Volume 89  ·   Issue 43  ·  2009

As we all know, myasthenia gravis (MG) is an autoimmune disease, and it is also a chronic treatable disease with the most changes and fluctuations among neurological diseases, and the treatment time can be 2~5 years or more.

1. Introduction Glioma is the most common tumor of the central nervous system (CNS), among which malignant patients [2007 World Health Organization (WHO) Central Nervous System Tumor Classification Grade III, IV] are more common. Table 1. Although the prognosis of CNS malignant glioma depends on many factors and diagnosis and treatment measures, generally, grade III patients survive for 2 to 3 years, and grade IV patients (such as glioblastoma) survive for about 1 year. 　　

Objective To investigate the association of two glucocorticoid receptor (GR) polymorphisms (Bcl I ,ER22/23EK) with Myasthenia Gravis (MG). Methods The genotypes of GR in 61 MG patients (MGG) and 57 age and gender -matched healthy controls (HCG) were determined by polymerase chain reaction and nucleotide sequence determination. Results The frequencies of three genotypes (GG,CG,CC) in Bcl I were 3.3% ,34. 4% ,62. 3% in MGG and 3.5% ,38.6% ,57.9% in HCG respectively. The difference in the distribution of genotypes between MGG and HCG was statistically insignificant (P=0.887). The frequencies of G and C allele were 20.5% vs 79.5 % in MGG, and 22.8% vs 77.2% in HCG. The difference in the distribution of alleles between MGG and HCG was statistically insignificant (P=0.968). The genotype frequencies in two groups were both in Hardy-Weinberg equilibrium (P > 0.05).The genotypes of ER22/23EK in MGG and HCG were all GG and no mutation was detected. Conclusion Bcl I and ER22/23EK polymorphisms of GR have no definite relationship with the risk of MG.

Objective To investigate the in situ expression of regulatory T cells (Tress) in thymus and its significance for myasthenia gravis (MG). Methods Thirty nine MG patients who had not accepted immunosuppressive therapy before thymectomy were recruited as study group and 19 patients undergoing eardiosurgery as control. There was no significant statistical difference in age and gender between the two groups (P> 0.05) . The location and proportion of Tress in thymus were analyzed using indirect immunofluorescence double labeling immunohistochemistry and image analysis software. Results (1) Tress were all located in medulla zone of thymus in control and MG groups. (2) Cells of germinal center had a high expression of CD25 and a low expression of CD4. It indicates that a majority of germinal center cells were B cells. (3) There were fewer Tress around germinal center. (4) There was no statistical significant difference in absolute number of Tregs between the two groups (P > 0.05). But the proportion of Tress was higher in control group (P < 0.05). Conclusion The proportion of thymus Tress decreases in MG so as to weaken the function of immuno-regulation and suppression. This is probably a precipitating factor of MG.

Objective To review the experience of extraanatomic aortic bypass grafting for the treatment of complex aortic coarctation. Methods From July 1997 to July 2008, 48 consecutive patients (median age 30 years; range 10 to 58 years) with complex aortic coarctation underwent extraanatomic aortic bypass grafting. Indications include: (1) coarctation with intracardiac anomaly (n=28) ; (2) coarctation with ascending aortic aneurysm (n=1) ; (3) adult coarctation with calcification of local aortic wall(n=7) ;(4) coarctation with hypoplasia aortic arch (n=4) ; (5) long or multiple coarctation segment(n=4);(6) coarctation with poststenotic aneurysm (n= 1) ; and (7) recurrent coarctation (n=3). Routing of the grafts was:ascending-to- posterior pericardial descending aorta (n = 37) ; ascending-to-infrarenal abdominal aorta (n=9) ; left subclavian artery-to-descending aorta (n=2). Concomitant cardiac operations were performed in 31 patients (65%) using cardiopulmonary bypass; procedures included: aortic valve replacement in 16; mitral valve repair or replacement in 9; Bentall procedures in 6; patent ductus arteriosus closure in 5 ; ascending aortic replacement or plasty in 4 ; ventricular septal defect closure in 3 and coronary artery bypass surgery in 2. Results There was no operative death. One patient died of septic shock 39 days postoperatively. Two patients received laparotomy because of mechanical ileus shortly after the ascending-to-subrenal abdominal aortic bypass. Mean systolic blood pressure gradient between upper and lower extremities decreased from (65±27) mm Hg preoperatively to (14±11) mm Hg postoperatively (P < 0.05). During a mean follow-up of 28.9 months, there were no late deaths or graft-related complications. Residual mild hypertension were observed in five patients. Conclusion Extraanatomic aortic bypass is an attractive treatment option for complex aortic coarctation in adults and adolescents. It can be performed with low morbidity and mortality. The midterm results is favorable.

