Showing papers by "Peking Union Medical College Hospital published in 2002"

Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome.

Abstract: Objectives. To study the risk factor for nosocomial bacteremia caused by Escherichia coli or Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL) and the influence on patient outcome. Design. Retrospective, single-center study of consecutive bacteremic patients. Settings. A university-affiliated teaching hospital. Patients. A total of 85 patients with nosocomial bacteremia due to E. coli or K. pneumoniae were enrolled. Intervention. None. Measurements and main results. The demographic characteristics and clinical information including treatment were recorded upon review of patients' records. The primary end point was hospital mortality. Twenty-seven percent of isolates produced ESBLs. Previous treatment with 3rd-generation cephalosporins was the only independent risk factor for bacteremia due to ESBL-producing pathogens [odds ratio (OR) 4.146, P=0.008]. Antibiotic treatment was considered appropriate in 71 cases (83%), and failed in 23 patients (27%). Twenty-one patients (25%) died in the hospital. Antibiotic treatment failure was the only independent risk factor for hospital mortality (OR 15.376, P=0.001). Inappropriate antibiotic treatment might lead to significantly higher mortality rate (7/14 vs 14/71, P=0.016). Patients treated with imipenem were more likely to survive while those receiving cephalosporin treatment tended to have a poorer outcome (1/19 vs 14/40, P=0.023). Conclusions. More judicious use of cephalosporins, especially 3rd-generation cephalosporins, may decrease ESBL-producing E. coli or K. pneumoniae bacteremia, and also improve patient outcome.

Very low prevalence of hip osteoarthritis among Chinese elderly in Beijing, China, compared with whites in the United States: the Beijing osteoarthritis study.

Abstract: Objective To compare the prevalence of osteoarthritis (OA) of the hip among elderly persons in China and the US. Methods We recruited a population-based sample of 1,506 persons (82% of those enumerated) ages ≥60 years living in Beijing, China. Subjects answered questions about joint symptoms and underwent radiography of the pelvis. Radiographs of the Beijing subjects were intermingled with hip radiographs of white women ages ≥65 years from the Study of Osteoporotic Fractures (SOF) and white men and women ages 60–74 years from the First National Health and Nutrition Examination Survey (NHANES-I) and were then interpreted. Radiographic hip OA was defined as the presence of 1 of the following 3 findings in either hip: minimum joint space of ≤1.5 mm, definite osteophytes and joint space narrowing, or ≥3 radiographic features of OA. Symptomatic hip OA was defined as both radiographic OA and hip pain. Results The crude prevalence of radiographic hip OA in Chinese ages 60–89 years was 0.9% in women and 1.1% in men; it did not increase with age. Chinese women had a lower age-standardized prevalence of radiographic hip OA compared with white women in the SOF (age-standardized prevalence ratio 0.07) and the NHANES-I (prevalence ratio 0.22). Chinese men had a lower prevalence of radiographic hip OA compared with white men of the same age in the NHANES-I (prevalence ratio 0.19). There were no cases of symptomatic hip OA in the Chinese men and only 1 case in the Chinese women; 35 cases were expected in both sexes. Conclusion This is the first population-based study of hip OA in China to use standardized radiographic methods and definitions. We found that hip OA was 80–90% less frequent than in white persons in the US. Identification of the genetic and environmental factors that underlie these differences may help elucidate the etiology and prevention of hip OA.

[Clinical efficacy and safety of huperzine Alpha in treatment of mild to moderate Alzheimer disease, a placebo-controlled, double-blind, randomized trial]

