Volume 85  ·   Issue 26  ·  2005

Aging is the common characteristic of all life phenomena in nature, which is manifested as the degenerative change of morphological structure and physiological function. Menopause is the transition period and prelude from middle age to old age, and it is the transition stage from maturity to aging. It is the objective law of life activity, and it is a natural phenomenon that does not depend on human will.

Objective to investigate the etiology, surgical indication, valve selection and postoperative anticoagulation of valvular heart disease in children.Methods the clinical data of 105 children who underwent valve replacement from May 1984 to May 2004 were retrospectively analyzed.The patients were 1.5~16 (13±3) years old; Among them, 43 cases were congenital heart valve disease, 55 cases were rheumatic heart valve disease, and 7 cases were infectious endocarditis; There were 58 cases of mitral valve replacement, 28 cases of aortic valve replacement, 5 cases of tricuspid valve replacement, 13 cases of double mitral and aortic valve replacement, 1 case of double mitral and tricuspid valve replacement, and 26 cases of tricuspid valve replacement; Preoperative cardiac function was grade Ⅱ in 36 cases and grade Ⅲ and Ⅳ in 69 cases. All patients were treated with artificial mechanical valve. After replacement, all patients were treated with oral low dose warfarin for long time. Results 5 cases (4.8%) died early, mainly severe low cardiac output syndrome after operation. The follow-up period was 6 months to 20 years, with an average of (10 ± 4) years. 91 cases were followed up, and 9 cases were lost to follow-up. 4 cases died late, 2 cases died of infectious endocarditis, 1 case died of intractable heart failure, and 1 case died of severe arrhythmia. 87 survivors recovered well, and no serious complications related to anticoagulation were found. The valve function was good, and the cardiac function was grade Ⅰ ~ Ⅱ. Conclusion Mechanical valve is effective in children's heart valve replacement. Larger valve should be used as much as possible during operation. It is safe and reliable to correct the combined deformities and low intensity anticoagulation after operation.

Objective to investigate the possibility of prenatal diagnosis of fetuses with EDA in X-linked anhidrosis ectodermal dysplasia (EDA) families, and to provide evidence for establishing prenatal diagnosis and genetic counseling.Methods the chromosome aberrations of one family of X-linked EDA were detected by karyotype analysis and pedigree analysis, and the prenatal diagnosis and postnatal identification of fetuses with suspected EDA were performed by combining fetal umbilical cord blood karyotype analysis, fetal necropsy, X-ray photography of fetal mandible, histopathological analysis and skin immunohistochemical cytokeratin (CK) and epithelial membrane antigen (EMA) detection. Results the karyotype analysis of probands and carriers in EDA families showed that one X chromosome showed interarm inversion [inv (X) (p22q13)], and the fetal umbilical cord blood karyotype was the same as that of probands. Fetal autopsy and histopathological analysis showed epidermal dysplasia, absence of sweat glands, hair follicles and sebaceous glands, which coincided with anhidrated ectodermal dysplasia. The dermal tissues of face, chest, upper abdomen and thigh were negative for CK and EMA, and the rest of the gross and microscopic pathological examinations were no special. Conclusion One X chromosome was interarm inversion in this family, and the breakpoint of [inv (X) (p22q13)] was located in the pathogenic gene region, which may be the cause of EDA.

Objective to investigate the possibility of benign and malignant cystitis glandularis and carcinogenesis, and to explore the rationality of clinical classification.Methods Cystitis glandularis was divided into low-risk type and high-risk type according to the cystoscopic manifestation.Fresh tissues of 25 cases of cystitis glandularis, including 12 cases of low-risk type and 13 cases of high-risk type, were detected by flow cytometry; The expressions of proliferating cell nuclear antigen (PCNA), mutant p53, p21ras, bcl-2 and Rb were studied by immunohistochemistry in 38 cases of cystitis glandular.The normal diploid DNA index was 1.00±0.03, 1.01±0.05 in low-risk cystitis glandularis group and 1.05±0.07 in high-risk group. The difference between low-risk group and high-risk group was not statistically significant (t = -1.639, P =0.115). The expression of PCNA and p53 was negative in the low-risk group, and the expression of PCNA and p53 was negative in 5 cases (27.8%) and 4 cases (22.2%) in the high-risk group, respectively. The difference between the two groups was statistically significant (P values were 0.017 and 0.041, respectively); There is no significant difference in the expression of p21ras, bcl-2 and Rb between low-risk and high-risk groups. Conclusion High-risk cystitis glandularis and low-risk cystitis glandularis are both benign lesions, and high-risk cystitis glandularis has the possibility of malignant transformation, so it is reasonable to divide cystitis glandularis into high-risk and low-risk types. p53 gene may play an important role in the malignant transformation of high-risk cystitis glandularis.

