Showing papers by "Peking Union Medical College Hospital published in 1998"

Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis

Abstract: Objective. To compare magnetic resonance (MR) imaging, computed tomography (CT), and radiography in the detection of sacroiliitis accompanying ankylosing spondylitis (AS). Design and subjects. Nine volunteers and 24 patients were recruited. Radiography, CT, and MR imaging were completed within a 1-week period in 24 patients with AS. In precontrast MR examination, spin-echo T1, fast spin-echo T2, and gradient echo with rephasing T2* images were obtained without fat saturation using a 0.3-T imager for all volunteers and patients. Postcontrast MR examination was performed using the same precontrast SE T1 sequence for patients with AS. Results and conclusions. MR imaging directly showed the normal cartilage in all 16 sacroiliac joints of the 8 volunteers. In the 24 patients with AS, cartilage abnormalities were observed in 42 sacroiliac joints. More diagnoses of sacroiliitis were made using MR and CT imaging than using radiography (P<0.001). Therefore, low-field-strength MR can be useful in detecting early sacroiliitis in patients with AS. MR imaging was able to reveal early cartilage changes and bone marrow edema, which could not be found by either CT or radiography.

Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis.

Abstract: A double-blind therapeutic investigation was performed on 178 Chinese patients suffering from osteoarthritis of the knee randomized into two groups, one treated for 4 weeks with glucosamine sulfate (GS, CAS 29031-19-4, Viartril-S) at the daily dose of 1,500 mg and the other with ibuprofen (IBU, CAS 15687-27-1) at the daily dose of 1,200 mg. Knee pain at rest, at movement and at pressure, knee swelling, improvement and therapeutic utility as well as adverse events and drop-outs were recorded after 2 and 4 weeks of treatment. The variables were recorded also after 2 weeks of treatment discontinuation in order to appreciate the remnant therapeutic effect. Both GS and IBU significantly reduced the symptoms of osteoarthritis with the trend of GS to be more effective. After 2 weeks of drug discontinuation there was a remnant therapeutic effect in both groups, with the trend to be more pronounced in the GS group. GS was significantly better tolerated than IBU, as shown by the adverse drug reactions (6% in the patients of the GS group and 16% in the IBU group--p = 0.02) and by the drug-related drop-outs (0% of the patients in the GS group and 10% in the IBU group--p = 0.0017). The better tolerability of GS is explained by its mode of action, because GS specifically curbs the pathogenic mechanisms of osteoarthritis and does not inhibit the cyclo-oxygenases as the non-steroidal anti-inflammatory drugs (NSAIDs) do, with the consequent anti-inflammatory analgesic activities but also with the several adverse reactions due to this not targeted effect. The present study confirms that GS is a selective drug for osteoarthritis, as effective on the symptoms of the disease as NSAIDs but significantly better tolerated. For these properties GS seems particularly indicated in the long-term treatments needed in osteoarthritis.

Diffusion-weighted MR imaging of acute cerebral ischemia.

Abstract: Diffusion-weighted MR imaging has been used in studies on experimental animal models and on patients with acute cerebral ischemia. Compared with CT and conventional MR techniques, diffusion-weighted imaging can provide earlier and more precise detection of the location and the extent of an ischemic lesion during the critical first few hours after the onset of strokeQuantitative apparent diffusion coefficient (ADC) mapping of the brain water can also be carried out by recording a series of diffusion-weighted images with different amplitudes of the displacement encoding gradients. ADC maps can provide important information about the extra- and intracellular water homeostasis. ADC reduction of the tissue water is one of the early signals of the pathophysiological cascade resulting from ischemic tissue injury. Diffusion MR imaging has become a valuable tool in stroke research. It may also prove a valuable tool in monitoring the efficiency of therapeutic effects in stroke patientsIt is our intention to provide...

Antibiotic susceptibility patterns of Streptococcus pneumoniae in china and comparison of MICs by agar dilution and E-test methods.

