Volume 91  ·   Issue 29  ·  2011

More than 50% of people in the world are infected with Helicobacter pylori (Hp), and the Hp infection rate in China is 42% ~84% [1], which belongs to the country with high Hp infection rate. Hp infection is not only closely related to confirmed upper gastrointestinal diseases: chronic gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue malignant lymphoma and gastric cancer [2], but also involves many extragastrointestinal diseases: cardiovascular, cerebrovascular, blood, immune, skin, oral and other multi-system and multi-disciplinary diseases [2], so the treatment of Hp infection has been the most popular research direction for gastrointestinal workers.

Objective To explore the effects of valproate (VPA) on endocrine system in adolescent and reproductive female patients with epilepsy. Methods A total of 30 adolescent and reproductive female patients with a diagnosis of epilepsy at our hospital during July 2009 to March 2010 were recruited. All cases with magnesium VPA alone were included. The levels of follicle-stimulating hormone ( FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), progesterone (P) and tesosterone (T) were detected respectively at pre-therapy and 3, 6 and 12 months post-therapy. And the changes of menstruation and ovaries were recorded. Results The serum concentration of PRL was lower at 3 and 6 months post-therapy than that at pre-therapy. There was significant difference (P = 0. 010 and 0.014 ) . The serum concentration of E2 significantly decreased after a 3-month therapy of valproate ( P ＜ 0. 05 ). While comparing the parameter's level between the initial test and at a 3, 6 and 12-month follow-up, the level of P significantly decreased in the later groups than that of the former one while the level of T showed a marked increase. The levels of FSH and LH were not significantly different at pre- and post-therapy. And 6 ( 20% ) of them presented with menstrual dysfunctions and 3 ( 10% ) polyeystic ovary. Conclusion The valproate therapy can not only cause the changes of endocrine system and hormonal levels, but also induce such endocrine dysfunction syndromes as menstrual suspension and polycystic ovary. It eventually causes polycystic ovary syndrome.

Objective To evaluate the relationship between the methylenetetrahydrofolate reductase (MTHFR) gene polymorphism and the susceptibility of ischemic stroke among different ethnic populations.Methods The databases of MEDLINE, EMBASE, Cochrane Library and others were searched. And a total of 17 studies published in English between 2000 and October 2010 on the association of MTHFR gene C677T polymorphism with ischemic stroke were selected. A comprehensive quantitative analysis was performed by meta-analysis. Results The results showed that the pooled OR values of ischemic stroke with TT and CC genotype were 1.30 (95% CI: 1.11 to 1.52) and 0. 88 (95% CI: 0. 79 to 0. 98 ) respectively. And when sub-grouped by ethnic populations, the Caucasians were more likely than other populations to suffer ischemic stroke. There was a low probability of publication bias. Conclusion The presence of MTHFR TT gene is associated with an elevated risk of developing ischemic stroke, especially in Caucasians.

Objective To analyze the magnetic resonance imaging (MRI) findings of lesions in the limbic system related structures in general paresis of insane (GPI) patients so as to explore its pathogenesis and provide a new MRI diagnostic method. Methods The clinical data and MRI findings of lesions in the limbic system related structures were retrospectively analyzed for a total of 31 GPI patients. The parameters were volume and signal abnormality. Results On MRI, structural abnormalities were found in amygdaloid body ( n = 29 ), hippocampus ( n = 28 ) , insular lobe ( n = 24 ) , parahippocampal gyrus ( n = 23 ),lenticular nucleus ( n = 23 ), corpus callosum ( n = 20), caudate nucleus ( n = 11 ), hypothalamus ( n =10), anterior nucleus of thalamus ( n = 10) , cingulate gyrus ( n = 8 ) and thalamus ( n = 2). The frequent manifestations were atrophy, swelling, T2 hyperintensiy in various structures and T2 hypointensity in lenticular nucleus. Conclusion A frequent involvement of limbic system structures in GPI patients may be related with dementia and other psychiatric symptoms. Swelling and T2 hyperintensity of involved structures may be the characteristic MRI manifestations of GPI.

