Volume 89  ·   Issue 21  ·  2009

According to the report of the World Health Organization in 2006, nearly 1/4 of the diseases in the world are caused by avoidable environmental exposure, and more than 13 million excess deaths every year are attributed to preventable environmental factors. In China, the excess deaths caused by urban air pollution and indoor air pollution reach 178,000 and 110,000 respectively every year. The harm of environmental pollution to human health has become a major obstacle to people's quality of life and building a well-off society in an all-round way. At the end of 2007, the United Nations held the launching ceremony of the 2008 International Year of Environmental Sanitation at its headquarters in New York, calling on the international community to make greater efforts to improve global environmental sanitation.

Since the records began in 1510, there have been more than 30 influenza epidemics or pandemics worldwide, among which the largest influenza pandemic is the famous "Spanish influenza". The harm of influenza is no less than AIDS, SARS and war. In March 2009, influenza A (H1N1) occurred in Mexico and the United States successively. It is a strain of influenza A and H1N1 subtype influenza virus. This strain contains the gene fragments of three influenza viruses, swine influenza, avian influenza and human influenza. It is a new type of influenza virus, which can be transmitted from human to human.

A 20-year-old male was admitted to the hospital for 4 months due to recurrent limb twitching and loss of consciousness. Four months ago, the patient suffered from general twitching during sleep after fatigue, fell to the ground, turned his eyes up, closed his teeth, foaming at the mouth, and urinary incontinence. He was rushed to a local hospital for treatment. No obvious abnormalities were found on head CT examination, and severe abnormalities in EEG were found.

The patient was an 18-year-old male. The pain of the left vulvar cyst caused by trauma lasted for half a month, and it was progressively aggravated. The anti-inflammatory and hemostatic treatment effect was not obvious. He reported that he had unobstructed urination, no macroscopic hematuria, no frequent urination and urgency. Specialist examination showed that the left vulvar cyst was about 12.0 cm ×6.8cm. A 2 cm ×2 cm mass was seen in the left groin. The mass was connected to the scrotum, tough in texture, and the skin of the scrotum was congested, hard to touch, and obvious tenderness. Imaging examination: Pelvic CT scan showed a huge mass in the left scrotum with low density, about 9.0 cm ×6.8 cm in size, and an arc-shaped high density shadow was seen behind it. The CT value was about 70 HU, and the boundary of the testis was not clear.

Objective To discuss and compare the model estabhshment of liver fibrosis in oral arsenic solution exposed mice and mice with high-fat feedstuff. Methods A total of 240 mice were divided randomly into 6 groups: control group, sodium arsenite group, sodium arsenate group, high-fat feedstuff group, sodium arsenite group with high-fat feedstuff and sodium arsenate group with high-fat feedstuff with 40 mice esch. Control group and high-fat feedstuff group (drinking tap water), sodium arsenite group and sodium arsenite group with high-fat feedstuff (drinking 300 mg/L iAs3+ water), sodium arsenate group and sodium arsenate group with high-fat feedstuff (drinking 300 mg/L iAs5+ water). The mice were sacrificed after 3, 6, 10 months' arsenic-exposure and examined for liver function. HE dyeing and Masson dyeing were also employed to observe the pathological changes in hepatic tissue in each group. Results After 3 months' modeling, ALT and AST in control group, sodium arsenite group, sodium arsenate group, sodium arsenite group with high-fat feedstuff and sodium arsenate group with high-fat feedstuff were (36.7±5.7 ) U/L and (110±22) U/L, (55.6±4.6) U/L and (249±41) U/L, (52.6±8.8) U/L and (161±15) U/L, (311.3±19.7)U/L and (484±15)U/L and (515.0±60.8)U/L and (671±24)U/L. They were higher in all the arsenic groups than in control group (P<0.05); all the HE dyeing samples in arsenic groups showed liver injury in varying degrees such as hydropic degeneration, fatty degeneration, spotty necrosis, fecal necrosis and inflammatory cell infiltration. There were liver cell regeneration and fibroplasias in varying degrees. The liver injury of the mice in all arsenic groups aggravated as exposure time prolonged. Masson dyeing after 10 months' modeling showed hyperplasia in portal areas and central venous areas; the mean area of fibrosis in control group, sodium arsenite group, sodium arsenate group, sodium arsenite group with high-fat feedstuff and sodium arsenate group with high-fat feedstuff were 0.1333, 0.5584, 0. 5250, 0.7534 and 0.7200 respectively. There was statistical significance between arsenic groups and control group (P<0.05) . Conclusion The liver injury and fibrosis model in oral arsenic solution exposed mice and those with high-fat feedstuff are successfully established and subsequently evaluated. It is a comparatively ideal animal model for studying arsenic liver injury and fibrosis.