Objective to observe the effect of rhein acid on glomerular sclerosis and apoptosis, and to investigate the protective effect of rhein acid on glomerular sclerosis. Methods A rat model of glomerular sclerosis was prepared by unilateral nephrectomy and tail vein injection of doxorubicin. Rats were randomly divided into control group, nephropathy group, rhein acid treatment group and benazepril treatment group. Six rats in each group were sacrificed at 6, 8, 10 and 12 weeks, respectively. caspase-3 was measured by immunohistochemical staining, caspase-3 activity was measured by colorimetry, nuclear factor-κ B (NF-κ B) activity was detected by gel electrophoresis mobility conversion assay (EMSA), and apoptosis was detected by in situ terminal transferase labeling (TUNEL). The expression of caspase-3, NF-κ B and apoptosis of renal tissues were observed. Results The nephropathy group showed obvious proteinuria, serum albumin decreased and cholesterol increased, and the glomerular sclerosis index, apoptosis index, NF-κ B activity and caspase-3 expression were significantly higher with time than the control group (<0.05 or P<The number of TUNEL positive cells in the nephropathy group at 10 weeks was slightly higher than that at 12 weeks (9.3±2.3 vs 8.4±1.2, P>0.05), and the expression of caspase-3 was also the most significant, significantly higher than that at 12 weeks (11.4±2.5 vs 8.2±1.7, P<After treatment with rhein or benazepril, TUNEL-positive cells decreased significantly from 8 weeks onwards, and maintained at a certain level, NF-κ B activity and caspase-3 expression both decreased (P<The expression of caspase-3 in renal cortex was positively correlated with apoptosis index (r =0.836, P<Conclusion Rhein has obvious preventive and therapeutic effects on glomerular sclerosis, which may regulate the pathological changes in the early stage of glomerular sclerosis by affecting the activities of NF-κ B and caspase-3. The decrease of caspase-3 expression may be one of the molecular mechanisms of rhein in reducing apoptosis of glomerular sclerosis cells.

Objective to investigate the effects of angiotensin Ⅱ (AngⅡ) and aldosterone (Aldo) on the signal transduction pathways of extracellular regulated protein kinase (ERK) and activated protein-1 (AP-1) in hepatic stellate cells (HSC). Methods HSC-T6 cell lines were treated with AngⅡ1 μ mol/L and Aldo1 μ mol/L, respectively, and the levels of phosphorylated P42/44 protein were detected by Western blot. In addition, the effects of AngⅡ1 receptor (AT-1 receptor) blocker-irbesartan, extracellular regulated protein kinase (ERK) specific inhibitor-U0126, antioxidants-acetylcysteine (NAC), angiotensin converting enzyme inhibitor (ACEI) and tumor necrosis factor α (TNF α) on the levels of phosphorylated P42/44 protein were detected by electrophoretic mobility change analysis (EMSA). The expression of α 1-Ⅰ procollagen gene was detected by reverse transcription polymerase chain reaction (RT-PCR). Results AngⅡ and Aldo could induce the changes of phosphorylated P42/44 protein levels, the ratios of which reached 4.3±0.1 and 4.0±0.1 as compared with those of the negative control group, and reached the peak value after 10 minutes, and then gradually decreased. AngⅡ and Aldo can enhance the DNA binding activity of AP-1 in HSC. irbesartan and ACEI can significantly inhibit the activity of AP-1; U0126 and NAC can significantly inhibit the activation of AP-1 induced by AngⅡ and partially inhibit the activation of AP-1 induced by Aldo. AngⅡ and Aldo can induce the expression of α 1-Ⅰ procollagen mRNA. irbesartan, U0126 and NAC can significantly inhibit the expression of α 1-Ⅰ procollagen mRNA induced by AngⅡ. U0126 and NAC can significantly inhibit the expression of α 1-Ⅰ procollagen mRNA induced by Aldo. Conclusion AngⅡ and Aldo can induce the enhancement of AP-1 binding activity in HSC through ERK pathway. AngⅡ and Aldo can regulate the expression of α 1-Ⅰ procollagen gene through AP-1 pathway.

