Volume 85  ·   Issue 42  ·  2005

The global population is aging, and the situation in China is also very prominent. By the end of 2003, the elderly over 65 years of age accounted for 8.5% of the total population of China, and the proportion in some provinces and cities was even higher, such as Shanghai and Beijing, which reached 14.7% and 11.2% respectively [1].

In 2005, the Nobel Prize in Physiology or Medicine was awarded to Dr. Marshall and Dr. Warren of Australia, which really made me lose and regret for Chinese scholars for a few days. After so many Nobel Prizes have been awarded over the years, this year's content is the closest to our gastroenterology department. When I think about it, the Nobel Prize is not so unattainable. Unfortunately, Chinese scholars did not seize this opportunity and missed the Nobel Prize.

The development of human society and scientific progress have brought human beings into the age of aging. In recent years, in the field of geriatrics, researchers have carried out a lot of research on 4 "D", that is, disease, disability, death and dementia. These research directions are mostly focused on the control study of disease and normal population, and no attention has been paid to the successful aging and usual aging among normal population and elderly population [1]. The so-called successful aging refers to those elderly people whose functional status related to aging has no change or little change. Although they are old, they have good cognitive function and mental and physical health; Normal aging refers to the elderly people who have changes related to aging, but have not reached the degree of pathological changes and disability, or "normal people" between morbid aging and successful aging [2, 3].

Objective to investigate the effect of transgenic human complement regulatory protein hCD59/hMCP double gene on inhibiting human complement activation, inhibiting complement-mediated hyperacute response and prolonging cardiac function in mice perfused in vitro.Methods the model of transgenic mice with hCD59/hMCP double gene was established by microinjection. Among the progeny, 8 mice with hCD59 single gene positive, 11 mice with hMCP single gene positive and 8 mice with hCD59/hMCP double gene positive were 3 experimental groups respectively, and 10 non-transgenic mice in the same litter were used as control group.The mice were perfused with fresh human plasma in vitro to study the inhibitory effect of mice expressing human complement regulatory protein which inhibits human complement activation on complement-mediated hyperacute rejection of xenograft. Results the heartbeat time of the transgenic group (138 min±25 min) was significantly longer than that of the single genome (78 min±27 min in hCD59 group, 43 min±21 min in hMCP group) and the non-transgenic group (20 min±12 min) (Dunnett's T test, P<0.01); Immunofluorescence staining and immunoenzymatic histochemical staining showed that the deposition of complement C3c and C9 in the transgenome heart was also significantly reduced. Conclusion Transgenic human complement regulatory protein hCD59/hMCP double gene can effectively inhibit complement-mediated hyperacute rejection of xenograft.

Objective to investigate the genetic susceptibility of colorectal cancer patients and the prevalence of hereditary non-polyposis colorectal cancer (HNPCC) in colorectal cancer population.Methods the patients with colorectal cancer were divided into two parts: the first part was the patients with colorectal cancer continuously investigated by the author, and the second part was derived from the published literature on the incidence of HNPCC in Chinese in recent years.The diagnosis of HNPCC was performed by Amsterdam criteria Ⅰ, Ⅱ and Japanese criteria. Multiple primary malignant tumors and multiple primary colorectal cancer accounted for 13.1% and 10.1% respectively; The occurrence of multiple primary malignant tumors (P =0.001) and multiple primary colorectal cancer (P =0.000) were related to the family history of malignant tumors. 21.4% of younger patients with colorectal cancer (≤50 years old) were closely related to the family history of malignant tumor (P =0.000) and colorectal cancer (P =0.000). The detection rates of HNPCC in accordance with Amsterdam criteria Ⅰ, Ⅱ and Japan criteria were 1.24%, 2.15% and 2.93%, respectively, and there was no statistically significant difference between southern and northern regions (P>0.05). Conclusion Family history of malignant tumors, multiple primary malignant tumors and younger colorectal cancer (≤50 years old) are clinical markers of three kinds of malignant tumors and genetic susceptibility to colorectal cancer. Multiple primary malignant tumors and younger colorectal cancer are related to family history of malignant tumors. The prevalence rate of HNPCC in China is comparable to that in western countries.

