Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih最新文献

Objective: To investigate the role of transforming growth factor-beta1 (TGF-beta1)/Smad4 pathway in development of renal fibrosis in streptozotocin (STZ)-induced diabetic nephropathy (DN) rats and explore its possible mechanism.

Methods: Male Wistar rats weighing 180-220 g were divided into 5 groups: group A (normal control), group B [diabetes mellitus (DM) 2 weeks], group C (DM 4 weeks), group D (DM 8 weeks), and group E (DM 16 weeks). Except for the normal control group, other groups were induced DM by single injection of STZ (55 mg/kg) respectively. Blood glucose level, serum creatinine, and 24-hour urine protein were examined. Expressions of TGF-beta1 and Smad4 protein and mRNA in kidney were detected using immunohistochemical technique, Western blot, and real-time PCR. mRNA expressions of stromelysin-1 (MMP-3), tissue inhibitor of metalloproteinase-1 (TIMP-1), and collagen In in kidney were also detected by real-time PCR.

Results: The levels of blood glucose, serum creatinine, and 24-hour urine protein in rats of group B, C, D, and E were higher than those of the control group. With the progression of renal fibrosis, the expressions of TGF-beta1 and Smad4 protein and mRNA in kidney of diabetic rats elevated. In addition, the renal MMP-3 mRNA expression diminished in diabetic rats, while TIMP-1 and collagen III mRNA increased.

Conclusions: In STZ-induced diabetic rats, the TGF-beta1/Smad4 appears to play an important role in renal fibrosis of DN. The increased expression of TGF-beta1 and Smad4 might result in the transcriptional regulation of downstream target genes of TGF-beta1/Smad4 pathway, which contributes to the progression of renal fibrosis in diabetic rats.

Objective: To investigate the feasibility and effectiveness of radiofrequency catheter ablation (RFCA) to treat per-manent atrial fibrillation (AF) under the guidance of Carto-Merge technique.

Methods: Fifteen male patients with permanent AF underwent RFCA under the guidance of Carto-Merge technique. The mean age was 54.00 +/- 10.44 years, and duration of AF was 23.66 +/- 14.93 months. Cardiac magnetic resonance angiography (MRA) was performed to obtain pre-procedural three-dimensional (3D) images on the anatomy of left atrium (LA) and pulmonary veins (PVs) before RFCA procedure. Then the electroanatomical map was integrated with 3D images of MRA to form Carto-Merge map that guided step-by-step ablation strategy of permanent AF. Circumferential PV ablation was performed first until complete PVs electric isolation confirmed by Lasso catheter. If AF was not terminated, lesion lines on roof of LA, mitral isthmus, and tricuspid isthmus were produced.

Results: The episodes of AF were terminated during RFCA in 2 patients, by direct current cardioversion in the remaining 13 patients. Transient AF occurred in 2 patients after ablation on 1st day and 1st week respectively, AF terminated spontaneously not long after taking metoprolol. One patient developed persistent atrial flutter (AFL) in 2 months after procedure and AFL was eliminated by the second ablation. Persistent AF recurred on 1st day, 1st and 5th week respectively in 3 patients, and did not terminate after 3 months even though amiodarone was given. The remaining 12 patients were all free of AF during 2-11 months of follow-up. The recent success rate for RFCA of permanent AF was 80%.

Conclusions: Carto-Merge technique can effectively guide RFCA of permanent AF. When combined with single Lasso mapping, it can simplify the mapping, lower expenses, and enhance the success rate of RFCA of permanent AF.

Objective: To investigate the effects of alcohol intake on penile structure and function in rats.

Methods: Thirty adult male Wistar rats were randomly divided into two groups: control group and alcohol intake group. They were administered with 2 mL of normal saline and 40% alcohol solution respectively through gastric tubes every day. Three months later, the animal model of alcohol intake was evaluated by modified Nayagida's method, and the effects of alcohol on the rats were studied by sexual behavior, the number of apomorphine-induced penile erection, level of testosterone in the sera, and the content of penile smooth muscle.

Results: The scores of animal model of alcohol intake evaluated by Nayagida's method were 0.66 +/- 2.05 in the control group and 9.26 +/- 5.50 in the alcohol intake group (P < 0.05), which indicated that an animal model of alcohol intake was successfully established. Sexual behavior, the number of apomorphine-induced penile erection, testosterone level in the sera, and the content of penile smooth muscle of the alcohol intake group were all statistically different as compared with the control group (P < 0.05).

