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    Medical career
    My life perception of past 90 years
    ZHANG Di-sheng
    2009, 29 (10):  1139. 
    Abstract ( 1131 )   PDF (4611KB) ( 1349 )  
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    Original article (Basic research)
    Mechanisms of phagocytosis of Leptospira by peritoneal macrophages of guinea pigs
    LOU Xiao-li, ZHANG Yan, HE Ping, et al
    2009, 29 (10):  1143. 
    Abstract ( 1941 )   PDF (6190KB) ( 1561 )  

    Objective To investigate the mechanisms of phagocytosis of virulent Leptospira by peritoneal macrophages of guinea pigs, and evaluate the role of innate immune in the pathogenesis of leptospirosis. Methods Peritoneal macrophages of guinea pigs were extracted. Three specific inhibitors (microfilament inhibitor cytochalasin D, microtube inhibitor colchicine and PI3K signalling pathway inhibitor LY294002) were added respectively to the macrophages 1 h before the infection of virulent Leptospira interrogans serovar Lai type strain Lai in vitro. Meanwhile, control group without inhibitor was established. Phagocytosis was observed by laser scanning confocal microscopy and phagocytic rates were evaluated by flow cytometry 3 h after infection. Results The phagocytic rates of control group, cytochalasin D group, colchicine group and LY294002 group were (38.98±0.91)%, (23.99±1.40)%, (40.81±0.91)%, and (39.64±3.56)%, respectively. The phagocytic rate of cytochalasin D group was significantly lower than that of control group (P<0.05), while those of colchicine group and LY294002 group were not significantly different from that of control group (P>0.05). Conclusion Microfilaments play an important role in the phagocytosis of strain Lai by peritoneal macrophages, but the process is independent on PI3K signalling pathway, and microtubes play little part during the phagocytosis.

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    Mechanism of Treg down-regulation by immunization with attenuated activated autologous T cells
    ZHANG Qiu-yu, WU Juan-juan, LIN Jin-biao, et al
    2009, 29 (10):  1148. 
    Abstract ( 1764 )   PDF (5836KB) ( 1407 )  

    Objective To explore the mechanism of down-regulation of regulatory T cells(Treg) by immunization with attenuated activated autologous T cells. Methods Autologous T cells were activated with ConA in vitro. Mice were immunized subcutaneously and intraperitoneally every 5 days for 3 times (5×106 per time for each mouse), and the number and function of Treg were examined. PBS was subcutaneously injected for control group. Serum level of anti-mouse CD25 antibody was measured by ELISA. The number and function of Treg was detected by serum adoptive transfer and proliferation and inhibition assays. Results Compared with control group, there were less CD4+CD25+Foxp3+ Treg in the mice after immunization (P<0.01), the immunosuppression ability decreased (P<0.01), and the level of anti-CD25 antibody increased (P<0.01). Adoptive transfer of serum from immunized mice to naive mice led to a significant decrease in Treg population and function in recipient mice (P<0.01). Conclusion Immunization with attenuated activated autologous T cells induces more anti-CD25 antibody, which may further down-regulate CD4+CD25+Foxp3+ Treg expansion and function in vivo.

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    Construction, purification and substrate specificity identification of recombinant human platelet-activating factor acetylhydrolase isoformⅠ
    CHEN Xiao-ying, XU Jing, YANG Jun-wei, et al
    2009, 29 (10):  1152. 
    Abstract ( 1799 )   PDF (5910KB) ( 1601 )  

    Objective To construct and purify the recombinant protein of platelet-activating factor acetylhydrolase (PAF-AH) isoformⅠ, and study the enzyme activity by different substrates. Methods The β subunit of PAF-AH isoformⅠwas cloned and expressed in E. coli. Exogenously expressed recombinant protein was purified to SDS-PAGE homogeneity, and its activity was identified by arylesterase detection. Phenylacetate, l-O-hexadecyl-2-deoxy-2-thioacetyl-sn-glycero-3-phosphocholine (2-Thio PAF) and 1-myristoyl-2-(4-nitrophenylsuccinyl) phosphatidylcholine (the latter two were commercial plasma PAF-AH substrates) were used for the substrate identification. The plasma type PAF-AH was served as positive control. Results Recombinant protein of β subunit of PAF-AH isoformⅠwas successfully constructed and expressed in E. coli after purification. Compared with positive control, the recombinant protein could hydrolyze phenylacetate and 2-Thio PAF, but could not hydrolyze 1-myristoyl-2-(4-nitrophenylsuccinyl) phosphatidylcholine. Conclusion Recombinant protein of β subunit of PAF-AH isoformⅠcan be successfully constructed. There are differences in the substrate specification to the two commercial PAF substrates for PAF-AH isoformⅠand plasma type PAF-AH, which provides a quick method to differentiate PAF-AH isoformⅠfrom plasma type PAF-AH.

