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    Editorial
    Hypertension of adrenal origin: a cause of hypertension worthy of attention
    NING Guang
    2010, 30 (5):  487. 
    Abstract ( 1247 )   PDF (1791KB) ( 1090 )  
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    Monographic report (Adrenal diseases)
    Roles of plasma metanephrine and normetanephrine in diagnosis of chromaffin cell tumors
    SU Ting-wei, WANG Wei-qing, ZHOU Wei-wei, et al
    2010, 30 (5):  489. 
    Abstract ( 3082 )   PDF (4275KB) ( 2098 )  

    Objective To explore the roles of plasma metanephrine (MN) and normetanephrine (NMN) in diagnosis of chromaffin cell tumors. Methods From May 2003 to December 2008, patients with indications for chromaffin cell tumor screening in Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine were selected. Plasma NMN and MN levels were detected by high performance liquid chromatogram, and were compared between patients with chromaffin cell tumors and those without. Besides, plasma NMN and MN levels before operation were compared with those after operation in patients with chromaffin cell tumors. Receiver operating characteristic (ROC) curves were employed to determine the sensitivity and specificity of plasma NMN and MN in diagnosis of chromaffin cell tumors. Results Two hundred and fifty-nine patients with chromaffin cell tumors and 4 387 patients without were enrolled. The area under ROC curve of NMN was 0.989±0.005, and that of MN was 0.783±0.019. There were significant differences in NMN and MN levels between patients with chromaffin cell tumors and those without, (2930.56±4166.56) pg/mL vs (70.48±25.07) pg/mL and (585.68±1368.75) pg/mL vs (45.61±42.63) pg/mL, respectively (P=0.00 for both).The sensitivity and specificity were 95.4% and 90.0% respectively for plasma NMN of 130 pg/mL, and those were 51.4% and 90.0% respectively for plasma MN of 83 pg/mL. Besides, there were significant differences between NMN and MN levels before operation and those after operation in 69 patients with chromaffin cell tumors, (3 145.8±3651.86) pg/mL vs (233.1±934.92) pg/mL and (653.7±1053.12) pg/mL vs (47.56±25.82) pg/mL, respectively (P=0.00 for both). Conclusion Plasma NMN and MN levels can be adopted as optimal parameters in screening chromaffin cell tumors, and plasma NMN and MN levels after operation may indicate the outcomes and help to detect early recurrence or metastasis of the tumors.

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    Characteristics of glucolipid metabolism and analysis of related factors in patients with primary aldosteronism
    YE Fei, TANG Zheng-yi, WU Jing-cheng, et al
    2010, 30 (5):  493. 
    Abstract ( 1878 )   PDF (4577KB) ( 1440 )  

    Objective To investigate the characteristics of glucolipid metabolism in patients with primary aldosteronism, and explore the related factors. Methods Two hundred and ninety-nine patients with primary aldosteronism were classified into aldosterone producing adenoma group (APA group, n=103), unilateral nodular adrenal hyperplasia group (UNAH group, n=52) and bilateral adrenal hyperplasia group (BAH group, n=144). Besides, another 100 patients with essential hypertension were served as control group. The clinical data of patients in each group were collected, and the parameters related to glucolipid metabolism were compared among groups. Meanwhile, correlation analysis was conducted between levels of serum and urine aldosterone and glucolipid metabolic parameters in patients with primary aldosteronism. Results Compared with control group, the levels of post-prandial 30 min and 60 min blood glucose, serum triglyceride and total cholesterol in patients with primary aldosteronism were significantly lower (P<0.01), and the level of serum high density lipoprotein was significantly higher (P<0.01). The levels of postprandial 60 min and 120 min blood glucose, post-prandial 60 min, 120 min and 180 min serum insulin and serum triglyceride in APA group were significantly lower than those in BAH group (P<0.05), while the level of high density lipoprotein in APA group was significantly higher than that in BAH group (P<0.05). Correlation analysis revealed that parameters of glucolipid metabolism were significantly negatively correlated with levels of 24 h urine aldosterone and serum baseline aldosterone in patients with primary aldosteronism (P<0.05), and the abnormality of lipid metabolism was significantly positively correlated with duration of disease in patients with primary aldosteronism (P<0.05). Conclusion Abnormalities of glucose and lipid metabolism in patients with primary aldosteronism were less severe than those in patients with essential hypertension. Among the subtypes of primary aldosteronism, the abnormalities of glucose and lipid metabolism of BAH were more severe, and the abnormalities are related with the duration of disease.

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    Accuracy of two cut-off points in 2 mg dexamethasone suppression test in diagnosis of Cushing's syndrome
    WANG Yi-feng, ZHOU Wei-wei, SU Ting-wei, et al
    2010, 30 (5):  497. 
    Abstract ( 2306 )   PDF (4313KB) ( 1543 )  

    Objective To evaluate the accuracy of 2 mg dexamethasone suppression test (DST) with serum cortisol or inhibition rate as cut-off points in diagnosis of Cushing's syndrome. Methods The clinical data of 163 patients with Cushing's syndrome confirmed by pathological examinations after operation were collected. The baseline serum cortisol levels at 8:00 and serum cortisol levels after 2 mg DST were recorded, and inhibition rates were calculated. Serum cortisol level and inhibition rate were served as cut-off points for diagnosis of Cushing's syndrome in 2 mg DST, and coincidence with pathological diagnosis was analysed. Results Pathological examinations after operation confirmed that there were 94 cases of Cushing disease, 63 cases of corticosuprarenaloma and 6 cases of ectopic adrenocorticotropic hormone (ACTH) syndrome among 163 cases of Cushing syndrome. With serum cortisol >5  g/dL after 2 mg DST as cut-off point, 88 cases of Cushing disease, 63 cases of corticosuprarenaloma and 6 cases of ectopic ACTH syndrome were diagnosed, and coincidence with pathological diagnosis was 96.3%. With inhibition rate <50% after 2 mg DST as cut-off point, 68 cases of Cushing disease, 63 cases of corticosuprarenaloma and 6 cases of ectopic ACTH syndrome were diagnosed, and coincidence with pathological diagnosis was 84.0%. Conclusion Compared with inhibition rate <50% after 2 mg DST as cut-off point, serum cortisol>5 g/dL after 2 mg DST as cut-off point may yield higher accuracy in diagnosis of Cushing's sydrome.

