Volume 85  ·   Issue 33  ·  2005

Streptococcus suis is a zoonotic acute and febrile infectious disease caused by C, D, E and L streptococci. It is manifested as acute hemorrhagic sepsis, meningitis, arthritis and endocarditis, diarrhea (severe diarrhea) in lactating piglets and abortion in pregnant pigs [1]. It can infect specific people and cause disease, with complicated clinical manifestations, dangerous disease, often multiple organ damage, and high mortality rate. Streptococcus suis is a second class animal disease stipulated by the state.

In<Academician Liu Depei, head of the research group on population and health science and technology issues, put forward the development strategy of China's medical and health care, which was summarized as "strategy moving forward, strategy moving down, mode transformation and system integration". Under the market economy, the gap between urban and rural areas in China is further increasing, and the medical and health care should first reflect fairness. The development of medical technology can't solve the fairness of medical care, and the solution of these problems can only be realized by the transformation of medical mode and the integration of medical and insurance systems. Undoubtedly, solving the medical insurance problem in rural areas in China is the most important and more difficult task that the current medical reform needs to face.

Objective to improve the diagnostic level of appendix mucous cyst by analyzing and summarizing the clinical manifestation,pathological basis and imaging examination.Methods Eighteen patients with appendix mucous cyst confirmed by pathology were treated in Peking Union Medical College Hospital from January 1985 to September 2004. Among them, 4 males and 14 females, the ratio of male to female was 1:3.5, the age was 31-78 years old, with an average of 59.8 years old. Among the patients, 11 patients underwent barium enema angiography, 9 of them underwent abdominal CT scan, and 1 case underwent three-dimensional CT colon reconstruction and virtual endoscopy simultaneously. Results (1) Clinical manifestations: 8 cases (44.4%) had right lower abdominal pain symptoms, and 12 cases (66.7%) had palpable mass. (2) Imaging examination: 10 cases showed filling defect at the end of cecum with external pressure changes and no mucosal damage; CT showed cystic mass in the right lower abdomen in 8 cases, 75% of which showed calcification of cystic wall, and 3-D reconstruction of colon and virtual endoscopy showed clearly the changes of the lesion inside and outside the cecal cavity in 1 case; 1 case of peritoneal pseudomyxoma showed a large amount of divided mucinous ascites in the peritoneal cavity. (3) Postoperative pathological examination: 4 cases were simple mucinous cyst (22.2%), 12 cases were mucinous cystadenoma (66.7%), and 2 cases were mucinous cystadenocarcinoma (11.1%).

Objective to study the brain activity of patients with Alzheimer's disease (AD) by functional magnetic resonance imaging (fMRI) and to explore the corresponding neuroanatomical basis. Methods Thirteen patients with possible clinical diagnosis of AD and 13 healthy elderly with matching age and sex participated in the experimental test of visual search (single feature task and joint feature task, the difference between the two is that the latter needs attention switching). At the same time, the data of brain functional imaging were collected by Siemens Sonata 1.5T imaging system, and the images of brain functional activity were obtained by statistical analysis through functional neuroimaging analysis software SPM 99. Results AD group had specific defects in joint feature task, but remained relatively intact in single feature task. The brain activation patterns of the two groups were similar under joint feature search task, including parietal lobe, frontal lobe and temporo-occipital junction, primitive visual cortex and subcortical structure, but the activation intensity and range of different brain regions were obviously different. In AD group, the activation of both parietal lobes decreased, while the activation of the right temporo-occipital junction area increased; Conclusion There are obvious defects in the neural mechanism of controlling attention switching in AD group, and the activation of other brain regions (ventral visual pathway and temporal lobe) in distant parts of AD group reflects the dynamic redistribution of functional resources in the brain.