Objective to report the experience and long-term follow-up results of nickel-titanium shape memory alloy mesh stent in the treatment of ureteral stricture. Methods From 1995 to 2004, 9 patients with ureteral stricture were treated with nickel-titanium shape memory alloy mesh stents, including 4 males and 5 females, aged 29-63 years. The ureteral stricture length was 1.0-4.0 cm, including 2 cases of ureteral stricture after radical rectal cancer surgery, 3 cases of chronic inflammatory ureteral stricture, and the other 4 cases were benign ureteral stricture after surgery. A total of 10 memory alloy mesh stents were placed under spinal anesthesia, and the median follow-up time was 27.2 months (5-96 months). Results The ureteral stricture was relieved and the hydronephrosis was relieved in 7 patients during the follow-up period. The lumen of the ureteral stent was blocked by fibrogranulation tissue hyperplasia in 2 patients 5-6 months after surgery. The stent was removed surgically in 1 case, and the double pig tail tube (D-J tube) was placed in the ureter in 1 case for drainage.

Objective to investigate the expression of topoisomerase Ⅲ α (TOPⅢ α) protein in different types of epithelial ovarian tumors and its relationship with pathological grade and clinical stage.Methods the expression of TOPⅢ α in paraffin samples of 169 ovarian tumors was detected by immunohistochemistry.Among them, 28 cases were serum/mucinous cystadenoma, 50 cases were serum/mucinous borderline cystadenoma, 63 cases were serum/mucinous cystadenocarcinoma, 19 cases were ovarian endometrioid carcinoma and 9 cases were clear cell carcinoma. Results the positive rate of TOPⅢ α expression was 17.9% in benign ovarian tumors, 74.0% in borderline ovarian tumors and 42.7% in malignant ovarian tumors. The difference between the three groups was statistically significant (χ 2=24.657, P<The expression level of TOPⅢ α in epithelial ovarian carcinoma was not related to clinical stage and pathological grade (P =0.903, P =0.844). Conclusion the expression of topoisomerase Ⅲ α in epithelial ovarian carcinoma was increased, and its level was related to the tumor nature and tissue type.

Objective to summarize the clinical experience of David's operation. Methods from 1998 to 2004, 29 patients underwent David's operation, including 20 males and 9 females; The age ranged from 10 to 64 years, with an average of 39 ± 17 years; Preoperative cardiac function was grade Ⅰ in 10 cases, grade Ⅱ in 15 cases and grade Ⅲ in 4 cases; Preoperative aortic regurgitation was mild in 15 cases, moderate in 9 cases and severe in 5 cases; We designed modified David surgery in 3 cases. Results There were no surgical deaths or recent deaths. The time of cardiopulmonary bypass was 126 min±25 min, the time of myocardial occlusion was 87 min±22 min. The follow-up time was 29 months ±15 months (5~74 months). All the patients had cardiac function of grade Ⅰ. There were no postoperative aortic regurgitation in 11 cases, mild regurgitation in 8 cases, and moderate regurgitation in 2 cases. No patient needed secondary surgery. Conclusion Aortic root replacement with preservation of aortic valve (David surgery) is an ideal surgical scheme for aortic root neoplasms with roughly normal aortic leaflets and annulus. The short-term results are satisfactory, but the long-term results remain to be observed.