Objective To measure such operative parameters of unipedicular kyphoplasty as optimal entry point, angle and depth so as to provide rationales for its clinical management and formulate a standardized protocol for unipedicular vertebroplasty. Methods Ten dry thoracolumbar specimens were prepared for measurement. The entry and target points were defined according to the Roy-Camille method. A 3mm Kirschner wire was used to puncture and view in the anteroposterior and lateral aspects of radiography until a satisfying position. The outside oblique and upward oblique angles were measured on the radiographic pictures. After extraction, the depth of Kirschner wire was measured. The positions of entry point were changed and the largest upward oblique angle and largest declination angle measured on the radiographic pictures. Results For safe puncturing, as the outside oblique and upward oblique angles enlarged from T11 to L3, the length enlarged from T11 to T12 and L1 to L3. The accepted error was that the largest upward oblique angle and largest declination angle enlarged from T11 to L3. The alteration range for outside oblique angle was extremely narrow. Conclusion The experimental results provide the guiding data for the operative management of unipedicular thoracolumbar vertebroplasty. ff the pedicle is too small or the angle too narrow,the operative sophistication of vertebroplasty will be highly demanding.

Objective To investigate the efficacy of autologous bone grafting plus screw fixation to reconstruct the medial tibial defects in total knee arthroplasty (TKA). Methods From November 2001 to November 2004, 46 patients (50 knees) with medial tibial bone defects underwent TKA at our hospital.There were 16 males (16 knees) and 30 females (34 knees). They included osteoarthritis (OA) (n = 35,38 knees) and rheumatoid arthritis (RA) (n = 11, 12 knees). A total of 46 patients underwent three-dimensional CT (computed tomography) reconstruction to evaluate the tibial plateau defects after osteotomy.Single or double distal femoral osteotomic bone was used to reconstruct the bone defects with the hollow nail internal fixation. Another 80 TKA patients (86 knees) were randomly selected as the control group. The surgical outcome, lateral migration of tibial component and joint line elevation, etc. were analyzed and the follow-up knee society scores recorded. Results The patients were followed up for 6 to 9 years. Two patients were lost to follow-up and 1 died of myocardial infarction at 5 years post-TKA in the test group. In the last follow-up, 1 case suffered deep infections and all others had no prosthetic loosening. One case ( 1 knee) had resorption of wedge-shaped bone graft after 8 years. The remaining graft healed and there was no screw displacement. Medial platform split fracture occurred in 3 patients (3 knees) in the OA group. The quantity of distal femoral osteotomy, thickness of polyethylene insert, tibial implant size, joint line elevation and lateral migration of tibial base were greater than the other two groups (q test, P ＜0. 05). The pre- and post-operative KSS scores had significant differences in each group ( F test, P ＜ 0. 05). But the same group showed no significant difference at 6, 9 years ( q test, P ＞ 0. 05). Conclusion As an easy and effective way of reconstructing the medial tibial bone defects, autologous bone grafting plus screw fixation can restore knee mechanical axis and stability. But in OA patients with tibial sclerosis, the complications of tibial component lateral migration, joint line elevation and splitting tibia fractures should be avoided during the reconstruction

