Volume 90  ·   Issue 45  ·  2010

Anxiety and depression disorders are not only seen in psychiatry, but also often coexist with somatic diseases. Many somatic diseases can have symptoms of anxiety and depression, even the first symptom or main symptom, and anxiety and depression disorders often have somatic symptoms. On the other hand, anxiety and depression disorders can directly affect the onset and prognosis of somatic diseases (such as hypertension, coronary heart disease and gastrointestinal diseases).

The telephone health care management strategy enables patients to make better use of medical service resources and reduce medical expenses by providing patients with decision-making support, improving patients' self-management ability and improving doctor-patient communication. Although the strategy has clinical application value, it is still unclear whether it can help to save medical expenses.

Objective To observe the clinical traits and treatment outcome of the comorbidity of depression and neurological disorders.Methods For patients diagnosed with depressive disorders based on the diagnostic and statistical manual of mental disorders-Ⅳ ( DSM-Ⅳ ) criteria in both outpatients clinics of neurology and psychology.The severity of depression in HAMD-17 scale and quality of life related to outpatients' emotional state and health in Short Form Health Survey (SF-36) were evaluated at the baseline and after a 6-week treatment respectively.Results Forty-five patients with concurrent depression and neurological disorders and 49 patients with depressive disorders were recruited.The impairs in outpatients with depressive disorder are various degree of both physical health and mental health.The severity of depression and quality of life had a negative correlation.The patients with concurrent depression and neurological disorders were elder and more bodily diseases than those with depressive disorders.According to the SF-36 scores,the patients with concurrent depression and neurological disorders had lower physical function scores(61 and 83 ,P =0.044) and higher vitality scores (39 and 29,P =0.007) than those patients with depression disorders at the baseline.After completing a 6-week treatment,both two groups have the same remission rate and response rate respectively.Bodily pain scores (60 at pre-treatment vs 65 at posttreatment,P = 0.048) changed more obviously in the patients with concurrent depression and neurological disorders.Conclusion More patients with concurrent depression and neurological disorders seek medical consultations at neurological clinics of a general hospital than those with depressive disorders.Their impairment extents of physical health factors were different And the anti-depressive regimens yield comparable rates of remission and efficacy.If a clinician knows these differences well,the diagnostic and therapeutic levels of the depressive patients will be boosted and their quality of life enhanced.

Objective To investigate the incidence rate and correlation factors of depression,anxiety and insomnia in patients with myasthenia gravis (MG).Methods A total of 161 MG patients were assessed and graded with HAMD,HAMA,PSQI,QMG,ADL and a self-made scale chart.And the correlation factors were analyzed by Logistic stepwise regression.Results The prevalence of depression,anxiety and insomnia was 58.3%,45.3% and 39.1% respectively.The correlation factors with significant influences on MG were as follows: depression with age,physical weakness,score of QMG,life scale grading;anxiety with experience-sharing;insomnia age,dyspnea,thymoma,physical status at 1 month post-operation,prednisone dose and score of QMG.Conclusion Nearly one half of the MG patients suffer from affective disorders to different degrees.And an analysis of its correlation factors provides references to prevent and treat the affective disorders concurrently with MG.

Objective To investigate the prevalence of anxiety disorder in internal medical outpatients at general hospital,explore some susceptible factors of anxiety disorder patients and assess the outpatients from cardiac medicine,digestive medicine,endocrinology and hypertension at Shanghai Ruijin Hospital were selected during November 2007 to January 2008.Hospital anxiety and depression scale (HADS) was used to screen the subjects.Those whose anxiety sub-score was higher or equal to 8 were interviewed with M.I.N.I.investigators further.The information of the physician diagnosis and treatment was collected from the history cards.Results The prevalence of anxiety disorders was 2.51%,panic attack 0.9%,agoraphobe 0.47%,social phobia 0.25%,specific phobia 0.31%,obsessive-compulsive disorder 0.28% and general anxiety disorder 1.47%.Women and widows were more susceptible to anxiety disorders ( P ＜0.01 ).And 23% of anxiety disorder patients received treatment.But the physician diagnosis rate of anxiety disorders was only 3.2%.Conclusion The prevalence of anxiety disorders in internal medical outpatients at general hospital is still high and general anxiety disorders are commonly encountered.Women and widows are more susceptible to anxiety disorders than others.The physician diagnosis rate of anxiety disorders remains low.