Abstract: Objective To evaluate the clinical efficacy and safety of huperzine Alpha in treatment of patients with mild to moderate Alzheimer disease (AD). Methods Two hundred and two patients with the diagnosis of possible or probable AD from 15 centers the nationwide were randomly divided into two groups: huperzine Alpha group (n = 100, given huperzine Alpha 400 micro g/day for 12 weeks) and placebo group (n = 102 ). Different scales were used to evaluate the cognitive function, activity of daily life (ADL), non-cognitive disorders, and overall clinical efficacy. Safety evaluation was conducted every 6 weeks. Results In comparison with the baseline data, there was an improvement of 4.6 points in cognition assessed by ADAS-Cog (P = 0.000); an improvement of 2.7 points by MMSE (P = 0.000), an improvement of 1.5 points in behavior and mood by ADAS-non-Cog (P = 0.008) with 59.2% of the patients being on the mend clinically; and an improvement of 2.4 points by ADL (P = 0.001) with the capacity of ADL improved by at least 10% among 32.75% of the patients. 70% of the patients in huperzine Alpha group scored 1 approximately 3 points, and 27.8% of them scored 1 approximately 2 points by CIBIC-plus. The proportions of patients with an improvement of >/= 4 points by ADAS-Cog were 56.1% and 12.5% in the huperzine Alpha group and placebo group respectively (P = 0.000). The proportions of patients with an improvement of >/= 4 points by MMSE were 37.8% and 10.1% in the huperzine Alpha group and placebo group respectively (P = 0.000). The proportions of patients with an improvement of 1 approximately 3 points in global rating by CIBIC-plus were 59.2% and 40.6% in the huperzine Alpha group and placebo group respectively (P = 0.01). The proportions of patients with an improvement of >/= 10% points by ADL were 32.7% and 17.2% in the huperzine Alpha group and placebo group respectively (P = 0.01). The proportions of patients with an improvement of > 0 points by ADS-non-C0g were 70.0% and 36.3% in the huperzine Alpha group and placebo group respectively (P = 0.000). Mild and transient adverse events (edema of bilateral ankles and insomnia) were observed in 3% of huperzine Alpha treated patients. Conclusion A safe and effective medicine, huperzine Alpha remarkably improves the cognition, behavior, ADL,and mood of AD patients.

Clinical characteristics of clear cell carcinoma of the ovary

Abstract: Objective To study the clinical characteristics of clear cell carcinoma of the ovary. Methods Forty three patients with clear cell carcinoma of the ovary and 51 patients with serous adenocarcinoma of the ovary who were admitted in Peking Union Medical College Hospital between 1984 to 2000 were analyzed retrospectively, and their chemosensitivities and the survival rates were compared. Results The percentage of early stage patients in the clear cell carcinoma of the ovary and the serous adenocarcinoma of the ovary was 14 4% and 3 8% respectively, the difference was significant ( P 0 005). In the late stage patients who underwent satisfactory cytoreductive surgery, the chemo resistant rate (88 9%) in the clear cell carcinoma of the ovary was significantly higher than that (57 1%) of the serous adenocarcinoma of the ovary ( P 0 02), the 1 year survival rate (79 0%) in the clear cell carcinoma of the ovary was significantly lower than that (96 2%)of the serous adenocarcinoma of the ovary ( P 0 01). In the late stage patients who underwent unsatisfactory cytoreductive surgery, the chemo resistant rate and the survival rate had no significant difference between the clear cell carcinoma of the ovary and the serous adenocarcinoma of the ovary ( P 0 05). Conclusions There are more early stage patients with clear cell carcinoma of the ovary. We should conduct auxiliary therapy and close follow up to them after surgery. Clear cell carcinoma of the ovary is chemo resistant to platinum based chemotherapy and has poor prognosis.

Genomic polymorphism within interleukin-1 family cytokines influences the outcome of septic patients.

Abstract: ObjectiveTo determine the allele frequencies and genotype distribution of interleukin-1α, interleukin-1β, and interleukin-1 receptor antagonist gene polymorphism in septic patients.DesignProspective, consecutive entry study of septic patients in a general intensive care unit.SettingA 14-bed general

Clinicopathologic study of 123 cases of prolactin-secreting pituitary adenomas with special reference to multihormone production and clonality of the adenomas.

Abstract: BACKGROUND Prolactinoma is the most invasive type of pituitary adenoma and is generally believed to be well-differentiated adenoma and to produce only prolactin (PRL). The factors related to the various biologic behaviors occurring in patients of different ages and sexes await clarification. Since different immunophenotypes of adenoma may show different biologic behaviors and responses to medical agents, the authors examined hormone production and tried to clarify the clonality of plurihormonal prolactinoma. METHODS Clinicopathologic factors were studied in 123 patients with prolactinomas (40 males and 83 females). The specimens were fixed in either 10% neutral buffered formalin or 70% alcohol and used for light microscopy. Alcohol-fixed tissue was used to extract DNA from 26 samples obtained from female patients for human androgen receptor gene (HUMARA) assay. RESULTS Sixty one cases (50%) were pure prolactinoma and 62 cases (50%) were plurihormonal prolactinoma. Spearman rank correlation analysis revealed a significant relationship between age and serum PRL level (P = 0.0002), age and tumor volume (P < 0.0001), and tumor volume and serum PRL level (P < 0.0001). Multiple regression analysis showed a significant correlation only between tumor volume and serum PRL level. The Mann-Whitney U test revealed that prolactinomas associated with higher PRL levels, larger adenomas, and higher ages were significantly more invasive to the cavernous sinus and that male patients had significantly higher PRL levels and larger adenomas. The HUMARA assay disclosed that 11 of 13 plurihormonal prolactinomas (85%) were compatible with monoclonal origin. CONCLUSIONS The current results suggest that not only can various hormones other than PRL be secreted by prolactinoma, but also that most multihormone-producing prolactinomas are monoclonal in origin. Cancer 2002;95:258–66. © 2002 American Cancer Society. DOI 10.1002/cncr.10676