Objective to investigate the effects of aldose reductase (AR) on the expression of fibronectin (FN) and collagen type IV (Col IV) protein in rat mesangial cells (MsC) induced by transforming growth factor β 1 (TGF-β 1) and their possible involvement in signaling pathways. Methods AR eukaryotic expression plasmid pCDNA3-AR was constructed by subcloning, and pCDNA3-AR was stably transfected into rat MsC by liposome mediation and G418 screening. The expression of AR in transfected MsC was detected by reverse transcription polymerase chain reaction (RT-PCR), Western blot and immunofluorescence. The expressions of FN, Col IV and MAPK/phospho-MAPK in normal MsC and AR transgenic MsC incubated with aldose reductase inhibitor (ARI) Sorbinil and Zopolrestat were detected by Western blot method before and after TGF-β 1 stimulation. Results Compared with normal MsC, both ARI Sorbinil and Zopolrestat could down-regulate the expression of FN and Col IV in MsC, while the expression of FN and Col IV in AR transgenic MsC increased (both P<0.05); After incubation with TGF-β 1, the expression of FN and Col IV proteins in MsC increased, and after incubation with Sorbinil or Zopolrestat, the expression of both proteins decreased, while the expression of both proteins increased further in AR transgenic MsC (both P<The expressions of total ERK, JNK and p38 in all groups were not significantly changed before and after TGF-β 1 stimulation. The expressions of phospho-ERK, phospho-JNK and p38 in normal MSCs increased after TGF-β 1 stimulation. Compared with the same, the expressions of phospho-JNK and p38 decreased after incubation with Sorbinil or Zopolrestat in advance, and the expression of phospho-JNK increased in AR transgenic MSCs (P<Conclusion AR gene, as one of TGF-β 1 responsive genes, may be involved in the regulation of FN and Col IV expression induced by TGF-β 1, and the role of AR may be related to the activation of JNK-MAPK and p38-MAPK signaling pathways after TGF-β 1 stimulation.AR may be involved in the pathological development of glomerular fibrosis and sclerosis caused by non-diabetic patients.

Objective to explore the feasibility of carrying out the "concern for early childhood development" project in poverty-stricken rural areas, so as to provide reliable basis for the further promotion of the project. Methods 100 normal healthy children under 2 years old and their mothers from 7 administrative villages under the national poverty-stricken county (Changfeng County) of Anhui Province with an average annual income of about 800 yuan were selected and divided into an experimental group (with project intervention) and a control group by means of computer-generated random numbers. Through questionnaires, the mothers' understanding of children's development knowledge and the changes of their attitudes towards the project before and after the project was implemented, and the differences in cognition and work quality of 29 village doctors before and after the project was implemented were understood. The effect of the project implementation on the children's development level was observed by Gesell test. Results After the project implementation, the mothers in the experimental group recognized the project very well and could actively put the contents taught in the project into practice. The work connotation of village doctors has been greatly expanded but their attitudes towards the project have not changed significantly. After half a year of the project implementation, The differences in fine motor, speech and interpersonal communication between the two groups were statistically significant (P<0.05). Conclusion The "Focus on Early Childhood Development" project is an economical, simple and effective technology suitable for implementation in poor rural areas in China.

Objective to investigate the effect of acute hypertension treatment on cerebral infarction volume and cerebral blood flow in rats with focal cerebral ischemia. Methods Thirty-six healthy male SD rats were randomly divided into 3, 4, and 6 h ischemic group and 2, 3, and 5 h ischemic hypertension group for 1 h, a total of 6 groups, 6 rats in each group. The middle cerebral artery infarction model was prepared. The regional cerebral blood flow (rCBF) in the marginal region of the cortical ischemic center in each phase of focal cerebral ischemia was measured by laser Doppler flow meter. The brain sections of rats were taken at each time point, stained with red tetrazole, and the cerebral infarction volume was measured by computer image analysis system. Results the rCBF of rats in the 2, 3, and 5 h ischemic hypertension group recovered to (81.8±3.1) %, (56.0±2.1) % and (38.8±2.0) % of basal rCBF, respectively. The cerebral infarction volumes in the 2 and 3 h ischemic hypertension group were (14±7) mm3 and (90±24) mm3, respectively, which were significantly smaller than the corresponding infarction volumes in the ischemic group (all P<Conclusion Improvement of cerebral blood flow in the marginal region of ischemic center may be one of the main mechanisms of vasopressor therapy in the treatment of focal cerebral ischemic injury in the acute phase.

Objective to investigate the mutation characteristics of the pathogenic genes of Charcot-Marie-Tooth disease (CMT). Methods the mutations of PMP22, MPZ, CX32, EGR2, GDAP1, NEFL, HSP22, HSP27 were detected in 113 confirmed CMT families by real-time quantitative fluorescence PCR, polymerase chain reaction-single-strand conformational polymorphism analysis (PCR-SSCP) or PCR direct sequencing. The results showed that 36 families were caused by repeated mutations of PMP22, 7 were caused by mutations of CX32, 1 was caused by mutations of MPZ, 1 was caused by mutations of GDAP1, 1 was caused by mutations of HSP22, 1 was caused by mutations of HSP27, and no point mutations of PMP22, EGR2 and NEFL were found. Conclusion The proportion of repeated mutations of PMP22, CX32, HSP22, HSP27, MPZ and GDAP1 in CMT was 31.9%, 6.2%, HSP22, HSP27, MPZ and GDAP1

