Volume 85  ·   Issue 45  ·  2005

In the past, the incidence of prostate cancer in China was relatively low, but with the continuous development of China's economy, the continuous improvement of people's living standard, the gradual westernization of dietary composition and living habits, the incidence of prostate cancer in China showed an obvious increasing trend in recent years. According to statistics, the incidence of prostate cancer in Beijing in 1985 was 2.41/100,000, and the mortality rate was 1.19/100,000; In 1995, the incidence rate was 4.55/100,000, and the mortality rate was 2.36/100,000 [2]; In recent years, the morbidity and mortality of prostate cancer are estimated to be 2~3 times that of 1995. According to statistics, the standardized incidence of prostate cancer in Shanghai in 2000 was 7.7/100,000, ranking first among male genitourinary tumors.

Objective to evaluate the safety and efficacy of thulium laser prostatectomy (TmLRP-TT) in the treatment of benign prostatic hyperplasia (BPH). Methods TmLRP-TT was performed on 30 patients with BPH diagnosed by international prostate symptom score (IPSS), digital rectal examination (DRE), transrectal ultrasound (TRUS), urodynamics and prostate specific antigen (PSA) with 50W 2.01 μ m continuous wave thulium laser. The average age of the patients was 74 years old. The average prostate volume estimated by B-mode ultrasound was 58 ml ± 13 ml. The average preoperative IPSS score was 19, and the average maximum urinary flow rate (Qmax 8.0) ml/s. The changes of Na +, K +, Cl-, hemoglobin (Hb) concentrations and hematocrit (HCT) were compared before and after operation. The average postoperative time was 56 min. There was no obvious bleeding during operation, no blood transfusion cases, and the changes of Na +, K +, Cl-and HCT before and after operation were not statistically significant (P>0.05). No bladder irrigation was needed after operation, and the catheter was kept for 1 to 3 days. The average postoperative Qmax was 23.1 ml/s, the average IPSS score was 7.9, the average Qmax was 24.7 ml/s after 3 months, and the average IPSS score was 7.1. There were no new cases of erectile dysfunction (ED) and retrograde ejaculation after 3 months of follow-up. Conclusion TmLRP-TT is safe in the treatment of benign prostatic hyperplasia

Objective to investigate the relationship between exon 1 A49→G polymorphism of cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene and genetic susceptibility to idiopathic dilated cardiomyopathy (IDC). Methods PCR-RFLP was used to analyze the A→G polymorphism of exon 49 of CTLA-4 gene in IDC (48 cases) and normal controls (50 cases). The serum levels of sCTLA-4, IFN-γ and IL-4 were detected by ELISA, and the ratio of IFN-γ/IL-4 was used as the deviation index of Th1/Th2. Results the frequencies of GG genotype and G allele in IDC group were significantly higher than those in control group (P =0.012, P =0.008); Compared with the control group, the level of sCTLA-4 in IDC group was higher (1.87 μ g/L ± 1.06 μ g/L, 0.54 μ g/L ± 0.19 μ g/L, P<0.05); The level of IFN-γ was low (16 ng/L±6 ng/L,30 ng/L±10 ng/L,P<0.05); The ratio of IFN-γ/IL-4 was low (1.63±0.50, 3.01±0.89, P<0.05); There was no significant difference in IL-4 between the two groups. GG genotype and G allele frequency in IDC group were correlated with sCTLA-4 level (r =0.57, P =0.021) and IFN-γ/IL-4 ratio (r =0.42, P =0.028). Conclusion The polymorphism of exon A49→G of CTLA-4 gene was correlated with IDC susceptibility.