Abstract: Beta-lactam resistance by Streptococcus pneumoniae is becoming a significant threat to public health worldwide. However, data concerning antibiotic susceptibility patterns in China have not been published. In this study, a total of 79 clinical isolates and 244 nasopharyngeal isolates of S. pneumoniae were recovered between June and November 1997 in Beijing. The agreement between the MICs (±1 log2 dilution) of penicillin and ceftriaxone obtained by the agar dilution and E-test methods for the 79 clinical strains was very good (97.5 and 93.7%, respectively). Of these 79 strains, 9 (11.4%) were intermediate and 2 (2.5%) were resistant to penicillin. Of the 244 nasopharyngeal strains, 32 (13.1%) were intermediate and 3 (1.2%) were resistant to penicillin. The total of 277 penicillin-susceptible clinical and nasopharyngeal isolates of Streptococcus pneumoniae were 100% susceptible to amoxicillin-clavulanic acid, cefuroxime, ceftriaxone, and cefotaxime. In the 35 penicillin-intermediate and -resistant nasopharyngeal strains, elevated MICs of amoxicillin-clavulanic acid, cefuroxime, ceftriaxone, and cefotaxime were seen for ≤4 isolates. Of 244 nasopharyngeal isolates, the overall percentages of tetracycline, erythromycin, chloramphenicol, ofloxacin, and trimethoprim-sulfamethoxazole resistance were 87.6, 74.0, 47.8, 3.7 and 63.3, respectively. Vancomycin and rifampin resistance were not detected. These findings demonstrate that the rate of penicillin-resistant pneumococci is relatively low in China compared to those of other Asian countries. Resistance to non-beta-lactams was much higher than to beta-lactams. The E-test and agar dilution methods appeared to be comparable in identifying resistant strains.

Tetramethylpyrazine, a Chinese drug, blocks coronary vasoconstriction by endothelin-1 and decreases plasma endothelin-1 levels in experimental animals.

Abstract: The purpose of this study was to investigate effects of tetramethylpyrazine (TMP), a Chinese plant-derived medicine, on coronary vasoconstriction and related electrocardiographic and histologic changes caused by endothelin-1 (ET-1), and on plasma ET-1 levels. ET-1 (75 pmol) was administered into the left coronary artery (LCA) in anesthetized closed-chest dogs with and without prior infusion of TMP (80 mg/kg). Coronary arterial diameter (CAD) was determined by coronary arteriography (CAG). Blood pressure and electrocardiogram (ECG) were monitored continuously. Histologic damage in tissues was ascertained microscopically. Plasma ET-1 and 6-keto-PGF1 levels were determined by RIA 90 min after i.v. injection of TMP (25 mg/kg; n = 5) in rabbits. Intracoronary injection of ET-1 resulted in a significant vasoconstriction of the entire vascular bed of the LCA, with a decrease in CAD of 35.9 +/- 5.7% (n = 5; p < 0.01) and ischemic changes on ECG and in tissues of endocardium, myocardium, coronary endothelial cells, and capillary vessels. Pretreatment with TMP produced a significant increase in CAD by 38.5 +/- 7.8% (n = 5; p < 0.01) and greatly suppressed the vasoconstriction produced by ET-1. The myocardial tissue damage estimated from the ratio of ischemic area for the entire area after ET-1 injection (35.6%) was completely abolished by TMP (0.6%). In addition, TMP injection induced a significant decrease in plasma ET-1 levels and an increase in 6-keto-PGF1 levels in rabbits. The Chinese medicine TMP could be a useful therapeutic agent in ischemic heart disease by suppressing coronary vasoconstriction and ischemic changes in the tissues produced by ET-1.

Antisense epidermal growth factor receptor RNA transfection in human malignant glioma cells leads to inhibition of proliferation and induction of differentiation.

