Volume 91  ·   Issue 15  ·  2011

Alzheimer's disease (AD) and vascular dementia (VaD) are the two main clinical types of cognitive impairment in the elderly.At present, the effective prevention and treatment methods for AD and VaD are very limited in clinic,and more detailed research on the pathogenesis of cognitive impairment is needed to find more effective measures. In recent years, a large number of studies have found that both AD and VaD patients have cerebral hypoperfusion on imaging [1-3]. Experimental studies have also confirmed that chronic cerebral hypoperfusion can lead to cognitive impairment [3-4].

Objective To investigate the prevalence and clinical feature of essential tremor (ET)in a community cohort of the elderly in kashkar. Methods By using a door-to-door, two-phase screening approach, some 2834 residents of Hans ethnicity were investigated form 2008 to 2009. Results In this study, 184 ET patients were found. The prevalence rate of ET was 6. 49%. The prevalence rate was increased with age and higher in men (8.45%) than in women (4. 59% ),especially in people ageds above 75years old. The prevalance rate of ET was 7.26% in illiterate people, followed by 7.27%, 5.81%, 5.58% and 9. 37% in those having received primary,junior, senior high school and college. The ratio of windowed people in ET patients was 15.21% ,higher to the ratio of windowed people in total number. Conclusions The prevalence rate of ET increased with age, but not influenced by education.

Objective To study the pathogenesis, clinical features, curative effect and prognosis of esophageal cancer associated with lung cancer. Methods We reviewed 16 cases of esophageal cancer associated with lung cancer managed at our hospital between January 2003 and July 2009 and analyzed their clinical data. Results There were 16 cases of esophageal cancer associated with lung cancer. There were 67 years old (range:51 -76). The resection rate of esophageal cancers was 100%. There was 1 case of nonradical resection. And the resection rate of lung cancer was 100%. There were radical resection (n =7) and wedge resection(n= 9). The 1-year overall survival rate was 87.5%. Conclusion Lung lesions of esophageal cancer patients may be discovered by computed tomography screening of chest. More male patients than female patients are diagnosed with esophageal cancer associated with lung cancer. The operative risks and complication rates are generally acceptable.

Objective To observe and compare the revasculation rate after embolization of hepatic artery-portal vein fistula (APVF) by gelatin sponge versus gelatin sponge with lipiodol. Methods The clinical data of 51 patients were retrospectively analyzed. They were divided into Groups A and B. APVF was embolized by gelatin sponge alone in Group A and gelatin sponge with lipiodol in Group B. Then the investigators observed and compared the revasculation rate of hepatic artery-portal vein fistula at Days 30 - 40and 60- 70 post-embolization respectively. Results There was no statistical difference in age, gender,pathological types and hepatic functions before intervention between Groups A and B. One of 28 APVF sites was embolized unsuccessfully in Group A while all APVF cases were embolized successfully in Group B. The revasculation rate of hepatic APVF were 70. 37% and 46. 15% at Days 30 -40 post-embolization in Groups A and B respectively (x2 = 4. 25, P = 0. 039, chi-square test); the revasculation rates of APVF were 92. 59% and 88.46% respectively at Days 60 - 70 post-embolization ( P = 0. 67). Conclusion Interventional therapy of hepatic APVF by gelatin sponge and lipiodol is a safe method of reducing the short-term revasculation rate. It may be employed in clinical practices to save precious time for controlling hepatic malignant tumors.

Objective To explore the relationships between serum levels of adiponectin, leptin,TNF-alpha and CRP (c-reactive protein) versus insulin resistance in early pregnancy. Methods A total of 342 pregnant women delivering at our hospital were recruited from October 2007 to July 2008. Their clinical data were collected and analyzed. According to the 50-g 1-hour oral glucose screening test, they were divided into 3 groups:gestational diabetes, gestational impaired glucose tolerance and normal pregnancy. The serum levels of adiponectin, leptin, TNF-alpha and CRP were determined by ELISA (enzyme-linked immunosorbent assay) and multivariate correlation analysis was used to analyze their relationships with the indices of insulin resistance. Results Among them, there were gestational diabetes ( n = 13) and gestational impaired glucose tolerance (n = 19 ). Thirty-five normal pregnant women were selected as the control group. The result of analysis of variance indicted that adiponectin, leptin and TNF-alpha had significant statistical differences among three groups. Through the multivariate correlation analysis, adiponectin had a adverse correlation with the indices of insulin resistance. Leptin, CRP, TNF-alpha and BMI (body mass index) had positive correlations with the indices of insulin resistance. Conclusion Adiponectin, leptin,TNF-alpha and CRP are correlated with the indices of insulin resistance. And TNF-alpha may become an important predictor of gestational diabetes in early pregnancy.