Objective to investigate the infection rate of different genotypes of Epstein-Barr virus (EBV) in subgingival specimens of chronic periodontitis (CP) and its relationship with the degree of CP lesions. Methods Nested polymerase chain reaction (nPCR) with EBV-1 and EBV-2 specific primers was used to detect EBV-1 and EBV-2 in subgingival specimens of 65 patients with CP, 65 patients with gingivitis and 24 healthy periodontal subjects, respectively. Restriction fragment length polymorphism analysis (RFLP) of endonucleases Afa Ⅰ and Stu Ⅰ was used to further identify the amplified products. Using periodontal attachment loss and gingival index as observation indexes, the relationship between EBV infection and the severity of periodontitis was analyzed. Results 0.01 ng of EBV-1 DNA could be detected by nPCR, and the results of nPCR were the same in all specimens. The 497 bp amplified product of EBV-1 could be divided into 355 bp and 142 bp fragments after digestion with Afa Ⅰ, and the 165 bp amplified product of EBV-2 could be divided into 118 bp after digestion with Stu Ⅰ The total positive rates of EBV-1 and EBV-1 were 36.5% (95/260), 20.0% (52/260) and 14.6% (14/96) respectively. The positive rates of EBV-1, EBV-2 and total EBV were higher in CP than in gingivitis specimens (P<0.05) and normal gingival crevicular specimens (P<Conclusion EBV-1 and EBV-2 infection are closely related to CP, and there is no direct relationship between EBV infection and the severity of periodontitis.

Objective to compare the difference of psychological scale of anxiety and depression between different subgroups of reflux esophagitis (RE) and non-erosive reflux disease (NERD), and to explore the influence of psychological factors on the occurrence of gastroesophageal reflux disease (GERD) symptoms.Methods 206 patients with GERD with typical acid reflux and heartburn were divided into four subgroups according to the presence of RE and pathological acid reflux after gastroscopy and 24-hour gastroesophageal pH monitoring: RE pH monitoring positive group (RE + group, 35 cases, 70.0%), RE pH monitoring negative group (RE-group, 15 cases, 30.0%), NERD pH monitoring positive group (NERD + group, 77 cases, 49.4%), NERD pH monitoring negative group (NERD-group, 79 cases, 50.6%); The last group was divided into positive symptom index group (NERD-SI + group, 18 cases, 22.8%) and negative symptom index group (NERD-SI-group, 61 cases, 77.2%) according to the monitoring symptom index (SI). The acid reflux characteristics, mental and psychological assessment [using self-rating symptom scale and general hospital anxiety/depression mood measurement (HAD scale)], demographic characteristics and body mass index were compared among the groups. Results (1) The proportion of males in RE group was higher, while females in NERD group were the predominant; The body mass index of patients in RE group and RE + group was higher than that in NERD group and NERD + group, respectively, and the differences were statistically significant. (2) The positive rate of pH monitoring in RE group was significantly higher than that in NERD group (70.0% vs 49.4%), and the differences in DeMeester score and other indexes were statistically significant [39.3 (96.5) vs 13.9 (33.6)]; Further comparison between RE + group and NERD + group showed that the DeMeester score and other indexes in RE + group were significantly higher than those in NERD + group [68.1 (95.2) vs 40.1 (64.4)]. (3) Among the patients who completed HAD scale, 44.6% (29/65) HAD depression, 36.9% (24/65) HAD anxiety, and most of them were mild to moderate depression/anxiety. The scores or indexes of NERD-group were higher than those of NERD + group, and the differences in most parameters were statistically significant. Among them, the scores or indexes of NERD-SI-group were higher than the overall level. Conclusion NERD + and RE may be lesions with increasing degree under the same pathogenesis. The psychological assessment indexes of patients in NERD-group (especially NERD-SI-group) were higher than those of patients in other groups, which suggested that mental stress played an important role in the occurrence of reflux symptoms in this group.

