Di 1 jun yi da xue xue bao = Academic journal of the first medical college of PLA最新文献

Objective: To categorize the patterns of abnormalities in exercise (201)TI myocardial scintigraphy and explore the mechanisms.

Methods: Exercise (201)TI myocardial scintigraphy was performed in 203 patients with clinically suspected coronary artery disease, including 74 normotensive patients, 78 hypertensive patients without left ventricle hypertrophy (LVH) and 51 hypertensive patients with LVH. All the patients underwent coronary angiography one month before or after (201)TI myocardial scintigraphy, and the patterns of abnormal findings were categorized as segmental, non-segmental and mixed patterns. Patients with abnormal (201)TI myocardial perfusion and normal coronary angiographic findings were followed up.

Results: In hypertensive patients without and with LVH, the ratios of abnormal perfusion in segmental, non-segmental and mixed types were 52/60 and 32/58, 4/60 and 9/58, and 4/60 and 17/58, respectively. The ratios of normal coronary angiography in the 3 types were 17/84, 13/13 and 10/21, respectively. Among the 40 patients followed up, 5 with segmental abnormality and 2 with mixed abnormalities developed large coronary artery disease, which was found in none of the patients with segmental abnormality.

Conclusions: In hypertensive patients with and without LVH, segmental perfusion abnormalities may be attributed to the anatomic and functional stenosis of the large coronary arteries, and the non-segmental abnormal perfusion might be only possible with coronary microvascular diseases.

Objective: To study the clinical features and immune-mediated pathogenesis of mycoplasma pneumonia (MP) in children.

Methods: The DNA of mycoplasma in nasopharyngeal swabs was detected by PCR in 485 children with respiratory tract infection, and serum circulating immune complex (CIC), IgG, IgM, MP IgM, and CH50 were measured on the same day in 45 children with pneumonia.

Results: Significant difference was noted between the results of mycoplasma DNA PCR detection and those of serum IgM detection. The positivity rate of CIC was 44% in children with MP whereas that in the control group was only 10% (P<0.01). The levels of serum IgG and IgM in MP group was significantly higher and serum CH50 lower than those of the control group (P<0.05).

Conclusion: Mycoplasma DNA detection facilitates early diagnosis and treatment of MP, whose pathogenesis in children may be involved in immune-mediated mechanism.

Objective: To discuss the causes for failure in diagnosis and removal of gallstone using choledochoscope.

Method: A retrospective analysis was conducted in 714 cases of gallstone treated with choledochoscopic operations.

Results: Residual stones in the bile duct were found in 132 (18.5%) cases after the operation. In 54 cases the bile duct stones failed to be completely removed even before the closure. By T-tube cholangiography and choledochoscopy after the operation, 78 cases were found to have residual bile duct stones, among them 29 were complicated with intrahepatic bile duct and bile duct opening stenosis, 37 with intrahepatic bile stone and bile duct variation, and 12 with choledochus inferior segment stenosis and stone formation.

Conclusion: Due attention should be paid during the choledochoscopic operation to bile duct variation, bile duct opening stenosis or choledochus inferior segment stenosis, which should be carefully inspected by segments in succession to minimize the possibility of residual stones.

Objective: To investigate the value of multislice spiral CT (MSCT) scanning and three-dimensional reconstruction in selecting optimal length and shape of mandible internal fixation material.

Methods: Three-dimensional reconstruction of the mandible was performed in 5 cases by MSCT scanning and the length of the mandible for operation was measured. Some isometric points were chosen on the mandibular curve and the distance from these points to the two ends of the curve was measured to depict the mandibular curve using a self-designed skeletal curve-depicting software. The optimal length and shape of the material for internal fixation was then determined.

Results: After removal of the soft tissues and other irrelevant bones from the reconstructed three-dimensional mandible with clear view from any directions, the length of the mandible was accurately measured with the software. The physiological curve of the mandible was generated after determination of the distances from the chosen points on the mandibular curve and to the two ends of the curve for precise determination of the length and shape of the material for internal fixation.

Conclusion: Three-dimensional mandible reconstruction with MSCT and measurement facilitates the determination of the optimal length and shape of the internal fixation material to enhance the attachment between the material and the bone surface and consequently the therapeutic effects.

Objective: To study the molecular mechanism underlying cisplatin resistance in ovarian carcinoma by detecting the expressions of DNA transcription- and repair-related genes in cisplatin-resistant human ovarian carcinoma COC1 cell line.

Methods: The differential expression of DNA transcription- and repair-related genes between the parental COC1 and cisplatin-resistant COC1/DDP cell line was determined using cDNA microarray.

Results and conclusion: Compared with COC1 cells, 143 genes in COC1/DDP cells showed significant differential expression, among which 20 were DNA transcription- and repair-related genes including 13 significantly up-regulated genes and 7 down-regulated ones. Abnormality of DNA transcription and repair might be involved in the development of cisplatin resistance in COC1/DDP cells.

Objective: To construct the eukaryotic expression vector for HPC2 for expression in HEK293 cells.

Methods: HPC2 from pcDNA3/HPC2 were inserted into the flag-tagged vector pcDNA3-flag by subcloning method. The recombinant plasmid pcDNA3-flag/HPC2 was then transfected into HEK293 cells using a routine lipofectamine method. The cell lysate was used for Western blotting to examine the expression of the target protein.

