Volume 89  ·   Issue 23  ·  2009

Influenza A (H1N1), which originated in Mexico and the United States between March and April 2009 (before April 30, it was called "swine influenza"), rapidly shifted global attention from the financial crisis to this old and new viral infectious disease. The disease has a rapid onset and spread rapidly. When the World Health Organization (WHO) first published the information on April 24, the epidemic was limited to Mexico and the United States, with 18 confirmed cases in Mexico and 7 confirmed cases in the United States. By May 7, the deadline of this article, the epidemic spread to 24 countries and regions around the world within 13 days, with 2371 confirmed cases and 44 deaths [1-2].<According to the International Health Regulations (2005)>, the WHO declared human infection with influenza A (H1N1) as a "public health emergency of international concern" and raised the warning level of influenza pandemics twice in three days for the first time, from level 3 to level 5 [3-5].

Objective To investigate the level of FOXP3 expressed in CD4+ CD39+ T cells in peripheral blood of patients with systemic lupus erythematosus (SLE) and observe the regulation of glucocorticoid on it . Methods Frequencies of CD4+ CD25+ CD39+, CD4+ CD25+ FOXP3+ and CD4+ CD39+ FOXP3+ T cells and levels of FOXP3 protein were analyzed by flow cytometry of 47 SLE patients (including 29 untreated/active SLE) and 22 healthy controls. Meanwhile, correlations among three groups and influences of glucocorticoid were analyzed. Results Percents of CD4+ CD25+ CD39+ T cells expressed in active SLE, inactive SLE and healthy controls were (1.3±0.5) %, (1.9±0.8) % and (2.3±1.0) % respectively, the level decreased in active SLE compared with inactive SLE and healthy controls P<0.05 in each group, but it had no significant difference between the latter two groups (P>0.05). In active SLE, levels of FOXP3 protein expressed in CD4+ CD25+, CD4+ CD25high and CD4+ CD39+ T cells were (45±12)% ,(65±14)% and(70±14)% respectively. Levels of FOXP3 expressed in CD4+ CD25high and CD4+ CD39+ T cells were higher than that expressed in CD4+ CD25+ T cells (P<0.01), while it had no significant difference between CD4+ CD25highT cells and CD4+ CD39+ T cells (P>0.05). Conclusions These results demonstrate that CD39 may be a better surface marker of regulatory T cells, and that deficiency of CD39+ Treg cells may play an important role in the pathogenesis of SLE.

Objective To explore the relation of cognition and uric acid in Parkinson's disease and analyze the related factors of cognition. Methods A total of 104 patients with Parkinsen's disease were divided into two groups:those with cognitive impairment and those without. Every patient was subject to the cognitive and depression function assessment. And the fasting blood uric acid samples. Then the serum uric acid levels of two groups and analyze the related factors of the cognitive with multiple linear. Results (1) The serum uric acid level in the group with cognitive impairment(249 μmol/L±59 μmol/L) is lower than that without cognitive impairment (323 μmol/L±52 μmol/L), and there was marked statistical significance (t=-6.78, P<0.001) (2) In PD patients,the cognitive scores correlated with serum uric acid levels, education, age, H-Y stages and the depression levels, but didn't with gender, disease duration, smoking and BMI. Conclusion (1) There was correlation between the serum uric acid and the cognitive impairment, Low serum uric acid level predicted worse cognitive scores. (2) In PD, the change of the cognitive function was impacted by their education, age, H-Y stages and depression levels.

Objective Observe the effect of operation plus post-operative chemotherapy for long-term results of stage Ⅰ lung adenocarcinorma. Methods From January 1994 to January 2005, 427 patients with stage Ⅰ lung adenocarcinorma underwent surgical resection therapy. The comparison of long-term survival rates was made between post-chemotherapy and surgical resection alone. Results The analyses disclosed that the stage Ⅰ a 1,3, 5 and 10-year survival rate of post-chemotherapy was 100.00%, 92.34%, 86.17% and 74.82%, respectively, while in surgical resection alone was 96.63%, 88.11%, 79.52% and 65.85%, respectively. The stage Ⅰ b 1, 3, 5 and 10-year survival rate of post-chemotherapy was 96.84%, 77.99%, 69. 56% and 64. 36%, respectively, while in surgical resection alone was 85.65% ,67.11%, 59.56% and 53.06%, respectively. There was statistically significant difference between 1 year survival rate of stage Ⅰ a patients with post-chemotherapy and those with surgical resection alone (P<0.05); 1 year survival rate of stage Ⅰ b patients with post-chemotherapy and those with surgical resection alone (P<0.01). Conclusion The operation plus post-operative chemotherapy is better than surgical resection alone in stage Ⅰ a and Ⅰ b. Surgical plus post-operative chemotherapy mode is indispensable for better prognosis of stage Ⅰ a and Ⅰ b lung adenocarcinorma.