Objective to investigate the binding effect of mitogen-activated protein kinase phosphatase 1 (MKP-1) 1 α (HIF-1 α) and p300 in vitro.Methods A prokaryotic expression vector containing HIF-1 α transactivating domain (TAD) was constructed by DNA recombination technology and expressed prokaryotically. Purification of glutathione S transferase (GST) fusion protein expressed prokaryotically by glutathione-agarose beads; Transferring MKP-1-containing sense eukaryotic expression vector and empty vector into SGC7901 cells using liposomes; The effects of MKP-1 or PD98059 on the binding of HIF-1 α to co-activator p300 in vitro were detected by Pull-down assay and Western blot; The effects of MKP-1 on the expression of p300 were detected by Western blot. Results (1) The prokaryotic expression vector containing HIF-1 α TAD was successfully constructed, and the GST fusion protein containing HIF-1 α TAD was expressed in E. coli BL-21. (2) The GST fusion protein containing HIF-1 α TAD was purified by glutathione-agarose beads. (3) After hypoxia for 12 h, the amount of p300 eluted by the GST fusion protein HIF-1 α TAD from the lysates of PD98059 treated cells was lower than that from the lysates of dimethyl sulfoxide (DMSO) treated cells and SGC7901 cells, respectively. (4) The MKP-1 sense eukaryotic expression vector and the empty pcDNA3.1 vector were transiently transferred into SGC7901 cells; After 12 h of hypoxia, the amount of p300 eluted by GST fusion protein from the lysates of MKP-1 sense eukaryotic expression vector transfected cells (SGC7901-MKP-1) was lower than that from the lysates of empty vector transfected cells (SGC7901-empty vector) and untransfected cells (SGC7901). (5) After 12 h of hypoxia, the expression of p300 did not change in SGC7901-MKP-1, SGC7901-empty vector and SGC79013 cells. Conclusion MKP-1 inhibits the binding of HIF-1 α to p300 in vitro

Objective to construct a full-length expression gene plasmid of peroxidase proliferator-activated receptor γ 1 (PPAR γ 1), and to observe the effect of PPAR γ 1 overexpression on the extracellular matrix (ECM) of mesangial cells. Methods the full-length cDNA of PPAR γ 1 from wild-type (WT) mice was ligated into the expression plasmid pIRES2-green fluorescent protein, and the expression plasmid pIRES2-EGFP-MPAR γ 1/WT was transfected into mesangial cells by liposome-mediated method. The expression and activity of PPAR γ 1 in mesangial cells were identified by RT-PCR, Western blot, and the binding activity of PPAR γ and PPR, and the expression and activity of PPAR γ 1 in mesangial cells were stimulated by high glucose (30 mmol/L), To observe the effect of PPAR γ 1 overexpression on ECM such as TGF-β 1, PAI-1 and fibronectin. In this study, a plasmid pIRES2-EGFP-mPAR γ 1/DN expressing functionally deficient (DN) PPAR γ 1 constructed by the same method was used as a control. Results Restriction enzyme digestion and DNA sequencing results showed that the constructed plasmid was a full-length expression gene plasmid of PPAR γ 1. The expression of this plasmid reached its peak 48 h after transfection. The overexpression of PPAR γ 1 significantly reduced the mRNA of transforming growth factor (TGF) -β 1 and plasminogen activator inhibitor (PAI) -1 in mesangial cells caused by high glucose and the high expression of FN in cultured cell supernatant (P<Conclusion The construction of the full-length expression gene plasmid of PPAR γ 1 provides an advantageous tool for further investigation of the effects and mechanisms of PPAR γ 1. The results of this study show that overexpression of PPAR γ 1 can inhibit the accumulation of extracellular matrix induced by high glucose.

Objective to investigate the factors affecting the phenotypic differentiation of dermal fibroblasts into chondroblasts induced by chondromorphogenetic protein 1 (CDMP1) growth factor in vitro.Methods Three cases of dermal tissues discarded after circumcision were collected, and the fibroblasts were isolated and expanded in vitro, and induced by F-12 medium containing 10% fetal bovine serum with CDMP1 (final concentration 100 ng/ml), and those without CDMP1 were used as control.The phenotypic differentiation of cells (P2, P5, P10) after multiple passages was observed; The concentrations of CDMP1 were adjusted to 10, 30, 100 and 300 ng/ml, respectively, and the phenotype changes of chondrocytes after induction were observed. Fibroblasts were induced in monolayer culture and micromass culture for 7 and 14 days in vitro, respectively. The expressions of bone morphogenetic protein receptor (BMPR), type II, IV and X collagen were detected by reverse transcription-polymerase chain reaction (RT-PCR) before and after induction. The expression of type Ⅱ collagen, SOX9 and proteoglycan before and after cell induction was detected by Western blot; Flow cytometry was used to detect the surface markers CD29, CD105, CD106, CD166 and the expression of type Ⅰ and Ⅱ collagen after induction. Results the cells could still express specific cartilage matrix type Ⅱ collagen and proteoglycan after multiple passages (P5, P10), and the positive rate of type Ⅱ collagen was not statistically different from that after induction of P2 (P>0.05). The concentrations of CDMP1 were 10 and 30 ng/ml for 7 and 14 days, but the expression of type Ⅱ collagen and proteoglycan was not observed. When CDMP1 concentrations were 100 and 300 ng/ml, there was no significant difference in the expression intensity of type Ⅱ collagen and proteoglycan, and the expression of cartilage matrix disappeared after 14 days of induction in monolayer fibroblasts; The expression of ActR-I/ALK-2, BMPR-IA/ALK-3, BMPR-IB/ALK-6 gene was significantly enhanced after induction by RT-PCR. Conclusion Human dermal fibroblasts can maintain the ability to differentiate into chondroblast phenotype after expansion in vitro induced by CDMP1 growth factor. Cell differentiation is related to CDMP1 concentration, three-dimensional culture conditions and BMPR mediation.