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    Effects of different dosages of BMSC on lung fibrosis in mice
    XU Jia-bo, LI Yan-qin, LI Li, et al
    2009, 29 (10):  1157. 
    Abstract ( 1942 )   PDF (10170KB) ( 1224 )  

    Objective To investigate the effects of different dosages of bone marrow mesenchymal stromal cells (BMSC) on lung fibrosis. Methods BMSCs with red fluorescence protein (RFP) from male FVB mice were cultured in vitro. Twenty-four female wild type FVB mice were randomly divided into four groups: normal group, model group, BMSC 1 group and BMSC 2 group (n=6). Mouse pulmonary fibrosis models were induced by bleomycin via single intratracheal perfusion. Twenty-four h after model establishment, mice in BMSC 1 group and BMSC 2 group were injected with 1×106 BMSCs and 2×106 BMSCs, respectively through vena caudalis for each mouse. All the animals were sacrificed 21 d after model estalishment, and mouse lung tissue samples were obtained. The pathological changes were observed by light microscopy, the hydroxyproline (Hyp) contents were measured by alkaline hydrolysis assay, the distribution of RFP(+) BMSCs and quantitation of RFP were analysed by laser scanning confocal microscopy and immunohistochemistry, the expression of surfactant protein A (SP-A) was detected by immunohistochemistry, and the expression of transforming growth factor-β (TGF-β) and platelet-derived growth factor (PDGF) mRNA was detected by Real-time PCR. Results Compared with model group, the pulmonary fibrosis in BMSC 1 group was significantly alleviated, and that of BMSC 2 group became much more severe. A large number of RFP(+) BMSCs were found in fibrosis area of BMSC 2 group, which exhibited morphology similar to fibroblasts. As far as the expression of SP-A was concerned, normal group was higher than BMSC 1 group, BMSC 1 group was higher than BMSC 2 group and model group (P<0.05), while there was no significant difference between BMSC 2 group and model group (P>0.05). Normal group, BMSC 1 group, model group and BMSC 2 group fell in the increase order by Hyp contents (P<0.01, P<0.05), and BMSC 2 group, BMSC 1 group, model group and normal group fell in the decrease order by expression of TGF-β and PDGF mRNA (P <0.05). Conclusion Proper dose of BMSC has a favourable effect on bleomycin-induced lung fibrosis, while excessive dose of BMSC can aggravate the fibrosis.

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    Study on inhibiting expression of IGF1R in hepatocellular carcinoma cells by constructing shRNA eukaryotic expression vectors
    ZHU Chen-fang, ZHONG Qiang, GU Yan
    2009, 29 (10):  1163. 
    Abstract ( 1972 )   PDF (7488KB) ( 1079 )  

    Objective To construct short-hairpin RNA (shRNA) eukaryotic express vectors targeting of insulin like growth factor-1 receptor (IGF1R) gene, and to explore the changes of adhesion, invasion and FAK protein expression of MHCC-97H hepatocellular carcinoma cells with RNA interference. Methods The shRNA oligonucleotide fragments were designed and synthesized based on the sequence of IGF1R mRNA. Double strands were formed after annealing and inserted into pGCsi-U6-Neo-GFP vector. The recombinant was transformed into Stable 3, then plasmids were extracted and identified by restriction enzyme and sequencing analysis. The most effective vectors were selected by RT-PCR and Western blotting after transfecting 293T cells. The best one was used to transform MHCC-97H cells which were selected with G418 to obtain positive colons. The changes of adhesion, invasion and FAK protein expression in MHCC-97H cells were studied. Results The restriction enzyme analysis and sequencing analysis demonstrated that shRNA had been inserted into vectors, and their sequences were the same as the design. It was indicated by RT-PCR and Western blotting that the silencing efficacy of IGF1R was 88%. The ability of adhesion and invasion significantly decreased after IGF1R silencing in MHCC-97H cells, and so was the expression of FAK protein. Conclusion IGF1R pGCsi-U6-Neo-GFP shRNA can significantly decrease the abilities of adhesion and invasion in MHCC-97H cells, and inhibit the expression of FAK protein.

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    Expression of TLR2 mRNA and TLR4 mRNA in renal tissues of rats with endotoxin-induced shock
    ZHANG Li-mei, ZHANG Yu-cai, HUANG Qi-wei, et al
    2009, 29 (10):  1169. 
    Abstract ( 1839 )   PDF (6920KB) ( 1466 )  