Objective to investigate the factors affecting the choice of embolization protocol and embolization effect of intracranial aneurysms, and to establish a new grading system for endovascular treatment of intracranial aneurysms. Methods the clinical data of 156 intracranial aneurysms in 151 patients treated by endovascular treatment were prospectively collected. The effects of sex, age, digital subtraction angiography characteristics (location, shape, longest diameter of tumor, width of tumor neck, ratio of capsule to neck), hemorrhage and embolization in acute phase on the choice of embolization technique and immediate effect of embolization were analyzed. Results Logistic regression analysis showed that the significant factors affecting the choice of embolization technique were aneurysm site (OR =3.734, P =0.018), width of tumor neck (OR =16.279, P =0.000) and ratio of capsule to neck (OR =4.090, P =0.003). The significant factors affecting the effect of embolization were longest diameter (OR =2.725, P =0.024), width of tumor neck (OR =2.600, P =0.033) and ratio of capsule to neck (OR =3.144, P =0.003). Intracranial aneurysms were classified into four grades, from 0 to 1 as general aneurysms, from 2 to 4 as complex aneurysms. Conclusion IAES is helpful to make individualized embolization protocol and predict the effect of embolization.

In recent years, the occurrence and solution of psychological disorders, the way of seeking medical treatment for modern people, the comorbidity of physical diseases and mental disorders, the mental health service and the actual demand, which are closely related to social development, have attracted more and more attention from all circles of society [1, 2]. Mental health service in general hospitals has become one of the hot spots.

Objective to investigate the diagnostic value of brain glucose metabolism in patients with Alzheimer's disease (AD). Methods 10 patients with AD (AD group) and 10 normal controls (NC group) with matched age, sex and education level were examined by 18-fluorodeoxyglucose positron emission tomography (PET) and analyzed the differences of brain glucose metabolism in different brain regions between the two groups. Results Compared with the NC group, the local glucose metabolism rate in many brain regions of interest in AD group was significantly reduced (P<0.05, P<0.01), the metabolism decreased 17.0% ~28.4% in the superior, middle, inferior gyrus and orbital gyrus of the frontal lobe, 3.3% ~25.0% in the superior, middle and inferior gyrus of the temporal lobe, 9.3% ~9.8% in the insula lobe, 10.5% ~10.6% in the hippocampus, 7.8% ~11.3% in the parahippocampal gyrus, 16.7% ~22.7% in the anterior and posterior cingulate gyrus, 10.6% in the right caudate nucleus, and 12.7% ~14.5% in the parieto-temporal-occipital junction area. Among them, the metabolism decreased most obviously in the superior frontal gyrus, middle frontal gyrus, orbital gyrus, middle temporal gyrus and anterior cingulate gyrus, all of which exceeded 20%. The metabolism decreased in the brain areas of mild dementia was less and the degree was milder. The correct rate of discrimination between right inferior temporal gyrus, left hippocampus, left superior temporal gyrus and right insula lobe was 100% (all P<Conclusion PET can sensitively reflect the changes of cerebral glucose metabolism in AD, which has high diagnostic value. The defects of cerebral glucose metabolism in AD are mainly concentrated in frontal lobe, temporal lobe and hippocampus, with frontal-temporal lobe defects. The degree and extent of metabolic defects are closely related to the degree of dementia. The decline of glucose metabolism in hippocampus, parahippocampal gyrus, anterior cingulate gyrus and inferior temporal gyrus may have early diagnostic value.

Methods 10 patients with successful aging (SA), 10 patients with normal aging (UA) and 9 patients with mild cognitive impairment (MCI) were examined by fMRI of vocabulary fluency work (VFT) to compare the brain activation.Results both SA and UA significantly activated the parietal lobe, frontal lobe, anterior cingulate gyrus and occipital lobe, and MCI activation was generally low except the right frontal lobe; The activation intensity of SA was higher than that of UA, but the difference was not statistically significant. The activation intensity of SA was higher than that of MCI, and the difference was statistically significant (P<The activation of SA left prefrontal lobe (especially the dorsolateral cortex of left prefrontal lobe) was significant, while the activation of UA and MCI was relatively weakened, and the difference was statistically significant (P =0.01). The brain activation of SA showed consistent dominant lateral deviation (lateralization index LIs =0.46), and the brain activation of UA and MCI was overall unlateral (LIs was-0.12 and-0.06, respectively); (4) Both SA and UA have significant occipital lobe activation, but MCI activation is not obvious. Conclusion There is heterogeneity in the process of brain aging, which involves complex brain function mechanism; The activation degree and lateralization index of the left prefrontal lobe dorsolateral cortex can be used as reference indexes to measure the aging level of brain function.