Objective To compare and analyze the differential expression of proteins between coal-burning arsenism serum and normal human serum and identify the proteins related with arseniasis caused by coal-burning. Methods Serum samples were collected from 6 normal subjects and 6 patients suffering from coal-burning arsenism. 2-DE was performed to separate serum proteins. After silver staining, the differential expression of proteins was analyzed and then identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). Results There were an average of 779±35 spots and 865± 30 spots on 2-DE matching of two groups and the matching rate was 90. 1% between two groups. From thecs two groups, 60 different protein spots were identified. Up-regulated expression was observed in 25 proteins and down-regulated expression in 35 proteins in the patient serum group. Among which 35 with differential expression above three times were singled out and MALDI-TOF-MS analysis was carried out on them. Thirteen proteins were identified, including keratin 10, apolipoprotein A-V, transferrin, alpha-1-antitrypsin, human zinc-alpha-2-glycoprotein, mitogen-activated protein kinase 3, vacuolar protein sorting 33A, O-linked GlcNAc transferase and etc. Up-regulated expression was observed in 5 proteins and down-regulated expression in 8 proteins in the patient serum group. Conclusion The well-resolved and reproducible 2-DE serum patterns of patients suffering from coal-burning arsenism were established and some differentially expressed proteins characterized. These data will be used to screen the biomarker and to further study arseniasis caused by coal-burning.

Objective To observe the oxidative stress and skin disease related genes expression in cells exfoliated from buccal mucous and blood in patients with arseniasis caused by coal-burning pollution in Guizhou. Methods Buecal and blood cell samples were collected from arsenicesis patients and healthy subjects residing in Guizhou. Total RNA was isolated for related genetic transcript analysis. Real-time PCR (RT-PCR) was employed to detect the change of related gene expression. Serum indicators of liver injury, such as serum alanine aminotrausferase (ALT), were detected. Results Serum levels of ALT in arsenic patients were significantly higher than those in controls (36.9±17.4 / 25.8±2.4, t=0.019, P < 0.05) even when no symptom was found in these patients. Buccal K10 gene was overexpressed (3.6±0.9/1.8± 0.7,t=0.041,P < 0.05) and MT-1 expression was significantly lower (0.8±0.5 / 3.9±0.4, t=0.028, P < 0.05) in arsenic patients than that in control while the expressions of other genes were the same as those of controls. Conclusion The expressions of MT-1 and K10 gene in buccal mucous cells may be regarded as sensitive molecular markers for skin and hepatic pathologic changes in arsenic patients. Protection of liver function should be considered as an important step in arseniasis prevention and control.

Objective To determine the incidence rate and correlation factors of the adverse reactions during fluorescence fundus angiography (FFA) in special patients. Methods 256 special patients were performed FFA with Heidelberg Retinal Angiography. Fluorescein Sodium was given according to the body weight and adverse reactions during FFA were observed. The special patients enrolled in this study include those with drug allergy history, system disease, light adverse reactions such as nausea, vomiting and pruritus during the fist FFA or patients over 80 years old. Results Adverse reactions were observed in 69 of 256 (27.0%) cases and the majority is at a mild to moderate degree. Nausea, sneezing, vomiting or pruritus occurred in 10 of 73 (13.7%) patients with drug allergy history. Nausea or vomiting occurred in 4 of 78 (5.1%) patients with systemic diseases. Different degrees of adverse reactions occurred in 54 of 56 (94.6%) cases who had nausea, vomiting or pruritus during the first FFA. Nausea occurred in 1 of 49 (2.0%) patients over 80 years old. Conclusion FFA is a safe examination for the above special patients. The incidence rate of adverse reaction due to FFA in these special patients is similar to that in the healthy population. Observing the patients closely and strengthening the containment and salvage measures are important to improve the safety of FFA in these special patients.