    Objective To investigate the expression of Toll like receptor 2 (TLR2) mRNA and TLR4 mRNA in renal tissues of rats with endotoxin-induced shock, and explore the possible effects and mechanism of vasoactive intestinal peptide (VIP) and methylprednisolone (MP) on renal injury. Methods Endotoxin (E coli O55:B5 LPS, 10 mg/kg) was injected intravenously to the rats to establish the endotoxin-induced shock models (LPS group, n=16). The rats in LPS+VIP group (n=16) was injected with VIP (5 nmol/kg) after model establishment, and those in LPS+VIP+MP group (n=16) was injected with VIP (5 nmol/kg) and MP (3 mg/kg) after model establishment. Besides, normal saline control group (control group) was established(n=8). Electron microscope was used to observe the histopathological changes in renal tissues 6 h and 24 h after model establishment, and RT-PCR was performed to evaluate the expression of TLR2 mRNA and TLR4 mRNA in renal tissues. Results Six h after model establishment, glomerular endothelial cell swelling and vacuolar degeneration of mitochondria were observed in LPS group under electronic microscope. Twenty-four h after model establishment, mitochondrial swelling, vacuolar degeneration and slight nucleus pyknosis of renal tubular cells were observed in LPS group. The renal pathological changes in LPS+VIP group and LPS+VIP+MP group were much less severe than those in LPS group at the same time. The expression of TLR2 mRNA and TLR4 mRNA in LPS, LPS+VIP and LPS+VIP+MP groups was significantly higher than that in control group 6 h after LPS injection (P<0.01), while the expression of TLR2 mRNA and TLR4 mRNA in LPS group was higher than that in the other groups 24 h after LPS injection (P<0.01). Conclusion The expression of TLR2 mRNA and TLR4 mRNA in renal tissues of rats with endotoxin-induced shock is markedly up-regulated. VIP and MP can obviously alleviate renal pathological changes, and the mechanism may contribute to impacting on the expression of TLR2 mRNA and TLR4 mRNA.

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    Effects of photochemotherapy on angiogenic ability of endothelial cells and expression of integrin
    DENG Hui, YUAN Ding-fen, YAN Chun-lin, et al
    2009, 29 (10):  1174. 
    Abstract ( 1998 )   PDF (6768KB) ( 1389 )  

    Objective To investigate the effects of photochemotherapy on the angiogenic ability of endothelial cells and expression of integrin. Methods In vitro angiogenesis assay (UVA exposure dose: 0, 2.0, 5.0 J/cm2) was used to detect the effects of photochemotherapy on the angiogenic ability of endothelial cells. Reverse polymerase chain reaction and flow cytometry were employed to determine the effects of photochemotherapy on the expression of integrin mRNA and protein, respectively. bFGF stimulation group and PMA stimulation group were divided according to the inductors, and subgroups were divided according to the UVA exposure doses of 0, 2.0 and 5.0 J/cm2 in each group. Results Combination of UVA (2.0 and 5.0 J/cm2) and 8-MOP (100 ng/mL) resulted in a decrease in the angiogenic ability of endothelial cells in vitro and the expression of integrin mRNA and protein. Conclusion Photochemotherapy may inhibit the angiogenic ability of endothelial cells through downregulating the expression of integrin.

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    Application of SELDI-TOF-Ms technology in research of molecular markers of lung cancer
    SHA Hui-fang, YE Jian-ding, SUN Qiang-ling, et al
    2009, 29 (10):  1178. 
    Abstract ( 1900 )   PDF (6090KB) ( 1455 )  

    Objective To explore the changes of proteomic spectra from plasma of patients with lung cancer or benign lung diseases and health controls in order to establish a primary diagnosis model of lung cancer. Methods The proteomic spectra from plasma of 108 patients with lung cancer, 40 patients with benign lung diseases and 22 healthy individuals were analysed by surface-enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-Ms). The best decision tree model was established by cluster analysis and principal component analysis. Then the model was blindly validated by the protein of 21 patients with lung benign diseases and 47 patients with stage I lung cancer. Results Twenty-three significantly differentially expressed protein peaks were successfully detected (P<0.001). Blinded validation suggested that the accuracy for diagnosing lung cancer was 72.06%, the sensitivity and specificity were 72.34% and 71.43%, respectively, and the positive predictive value and negative predictive value were 85.0% and 78.95%, espectively. Conclusion SELDI-TOF-Ms protein chip technology provides a new tool for the early diagnosis of lung cancer.

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    Oxidative mechanism of homocysteine-induced apoptosis in endothelial progenitor cells
    BAO Xiao-mei, WU Chun-fang, LU Guo-ping
    2009, 29 (10):  1182. 
    Abstract ( 2265 )   PDF (5850KB) ( 1480 )  

    Objective To investigate the oxidative mechanism of homocysteine (Hcy)-induced apoptosis in endothelial progenitor cells (EPCs). Methods Total mononuclear cells were isolated from mouse bone marrow by Ficoll density gradient centrifugation and were cultured in vitro for 7 d. Adherent cells were harvested and identified by fluorescence microscopy. EPCs were cultured with Hcy (0, 50, 100 and 500 μmol/L) for 12, 24 and 48 h, or pretreated with NAC(1 mmol/L), DPI(10 μmol/L) or SB203580 (10 μmol/L) for 30 min, then cultured with 500 μmol/L Hcy for 24 h. Apoptosis was detected by Annexin-V/PI flow cytometry, levels of reactive oxygen species (ROS) in cells were measured using H2DCF-DA as a fluorescence probe, NADPH oxidases were evaluated with lucigenin-enhanced chemiluminescence, and NO in the supernatant was determined by nitrate reductase assay. Results Hcy induced EPCs apoptosis, ROS accumulation, NADPH oxidase activation and decrease of NO in a time-dose dependent manner(P<0.05 or P<0.01). Pretreatment with NAC, DPI and SB203580 could inhibit these effects (P<0.05 or P<0.01). Conclusion Hcy could activate NADPH oxidase, induce ROS increase and NO decrease, and activate p38MAPK to enhance EPCs apoptosis.