Objective To observe and evaluate the pathologic changes and curative effects of irinotecan (CPT-11 ), 5-fluorouracil (5-FU) and combined short-term radiotherapy before low-set rectal cancer operation so as to provide a theoretic basis for formulating a new effective adjuvant therapeutic regimen. Methods A total of 41 patients of low rectal cancer were treated with CPT-11,5-FU therapy or CPT-11 plus 5-FU combined short-term radiotherapy from April 2002 to April 2009. They were divided into 2 groups according to different treatment schemes, including irinotecan group (n = 18) and irinotecan combined short-term radiotherapy group (n = 23 ). The pathologic changes before and after treatment were observed and the differences of two treatment approaches compared. Results Tumor cells had different degrees of degeneration and necrosis under microscope in two groups. Compared with computed tomographic findings before therapy, tumor sizes of two groups were reduced by an average of 33.1% ( 13.5 mm vs 20. 2mm) and 34. 4% (12. 8 mm vs 19.5 mm) respectively. Two groups were graded according to the RCRG (rectal cancer regression grade)score: RCRG1: 7 cases vs 18 cases, RCRG2:4 cases vs 3 cases and RCRG3:7 cases vs 2 cases. According to the pathologic evaluation standard, 3-degree necrosis, cell interstitial fibrosis and intimal thickening in vessels were observed in two groups: 7 cases vs 17 cases, 6 cases vs 17 cases and 3 cases vs 14 cases respectively ( all P ＜ 0. 05). Five patients achieved complete pathological remission in the irinotecan combined short-term radiotherapy group. Conclusion Based on the pathological changes and mitigation results after treatment, CPT-11 and 5-FU may be used as neoadjuvant drugs for rectal cancer. If the above two drugs can be used in combination with short-term radiation, the curative effect will be better.

Objective To investigate the expression and relationship of Rho-associated protein kinase 2 (ROCK2) and clinical characteristics in esophageal squamous cell carcinoma (ESCC). Methods Immunohistochemistry was performed to assay the expression of ROCK2 in tumor tissues and adjacent normal epithelium from 118 ESCC patients in tissue microarray. The relationship between ROCK2 level and clinicopathologic profiles such as age, gender, location, smoking, differentiation degree, T stage, lymph node metastasis and TNM stage were analyzed. Results The ROCK2 expression was up-regulated in 54 of 118 (45. 76% ) ESCC tissues. The up-regulated expression of ROCK2 was observed in 55.74% (34/61) ESCC tissues of patients under 61 years old. And it was significantly higher than that in 35.09% (20/57) of patients over 61 years old ( x2 = 5.062, P = 0. 024 ). In addition, the rate of up-regulation of ROCK2 was significantly higher in high-grade differentiation group (58. 70%, 27/46 ) than that in moderate-grade and low-grade differentiation group ( 37.50%, 27/72 ) ( x2 = 5.080, P = 0. 024 ). Conclusion The upregulated expression of ROCK2 is correlated with patient age and differentiation grade of ESCC.

Objective To evaluate the clinical efficacy of knee arthroscopic synovectomy plus disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA) patients.Methods A total of 97 RA patients were treated with knee arthroscopic synovectomy plus DMARD after arthroscopy. The control group received only DMARD. The patients were assessed at pre-treatment and 1,6, 12, 24 month post-treatment. Tender joint count, swollen joint count, morning stiffness, resting pain,patient global assessment, physician global assessment, erythrocyte sedimentation rate ( ESR), C-reactive protein (CRP), rheumatoid factor (RF) and disease activity score (DAS) 28 were observed. Results Tender joint count, swollen joint count, morning stiffness, resting pain, patient global assessment, physician global assessment and DAS 28 score improved significantly at 1, 6 month post-treatment in the combined treatment group versus the control group. At 2 years post-treatment, there was still significant difference in DAS28 between two groups. Conclusion The combined treatment of knee arthroscopic synovectomy and disease modifying antirheumatic drugs can control the disease activity of RA during an early period. And a long-term efficacy may be maintained.