Objective To explore the clinical manifestations and treatment of pulmonary sequestration. Methods Thirty-five patients with pulmonary sequestration confirmed by pathological studies were analyzed. Results Among these patients, 29 were of intralobar type and 6 of extralobar type. All patients of intralobar type had symptoms of cough, expectoration, fever and hemoptysis while 6 cases of extralobar type were asymptomatic. Twenty-three cases were diagnosed preoperatively by enhanced CT scan,CT angiography or selective arteriography. Success of operation had been achieved in all cases. Conclusion The clinical manifestations of pulmonary sequestration are non-specific. Though invasive, selective arteriography plays a decisive role in the diagnosis. Such non-invasive angiographies as enhanced CT scan and CT angiography have become important supplements to it. Once the diagnosis is confirmed, operation should be performed.

Objective To study the expression of Cx32 and Cx43 in medically intractable temporal lobe epilepsy in human and investigate the pathogenic relationship between gap junctions and seizures. Methods The expression of Cx32 and Cx43 was detected by Western blot and immunohistochemistry in 14 consecutive samples of hippocampus from epileptic patients undergoing an amygdalohippocampectomy for the treatment of intractable seizures. During postmortem dissection, 8 samples of hippocampus in nonepileptic patients dying of other diseases were taken as control group. Results The expression of Cx32 and Cx43 was at a low level in the control group [Cx32 : count of positive cell (9.4± 1.1), ratios of gray scale (0.2±0.1) ; Cx43 : count of positive cell (9.2±4.7), ratios of gray scale (0.5±0.2)], but Cx43 and Cx32 appeared to be expressed at a higher level in epileptic patients compared with that of the control group by immunohistochemistry [Cx32 : count of positive cell (14.6±3.4), Cx43:count of positive cell (16.5±3.1) ] (P<0.01), and their expression significantly increased by Western blot [Cx32 : ratios of gray scale (1.5±0.2), Cx43 : ratios of gray scale (1.4±0.3)] (P<0.01). Over-expression of Cx32 and Cx43 was found in 14 consecutive samples of hippocampus from epileptic patients. Conclusion Gap junctions play an important role in the occurrence and progression of intractable seizures.

Objective To determine the relationship between hyperhomocysteinemia and multiple sclerosis (MS). Methods Cochrane, Medline, EMbase, Springerlink, Highwire, CBM, CNKI and some other databases were searched for literatures. Articles were identified using the Medical Subject Heading term "hyperhomocysteinemia, homocysteine, multiple sclerosis". The methodological quality of internalized literatures were valuated, screened and heterogeneity tested. Case control studies involving unrelated subjects and valid data were extracted and analyzed in Stata 8.0. Results Nine studies were included in this review. The involved 1146 subjects were made of 676 patients and 470 controls. A meta-analysis showed that the level of homocysteine in MS was higher than that in controls (standardized mean difference 1.25, 95% CI:0.48-2.01). The analytical result of sensitivity proved that the result of meta-analysis was coherent. Conclusion Hyperhomocysteinemia is associated with MS, and it may contribute tu the pathological course of MS.

Objective To compare two common techniques for motor unit number estimation (MUNE), multiple point stimulation and incremental stimulation to determine which is preferable in patients with amyotrephie lateral sclerosis (ALS). Methods Surface recorded motor unit action potentials of median nerve or thenar muscle were measured in 60 ALS patients and 60 controls. The maximal baseline to negative peak compound muscle action potential (CMAP) amplitude was recorded. For multiple point stimulation,the stimuli sites included the skin of wrist, 6 cm above the wrist, elbow and 6 cm above the elbow.Individual motor unit responses were obtained by moving the stimulating electrode and isolating threshold responses with distinct morphologies. Then, with finely graded stimulus intensity at one point, 3 steps in a CMAP were investigated. 10-12 different single motor unit action potentials (SMUPs) were recorded. For incremental stimulation, stimulus intensity was slowly increased from subthreshold levels until a small all-or-none response was evoked. The intensity was slowly increased until the response increased in a quantal fashion. This process was repeated for a total of 10 increments. Individual motor unit amplitudes were obtained by subtracting amplitudes of each response from that of prior response. Both techniques were performed twice, electredes changed and results averaged. Results For controls, MUNE was 228±30 for multiple point stimulation and 198±26 for incremental stimulation. Test-retest correlation coefficients and coefficients of variation for mean of two MUNE were 0.88-0.91 and 13.20%-15.24% for multiple point stimulation, 0.86 and 13.30%-15.65% for incremental stimulation- For ALS patients, MUNE was 64±6 and 59±7 respectively. Conclusion Both MUNE methods are similarly reproducible and are equally effective at documenting progression of a lower motor neuron disorder in ALS patients.