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    One case report of adrenocorticotrophic hormone independent macronodular adrenal hyperplasia
    ZHOU Wei-wei, JIANG Lei, SU Ting-wei, et al
    2010, 30 (5):  500. 
    Abstract ( 2049 )   PDF (4689KB) ( 1371 )  

    Primary adrenal causes contribute to 15% to 20% of Cushing's syndrome, and bilateral adrenal hyperplasia was found in 10% of patients with Cushing's syndrome. Cortisol secretion in adrenal Cushing's syndrome can be regulated by the aberrant adrenal expression of receptors for gastric inhibitory polypeptide, vasopressin, catecholamines, luteinizing hormone/human choriogonadotropin (LH/hCG) and serotonin. In this paper, a case of Cushing's syndrome caused by adrenocorticotrophic hormone-independent macronodular adrenal hyperplasia is reported.

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    Genetic screening in pheochromocytoma and paraganglioma
    QI Yan
    2010, 30 (5):  503. 
    Abstract ( 2063 )   PDF (5493KB) ( 1577 )  

    The disease-causing genes for pheochromocytoma and paraganglioma included RET gene, which is associated with multiple endocrine neoplasia type 2, VHL gene with von Hippel Lindau disease, SDHx gene with paraganglioma/pheochromocytoma syndrome and NF1 gene with neurofibromatosis type 1. About 27.4% of the pheochromocytomas and paragangliomas are considered to be caused by genetic factors. Furthermore, 7.5% to 27% of patients with nonsyndromic pheochromocytoma without family history  carry mutations. Hence, genetic screening has been regarded as an important part in the diagnosis of pheochromocytoma and paragangliomas. The status of genetic screening in pheochromocytoma and paraganglioma is reviewed in this paper.

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    Research advance in molecular biochemistry of ACTH-independent Cushing syndrome
    JIANG Yi-ran
    2010, 30 (5):  508. 
    Abstract ( 1781 )   PDF (3408KB) ( 1358 )  

    Adrenocorticotropic hormone (ACTH)-independent Cushing syndrome includes adrenocortical adenoma, adrenocortical carcinoma and adrenocortical nodular hyperplasia, the  pathogenesis of which is related to genetic mutations (GNAS1, PRKAR1A and PDE11A), expression of aberrant hormone receptors, dysfunction of WNT pathway and loss of heterozygosity of tumor suppressor gene. The pathogenesis mentioned above is introduced in this article.

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    Aldosterone and resistant hypertension
    ZHANG Xia
    2010, 30 (5):  511. 
    Abstract ( 1583 )   PDF (4504KB) ( 1209 )  

    Resistant hypertension is defined as blood pressure that remains above goal despite the use of three different antihypertensive medications in effective doses, ideally including a diuretic. It is special and not rare in clinic. Aldosterone, the most important mineralocorticoid, is extensively involved in various metabolic activities. However, aldosterone excess plays an important role in the development of resistant hypertension.

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    Analysis of quantity increase in medical scientific papers of Department of Endocrine and Metabolic Diseases of Ruijin Hospital
    XU Qin-yi, XU Yan, BI Yu-fang, et al
    2010, 30 (5):  515. 
    Abstract ( 2800 )   PDF (3379KB) ( 1273 )  

    Objective To analyse the causes of quantity increase in medical scientific papers of Department of Endocrine and Metabolic Diseases of Ruijin Hospital, and provide references for the development of the other medical disciplines. Methods With the method of literature metrology, the condition of medical scientific papers of Department of Endocrine and Metabolic Diseases of Ruijin Hospital published between 2004 and 2008 was analysed. Results During the 5 years, there was a stead increase in both the quantity and quality of medical scientific papers, especially the quantity of papers published on international journals. The quantity of papers published on international journals in 2008 was approximately 8 times of that in 2004. Among the paper contributors, postgraduates accounted for the majority, and then came the research fellows. Applied basic research papers constituted the largest number of papers, and basic research papers fell into the second largest category. Conclusion The union of clinical department and research institute may benefit the discipline development. Paper publication is closely related to postgraduate cultivation. The integration of basic research and clinical research is the development model for scientific research in future. The translational medical model may promote the discipline development.