Objective to investigate the effects of interferon-α (IFN-α) on the expression of thymidine phosphorylase (TP) and angiogenesis in human hepatocellular carcinoma. Methods IFN-α was used to treat human hepatocellular carcinoma cells SMMC-7721 in vitro and in vivo. The expression levels of TP mRNA and protein were detected by RT-PCR and ELISA, the ability of inducing endothelial cell migration was detected by Boyden chamber method, and the microvessel density (MVD) was detected by immunohistochemistry. Results IFN-α upregulated the expression level of TP mRNA in SMMC-7721 cells in a dose-dependent manner. Compared with the untreated group, the expression level of TP mRNA in IFN-α-treated cells at concentrations of 5000 and 10000 U/ml was significantly increased (P<With the increase of IFN-α dose, the expression level of TP protein in subcutaneous transplanted tumor tissues of nude mice gradually increased, while the number of MVD increased first and then decreased. At different doses of IFN-α (9.0×106, 1.5×107U·kg-1·d-1), the expression level of TP protein in tumor tissues was significantly higher than that in untreated group (48 ng/mg ± 24 ng/mg) (60 ng/mg ± 6 ng/mg, P<0.01); The number of MVDs were 6.0 ± 1.8, 4.0 ± 1.5, P<0.05). Compared with the untreated group, the tumor weight of IFN-α (1.5×107 U·kg-1 ·d-1) group decreased significantly (P<Conclusion A certain dose of IFN-α can not only up-regulate the level of TP expression in hepatocellular carcinoma, but also counteract the enhancement of angiogenesis after up-regulation of TP expression.

Objective to investigate the effects of angiotensin converting enzyme inhibitor (ACEI) ramipril and angiotensin receptor antagonist (ARB) losartan on left ventricular hypertrophy (LVH) and diastolic function in spontaneously hypertensive rats (SHR). Methods Sixty-two SHR rats and twenty Kyoto-Wistar rats (WKY) were randomly divided into WKY control group, SHR control group, SHR-ramipril group, SHR-losartan group and SHR-combination group. The blood pressure of the rats was reduced to the normal range at 12 and 24 weeks after treatment. The left ventricular function, the concentration of Ca2+ in myocardial cells, the concentration of hydroxyproline in myocardial tissue, the expression of sarcoplasmic reticulum calcium pump (SR Ca2+ -ATPase), phosphoprotein (PLB), L-type Ca2+ channel mRNA and the protein expression of SR Ca2+ -ATPase in myocardial tissue were measured at 12 and 24 weeks after treatment. The distribution of myocardial collagen was observed by light microscope and the changes of myocardial ultrastructure were observed by electron microscope Left ventricular relaxation time constant τ (14.3 ms±4.1 ms,19.0 ms±3.7 ms,18.5 ms±1.7 ms), intracellular Ca2+ concentration (126 nmol/L±15 nmol/L,128 nmol/L±14 nmol/L,118 nmol/L±15 nmol/L), The concentrations of hydroxyproline in myocardial tissue (1.13 μ g/mg protein ± 0.15 μ g/mg protein, 1.04 μ g/mg protein ± 0.12 μ g/mg protein, 0.83 μ g/mg protein ± 0.13 μ g/mg protein) were significantly lower than those in SHR control group (209 mmHg ± 17 mmHg, 3.28 mg/g ± 0.29 mg/g, 44.1 ms ± 18.0 ms, 279 nmol/L ± 19 nmol/L, 1.77 μ g/mg protein ± 0.21 μ g/mg protein) (P<0.01); Ca2+ -ATPase mRNA (1.03 ± 0.09, 1.16 ± 0.11, 1.23 ± 0.12) and protein expression (0.89 ± 0.08, 0.92 ± 0.10, 1.03 ± 0.11) and L-type Ca2+ channel mRNA expression (0.85 ± 0.08, 0.99 ± 0.11, 1.11 ± 0.13) were significantly higher than those in SHR control group (0.77 ± 0.09, 0.69 ± 0.08, 0.56 ± 0.08) (P<0.05～0.01); There was no statistical difference in the expression of phosphoprotein mRNA between the groups; The degree of reversal of myocardial fibrosis and the degree of improvement of myocardial ultrastructure were as follows: combination group>losartan group>ramipril group. Conclusion When blood pressure is reduced to the same level, both ACEI and ARB alone and in combination can resolve myocardial hypertrophy and improve left ventricular diastolic function, and the combination is superior to the single drug in reversing myocardial fibrosis and myocardial ultrastructure abnormalities.