Objective To analyze the characteristics of vascular involvement in Takayasu's arteritis (TA) patients and explore the differences between the involvements of whole range versus origin of vessels and those whose origin of vessecs were involved. Methods A total of 57 TA patients were divided into the origin and whole range groups according to their CTA (computed tomography angiography) examination reports. Then a retrospective analysis was performed on their clinical data. Results (1) TA had a female arteries were the most common sites of involvement. (2) The ratio of whole range and origin groups was group was 1.28∶1.The delay of whole range group from the onset to a correct diagnosis was longer than that of origin group (P ＜ 0. 05 ). The rate of aortic arch type in whole range group was less than that in origin group (P ＜0. 05 ). (3) More patients in whole range group had the initial symptom of headache than those in origin group, as well as the subsequent symptoms of claudication, weight loss and urination problems (P ＜0. 05 ).(4)37.5% of patients in whole range group and 64% in origin group had an elevated level of C-reactive protein (CRP) (P ＜ 0. 05 ). Conclusion Patients with whole range of arteries involved in TA are common. With atypical clinical manifestations and a low positive rate of CRP, a diagnostic delay is an important issue. Thus due attention should be paid to its clinical diagnosis and treatment.

Objective To study the related factors of early post-operative prognosis of meningiomas. Methods The clinical data of 953 patients with meningiomas were recorded and statistically analyzed withx2 test of single factor and logistic regression model of multivariate factors. Patient age; tumor size; tumor location; pre-operative complication of patients such as hypertension, diabetes, heart disease and cerebral infarction; the extent of tumor resection; hemorrhagic shock; blood loss or hemorrhagic shock and brain swelling intra-operatively were taken as variables. The prognosis was evaluated by postoperative Karnofsky performance scale. Results The prognosis was significantly correlated with the patient age, tumor size, tumor location, preoperative cerebral infarction, the extent of tumor resection, blood loss and hemorrhagic shock intra-operatively ( P ＜ 0. 05 ) . Such factors as tumor size, preoperative cerebral infarction, the extent of tumor resection (Simpson's scale) and intra-operative hemorrhagic shock were independent risk factors of prognosis for meningiomas. Other factors, such as hypertension, diabetes and heart disease, were unrelated with the prognosis of meningiomas ( P ＞ 0. 05 ). Conclusion Patient age,tumor location and pre-operative complications of patients maybe affect the early postoperative prognosis of meningiomas. But such factors as tumor size, preoperative cerebral infarction, the extent of tumor resection and intra-operative hemorrhagic shock are independent risk factors for the post-operative prognosis of meningiomas.