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    Original article (Basic research)
    Effects of high glucose and Rapamycin intervention on expression of type Ⅳ collagen and matrix metalloproteinase-9 in podocytes
    LIANG Xin-yue, GU Le-yi, WANG Li-hua, et al
    2010, 30 (5):  518. 
    Abstract ( 1870 )   PDF (6278KB) ( 1503 )  

    Objective To investigate the effects of high glucose and Rapamycin intervention on the expression of type Ⅳ collagen and matrix metalloproteinase-9 (MMP-9) in podocytes. Methods Mouse podocytes cultured in vitro were divided into blank control group, high permeability group, high glucose group and high glucose+Rapamycin intervention group. The expression of type Ⅳ collagen α3 chain (COL4A3) mRNA, type Ⅳ collagen α5 chain (COL4A5) mRNA, MMP-9 mRNA and MMP-9 protein in podocytes of each group was detected by Real-time PCR and Western blotting, respectively. The contents of type Ⅳ collagen in the supernatants of culture fluid were determined by ELISA. Results Compared with control group, the expression of COL4A3 mRNA and COL4A5 mRNA in podocytes and the contents of type Ⅳ collagen in the supernatants of culture fluid in high glucose group were significantly increased (P<0.05), while the expression of MMP-9 mRNA and MMP-9 protein in podocytes was significantly decreased (P<0.05). Compared with high glucose group, the expression of COL4A3 mRNA and COL4A5 mRNA in podocytes and the contents of type Ⅳ collagen in the supernatants of culture fluid in high glucose+Rapamycin intervention group were significantly decreased (P<0.05), while the expression of MMP-9 mRNA and MMP-9 protein in podocytes was significantly increased (P<0.05). Conclusion Rapamycin could reverse the abnormal expression of type Ⅳ collagen and MMP-9 in podocytes treated with high glucose.

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    Effects of TGF-β1 signal transduction inhibition by antisense-Smad3 adenovirus vector transfection on intimal hyperplasia after balloon injury in rats
    WANG Song-hao, SHENG Jing, CAI Wen-wei, et al
    2010, 30 (5):  522. 
    Abstract ( 1745 )   PDF (6925KB) ( 1261 )  

    Objective To investigate the effects of antisense-Smad3 adenovirus vector transfection on carotid intimal hyperplasia after balloon injury in rats. Methods Ninety SD rats were randomly divided into injury group (balloon injury on carotid intima), intervention group (antisense Smad3 adenovirus vector transfection after balloon injury) and blank control group (blank adenovirus vector transfection after balloon injury). Another six age-matched rats were served as control groups (without any treatment). Rats in each group were sacrificed 1 d, 3 d, 1 week, 2 weeks, 1 month and 3 months after injury, and samples were harvested. The serum concentrations of TGF-β1 in injury group and normal control group of different time points were determined by ELISA. The expression of Smad3 mRNA of carotid artery in injury group, intervention group and blank control group was detected by Real-time PCR, and the carotid intima and media thickness was measured by HE staining. Results The serum concentrations of TGF-β1 of each time point in injury group were significantly higher than those of normal control group (P<0.05). The expression of Smad3 mRNA 1 d, 3 d, 1 week, 2 weeks and 1 month after injury and intima/media thickness ratios 1 d, 2 weeks and 3 months after injury in intervention group were significantly lower than those in injury group (P<0.05), while there was no significant difference in the expression of Smad3 mRNA and intima/media thickness ratios between injury group and blank control group (P>0.05). Conclusion Antisense-Smad3 adenovirus vector transfection can block TGF-β1/Smad3 signal transduction, and inhibit intimal hyperplasia.

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    Growth inhibitory effect of β-hydroxyisovalerylshikonin on prostate cancer cells and related mechanism
    LIU Xin, NIU Xin, ZHOU Wen, et al
    2010, 30 (5):  527. 
    Abstract ( 1813 )   PDF (4224KB) ( 1347 )  

    Objective To investigate the growth inhibitory effects of β-hydroxyisovalerylshikonin (β-HIVS) on hormone-independent prostate cancer cell line PC-3, and explore the related mechanism. Methods The inhibition rates of β-HIVS on PC-3 cells and normal human skin fibroblasts (HSF) were determined by MTT method. Luciferase reporter assay was adopted to examine the transcriptional activity of hypoxia-inducible factor-1 (HIF-1) and nuclear factor-kappa B (NF-κB). The expression of vascular endothelial growth factor (VEGF), the target gene of HIF-1, was detected by RT-PCR. The expression of HIF-1α protein in PC-3 cells treated by β-HIVS was detected by Western blotting. Results β-HIVS significantly inhibited the growth of PC-3 cells (P<0.05), while had no significant effect on HSF cells (P>0.05). There was no significant change in transcriptional activity of NF-κB in PC-3 cells after drug treatment (P>0.05). β-HIVS inhibited the transcriptional activity of HIF-1 and decreased the expression of VEGF. The protein level of HIF-1α in PC-3 cells was reduced by β-HIVS. Conclusion β-HIVS inhibits the growth of PC-3 cells by decreasing the level of HIF-1α protein in PC-3 cells under hypoxia condition, thus attenuating the transcriptional activity of HIF-1α and decreasing the expression of VEGF.

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    Mechanism of low-dose chemotherapy in combination with dendritic cell vaccines in modulation of murine lung cancer microenvironment
    ZHONG Hua, ZHONG Run-bo, HAN Bao-hui
    2010, 30 (5):  531. 
    Abstract ( 1894 )   PDF (4522KB) ( 1453 )  

    Objective To explore the mechanism of low-dose chemotherapy in combination with dendritic cell (DC) vaccine in treatment of murine lung cancer. Methods Lewis lung cancer cells (3LL) were inoculated subcutaneously in mice. Mice were divided into four groups (n=6) after tumor formation: control group (no treatment), low-dose chemotherapy group (treated with Paclitaxel 2 mg/kg), DC vaccine group and combined treatment group (treated with low-dose Paclitaxel and DC). On day 21, interferon-γ-induced protein 10 (IP-10), monocyte chemoattractant protein-1(MCP-1), keratinocyte (KC) and interleukin-1α (IL-1α) in intratumoral and peritumoral tissues were detected by microdialysis combined with Luminex technology in mice. Results Compared with the other three groups, the production of IP-10, MCP-1 and KC at some different time points was significantly higher in combined treatment group (P<0.05), while there was no significant difference in the production of IP-10, MCP-1, KC and IL-1α in peritumoral tissues among these four groups (P>0.05). Conclusion The combination of low-dose chemotherapy with DC vaccine may inhibit the growth of murine lung cancer,and the mechanism probably relates to regulation of microenviroment in the tumors.