Objective To understand the curve of thoracolumbar junction in patients with thoracolumbar intervertebral disc hemiation and analyze the relation between thoracolumbar intervertebral disc herniation and spinal sagittal curve. Methods The radiographic films of thoracolumbar junction of spine from 27 patients with thoracic disc herniation and 37 healthy persons as control were taken at reclining position. The Cobb angles of sagittal plane of thoracolumbar junction of spine were measured and statistically compared by SPSS (statistics package for social science). Results The Cobb angles of T10-L2, T10-L12 and T12-L2 in patients with thoracolumbar intervertebral disc herniation were greater than those in healthy controls respectively. Conclusion The Cobb angles of sagittal plane of thoracolumbar junction of spine in patients with thoracolumbar intervertebral disc herniation are greater than those in healthy controls. The abnormal spinal curve is possibly responsible for thoracolumbar intervertebral disc herniation by abnormal biomechanical action.

Objective To understand the current status and clinical relevance of early (< 24 weeks)glucose challenge test (GCT) in pregnant women with risk factors of gestational diabetes mellitus (GDM) in China. Methods Data from the survey of incidence of GDM in China were re-analyzed. The incidence of abnormal glucose metabolisms and the rate of early GCT in all women were calculated according to different numbers of risk factors. Sixteen risk factors were included in the survey. However, 4 independent risk factors were considered separately in this re-analysis. The ADA criteria for GDM diagnosis were applied. Results A total of 16 286 pregnant women were included in this analysis and 64.3% (10 468) presented with at least one risk factor. The incidence of GDM became elevated with the increasing number of risk factors (P <0.001). Early GCT was performed in 1687 (16.1%) pregnant women and the early detected GDMs only accounted for 11.9% of all GDMs among those with at least one risk factor. Among those who had early GCT, the GDM diagnosis rate increased with the number of risk factors (P < 0.001).Previous analysis in this survey identified 4 independent risk factors for GDM among 16 risk factors: BMI ≥ 24, age over 30 years old, family history of DM and southerners. Similar analysis was performed according to the above 4 risk factors and similar results were found as those found for 16 risk factors. No significant difference was found in the GDM and GIGT incidence between the two analyses in those with at least one risk factor. Conclusion Early GCT is necessary for pregnant women with risk factors of GDM, but the screening rate in China is low. GCT should be repeated for those women with risk factors of GDM and normal GCT at early screening.

Objective To investigate two single nucleotide polymorphism sites of IRF5 and TLR-9 and to detect their relationship with SLE (systemic lupus erythematosus) in a Hart population from Shandong province. Methods The polymorphisms of rs2004640 G/T, rs10954213 G/A in IRF-5 and rs187084C/T,rs352139A/G in TLR-9 were detected with PCR-RFLP in 92 cases of SLE and 88 healthy controls. The genotype and allele frequencies were calculated and analyzed. Results (1) The genotype frequencies of GG, GT and TT in rs2004640 site in SLE were 0.198, 0.521 and 0.281 respectively. The difference was significant between SLE and controls (X~2 = 8.73, P < 0.05) ; the genotype frequencies of GG, GA and AA at rs109542130 site in SLE were 0.318, 0.409 and 0.273 respectively. The difference was significant between SLE and controls (X~2 = 6.36, P < 0.05). (2) The genotype frequencies of CC, CT and TT at rs187084 site in SLE were 0.185, 0.413 and 0.402 respectively. There was no difference between SLE and controls (X~2 =2.99, P >0.05) ; the genotype frequencies of AA, AG and GG at rs352139 site in SLE were 0.228, 0.533 and 0.239 respectively. There was no difference between SLE and controls (X~2=4.54, P > 0.05). Conclusion The polymorphism of rs2004640 and rs10954213 in IRF5 may be associated with SLE in the population of Han nationality from Shandong province. However, the polymorphism of rs187084 and rs352139 in TLR-9 is not associated with SLE.

