonic angiogenesis, namely, vasculogenesis and angiogenesis. angiogenesis refers to the process in which mesoderm-derived angioblasts migrate, aggregate and differentiate into mature endothelial cells, and form primitive capillary network in situ or at a distance [1].

Clinically, most patients with obstructive jaundice caused by malignant tumors are in advanced stage at the time of consultation, and the surgical resection rate is low. Some patients can only undergo palliative surgery, and traditional surgical methods have certain complications and mortality. For patients with malignant obstructive jaundice that are difficult to be treated by surgery, in order to further improve the curative effect, 28 patients with obstructive jaundice were treated with bile duct and jejunum bridge internal drainage from October 2000 to October 2004, and the clinical results are satisfactory.

Laparoscopic pancreatic surgery is still rare in China because the pancreas is deep in the abdomen, difficult to expose, and severe complications such as pancreatic leakage are easy to occur after operation. Since December 2003, we have performed 8 consecutive cases of laparoscopic pancreatectomy, all of which were successful and satisfactory, and the results are reported below.

A 47-year-old female suffered from non-insulin-dependent diabetes mellitus (NIDDM) for 12 years, complicated with diabetic microvascular disease. The patient was treated with oral hypoglycemic drugs, but the blood glucose control was not satisfactory [glycosylated hemoglobin (Hb) A1c15%]. In June 2001, the patient went to a private hospital with non-induced right thigh pain and swelling as the main complaint. Magnetic resonance imaging (MRI) showed significant enhancement of T2-weighted layer signal of right medial femoral muscle, and histological biopsy showed acute myositis with mild muscle necrosis. The patient was diagnosed as right medial femoral muscle inflammation. After 1 month of oral antibiotic treatment, she was discharged from hospital.

A 22-year-old female from Inner Mongolia was admitted to the General Hospital of the People's Liberation Army on January 18, 2005 with the main complaint of "distension and pain in the upper abdomen for more than 6 months". The distension and pain gradually worsened after meals. There was no fever or jaundice, and there was no significant weight gain or loss recently.

In order to further understand the biological characteristics of hilar cholangiocarcinoma, we established a hilar cholangiocarcinoma cell line named FRH-0201, which has been passed down for 160 generations and has grown stable.

Uric acid (UA) is the final product of purine metabolism. When the production of UA increases or/or the excretion of UA decreases, it can cause the concentration of uric acid in blood to increase and cause hyperuricemia (HUA). This cross-sectional study focused on the status of blood UA level in middle-aged people in Qingdao urban area, and investigated the relationship between HUA and other risk factors of cardiovascular disease.

The increased risk of invasive pneumococcal infection in patients with chronic obstructive pulmonary disease (COPD, such as emphysema and chronic tracheitis) has been confirmed, but the situation in asthma patients is unclear. Talbot et al. used an intra-cohort case-control study to analyze the association between asthma and invasive pneumococcal disease, and the results were published in the New England Journal, May 19, 2005 (N Engl J Med, 2005: 352: 2082-2090).

On July 8, 2005, the Department of Disease Control of the Ministry of Health and the Allergy Branch of the Chinese Medical Association announced that we will participate in and support the global initiative of the World Allergy Organization (WAO). July 8, 2005 is the world's first Allergic Diseases Day.

Professor Yao Yan of the Arrhythmia Diagnosis and Treatment Center of Beijing Fuwai Cardiovascular Hospital of Chinese Academy of Medical Sciences, on the basis of summarizing the previous experience in the treatment of atrial fibrillation (AF), used intracardiac non-contact isopotential mapping technology to individualize the "disease base" causing AF, and achieved nearly 90% of the conversion rate of AF.

A 45-year-old female patient was admitted to Beijing Xuanwu Hospital of Capital Medical University on December 5, 2003 with upper abdominal pain for 1 month. After admission, a mass of 5 cm ×6 cm was palpable under the xiphoid process in the middle and upper abdomen, with unclear boundary and tenderness.

The 4th C1 inhibitor deficiency workshop (4th C1 inhibitor deficiency workshop) was held in Budapest, Hungary, from April 28, 2005 to May 1, 2005. Nearly 200 delegates from 23 countries attended the workshop. C1INH deficiency can be divided into hereditary and acquired. hereditary C1INH deficiency, also known as hereditary angioedema (HAE), is a rare autosomal dominant genetic disease. The etiology is caused by the defect of the gene encoding C1INH, which leads to plasma C1INH deficiency, and the incidence is about 1/10 000~50 000. Its clinical manifestation is recurrent skin and mucosa edema, mainly involving the limbs, face, upper respiratory tract and gastrointestinal tract. If not diagnosed and treated in time, 30% of patients die of asphyxia due to laryngeal edema. At present, more and more studies support that bradykinin is the main mediator of clinical symptoms of HAE. Acquired C1INH deficiency (AAE) is caused by excessive consumption of C1INH caused by immune and other reasons, and its incidence is much lower than that of HAE.