Objective To compare the clinical features and prognosis among patients with different chemosensitivity and determine the specific clinical influencing factors of chemotherapeutic resistance.Methods In references to the 2010 NCCN clinical practice guidelines on ovarian cancer and in accordance with the length of disease-free interval, 244 patients were divided into 3 groups: platinum-resistant, partially sensitive and platinum-sensitive. The differences of clinical features, treatment and prognosis were compared among these 3 groups. Results The resistant, partially sensitive, sensitive rates to platinum-based chemotherapy were 23.4%, 13.5% and 63. 1% respectively. Such factors as age, pathological type,primary tumor size. intraperitoneal chemotherapy and venous chemotherapy regimen had no effect on the responses to the combination platinum-based chemotherapy. The platinum-resistant percentage of advanced stage patients without optimal cytoreductive surgery was higher(P ＜ 0. 01 ). The poorly differentiated rate of partially sensitive patients was higher than that of platinum-sensitive ones (P ＜ 0. 05 ). The CA125 level and lymph node metastasis rate of platinum-resistant patients were higher than those of platinum-sensitive patients (P ＜ 0. 05, P ＜ 0. 01 ). The 5-year survival rates of resistant, partially sensitive and sensitive patients were 9.5%, 38.4% and 81.9% respectively. There were statistics differences in overall survival and progression-free survival among the 3 groups ( P ＜ 0. 01 ). Conclusion Advanced ovarian cancer, poor differentiation, lymph node-positivity, CA125 rising above 1000 × 103 U/L and suboptimal cytoreductive surgery would lead to the occurrences of resistance or partially sensitivity. Clinical factors have some

Objective To explore the correlation between severe preeclampsia and abnormal expression of long-chain 3-hyroxyacyl-CoA dehydrogenase (LCHAD). Methods Serum-free trophoblast cells cultured in vitro were divided into 4 groups under the stimulations of normal pregnancy serum ( NP group), early onset severe preeclampsia serum (E-PE group), late onset severe preeclampsia serum (L-PE group) and HELLP ( hemolysis, elevated liver enzymes & low platelets) syndrome serum ( HELLP group)respectively. The expressions of mRNA and protein of LCHAD in trophoblast cells were detected by real-time polymerase chain reaction (PCR) and Western blot. Result ( 1 ) Expression of LCHAD mRNA: the relative expressions of mRNA of LCHAD in NP, E-PE, L-PE and HELLP groups were 1.00 ±0.00, 3.08 ±0.22, 1.62 ± 0. 23 and 3.36 ± 0. 18 respectively. The relative expressions of LCHAD mRNA were significantly reduced in the E-PE, L-PE and HELLP groups versus the NP group ( P ＜ 0. 05 ). Compared with the L-PE group, the gene expressions of LCHAD significantly decreased in the E-PE and HELLP groups (P ＜0.05 ) while no significant difference was found between the E-PE and HELLP groups (P ＞ 0. 05 ).(2) Expression of LCHAD protein: the relative expressions of LCHAD protein were 4.94 ±0.02, 2.93 ±0. 13, 4. 14 ±0. 06 and 2.80 ±0.09 in the NP, E-PE, L-PE and HELLP groups respectively. The protein expressions of LCHAD were remarkably reduced in the E-PE, L-PE and HELLP groups versus the NP group (P ＜ 0.05 ). The expressions of LCHAD protein remarkably decreased in the E-PE and HELLP groups versus the L-PE group (P ＜0.05) while no significant difference was found between the E-PE and HELLP groups (P ＞ 0. 05 ). Conclusion Long chain fatty acid oxidation is involved in the pathogenesis and development of preeclampsia. The expressions of LCHAD gene and protein are remarkably affected by early onset severe preeclampsia and HELLP syndrome. The interacting mechanism and influence between fatty acid oxidation and the development of preeclampsia are worth further exploring.

Objective To investigate the generation of antitumor response against hepatocellular carcinoma by in vitro transduction of dendritic cells (DC)with recombinant adeno-associated virus expressing α-fetoprotein (rAAV-AFP). Methods Peripheral blood mononuclear cells were isolated from healthy volunteers. Adherent peripheral blood mononuclear cells were transduced with AAV-AFP and cultured in the presence of granulocyte macrophage colony stimulating factor and interleukin-4 to generate dendritic cells.MTS assay was used to measure the ability of DC transduced with AAV-AFP ( AAV-AFP + DC) to stimulate the proliferation of T cell. The phenotype and AFP protein expression of DC and the secretion of IFN (interferon)-γ and IL (interleukin)-4 by T cells were detected by flow cytometry. The killing efficacy of cytotoxic T lymphocytes (CTL) activated by AAV-AFP + DC against AFP positive hepatocellular carcinoma cell lines was detected by lactate dehydrogenase (LDH) release assay. Results AAV-AFP + DC expressed HLA Ⅰ (97. 12%), HLAⅡ (97.32%), CD80(38.94%), CD83(60.84%)and CD86(98. 14%). AFP was secreted by 81.2% of AAV-AFP + DC. And it could stimulate effectively the proliferation of T cell.19. 84% of CD4 + T cells and 18.65% of CD8 + T cells activated by AAV-AFP + DC produced IFN-γbut not IL-4 and showed distinct killing activities against AFP positive hepatocellular carcinoma cell lines HepG2 (56. 45% ) and BEL7402 (78. 84% ). Conclusion AAV-AFP + DC can elicit distinct antitumor responses against AFP positive hepatocellular carcinoma cell lines so as to provide a basis for further researches on the clinical application of AAV-AFP + DC in the treatment of hepatocellular carcinoma.