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    Effects of CTGF antisense oligodeoxynucleotide on transition of human kidney epithelial cells
    LIAO Xiao-li, CHEN Chao, CHEN Tao, et al
    2010, 30 (5):  535. 
    Abstract ( 1502 )   PDF (7051KB) ( 1188 )  

    Objective To investigate the effects of antisense oligodeoxynucleotide (ASODN) targeting connective tissue growth factor (CTGF) on transition of human kidney epithelial cells (HKC). Methods Transition models of HKC were induced by monocyte chemotactic protein-1(MCP-1) and aristolochic acid Ⅰ(AAⅠ). HKC were randomly divided into blank control group, model control group, PEI group, CTGF ASODN 10 ng/mL group and CTGF ASODN 100 ng/mL group. The effects of CTGF ASODN on proliferation and cell cycle of transition models of HKC were evaluated by WST-8 method and flow cytometry, respectively. The expression of α-smooth muscle actin (α-SMA) mRNA and α-SMA, Fibronectin (FN) and TGF-β1 protein of transition models of HKC were detected by RT-PCR and immunohistochemistry, respectively. Results 100 ng/mL CTGF ASODN reversed the proliferation inhibition, reduced S phase arrest, decreased the expression of α-SMA mRNA and α-SMA, FN and TGF-β1 protein of HKC induced by MCP-1 and AAⅠ. Conclusion CTGF ASODN can inhibit the transition of HKC induced by MCP-1 and AAⅠ.

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    Effects of hydroxy safflor yellow A on cardiac function of isolated hearts
    NIE Pei-he, ZHANG Wen-hui, JIN Zhu, et al
    2010, 30 (5):  540. 
    Abstract ( 1338 )   PDF (4771KB) ( 1587 )  

    Objective To investigate the effects of hydroxy safflor yellow A (HSYA) on contractile function of left ventricle of isolated rat heart. Methods Forty-two rats were randomly divided into control group, HSYA (1-100 μmol/L) group, HSYA (30 μmol/L) control group, HSYA (30 μmol/L)+glibenclamide (Gli) group, HSYA (30 μmol/L)+tetraethylammonium (Tea) group, HSYA (30 μmol/L)+4-aminopyridine (4-AP) group and HSYA (30 μmol/L)+atropine (Art) group, with 6 rats in each group. Langendorff perfused heart preparation was made, and the isolated hearts were perfused with HSYA in a stepwise fashion. The effects on contractile function of left ventricle before and after treatment with different concentrations of HSYA were observed by PowerLab system from a fluid filled latex balloon in the left ventricle. The influence of different types of K+ channel blockers on the effects of HSYA was also observed. Results HSYA reduced left ventricular systolic pressure, left ventricular end-diastolic pressure, maximum rate of increase of left ventricular pressure  and heart rate in a dose-dependent manner (P<0.05 or P<0.01), while had no significant effect on maximum rate of decrease of left ventricular pressure (P>0.05). Gli and Tea blocked the effects of HSYA in a concentration-dependent manner (P<0.05 or P<0.01), but 4-AP and Art did not block the effects of HSYA (P>0.05). Conclusion HSYA could significantly decrease the myocardial contractility and heart rate in a dose-dependent manner, and its action mechanism might be related to the opening of ATP sensitivity K+ channel and Ca2+ dependent K+ channel.

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    Changes of serum Th2 related cytokines in lactalbumin hydrolysate induced oral tolerance to food in mice
    JIANG Ping, SHAO Jie
    2010, 30 (5):  544. 
    Abstract ( 1292 )   PDF (8413KB) ( 1270 )  

    Objective To observe whether lactalbumin hydrolysate can induce oral tolerance, and explore the relationship between Th2 related cytokines and oral tolerance to food. Methods BALB/c mice (n=176) were fed with lactalbumin and its hydrolysate, the models of oral tolerance were established, and control group A, lactalbumin group, partially hydrolysed lactalbumin group and extensively hydrolysed lactalbumin group (n=44) were divided. Meanwhile, BALB/c mice (n=83) were allergized and stimulated by lactalbumin to establish the models of food allergy, and control group B (n=41) and lactalbumin allergy group (n=42) were divided. The serum levels of IgE, IgG, IgG1, IL-4 and TGF-β1 were detected by ELISA, the pathological features of intestines were analysed, and the percentages of CD4+CD25+Foxp3+Treg in splenic cells were determined by flow cytometry. Results Compared with control group A, the serum levels of IgE, IgG1, IgG and IL-4 in lactalbumin group were lower, while the serum level of TGF-β1 was higher, and the percentage of CD4+CD25+Foxp3+Treg in splenic cells was higher (P<0.05). The serum levels of IgE and IL-4 were lower in partially hydrolysed lactalbumin group, while the serum level of TGF-β1 was higher, and the percentage of CD4+CD25+Foxp3+Treg in splenic cells was higher (P<0.05). There was no significant difference in each parameter between extensively hydrolysed lactalbumin group and control group A (P>0.05). Compared with control group B, the serum levels of IgE and IL-4 in lactalbumin allergy group were higher, while the serum level of TGF-β1 was lower, and the percentage of CD4+CD25+Foxp3+Treg in splenic cell was higher (P<0.05). Conclusion Both lactalbumin and partially hydrolysed lactalbumin may induce oral tolerance with main feature of suppression of Th2 lymphocyte responses, while extensively hydrolysed lactalbumin may induce no significant reaction.