Retrospective analysis of 18 cases of antithyroid drug (ATD)-induced agranulocytosis.

Abstract: In this study, we retrospectively analyzed 18 patients in whom antithyroid drug (ATD)-induced agranulocytosis developed during treatment of Graves' disease. All patients were more than 20 years of age, and we saw no correlation between age and the development of agranulocytosis. In 17 of 18 patients, ATD-induced agranulocytosis developed within 2 to 12 weeks of starting ATD treatment. Development of agranulocytosis was related to the dose of ATD. In some patients, agranulocytosis developed abruptly, and even weekly routine WBC and granulocyte counts failed to predict all case occurrences. Fever and sore throat were the earliest symptoms of agranulocytosis; patients who developed either of these symptoms were closely monitored immediately with WBC and granulocyte count examinations. In this series of patients, treatment with granulocyte-macrophage colony stimulating factor (GM-CSF) increased the granulocyte counts, whereas the effectiveness of glucocorticoid treatment was not confirmed.

Intestinal infection and irritable bowel syndrome

Abstract: Objective To determine whether intestinal infection plays a role on the pathogenesis of irritable bowel syndrome (IBS). Methods 295 patients who had no previous history of functional bowel disorder had received treatment for dysentery (n=235) or for acute bowel infection at the hospital between April-October, 1998 ,were followed up for 1-2 years and evaluated for their subsequent bowel habits. A cohort study of 243 subjects using their siblings, husbands or wives who did not have dysentery or acute bowel infection at the same period was taken as control. Furthermore, the contents of mRNAs of IL-1α?IL-1β and IL-1ra in the mucosa at the terminal ileum and recto-sigmoid junctions were determined and compared using RT-PCR method in 30 IBS patients and 12 controls. Results (1)Sixty-six (22.4%) patients were reported to have functional bowel disturbance, and 24(8.1% total and 10.2% among cases of dysentery ) developed IBS in the study group, whereas, only 7.4% had altered bowel habit and 0.8% had IBS in the control group(P0.01). (2)The risk of having functional bowel disturbance was higher in patients who suffered from a longer duration (8 d, OR=3.5)of dysentery. (3)The IL-1β mRNA level in the mucosa of terminal ileum and recto-sigmoid junction of IBS patients with dysentery was higher than that of controls and IBS patients without dysentery (P0.01).Conclusion Intestinal infection plays a role on the pathogenesis of IBS through some immunological factors.

Diagnostic criteria for locating acquired arteriovenous fistulas with color Doppler sonography.

Abstract: Purpose. The purpose of this prospective study was to evaluate and determine criteria for locating acquired arteriovenous fistulas using color Doppler sonography. Methods. We performed color Doppler sonography on 12 consecutive patients with acquired arteriovenous fistulas. We evaluated the morphologic and hemodynamic changes in the involved vessels to help locate the fistulas (10 in the extremities, 1 in the neck, and 1 in the abdomen). Results. In all cases, turbulent high-velocity flow spectrum and flow signals were present at the fistula sites, and arterialized waveforms from the draining veins were detected. In the 10 cases of acquired arteriovenous fistulas in the extremities, the resistance indices in the arteries proximal to the fistulas were all less than 1.00 (mean, 0.65), whereas the resistance indices in the arteries distal to the fistulas were all 1.00 or greater (mean, 1.17). In 70% of the cases, the diameter of the artery proximal to the fistula was at least 1.2 mm larger than that distal to the fistula. The fistula site was inferred by the point of maximal venous dilatation in 70% of the cases and by the focal perivascular color artifact in 82% of the cases. The fistula site was identified on gray-scale sonography and color flow imaging in 33% and 75% of the cases, respectively. Conclusions. Fistula sites can be located effectively and quickly by a combination of major and minor diagnostic criteria. The major diagnostic criteria are (1) junction of low- and high-resistance flow in the supplying artery, (2) a high-velocity arterialized waveform in the draining vein, and (3) a turbulent, high-velocity flow spectrum at the junction of the artery and the vein. The minor diagnostic criteria are (1) direct communication between the involved artery and vein, (2) significant change in the diameter of the supplying artery, (3) a focal point of venous dilatation, and (4) a focal perivascular color artifact. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:336–342, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.10084