Objective To study the application of Doppler tissue imaging (TDI) in the assessment of right ventricular function of patients with intraoperative device closure of atrial septal defect (ASD). Methods A total of 48 ASD patients, 18 males and 30 females, were selected for intraoperative device closure. The mean age was 31±16 years old. Color Doppler echocardiographic instrument (Sonos 4500) was employed to perform the Doppler tissue imaging before and at 3-5 days after operation. The parameters included: (1) Time and peak speed of systolic motion of anterior tricuspid valve annulus (TDI-TS, TDI-PVS),early diastole motion time (TDI-TE) and late diastolic motion time (TDI-TA) and peak speed of early and late diastolic motion (TDI-PVE, TDI-PVA), interval between the early diastolic motion and late diastolic motion (TDI-TE-A); (2) Peak speed of systolic, early diastolic and late diastolic motions of the middle lateral and basic lateral walls of right ventricle. Results The TDI-PVS(0.16±0.05) m/s in post-operation was decreased than TDI-PVS(0.20±0.04) m/s in pre-operation and TDI-PVA (0.12±0.03) m/s in post-operation was decreased than TDI-PVA (0.16±0.02) m/s in pre-operation apparently (P<0.01). The TDI-TS(231±36) msec in post-operation were shorter than TDI-TS (265±24 )msec in pre-operation(P<0.01). Peak spead of Systolic, early diastolic and late diastolic motions of middle lateral and basic lateral walls of right ventricle declined post-operatively (P<0.01). Conclusion TDI is an effective method to evaluate the function of right ventricle quantitatively in patients with intraoperative device closure of ASD.

Objective To investigate the difference between autolagous radial artery (RA) and great saphenous vein (GSV) harvesting in the elderly aged 65 years and older in coronary artery bypass grafting. Methods 171 patients aged 65 years and older underwent CABG with left internal mammary artery (LIMA), RA and GSV harvesting between January 2004 and June 2008. The harvesting time, length of conduits, intraoperative graft flow and harvest-site complications between RA and GSV was observed and follow-up was performed. Results A total of 171 RA and 171 GSV grafts were collected. The mean number of distal anastamoaes was 3.20±0. 35. There was no signifieant difference in harvesting time, length of conduits and intranperative graft flow between RA and GSV(29±10 min vs 28±8 min,18. 2 cm±1.5 cm vs 21.3 cm±5.7 cm and 41 ml/min±19 ml/min vs 34 ml/min±9 ml/min, P>0.05), however, postoperatively, the length of wound healing and the incidence of infection, hematoma, exudation, paresthesia and tumescence of wound in RA was obviously lower than those in GSV (P<0.05). Conclusions Harvesting of RA in the elderly aged 65 years and older was superior to that of SVG and RA might play an more important role in CABG in the elderly.

Objective To study the efficacy of alendronate to prevent hip fracture risk of postmenopausal women. Methods Randomized controlled trials in postmenopausal women receiving alendronate or placebo for preventing hip fractures rate were searched from Medline, EMBASE, Cochrane Trial Registry and China Biological Medicine database between January 1980 to December 2007. Key words included hip fractures, alendronate, postmenopausal and placebo-controlled. Language was limited in English and Chinese. The software Revman 4.2 was used to perform meta-analysis. Results Six trials, which included 8610 postmenopausal women, met all our inclusion criteria.Meta-analysis showed that alendronate can decrease hip fracture rate (OR=0.51, 95% CI:0.34,0.77). Conclusion Alendronate can reduce significantly hip fracture rate in postmenopausal women.

Objective To investigate the influence of combined intercostal nerves block-sevoflurane used inhalation anesthesia with laryngeal mask ventilation on the stress response to modified radical mastectomy. Methods 60 patients with ASA physical status Ⅰ-Ⅱ, aged 33-53 years and scheduled for modified radical mastectomy were randomly divided into group Ⅰ and group Ⅱ. 30 cases each group. Patients in both groups received modified radical mastectomy under sevoflurane used inhalation anesthesia with laryngeal mask ventilation, and group Ⅱ received intercostal nerves block befor anesthesia induction. Blood samples were taken before anesthesia,at incision,one hour after incision and 5 munites after the end of surgery for determination of serum concentration of cortisol and angiotension. Blood pressure and heart rate of patients was also recorded during the operation. Results Compared with the baseline value before anesthesia,serum cortisol and angiotension increased 5 munites after the end of surgery in both groups,but the concentration in group Ⅰ were higher than that in group Ⅱ. At incision the concentration of cortisol in group Ⅰ were higher than the baseline value and the same time in group Ⅱ. Conclusion Combined intercostal nerves block-sevoflurane used inhalation anesthesia with laryngeal mask ventilation can reduce the stress response in patients undergong modified radical mastectomy.