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    Expression of Ghrelin and PYY mRNA and protein in gastrointestinal tract and their receptors mRNA in hypothalamus in neonatal rats
    CHEN Xia-fang, LIN Ning, ZHANG Zhu-hua, et al
    2010, 30 (5):  550. 
    Abstract ( 1872 )   PDF (4765KB) ( 1275 )  

    Objective To investigate the changes of expression of Ghrelin and peptide YY (PYY) mRNA and protein in gastrointestinal tract and their receptors mRNA in hypothalamus in neonatal rats, and explore their relationship with the maturity degree of gastrointestinal tract. Methods Ten neonatal rats of 0 day old (day 0 rats) and 10 neonatal rats of 7 days old (day 7 rats) were selected, and Real-time PCR and immunohistochemical staining were employed to detect the expression of Ghrelin mRNA and protein in gastric fundus tissues, PYY mRNA and protein in colon tissues and Ghrelin and PYY receptors mRNA in hypothalamus. Results The expression of Ghrelin mRNA in gastric fundus tissues of day 0 rats was significantly higher than that of day 7 rats (P<0.05), while the expression of PYY mRNA in colon tissues of day 0 rats was significantly lower than that of day 7 rats (P<0.01). The expression of Ghrelin and PYY protein in gastrointestinal tract tissues of day 0 rats was significantly higher than that of day 0 rats (P<0.05). There was no significant difference in the expression of Ghrelin and PYY receptors mRNA in hypothalamus between day 0 rats and day 7 rats (P>0.05). Conclusion The levels of Ghrelin and PYY synthesis and secretion may increase in immature gastrointestinal tract, which may promote the development and maturation of gastrointestinal tract. The unparalleled expression of PYY mRNA and protein indicates the diversity in the regulation of gene expression.

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    Original article (Clinical research)
    Effects of icodextrin dialysate on CA125 level in peritoneal effluent
    LIN Ai-wu, QIAN Jia-qi, FANG Wei, et al
    2010, 30 (5):  554. 
    Abstract ( 2621 )   PDF (5419KB) ( 1465 )  

    Objective To prospectively observe the changes of carbohydrate antigen 125 (CA125) level in peritoneal effluent after application of icodextrin dialysate, and investigate the effects of icodextrin on peritoneal mesothelial cells. Methods Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with 2.5% glucose dialysate were selected, and were randomly divided into icodextrin group (treatment with 7.5% icodextrin dialysate for night dwell) and control group (treatment with 2.5% glucose dialysate for night dwell). The therapeutic session lasted 4 weeks, and follow-up was conducted on 14 d and 28 d after treatment. Ultrafiltration volumes and peritoneal creatinine clearance of night dwell were measured at baseline and 14 d and 28 d after treatment. CA125 levels in peritoneal effluent of night dwell at baseline and 28 d after treatment were determined, and CA125 appearance was calculated. Results Fifty-four patients with CAPD were enrolled, with 27 in each group. There was no significant difference in baseline parameters between the two groups (P>0.05). Ultrafiltration volumes and peritoneal creatinine clearance of 14 d and 28 d after treatment in icodextrin group were significantly higher than baseline data, and were significantly higher than those in control group (P<0.05). The differences in CA125 appearance in peritoneal effluent of night dwell between 28 d after treatment and baseline were (1484.0±1571.6) U/h and (-222.1±1816.7) U/h in icodextrin group and control group, respectively (P<0.01). Conclusion Compared with 2.5% glucose dialysate, 7.5% icodextrin dialysate can significantly increase CA125 level in peritoneal effluent, indicating an increase in peritoneal mesothelial cell production.

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    Prevalence of metabolic syndrome and analysis of risk factors among patients with maintenance hemodialysis
    CHEN Yong-hua, PANG Hui-hua, ZHU Ming-li, et al
    2010, 30 (5):  558. 
    Abstract ( 1556 )   PDF (4643KB) ( 1220 )  

    Objective To investigate the prevalence of metabolic syndrome (MS) in patients with maintenance hemodialysis, and analyse the related risk factors. Methods The clinical data of 202 patients with maintenance hemodialysis were collected. Patients were divided into MS group and non-MS group according to the diagnosis criteria of International Diabetes Federation, and the prevalence of MS was calculated. The demographic data, results of laboratory and anthropometric examinations, dialysis prescription and cardiovascular events were compared among groups. Multivariate Logistic regression analysis was performed to analyse the risk factors for MS. Results The prevalence of MS in 202 patients was 29.2%. There were significant differences in body weight, waist circumference, body mass index, serum levels of glutamate-pyruvate transaminase, cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, fasting blood glucose, C-reactive protein (CRP) and intact parathyroid hormone (iPTH), urea reduction ratio, urea clearance index, hemodialysis frequency and time of hemodialysis per week between two groups (P<0.05). There was no significant difference in the prevalence of cardiovascular events between MS group and non-MS group (25.4% vs 18.2%, P>0.05). Multivariate Logistic regression analysis revealed that iPTH (OR=2.525), CRP (OR=4.700), female (OR=8.000)and body weight(OR=24.625)were related with MS. Conclusion MS is not rarely found in patients with maintenance hemodialysis, and high levels of iPTH and CRP, female and obesity are risk factors for MS.