Conclusion: Alcohol intake induces sexual dysfunction in rats, which may be due to the decline of testosterone level in the sera and decline of penile smooth muscle.

Objective: To analyze the diagnosis and treatment of pancreatic tuberculosis.

Methods: Retrospectively reviewed and summarized 13 pancreatic tuberculosis patients' clinical information, presentation, diagnostic methods, therapeutic approaches, and prognosis from 1958 to 2004 at Peking Union Medical College Hospital.

Results: All cases presented a wide series of symptoms, including fever in 6 cases, upper abdominal tenderness in 13, epigastric mass in 4, obstructive jaundice in 3, night sweat in 4, weight loss in 7, hypersplenotrophy and hypersplenism in 1, and being complicated with tuberculosis of other organs in 3. One case was diagnosed by clinical symptoms and biopsy of lymph node, and only received anti-tubercular treatment Others were diagnosed by intra-operative biopsy and anti-tubercular treatment, and got well without recurrent tuberculosis in pancreas and other organs during 6 months to 2 years of follow-up. The non-operative case presented extrahepatic portal hypertension.

Conclusions: Pancreatic tuberculosis may be considered in the patients with fever, abdominal tenderness, weight loss, and imaging evidence of regional pancreatic lesion. Efficacy of anti-tubercular agents and laparotomy for pancreatic tuberculosis is evident.

Objective: To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis.

Methods: Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in Central Hospital Conde S. Januario of Macao. Sixteen patients had PAs of AVF in upper extremities, 4 in lower extremities. All patients were treated with surgical therapy.

Results: All operations were finished without death. One patient suffered from acute thrombosis, recovered without any complication through instant thrombectomy. One patient with postoperative incision bleeding recovered after low molecular weight heparin was ceased. And one AVF could not be mature six weeks later, was recovered after ligation of branch vein. And one patient died due to recurrent cerebral infarction.

Conclusion: Surgical repair is the best choice for PA of AVF for renal hemodialysis.

Objective: To measure the quantities and apoptosis-related protein levels of B lymphocyte in the patients with immunorelated pancytopenia (IRP) and explore the action of B lymphocyte in the pathogenic mechanism of IRP.

Methods: Quantities of whole B lymphocytes and CD5+ B lymphocytes as well as the expressions of Fas and Bcl-2 in B lymphocytes in 35 patients with untreated IRP, 15 IRP patients in complete remission (CR), and 10 normal controls were assayed by flow cytometry.

Results: The percentages of B lymphocyte and CD5+ B lymphocyte were significantly higher in untreated IRP patients than in CR IRP patients and normal controls (P < 0.05), and there was no significant difference between the latter two groups (P > 0.05). There was no significant difference of Fas expression in B lymphocyte among three groups (P > 0.05). The expression of Bcl-2 in B lymphocyte was significantly higher in untreated patients than in CR patients or normal controls (P < 0.01), and significantly higher in CR patients than in normal controls (P < 0.01). The apoptosis-related index was significantly lower in untreated patients than in CR patients or normal controls (P < 0.05), and significantly lower in CR patients than in normal controls (P < 0.05). The percentage of B lymphocyte was positively correlated with post-treated response time (r = 0.53, P < 0.01).

Conclusion: The production of auto-antibodies in IRP patients probably has some relationship with the abnormal quantities of B lymphocyte and its subpopulations as well as with the inhibition of B lymphocyte apoptosis.

Objective: To evaluate the operative technique and preliminary results of video-assisted thoracoscopic anterior correction and fusion of scoliosis.

Methods: Eleven cases underwent thoracoscopic anterior correction and fusion of scoliosis from March 2003 to April 2005 in our hospital were reviewed. They were all females with an average age of 13.1 years old. Of which, 9 cases were idiopathic scoliosis, 1 case was congenital scoliosis, and 1 case was Marfan syndrome scoliosis. The coronal Cobb angle and apical vertebral translation before and after surgery as well as at final follow-up were measured. The operation time, blood loss during operation, and peri-operative complications were recorded. Results The mean operation time was 6.4 hours, mean instrumented vertebrae were 6.4 segments, and mean blood loss during operation was 364 mL. The coronal Cobb angles of the thoracic curve before and after surgery were 45.5 degrees and 15.4 degrees respectively, with an average correction rate of 65.4%. The lumbar curve was corrected from 28.4 degrees lation to 11.8 degrees, with an average simultaneous correction rate of 57.2%. All of the patients were followed up regularly with an average time of 21.4 months. At the final follow-up, the coronal Cobb angles of the thoracic and lumbar curves were 19.0 degrees and 20.1 degrees, with a 3.6 degrees and 8.3 degrees loss of correction, respectively. The apical vertebral translation was improved from 32.3 mm to 10.5 mm for the thoracic curve, and from 13.1 mm to 8.2 mm for the lumbar curve. There were 6 cases with peri-operative complications, including 1 case of thoracic effusion, 1 case of chylothorax, 1 case of locking plug loosing, 2 cases of aggravation of the unfused lumbar curve (1 case also with thoracolumbar kyphosis), and 1 case with a screw tip causing a contour deformity of the aorta. And 4 of them underwent revision surgery.