Objective To systematically review the clinical efficacy of interferon-β in secondary progressive multiple sclerosis. Methods A systematically review of Cochrane were conducted. The authors searched in electronic literatures of Medline (1980.1-2008.1), Ovid (1980.1-2008.1), Pubmed (1980.1-2008.1), CBMdisc (1980.1-2008.1), Cechrane Library (2008.1) and hand-searched the relevant literatures and symposium reports. The randomized controlled trials of interferon-β were assessed in secondary progressive MS patients. After evaluating the quality of literatures and extracting the valid data, the authors assessed the randomized controlled trials of interferon-β in secondary progressive MS patients. RevMan 4. 2. 3 software was used. Based upon the testing result of heterogeneity, fixed or random effect model was employed to calculate the odds ratio (OR) and 95% CI. Results Six RCTs of 3115 patients were included. The results indicated that interferon-β could reduce 1 and 2-year progression rate (OR= 0.73, 95 % CI=0.61-0.88 and OR=0.84, 95% CI=0.72-0.98) and lower the relapses rate (OR =0.67, 95% =0.55-0.82). Subgroup analysis suggested that relapsing women and patients during the two years before the study benefit much more from interferon-β (OR =0.69, 95% CI=0.53-0.92 vs. OR=0.73, 95% CI=0.55-0.97). Conclusion The treatment of interferon-β in secondary progressive multiple sclerosis could reduce I and 2-year progression rate and lower the relapses rate.

Objective To compare the impact of rehabilitative process of placing drainage versus no drainage during total knee arthroplasty (TKA). Method A prospective study was performed in 30 usteoarthritic patients who underwent one-stage bilateral TKA between October 2007 and December 2008. For every patient, drainage was randomly placed intra-operatively only on one knee side. Pain VAS scores, extremity swelling, incision healing, recovery of knee joint flexion and extension function and early post-operative complications were compared statistically as a self-control study. Results All patients were followed up for at least one month. Comparing drainage side with non-drainage side, the mean pain VAS scores at Day 3 post-operation were 4.7 + / - 1.8 and 4.9 + / - 1.9 respectively; the mean extremity swelling differences of supra patollar (infra patellar) perimeter at Day 6 post-operation were 1.8 +/-1.7 (0.7+/-1.0) cm and 1.7+/-1.3 (1.0+/-1.0) cm respectively; the mean flexion (extension) differences at Day 30 post-operation were 12.5 +/- 21.6 (4.4 +/- 6.9)° and 11.7 +/- 23.9 (4.2 +/-6.4)° respectively. There was no obvious statistical difference between placing drainage and no drainage in all the above aspects (paired t-test, P>0.05). There was also no statistical difference of early postoperative complications between two groups (exact Fisher test, P>0.05). Conclusion For unsophisticated TKA, placing drainage had no effect upon reducing the pain, extremity swelling and incision exudation. It also had no effect upon reducing the incidence of hematoma to prevent early infections and promoting rehabilitation. Comparing with no drainage, placing drainage had no obvious advantage. On the contrary, it might complicate the surgical steps and increase the chances of post-operative hemorrhage and retrograde infections. Thus no drainage is recommended in such a kind of operation.

Objective To report the authors' own experience in the treatment of spontaneous intracranial hypotension (SIH) with targeted epidural blood patch after locating the CSF leaks with CT myelography (CTM) and to discuss the mechanism and value of this method. Methods Six patients with SIH (3 males and 3 females aged 33-66 years) were included. All patients met the diagnostic criteria of 2ndedition of International Classification of Headache Disorders (2004). CT myelography revealed the CSF leak sites in all 6 patients. Autologous blood mixed with Omnipaque (300 mg/ml) was injected after selective puncture at the leak site indicated by CTM. Results All patients responded well to the treatment and achieved a complete resolution of symptoms. Nerve root irritation occurred in 2 patients. Three patients suffered from a temporary back pain. Conclusion With the location of leak sites by CTM, targeted epidural blood patch is an effective way to treat spontaneous intracranial hypotension.

Objective To investigate the multiple correlation factors of deep vein thrombosis after trauma to lower extremities. Methods A total of 2727 patients with traumas from pelvis to ankle were admitted from August 2006 to March 2008 and detected by Color Doppler ultrasound for DVT of bilateral lower extremities before operation. Emergency internal fixation or external fixation was not used for all patients before operation. Seventeen clinical factors were examined in order to analyze their influences upon DVT occurrence after trauma. Results DVT occurred in 351 patients after trauma. The incidence of DVT in all patients was 12.9%. The analysis of logistic regression demonstrated a definite correlation with the increment of age, the length of presentation time and the gender of female. No associated injury lowered the odds ratio of DVT down to 1.484, 1.816, 0.637 and 0.671 respectively. Other clinical factors had no statistically significant correlation with DVT. Conclusion Both the increment of age and the length of presentation time are risk factors for DVT after trauma to lower extremities. It is best to perform conventional ultrasound examinations in patients with these risk factors so as to timely treat a possible DVT.