Objective To explore the changes of sera S100B and NO and their significance of patients with brain injury. Method We detected sera S100B and NO level of 30 healthy persons and 108 cases with brain injury by ELISA and method. Results The sera S100B level of patient group was increased after 12 h brain injury,and sera NO concentrations of sereve type were significantly high than control group, P<0.01. NO concentrations of sereve type, middle type and minor type were significantly high than control group, middle type and minor type group. P<0.05, However ,sera NO level of middle type and minor type group of brain injury had no significance than control group, P>0.05. Conclusion Sera S100B examinations can be indicas as diaognosis of early brain injury.

Objective To study on lesion characteristic and treatment of atherosclerosis occlusion (ASO). Methods Collect and analysis 413 patients, 778 lower extremities digital subtraction angiography (DSA) from Jan. 1, 1996 to Dec. 31, 2007 in our hospital. Results Left 220 (28.3%), right 208 (26.7%) ,both 350(45.0%);type Ⅰ 65(8.4%),type Ⅱ 194(24.9%),type Ⅲ 519(66.6%);single level 135 (17.4%), multilevel 643 (82.6%); profound lesions stenosis 82 (10.5%), occlusion 16 (2.1%). Conclusions Multilevel lesions are the main characteristic in all cases (about 4/5); we should design individual treatment dependent on lesion characteristic. Endovascular intervention and bypass reconstruction is main treatment for ASO.

Objective To study a mini-invasive extraperitoneal approach to lumbar spine and discuss its exposure technique, complications and management. Method Anterior lumbar surgery was performed in 52 patients via the mini-invasive anterior extraperitoneal approach. Diagnoses included lumbar degenerative instability (n=23), discogenic lumbar pain (n=25), lumbosacral congenital deformity (n=2) and revision after posterior laminectomy & disectomy (n=2). The patients underwent anterior lumbar interbody fusion (n=32) and total disk replacement (n=20). The operated disks included L4-5 and L5-S1. There were single level (n=47) and double level (n=5). Operation time, blood loss, perioperative complications, postoperative bed-leaving time, incision length, pain of abdomen incision and postoperative hospitalization duration were recorded in details. Results All cases were exposed clearly and no one needed to prolong incision or change operation for an insufficient exposure. Average operation time was 85 min, average blood loss 155 ml, average postoperative bed-leaving time 3 days and average incision length 6.5 cm. All cases felt very little pain of abdominal incision and postoperative hospitalization duration was 7-10 days. Perioperative complications included vena cava tear (n=1), peritoneum tear (n=2), postoperative abdominal distention (n=3) and postoperative fever (n=5). No retrograde ejaculation was found in all male cases. Conclusion The technique of mini-invasive extraperitoneal approach to anterior lumbar has such multiple advantages as fewer complications, less trauma, excellent exposure to anterior vertebrae and disk and without destruction of posterior spinal component.

Objective To explore the differentially expressed serum proteins in healthy women and OEC patients by using protein chips. Methods Sera of 11 cases of EOC and 11 matched healthy women were labeled with cy3 and cy5 fluorescent dyes and then were made to hybridized with the same protein antibody chips. The internally normalized ratio (INR) was calculated according to the fluorescent intensity of each protein spot. The value of INR >2.0 or <0.7 was considered as a cut-value to screen the differentially expressed serum proteins in EOC patients and healthy women. Results Twenty-seven differentially expressed serum proteins were found in healthy women and EOC patients, including 17 up-regulated and 10 down-regulated proteins in EOC patients. Conclusion Proteome-protein antibody chip can be used to detect the differentially expressed serum proteins in the tissues. These target proteins will facilitate the study of diagnostic biomarkers of EOC and aid in monitoring the therapeutic effect of EOC.

Objective To investigate the different immune functions in normal cervix, CIN and cervical cancer tissue and the ralationship between HPV infection and local cervical immune functions. Methods The morphology, quantity, distribution and optical density of CD4+ Th cells, S-100+ dendritic cells and CD57+ NK cells in normal cervical tissue, CIN cervical tissue and cervical cancer tissue were determined by immunohistochemistry and imaging analysis. Results In the precancerous lesions, the numbers of the CD4+ Th cells, S-100+ DC and CD57+ NK cells increased with the disease progression in CIN (P<0.05). But, after carcinogenesis, the immune cells decreased in local cervix tissue (P<0.05). Conclusion The local tissue of human cervical precancerous lesions had more heightened immune functions as compared with the cancer tissue.