Objective To explore the efficacy of shoulder arthroplasty for comminuted proximal humeral fracture and measure anatomical specimens to determine the proximal humeral data for placing a shoulder prosthesis and designing a new prothesis.Methods A total of 68 Chinese adult cadaveric humeri were selected.The parameters of humeral breadth of proximal epiphysis,across diameter of humeral head,vertical diameter of humeral head,retroverion angle,maximal interval of humeral head-tuberosity and humeral head-shaft angle were measured and analyzed with SPSS 10 program.Results The data were as follows: Across diameter of humeral head: left (40.7 ± 1.9) mm,right (40.5 ± 1.4) mm;Vertical diameter of humeral head: left (44.5 ± 1.3) mm,right (43.4 ± 1.5) mm;Retroversion angle: left (26.6 ± 1.4) °,right (26.8 ± 1.6) °;Max interval of humeral head-tuberosity: left (6.6 ± 1.1) mm,right (6.8 ± 1.0)mm;Head-shaft angle: left (134.3 ±3.5)°,right (135.6 ±1.5)°;Superior breadth: left (47.2 ±1.3)mm,right (46.9 ± 1.5) mm.Conclusion Ideally the fitting prosthesis' diameter is 40-45 mm with a retroversion angle of approximately 30°.And the prosthesis should be higher than the greater tubercle by 6-8mm.

Objective To discuss the computerized tomography (CT) finding of early postoperative inflammatory small bowel obstruction(EPISBO)so as to enhance its diagnostic level.Methods The CT findings of 35 EPISBO cases proved by surgery were retrospectively analyzed from August 2003 to October 2008.Results The main CT findings were as follows: (1) Incomplete small bowel obstruction;(2)Thickening and edema of focal or global bowel wall;(3) Local or diffuse effusion mainly around operative incision;(4) Without definite obstruction point or bent adhesive point;(5) Locally ring-shaped or delayed enhancement during an enhancement scan.Conclusion Spiral CT has an important value in the diagnosis of EPISBO.

Objective To evaluate the rare entity of partial mole or choriocarcinoma with co-existing fetus.Methods A total of 7 cases of partial mole or choriocarcinoma with co-existing fetus were selected to collect clinical profiles and perform auxiliary examinations such as serum β-hCG and sonography.The data were analyzed retrospectively and all cases confirmed by surgery and histopathological diagnosis.Results There were 5 cases of partial moles with co-existing fetus.All patients stayed alive at follow-up.However,only 1 fetus delivered at 32-week gestation survived.All patients of choriocarcinoma with co-existing fetus died.Among them,1 newborn died and another one lost follow-up after 2 years.Conclusion Recently the rate of gestational trophoblastic disease with co-existing fetus is rising.It is quite important that the professionals of genetics,reproductive medicine,gynecological oncology,perinatal medicine and pathology should pay more attention to this emerging disease.

Objective To analyze the effect of endometrial stimulation on the pregnancy outcome of patients undergoing in vitro fertilization-embryo transfer (IVF-ET).Methods A total of 759 subjects were treated by fresh IVF at our hospital in 2007.Sixty-eight subjects received endometrial stimulation at Days 4-5 of menstruation before IVF while other 691 were controls without treatment.No significant difference was found between two groups in terms of duration and cause for infertility,day and dosage of Gn ,number of retrieved oocytes and transferred embryos and fertilization rate.The clinical pregnancy rate of two groups were analyzed.Firstly the clinical outcomes for the patients of primary or secondary infertility were compared in treatment and control groups respectively.Then the clinical outcomes of the patients in first cycle and later cycles were compared in treatment and control groups respectively.Results There were no significant differences in clinical pregnancy rate and incidence of abortion and ectopic pregnancy.For first cyclers,the clinical pregnancy rate showed no significant difference between two groups (38.89% vs 37.16%).But for later cyclers,the clinical pregnancy rate was higher in the treatment group than that in the control group (53.13% vs 34.33%).Conclusion Endometrial stimulation may improve endometrial receptivity to some extent.And it can boost the clinical pregnancy rate for those patients with a repeated implantation failure.