Objective To study the regulation of the proliferation of epiphysis stem cells by the PTHrP (parathyroidhormone related peptide) and Notch signaling systems. Methods An organ culture system of femurs of SD rat in 24 h after birth was employed. PTHrP ( 1 - 34) was used as the activator of the PTHrP signaling pathway and PTHrP (7 - 34) as the antagonist of PTH (parathyroidhormone) -receptor. For Notch signaling system, Jaggedl/Fc was used as the activator and DAPT as its inhibitor. The femurs were cultured in DMEM ( Dulbecco's modified Eagle's medium)/F12 medium while phosphate buffered saline was used for the control groups. Hhematoxylin and eosin staining and bromodeoxyuridine analysis were used to analyze the length of the epiphysis stem cells zone and the proliferation of epiphysis stem cells. The expression of NICD (Notch intra-cellular domain) and Jaggedl were analyzed by immunohistochemistry. The epiphysis stem cells were transfected with the lentiviral vectors with rat PTHrP gene overexpression or inhibition properties, the cells transfected with the PGC-GFP-lentivirus or NC-GFP-lentivirus were used as control. Western blot was employed to detect the expression of NICD and Jaggedl genes. Results PTHrP (1 -34) and Jagged1/Fc could dramatically elevate the rate of epiphysis stem cells zone by the whole growth plate length measurement while PTHrP (7 - 34 ) and DAPT could decrease the rate. Brdu analysis also showed that the number of proliferative epiphysis stem cells could be up-regulated by the PTHrP (1 -34 ) or Jagged1/Fc signaling. By contrast, the treatment with PTHrP (7 -34) or DAPT reduced the number of proliferative epiphysis stem cells. Immunohistochemistry and Western blot showed a significantly elevated expression of NICD and Jagged1 when PTHrP signaling was activated while a reductive expression of NICD and Jagged1 when PTHrP signaling was inactivated. Conclusion Both of PTHrP and Notch signaling system could promote the proliferation of epiphysis stem cells. And the PTHrP signaling can stimulate Notch signaling to promote the proliferation of epiphysis stem cells.

Objective To employ 18F-fluoro-2-aeoxyglucose (18 F-FDG) and (3-N-[11 C] methylspiperone ) 11C -NMSP microPET to assess the changes of regional cerebral glucose metabolism and the expression of dopamine receptor type 2 ( DRD2 ) in a rat model of Parkinson's disease (PD). Methods A hemiparkinsonian model was established in rats by unilateral pretreatment with 6-hydroxydopamine (6-OHDA). At 2 weeks after 6-OHDA insult, 18F-FDG and 11C-NMSP microPET scan were performed to compare the differences of regional cerebral glucose metabolism and the expression of DRD2 between the PD and control groups respectively. The immunohistochemical staining was used to detect the expression of tyrosine hydroxylase in two groups. Results In the PD model, the glucose metabolism rates were 88. 2% ± 2. 2%, 94. 5% ±4.5% and 96. 2% ±5. 8% respectively, in right striatum, hippocampus and sensorimotor cortex. And they were significantly lower than those in the control group [ 92. 7% ± 2. 8% ( P ＜ 0. 01 ),98.9% ±3.9% (P＜0.01) & 102.8% ±2. 1% (P＜0.01) ].The expression of DRD2 in right striatum was significantly higher in the PD group than that in the control group ( 112. 9% ± 9. 0% vs 102. 3% ± 1.4%, P ＜ 0. 01 ). Conclusion In the PD rats, glucose metabolism decreases in injured side striatum,hippocampus and sensorimotor cortex while and the expression of DRD2 increases in injured side striatum.18F-FDG and 11C-NMSP microPET can effectively assess the regional cerebral glucose metabolism and the expression of DRD2 in PD. They may serve as effective molecular imaging tools for an early diagnosis of PD.