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    Formation and characteristics of Acinetobacter baumannii bacterial biofilm on inner surfaces of endotracheal tubes of burn patients
    XIANG Jun, SUN Zhen, XIA Jun-xing, et al
    2010, 30 (5):  562. 
    Abstract ( 1778 )   PDF (5537KB) ( 1607 )  

    Objective To observe the formation and characteristics of Acinetobacter baumannii bacterial biofilm (BF) on inner surfaces of endotracheal tubes of burn patients. Methods Samples of clinical strains were obtained from inner surfaces of endotracheal tubes of burn patients, and 9 drug resistant Acinetobacter baumannii strains were isolated and identified by Vitek2 Automated Identification System. Clinical strains were cultured in vitro for 12, 24, 48 and 72 h, respectively, and modified microtiter-plate method was employed for semi-quantification test of BF formation. The thickness of mature BF of samples was determined by confocal laser scanning microscopy (CLSM) with FITCConA/PI immunofluorescence double staining. Acinetobacter baumannii standard stains (ATCC19606) were served as controls. Meanwhile, samples of inner surfaces of endotracheal tubes were collected at tube withdrawal, and were also observed by scanning electron microscopy. Results Compared with standard strains, the adherence capabilities of clinical strains isolated from the tubes were much more enhanced (P<0.05), and the peak time of adherence for all strains was at 24-48 h post culture. CLSM revealed that mature BF of clinical strains was formed after culture for 48 h, and was much thicker than that of the standard strains (P<0.05). SEM revealed that mature BF assembled in mass, and the bacteria were embedded in the matrix. Conclusion Acinetobacter baumannii strains can form BF on the inner surfaces of endotracheal tubes of burn patients with favorable characteristics, which is a major cause for endotracheal tube associated infection in burn patients.

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    Value of anti-Müllerian hormone in prediction of poor ovarian response to controlled ovarian stimulation
    SONG Wei, NIU Zhi-hong, CHEN Qian, et al
    2010, 30 (5):  566. 
    Abstract ( 1565 )   PDF (4418KB) ( 1538 )  

    Objective To evaluate anti-Müllerian hormone (AMH) in prediction of poor ovarian response to controlled ovarian hyperstimulation. Methods The serum levels of basal follicle-stimulating hormone (bFSH), basal luteinizing hormone (bLH), basal estradiol (bE2), bilateral antral follicle count (AFC) and AMH in 54 patients with first cycle of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) were determined. The values of each parameter in prediction of poor ovarian response were assessed using receiver-operating characteristic (ROC) curves. Results The serum AMH level of 11 patients (20.4%) with poor ovarian response (no more than five oocytes) was significantly lower than that of patients with normal ovarian response [(1.46±0.46) ng/mL vs (2.36±1.12) ng/mL, P<0.05]. ROC curve analysis revealed that area under curve (AUC) was 0.774 for AMH (P<0.01) and 0.728 for AFC (P<0.05), and AUC was less than 0.5 for each basal hormone (P>0.05). The sensitivity and specificity were 81.8% and 72.1%, respectively when the cutoff value of AMH was no higher than 1.64 ng/mL, and the sensitivity and specificity were 63.6% and 76.7%, respectively when the cutoff value of AFC was less than 6. Conclusion Serum AMH may serve as a predictor for poor ovarian response to exogenous gonadotrophin in patients undergoing controlled ovarian hyperstimulation.

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    Relationship between expression of PHDs mRNA and Bax and Bcl-2 in non-small cell lung cancer
    CHEN Su-feng, ZHANG Jie, ZHU Xiao-li, et al
    2010, 30 (5):  570. 
    Abstract ( 1972 )   PDF (5376KB) ( 1250 )  

    Objective To investigate the expression of prolyl hydroxylase domain enzymes genes (PHDs mRNA), and explore its relationship with expression of apoptosis-related protein Bax and Bcl-2 in non-small cell lung cancer. Methods The expression of PHD1, 2, 3 mRNA and Bax and Bcl-2 in cancer tissues and para-cancerous normal tissues in 56 cases of non-small cell lung cancer was detected by Real-time PCR and immunohistochemical staining, respectively. Results The expression of PHDs mRNA in cancer tissues was significantly higher than that in para-cancerous normal tissues (P<0.05). Patients with positive expression of Bax and Bcl-2 accounted for 33.9% (19/56) and 32.1% (18/56), respectively. The positive expression rates of Bcl-2 in cancer tissues with high expression and low expression of PHD3 mRNA were 19.5% and 66.7%, respectively. Conclusion The expression of PHDs mRNA is increased in nonsmall cell lung cancer tissues, and the increased expression of PHD3 mRNA may be associated with cell apoptosis.

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    Clinical analysis of arrhythmia after pulmonary resections
    MAO Teng, FANG Wen-tao, ZHANG Jun-hua, et al
    2010, 30 (5):  574. 
    Abstract ( 1920 )   PDF (4192KB) ( 1302 )  

    Objective To investigate the risk factors for arrhythmia after pulmonary resections. Methods The incidences of postoperative complications of 399 patients undergoing pulmonary resections were retrospectively analysed, and univariate and multivariate regression analysis was conducted on risk factors for arrhythmia after operation. Results Thirty-two patients (8.02%) experienced arrhythmia after operation. Univariate analysis revealed that the risk factors included age (≥60 years old), complication with cardiopathy other than coronary heart disease, operative approaches (more than single lobectomy), and non-tumor conditions (P<0.05 or P<0.01). Multivariate analysis demonstrated that the independent risk factors included age (≥60 years old) and operative approaches (more than single lobectomy) (P<0.01, P<0.05). Conclusion For patients with risk factors undergoing pulmonary resections, it is important to avoid unnecessary injury during operation, and perform diagnosis and treatment as early as possible. The management of primary respiratory diseases also plays a role in reducing tissue hypoxia.