Conclusions: Video-assisted thoracoscopic anterior correction and fusion of scoliosis has good correction capability, less intraoperative bleeding, and favorable cosmetic effect for mild and moderate thoracic scoliosis, but with higher rates of correction loss of the lumbar curve and peri-operative complications. A surgeon should be cautious to perform this technique. ders

Objective: To investigate the methylation status of LRP15 gene in acute leukemia (AL) patients and its role in the tumorigenesis.

Methods: The methylation of LRP15 promoter and first exon of bone marrow mononuclear cells in 73 patients with AL, 10 with chronic leukemia (CL), 9 with hematological benign diseases, and 20 healthy transplantation donors was analyzed by using methylation specific polymerase chain reaction. The methylation of LRP15 gene promoter and first exon in COS7, K562, and HL60 cell lines was also assayed.

Results: No LRP15 gene promoter methylation was detected in COS7 cell line. LRP15 gene promoter was methylated in K562 and HL60 cell lines. No deletion of LRP15 gene was detected in all samples. In nearly all French-American-British leukemia subtypes, we found that frequency of LRP15 methylation in adult patients with AL was 71.23% (52/73). There was no detectable methylation in any of the 20 healthy donors and 8 chronic myeloid leukemia patients. The difference in frequency of LRP15 methylation between AL patients and healthy donors or CL patients (10.00%, 1/10) was significant (P < 0.01). Hypermethylation of LRP15 gene was found in 57.14% (16/28) of newly diagnosed AL patients, 83.33% of relapsed AL patients respectively, which was significantly different (P < 0.05). We also demonstrated LRP15 methylation in 55.56% (5/9) adults with benign hematological diseases.

Conclusions: LRP15 methylation changes are common abnormalities in leukemia. LRP15 is postulated to be a tumor suppressor gene.

Objective: To evaluate the anti-tumor effect and toxicity of gemcitabine combined with platinum chemotherapy on recurrent epithelial ovarian cancer.

Methods: Phase II study of gemcitabine combined with platinum chemotherapy was carried out in 22 patients with recurrent epithelial ovarian cancer. Median age of patients was 50.5 years old. Seven patients were platinum-sensitive and 15 patients were platinum-resistant or -refractory. All patients received gemcitabine combined with carboplatin or oxaliplatin chemotherapy. Patients' response rate (RR) and toxicity of gemcitabine combined with platinum chemotherapy were evaluated.

Results: A total of 98 gemcitabine-based chemotherapy cycles were performed. Total RR was 36.4%, RR of platinum-sensitive patients was 4/7 and platinum-resistant and -refractory patients was 4/15. The estimated median survival time was 10.0 months (95% CI: 7.0-13.0) after initiation of gemcitabine combined with platinum chemotherapy. There was no significant difference in survival time between platinum-resistant/refractory group and platinum-sensitive group (P = 0.061). Side effects of gemcitabine combined with platinum chemotherapy were observed in 81.8% of patients. Grade II/III anemia (54.5%) and grade III/IV neutropenia (54.5%) were most common toxicities. Ten (45.5%) patients had to delay their chemotherapy cycles or reduce the dose of chemotherapeutic drugs because of the severe side effects. Fourteen (63.6%) patients received granulocyte colony-stimulating factor to relieve neutropenia, and 8 (36.4%) patients received component blood transfusion to treat anemia or thrombocytopenia. There was no treat-ment-associated death.

Conclusion: Gemcitabine combined with platinum chemotherapy appears to be an effective and well-tolerant treatment for recurrent epithelial ovarian cancer, including platinum-resistant or -refractory diseases.