Objective To report two cases of pleuropulmonary blastoma (PPB) of adults and improving the understanding of this tumor.Methods The clinicopathological features of two cases of adult PPB were examined by light microscope and an immunohistochemical study.Results As a rare malignant mesenchymal tumor,PPB arose from primitive cells of lung,pleura and mediastinum.Consisting of primitive undifferentiated sarcoma cells and few epithelial cells,the tumor was positive for mesenchymal differentiated markers by immunohistochemistry.Conclusion PPB is a rare malignant embryonal tumor.The diagnosis of this tumor is rather difficult since it lacks pathomorphological or immunohistochemical features.

Objective To investigate whether annular tears is a cause of low back and radiating leg pain and explore the clinical characteristics and treatment for patients with this condition.Methods A total of 34 patients with low back and radiating leg pain,but without lumbar disc herniation on CT (computed tomography) or MRI (magnetic resonance imaging),were examined by electrophysiological studies and discography to identify whether there were or not annular tears and nerve root injury and decipher the relations between them.The series included 15 males and 19 females with an average age of 45.6 years old and the average duration of symptoms was 25.8 months.All patients with annular tears and positive pain provocation test were treated by local windowing decompression and debridement of nucleus pulposus after failed conservative treatment.The pre- and post-operative functions and pain were evaluated by JOA (Japanese Orthopedic Association) and VAS (visual analog scale) scores respectively.The average followup was 17.4 months.Results The clinical manifestations included low back and radiating leg pain,intermittent claudication and nerve root injury.No significant abnormalities were discovered on X-ray and CT scan.T2W images of magnetic resonance demonstrated a low intensity or black disc in all patients and highintensity zone (HIZ) (n = 21).Electromyography showed nerve root injury (n = 27).Abnormality of conduction velocities of common peroneal nerve (n = 7) and tibial nerve (n = 3) were found.Thirty-four patients with 38 discs displayed pain reproduction on contrast injection during discography and the sites of annular tears were confirmed on CT scan after discography.Pre- and post-operative average JOA scale score was 8.7 points and 13.5 points,the recovery ratio 76.2% and the excellent and good outcomes 88.2%.Pre-and post-operative average VAS score was 8.6 points and 2.8 points.And the recovery rate was 80.5%.Conclusion The annular tears result in low back and radiating leg pain.And the typical characteristics are low back and radiating leg pain,intermittent claudication and nerve root injury.MRI and electrophysiological studies play an important role in diagnosing this condition.Lumbar discography is the decisive method and prerequisite of selecting surgery.Local windowing decompression and debridement of nucleus pulposus is a simple and effective method.

Objective To investigate the molecular mechanism of osteoarthritis (OA) through the differential expressed proteins of advanced osteoarthritic chondrocytes.Methods Normal articular cartilage (NAC,n = 22) were obtained from knee cartilage of donors without knee diseases and osteoarthritic cartilage (OAC,n = 17) from OA patients undergoing knee arthroplasty.Total protein was extracted from chondrocytes and loaded directly for two-dimensional gel electrophoresis (2-DE).Gel images were analyzed with the software Imagemaster 2-D platinum3.0 to screen the differential expression protein spots.Target spots were excised and digested and the resulting peptides submitted for mass spectrometry analysis.Identities of differential expressed proteins were recognized through matching the peptide mass finger printings of each spot with NCBI protein database by MASCOT.Results About 1000 protein spots were presented in the 2-DE gels for each group.Thirty-five NAC spots and 31 OAC spots were confirmed to be differential expression protein spots.Among these spots,19 proteins were identified by MASCOT,including type Ⅵ collagen,enzymes involved in collagen synthesis,shock related proteins and some novel proteins with unknown functions.Conclusion The differential expressed proteins isolated and identified by the present study provide valuable information on various aspects of OA pathology.It may help us to gain new insights into the molecular mechanism of OA.