Prevalence of glaucoma and normal intraocular pressure among adults aged 50 years or above in Shunyi county of Beijing

Abstract: OBJECTIVE: To estimate the prevalence of glaucoma and normal intraocular pressure among older adults aged 50 years or above in Shunyi county of Beijing. METHODS: Cluster sampling was used in randomly selecting 5 555 individuals aged 50 years or above in Shunyi county in fall, 1996. The examines received the visual acuity and general eye examination, and in the mean time attention was paid to rule out glaucoma, including inquiry of family and personal history of glaucoma, measurement of anterior chamber depth and intraocular pressure, examination of the optic disc. RESULTS: The examinations about glaucoma were finished in 4 880 individuals. The response rate was 87.85%. In this population, the prevalence of glaucoma was 2.07%. The prevalence of the primary angle closure glaucoma, primary open angle glaucoma and secondary glaucoma was 1.66%, 0.29% and 0.12% respectively. The prevalence of the variety of glaucoma was increasing by aging. The visual function in 64.00% of glaucoma patients was damaged in certain degree. The rate of the bilateral blindness among glaucoma patients was 16.00%. These patients were all 60 years old or above. The rates of unilateral blindness, bilateral allow vision and unilateral low vision were 17.00%, 23.00% and 8.00%, respectively. The mean and standard deviation of the intraocular pressure among the normal eyes were (13.53 +/- 2.20)mm Hg(1 mm Hg = 0.133 kPa). The tendency of the mean normal intraocular pressure is decreasing by aging. CONCLUSIONS: Glaucoma is a serious eye disease leading to blindness according to the prevalence and the visual function of the glaucoma patients. The mean intraocular pressure among the normal eyes is lower than the expected value. The lower value (18 mm Hg) of the upper limited normal intraocular pressure should be used in screening glaucoma patients among the older adults.

Effect of Dexrazoxane on Homocysteine-Induced Endothelial Dysfunction in Normal Subjects

Abstract: Objective — Dexrazoxane is an antioxidant prodrug that on hydrolysis is converted into an intracellular iron chelator. We hypothesized that the antioxidant effects of dexrazoxane would prevent homocysteine-induced endothelial dysfunction in the brachial artery of normal human subjects. Methods and Results — Ten healthy volunteers completed a randomized, double-blind, crossover study. Plasma homocysteine levels and brachial artery endothelium-dependent (flow-mediated dilation [FMD]) and endothelium-independent (sublingual nitroglycerin) responses were measured before and 4 hours after ingestion of l-methionine (100 mg/kg), preceded by intravenous administration of dexrazoxane (500 mg/m 2 ) or placebo over 30 minutes. After placebo, oral methionine increased plasma homocysteine (from 5.1±0.4 μmol/L at baseline to 14.2±1.3 μmol/L at 4 hours, P P =0.02). Dexrazoxane did not change homocysteine concentrations after methionine administration (14.9±1.1 μmol/L at 4 hours, P =0.29 versus placebo) but did completely abrogate the homocysteine-induced reduction in FMD (from 3.5±0.5% at baseline to 5.9±1.1% at 4 hours, P Conclusions — Administration of the novel antioxidant agent dexrazoxane prevents homocysteine-induced impairment of vascular endothelial function in the brachial artery of healthy subjects.

beta-fibrinogen gene -455A/G polymorphism and plasma fibrinogen level in Chinese stroke patients.