Abstract: The epidermal growth factor receptor (EGFR) is a protooncogene that is frequently observed with alterations in late stage gliomas, suggesting an important role of this gene in glial tumorigenesis and progression. In this study we evaluated an antisense EGFR approach as an alternative therapeutic modality for glioblastomas. We transfected U-87MG cells with an antisense EGFR construct and obtained several clones stably expressing lower or undetectable levels of EGFR protein. These clones were found to have impaired proliferation as well as a reduced transforming potential to grow in soft agarose. The number of cells positive for the cell cycle-specific nuclear antigen Ki-67 was also significantly decreased (P<0.05) in antisense EGFR-transfected clones compared with parental or empty vectortransfected cells. Flow cytometric analysis revealed that the proportion of cells in G 0 /G 1 phases of the cell cycle in the antisense clones increased by up to 31% compared with control cells, whereas the proportion of cells in S phase decreased by up to 58%. In addition, the antisense EGFR-transfected cells showed higher expression of glial fibrillary acidic protein and a more differentiated form, with smaller cell bodies possessing fine tapering cell processes. These results suggest that EGFR plays a major role in modulating cell growth and differentiation in glioblastoma cells. Our experimental model of antisense EGFR provides a basis for future development of antisense EGFR oligodeoxynucleotides in treatment of glioblastomas.

Detection of gsp oncogene in growth hormone-secreting pituitary adenomas and the study of clinical characteristics of acromegalic patients with gsp-positive pituitary tumors.

Abstract: Objective To investigate the incidence and clinical characteristics of gsp oncogene positive growth hormone-secreting adenomas of Chinese acromegalic patients. Methods Continuously 40 patients were studied. Serum hormone levels of pituitary and target glands were measured and growth hormone (GH)-TRH stimulating tests were done before transsphenoidal or transfrontal hypophysectomy. Deoxyribonucleic acid (DNA) was extracted from the frozen tumor tissue, and the DNA fragment encompassing codon 201 and 227 of the Gs alpha gene was amplified by polymerase chain reaction (PCR). Point mutations at codon 201 and 227 were detected using PCR direct sequencing method in order to get the incidence of gsp oncogene in GH secreting adenomas. Results Of 40 tumors studied, 22 (55%) were gsp positive. The point mutation from CGT (Arg) to TGT (Cys) at codon 201 was detected in 21 pituitary tumors, but the point mutation from CAG (Gln) to CTG (Leu) at codon 227 of the Gs alpha gene was found in only 1 tumor. All of the point mutations are heterozygous. The number of gsp positive patients which have 30% or more decrease of serum GH concentration after glucose inhibition is less than that of gsp negative patients (P = 0.042). Compared to gsp negative patients, most of gsp positive patients showed paradoxical response to TRH stimulation (P = 0.002). There were more gsp positive patients with the tumor diameter less than 25 mm (P = 0.029) and with normal GH levels in OGTT after surgery (P = 0.007). Conclusions Gsp mutation is one of the major intrinsic defects in the pathogenesis of growth hormone-secreting pituitary tumors and the identification of gsp mutation can be a reference for classification and prognosis of GH tumors.

Immunoreactive endothelin-1 and its receptors in human adrenal tissues.

Abstract: To elucidate the pathophysiologic significance of endothelin-1 (ET-1) in adrenal and the mechanism for reduced responsiveness to exogenous ET-I in aldosterone-producing adenoma (APA), we have investigated ET-1 receptors by radioligand binding assay (RBA) in human normal adrenal (NA), APA. idiopathic hyperaldosteronism (IHA), and pheochromocytoma (PHEO), immunoreactive (ir-) ET-1 content in NA, APA and PHEO by radioimmunoassay (RIA), and immunohistochemical staining of ET-I with the peroxidase-anti-peroxidase (PAP) method in NA, APA, and PHEO. A single class of high-affinity binding sites for ET-1 was found in human NA and tumor tissues. Dissociation constant (K d ) values of ET-1 receptors were similar in NA, APA, and IHA, but maximal binding capacity (B max ) of ET-1 receptors was lower in APA than in NA and IHA. Both K d and B max in PHEO were higher than those in NA, APA, and IHA. Ir-ET-I content in tumors of APA and PHEO were higher than in NA. Immunohistochemical staining was more intense in the tumor cells of APA and PHEO than in NA. These results suggest that the reduced response to exogenous ET- I in APA could be related to downregulation of ET-1 receptors in the tumor. Increased ET-1 content and receptors may lead to hypersecretion of catecholamine in PHEO. ET-I produced in normal and tumor adrenal tissues may regulate aldosterone and catecholamine secretion from adrenals in a paracrine/autocrine fashion.