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    Arsenic trioxide induced JAK/STAT3 pathway inhibition in myeloma cell lines
    WANG Ming-ming, ZOU Li-fang, DOU Hong-ju, et al
    2009, 29 (10):  1187. 
    Abstract ( 1661 )   PDF (5130KB) ( 1346 )  

    Objective To explore the possible relationship between alteration of cell cycle and JAK/STAT3 signal transduction pathway inhibition induced by arsenic trioxide (As2O3) in myeloma cell lines U266 and RPMI8226 in vitro. Methods Multiple myeloma cell lines U266 and RPMI8226 were used as in vitro models. The influence of As2O3 on myeloma cells were evaluated by MTT assay and flow cytometry. Meanwhile, methylation specific PCR and Western blotting were employed to detect the methylation status of gene SOCS-1 and protein expression level of P-STAT3 in these cells after As2O3 treatment. Results As2O3 significantly inhibited the growth of U266 and RPMI8226 cells in a dose-dependent manner. Furthermore, cell cycle was arrested at G0/G1 phase with inhibition of protein expression level of P-STAT3 and SOCS-1 gene demethylation after exposure to As2O3 for 72 h(r=0.85, P<0.05). Conclusion As2O3 could induce the alteration of cell cycle which might be related to JAK/STAT3 signal transduction pathway inhibition and SOCS-1 demethylation in myeloma cell lines. The study puts forward a new idea of As2O3 treatment in multiple myeloma.

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    Effects of PI3-K/AKT signal transduction pathway in rat neural stem cells
    ZHAO Yu, XIE Peng, ZHU Xiao-feng
    2009, 29 (10):  1191. 
    Abstract ( 1648 )   PDF (7193KB) ( 1180 )  

    Objective To incubate rat neural stem cells (NSCs) with selection-specific inhibitor (LY294002) of PI3-K, and explore the effects of PI3-K/AKT signal transduction pathway in NSCs. Methods NSCs derived from E15-16 rats were isolated and cultured. After incubation of NSCs with different concentrations of LY294002 (0 to 40 μmol/L), cell survival (WTS-8 assay), proliferation (BrdU immunohistochemical identification), differentiation (β Tubulin-Ⅲ immunohistochemical identification) and AKP phosphorylated protein (Western blotting) were detected. Results The effects of LY294002 on the survival, proliferation and differentiation of NSCs was concentration-dependent. The survival of the NSCs decreased significantly with a higher concentrations of LY294002 (25, 30, 35, 40 μmol/L)(P<0.05). The numbers of BrdU positive cells with LY294002 of 30, 35 and 40 μmol/L were significantly smaller than that of the control (LY294002 0 μmol/L)(P<0.05). The numbers of β Tubulin-Ⅲ positive cells with LY294002 of 35 and 40 μmol/L were significantly smaller than that of the control (P<0.05). The expression of AKT was blocked by LY294002 in a concentration-dependent manner. Conclusion PI3-K/AKT signal transduction pathway plays a vital role in the survival, proliferation and differentiation of NSCs.

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    Neuroprotection of Copolymer 1 in glaucoma rats with elevated intraocular pressure
    SUN Jing-fen, WANG Ling
    2009, 29 (10):  1196. 
    Abstract ( 1600 )   PDF (5803KB) ( 1373 )  

    Objective To observe the neuroprotective effect of Copolymer 1(Cop 1) in rats with elevated intraocular pressure (IOP), and explore the clinical application of Cop 1 in the prevention of optic nerve atrophy induced by glaucoma. Methods Thirty adult Wistar rats were rendered for elevation of IOP in both eyes by Shareef-Sharma method. At the third week of IOP elevation, a mixture (1∶1) of Cop 1 (100 μg) emulsified in complete Freund's adjuvant (CFA) was injected intracutaneously at two hind footpads in 15 rats (Cop 1 model group), and the other 15 rats were given the same dose of PBS emulsified in CFA (model control group). Retinal ganglial cell (RGC) retrograde labeling was performed with Fluorogold 6 d later, and retina was taken after 24 h to compared the density of RGC between two groups. Another normal rats were served as blank controls. Results It was found that lymphocytes were accumulated on the histological slices of retina and optic nerve in Cop 1 model group. The rates of RGC loss of Cop 1 model group and model control group were 10.24%±3.75% and 29.00%±6.92%, respectively. The RGC density in Cop 1 model group was significantly lower than that in model control group (P<0.05), while there was no significant difference in that between Cop 1 model group and blank control group (P>0.05). Conclusion Intracutaneous injection of Cop 1 can reduce the damage of RGC induced by elevated IOP.

