Volume 91  ·   Issue 03  ·  2011

The hypothalamus-pituitary-target gland axis is the basic structure of human endocrine. It has the functions of regulating and perfecting human endocrine function, coordinating and enhancing immunity, affecting metabolism of many systems and tissues, etc. It plays an important role in human growth, development and reproduction.

Objective To evaluate the effect of first and second-trimester integrated screening so as to provide an efficient screening protocol for Down's syndrome. Methods Using the dissociation-enhanced lanthanide fluorescent immunoassay (DELFIA), the freeβhCG (beta human chorionic gonadotropin),PAPP-A (pregnancy associated plasma protein-A) and NT (nuchal translucency) value of type B ultrasound were assayed in the pregnancy serum during the first trimester(11-13W+6d)and free βhCG and AFP (alpha fetoprotein) during the second trimester(15-20W+6 d). By the risk calculation software, the risks during both trimesters and their integrated risk were calculated for each patient respectively. Amniocentesis and venepuncture were employed for diagnosing the high-risk patients(＞1/270). Electronic network follow-up was carried out after delivery. Results In a total of 4237 pregnant women, 98 were found to carry a high risk during the first trimester, 241 during the second trimester and 101 during the integrated screening respectively. And 2, 3 and 4 cases were diagnosed with Down's symptom at a detection rate of 50%, 75% screening is superior to either the first or second-trimester screening, With a lower false positive rate and a higher detection rate, it reduces the chance of invasive puncture. Advanced type B ultrasonic technology is needed to improve the first-trimester diagnostic efficiency and to develop a better integrated screening protocol.

Objective To study the new computed tomographic (CT) classification, surgical approaches and clinical efficacy of posterior condylar tibial plateau fractures. Methods From January 2006 to July 2009, a total of 39 patients of posterior condylar tibial plateau fractures were treated by posteromedial and posterolateral knee approaches. There were 23 males and 16 females. The mean age was 41.6 years old (range:28 -68). Among all patients, the causes were traffic accidents (n =26), falls (n =9) and other injuries (n=4). By CT classification, there were type Ⅰ with posteromedial condylar tibial plateau split fracture(n=7), type Ⅱ with posterolateral condylar tibial plateau split fracture (n=5), type Ⅲ with posterolateral condylar tibial plateau depression fracture (n=11), type Ⅳ with posterolateral condylar tibial plateau split depression fracture(n=2) and type Ⅴ with posteromedial split and posterolateral condylar tibial plateau depression fracture (n=14). Results The mean follow-up period was 18.1 months (range:12-30). The radiographic bony union time was 11 -16 weeks (mean:15.2) and the full weight-bearing time 12-20 weeks (mean:15.6). No infection, knee varus/valgus, nerve injury or screw loosening/breakage was found. Bony union was achieved in all cases. According to the Rasmussen functional scoring, the results were excellent in 20, good in 14 and fair in 5. And the excellent and good rate was 87. 2%. The radiological results were graded with the Rasmussen score to evaluate the reduction of fracture. The outcome was excellent in 28, good in 8 and fair in 3. And the excellent and good rate was 92.3%. Conclusion This new CT classification scheme of posterior condylar tibial plateau fractures can significantly improve the reliability,guide the clinicians to select appropriate treatment plans and design an ideal regimen of operative approach and internal fixation.

Objective To evaluate the efficacy and safety of combining transarterial chemoembolization and percutaneous vertebroplasty (PVP) in the treatment of vertebral and paravertebral metastatic tumors. Methods A retrospective review was conducted in 49 patients with severer painful tumor metastasis in 72 vertebrae and paravertebral tissue who had failed noninvasive treatment at our institution from March 2003 to December 2009. Among them, there were intractable radicular pain ( n = 17) and slight or no motor and sensory function ( n = 6). All patients under transarterial chemoembolization were followed within 6 days by PVP. Computed tomography (CT) was performed within 3 days after PVP to observe the distribution of PMMA ( para-methoxymethamphetamine ) in vertebrae and whether or not there was any leakage. The efficacy was assessed by the change of pain level after combined treatment. Results Bilateral vertebral arteries were selected in 44 cases with 65 vertebrae. And only unilateral vertebral artery was selected in 5 cases with 7 vertebrae. Except for 2 vertebrae with simple artery infusion, 29 vertebrae were embolized by 1-2 ml of lipiodolization and gelfoam particles and 41 vertebrae by gelatine particles. And an average volume of 4. 23 ml and 5.39 ml was injected in each thoracic and lumbar vertebra respectively. The rate of efficacy was at 87. 8% within 3 months after combined therapy. There were CR( complete response)21cases (42. 9% ), PR (partial response) 22 cases(44.9%)and MR/NR (minimal/no response) 6 cases (12. 2% ). No serious complication related to the technique occurred. Only 12 cases with asympotomatic PMMA leakage around 16 vertebrae were demonstrated on post-operative CT. Conclusion Transarterial chemoembolization plus PVP is an effective and safe procedure in the treatment of severe painful vertebral and paravertebral metastatic tumors.