Objective To analyze a presumed association of gene polymorphism of killer cell immunoglobulin-like receptor three domains, long cytoplasmic tail, 2 (KIR3DL2) gene with pre-eclampsia. Methods The KIR3DL2 gene A52G in exon 3 and C32T in exon 9 polymorphism were determined by polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) in 95 pre-eclampsia and 91 normal pregnant women. Results There was significant difference between two group in exon 3 in terms of genotypes and allele (P < 0.05). There was a significant differenee between two groups regarding the frequencies of exon 9 CC, CT and Tr genotypes (P<0.05). But no significant difference was found between mild pre-oclampsia and severe pre-eclampsia groups in terms of the two SNP loci (P>0.05). Conclusion The A52G polymorphism in exon 3 and the frequencies of C32T in exon 9 of KIR3DL2, gene polymorphism are associated with the pathogenesis of pre-eclampsia, But it has no correlation with the severity of preeclampsia.

Objective To evaluate the long-term trend of cataract prevalence and the effect of prevention and treatment blindness in Zhejiang Province. Methods The data were obtained from handicapped sampling investigation in 1987 and 2006 in Zhejiang Province, and from a database of prevention and treatment blindness of the Zhejiang Province Disabled Persons' Federation. Results In 2006, a random sampling investigation were carried out on both eyes blind and the low vision in Zhejiang Province. Sample size were 95 392, the prevalence rate of blindness and low vision were 2.67‰ and 5.94‰, respectively. The prevalence rate of cataract was 7.35 ‰, the female was higher than the male (X2=81.66, P<0.01). Among the blind, 58. 86% was caused by cataract, and the low vision caused by cataract was 63.79%. Comparing with the first disabled person' investigation in 1987, the result showed that the prevalence of blindness had reduces slightly, but no significantly difference (X2=0.384, P=0.535), and that the prevalence of low vision appeared significantly increase (X2=32.434, P<0.01). Together with two investigations results indicated that cataract is the first cause for the vision disability. Conclusion Cataract is still the first cause for blindness and low vision. Though the effort to prevention and treatment blindness during 20 years obtains some certain results, prevent and treat blindness will still be an arduous work in Zhejiang province, because of accelerated aging population problem, which will induce an increase on number of cataract patient.

Objective To study the effectiveness of RANTES in the pathogenesy of venous ulceration. Methods 40 Chronic venous insufficiency (CVI) individuals were enrolled in the study and separated into the ulceration group (n=20) and non-ulceration group (n=20), according to CVI with or without ulceration, 10 healthy individuals were enrolled as control group. The expression of RANTES mRNA was analyzed by reverse transcription-polymerase chain reaction (RT-PCR) in blood. Immunohistochemical staining of RANTES were carried in normal skin, in the tissue at the brim of ulceration and in the tissue of cured or curing ulceration. Results In ulceration group, the expression of RANTES mRNA in blood increased obviously. Compared with the other two groups, they were significant different(P<0.05). The difference was also significance in the other two groups(P<0.05). The average number of RANTES positive expression in normal skin is 28±13, in the tissue at the brim of ulceration is 107±44, and in the tissue of cured or curing ulceration is 35±20. There are significant difference between normal skin and the tissue at the brim of ulceration(P<0.05). The average number of RANTES positive expression in the tissue of cured or curing ulceration is lower than that's in the tissue at the brim of ulceration. Conclusion The high expression of RANTES may be one of the important mechanisms of varicose ulcer.