Objective to observe the effect of clearance of circulating cytokines on renal and pulmonary function in patients undergoing open heart surgery with cardiopulmonary bypass. Methods 30 patients with rheumatic valvular heart disease undergoing valve replacement were divided into two groups, 15 cases in each group. The plasma levels of tumor necrosis factor (TNF-α), interleukin (IL) -6, IL-8, IL-10, interleukin-1 receptor antagonist (IL-1ra) and C-reactive protein (CRP) were compared between the two groups before, during and after operation. The changes of renal and pulmonary function were observed between the two groups. Results (1) The levels of TNF-α, IL-6, IL-8, CRP, IL-10 and IL-1ra were significantly higher in the two groups than those before operation (all P<0.05). At the end of CPB, the levels of TNF-α (10 ng/L±3 ng/L) and IL-6 (115 ng/L±22 ng/L) in the experimental group were significantly lower than those in the control group (both P<The levels of IL-10 and IL-1ra in the experimental group were only slightly lower than those in the control group (all P>0.05). (2) At 24 h after CPB, the white blood cell count increased by (17±3) ×109/L and (22±3) ×109/L, the body temperature increased by 1.6℃±0.2℃ and 2.1℃±0.2℃, the heart rate increased by 15 beats/min±4 beats/min and 23 beats/min±6 beats/min, and the CRP increased by 56 mg/L±13 mg/L and 69 mg/L±15 mg/L, both of which were significantly lower than those in the control group (all P<(3) At 24 hours after operation, the urinary protein of the experimental group and the control group were 0.20 g/d ± 0.08 g/d and 0.30 g/d ± 0.14 g/d, respectively, and the urinary NAG enzyme was 28 U/L ± 11 U/L and 38 U/L ± 13 U/L, respectively. The experimental group was significantly lower than the control group (all P<The clearance rate of endogenous creatinine in the experimental group (68±7) ml·min-1·1.73m-2 was significantly higher than that in the control group (57±11) ml·min-1·1.73m-2 (P<(4) 60 min after CPB, the increase of airway plateau pressure and peak airway pressure in the experimental group was also significantly lower than that in the control group (both P<The time to stop mechanical assisted breathing in the experimental group was 4.9 h ± 0.6 h, which was significantly earlier than that in the control group (5.8 h ± 0.8 h) (P<Conclusion the absorption of circulating inflammatory factors by AN69 membrane filter in CPB can significantly improve the systemic inflammatory response and reduce the damage to kidney and lung after CPB.

Objective to investigate the role of thrombin sensitive protein 1 (TSP1) antigen in the pathogenesis of thrombotic platelet purpura (TTP) and the relationship between the activity of von Willebrand factor cleaving protease (ADAMTS13). Methods TTP, idiopathic thrombocytopenic purpura (ITP), systemic lupus erythematosus (SLE) and myocardial infarction were detected by TSP1 detection kit and residual collagen binding assay (r-CBA). Cerebral infarction; Plasma TSP1 content and ADAMTS13 activity were observed in patients with malignant tumor (20 cases each) and patients after bone marrow transplantation (8 cases). Results the mean plasma TSP1 content of TTP patients was 6.49 mg/L before treatment and increased to 13.02 mg/L after treatment, but it was significantly decreased compared with the mean 18.34 mg/L in normal subjects. The activity of ADAMTS13 (r-CBA method) was decreased to varying degrees (0% ~52%) before treatment. Among them, the activity of ADAMTS13 decreased to varying degrees (2.9% ~93.4%) in 8 patients with activity<10%, and the activity of ADAMTS13 decreased slightly (63% ± 16% and 70% ± 14%, respectively) in patients with ITP and SLE, while the activity of ADAMTS13 decreased to some extent (15.6 mg/L ± 7.6 mg/L). In patients with myocardial infarction, cerebral infarction and tumor, the content of TSP1 increased significantly (24.0 mg/L ± 2.9 mg/L), but the activity of ADAMTS13 was not abnormal (72% ± 16%).