Objective To evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) in patients with symptomatic vertebral hemangiomas and determine whether prior intraosseous venography decreases extravertebral leakage of PMMA and improves clinical outcomes in these procedures.Methods Retrospective review was conducted on 45 consecutive patients with 53 symptomatic vertebral hemangiomas associated with chronic pain (all cases) or paralysis caused by spinal cord compression (1 case) or vertebral compression fractures (3 cases) treated with PVP at our institution to define two populations.Group A consisted of 27 vertebral hemangiomas in 23 patients who underwent intraosseous venography before injection polymethylmethacrylate (PMMA).Group B consisted of 26 vertebrae in 22 patients who underwent injection PMMA without prior venography.CT was done 1 to 3 days after PVP to observe PMMA distribution in vertebrae and whether leakage.Clinical outcomes,included pain relief,leakage of PMMA,volume of PMMA injected,expense and X-ray exposure times in each vertebral body,were compared in the two groups by using x2 or t test.Results No significant difference was seen between the groups with respect to age,sex,the number of treated vertebrae,or preprocedural degrees of pain.The successful rate of technique of PVP was 100%.The mean volume of PMMA injected in each vertebra was 3.96 ml.CR,PR and NR was obtained respectively 84.5%,13.3% and 2.2% during 6 months to 5 years of follow-up expect one case had unrelieved pain in group A.At 6 months after PVP,22 cases (95.7%) in group A and 22 cases (100%) in group B achieved adequate pain relief (P = 0.323).6 vertebrae (6/27) in group A and 2 vertebrae (2/26) in group B with asymptomatic leakage of PMMA were demonstrated by CT (P =0.140).The mean volume of PMMA injected in each vertebra was 3.70 ml in group A and 4.23 ml in group B (P =0.157).The mean expense of each vertebra was (￥)7.24 × 103 in group A and (￥)5.84 × 103 in group B (P=0.000),the mean decreases were (￥)1.4 × 103 in group B than group A.The mean X-ray exposure times on each vertebral body was 13.28 minutes in group A and 8.78 minutes in group B (P =0.000),the mean decreases were 4.5 minutes in group B than group A.Conclusions PVP is an effective and safe procedure for treating symptomatic vertebral hemangiomas.Prior intraosseous venography does not significantly improve the effectiveness or safety of PVP for vertebral hemangiomas performed by qualified,experienced operators,on the other hand,it increases the expense and X-ray exposure times of PVP.

Objective A3243G mutation in mitochondrial DNA is the most common pathogenic point mutation causing a variety of phenotypes.The clinical phenotype and the relationship between the clinical phenotype and the ratio of A3243G mutation were studied in the members from nuclear families carrying A3243G mutation.Methods A total of 42 families carrying A3243G mutation were recruited and their clinical symptoms,laboratory results and the ratio of A3243G analyzed.Result ( 1 ) In probands,myopathy,seizure,hirsutism,headache,cognitive impairment,weight loss and short stature were the most common clinical features.They tended to occur simultaneously.Lactic acid,pyruvate and MRI were abnormal in most probands;( 2 ) most carriers had a normal phenotype.Myopathy,weight loss and short stature were their most common clinical features;(3)the ratio of A3243G mutation in urine was higher than that in blood in probands ( t = - 15.06,P ＜ 0.001 ).And the ratio of A3243G mutation in urine was higher than that in blood in their mothers(z = -6.241,P ＜0.001 );(4) the ratio of A3243G mutation in probands was 2-fold higher than that in their mothers in both blood and urine.Conclusion The phenotype of patients carrying A3243G mutatiom is varied.The clinical symptoms and laboratory results of probands are worse than those of mothers.It is probably due to a higher mutation ratio of m.3243 A ＞ G in their tissues.