Effects of tetramethylpyrazine, a Chinese medicine, on plasma endothelin-1 levels during acute pulmonary hypoxia in anesthetized dogs.

Abstract: Our study was designed to elucidate the effects of tetramethylpyrazine (TMP), a Chinese medicine, on plasma endothelin-1 (ET-1) levels in dogs with acute pulmonary alveolar hypoxia. Anesthetized dogs were used under artificial ventilation with room air or a hypoxic gas mixture (10% O2 and 90% N2) (n = 10) for 60 min. Effects of TMP (80 mg/kg) were studied by i.v. injection of TMP before exposure to hypoxia (n = 8). Mean pulmonary arterial pressure (PAPm), systemic arterial pressure (SAPm), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and heart rate (HR) were measured. The pulmonary vascular resistance (PVR) was calculated by the equation of (PAPm-PCWP) x 8/CO. Plasma ET-1 levels were determined in the abdominal aorta and pulmonary artery by RIA. The effects of TMP on PAP and plasma ET-1 level were evaluated by using percent increase in PAPm and the change of Da-pET (delta ET) before and after hypoxia. Both PAPm and PVR were significantly elevated 5 min after acute hypoxia over a period of 60 min, whereas CO and PCWP did not change. Plasma ET-1 levels in the abdominal aorta and Da-pET showed a significant increase. Administration of TMP significantly decreased the hypoxia-induced increase in the PAPm, PVR, and delta ET. These results suggest that TMP could be a useful therapeutic agent in the treatment of pulmonary hypertension induced by acute hypoxia through decrease of plasma ET-1 levels.

Temporal and spatial relationship of pylorus to antroduodenal motility in functional dyspepsia.

Abstract: OBJECTIVE To investigate the temporal and spatial relationship of pylorus to antroduodenal motility in functional dyspepsia (FD). METHODS Eleven healthy subjects (HS) and 14 patients with FD were studied. Antral-pyloro-duodenal manometry was performed for 3 hours fasting and 2 hours after 80 Kcal of solid test meal. RESULTS (1) The incidence of phase III was 7/11 in HS and 3/14 in FD in antrum (P < 0.05), 8/11 and 4/14 in pylorus (P < 0.05), 10/11 and 6/14 in duodenum (P < 0.05), respectively. (2) The percentage of antropyloroduodenal coordinations during phase II of MMC was 58.5% in HS and 18.5% in FD (P < 0.001). (3) The pyloroduodenal coordination was 78.2% and 38.9% (P < 0.01) at 60 minutes after meal and 77.1% and 54.0% (P < 0.01) at 120 minutes postprandially in HS and in FD. (4) The percentage of isolated pyloric pressure waves (IPPWs) was 4.8%, 29.7% (P < 0.001) at 60 minutes, and 9.3%, 25.1% (P < 0.01) at 120 minutes in HS and FD. CONCLUSIONS There were abnormalities of gastro-pyloro-duodenal motility in both interdigestive and digestive stages; the higher incidence of IPPWs and disordered temporal and spatial relationship of pylorus to antroduodenal motility may result in a delayed gastric emptying in FD. The possible mechanism may be involved in abnormal neural control.

Long-term studies on allotransplantation of rabbit retinal pigment epithelial cells double-labelled with 5-bromodeoxyuridine and natural pigment.