Objective to investigate the occurrence of ABL tyrosine kinase region mutation in patients with chronic myeloid leukemia (CML) treated with imatinib. Methods Nested PCR was used to amplify 30 patients with imatinib in the accelerated/abrupt or late chronic phase. The clinical effect of imatinib was not good. The ABL kinase region of bcr/ABL fusion mRNA was detected in 45 patients with CML at different times of treatment, purified, sequenced and analyzed sequence homology. Results Point mutation was detected in 13 patients (43.3%). The types were E255K in 4 cases, G250E in 4 cases, F359C + G250E in 1 case, E355G in 1 case, M244V, Y253H and D276G1 in 1 case, 12 of them developed disease progression and transferred to the accelerated/abrupt phase, 8 cases showed homozygous point mutation at the time of disease progression, and 3 cases showed both wild and mutant ABL (1 case without progression). The patients with accelerated/abrupt phase (1.5~30 months, median 5 months) were significantly earlier than those with late chronic phase (11~45 months, median 25.5<Conclusion ABL kinase point mutation is one of the main reasons for the failure of imatinib in the treatment of CML. Regular monitoring of ABL kinase point mutation is helpful for early intervention therapy and improvement of curative effect.

Objective to detect the single nucleotide polymorphism (SNP) in the regulatory and structural regions of CCR5 gene in Chinese Yi population and analyze the relationship between SNP and HIV infection. Methods the regulatory and structural regions of CCR5 gene were amplified by nested-PCR in 102 normal subjects and 68 HIV infected subjects, respectively. The mutated gene fragments were screened by denaturing high pressure liquid chromatography (DHPLC), and the mutated fragments were sequenced by bidirectional DNA. Then, the single nucleotide polymorphism of CCR5 gene was analyzed by Sequence Navigator software, and the relationship between SNPs and HIV infection was analyzed by SPSS and PPAP software. Results Five SNPs, A77G, G316A, T532C, C921T, G668A, and AGA deletion mutations at positions 686-688 (686Del3) were detected in the coding regions of CCR5 gene in Chinese Yi population. Except for C921T (Y307Y), the other SNPs, A77G, G316A, T532C, G668A, were all significant mutations And there was no significant difference in allele frequency between normal population and HIV infected people (P>0.05); Different from the coding region, five SNPs, T58934G, G59029A, T59353C, G59402A and C59653T, were detected in the regulatory region, and their allele frequencies were higher, ranging from 0.1912 to 0.2941. There was no significant difference in the distribution of each mutation detected between normal population and HIV infected population (P>0.05). The correlation between the mutation sites and HIV infection suggests that T59353C-G59402A haplotype may be associated with HIV infection. Conclusion DHPLC is a rapid and efficient high-throughput method for screening unknown gene mutations. The correlation between SNP and HIV infection needs further study.

In recent years, medical dispute (medical dispute) has risen abruptly, and the medical error (medical error) hidden behind it has gradually emerged, which has become an important public health problem. In 1999, the American Institute of Medicine published a milestone research report on medical error<to err is human: building a safer health system, this report estimates that 44,000 to 98,000 people die from medical errors in the United States every year, far exceeding the number of deaths from traffic accidents, breast cancer and AIDS in the United States every year [1]. If a rough estimation is made according to the probability of patients suffering medical errors (about 1.00%) revealed by the medical injury research report-"Harvard Study" [2], the number of medical errors in China in 2003 was 609,200 (according to the Statistical Information Center of the Ministry of health<Statistical Bulletin on the Development of Health Services in China in 2003>The number of hospitalized patients in China in 2003 was 60.92 million). Although medical errors exist so widely, we know very little about their frequency, distribution, inducing causes and risk factors, and it is very inaccurate.

A 21-year-old male was admitted to the hospital on April 26, 2005 due to cough for more than 20 days. More than 20 days ago, the patient had cough without obvious trigger, a small amount of white phlegm, occasional chest pain, no fever, headache, chest tightness and night sweats, etc. The chest radiograph of the local hospital showed upper mediastinal mass and lung infection, but there was no obvious improvement after anti-infective treatment for one week.