To investigate the correlation between autoimmune diseases and leukemia, the clinical data of 8 patients with autoimmune diseases complicated with leukemia were summarized and analyzed in this study. 1. Subjects and methods 1. Subjects: There were 9021 cases of autoimmune diseases in Peking Union Medical College Hospital from July 1993 to January 2010, including 8 cases with leukemia. The incidence of autoimmune diseases with leukemia was 0.08%, including 3 cases of systemic lupus erythematosus (SLE), 2 cases with partially differentiated acute myeloid leukemia (AML-M2) and 1 case with acute promyelocytic leukemia (AML-M3). Two cases of Behcet's disease were complicated with AML-M2 and acute monocytic leukemia (AML-M5b), respectively; One case of juvenile rheumatoid arthritis (JRA) with acute lymphocytic leukemia (ALL-L2) and one case of primary Sjogren's syndrome (pSS) with ALL-L2 hypoproliferative type; A case of recurrent polychondritis (RP) complicated with chronic myelomonocytic leukemia (CMML).

oculopharyngeal muscular dystrophy (OPMD) is a late-onset hereditary skeletal muscle disease with progressive eyelid ptosis, dysphagia and limb weakness as the main manifestations. It is caused by the mutation of poly (a) binding protein nuclear 1 gene (PABPN1) on chromosome 14. The pathological changes are characterized by the appearance of rimmed vacuoles in skeletal muscle fibers and filament inclusions arranged in palisade-like arrangements in myocyte nuclei [1-3].

The patient, a 72-year-old female, was admitted to the hospital on July 7, 2010 due to sudden aphasia and right limb weakness for 24 hours. At 19:00 25 hours before admission (July 6, 2010), the patient suddenly suffered from inability to speak, right limb weakness, angled mouth corner, no nausea and vomiting, no limb twitching, and no loss of consciousness. After taking Angong Niuhuang Pill, her speech improved slightly. When she got up in the morning, her family felt that the patient was unconscious, sleepy, completely unable to speak, unable to answer, and right limb weakness, so she needed the help of her family to stand, so she came to Guangdong Provincial Hospital of Traditional Chinese Medicine for treatment. She had a history of hypertension in the past. Physical examination on admission: blood pressure 160/95 mm Hg (1 mm Hg =0.133 kPa), National Institutes of Health Stroke Scale (NIHSS) score 11, clear level of consciousness, complete mixed aphasia, unable to cooperate with advanced intelligent physical examination, unable to cooperate with physical examination. Bilateral pupils were equal size and round, with a diameter of 3 mm, sensitive to light, and bilateral eyeballs stared to the left, which could not be corrected.

A 69-year-old male was admitted to the hospital on December 23, 2009 due to "nausea and vomiting for more than 1 month, aggravated for 10 days". More than 1 month before admission, the patient gradually felt poor appetite, reduced eating, upper abdominal fullness, nausea, and repeated vomiting of stomach contents after eating, accompanied by gradual darkening of complexion, weight loss of nearly 10kg, and obvious fatigue. He had visited the outpatient clinic of other hospitals many times. Gastroscopy showed: (1) duodenal bulb frost ulcer; (2) Chronic superficial gastritis (active stage). Liver function and thyroid function were basically normal. There was no improvement after treatment with "omeprazole and mosapride" for acid suppression and kinetic promotion.