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    Studies on strengthening and restoring effects and hepatoprotective effect of Eclipta
    XU Ru-ming, DENG Ke-min, LU Yang
    2009, 29 (10):  1200. 
    Abstract ( 2481 )   PDF (5785KB) ( 1524 )  

    Objective To evaluate the strengthening and restoring effects and hepatoprotective effect of Eclipta extracts. Methods Sixty Kunming mice were randomly divided into control group, low-dose Eclipta group, high-dose Eclipta group, cyclophosphamide(CY) group, low-dose Eclipta CY group and high-dose Eclipta CY group (n=10). Eclipta 8 g·kg-1·d-1 or 4 g·kg-1·d-1 were administered by oral gavage for 7 d. Immunosuppression mouse models were established by intraperitoneal injection of 0.05 g/kg CY on the fourth day of administration. The effects of Eclipta extracts on thymus index, spleen index and carbon clearance index in both normal mice and immunosuppression mice induced by CY were tested, and those on proliferation of lymphocyte and T cells induced by ConA were examined. Based on these data, strengthening and restoring effects of Eclipta were observed. Besides, 70 Kunming mice were randomly divided into control group, low-dose Eclipta group, high-dose Eclipta group, CCl4 group, DDB group, low-dose Eclipta CCl4 group and high-dose Eclipta CCl4 group. 20 g·kg-1·d-1 and 10 g·kg-1·d-1 Eclipta were administered by oral gavage for 7 d. Hepatic injury mouse models were established by intraperitoneal injection of 10 mL/kg CCl4 2 h after the last administration. The effects of Eclipta extracts on serum ALT, MDA, TP and T-Bil levels in both normal mice and hepatic injury mice induced by CCl4 was tested, and those on the viability of the primary culture hepatocytes were determined. Based on these data, hepatoprotective effect of Eclipta was observed. Results Eclipta extracts increased thymus index and carbon clearance index in both normal mice and immunosuppression mice induced by CY, promoted proliferation of lymphocyte and proliferation of T cells induced by ConA, reduced serum ALT and MDA levels in hepatic injury mice, and improved the viability of the primary culture hepatocytes. Conclusion Eclipta herb has strengthening and restoring effects and hepatoprotective effect.

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    Original article (Clinical research)
    Four-year follow-up study of changes in prescriptions of antidepressants for inpatients with psychosis
    CHEN Jun, WANG Zu-cheng, WANG Min, et al
    2009, 29 (10):  1205. 
    Abstract ( 1997 )   PDF (4988KB) ( 1540 )  

    Objective To investigate the changes in the prescriptions of antidepressants for inpatients with psychosis from 2005 to 2008. Methods The prescriptions of antidepressants for all the inpatients with psychosis in Shanghai Mental Health Center were investigated by one day survey on each June 1st from 2005 to 2008. The most common diseases treated with antidepressants, the most commonly used antidepressants, the average dosage of antidepressants and the combination use of antidepressants were analysed. Results The most common diseases treated with antidepressants were affective disorder, schizophrenia and neurosis. The prescription rate of tricyclic antidepressants declined year by year, and that of selective serotonin reuptake inhibitors (SSRIs) fluctuated moderately, while that of antidepressants of newer generation with the other transmitter mechanisms such as venlafaxine, mitrazapine and trazodone increased gradually. Single antidepressant prescription was common, while the combination use of antidepressants accounted for a small portion. Combination use of antidepressants with one psychotropics (antipsychotics, mood stabilizer, sedative hypnotics) was common, while with two were less frequently occurred. Conclusion Prescriptions of antidepressants for patients with psychosis hospitalized in Shanghai Mental Health Center from 2005 to 2008 are relatively safe and reasonable. Antidepressants of newer generation have been widely used in clinics, and SSRIs have been serving as the major antidepressants.

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    Relationship between serum uric acid and urinary albumin excretion and carotid intima-media thickness in patients with type 2 diabetes mellitus
    WU Jing-cheng, LI Xiao-hua, CHENG Qun, et al
    2009, 29 (10):  1210. 
    Abstract ( 1892 )   PDF (4063KB) ( 1442 )  

    Objective To investigate the relationship between serum uric acid (SUA) concentration and urinary albumin excretion rate (UAER) and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM). Methods The clinical data of 372 patients with T2DM, including 184 males and 188 females, were collected. The correlations between SUA and the other clinical indexes were analysed by Pearson method, and multiple regression analysis was employed to examine the effects of various factors on UAER and CIMT. Results SUA concentration was higher in males than in females with T2DM (P<0.01), and was positively correlated with UAER both in males and females with T2DM, even after adjustment for the creatinine clearance (r=0.24, P<0.01 for males; r=0.29, P<0.01 for females). Positive correlation was found between SUA concentration and CIMT in females (r=0.29, P<0.01). Multiple regression analysis demonstrated that SUA concentration was an independent determinant of UAER for males as well as females (β=0.16, P<0.05 for males; β=0.20,P<0.05 for females), and was also an independent determinant of CIMT for females (β=0.16, P<0.05). Conclusion SUA plays an important role in the progression of diabetic nephropathy and cardiovascular diseases in patients with T2DM. SUA control may provide a novel approach for the treatment of diabetic nephropathy and vascular complications.