Results and conclusion: Double restriction enzyme digestion and DNA sequencing indicated successful construction of the eukaryotic expression vector for HPC2 and the fusion protein was highly expressed in HEK293 cells, which provides an important basis for functional study of HPC2.

Objective: To explore the clinical value of (18)F-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) in three-dimensional conformal radiotherapy (3D-CRT) for locally residual and recurrent nasopharyngeal carcinoma (NPC).

Methods: Between July 1998 and October 2000, 36 patients with recurrent or residual NPC confirmed by biopsy after initial radiotherapy underwent treatment with 3D-CRT. CT simulation was performed and (18)FDG-PET carried out for delineating the gross tumor volume (GTV) in all the patients. The radiotherapy was designed by 3D treatment planning system and dose-volume histogram (DVH) was used to verify and optimize the radiation plan. Acute and late radiation injuries, survival rates and GTV delineated by CT and (18)FDG-PET were observed in all the cases after the treatment.

Results: In comparison with CT simulation, (18)FDG-PET delineated similar GTV in 36.1% (13/36) cases, larger and smaller GTV in 16.7% (6/36) and 47.2% (17/36) of the cases, respectively. After 3D-CRT, 97.2%, 75.0%, and 58.3% of the patients were free of evidence of 1-, 2-, and 3-year local failure, respectively, and the 1-, 2-, and 3-year survival rate of the patients were 94.4%, 86.1%, and 72.0%. The 1-, 2-, 3-year tumor-free survival rates were 85.7%, 76.6%, and 56.1% respectively. Acute xerostomia, nasopharyngitis and oropharyngitis were the most common complications in relation to the radiation, but all within acceptable range of grades 1 or 2. The lesions resulting from the radiation included hearing loss, trismus, dysphagia, chronic sinusitis, and cranial neuropathy, with the incidences of 5.6% (2/36), 25.0% (9/36), 8.3% (3/36), 33.3% (12/36), and 13.9% (5/36) respectively.

Conclusions: 3D-CRT combined with (18)FDG-PET for delineation of GTV is effective and feasible in the treatment of locally residual or recurrent nasopharyngeal carcinoma after initial radiotherapy, producing good responses without serious complications.

Objective: To investigate the relationship between COX-2 expression and the clinicopathological factors in colorectal carcinoma and assess the prognostic value of COX-2 detection.

Methods: Tissue microarray and immunohistochemistry by SABC method was employed for detecting COX-2 expression in 126 patients with advanced colorectal cancer, and the relationship of COX-2 expression with the clinicopathological features and prognosis of the patients was retrospectively analyzed.

Results: The patients were divided into two groups of low and high COX-2 groups according to the grade and extent of COX-2 expression. High COX-2 expression was detected in 32 (25.4%) cases, and low expression in 94 (74.6%) cases. No significant correlation was noted between COX-2 expression and the patients' age, sex, tumor size, tumor location, histological type, lymphatic-node metastasis and Dukes' classification, but high COX-2 expression was strongly correlated with tumor recurrence and especially with blood-borne metastasis (P<0.05). The survival rate without tumor recurrence for high- and low-COX-2 groups was assessed by the Kaplan-Meier method and compared by log-rank test, which revealed significant difference between the two groups (P=0.0067). Multivariate analysis for all patients suggested that among the 8 prognostic factors (age, sex, tumor size, tumor location, histological type, lymphatic-node metastasis, Dukes' stage, and COX-2 expression), Dukes' stage and COX-2 expression was the independent significant factor related to disease-free survival.

Conclusion: The expression of COX-2 is strongly correlated with recurrence of colorectal cancer, especially with blood-borne metastasis. COX-2 is an independent factor for prognostic evaluation of the patients, and tissue microarray allows rapid, convenient, economic and accurate COX-2 detection for large-scale application.

Objective: To investigate the application of flexible bronchoscopy in the postoperative management of lung transplantation.

Methods: Four male patients with end-stage chronic obstructive pulmonary disease received examination with bronchoscope following the unilateral lung transplant for management of airway complications. One patient developed stenosis at tracheal anastomosis 2 months after transplantation and underwent balloon dilatation and endobronchial metallic stent placement.

Results: The 4 patients showed good recovery after transplantation with obviously improved pulmonary function and quality of life.

Conclusion: Flexible bronchoscopy provides a valuable means for postoperative management of lung transplantation.

Objective: To identify the clinical features and pathogenesis of hypoglycemia with brain dysfunctions as the main manifestations.

Method: A retrospective analysis of 73 cases with brain dysfunctions caused by hypoglycemia was performed.

Result: Hypoglycemic brain dysfunctions were mainly caused by poor control of the dosage of hypoglycemic agents in diabetic patients, and the major clinical manifestations included coma, hemiparalysis, epilepsy and mental disorders. The pathogenesis was complicated, possibly related to a variety of factors such as rapid declination of blood sugar level, aging, cerebral arteriosclerosis, and hypoglycemic cerebral vasospasm or selective nerve injury.

Conclusions: A blood sugar test should be performed for any patients with brain dysfunctions of unidentified causes for early diagnosis and treatment. In addition, diabetic patients should take hypoglycemic agent adequately. Regular monitoring of blood sugar level is key to the prevention of hypoglycemia.