Objective To evaluate and compare the efficiency and safety of levonorgestrel-releasing intrauterine system (LNG-IUS) and combined oral contraceptives ( COC ) in the treatment of recurrent ovarian endometriosis after conservative surgery or conservative surgery plus medical therapy. Methods A total of 48 patients with recurrent ovarian endometriosis underwent randomization. The regimens of LNG-IUS (n = 24) and COC. ( n = 24) were offered. The volume of ovarian endometriotic cysts was recorded before treatment and at 6, 12, 18 and 24 months. The volume of ovarian endometriotic cysts, pain score of visual analogue scale (VAS), menstrual pattern, body weight, serum CA125 and serum lipids were compared to the pretreatment level within each treatment group, as well as between two treatment groups during the same period. Results (1) At 18 months after LNG-IUS, the cysts in 2 subjects entirely disappeared. At 24months, 18 patients had a disappearance of cysts. The overall size reduction was statistically significant (9. 2 ± 3.0) vs (0. 9 ± 1.5) cm3 ( P ＜ 0. 01 ＝. In the COC group, 12 subjects had a complete resolution of cysts at 24 months. The overall size reduction was statistically significant (9.4 ±2. 2) vs (2. 9 ±3. 1 )cm3 (P＜0.01＝.At 18&24 months, the cyst size reduction was significantly larger in the LNG-INS group than ( P ＜0. 01 ＝. At 18 the COC group (2.4±1.5) vs (4.7±2.6) cm3(P＜0.01＝ and (0.9±1.5) vs (2.9±3.1) cm3(P＜0. 05＝; (2) There was a significant improvement of dysmenorrhea, chronic pelvic pain and dyspareunia at 6- & 12-month follow-up in both groups; (3) serum CA125 decreased at 6 & 12 months in both groups with statistical significance. It decreased more sharply in the LNG-IUS group and remained at low levels beyond 12months; (4) within 6 months of LNS-IUS, irregular bleeding and spotting were the major side effects. Beyond that period the symptoms were significantly relieved. Weight gain and dyslipidemia were the major side effects of COC. Conclusion For patients with recurrent ovarian endometriosis after conservative surgery or conservative surgery plus medical therapy, LNG-IUS and COC may be used to control and reduce endometriotic cysts, relieve pain and reduce the level of CA125. LNG-IUS has the advantages of a greater convenience and minor systemic side effects.

Objective To investigate vertebral augmentation with a novelreticulate bone filling container system by polymethyl methacrylate (PMMA) injection incadaveric simulated vertebral compressive fracture and explore the effect of reticulatebone filling container on cement distribution controlling within vertebral body and therestoration of biomechanical properties after augmentation. Methods A total of 28 freshlyfrozen human vertebrae specimens were randomly divided into 4 groups. After themeasurements of bone mineral density (BMD) and vertebral height, each vertebra received anaxle load by a MTS (material testing system) machine to test the initial strength andstiffness. Subsequently a simultaneous compressive fracture model was created to measurethe stiffness and height of fractured vertebrae. Then the augmentation procedure wasperformed. Afterward the biomechanical properties and the vertebral height were similarlymeasured as pre-operatively. The expansion of bone filling container and the distributionof cement within vertebral body were morphologically observed by crossing the specimens insagittal midline and also intergraded with the radiographic results. Results Stiffness wassignificantly restored comparing with that of fractured level (P ＜ 0. 05). And the bipediculargroups had better restoration results than the unipedicular groups. The strength andheight of specimens significantly increased after the augmentation procedure but withoutdifference among groups. In axial radiographic view, the distribution of cement invertebral body was oval or long oval-shaped in double-layer bone filling container groupswhile it was irregular in single-layer groups. After crossing, the double-layer versionexpanded well in vertebral body and could enwrap most of injected cement. There was only alittle leakage near the vessel layer. But the single-layer version had a poor expansionand a large amount of cement leakage. Conclusion This novel reticulate bone voidfillingcontainer system with different layers may restore both the biomechanicalproperties and the height of fractured vertebrae. But, with the benefit of reducing cementleakage, a double-layer design can enwrap most of injected PMMA and has a brighterprospect of clinical application.

：Objective To investigatethe influence of tubulin disassembly on the in vitro metabolism of articular chondrocytes.Methods Eight New Zealand rabbits aged 2 months were sacrificed by air embolism. Thefull-thickness cartilages were harvested from both knees under sterile conditions. Then 0.4% pronase and 0. 025% Ⅱ collagenase were used todigest for primary chondrocytes. The cells were cultured for 3 days after attachment andthen divided into the control and experimental groups. The control group continuedculturing with primary medium and the experimental group with colchicine, a tubulindestructive & 2, the early apoptosis of two cell groups was 0. 1 μmol/L.At Days 1 agent,at a final concentration of assayed with phosphatidylserine ( AnnexinⅤ). At Day 6, the morphological changes of cells were observed by hematoxylin andeosin staining. At Days 3, 6 & 9, the expression levels of type Ⅱ collagen, proteoglycan and MMP (matrix metalloproteinase)-13 mRNAwere measured by real time quantitative fluorescent reverse transcription-polymerase chainreaction (real time RT-PCR). Meanwhile at Days 3, 6 & 9, the cultured supernatant ofeach group was obtained to detect the contents of type Ⅱ collagen and proteoglycan by the methods of ELISA (enzyme-linked immunosorbentassay) and Alcian blue. Results At Day 2, the early cell apoptosis rate of theexperimental group was higher than that of the control group ( P ＜0.05 ). At Day 6 post-dosing, the experimental cell morphology was found to be irregular andpolygonal. Hyperchromatic nucleus and division phase increased while matrix celldecreased. At Days 3, 6 & 9, the expressions of collagen and proteoglycan mRNA in theexperimental group decreased versus those in the control group (P ＜0.05). The level of MMP-13 mRNA showed no significant changes in the control group at Day 3.And it 0. 01). Meanwhile, type Ⅱ collagen andglycosaminoglycan were & 9 (P＜significantly increased atDays 6 & 9 than those in the control group ( P ＜0. 05 ).significantly lowerin the experimental group at Days 3, 6 Conclusion A disassembly of tubulin can induceearly apoptosis of chondrocytes. The synthesis and secretion of type Ⅱ collagen and proteoglycandecrease while there is an elevated expression of MMP-13.The degeneration of cartilagecells and their disrupted synthesis and catabolism result in a serious decline inbiological functions.