Objective to investigate the relationship between mental health and coping strategies of different ethnic dementia caregivers. Methods 121 dementia caregivers, including 29 Chinese-Americans (CN), 29 African-Americans (BK), 32 Caucasians (WT) and 31 Latinos (LT), received the "Prognosis of Elderly Caregivers" questionnaire. The contents included the caregivers' cognitive status questionnaire, the caregivers' short living ability scale, the caregivers' instrumental living ability scale, the caregivers' depression scale, the caregivers' health status questionnaire and the caregivers' coping style questionnaire. Results the caregivers in BK, WT and LT groups were mostly daughters; In CN group, the role of spouse and children was more balanced. There was no significant difference in caregiver depression scale and health status score between groups. Accept status entry and find positive factors entry were scored as BK>WT>LT>CN (P<Multiple stepwise regression analysis showed that the caregivers' experience of depression was related to the basic background and coping style of caregivers and recipients (P<Conclusion the psychological status of different ethnic dementia caregivers is related to their coping strategies, and the coping styles related to depression experience are different across races. It is necessary to explore coping strategy training and health care models suitable for different cultural backgrounds for caregivers to improve the quality of dementia care and quality of life.

Objective to establish a national T-score norm for the complete set of neuropsychological test (NTBE) for the elderly. Methods A cross-sectional study was conducted in 15 regions of China. 903 normal elderly over 60 years old were investigated and NTBE tested. The T-score norm was obtained by mathematical analysis. The NTBE results of 474 normal elderly were also evaluated. The T-score of NTBE was used to assist in the diagnosis of 110 cases of mild cognitive impairment (MCI) and 63 cases of Alzheimer's disease (AD), and the sensitivity and specificity of the diagnosis of MCI and AD were determined. Results Stepwise regression analysis showed that the results of NTBE were significantly affected by age and educational level, but not by gender, so the results were grouped according to age and educational level. The original variables were combined and processed according to the cluster analysis results to make them conform to the normal distribution, and the standard score, normality standard score and T-score were calculated. The internal consistency of NTBE was good between the self-sample and the assessment sample. The sensitivity and specificity of NTBE in the diagnosis of MCI were 66% and 96% The sensitivity and specificity of diagnosis of AD are 79% and 96%. Conclusion the T-score norm grouped according to age and educational level is in accordance with the actual situation of Chinese elderly, and the sensitivity and specificity are good when used for auxiliary diagnosis of MCI and AD.

Rheumatoid arthritis (RA) is a chronic progressive autoimmune disease with synovial inflammation as the main pathological change. It has a high disability rate. With the in-depth understanding of the pathogenic mechanism of various inflammatory cells in synovial membrane, including macrophages, fibroblasts, endothelial cells, T cells, B cells and related cytokines, targeted therapy against immune cells or immune molecules has introduced RA into a new stage of biological therapy. At present, monoclonal antibodies (etanercept, infliximab, adalimummab) and interleukin-1 receptor antagonists (IL-1Ra, anakina) against tumor necrosis factor α (TNF α) have been marketed and have achieved good efficacy. Recently, it has been found that B lymphocytes play a very important role in the immunopathogenesis of RA synovitis, and B lymphocyte clone clearance is another new biological therapy breakthrough [1]. This paper aims to discuss the pathogenesis of RA synovitis, the therapeutic effect of B lymphocyte clone clearance on RA and its safety

mild cognitive impairment (MCI) in the elderly is a kind of cognitive impairment state between normal aging and dementia. It is the pre-clinical stage of senile dementia. On average, 10% ~15% of MCI develop into dementia every year, and most of them are Alzheimer's disease (AD) [1, 2]. In recent years, more progress has been made in the research of biological diagnostic markers of MCI.