Abstract: Objectives To investigate the relationship between the β-fibrinogen gene -455A/G polymorphism and plasma fibrinogen level and to determine the influence of the mutation on ischemic stroke. Methods Ninety-one patients (63.5 ′ 10.1 years) with ischemic stroke and 74 elderly control subjects (60.6 ′ 10.8 years) without any thromboembolic events and 98 healthy blood donators as young control (37.5 ′ 13.3 years) were enrolled in this trial. The β-fibrinogen gene -455A/G polymorphism was analyzed for all subjects by PCR-RFLP with the restrictive enzyme Hae III, while plasma fibrinogen levels were obtained from the prothrombin time (PT) assay. For statistical analysis, the parameters were compared between any two different groups by the unpaired Student's t test and the Chi-square test. Before analysis, log transformations for concentrations of fibrinogen were carried out. Results H2 allele frequency was higher in male ischemic stroke patients than in the elderly control (22.7% vs 7.1%, Χ 2 = 5.56, P < 0.02). There was no significant difference between the female groups. In those patients without any thromboembolic events (both elderly and young control groups), the frequency of H2 decreased with age (≤40, 21.3%; 41 - 59, 15.4%; and ≥60, 10.2%). In the male elderly and young control groups, the level of plasma fibrinogen was lower in the H1H1 genotype (287 ′ 96 mg/dl and 234 ′ 58 mg/dl) than in H1H2 and H2H2 (331 ′ 44 mg/dl and 307 ′ 55 mg/dl; t = 2.53 and 9.67, P < 0.05). In the female elderly groups, this tendency was not found. Conclusion Plasma fibrinogen expression is affected by the β-fibrinogen gene -455A/G polymorphism, and the H2 allele may be a risk factor for ischemic stroke in Chinese males.

Retrospective investigation of hospitalized patients with heart failure in some parts of China in 1980, 1990 and 2000

Abstract: Objective To evaluate the current status of heart failure in some parts of China and analyze the epidemiological evolution of its general condition,etiology,pharmaceutical therapy, outcome and mortality,and provide information on the prevention and treatment strategy of heart failure in China Methods Data on primary diagnosis of chronic heart failure were taken from 42 hospitals in different cities of China All patients were admitted to hospital in 1980, 1990 and 2000 Results (1) A total of 10 714 patients with heart failure were enrolled The majority (56 7%) were males and the average age was( 63 1±16 1)years to (67 8±16 5)years More than 60% were older than 60 years (2)The courses of the heart failure in 1980,1990 and 2000 were (128 9±125 7)months,(88 1±98 6)months and (46 6±77 4)months ( P 0 001), respectively,and in hospital durations were (35 1±43 0) days,(31 6±34 1) days, (21 8±25 6) days( P 0 001), respectively,with the trend of decreasing year by year (3) Common causes of heart failure were coronary heart disease, rheumatic valvular heart disease and hypertension From 1980 to 2000,the rate of coronary heart disease and hypertension rose from 36 8% and 8 0% to 45 6% and 12 9%, respectively Meanwhile the rate of rheumatic valvular heart disease fell from 34 4% to 18 6%(all P 0 001 ) (4)The most patients′ heart functions before hospitalization of all the three years were graded as level Ⅲ (42 5%-43 7%),and patients with heart function of level Ⅱ increased year by year(24 5%, 26 7%, 27 7%, respectively); by contrast the patients of level Ⅳ heart function reduced at the same time (32 4%, 28 8%, 27 5%) (5)There was no distinct difference of the rate of thoracic X ray examination and the abnormal heart thoracic ratio among the three years; but proportion of UCG examination and the patients with low LVEF increased year by year,being 27 6%, 40 5%, 47 5%( P 0 001)and 40 1%, 45 0%, 53 5%( P 0 001), respectively (6)The diuretics, nitride and digitalis still dominated the drug therapy in hospital, with the total proportion of 55 4%, 43 2%, 48 2%, respectively The proportion of patients receiving digitalis decreased (51 7%, 45 5%, 40 3%);and the users of β blocker and ACEI increased from 8 5% and 14 0% in 1980 to 19 0% and 40 4% in 2000, respectively (7)The heart failure were obviously corrected during hospitalization, the improvement rate being 15 5%, 19 6% and 22 2% ( P 0 001), respectively, with significantly decreased mortality of 15 4%, 12 3%, 6 2%( P 0 001),but still higher than that of whole cardiac diseases at the same period (8 2%, 5 6% and 2 6% in the three years, respectively) The proportion of heart failure mortality to the whole cardiac deaths still remained unchanged (39 9%,37 7%,41 1%, respectively) (8)The causes of the heart failure were pump failure(59%),arrhythmia (13%),sudden death (13%), and others (14%) in turn Conclusions There was no decrease in the proportion of heart failure to the whole cardiac diseases hospitalized patients The primary diseases causing heart failure in the hospitalized patients shifted from the rheumatic heart disease to the coronary heart disease, and the conventional drugs still dominate the medical therapy for the heart failure, but the use of β blocker and ACEI increased significantly Although the mortality of heart failure decreased, the proportion of it to cardiac diseases mortality kept unchanged

[Hyperhomocysteine, methylenetetrahydrofolate reductase gene, and other risk factors in ischemic stroke].