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    Comparison of RIFLE and AKIN diagnosis criteria for acute kidney injury in patients undergoing cardiac surgery
    CHE Miao-lin, LI yi, LIANG Xin-yue, et al
    2009, 29 (10):  1214. 
    Abstract ( 2421 )   PDF (4656KB) ( 1417 )  

    Objective To compare the RIFLE and AKIN diagnosis criteria for acute kidney injury (AKI) in patients undergoing cardiac surgery. Methods Patients undergoing cardiac surgery from January 2004 to June 2007 were retrospectively evaluated. RIFLE and AKIN criteria were employed for the diagnosis and staging of AKI which occurred 7 d after cardiac surgery. The diagnosis sensitivity and precision for prediction of hospital mortality were compared between these two criteria. Results One thousand and fifty-six patients were included in this study. There was no significant difference between the prevalence of AKI after cardiac surgery diagnosed by RIFLE criteria and that diagnosed by AKIN criteria (29.55% vs 31.06%, P>0.05). There was no significant difference between the total hospital mortality and the hospital mortality of each stage of AKI diagnosed by RIFLE criteria and those diagnosed by AKIN criteria (P>0.05). Logistic regression analysis suggested that the relative risk of hospital mortality for AKI was similar between patients diagnosed by AKIN criteria and those diagnosed by RIFLE criteria. The area under the ROC curve for hospital mortality was 0.856 for RIFLE and 0.865 for AKIN in all patients (P<0.001). Conclusion Compared to RIFLE criteria, AKIN criteria do not improve the sensitivity of diagnosis and predictive ability of hospital mortality of AKI after cardiac surgery.

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    Design of questionnaire on factors for diagnosis of irritable bowel syndrom for physicians
    QIAO Yu-qi, CHEN Guang-yu, ZHOU Hui-qing, et al
    2009, 29 (10):  1218. 
    Abstract ( 1841 )   PDF (4444KB) ( 1333 )  

    Objective To design a questionnaire on factors that affect diagnosis of irritable bowel syndrome for physicians, and determine the retest reliability. Methods The questionnaire was completed after literature review, and 9 experts were invited to revise the questionnaire. Thirty-four physicians filled the questionnaire for pre-test and did it again for re-test 4 weeks later. Kappa value of each question of the questionnaire was calculated. Results Content validity and face validity were assured by experts. Kappa values were over 0.61 in all items, which achieved substantial level. Conclusion The questionnaire designed has fairly good reliability and validity, and can be used in investigation of irritable bowel syndrome for physicians.

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    Clinical analysis of treatment of myocardial bridge by coronary artery bypass grafting
    YE Yi-zhou, SHEN Feng, YUAN Zhong-xiang
    2009, 29 (10):  1222. 
    Abstract ( 2289 )   PDF (4605KB) ( 1359 )  

    Objective To analyse the clinical features and outcomes of myocardial bridge treated by coronary artery bypass grafting (CABG). Methods The hospitalization and follow-up data of patients with myocardial bridge treated between March 1999 and March 2009 were collected. The symptoms, examinations, diagnosis, treatment and follow-up findings were retrospectively analysed, the clinical features and outcomes were analysed, and discussion was performed after literature review. Results Twenty-six patients with myocardial bridge were hospitalized, all of whom were confirmed by coronary angiography. All patients experienced symptoms of myocardial ischemia such as angina, which could not be relieved by medication. Electrocardiography was characterized by depressed ST, flat or inversed T wave. All patients received CABG(off-pump operation in 15 patients and on-pump operation in 11 patients). No surgery-related death or complications occurred. Patients were followed up for (3.5±2.0) years, and symptom of myocardial ischemia was relieved in all. Angina took place in 5 patients, and was eased by medication. Electrocardiographic reexaminations revealed that ST was normal in 22 patients, and flat ST was improved in the other 4 patients after operation. Conclusion Myocardial bridge is one of the congenital coronary artery malformations, and was mainly diagnosed through coronary arteriography examination. CABG is one of the best choices for the treatment of myocardial bridge with severe myocardial ischemia. Angina after operation in some patients may be related to the vascular spasm, as well as the blood flow competition between own vessels and grafts.

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    Value of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide in diagnosis of heart failure in the elderly
    CAI Qin, JIN Yu-hua, FANG Ning-yuan
    2009, 29 (10):  1226. 
    Abstract ( 4656 )   PDF (4225KB) ( 1525 )  

    Objective To investigate the relationship between brain natriuretic peptide(BNP)/N-terminal pro-brain natriuretic peptide (NT-proBNP) and New York Heart Association (NYHA) classification, left ventricular structure and function, and explore the value of BNP/NT-proBNP in the diagnosis of heart failure in the elderly. Methods Fifty-five elder patients with heart failure were selected (NYHA Ⅱ, n=15; NYHA Ⅲ, n=25; NYHA IV, n=15) (heart failure group), and another 16 elder people with NYHA I were served as control group.The plasma mass concentrations of NT-proBNP and BNP were detected by electrochemiluminescence immunoassay and immunofluorescence method, respectively, and the structure and function of left ventricle were examined by echocardiography. Results The levels of plasma BNP and NT-proBNP increased with NYHA grades, were negatively correlated with LVEF (P<0.001), and were positively correlated with LVST, LVEDD, LAD and LVMI(P<0.05). The area under the curve of BNP in diagnosis of heat failure was 0.879 (P<0.001), and that of NT-proBNP was 0.914(P<0.001). Conclusion Both plasma BNP and NT-proBNP can be used to evaluate the heart function of patients with heart failure, and are useful tools for diagnosis of HF in the elderly.