Objective to investigate the value of radionuclide technetium-99m (99mTc) -labeled survivin antisense oligonucleotide (ASON) imaging in the diagnosis of hepatocellular carcinoma. Methods 18-base single-stranded survivin ASON was synthesized by DNA synthesizer, modified with amino group at 5' end, and then labeled with S-acetyl-N-hydroxysuccinimide-mercaptoacetyltriglycine (S-acetyl-NHS-MAG3) as chelating agent. The biological distribution, tumor antisense gene imaging and tumor antisense gene inhibition imaging of 99mTc-survivin ASON in nude tumor-bearing mice (SMMC-7721) were analyzed. Results the imaging time of tumor tissue was early, and the development began at 0.5 h. The aggregation degree of 99mTc-survivin ASON in tumor tissue increased gradually with the prolongation of time, and reached the maximum at 4 h. The ratio of tumor/contralateral limb muscle was 2.48±0.44 (in vitro imaging) and 3.35±0.57 (biological distribution), respectively<After inhibition with unlabeled survivin ASON, the aggregation of 99mTc-survivin ASON in tumor tissue was significantly reduced, and the ratio of tumor/contralateral limb muscle decreased to 0.93±0.23 at 4 h, which was significantly lower than that of 2.48±0.44 before inhibition (P<Conclusion 99mTc-survivin ASON can specifically aggregate in tumor tissues of tumor-bearing nude mice model, which provides a possible new method for the specific diagnosis of hepatocellular carcinoma.

Objective to investigate the survival and influencing factors of primary hepatocellular carcinoma treated with radiofrequency ablation (RFA), and to conduct univariate and multivariate analysis to guide the treatment of RFA ablation. Methods 172 cases of primary hepatocellular carcinoma treated with RFA from 1999 to 2004, of which 150 cases (87.2%) could not or could not be treated with surgery. The 24 factors that may affect survival were analyzed to explore the correlation with survival. The follow-up time was 4~51 months, and the follow-up rate was 94.8% (163 cases). The univariate analysis using Kaplan-Meier model and Log-rank test, and the multivariate analysis using COX proportional hazard model. Results the survival rates of primary hepatocellular carcinoma after RFA treatment were 91.5%, 77.4%, 55.7% and 51.2% respectively. Eight of the 24 univariates that may affect survival were statistically significant, namely: Child-Pugh grade of liver function, UICC stage, alpha-fetoprotein (AFP) value before primary RFA, portal hypertension, tumor recurrence, pathological grade, therapeutic purpose and safe range of ablation Stage Ⅰ and Ⅱ (33 cases) reached 96.7%, 92.3%, 81.6% and 65.3%; Stage Ⅲ and stage Ⅳ (83 cases) were 91.2%, 76.3%, 56.6% and 51.4%; The survival rates of 56 cases of recurrent cancer were 88.5%, 70.2%, 41.4% and 24.5%, respectively, but there was no significant difference from those of first-episode cancer stage Ⅲ and Ⅳ. There were three factors related to survival rate, namely: Child-Pugh grade, portal hypertension and treatment purpose. Conclusion The factors affecting the prognosis of primary liver cancer treated with RFA can be divided into two aspects: the patient factors are Child-Pugh grade of liver function and portal hypertension degree; Therapeutic factors are the therapeutic purpose plan; This result helps guide RFA treatment.