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    Occlusion model analysis of patients with unrepaired nonsyndromic cleft palate
    CHEN Zhen-qi, QIAN Yu-fen, SHEN Gang, et al
    2010, 30 (5):  578. 
    Abstract ( 1855 )   PDF (2929KB) ( 1158 )  

    Objective To analyse the characteristics of appearance of dental arch of patients with unrepaired cleft palate. Methods Forty patients with unrepaired nonsyndromic cleft palate were collected, among whom 15 had unilateral cleft lip and palate (UCLP) with the mean age of 20.2 years old, and the other 25 had isolated cleft palate (ICP) with the age of 21.8 years old. Dental cast assessments were conducted in two groups. Besides, 40 age and gender-matched patients with classⅠ malocclusion were served as controls. Results Compared with controls, patients with UCLP had decreased anterior dental-arch width, anterior dental-arch length and total dental-arch length (P<0.05), while those with ICP had increased posterior dental-arch width, decreased anterior dental-arch length and total dental-arch length (P<0.05). Conclusion There exist inhibitory effects of sagittal growth and maxilla development in patients with unrepaired cleft palate, while inhibitory effects of transverse growth in canine region only exist in patients with UCLP.

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    Original article (Preventive medicine)
    Investigations on social psychology and sexual behavior of 52 male homosexual adolescents in Shanghai
    HUANG Feng-rong, HUANG Hong, ZHUANG Ming-hua, et al
    2010, 30 (5):  581. 
    Abstract ( 2864 )   PDF (4280KB) ( 1725 )  

    Objective To investigate the social psychology and sexual behavior of male homosexual adolescents in Shanghai, and provide scientific evidence for advanced intervention in acquired immune deficiency syndrome (AIDS)-related risk behaviors for adolescents. Methods Anonymous questionnaires, including self-composed questionnaire, self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were employed for investigations among 52 male homosexual adolescents in Shanghai. Results The investigated adolescents aged between 15 to 19 years. Thirty-five adolescents (67.31%) had oral sex in the past 6 months, among whom 30 (85.71%) had unprotected oral sex and 25 (71.43%) did not use condom in the last oral sex. Thirty-four adolescents (65.38%) had anal sex in the past 6 months, among whom 16 (47.06%) insisted on condom use for anal sex and 10 (29.41%) did not use condom in the last anal sex. The awareness rate of AIDS-related knowledge was relatively higher, with the total correct answer rate of 82.47%. The rates of depression and anxiety were 36.54% and 26.92%, respectively. Conclusion AIDS-related risk sexual behaviors and psychological problems exist in homosexual adolescents. Attention should be paid to the psychological health during the health intervention for AIDS.

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    Original article (Public health administration)
    Current situation and strategy of dual referral implementation in Songjiang District of Shanghai
    YANG Guo-ping, CHEN Min-sheng, LAI Wei
    2010, 30 (5):  585. 
    Abstract ( 1627 )   PDF (4055KB) ( 1289 )  

    Objective To investigate the current situation and problems of dual referral implementation in Songjiang District of Shanghai, and provide references for the optimization of dual referral system in China. Methods Three medical institutions were randomly selected from Songjiang District of Shanghai, with one first-grade hospital (community health center), one second-grade hospital and one third-grade hospital. Four hundred medical staff and 400 patients were surveyed with questionnaires, and 392 effective questionnaires from medical staff (176 from second-grade hospital or third-grade hospital and 216 from community health center) and 380 effective questionnaires from patients were recovered. The questionnaires were involved with the basic condition, dual referral willingness of patients, knowledge of medical staff and patients on dual referral policy, opinion of medical staff and patients on dual referral implementation channels, determinative right of dual referral, indications of dual referral and implementation difficulties of dual referral. Results Patients who often visited the community health center accounted for 52.9%, and 57.6% of patients with stable illness state were reluctant to be referred back to the community health center. There were significant differences in knowledge on dual referral policy, opinion on dual referral implementation channels, determinative right of dual referral and indications of dual referral between medical staff and patients (P<0.05). It was drawn from medical staff that the drive from economic benefits and lack in communications among medical institutions were the important influencing factors for dual referral. Conclusion The inadequate knowledge of medical staff and patients on dual referral, the unwillingness of patients on dual referral and the drive from economic benefits are the obstacles for the implementation of dual referral. Rational strategies and compensation system should be adopted to facilitate the implementation of dual referral.

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    Review
    Research advance in Notch signals in modulation of angiogenesis
    JIANG Meng
    2010, 30 (5):  589. 
    Abstract ( 1670 )   PDF (3272KB) ( 1127 )  

    The research in roles of Notch signals in angiogenesis mainly concentrates on endothelial cell proliferation, regulation of ratio of tip cells to stalk cells, arterial-venous differentiation and perithelial cell mobilization. The research on Notch signals in angiogenesis may enable us to launch rational treatment targeting tissue ischemia, trauma and tumors. The composition of Notch signaling, roles and mechanism of Notch in physiological angiogenesis and application research on cord blood hematopoietic stem cells are reviewed in this paper.