：Objective To detect theserum protein profiles of Kazakh's esophageal carcinoma (EC)patients in Xinjiang bySELDI-TOF-MS ( surface enhanced laser desorption & ionization time-of-flight massspectrometry) and build up a diagnostic model of Kazakh's EC in Xinjiang. Methods Theserum samples from 41 Kazakh's EC patients and 20 Kazakh's healthy controls were collectedand analyzed on weak cation exchange and hydrophobic surface protein chip by SELDI-TOF-MStechnology. The differentially expressed markers of esophageal carcinoma were detected.Results The values of M/Zs were significantly different between Kazakh's EC patients andcontrols (P ＜ 0.05 ). Among these, 6 proteins peaks were up-regulated (5495. 2265, 15 964. 6951, 16 152.0872, 4488. 4818, 8164. 7652, 4979. 4223 ) and 4 down-regulated(6900. 3285, 13 790. 9241,8790. 8130, 8714. 7915 ) in the Kazakh' s EC group. According to cross validation, themodel of Kazakh's EC made up of 7 proteins ( M/Z 6900. 3285, 13 790. 9241,8790. 8130,15964. 6951, 16 152. 0872, 4488. 4818, 4979. 4223) was established. The sensitivity andspecificity of this model were 100% (41/41) and 100% (20/20) respectively. Conclusion Themodel with 7 proteins markers has a higher sensitivity and specificity for Kazakh's ECpatients in Xinjiang. It may provide a new serum diagnostic tool for Kazakh's EC patientsin Xinjiang.

Objective To investigate the expression and relationship of activated Cdc42-associated kinase 1 ( ACK1 ) and the clinical characteristics of esophageal squamous cell carcinoma (ESCC). Methods The ACK1 expression in ESCC cell lines was detected by Western blot Immunohistochemistry was performed to assay the expression level of ACK1 protein in tumor tissues and adjacent normal epithelium from 105 ESCC patients in tissue microarray and 45 patients in normal tissue slices. Semi-quantitative RT-PCR (reverse transcription-polymerase chain reaction)was performed to determine the expression level of ACK1 mRNA in 45 pairs of ESCC frozen tissues. Results The expression level of ACK1 protein was significantly upregulated in 48. 6% ESCC tissues as compared with the normal adjacent epithelium in tissue microarray. The overexpression of ACK1 was significantly correlated with the lymph node metastasis and TNM stage of ESCC patients. The results of normal tissue slices were consistent with those of tissue microarray. Furthermore the overexpression of ACK1 was associated with a poor survival of ESCC patients ( P = 0. 030 ). The elevated mRNA level of ACK1 in ESCC tissues was correlated with the lymph node metastasis and TNM stage of ESCC patients. And a significant correlation was observed between protein and mRNA level of ACK1 (P =0.021 ).Conclusion The up-regulated expressions of ACK1 protein and mRNA are correlated with the progression and prognosis of ESCC.