Abstract: Objective To investigate the relation between plasma homocysteine (Hcy) and cerebral ischemic diseases and that between polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene and cerebral ischemic diseases. Methods The plasma homocysteine (Hcy) and genetic polymorphism of MTHFR among forty nine cases with ischemic cerebral diseases, including 25 with acute cerebral infarction (CI) and 25 with transient ischemic attacks (TIA), were investigated. Fifty five age and sex matched healthy persons were used as controls. All the subjects underwent brain CT, carotid duplex, transcranial Doppler examination, plasma Vitamin B 12 and folic acid examination, besides examination of plasma Hcy and nucleotide 677 MTHFR genotypes. The effects of age, liver function, renal fuction, smoking, drinking, plasma vitamin B 12 , and folic acid were analyzed. Results The mean plasma Hcy was significantly higher in the CI group and TIA group (17 4±7 6 μmol/L and 16 6±5 2 μmol/L) compared with that in the control group(12 6±5 2 μmol/L, P 0 01) The odds ratio was 3 26 (95% CI, 1 05～10 09, P 0 01) The Hcy concentration was significantly higher in persons with T/T genotype than in those with C/C or CT There was no significant difference of frequency of mutant alleles (T) in site 677 of MTHFR gene and in frequency of homozygote T/T among the patients and controls (52 0% vs 44 0%, P 0 05 and 26% vs 20 0%, P 0 05). The difference of Hcy was significant between those being T/T homozygotic and those not being T/T homozygotic in defferent groups. There was no statistical correlation between plasma Hcy level and extra and intracranial stenosis of cerebral artery. Increase of BUN and smoking were significantly correlated with increase of Hcy ( P 0 05). The concentrations of plasma Vitamin B 12 and folic acid were significantly correlated with that of Hcy. Conclusion Homozygote of mutant MTHFR gene C677T causes hyperhomocystinemia. There is a significantly association between hyperhomocystinemia and ischemic cerebrovascular disease. The frequency of mutation in MTHFR genotype is higher in Chinese than in Caucasians. In addition to gene mutation, renal function and smoking are related to increase of plasma Hcy. No correlation between genotype of MTHFR and stroke is found.

Clinical study on collagen and stress urinary incontinence.

Abstract: Objective: To investigate the histological characteristics in uterine ligaments of stress urinary incontinence (SUI) and pelvic organ prolapse (POP); to detect the alteration of collagen ultrastructure in uterine ligaments that contribute to SUI and POP; to study the relationship between collagen alteration and SUI and POP. Methods: The cardinal ligament (Car lig.) and uterosacral ligaments (U-S lig.) samples were obtained from 73 subjects suffering from SUI, or normal controls who underwent hysterecotomy. Collagen ultrastructure was examined with transmission electron microscopy (TEM). Results: 1) The smooth muscle fascicles in the patients with SUI and POP were thinner. Arrangement of smooth muscle fascicles was in disorder. 2) The collagen constituting the ligaments was active in metabolism. The mean collagen fibril diameters in the SUI and POP groups were about 25% larger than that in the control groups (p ≤ 0.01). 3) Histological characteristics of the Car lig. and the U-S lig. were similar. Conclusions: 1) The Car lig. and U-S lig. are homologous. Abnormalities in arrangement of smooth muscles and the collagen ultrastructure were obviously seen in SUI and POP. 2) The collagen fibril diameter in the SUI and POP subgroups was significantly larger than that in the control groups. Those ligaments are probably less elastic and more likely to break. Predominance of collagen degradation during tissue repair may contribute to POP and SUI.

Association of genetic variants of vit D binding protein (DBP/GC) and of the enzyme catalyzing its 25-hydroxylation (DCYP2R1) and serum vit D in postmenopausal women.