Objective To study the effect of shh on the migration, proliferation and phenotypic modulation of vascular adventitial fibroblasts. Method Cultivate the vascular adventitial fibroblast in vitro.Use immunofluorescent,laser confocal microscopy, Western-blot and real-time PCR to detect the expression of mRNA and protein of related index. Estimate cell proliferation according to the expression of Ki67 and cell proliferation curve. Application of wound healing test to estimate migration of fibroblast. The expression of α-actin is thought to be marker of phenotypic modulation of fibreblast. Result The expression of shh was detected in vascular adventitial fibrolast in vitro. After addition of exogenous shh (3.5 μg/ml), there were more Ki67~+ cells and the wounding area which was covered by cells became larger. The expression of α-actin was detected. After addition of cyclopamine(40 0.μmol/L), there were less Ki67~+ cells and the wounding area which was covered by cells became smaller. Conclusion Shh can promote proliferation, migration and phenotypic modulation of vascular adventitial fibroblasts.

Objective To investigate the apoptosis induction effect by the rat recombinant caspase-3. Methods Reversed rat caspase-3 gene was gained by settling the small subunit prior to the large one through recombinant PCR, and cloned into the expression vector to transfect human 293T cells and rat immortalized neural progenitor cells. The expression and pro-apoptotic effect of recombinant caspase-3 was observed by the changes of morphology of the transfected cells through immunofluorescence and analyzed by Annexin V-FITC staining, Flowcytometry and MTT assay. Results The transfected cells presented obvious apoptosis as detected by immunofluorescence. MTT assay showed that the proliferation of recombinant caspase-3 transfected cells was significantly inhibited [(48.35±0.16)%, (44.61±0.15)%] (P <0.05). Annexin V-FITC staining revealed that the percentage of apoptotic cells in the transfectants of recombinant caspase-3 gene was [(30.7±1.5) %, (16.0±1.0)%] (P<0.05), which was much higher than that of control cells. Conclusions Rat recombinant caspase-3 can be expressed and induce apoptosis effectively, and used safely both in vitro and in vivo. It can also cause neural cells to death.

Objective To investigate the down-regulating effect of HBV pre-S2 protein upon insulin receptor (INSR) gene promoter. Methods Eukaryotic expression plasmid pcDNA3.1 (-)-preS2 and report plasmid pCAT3-INSRp containing INSR gene promoter upstream of CAT gene were constructed with routine molecular biological methods and were confirmed by endonuclease digestion analysis and sequencing. Then HepG2 cells were transfected with pcDNA3.1 (-)-preS2 plasmid and the total RNAs were examined with relative quantitative real-time PCR to confirm the expression of HBV pre-S2 protein. Later HepG2 and Huh7 cells were transfected with pCAT3-INSRp at various doses (0-2.0 μg ). The choloraphenical acetyltransferase (CAT) activity of transfected cells was detected with CAT-ELISA to generate the dose-effect curve of pCAT3-INSRp. Lastly pCAT3-INSRp (1.0 μg) and pcDNA3.1 (-)-preS2 (1.0, 1.5, 2. 0, 2.5, 3.0 μg) were co-transfected into HepG2 and Huh7 cells respectively to study the regulation effect of pre-S2 protein upon INSR promoter. Meanwhile pre-S2 monoclonal antibody was added into additional cells transfected with 2.0 μg of pcDNA3.1 (-)-preS2 plasmid to evaluate the effect when pre-S2 protein was blocked. Results The mRNA of pre-S2 protein could be detected with real-time PCR indicating that pre-S2 protein was properly expressed in pcDNA3.1 (-)-preS2-transfected cells. The expression of CAT increased proportionally with the incremental doses of pCAT3-INSRp. It suggested that the INSR gene promoter had its transcription activity. After co-transfection of pCAT3-INSRp and pcDNA3.1 (-)-preS2, the CAT expression in HepG2 cells, comparing with that of controls, were 69.8%, 60.1%,19.7%, 10.3%, 5.6% (36 h) and 68.6%, 56.0%, 10.3%, 8.6%, 3.2% (72 h) respectively.When pre-S2 monoclonal antibody was added into the supernatant of HepG2 cells transfected with 2.0 μg of pcDNA3.1 (-)-preS2, the CAT expression was partly restored to 55.4% (36 h) and 69.7% (72 h) of controls. The similar results were observed in Huh7 cells. Conclusion The pre-S2 protein down-regulates the activity of INSR gene promoter so as to reduce the expression of INSR. It may partly elucidate the pathogenesis of hepatogenous diabetes at the molecular level.