Abstract: Objective To facilitate the identification of transplanted retinal pigment epithelial (RPE) cells, we sought to double-label the cells with 5-bromodeoxyuridine (BrdU) and with natural pigment. The BrdU is not lost during cell division but does require immunohistochemical methods for visualization; the pigment on the other hand, allows immediate, obvious identification, but is gradually lost with cell division. Together they provide a convenient, long-term double label. Methods Non-confluent RPE cells at the second to the fifth passages were labelled with 5-BrdU and pigment. The double-labelled RPE cells were transplanted onto Bruch's membrane of 72 eyes of New Zealand albino rabbits. The labelled cells were localized by anti-BrdU antibody and the avidin biotin-alkaline phosphatase complex (ABC-AP) method, and by visible inclusions of pigment. Results The transplanted RPE cells had distinct basal and apical morphology, and were in close contact with the photoreceptor outer segments of the host. The BrdU label was restricted to the nuclei of the RPE cells, which were stained blue. The pigment was located in the cytoplasm of the apical portion of these RPE cells. No evidence of severe rejection was seen. Conclusions Using this double-label method, transplanted RPE cells could be readily and reliably identified till one year after transplantation. The transplanted RPE cells revealed normal morphology with some function: they had distinct basal and apical morphology as seen in close contact with the outer segment of photoreceptor cells. The junctional complexes were well formed with neighboring RPE cells. The transplanted RPE cells phagocytose shed outer segments of the host. No evidence of rejection was observed, suggesting that the subretinal space of the rabbit may possess some degree of immunologic privilege. This experiment provides reliable evidence for the clinical research of allotransplantation of RPE cells.

[HLA-DRB alleles polymorphism in susceptibility to asthma in Beijing Chinese].

Abstract: OBJECTIVES To investigate whether susceptibility or resistance to asthma associated with HLA-DRB alleles and analyze the relationship between HLA-DRB genes and clinical phenotype of asthma (TIgE, sIgE, BHR). METHODS Using PCR-SSP(sequence-specific primer polymerase chain reaction), we tested the frequency distribution of HLA-DRB alleles in 50 asthmatic patients and 80 healthy volunteers from Beijing China. All patients had their serum TIgE, IgE antibody specific to house dust mite measured by RAST, bronchial responsiveness assessed by methacholine bronch-provocation (if FEV1% > or = 70%), and broncho-dilation measurement by inhaling salbutamol. RESULTS There was significantly increased gene frequency of alleles DR6(13), DR52 in asthmatics compared with normal controls (17% vs 4.3%, P or = +4). There was no relationship between HLA-DRB alleles and total IgE, BHR. CONCLUSIONS Alleles DR6(13), DR52 are significantly implicated in their susceptibility to asthma, at least they may be closely associated with this disorder. Conversely DR2(15), DR51 alleles might confer protection against asthma. Positive associations between DR6(13), DR52 and IgE response to d1 allergen are noted. HLA-DRB genes are particularly involved in regulating human atopic immune response.

Effect of cardiogenic and noncardiogenic pulmonary edema on histamine responsiveness in sheep

Abstract: We compared the effects of cardiogenic pulmonary edema, brief pulmonary vascular congestion without frank edema, and noncardiogenic pulmonary edema on responsiveness to inhaled histamine in chronic...

[Rheumatoid arthritis synoviocyte hyperplasia and expression of fas and bcl-2 genes].

Abstract: OBJECTIVE To determine whether apoptosis occurs in the proliferative synovial tissue and cells from patients with rheumatoid arthritis (RA). METHODS In situ hybridization was carried out by using labeled RNA probes of fas, fasL, and bcl-2 synthesized by in vitro transcription. Apoptosis was examined by DNA electrophoresis and flow cytometry. RESULTS fas mRNAs were expressed in 6 of 7 patients with RA. bcl-2 mRNAs were positive in 5 of 7 patients with RA. fasL mRNAs were not detectable in all the patients. bcl-2 mRNAs were always coexpressed with fas in RA synovial lining cells. The positive rates of fas and bcl-2 expression in RA synovial tissues were significantly higher than those of patients with osteoarthritis (OA) and normal synovial tissues (P < 0.05). Immunochemistry staining showed that Fas and Bcl-2 proteins were expressed in the synovial lining cells. Nucleic DNA extracted from the synovial tissues of 6 patients with RA, 4 patients with OA and 2 normal controls. Agarose gel electrophoresis demonstrated that DNA ladders occurred in only one OA synovial tissue. The spontaneous apoptosis in cultured synoviocytes from patients with RA and OA was lower as analyzed by immunofluorescence staining and flow cytometry. CONCLUSION The phenomena of apoptosis in RA synoviocytes was not significant and overexpression of bcl-2 perhaps inhibited apoptosis in these cells, leading to hyperplasia of RA synoviocytes.