A large number of previous studies have proved that there are two forms of neuronal death after cerebral ischemia and reperfusion (IR): necrosis and apoptosis. Necrosis is irreversible, but early apoptosis is reversible, so the study of neuronal apoptosis has become a hot topic. caspase family and bcl-2 family play an important role in the development of neuronal apoptosis. caspase-3 is considered to be the most important effector protease in caspase family for apoptosis, and its activation largely depends on the release of cytochrome C from mitochondria into cytoplasm [1]. bcl-2 is a representative of bcl-2 family to inhibit apoptosis, and forms heterodimer with bax or bid pro-apoptotic genes, which regulates apoptosis by regulating the release of cytochrome C in mitochondrial membrane [1]. In this paper, the temporal immune expression of caspase-3 and bcl-2 in the cerebral cortex of SD rats after FCIR injury was observed by focal cerebral ischemia and reperfusion (FCIR) injury animal model. To investigate the relationship between apoptosis and apoptosis in the process of apoptosis, and provide experimental basis for elucidating the mechanism of apoptosis and the prevention and treatment of IR injury.

Cerebral watershed infarction, also known as marginal zone infarction, refers to the infarction caused by localized ischemia of the marginal zone supplied by two or three adjacent cerebral arteries or deep penetrating arteries in the basal ganglia area. The incidence rate of cerebral watershed infarction accounts for 10% of ischemic cerebrovascular diseases [1]. In recent years, with the wide application of CT, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), single photon emission computed tomography (SPECT) and digital subtraction angiography (DSA), the understanding of cerebral watershed infarction is increasingly deep [2-5], but there are no reports of multiple cerebral watershed infarctions.

On August 12, 2004, at 20 o'clock in the evening, typhoon rananim landed in Shitang Town, Wenling City, Zhejiang Province, which caused serious casualties and economic losses.In order to understand the epidemiological characteristics of the injuries caused by this typhoon, analyze the causes of injuries, and provide preventive and control countermeasures, we carried out on-site epidemiological investigation, and the investigation results are reported as follows.

The prevalence of senile dementia (AD) has been reported many times [1], but the prevalence is affected by the onset of dementia, the course of dementia and the survival rate of patients, which are closely related to the socio-economic environment. To accurately compare the disease situation, the incidence study is more appropriate and can accurately reflect the incidence of dementia in the elderly. Therefore, we investigated the incidence of senile dementia in urban and rural Chengdu.

A 53-year-old female, weighing 98 kg, was admitted to hospital on October 8, 2004 due to sudden chest pain and chest tightness for 4 months. She had hypertension for 10 years, diabetes for 4 months and myocardial infarction 4 months ago. Electrocardiogram (ECG): sinus heart rate, atrial prematurity with transient paroxysmal atrial tachycardia, abnormal Q wave. Coronary angiography: coronary atherosclerotic heart disease, involving anterior descending artery, circumflex artery and right coronary artery. Ejection fraction: 70%. B-ultrasound: segmental wall motion function was weakened. Diagnosis: coronary heart disease, old inferior wall myocardial infarction, fatigue angina pectoris, hypertension.

A 76-year-old male patient had obvious memory loss in the past two years. He often lost things when he went out, and collected a lot of waste products and hid them under his bed. At the same time, he had suspicion and personality change, and was emotionally irritable. He was diagnosed as senile dementia (early stage) in an outside hospital, and was treated with various nootropic drugs (such as huperzine A, cerebrolysin, dihydroergotine, flunarizine, etc.), but the curative effect was not good. In the past 2 months, the patient often suffered from insomnia at night and complained that there were burglars in his home; He often gets up in the middle of the night and wants to go out for a meeting. He eats irregularly and often needs the supervision and help of his family. He often makes noise at home in the past month, suspects that his spouse (74 years old) has an ambiguous relationship with his neighbors, often mistakes his children for his brother and sister, and his family has difficulty in taking care of him and is admitted to hospital. He has no history of hypertension, stroke and coronary heart disease. Psychiatric examination found that the patient has obvious recent and immediate memory impairment, and some distant memory impairment. He can't correctly answer the date, children's age and home address.