Objective To investigate the influence of siRNA-COX-2 gene upon the growth inhibition and apoptosis of cartilage endplate chondrocytes and provide new methods and evidence for siRNA in gene therapy of cartilage endplate chondrocytes. Methods According to the sequence of COX-2 mRNA,COX-2 siRNA was designed, synthesized, cloned into the GFP reporter pcDNA6. 2GW/EmGFPmiR vector and transfected into Hep cell line. The integrity of inset fragment was detected by colony PCR ( polymerase chain reaction) and sequencing analysis. The cultured cartilage endplate chondrocytes were divided into 4 groups: control group (untreated), negative siRNA group (treatment with 30 nmol/L negative control siRNA), siRNA1 group (treatment with 15 nmol/L COX-2 siRNA) and siRNA2 group (treatment with 30 nmol/L COX-2 siRNA). The biological activity of recombinants was identified with the interference efficiency of COX-2 siRNA recombinant by real-time PCR and Western blot. And the effects of COX-2 inhibitor on the growth of chondrocytes were detected by WST-8 and the mRNA expressions of survivin, bcl-2 and bax genes measured by real-time PCR. Results The sequences of inset fragment in 4 siRNA expressing recombinants were correct After COX-2 transfection, the expression of COX-2 mRNA in chondrocytes was 51.3% ±7. 2%in the siRNA1 group and 35.4% ±3.6% in the siRNA2 group. Western blot showed that the expression of COX-2 protein decreased, especially in siRNA2 group (P ＜ 0.05 ). And the cell survival rate was 100.0% ±8.3% in the control group, 84.9% ±4.2% in the negative control siRNA group, 52.5% ±6. 7% in the siRNA1 group and 48.9% ± 5.4% in the siRNA2 group ( P ＜ 0. 05 ). Meanwhile, the expressions of mRNA of survivin and bcl-2 decreased while the expression of bax mRNA increased in degenerative cartilage endplate chondrocytes transfected with COX-2 siRNA ( P ＜ 0. 05 ). Conclusion COX-2-targeting siRNA inhibits the expression of COX-2, suppresses the proliferation of chondrocytes and induces the cell apoptosis. These effects may be attributable to the up-regulation of survivin and bcl-2 and the downregulation of bax.