Abstract: OBJECTIVE: To determine if GC (group-specific component globulin) and CYP2R1 genetic variants have an association with serum 25-OHD3 levels, BMD or bone turnover markers in a population of Chinese postmenopausal women. DESIGN: We randomly selected 1494 postmenopausal women of the Han ethnic group from seven communities in Beijing. BMD was determined by dual energy X-ray absorptiometry; serum bone turnover markers and 25-OHD3 were measured by the automated Roche electrochemiluminescence system; genotypes of GC and CYP2R1 were detected by the TaqMan allelic discrimination assay. Multiple statistic methods were used to test the associations of SNP genotypes and vitamin D levels. RESULTS: In our sample, 89.6% women had vitamin D deficiency and another 9.8% had vitamin D insufficiency. The variants of rs2298849 (β=0.105, P < 0.001) in GC were significantly associated with serum 25-OHD3 levels. Allele G of rs2298849 might be protective for serum 25-OHD3 level. Among the haplotypes of rs222020-rs2298849, CG (β = 0.104, P=0.001) corresponded to increasing serum 25-OHD3 concentrations. CYP2R1 polymorphisms showed some significant association with serum β-CTX and P1NP levels. CONCLUSIONS: We found that GC variants had a significant association with serum 25-OHD3 levels among postmenopausal women of the Han ethnic group in Beijing, while CYP2R1 variants were not found to be significant.

Microsurgical treatment of Nelson's syndrome.

Abstract: OBJECTIVE To discuss the etiology, diagnostic criteria and treatment of Nelson's syndrome. METHODS Twenty-three patients with Nelson's syndrome who were treated in our department over the last 19 years were analyzed retrospectively. Removal of adenoma by the transsphenoidal approach was done in 21 patients and by transfrontal craniotomy in 2. The follow-up period ranged from six months to nine years. RESULTS The incidence of Nelson's syndrome was 7.7% in a series of 300 patients with Cushing's disease treated by microsurgery in the same period. Hyperpigmentation was relieved and adrenocorticotropic hormone (ACTH) levels decreased in all patients after tumor excision. Eight patients with visual disturbance improved after surgery. The curative and remission rates were 56.5% and 26.1%, respectively. CONCLUSIONS Transsphenoidal microsurgical removal of pituitary ACTH adenoma is the first choice in the prevention and treatment of Nelson's syndrome. Regular follow-up examinations should be performed over a long time.

Glomerular size and global glomerulosclerosis in normal Caucasian donor kidneys: effects of aging and gender.

Abstract: BACKGROUND: To assess the effects of aging and gender on glomerular size and global glomerulosclerosis (GS) and evaluate the relationship between glomerular size and GS in normal Caucasian donor kidneys. METHODS: All baseline graft biopsies between 1990 and 1998 were reviewed and sections with tissues containing at least 15 glomeruli were selected for morphometric analyses using a Digital Imaging Analyzer. Glomerular volumes (GV) were measured using the maximal profile area (MPA) method. The frequency of glomeruli with totally sclerotic lesions representing degree of global GS was expressed as a percentage of total number of glomeruli counted. RESULTS: 102 donor specimens (M/F, 46/56; mean age, 37.4 +/- 17.3 yrs) were analyzed showing mean MPA of 27.8 +/- 6.6 (x 10(-3)mm2), mean GV of 3.6 +/- 1.2 (x 10(6)microm3) and mean GS% of 6 +/- 10%. GV was increased with increasing age (r2 = 0.32, p < 0.0001). There was a progressive increase in glomerular size between infancy and adolescence (2-18 years old). The rate of MPA growth over childhood appeared to be linear (n = 13, r2 = 0.66, p = 0.0004). However, MPA increased with age at a slower rate (n = 99, r2 = 0.66, p = 0.0004) in adults (excluding data for patients < 18 years) than in infancy and adolescence. There wasn't significant gender difference in GV. Age (r = 0.47, p < 0.0001) and MPA (r = 0.31, p < 0.05) were both positively correlated with global GS. CONCLUSIONS: 1. Aging contributes to enlargement of glomerular size and global GS. 2. Gender had no significant effect on glomerular size. 3. Enlargement of glomerular size was associated with global GS in normal Caucasians.

Pharmacokinetics and relative bioavailability of salbutamol metered-dose inhaler in healthy volunteers.