Prevention of maternal-fetal blood group incompatibility with traditional Chinese herbal medicine.

Abstract: OBJECTIVE To evaluate the effect of traditional Chinese herbal medicine on the prevention of hemolytic disease caused by maternal-fetal blood group incompatibility. METHODS A total of 126 Chinese patients with maternal-fetal blood group incompatibility were studied, including 105 cases of ABO type and 21 cases of Rh type incompatibility. The traditional Chinese herbal medicine was used for preventative treatment in 79 cases, and 47 cases served as controls. The prescription consisted of Herba leonuri 500 g, white peony root 180 g, Banksia rose 12 g, root of Chinese angelica 150 g and Rhizomal ligustica 150 g. RESULTS Preventative treatment with traditional Chinese herbal medicine significantly reduced the perinatal mortality rate in cases of Rh type incompatibility, from 50.0% in the control group to 7.7% in the treatment group (P < 0.05). There was no death in the cases of ABO incompatibility. The traditional Chinese herbal medicine also decreased the degree of hemolysis. The percentage of severe cases in the control group was 29.8%, while it was 15.2% in the treatment group (P = 0.05). The duration of treatment was closely related to the outcomes. In patients who used traditional Chinese herbal medicine for more than 10 weeks, the incidence of severe hemolysis was 8.2%, compared with 38.9% in those treated for less than 10 weeks (P < 0.05). The change of serum immune antibody (A and/or B) titers during the treatment was a very important predictive factor for the outcome of the pregnancy. CONCLUSION Traditional Chinese herbal medicine is effective not only for ABO type but also for Rh type maternal-fetal blood group incompatibility, with no side effects.

Stroke and functional rehabilitation: the Chinese experience.

Abstract: According to an epidemiological study of cerebrovascular disease carried out in China in 1986, the prevalence, incidence, and mortality rates were 159.93/100,000, 115.61/100,000, and 31.33/100,000, respectively. These figures were high compared to available epidemiological data for the rest of the world. This highlights the fact that, as in other countries, functional rehabilitation after stroke is an important medical and social need in China. Clinical experience shows that within a few hours to a few months after a stroke, a large proportion of patients spontaneously experience partial, or on occasion, complete recovery from neurologic symptoms. However, functional rehabilitation in medical care units is required because it assists in and accelerates the recovery of impaired function. Almitrine-raubasine has been used to improve functional rehabilitation after stroke for some time in China. By enriching the oxygen content of arterial blood, it brings more oxygen to the cerebral tissues and therefore promotes cerebral aerobic metabolism during ischemia. In the acute phase of stroke, positron emission tomography showed, in man, that almitrine-raubasine helps normalize the ischemic penumbra area, as shown by an improvement in the coupling between oxygenation and perfusion. Long after stroke, single photon emission computed tomography showed that almitrine-raubasine restores normal cerebral vasodilator response to acetazolamide. With a view to further documenting the clinical efficacy of almitrine-raubasine on the convalescent period of patients with cerebrovascular disease, a double-blind, placebo-controlled study is planned. One hundred patients with ischemic cerebrovascular disease in the territory of the carotid artery will be included 4–6 weeks after the acute onset. Two tablets daily of almitrine-raubasine or placebo will be prescribed for 3–6 months. Before treatment, there will be a 2-week washout period for all other drugs, except for antihypertensive and antidiabetic drugs. In addition to complete clinical monthly examinations, neurological functional deficit scores, Barthel index, Hasagawa Dementia scales, and CT scan are scheduled. The study results should confirm those reported in the scientific literature: although untreated patients may show spontaneous improvement, almitrine-raubasine should accelerate patients’ functional rehabilitation.

Clinical manifestations and immunological features of primary Sjögren's syndrome with liver involvement: analysis of thirty cases.