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    Risk factors for pneumonia in patients with acute stroke
    FENG Zhi-ying, LI Ying, LI Yan-sheng
    2009, 29 (10):  1230. 
    Abstract ( 1862 )   PDF (3953KB) ( 1247 )  

    Objective To assess the risk factors for pneumonia in patients with acute stroke. Methods Three hundred and forty patients with acute stroke were studied, and risk factors for pneumonia such as demographics, history of hypertension, diabetes and smoking, initial blood pressure, body temperature, fasting plasma glucose level, C-reactive protein, National Institutes of Health Stroke Scale (NIHSS) scores, degree of dysphagia and mechanical ventilation were evaluated. Besides, the correlation between incidence of pneumonia and pneumonia scores in patients with acute stroke was studied. Results Pneumonia was developed in 63 patients (18.5%). Logistic regression analysis revealed that age, gender, initial NIHSS scores, dysphagia and mechanical ventilation were independent predictors for pneumonia (P<0.05). The incidence of pneumonia gradually increased with the pneumonia scores. Conclusion The occurrence of pneumonia after acute stroke is associated with older age, male gender, high NIHSS scores, dysphagia and mechanical ventilation. The pneumonia scores can be adopted to identify the risks of pneumonia after acute stroke.

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    Effects of atorvastatin on levels of serum lipid and metalloproteinases
    YANG Hui, LIANG Wei, HU Wei, et al
    2009, 29 (10):  1233. 
    Abstract ( 1603 )   PDF (4128KB) ( 1292 )  

    Objective To compare the effects of higher dosage of atorvastatin alone and combination of lower dosage of atorvastatin with ezetimibe on levels of lipid and metalloproteinases in patients with coronary artery disease. Methods Forty-two patients with coronary artery stenosis (50% to 70% stenosis) without stent replacement were selected, and were randomly divided into atorvastatin group (treated with 20 mg or 40 mg atorvastatin alone, n=19) and combined-therapy group (treated with 5 mg,10 mg atorvastatin and 10 mg ezetimibe, n=23). The levels of serum lipid, hepatic and renal functions, creatine kinase, metalloproteinase (MMP)-2, MMP-9 and tissue inhibitor of MMP-1 (TIMP-1) were detected 12 weeks after treatment. Results Twelve weeks after treatment, the level of LDL-C in atorvastain group was (1.94±0.49) mmol/L (37.82% decrease from baseline), and that in combined-therapy group was (1.92±0.54) mmol/L (38.26% decrease from baseline), and there was no significant difference between these two groups (P>0.05). Twelve weeks after treatment, the levels of MMP-2 and MMP-9 were significantly decreased and that of TIMP-1 was significantly increased compared with baseline levels in atorvastatin, while no such changes were detected in combined-therapy group. Conclusion In patients with coronary artery stenosis, combined therapy with lower dosage of atorvastatin and ezetimibe may lead to the same lipid-lowing effects compared with therapy with higher dosage of atorvastatin, but it may not result in a significant reduction in serum levels of MMP-2, MMP-9 and increase of TIMP-1.

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    Original article (Preventive medicine)
    Behavior, attitude and influencing factors of smoking among residents aged 15 to 69 years in Hongkou District of Shanghai
    QIAN Meng-hua, LIU Xiao-qin, WANG Li-yi, et al
    2009, 29 (10):  1237. 
    Abstract ( 1625 )   PDF (5531KB) ( 1364 )  

    Objective To investigate the prevalence and attitude of smoking and its influencing factors among residents in Hongkou District of Shanghai, so as to provide evidence for tobacco control. Methods Nine hundred and sixty residents in Hongkou District of Shanghai aged 15 to 69 years were selected by multi-level random sampling, among whom 958 completed the investigations on smoking status. Results The smoking rate and standardized smoking rate were 20.04% and 18.73%, respectively. The smoking rate and standardized smoking rate of males were 41.05% and 30.07%, and those of females were 0.80% and 1.70%, respectively. The smoking rate of males was higher than that of females (RR=0.02, 95%CI: 0.01-0.03). The smoking rates of age groups of 25 years old and over were higher than those of 15 to 24 years old, and the smoking rate of subjects with or above junior college education was lower than that of subjects with or below middle school education (RR=0.45, 95%CI: 0.25-0.79). Subjects who drank alcohol smoked more than those did not (RR=2.68, 95%CI: 1.76-4.09). Lower annual per capita income and higher knowledge on smoking hazard led to more tendance to object to smoking and agree with anti-smoking. Conclusion The prevalence of smoking of residents aged 15 to 69 years in Hongkou District of Shanghai was relatively lower. Age, gender, education status and alcohol drinking were influencing factors of smoking. Education on tobacco control among subjects aged more than 35 years should be strengthened, and more attention should be paid to those with lower education. Besides, education on alcohol control should be managed together with tobacco control.