Objective To compare the difference of muscle dynamic characteristics for the ankle dorsiflexors and plantarflexors between stroke patients at the chronic stage and healthy controls so as to provide a new method of assessing thein vivo muscle function in patients with hemiplegia. Methods From May 2008 to May 2009, 26 stroke patients and 21 age-and gender-matched normal controls were recruited. All subjects were positioned on a scanner table and requested to perform the voluntary movement of ankle flexion-extension. The velocity encoded phase contrast magnetic resonance imaging (VE-PC MRI )provided the images of tibialis anterior muscle ( TA), medial head of gastrocnemius muscle (MG) and soleus muscle (SOL) during a movement cycle. By measuring the calf muscle contraction velocity, the balance function was assessed by Berg balance scale(BBS). The correlation between scores of BBS and the mean maximum velocity were compared and analyzed. Results The peak velocity of TA( 1-8 phase,8. 900-21. 120 mm/s vs 12.99-34.50 mm/s), MG(12-19phase,13.60-13. 28 mm/s vs 25.85-18.38 mm/s)and SOL(12-16 phase,18. 63-33. 62 mm/s vs 27.68-47.22 mm/s) was lower in the affected side than that in the controls during ankle extension(P ＜0. 05 ); During ankle dorsiflexion, the co-contraction index of SOL/TA(2-9 phase,0. 81-0. 82 vs 0. 27-0. 44)and the co-contraction index of GM/TA(2-9 phase,0. 73-0. 58 vs 0. 10-0. 11 ) was markedly higher in the affected side than the controls. The patient score of BBS was negatively correlated with the mean velocity of TA ( r = - 0. 69, P = 0. 001 ) and GM ( r = - 0. 47, P =0. 01 ) in the affected side. There was correlation between TA ( r = - 0. 60, P = 0. 001 ) and GM ( r =-0. 49 ,P =0. 01 )in the unaffected side. Conclusion During the movement of active ankle flexionextension, the velocities of TA, SOL and MG are lower in the affected side. The co-contraction index is markedly higher in the affected side during ankle dorsiflexion. This in turn leads to a decline of balance function in patients. VE-PC MRI can provide quantitative in vivo measurements of lower extremity muscle function in stroke patients.

Objective To explore the profile of false memory in aMCI ( amnesia mild cognitive impairment) and to elucidate the neuropsychological mechanism of false memory. Methods False memory provoked by pictures and feeling-of-knowing (FOK) test in episodic memory (EM) were conducted in 25 aMCI patients at our hospital from October 2009 to May 2010. And 25 age and education level-matched healthy patients were recruited into the healthy control (HC) group. Results As compared with HC group,the rate of false memory was higher in the aMCI group. The rate of false memory in recall stage was 26% ±7% and that of questionnaire stage 28% ± 12%. And the difference between two group was significant (t = 14. 437, 7. 597, P ＜0. 05). The FOK-EM of correct judgment and false recognition in the aMCI group (41% ± 10% ) was higher than the HC group. And the difference was significant (t =4. 207, P ＜0. 05).The rates of false memory in recall and questionnaire stages were positively correlated with FOK-EM in aMCI group(r = 0. 563, 0. 705, P ＜ 0. 01 ). Conclusion The aMCI patients tend to have more false memory provoked by pictures. The deficit of memory monitoring in aMCI may be the foundation of false memory.

Objective To study the effects of neuronal apoptosis under the induction of β-amyloid inflammatory supernatant. Methods The neurons were intervened by β-amyloid-induced inflammatory supernatant at the concentration of Aβ1-42 at 125 nmol/L. And the expressions of Bcl-2, caspase-3, PARP and neuronal apoptosis were detected. Results The caspase-3 ( 14. 2 ± 1.8 ), Bcl-2 ( 10. 6 ± 0. 8 ) positive cells of microglia inflammatory supernatant stimulated group were significantly elevated than the control(2. 2 ± 0. 6,5. 0 ± 0. 3, P ＜ 0. 01 ). Nuclear chromatin was uniform yellow-green fluorescent. And there was significant difference of neuronal apoptosis between microglia inflammatory supernatant group and Aβ1-42directly stimulated group. Conclusion Neuronal apoptosis is induced by caspase-3 in β-amyloid inflammatory supernatant. One of the important causes is chronic inflammatory process of activated microglia by Aβ.

Objective To construct an adenovirus containing a mifepristone (RU486)-inducible regulation system for NRF2 gene, express the product in H460 cell and verify whether the mentioned system can control the gene expression and assess its efficiency. Methods A RU486-inducible regulation system for Nrf2 gene was introduced into an adenovirus. The confirmation was performed through the LUG and Dsred genes. And the expression pattern of Nrf2 at the viral level was examined by Western blot and RT-PCR (reverse transcription-polymerase chain reaction). Results The expressions of LUG and Dsred showed a rising trend with the incremental dose of RU486. After the transfection H460 cell with Ad-RUNrf2, the results of RT-PCR and Western blot demonstrated that the expression of Nrf2 was elevated with a rising dose of RU486. After the removal of RU486, the expression of Nrf2 was reduced. Conclusion The construction of an adenovirus carrying Nrf2 gene regulated by a RU486-inducible system is successful, and RU486 can adjust the cellular expression of Nrf2 factor. The LUG and the Dsred expression assumes the dosage dependence along with RU486 to increase; after the Ad-RUNrf2 infects the H460 cell, through RTPCR and Western the Blot result demonstrated that the expression of Nrf2 increases along with the RU486 dosage increases, after removing RU486, the Nrf2 expression is weaken. Showing the construction of the adenovirus carrying Nrf2 gene regulated by the mifepristone ( RU486 )-inducible system is successful, and RU486 can adjust the Nrf2 factor in the cell the expression.