Objective To explore the changes of paclitaxel sensitivity by RNA interference of RhoC gene in ovarian cancer cell lines. Methods The microRNA (miRNA) targeting RhoC gene was designed and synthesized by in vitro transcription and transfected into ovarian cancer cell line SKOV3. The mRNA and protein of RhoC were detected by the means of RT-PCR and Western blot. The changes of paclitaxel sensitivity after interference were examined by methyl thiazolyl tetrasolium (MTT) assay. At the same time, the mRNA of apoptosis gene Caspase-3 and survivin were evaluated by RT-PCR. Results In SKOV3 cell, the mRNA and protein of RhoC dramatically decreased at 24, 48 and 72 hours post-transfection. The sensitivity of SKOV3 cell line to paclitaxei increased significantly after turning off the RhoC gene. The pro-apoptotic gene Caspase-3 increased significantly and anti-apoptosis gene survivin dramatically decreased after the combination treatment of paclitaxel and RhoC-miRNA in comparison with paclitaxel alone treatment. Conclusion The sensitivity of ovarian cancer cell lines SKOV3 to paclitaxel can be enhanced by RNA interfering RhoC gene. The synergistic mechanism is possibly correlated with the up-regulation of Caspase-3 gene and the down-regulation of suvivin gene.

Objective To explore the effects of androgen upon the production of inflammatory factors in 3T3-L1 adipocytes and to investigate the mechanism at the molecular level Methods Cultured pre-adipocytes from 3T3-L1 cell line were induced to differentiate into adipocytes. Mature adipoeytes were treated with testosterone at a concentration of 10-9 to 10-5 mol/L for either short (0 to 30 min) or long (12, 24 and 48 h) treatment course. Secretion of inflammatory factors, i.e. interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1), in the culture medium were determined by enzyme-linked immunosorbent assay (ELISA). The mRNA expression of IL-6 and MCP-1 were determined by reverse transcriptase PCR. Phosphorylation of NF-κB was analyzed by Western blot with β-actin as the reference gene. In another experiment, adipocytes were manipulated according to the same protocol except being pretreated with PDTC (inhibitor of NF-κB) for 2 h prior to the addition of testosterone. The results of two experiments were compared. Results (1) The secretion of IL-6 and MCP-1 in the culture medium were higher in the testosterone-treated groups than in the control groups (P<0.05). The highest concentration of IL-6 and MCP-1 were observed in the group treated with 10-5M testosterone for 24h. The mRNA expression of IL-6 and MCP-1 were higher in the groups treated with testosterone for 12 h, especially with testosterone of 10-5mol/L; (2) With a short treatment course of testosterone, more NF-κB were phosphorylated than in control, especially with testosterone of 10-5mol/L. More NF-κB was phosphorylated following the 12 h testosterone treatment (10-9, 10-7 and 10-5mol/L), especially with a testosterone concentration of 10-9 and 10-5mol/L. (3)When pretreated by NF-κB inhibitor and followed by 10-5moL/L testosterone for 24 h, the secretion of IL-6 and MCP-1 in the culture medium decreased significantly (P<0.01). Likewise, when pretreated by NF-κB inhibitor and followed by 10-5M testosterone for 12 h, the mRNA expression of IL-6 and MCP-1 decreased significantly. Conclusion Within the certain scope, testosterone could increase the expression of inflammatory factors in adipocytes through the activation of NF-κB.

The patient was a 57-year-old female who suffered from right chest and back pain for 7 days, obvious deep inhalation, tingling pain, no radiation pain, no fever, no cough, expectoration, no precordial squeezing pain, no headache, dizziness. The chest CT in the outside hospital showed peripheral lung cancer in the right lower lung, with a little pleural effusion in the lower right. The absence of right lower back was found by fiberoptic bronchoscopy in the outside hospital, and no cancer cells were found by brush examination.

Soft tissue balancing is one of the important procedures in total knee arthroplasty, especially for patients with flexion contracture and valgus deformity of the knee. Most of the clinical joint deformities such as valgus and flexion contracture of the knee are balanced by ligament release technique.

post-traumatic stress disorder (PTSD) is one of the few mental disorders with relatively clear etiology. It refers to the immediate or delayed emergence of post-traumatic psychological imbalance after experiencing sudden, threatening or catastrophic life events. Its clinical symptoms include intrusive memory, flashback and psychological amnesia (APA), and depersonalization in severe cases [1]. These symptoms are related to abnormal brain function. Functional neuroimaging can reveal the relationship between clinical symptoms and brain activity of PTSD, and further understand the relationship between brain physiopathology and psychopathology of PTSD.

The Department of Cardiac Surgery, Zhongshan Hospital affiliated to Fudan University successfully performed combined cardiopulmonary transplantation on a patient with congenital heart disease and Eisenmanger syndrome on December 17, 2003, and has survived until now. It is one of the longest survival times of similar surgery in China.