Objective To study the protective effects of butylphthalide (NBP) on the Aβ25-35-induced apoptosis in PC-12 cells.Methods The apoptosis of PC-12 cell was analyzed by MTT assay,transmission electron microscope and PI method at different concentrations of NBP (0.1,1.0,10,100μmol/L) with the addition of Aβ or not.The expressions of Bcl-2 and cytochrome C (Cyt-C) were detected by Western blot.Results As demonstrated by the MTT assay,the values of cell viability were 76.5% ±1.1%,84.2% ±1.3%,89.5% ±1.3% and 81.9% ±1.9% at various concentration (0.1,1.0,10,100 μmol/L) of NBP respectively.The model group was 71.7% ± 1.4%.It was revealed that the former could significantly prevent the cell viability under the induction of Aβ25-35 (P ＜ 0.05).A pretreatment with 10 μmol/L NBP could significantly inhibit the decrease of viability under the induction of Aβ25-35 (P ＜0.05).PI showed that the apoptosis rate of the 10 μmol/L NBP treatment group was significantly lower than that of the model group.Under electron microscope,the characteristics of cell apoptosis were significant in the model group.And the cell morphology of the 10 μmol/L NBP treatment group was normal.The expression rate of Bcl-2 protein in the 10 μmol/L NBP treatment group was obviously higher than that in the model group.Cyt-C was weakly expressed in nerve cells of the normal and the 10 μmol/L NBP groups.But it had a strong expression in the model group.Conclusion NBP prevents the injury of PC12 cells by Aβ.And the mechanism may be related to the elevated level of Bcl-2 and the inhibited mitochondrial release of Cyt-C.

Objective To investigate the exposure effect of electromagnetic pulse (EMP) on the structure and secretion of pituitary gland in rats.Methods Forty-eight male SD rats were randomly divided into eight groups.Four groups were subject to the EMP exposure of 200 kV/m and the others received a sham exposure.At different time points (12,24,48 & 96 h) post-exposure,the pathological changes of pituitary gland were observed by light and transmission electron microscope.And the serum levels of prolactin (PRL),growth hormone (GH),adrenocorticotropic hormone (ACTH),thyroid stimulating hormone (TSH) and luteinizing hormone (LH) were measured dynamically by radioimmunoassay.Results At 12 h post-exposure,swollen mitochondria with cristae loss,dilatation of Golgi complex and diffusive lysosomes were found in endocrine cells of pituitary gland.The above changes became gradually worse.Mitochondrial vacuolization,the formation of myelin figures,distinct dilatation of endoplasmic reticulum,the occurrence of numerous secondary lysosomes and the clustering of heterochromatin under the nuclear membranes could be observed at 48 h.These lesions were alleviated to some degree at 96 h.The serum levels of PRL and ACTH both increased significantly at 12 h (P ＜ 0.01,P ＜ 0.05) and returned to normal at 24 h.The level of GH decreased significantly at 12 h and then returned gradually to normal at 48 h.The level of TSH decreased at 12 h and reached the lowest point at 24 h,then returned to normal at 96 h.LH increased significantly from 24 h to 96 h.Conclusion The EMP exposure of 200 kV/m may induce the changes of the structure and secretion of pituitary gland in rats.