Objective To investigate the impact of different section injury on the median nerve during peripheral nerve regeneration. Methods 18 New-Zealand rabbits were divided into 3 groups. We took the proximal,intermediate and distal nerve segment as donor nerve, the restore ratio of the number of donator fibers to recipient fibers is 1:4. We took the corresponding right side nerve as control, the restore ratio of the number of donator fibers to recipient fibers is 1:1. We then observed the general condition of regenerated nerve, counted the number of regenerated fibers, measured its conduction of velocity and wet weights of musculus flexor digitorum sublimis 3 months after operation. Results The numbers of recipient fiber of 3 different groups were as follows: goup Ⅰ: 1747±375, goup Ⅱ:1785±442,goup Ⅲ: 1863±321; Control goup Ⅰ: 2234±364, control goup Ⅱ: 2319±237, control goup Ⅲ: 2346±308. The results of conduction of velocity were:goup Ⅰ: 19. 5 m/s,goup Ⅱ: 19. 9 m/s,goup Ⅲ: 21.3m/s;Control goup Ⅰ: 57.1±3.7 m/s, control goup Ⅱ: 56.4±2.5 m/s, control goup Ⅲ: 56. 8±2.3 m/s. The results of wet weights of musculus flexor digitorum sublimes were as follows: goup Ⅰ: 1.7247±0. 0891 g,goup Ⅱ: 1.7239±0. 0903 g,goup Ⅲ: 1.7253±0.0798 g. Control goup Ⅰ: 2.0448±0.1013 g, control goup Ⅱ: 2.0433±0.0861 g, control goup Ⅲ: 2.0456±0.0947 g. Conclusion The amplification phenomenon exist in every group, the amplified ratio augment according to the distance of the site from neuron, but the conduction of velocity is decreased gradually. The wet weights of musculus flexor digitorum sublimes has no significant difference between 3 groups.

Objective To investigate the effects of bone morphogenic protein (BMP)-7 upon epithelial-to-mesenchymal transition (EMT) and the expression of connective tissue growth factor (CTGF)in human renal proximal tubular epithelial cells (HK-2) induced by transforming growth factor-β1 (TGF-β1) and to explore the possible mechanisms of BMP-7 for the inhibition and reversal of renal interstitial fibrosis. Methods HK-2 cells were treated with TGF-β1 or a combination of TGF-β1 and BMP-7. RT-PCR and Western blot were used to determine the mRNA and protein expression of α-SMA, E-cadherin and CTGF. For EMT reversal experiments, when TGF-β1 -induced EMT occurred, then the medium was removed and replaced with medium containing 200 ng/ml BMP-7. After 48 h, the morphological changes and the expression of E-cadherin were assessed by phase contrast microscopy or immunofluorescent microscopy. Results The control cells displayed typical cobblestone morphology of epithelial cells. 3 ng/ml TGF-β1 induced profound morphologic changes after 48 h, with cells becoming elongated in shape, but addition of 200 ng/ml BMP-7 for 48 h restored the epithelial morphology of HK-2 cells. Indirect immunofluorescence showed that treatment of 3 ng/ml TGF-β1 resulted in a distinct loss of E-cadherin staining in the plasma membrane of HK-2 cells but subsequent treatment with 200 ng/ml BMP-7 largely restored the E-cadherin protein staining. 3 ng/ml TGF-β1 significantly up-regulated the mRNA and protein expression of α-SMA,reduced the expression of E-cadherin and increased the expression of CTGF after 48 h (vs. Control, P< 0.01). BMP-7 dramatically suppressed the mRNA and protein expression of α-SMA, restored the expression of E-cadherin and prevented the expression of CTGF in a dose-dependent manner after co-incubation with TGF-β1 for 48 h (400 ng/ml BMP-7 + TGF-β1 vs. TGF-β1 alone, P<0.01). Conclusions BMP-7 exerts its antifibrotic effect partially through blocking and reversing TGF-β1-induced EMT and down-regulating the expression of CTGF in human renal tubular epithelial cells.

A 12-year-old male was admitted to hospital for 9 months due to intermittent headache and grand mal seizure. No obvious abnormalities were found in past history, personal history and family history. Neurological examination showed that the right parietal parietal tubercle was slightly protruding outward, about 4 cm in diameter. Laboratory examination showed that the hemoglobin count was 4.53×1012/L (normal range 3.512/L ~5.512/L), and the hemoglobin was 96 g/L (normal value 110 g/L ~160 g/L). Hematocrit 28.7% (normal value 37%-49%); Platelet count 281×109/L (normal range 1009/L ~3009/L); Prothrombin time 12.5 s; Partial thromboplastin time 55.9 s; prothrombin time 14.3 s; The fibrinogen time was 3.6 s (normal value 2~4.5 s). Irregular erosion of the parietal bone was found on the anterolateral plain film of the skull. CT scan showed that the left parietal bone occupied a high density circular space with uneven density and calcification (Figure 1).