Antibacterial materials refer to a kind of functional materials that have the function of killing harmful bacteria or inhibiting the growth and reproduction of harmful bacteria. The effective ingredient of antibacterial materials is antibacterial agents. Antibacterial agents can usually be divided into two categories: organic antibacterial agents and inorganic antibacterial agents.

Objective To evaluate the effects of tissue engineered allogeneic platelet lysates (PL) upon bone reconstruction.Methods After preparation of recombinant material with PL, allogeneic decalcified bone granules (ADBG) and collagen type Ⅰ (CG), 30 healthy Wistar rats were used to prepare the bilateral bone defects in femoral condyles. The defects were filled with equivalent PL/ADBG/CG,ADBG/CG and CG in different groups of A, B and C (with 10 rats each) respectively. At 4 weeks, the defect reconstruction was evaluated with radiology, histology, immunology and biomechanics. Results (1) The X-ray showed that bone density in group A (4.18±0.96) was close to that of normal bone and it was significantly higher than that in group B (2.36±0.87) and group C (1.09±0.55) (P < 0.01). (2) In comparisons with B and C, the histological assay revealed that there were markedly more activities of new bone formation and more implanted bone granules surviving without significant lymphocyte infiltration, as well as more osteoclastic bone resorption in group A. The bone histomorpbometric assay showed the newly formed bone area in group A (286.73±17.22) was significantly higher than that in group B (94.34±33.56) and group C (19.12±14.53) (P<0.01). (3) Anti-press mechanical measures showed that the destructive load in A, B, C and normal control group was 259.63±34.57,187.90±21.07, 91.33±26.58 and 311.93±82.45 respectively. The destructive energy in A, B, C and normal control group was 10.82±1.44, 7.83±0.88, 3.81±1.11 and 12.97±3.43 respectively. These results showed either destructive load or destructive energy in group A was markedly higher than that in group B and group C with significant difference (P < 0.01), but still lower than that in normal controls (P < 0.01). (4) Three-color flow cytometry assay showed that the T lymphocyte subsets of CD3 + CD4 + CD8 -, CD3 + CD8 + CD4 - and the ratio of CD4/CD8 showed no significance difference within these three groups as well as normal controls. Conclusion Tissue engineering PL (PL/ADBG/CG) is capable of accelerating the regenerative repair of bone defect and promoting the bone regeneration and osetointergretion of ailograft bone after transplantation.

A 59-year-old male was admitted to the hospital on 11 March 2008 due to recurrent fever for 6 months and decreased urine output for half a month. The patient suffered from subarachnoid hemorrhage caused by ruptured intracranial hemangioma in September 2007 and secondary hydrocephalus causing disorder of consciousness, and underwent "ventricular-atrial shunt" in October 2007. 　　

A 64-year-old male was admitted to the General Hospital of the People's Liberation Army (PLA) on October 23, 2007, mainly due to sudden right lower abdominal pain and low back pain for 13 h. Emergency CT angiography (CTA) in other hospitals showed abdominal aortic aneurysm, left common iliac aneurysm and right common iliac aneurysm rupture, combined with right iliac arteriovenous fistula.

A 38-year-old woman was admitted to Peking Union Medical College Hospital from March to October 3, 2004 due to repeated nasal congestion, epistaxis, collapsed nasal bridge for 7 years and exophthalmos for 4 years. In February, 2001, she suffered from nasal congestion, pain in nasal bridge, collapsed nasal bridge, multiple epistaxis, cough and shortness of breath. Endoscopic examination in an external hospital showed mucosal erosion, and pathological report of biopsy showed inflammatory changes, granulation tissue and thickening of small blood vessel walls.

There was one male and one female patient, a sibling relationship, Han nationality, whose parents were not closely married, and there were no cases of illness among parents and offspring, and no difference was found in the course of life and growth. A 49-year-old male patient developed lumbago with morning stiffness without inducement since 1992, which was relieved after activity, and then developed swelling and pain of both knees with varus deformity. He was identified as ankylosing spondylitis and synovitis of both knees after seeking medical treatment from multiple parties, and the symptoms were not relieved after treatment.