Abstract: Objective To evaluate the incidence, severity, clinical manifestations and immunological features relevant to liver involvement in 135 cases of primary Sjogren's syndrome. Methods One hundred and thirty-five patients with definite primary Sjogren's syndrome were analyzed retrospectively for liver involvement by the abnormalities of the liver enzymes, bilirubin level and liver biopsied section. Results The liver involvement in 30 patients (22.2%) could be etiologically ascribed to Sjogren's syndrome itself. The clinical spectrum and severity of this entity differed widely, 36.6% showed no relevant clinical symptoms, however jaundice was found in 46.7% of patients. Six patients showed pathological changes of chronic active hepatitis. 73.3% of all patients with liver involvement responded to steroid and immunosuppressive drugs, yet with a tendency to relapse (two cases). Liver cirrhosis was developed in five cases. The spectrum of serum autoantibodies in the patients with liver involvement showed no difference from those without liver involvement. Most of them were compatible with the serum profile of autoimmune hepatitis type-1. Conclusions Liver involvement was complicated in 22.2% patients of primary Sjogren's syndrome. Clinical manifestations were non-specific and the main pathological change was chronic active hepatitis. The differential diagnosis between Sjogren's syndrome with liver involvement and type-1 autoimmune hepatitis could be only ascribed to other systemic clinical manifestations of Sjogren's syndrome.

Steroid-resistant asthma: effects of glucocorticoids on interleukin-4 and interleukin-5 gene expression.

Abstract: OBJECTIVE: To investigate the role of interleukin-4 (IL-4) and interleukin-5 (IL-5) in the pathogenesis of steroid-resistant (SR) asthma. METHODS: Fifteen patients with SR asthma and 15 patients with steroid-sensitive (SS) asthma were selected based on their clinical responses to prednisone therapy. The peripheral blood mononuclear cells (PBMCs) were obtained and incubated with phytohemagglutinin (PHA) in vitro for 48 h in the presence or absence of dexamethasone (10(-7) mol/L). Expressions of IL-4 and IL-5 mRNA in PBMCs were determined by reverse transcription-polymerase chain reaction (RT-PCR), and mRNA positive PBMCs for IL-4 and IL-5 were measured with in situ hybridization using digoxin-labeled cDNA probes. RESULTS: In the absence of dexamethasone, there was no significant difference in the expressions of IL-4 and IL-5 mRNA between SR and SS asthmatics, and the numbers of mRNA positive cells for IL-4 and IL-5 were also similar between these two groups, however, in the presence of dexamethasone (10(-7) mol/L), expressions of IL-4 mRNA (P 0.05). The numbers of IL-4 and IL-5 mRNA positive cells decreased from 5.50 +/- 1.60 to 2.27 +/- 0.98 (P < 0.01) and from 5.03 +/- 1.29 to 1.67 +/- 0.70 (P < 0.01), respectively in SS asthmatics, but in the patients with SR asthma, there was no significant change in the number of cells expressing mRNA for IL-4 or IL-5. CONCLUSION: The gene expression of IL-4 and IL-5 in SR asthma was not inhibited by dexamethasone at the concentration of 10(-7) mol/L. It is suggested that the relative unresponsiveness of T cells to glucocorticoids and persistent production of cytokines may be one of the mechanisms of steroid resistance in asthma.

Analysis of the characteristics of folate binding proteins and its relationship with expression of multidrug resistance P-glycoprotein in myelodysplastic syndromes.

Abstract: OBJECTIVE To observe the characteristics of folate binding proteins (FBP) in myelodysplastic syndromes (MDS) and leukemia and to study the clinical significance of reduced folate carrier (RFC) present in MDS and its relationship with multidrug resistance (MDR). METHODS The features of FBP on bone marrow cells were analyzed using radiolabeled 3H-folic acid (3H-FA) binding membrane proteins and SDS-polyacrylamide gel electrophoresis (SDS-PAGE). In the same time, P-glucoprotein and mRNA of MDR gene were detected using immunocytochemistry and reverse transcription polymerase chain reaction (RT-PCR) respectively in patients with MDS and leukemia. RESULTS Two kinds of FBP, folate receptor (FR) and reduced folate carrier (RFC), were found on the leukemic cells. The same results were presented on mononuclear cells of bone marrow in 5 out of 14 MDS patients, and MDR positive was seen in 4 patiens of them. In normal control and other 9 cases of MDS FRs were only found on the mononuclear cells of bone marrow. CONCLUSION Reduced folate carrier, which is present in the leukemic cell, is a product of neoplastic cell. It might reveal preleukmic state and have the same significance with MDR that RFC is found in MDS patients.