Objective to analyze the differential methylation profiles of CpG islands in the genome of monozygotic twins with inconsistent phenotypes after hepatitis B virus infection in order to find possible differential methylation genes.The modified methylation interval site amplification technique was used to analyze the differential methylation bands according to the two main base combinations of human genome CpG island methylation sites, -CGCG-and-CCGG-, with three different enzyme digestion combinations (SmaⅠ-XmaⅠ, HpaⅡ-MspⅠ, BssHⅡ-PauⅠ/BsePⅠ). The differential methylation bands were isolated and recovered by Quantity One 4.4.0 gel image analysis software, and the positive clones were sequenced. The sequencing results were analyzed by BLAST, and the differential methylation genes related to monozygotic twins with inconsistent phenotypes after hepatitis B virus infection were preliminarily understood. Results The methylation analysis of CpG islands in the genome of a pair of monozygotic twins with identical phenotypes showed that the bands were almost identical, However, there were differential methylation bands between the other pair of monozygotic twins with consistent phenotype and the other pair with inconsistent phenotype, and the number of differential methylation bands in the former was less than that in the latter. The obtained differential methylation bands were cloned into T vector. At present, four differential methylation genes that may be related to monozygotic twins with inconsistent phenotype after hepatitis B virus infection were obtained by sequencing analysis. Conclusion The methylation levels of CpG islands in the genome of monozygotic twins with inconsistent phenotype after hepatitis B virus infection are different, and their influence on the disease phenotype and mechanism need to be further studied.

Objective to investigate the relationship between GSTT1, GSTM1 and NQO1 gene polymorphisms and the susceptibility of primary acute myeloid leukemia (AML) and AML karyotype abnormalities. Methods 228 AML patients and 241 normal controls were detected by multiplex polymerase chain reaction (PCR), and NQO1 genotypes were analyzed by PCR-restriction endonuclease fragment length polymorphism (RFLP). Results the proportion of GSTM1 null type (62.3%) in AML patients was significantly higher than that in normal controls (52.7%), but the proportion of GSTT1 null type (null) was not statistically significant compared with that in normal controls. The proportion of NQO1C609T C/T and T/T genotypes was 53.1% and 25.0%, respectively, in AML patients, T (8; 21) (q22; q22) /AML-ETO positive patients (64.3% and 25.0%, respectively), T (15; 17) (q22; q11) /PML-RAR α positive patients In particular, t (8; 21) (q22; q22) /AML-ETO positive and t (15; 17) (q22; q11) /PML-RAR α positive AML with recurrent chromosomal abnormalities were highly correlated.

Medical quality is the core of hospital construction and the lifeline of hospital invincible position in medical market competition. It directly relates to the quality of diagnosis and treatment of patients, and also affects the rise and fall and development of hospitals. In recent years, with the transformation of medical mode, the connotation of medical quality has changed from a single clinical medical quality to a comprehensive quality of clinical efficacy, service, time and cost [1].

A 41-year-old male was admitted to our hospital on October 19, 2004 due to repeated fever and fatigue for more than 1 month and left hypochondrial pain for 4 days. At the beginning of September 2004, the patient had fever after catching a cold, and his body temperature was 37.8℃, without chills, cough, chest pain and shortness of breath. He took "antipyretic drugs" (details unknown), but his body temperature did not drop, and gradually appeared fatigue and anorexia. On October 7, he went to the local people's hospital for hospitalization. The auscultation of the heart found continuous murmur in the intercostal areas of the left margin of the sternum at 3 and 4. The peripheral blood leukocytes were 11.8×109/L, neutrophils 0.76, hemoglobin 115 g/L, and erythrocyte sedimentation rate (ESR) was 42 mm/1 h. The chest X-ray showed infection of the left lower lung, changes of the left pleura, and enlarged heart shadow, which was considered "left pneumonia". The body temperature was normal after 3 days of treatment with aloxicillin + pefloxacin. 　　

Under normal physiological conditions, bile formation depends on Na + -taurocholate cotransporting polypeptide (NTCP/NTCP), organic anion transporting protein (OATP/OATP), multidrug resistance-associated protein 3 (MRP3/MRP3), multidrug resistance-associated protein 4 (MRP4/MRP4), and the canalicular bile salt-export pump (BSEP/BSEP) distributed on the capillary bile duct membrane of small bile duct side hepatocytes, multidrug resistance-associated protein (MRP2/MRP2), multidrug resistance-1P-glycoprotein (MDR1/MDR1), multidrug resistance-2P-glycoprotein (MDR2/MDR2), multidrug resistance-3P-glycoprotein (MDR3/Mdr) and other transporters.