Objective To evaluate the ability of a kind of novel magnetic liposomes modified with polyethylene glycol(PEG) and transactivating-transduction protein (TAT) to cross the blood spinal cord barrier (BSCB) so as to demonstrate whether or not they can accumulate at the lesions of injured spinal cord. Methods The novel liposomes were made through reverse-phase evaporation method modified with polyethylene glycol (PEG) and transactivating-transduction protein (TAT) with an iron core. Thirty-six Wistar rats subject to spinal cord injury (SCI) at T10 were randomly divided into three groups (Groups Ⅰ ,Ⅱ and Ⅲ ). The rats of Group Ⅲ were injected with TAT-PEG loaded magnetic liposomes (4.55 mg/kg).The rats of Group Ⅱ received an injection of the equivalent PEG loaded magnetic liposomes while those of control group ( Group Ⅰ ) the equivalent normal saline. The accumulation of liposomes was observed by MRI (magnetic resonance imaging), Prussian blue staining, electron microscope and flame atomic absorption spectrophotometer. Results This kind of TAT-PEG loaded magnetic liposomes could croas the BSCB and enter into the cells around the injured tissue. A low signal of T2WI on MRI could also be found in Group Ⅲ.The results of flame atomic absorption spectrophotometer showed that the iron content accumulated around the lesion site in Group Ⅲ was obviously higher than the other two groups (P＜0.05). Conclusion The TATPEG loaded magnetic liposomes may be employed as one kind of novel drug carrier to cross the BSCB and accumulate at tissue cells of spinal cord. It is likely to become a new therapy for SCL

Objective To study the expression of the pyrophosphoric acid loop's key enzymes (ENPP1, TNAP and ANK proteins) in the degeneration of rat endplate chondrocyte. Methods The method of enzyme digestion plus natural subculture was employed. And the primary to forth-generation cells were collected. Western blot was used to analyze the expression of ENPP1, TNAP and ANK proteins in each generation of endplate chondrocytes. Results The expression of ENPP1, TNAP and ANK proteins could be detected in each generation of endplate chondrocytes. With the continuing passage of cells, the level of protein expression declined gradually and that of the third and forth-generation decreased. Conclusion While studying the correlation between the degeneration of rat endplate chondrocytes and pyrophosphoric acid loop,it is more significant to choose the cells before the third generation. Meanwhile it is possible to lower the incidence of intervertebral discs degeneration by controlling the expression of the above-mentioned proteins in endplate cartilage.

Wallerian degeneration (WD) is a common type of neurogenic degeneration in distant parts caused by primary brain injury, and the common cause of pyramidal WD is cerebral infarction. Many studies have shown that the appearance of pyramidal WD after stroke is related to severe motor function deficit in patients, and there is a clear correlation between the degree of motor function recovery and the degree of WD [1].

A 42-year-old female was admitted to Peking Union Medical College Hospital on February 18, 2009 because her hands and feet turned white and purple when exposed to cold for more than 20 years, and her nasal epistaxis and menstruation increased for 5 years. In 1980, her hands and feet turned white and purple when exposed to cold.

Since Horsley [1] first tried trans-frontal approach to pituitary adenoma resection in 1889, the surgery of pituitary adenoma has experienced great changes in the surgical approach, surgical method, surgical technique and curative effect.

A 56-year-old male came to the outpatient clinic of Peking Union Medical College Hospital in May 2010 due to swelling and pain of multiple joints for 3 years, erythema and nodules on the extension of limbs for 5 months. Three years ago, the patient gradually developed swelling and pain of the second metacarpophalangeal joint, the third proximal interphalangeal joint, both knees and both ankle joints of both hands without obvious trigger, accompanied by morning stiffness for about 1 h; At the same time, intermittent dry cough, holding breath and dyspnea after no activity.