Myopic regression after photorefractive keratectomy

Abstract: OBJECTIVE To investigate myopic regression after excimer laser photorefractive keratectomy (PRK) in patients with myopia. METHODS 103 eyes with regression (>or= -1.00 D) found in the follow-up for more than 1 year were included in this study. The preoperative spherical equivalent was -4.00 - -14.50 D (-8.72 +/- 2.65 D). Patients were divided into two groups: (1) moderate myopia (-4.00 - -7.90 D) and (2) high myopia (>or= -8.00 D). RESULTS A significant positive correlation was found between regression and the extent of attempted correction, the rate of regression in high myopia group was 6.93% and that in moderate group, 1.17%. The rate of regression in older age group was higher than that in younger cases. (P < 0.01). Relatively severe haze under the corneal epithelium often accompanies the regression, and decrease of the dosage of topical corticosteroid application or its withdrawal because of the development of corticosteroid ocular hypertention could lead to the regression. The stability of the refraction is not related to the difference in sex. The regression is often accompanied by the increase in K value. CONCLUSION The regression is significantly related to the extent of attempted correction, patients' age, corneal haze and topical application of corticosteroid.

The diagnosis and treatment of cerebrospinal fluid rhinorrhea

Abstract: OBJECTIVE: To summarize our experience in managing cerebrospinal fluid(CSF) rhinorrhea. METHODS: Twenty-nine cases with cerebrospinal fluid rhinorrhea from 1982 to March of 1997 were reviewed. The duration of CSF rhinorrhea varied from 3 months to 23 years. The ages of the patients ranged from 7 to 72 years. RESULTS: The causes of CSF leak were spontaneous in 18 cases, traumatic in 6 (1 had two accidents and got two different leaking sites) and iatrogenic in 5 cases. Twenty-two cases underwent surgical repair. Overall closure rate was 81.8%. The causes, symptoms and signs, sites of leakage and surgical techniques were analyzed. The classification, diagnosis and treatment of CSF rhinorrhea were discussed. CONCLUSION: Transnasal extracranial repair undertaken by otorhinolaryngologist got better closure rate(93.8%) in this group. Transnasal endoscopic repair could afford excellent view, facilitate precise tissue graft placement and get better closure rate. Language: zh

[The diagnosis of non-pituitary space-occupied lesions in sphenoidal sinus and sellar area].

Abstract: Objective To improve the diagnostic accuracy of non-pituitary lesions in sphenoidal sinus and sellar area. Methods Twenty-four cases with non-pituitary lesions in sphenoidal sinus and sellar area were analyzed. Eighteen cases were benign, including 7 sphenoidal sinus cyst, 6 craniopharyngioma, 2 chordoma, 1 nasal polyp extending into the sella, 1 neuronoma in sella, and 1 pinealoma. Six cases were malignant, including 2 malignant neuroendocrinoma in sphenoidal sinus, 1 adenoidocystic carcinoma, 1 sphenoidal sinus low differentiated carcinoma, 1 nasopharyngeal carcinoma extending into sella, 1 lung cancer metastasis to sphenoidal sinus. Clinical presentation, examination, imaging study, diagnosis and treatment were discussed. Results Among 24 cases, 18 had headache, 17 had visual symptoms. In all cases the space-occupied lesions in sphenoidal sinus and sellar area were verified by CT scan. Conclusions 1. Headache at different levels was the commonest symptom for benign and malignant lesions. The visual loss was another common symptom. It is important to realize the relationship between visual symptom and space-occupied lesions in sphenoidal sinus and sellar area; 2. Imaging study is very important for the diagnosis of the lesions in sphenoidal sinus and sellar area; 3. It is helpful to do needle-aspirating biopsy under endoscopy to confirm the pathologic diagnosis. The benign lesions were operated on, and malignant lesions were treated by combined operation and radiation.