The patient was a 33-year-old male. He had intermittent headache for more than two years without obvious trigger, which was dull pain, and each time lasted for a short time. When the headache was obvious, he took "headache powder" by himself. The headache worsened in the past half month, but there was no obvious improvement after taking Fenbid. Six hours ago, the headache worsened, and suddenly appeared limbs twitching, foaming at the mouth, and lasted for about 1 h. He was rushed to a nearby hospital, and vomited stomach contents many times on the way. After dehydration treatment, his symptoms slowly improved to our hospital. Admission examination: clear mind, sharp speech, pupils of equal size and round size, sensitive light reflex, no skew of mouth corner, tongue extension in the center, muscle strength of limbs, abdominal wall reflex and levator anal reflex, and negative Pap sign.

Liver transplantation has been developed for more than 40 years. From early animal experiments to now, it has become a routine treatment for end-stage liver disease in clinic. During this period, it has experienced many understanding and breakthroughs in relevant basic theories and technologies. However, with the continuous increase of the number of recipients in clinic, the shortage of donors is becoming more and more serious, and many recipients die while waiting for donor liver. In order to alleviate the situation of donor shortage, split liver transplantation and living donor liver transplantation (LDLT) techniques have also emerged and developed rapidly, which has increased the number of donor liver to a certain extent [1, 2]. However, compared with whole liver transplantation, the above two methods often have the problem of too small graft volume. The reduction of liver volume will cause the relative or absolute increase of blood flow into the liver from the prehepatic portal vein and the poor outflow of the retrohepatic hepatic vein system. Transient or persistent portal hypertension is undoubtedly a mechanical injury factor for donor liver. Insufficient effective volume of transplanted liver can cause postoperative hyperbilirubinemia, refractory ascites, international normalization ratio of prothrombin time (INR) and prolonged prothrombin time, gastrointestinal bleeding, secondary infection, renal failure and other serious complications, which are clinically called small volume liver syndrome (SFSS). Ku et al. [3] believed that the change of portal vein pressure after small volume liver transplantation is a big influencing factor for the prognosis of surgery as early as 1995. After that, more and more scholars and clinicians gradually realized this problem [4, 5]. The author intends to comment on this problem.

From 5 to 6 September 2005, the "21st Century Forum-China-EU Sub-Forum on Sustainable Development" jointly sponsored by the Ministry of Science and Technology of the People's Republic of China, the Foreign Affairs Committee of the National Committee of the Chinese People's Political Consultative Conference, the China Association for Science and Technology and the European Commission Delegation to China and Mongolia was held in Beijing. The whole forum was divided into six parts according to different themes, Among them, "Health and Sustainable Development" is a sub-forum dedicated to the relationship between health and sustainable development. This forum invited more than 100 representatives, including government officials, scholars and entrepreneurs from the Ministry of Health, the Ministry of Science and Technology, the Chinese Academy of Sciences, the Chinese Academy of Medical Sciences, the Chinese Academy of Traditional Chinese Medicine, the National Center for Disease Control and Prevention, the National Institute of Housing Engineering, the Office of the World Health Organization in China, the United Nations International Development Organization, the United Nations Population Fund, the China Investment Promotion Office of the United Nations Industrial Development Organization, the United Nations Programme on AIDS (UNAIDS), the Federal Centers for Disease Control and Prevention, the American Pioneering Alliance for Medicine and Public Health, the Ford Fund, and some famous domestic universities and research institutions.

In this study, sibutramine hydrochloride was applied to patients with simple obesity for 6 months in order to understand the effect of serum leptin before and after weight loss.

Vascular endothelial growth factor family (VEGF:VEGF-A, B, C, D, E and PIGF) and their receptors are one of the most important known regulators of vascular/lymphangiogenesis. VEGF-C can promote vascular/lymphangiogenesis through VEGFR-2,3 signaling pathway, so it also plays an important role in the pathological process of solid tumor progression and invasion and metastasis. Recently, it has been found that vascular endothelial growth factor (VEGF) -C and its receptors are also expressed in some hematological tumor cells, but the effects on the biological characteristics of leukemia cells are still unknown. Therefore, we used our own eukaryotic expression vector of human VEGF-C and transfected it into Chinese hamster ovary (CHO) cells through liposome mediated stable expression to study the effects of this vector on the biological characteristics of leukemia cells.