I. The challenge of the epidemic trend of cardiovascular diseases. According to the survey data of adult nutrition and health in China published in 2004, the prevalence of hypertension and dyslipidemia in adults in China is 18.8%, that is, 160 million patients with hypertension and dyslipidemia are both; Other factors: 60 million obese, 200 million overweight and 20 million diabetic patients. Smoking is still serious, and the aging of the population is accelerating. These factors lead to a sharp increase in the incidence of cardiovascular diseases with serious consequences of disability and death, which are mainly manifested by stroke and myocardial infarction. 　　

Abstract of medical records: A 42-year-old female was admitted to hospital because of "multiple lung nodules found for 20 years, cough and sputum for 3 months". Twenty years ago, the chest X-ray revealed "diffuse nodular density increased shadow in both lungs", and was diagnosed as "idiopathic pulmonary ossification disease". Two years ago, the chest X-ray revealed "a mass appeared in the dorsal segment of the lower lobe of the right lung (Figure 1), and the remaining lungs were the same as before". After repeated chest X-ray, the mass shadow of the right lower lung increased and thickened (Figure 2, 3), but it was not paid attention to because of unconscious discomfort. Three months ago, the chest X-ray revealed cough and sputum, with white and viscous sputum, accompanied by head swelling and pain, symmetrical swelling and pain of both wrists, knees and ankle joints. 　　

For a long time, the research on brain tumor has been invested heavily, but the results are not satisfactory. The main reason is that the nature of tumor cells contained in solid tumor or cell line as the research object is unclear.

The 6th International Symposium on Clinical Liver Transplantation was held in Xiangshan, Beijing from June 2 to 5, 2005. The International Symposium on Clinical Liver Transplantation sponsored by Chinese Medical Association is held once a year. It is the largest and highest-standard academic conference on liver transplantation in China. Experts from internationally renowned liver transplantation centers and scholars from major domestic transplantation centers have conducted extensive discussions on hot issues in the field of liver transplantation. First, Vice Minister Huang Jiefu of the Ministry of Health introduced the legislative construction of organ transplantation in China, the access system of organ transplantation, etc. Next, the conference discussed the following aspects.

A number of cross-sectional studies have observed that the vital capacity of adults with Diabetes is significantly lower than that of non-diabetics. After a nine-year prospective cohort study by Yeh et al. of Johns Hopkins University in the United States, it was found that low vital capacity is a new risk factor for predicting the onset of type 2 Diabetes. The results were published in the June 2005 issue of Diabetes Care (Diabetes Care, 2005, 28:1472-1479).

Because the ventral meningioma in the foramen magnum area is difficult to expose, the blood supply is abundant, and there are important vascular and nerve tissues around it, so the operation is difficult and risky. In the past, the posterior sigmoid approach and the median approach were commonly used, which was difficult to fully expose the ventral tumor, nerve and vascular structure of the foramen magnum, so the surgical effect was not good. The author used the distal lateral approach to surgically resect 16 cases of ventral meningioma of the foramen magnum from July 2000 to June 2004, and the curative effect was satisfactory. The exposure of the surgical approach and the intraoperative precautions are summarized and reported as follows.

In 1981, Evans et al. [1] first reported that embryonic stem cells (ES) were successfully obtained from cell populations in mouse blastocyst by in vitro culture. In the same year, Martine [2] established a mouse ES cell line. Because ES cells have the totipotency of differentiation, the special type of cells and tissues needed can be induced by adding suitable differentiation-inducing agents in the process of in vitro culture, which has attracted great attention. The study of ES cells' directed differentiation into cardiomyocytes will provide a new way of thinking for the treatment of clinical myocardial damage.

Neuroimaging, especially high-resolution MRI, can detect the focal pathological changes in the brain of some patients with epilepsy, which provides a basis for surgery.

Cerebral infarction is one of the main diseases that seriously endanger human health, and the decisive factor in the formation of cerebral infarction is the duration and severity of local ischemia of brain tissue. Thrombolytic therapy of cerebral infarction can recanalize occluded arteries early, restore blood supply, and save nerve function as much as possible. This article reports the experience of a case of successful rescue of cerebral infarction by early intraarterial thrombolysis as follows.

A 4-year-old male, orphan, was adopted by a children's welfare home. The child was admitted to the hospital with "polylimb deformity, left lower limb paralysis and left foot equine varus deformity". No relevant background information could be obtained, such as whether the parents were inmate or not, and the exposure history of teratogenic factors, etc.