Since the end of June 2005, an epidemic of infectious diseases with acute onset, high fever, headache and other systemic poisoning symptoms, toxic shock and meningitis in severe cases has occurred in Ziyang City, Sichuan Province. The infectious diseases were diagnosed as human-Streptococcus suis infection. As of 12: 00 on August 3, a total of 206 cases of human-Streptococcus suis infection were reported in Sichuan Province, including 43 cases confirmed by laboratory, 122 cases diagnosed clinically and 41 cases suspected. Among these cases, 26 cases were cured and discharged, 18 cases were critically ill and 38 cases died [1]. Although the epidemic of Streptococcus suis in pigs has been reported earlier, the reports of human-Streptococcus suis infection are less, and the understanding of this disease is relatively limited. This outbreak of human-Streptococcus suis infection in China makes the understanding and research of human-Streptococcus suis infection imminent. This paper reviews the literature of Streptococcus suis infection, aiming to further understand and master human-Streptococcus suis infection, and lay a theoretical foundation for further research.

Acute abdomen is still a frequently-occurring and common disease in general surgery, and it is an abdominal disease that needs early diagnosis and urgent treatment. It is characterized by acute onset, rapid progression, many changes and severe disease. Once the diagnosis is delayed and the treatment is improper, it will bring serious harm and even death to the patients. Acute abdomen affects the elderly because of immunodeficiency, vague signs and medical diseases, and early diagnosis and treatment are especially necessary for them. From January 1996 to January 2005, 102 elderly patients with acute abdomen were examined and treated by laparoscopy, and satisfactory results were achieved. The report is as follows.

A 47-year-old male was admitted to the hospital on February 6, 2004 due to right hip pain for more than 2 years and difficulty in standing and turning over for more than 1 year. In 2001, the patient developed right hip pain without obvious trigger. In early 2002, CT showed "right femoral neck fracture", and underwent internal fixation of right femoral neck fracture. In the second half of 2002, he developed double rib pain without trigger. X-ray examination showed multiple rib fractures, weakness of lower limbs, difficulty in standing and turning over, and the need to use handrails to go upstairs. He was diagnosed as primary osteoporosis by the local hospital. Intermittently, he was treated with alendronate sodium (Fosamax) 10 mg once daily, calcitonin (Migaxi) 50 U intramuscular injection once daily and oral calcium tablets, but no obvious effect.

In recent years, with the widespread use of prophylactic propoxyguanosine (DHPG), the incidence and mortality of cytomegalovirus (CMV) pneumonia have decreased significantly [1, 2]. Some pneumonia are not caused by definite infection, which is called "idiopathic pneumonia syndrome (IPS)". IPS may be caused by lung injury caused by chemoradiotherapy before transplantation or chronic graft versus host disease (GVHD) involving lung tissue, but some other unknown pathogens cannot be ruled out [3]. IPS has been reported abroad, but there are few systematic reports in China. We retrospectively analyzed 36 cases of idiopathic IPS, and summarized and analyzed their clinical characteristics.

Actively and effectively controlling risk factors is the key to prevent the occurrence of coronary atherosclerotic heart disease (CHD) events and reduce the death due to CHD events [1-4]. Total cholesterol levels and the risk of CHD have been continuously correlated in populations all over the world [5]. Because serum low-density lipoprotein cholesterol (LDL-C) levels are highly correlated with total cholesterol levels in the population, there is the same relationship between LDL-C and the risk of CHD, and it is a log-linear relationship [1]. The third report (ATPⅢ) of the Expert Committee on Detection, Evaluation and Treatment of Adult Hypercholesterolemia of the United States Cholesterol Education Program (NCEP) once again defines LDL-C as the primary goal of lipid-lowering therapy [2], and it has been confirmed by many large randomized controlled clinical studies [6,7]. The latest report of NCEP ATPⅢ proposes a more active lipid-lowering goal based on recently published clinical trials [1].

Gliocytoma multiforme is a highly malignant glioma with a prevalence of 3/100,000 and 13/100,000 in those aged 65 years or older. After diagnosis, the 5-year survival rate is only 3.3%, and even lower in those aged 65 years or older. A few years ago, scientists suggested that there is a reverse link between asthma, anaphylaxis and gliocytoma multiforme. However, previous studies were only based on the history of asthma and anaphylaxis given by participants. We need to use an objective method to judge the accuracy of this history, and it is not affected by the existence of brain tumors.

On July 25, 2005, West China Hospital began to notify the first batch of 40 patients selected for "operation walk West" to be admitted to the hospital for artificial joint replacement around August 3. So far, the "operation walk West China" campaign jointly carried out by West China Hospital of Sichuan University, University of Southern California in Los Angeles, USA and Northwestern University in Chicago, USA began to be implemented.