Objective To explore the effect of lentivirus-mediated APP695 RNAi on Aβ level in the cortical neurons of APP695 transgenic mice.Methods The pFU-GW-iRNA plasmids expressing the RNAi sequences of human APP695 gene were confirmed by PCR (polymerase chain reaction) and sequencing.The recombined plasmids in combination with pHelper 1.0 and Helper 2.0 plasmids were transfected into 293T cells so as to construct the lentiviral vectors of RNA interference of APP695 gene.Virus in supernatant was collected and the viral titer measured.The cortical neurons of APP695 transgenic mice were infected with the packaged lentivirus.And it was designated as APP695-RNAi group.Cells infected with APP695-NC was designated as NC group and non-infected cells as CON group.The levels of APP695 mRNA were detected by real-time quantitative PCR.The APP695 protein was detected by Western blot and the levels of Aβ40 and Aβ402 were measured by ELISA (enzyme-linked immunosorbent assay).Results PCR and DNA sequencing demonstrated that the inserted sequences of APP695 shRNA were correct.The viral titer was 5 ×108 TU/ml.After the infection of APP695 shRNA recombinant lentivirus,the expression level of APP695mRNA in the cortical neurons of APP695 transgenic mice decreased significantly (inhibition rate:76.70%)versus NC and CON groups(P ＜0.001).The lowered expression of APP695 proteins was consistent with APP695 mRNA.The levels of Aβ40 were (184 ± 15) ng/L,(647 ±30) ng/L and (656 ±40) ng/L in APP695-RNAi,NC and CON groups respectively.As compared with NC and CON groups,the levels of Aβ40 in APP695-RNAi group decreased significantly(P ＜0.001).The levels of Aβ42 were (19.2 ± 1.9)ng/L,(67.6 ± 6.0) ng/L and (68.6 ± 7.0) ng/L in APP695-RNAi,NC and CON groups respectively.As compared with NC and CON groups,the levels of Aβ42 decreased significantly in APP695-RNAi group (P ＜0.001).Conclusion The inhibition of APP695 by lentivirus-mediated RNAi effectvely decreases the levels of Aβ40 and Aβ42 in the cortical neurons of APP695 transgenic mice.

Objective To investigate the effects on HIF-1α expression of rabbit adipose-derived mesenchymal stem cells (ADSCs) by dynamic compression plus IGF-1 gene transfection and explore the mechanism of promoting chondrogenesis by HIF-1α.Methods The ADSCs were harvested after the digestion of type I collagenase and transfection with pcDNA3.1-IGF-1.And then the cells were seeded onto chitosan/gelatin scaffolds with a density of 5 × 107 cells/ml and divided into groups:Group A (control),non-transfected ADSCs;Group B (IGF-1),hlGF-1 gene transfected ADSCs;Group C (loading),untransfected ADSCs with stimulation of compressive loading;Group D (loading + IGF-1),hlGF-1 gene transfected ADSCs and loading stimulation.The dynamic compression was carried out with a bio-reactor at a frequency of 0.1 Hz and a sinusoidal strain amplitude of 2% (2% at 0.1 Hz).The dynamic load was performed every 20 minutes,4 hours daily.After 7 days,morphological observation was performed.The MTT assay was used to detect the cell proliferation.Meanwhile the CM-DiI cell-labeling solution was used to observe the distribution of cells.The total amount of GAG and the expression of related genes of IGF-1,HIF-1α,type Ⅱ collagen (COL Ⅱ) and Sox-9 were quantified.Results The best morphology was found in loading + IGF-1 group.The results of proliferating capacity were:Group A ＜ C ＜ B ＜ D (P ＜ 0.01);Dil fluorescence showed that the cells were well-distributed in Group D.Meanwhile,the content of total GAG and the expression of related genes demonstrated:Group A ＜ C ＜ B ＜ D (P ＜ 0.01).And the combined effect was more significant than either alone.Conclusion In three-dimensional culture conditions,dynamic compression plus IGF-1 transfection can significantly enhance the level of autocrine IGF-1.Both of two experimental intervention factors can significantly up-regulate the mRNA level of HIF-1 α.And they exert a synergistic effect.HIF-1α plays an important role in promoting the chondrogenesis and the synthesis and secretion of extra-cellular matrix.

The 2nd International Forum on Rheumatoid Arthritis sponsored by Peking University School of Medicine was held in Beijing on September 18-19, 2010. Nearly 400 delegates from all over the country attended the conference. More than 20 famous rheumatologists and immunologists from home and abroad were invited to report on the latest progress in basic and clinical research on rheumatoid arthritis (RA). The main contents of the conference are reported as follows.

A 50-year-old female was seen for 19 years because of joint swelling and pain, facial erythema and proteinuria for 13 years. In 1991, the patient began to develop swelling and pain in the proximal interphalangeal joints of both hands, morning stiffness for about 30 minutes, accompanied by facial erythema and no photosensitivity.