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    Original article (Public health administration)
    Competitiveness evaluation of hospitals based on factor analysis
    LIU Jun, HE Meng-qiao, LIU Xia, et al
    2009, 29 (10):  1242. 
    Abstract ( 1644 )   PDF (4175KB) ( 1410 )  

    Objective To comprehensively evaluate the competitiveness of hospitals so as to provide objective referrences for the long-term development. Methods Competitiveness evaluation index system and evaluation model were established. Using related data of 2007, 16 hospitals nationwide were evaluated and factor scores and comprehensive scores were obtained by means of factor analysis. Results Four factors were extracted, which were "technical efficiency factor", "economic income factor", "sustainable development factor" and "resource allocation factor". All hospitals were ranked by each factor score and comprehensive score. Conclusion Each hospital has its advantages and disadvantages, therefore, hospital managers should constitute individual development strategy accordingly.

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    Review
    Application of metabolomics in malignant tumors
    FAN Xing
    2009, 29 (10):  1246. 
    Abstract ( 2148 )   PDF (5156KB) ( 1334 )  

    Metabolomics is one of the branches of systems biology, which employs nuclear magnetic resonance and mass spectrometry technologies to detect the abnormal metabolites from a variety of body fluids. Study of various molecules and their functions may help to find the disease-related early metabolic marker clusters, understand the molecular mechanism of pathogenesis, which provides broad prospects for the early diagnosis and individualized treatment of malignant tumors.

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    Characteristics of choroidal neovascularization secondary to pathologic myopia and anti-VEGF therapy
    WANG Li-na
    2009, 29 (10):  1251. 
    Abstract ( 1810 )   PDF (5545KB) ( 1370 )  

    Choroidal neovascularization is one of the common causes resulting in vision loss in patients with pathologic myopia, and the irreversible central vision loss is often found. This article reviews the epidemiology of pathologic myopia, pathogenesis, clinical manifestation and anti-VEGF therapy of choroidal neovascularization secondary to pathologic myopia.

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    Epigenetic regulation and human common diseases
    GAO Yan-hong
    2009, 29 (10):  1256. 
    Abstract ( 1594 )   PDF (3279KB) ( 1904 )  

    In the past few years, it has been disclosed that identified epigenetic processes and epigenetic changes are involved in human diseases. Disorders of these processes may influence chromatin structure and gene expression, which may result in complicated syndroms, multiple-factor diseases and cancers. The research progress of epigenetic processes of several diseases is reviewed in this paper.

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    Research on spinal cord stimulation for treatment of cerebral ischemia
    GUAN Hong-xin
    2009, 29 (10):  1259. 
    Abstract ( 1405 )   PDF (4110KB) ( 1528 )  

    Cerebral ischemia is one of the diseases of the central nervous system, which is harmful to the morphology and function of brain cells due to reduced cerebral blood flow. Increasingly more reports have demonstrated that spinal cord stimulation could augment the cerebral blood flow, which is expected to be a potential method for the treatment of cerebral ischemia. In this article, the research progress and related problems of spinal cord stimulation for the treatment of cerebral ischemia are reviewed.

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    Brief original article
    Observation of contrast-enhanced ultrasound in experimental testicular torsion and detorsion of rabbits
    LV Chen, ZHAN Wei-wei, CHEN Lin, et al
    2009, 29 (10):  1263. 
    Abstract ( 1229 )   PDF (2942KB) ( 1296 )  
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    Outcomes of breast-conserving surgery and radical mastectomy for early stage breast cancer
    KONG Lei, YANG Hua-li, LI Wei, et al
    2009, 29 (10):  1266. 
    Abstract ( 1964 )   PDF (4440KB) ( 2501 )  
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    Changes of serum TNF-&alpha|and IL-4 levels in Hashimoto's thyroiditis
    XIE Yong-shuang, QIN Wei-wu, PENG Sheng-mei, et al
    2009, 29 (10):  1269. 
    Abstract ( 1418 )   PDF (3337KB) ( 1391 )  
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    Clinical experience
    Treatment of carpal tunnel syndrome by double small incision and follow-up analysis
    LIU Jin-hao, SHEN Yu-hui, XU Xiang-yang
    2009, 29 (10):  1272. 
    Abstract ( 1222 )   PDF (3163KB) ( 1012 )  
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    Case report
    One case reprot of metachronous multiple primary tumors
    ZHAI Ge, LI Biao, XU Hao-ping
    2009, 29 (10):  1274. 
    Abstract ( 1140 )   PDF (2684KB) ( 1054 )  
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