Objective To analyze the expression of toll-like receptor 9 mRNA,TNF (tumor necrosis factor)-α and IL (interleukin)-6 afterthe stimulation of murine microglia (BV2) by hepatitis C virus (HCV) so as to elucidatethe immune pathogenesis of HCV in the injury of central nervous system (CNS). Methods BV2cells were cultured in vitro and divided into 3 groups: HCV-positive serum group,normalserum group (negative control) and blank control group. Each group had 20 samples. Thecells and supernatant were collected at 4, 12, 20, 36 h. And TLR9 mRNA was detected byRT-PCR (reverse transcription-polymerase chain reaction) and the levels of TNF-α and IL-6 were detected by ELISA (enzyme-linked immunosorbentassay). Comparison analyses were performed by SPSS13. 0 statistical package.Results (1)RT-PCR showed that there was the expression of TLR9 mRNA in BV2 cells. And the level ofTLR9 mRNA in HCV-positive serum group (0. 85 ±0. 11, 0. 55 ±0. 08, 0. 58 ±0. 09, 0. 61±-0. 07) was higher than that in the other groups. The difference had statisticalsignificance( F = 17. 258, P ＜ 0. 05 ). It was the highestat 4 h (0. 85 ± 0. 11 ). And the difference had statistical significance ( F = 7. 427, P＜0. 05); but there were no statistical significance between normal serum group andcontrol group( P ＞ 0. 05 );no significantdifference existed among 12, 20 and 36 h (P ＞0. 05 ). (2) Thelevels of TNF-α[(926 ±133), (327 ±59), (367 ±69), (354 ±71) pg/ml] and IL-6[(125 ±34), (84 ±20), (82 ±24),(87 ± 18) pg/ml] in the HCV-positive serum group werehigher than those in the other groups( F = 18. 263 -27. 469, P ＜ 0. 05 ); in HCV-positive serum group, the levels of TLR9 mRNA andTNF-α(r = 0. 425, P ＜0. 01 )/IL-6( r =0. 489, P＜0. 01 )were positively correlated. Conclusion The expression of TLR9 mRNA iselevated after the stimulation of BV2 cells by HCV-positive serun. It peak comes at 4 h.And it may induce the secretions of TNF-α and IL-6. Thus TLR9 may increase the secretions of Th1 andTh2 cytokines so as to participate in the early inherent immune response during theinfection of CNS by HCV.

The most common ectopic pregnancy occurs in the fallopian tube, accounting for about 90% ~95% [1]. Ectopic pregnancy is a common acute abdomen in gynecology, and its exact incidence is difficult to estimate, and the literature reports are quite different. The possible reason is that some cases, especially unruptured ectopic pregnancy, have atypical symptoms or no special complaints, and it is difficult to confirm the diagnosis; Some ectopic pregnancy is difficult to distinguish from abortion. On the other hand, the statistical standards used in various reports are different. Some use the ratio of ectopic pregnancy to normal pregnancy (usually the number of live births), some use the ratio of ectopic pregnancy to the number of local women of childbearing age, and some use the ratio of ectopic pregnancy to the number of gynecological hospitalizations in the same period. Therefore, it is easy to make misunderstandings when evaluating the occurrence of ectopic pregnancy.

high-resolution melting analysis (HRM) is an emerging nucleic acid sequence analysis technology in recent years.Compared with traditional gene detection technology,HRM not only has extremely high specificity and ideal sensitivity,but also can complete high-throughput sample detection and realize truly contamination-free closed tube operation, so it has gradually become the first choice technology in modern medical research and gene diagnosis. At present, HRM has very high application value in various fields such as gene mutation scanning,genotyping,sequence matching and methylation analysis.This paper summarizes the characteristics of HRM and its application in medical research and gene diagnosis.

A team of scientists from the Hebrew University of Jerusalem,Harvard Medical School and other institutions in the United States and Japan has developed a low-cost, nano-scale drug.The drug is used to treat chronic wounds,such as diabetic foot ulcers or burns.Diabetes is a rapidly growing medical problem,which affects nearly 3% of the world's population.Poor blood circulation caused by diabetes often makes skin wounds difficult to heal,resulting in pain, infection and even amputation.

The patient was a 53-year-old female with left lower limb weakness for more than 1 month when walking. Physical examination showed that the left lower limb muscle strength was grade IV. MRI of the head showed that the right temporal lobe showed a circular mixed signal mass shadow with clear boundary, and multiple patchy short T2 and short T1 signal shadows, about 32 mm ×27 mm ×17 mm in size, and large patchy and slightly longer T2 and T1 edema signal shadows were seen around the lesion. The right ventricle was obviously compressed and deformed, the midline structure shifted to the left, and the left ventricle was slightly larger. Enhanced scan showed that the lesion showed obviously uneven enhancement shadows. During the operation, the local brain tissue was edema, and the tumor was substantial, located at the bottom of the temporal lobe, purple-red in color, with abundant blood supply. The boundary with the brain tissue was unclear, but the texture was tough. The base was located in the temporal bone.