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    Development of vectors used in pulmonary gene delivery
    CHU Chen
    2010, 30 (5):  592. 
    Abstract ( 1660 )   PDF (4986KB) ( 1084 )  

    Pulmonary gene delivery is one of the main branches of gene therapy. Pulmonary gene delivery system consists of gene drugs, vectors and pulmonary delivery devices. Vectors, which can protect gene drugs and mediate gene delivery, are divided into viral vectors and non-viral vectors. Viral vectors have greater toxicity, and are less widely used. Cationic lipids served as non-viral vectors of first generation, and were later replaced by cationic polymers. Polyethylenimine vectors, which have favourable gene transfection efficiencies, are most widely studied. New cationic polymer poly ester amine vectors enjoy broad application prospects in pulmonary gene delivery.

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    Brief original article
    Effects of body mass index on procedures and outcomes of IVF-ET
    GUAN Xiao-hong, ZHANG Ai-jun, LU Xiao-wei, et al
    2010, 30 (5):  597. 
    Abstract ( 2010 )   PDF (3888KB) ( 1351 )  

    Objective To investigate the effects of body mass index (BMI) on procedures and outcomes of in vitro fertilization and embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI). Methods Three hundred and twenty-three patients undergoing first long protocol for IVF-ET or ICSI were divided into group A (BMI<18.5 kg/m2, n=43), group B (18.5 kg/m2≤BMI≤24.9 kg/m2, n=253) and group C (BMI>24.9 kg/m2, n=27). The parameters of procedures and outcomes were compared among groups. Results Compared with group A and group B, the duration of ovarian stimulation and dose of rFSH of group C were significantly increased (P<0.05), while the peak oestradiol and number of big follicles on day of HCG injection and number of follicles collected were significantly decreased (P<0.05). There was no significant difference in the rates of fertilization, overall cancellation and clinical pregnancy among three groups(P>0.05). Conclusion Higher BMI may result in increased duration of ovarian stimulation and dose of rFSH, decreased peak oestradiol and number of big follicles on day of HCG injection and decreased number of follicles collected, while has no significant effect on pregnancy outcome.

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    Clinical experience
    Reconstructive surgery for scar of extensive burn in later stage post burn
    ZHENG Jie-xin, ZHANG Qin, LIU Yan, et al
    2010, 30 (5):  600. 
    Abstract ( 1699 )   PDF (5083KB) ( 1426 )  

    Objective To explore an optimal method of providing efficient donor sites for the reconstructive surgery for scar of extensive burn in later stage post burn. Methods Twenty-one patients undergoing reconstructive surgery for extensive burn in later stage post burn were selected, among whom 15 were performed split-skin grafting (47 times of operations) and the other 6 received skin flap grafting. Split-skin grafts or flaps were harvested from scar skin, splitskin grafting or skin flap grafting was performed, and stamp-like grafts were reimbursed to the donor sites. Results In 47 times of split-skin grafting, skin grafts survived in 42 times of operations, with improved appearance of operative sites and functional recovery. Of 6 cases undergoing skin flap grafting, the flaps of 5 cases survived, with restoration of wound surface of operative sites and improved function. While the other 1 case with skin flap grafting experienced skin flap necrosis, and wound closure was achieved after local changes of dressing, with function restoration of operative sites. Conclusion Split-skin grafts and flaps harvested from scar skin are proved as effective way of providing efficient donor sites for reconstructive surgery for scar of extensive burn in later stage post burn.

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    Technique and method
    Application of fluorescence in situ hybridization in prenatal diagnosis of chromosome abnormalities
    JIANG Wen-ting, LONG Fei, NI Lin, et al
    2010, 30 (5):  604. 
    Abstract ( 2193 )   PDF (5721KB) ( 1654 )  

    Objective To evaluate the performance of domestic fluorescence in situ hybridization (FISH) probes in prenatal diagnosis of chromosome abnormalities. Methods One hundred and fifteen amniotic fluid specimens were analysed in parallel by interphase FISH and conventional cytogenetics. Five domestic FISH probes were used to detect chromosomes 21, 18, 13,  X, Y, respectively. Results Interphase FISH experiments succeeded in 100 out of the 115 cases, and the average turn-around time of FISH was 24-48 h. The results of FISH were in conformity with those of cytogenetics in 99 cases, including 95 normal cases, 3 cases of trisomy 21 and one case of trisomy 18. A case of mosaic 47, XXY[7]/46, XY[43] was considered as uninformative on the basis of FISH reporting criteria. There were no false-positive and false-negative findings. Conclusion Domestic FISH probes have high specificity and sensitivity in prenatal diagnosis of chromosome abnormalities. Compared to conventional cytogenetics, interphase FISH with uncultured amniotic fluid cells needs less analytic material, and is rapid and easy to handle. In the designed detection scope, interphase FISH is accurate and reliable. However, there exist targets limitation and higher incidences of test failure and uninformative results.

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    Case report
    One case report of long-segmental lumbosacral neurilemmoma
    LIANG Yu-min, BAO Ying-hui, GAO Guo-yi, et al
    2010, 30 (5):  608. 
    Abstract ( 1780 )   PDF (2592KB) ( 1065 )  

    This paper reported a rare case of long-segmental lumbosacral neurilemmoma. The patient experienced weakness of both lower limbs and urinary retention as main clinical manifestations. As the lesions exhibited discrete enhancement on preoperative MRI, the initial diagnosis was made as multiple neurilemmoma. The tumor was resected by microsurgery, and the patient had favourable recovery. On basis of literature review, some issues about this case were discussed.

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