Abstract: AIM: To study the pharmacokinetics and relative bioavailability of salbutamol metered-dose inhaler (MDI) in healthy volunteers. METHODS: An HPLC method for the determination of salbutamol in human plasma was improved. Ten healthy male Chinese volunteers were enrolled in a randomized crossover study. After the subjects inhaled or orally administered 1.2 mg salbutamol, fourteen blood samples were collected at predetermined time points. The concentrations of salbutamol in plasma were assessed with non-compartment model to obtain the pharmacokinetic parameters. The relative bioavailability of MDI versus water solution was calculated. RESULTS: The HPLC assay was sensitive, specific, accurate, and precise. The pharmacokinetics of salbutamol MDI was described well with two-compartment model. The parameters for salbutamol inhaled and orally administered were as following: T(max) (0.22+/-0.07) and (1.8+/-0.6) h, C(max) (3.4+/-1.1) and (3.9+/-1.4) microg/L, T(1/2) (4.5+/-1.5) and (4.6+/-1.1) h, AUC0-20 min (0.9+/-0.3) and (0.16+/-0.10) microg x h x L(-1), respectively. There were significant differences in T(max) and AUC0-20 min between the two dosage forms. The AUC0-20 min (inhal) was 8 times as high as the AUC0-20 min (po). The relative bioavailability of salbutamol MDI was 57 %+/-24 % compared with oral solution. CONCLUSION: The absorption process of salbutamol MDI in human was significantly different from that of oral solution.

Risk factors for late renal allograft dysfunction: effects of baseline glomerular size.

Abstract: BACKGROUND: Both alloantigen dependent and alloantigen independent factors contribute to late allograft dysfunction. Among the latter, the importance of the mass of the donor kidney is an issue of interest. We hypothesized that glomerular hypertrophy is a risk factor for deterioration of allograft function. The goal of this study was to examine the role of glomerular size in predicting late allograft dysfunction. METHODS: All baseline graft biopsies between 1990 and 1998 were reviewed and sections containing at least 15 glomeruli were selected for morphometric analyses. Glomerular size was measured using the maximal profile area (MPA) method. Linear correlations between creatinine clearance (Ccr) and variables were evaluated. Covariates that tended to correlate with Ccr on univariate analysis (p < 0.2) were examined using multivariate analysis to determine the covariates associated with Ccr at 6 months (M) and 1, 2, 3, 4 years (yrs) after transplantation. RESULTS: Eighty-six patients were enrolled. Donor age, MPA, baseline Ccr, percent of global glomerulosclerosis (GS%), cyclosporin nephrotoxicity, cold ischemic time(CIT) and episodes of rejection were significantly correlated with interval Ccr in univariate analyses. MPA was a significant covariate at 6M, 1 yr, 3 yrs and 4 yrs. Other covariates significantly associated with interval Ccr included GS%, baseline Ccr, CIT and number of acute rejection episodes. CONCLUSIONS: Glomerular size in baseline biopsies is predictive of late allograft function, and the presence of hypertrophied glomeruli combined with other factors contributes to chronic renal allograft dysfunction.

Use of stable calcium isotopes (42Ca & 44Ca) in evaluation of calcium absorption in Beijing adolescents with low vitamin D status.

Abstract: Female adolescent populations with low calcium intakes and sub-optimal vitamin D status are found in northern China. Whether these individuals are able to adapt by enhancing calcium absorption and reducing calcium excretion for maximizing calcium retention is unknown. This study examined the association between true-fractional-calcium-absorption (TFCA), plasma 25-hydroxy-vitamin-D, and urinary calcium excretion among adolescents in Northern China. Twelve healthy girls 9 to 17 years old were recruited from Beijing during a winter. Calcium intake, anthropometry, pubertal status, plasma 25-hydroxyvitamin-Ds (25-OHD), serum calcium, and urinary calcium were determined. TFCA was evaluated by dual stable calcium isotopes. The mean +/- SD calcium intake, 24-hour urinary calcium excretion, plasma 25-OHD and TFCA were 591 +/- 164 mg/day, 79.9 +/- 49.6 mg/day, 30.5 +/- 9.8 nmol/L, and 60.4 +/- 14.4%, respectively. TFCA was inversely correlated with 25-OHD (r = -0.73, p = .008). Urinary calcium was correlated with the onset of menarche (r = 0.63, p = .027). Post-menarcheal girls had a higher urinary calcium output than premenarcheal girls (p = .03). Adolescents from north China with sub-optimal vitamin-D status are able to adapt by enhancing TFCA and reducing urinary calcium excretion to retain calcium for bone development. TFCA was inversely correlated with plasma 25-OHD. Whether a higher efficiency of calcium absorption is sustainable if the shortfall of vitamin D persisting remains to be studied.