Showing papers by "Peking Union Medical College Hospital published in 2003"

The impact of tobacco on lung health in China.

Abstract: China has the largest production and consumption of tobacco worldwide. It has witnessed a dramatic increase in tobacco consumption over the past two decades, with more than 34.8 million cartons of cigarettes being produced and 34.7 million sold annually. Approximately 67% of males and 4% of females aged over 15 years in China are smokers, and the total of over 320 million Chinese smokers represents about one-third of all smokers worldwide. The continuous, rapid increase in the number of Chinese smokers is largely due to teenagers taking up smoking. Among teenagers aged 15–19 years, 18% of men and 0.28% of women (making a total of 9 million teenagers) are smokers. The prevalence of passive smoking is very high at 53.5%, about 0.3 billion people aged above 15 years were affected. The average daily consumption of tobacco per person in China rose from one cigarette in 1952 to 10 cigarettes in 1990, a rate similar to that of the USA 40 years earlier. It seems inevitable that China will witness a substantial increase in mortality following this increase in smoking. Based on current smoking rates, the predicted deaths attributed to smoking in China will rise to 3 million in 2050. If the current smoking pattern in China remains unchanged, 100 million men now under 30 years will die from smoking-related diseases. The respiratory system is harmed most by tobacco smoke. Over two-thirds of all deaths related to smoking in China are attributed to chronic obstructive pulmonary disease (COPD), lung cancer and pulmonary tuberculosis. The morbidity of COPD alone in China is estimated at over 3%, or 25 million people, of whom 72% were smokers. The Chinese government consistently supports smoking control and advocates smoking abstinence via laws to restrain the sale and advertising of tobacco. These actions have been successful in some aspects, and in particular, more people are aware that ‘cigarette smoking is harmful to health’. In future, the emphasis of smoking control should be directed at restraining teenagers and adolescents from smoking. Cigarette smoking has already caused significant ill-health to the Chinese population with over 1 million people dying each year of various disorders caused by smoking. However, the peak of smoking-induced diseases is still to come and therefore, it is very important to strengthen anti-smoking measures so as to have a far-reaching effect on the future health of the Chinese population.

Molecular cloning and characterization of LAPTM4B, a novel gene upregulated in hepatocellular carcinoma.

Abstract: Lysosomal-associated protein transmembrane-4 beta (LAPTM4B), a novel gene upregulated in hepatocellular carcinoma (HCC), was cloned using fluorescence differential display, RACE, and RT-PCR It contains seven exons and encodes a 35-kDa protein with four putative transmembrane regions Both the N- and C-termini of the protein are proline-rich, and may serve as potential ligands for the SH3 domain Immunohistochemical analysis localized the protein predominantly to intracellular membranes Northern blot showed that the LAPTM4B mRNAs were remarkably upregulated in HCC (873%) and correlated inversely with differentiation status LAPTM4B was also overexpressed in many HCC-derived cell lines It was also highly expressed in fetal livers and certain adult normal tissues including the heart, skeletal muscle, testis, and ovary Promoter function assays showed a distinct difference in the gene's activities between BEL7402 and HLE cell lines, suggesting that the transcription factors responsible for regulation of the gene in the two cell lines are different, and that possible negative regulatory cis-elements may exist upstream of the promoter region It was demonstrated that the N-terminus of LAPTM4B was essential for survival of the cells Cells harboring the full-length LAPTM4B cDNA expression clone displayed a slightly increased efficiency in colony formation These results suggest that LAPTM4B is a potential protooncogene, whose overexpression is involved in carcinogenesis and progression of HCC In normal cells, it may also play important roles such as regulation of cell proliferation and survival

Expression of lymphocytes and lymphocyte subsets in patients with severe acute respiratory syndrome.

Abstract: In a cohort of 38 patients with severe acute respiratory syndrome (SARS), we observed leukopenia in 47% of patients, lymphopenia in 84%, and T lymphopenia in 95%. CD4(+) T lymphocyte levels were reduced in 100% of patients, CD8(+) T lymphocyte levels were reduced in 87%, B lymphocyte levels were reduced in 76%, and natural killer cell levels were reduced in 55%. Our data suggested that these patients' immune systems were impaired during the course of SARS. The absolute counts of lymphocyte subsets demonstrated a clinical significance for patients with SARS.

Lower prevalence of hand osteoarthritis among Chinese subjects in Beijing compared with white subjects in the United States: the Beijing Osteoarthritis Study.

Abstract: Objective Fewer Chinese subjects in Beijing have hip osteoarthritis (OA) compared with whites in the United States, but as many or more Chinese subjects have knee OA. If these differences are due to a systemic predilection for disease, then the prevalence of hand OA, the best indicator of generalized disease, should be different in China. The goals of this study were to estimate the prevalence of hand OA among elderly Chinese in Beijing, and to compare it with that among elderly whites in the United States. Methods We recruited a random sample of Beijing residents ages ≥60 years. Subjects answered questions on joint symptoms and provided posteroanterior radiographs of the hand. The protocol was identical to that used in the Framingham, Massachusetts OA Study. The hand radiographs from the Beijing OA Study were read intermingled with films from the Framingham OA Study. We defined a hand joint as having radiographic OA if it had a Kellgren and Lawrence grade ≥2. Symptomatic OA was present when both radiographic OA and self-reported pain were present in the same joint. We classified a subject as having radiographic or symptomatic hand OA if at least 1 hand joint had radiographic or symptomatic OA. We estimated the prevalence of hand OA in elderly subjects in Beijing and compared it with the prevalence of hand OA in elderly subjects from Framingham, using an age-standardized prevalence ratio. Results We obtained both symptom information and hand radiographs from 2,525 subjects. Despite the older age of the group, only 44.5% of men and 47.0% of women had radiographic hand OA. Symptomatic hand OA occurred in 3.0% of men and 5.8% of women. Compared with white men in Framingham, the Beijing Chinese men had a much lower prevalence of radiographic hand OA (age-adjusted prevalence ratio 0.64, 95% confidence interval [95% CI] 0.58–0.70) and symptomatic hand OA (age-adjusted prevalence ratio 0.25, 95% CI 0.16–0.34). The proportion of multiple hand joints affected by OA in Chinese men was also significantly lower than in white men. A similar magnitude of difference was also observed in the women. However, prevalence of symptomatic OA at the metacarpophalangeal (MCP) joints in Chinese men and prevalence of radiographic OA at the MCP joints in Chinese women were similar to those in their white counterparts in Framingham. Conclusion Elderly Chinese subjects in Beijing had a much lower prevalence of hand OA than did elderly whites in Framingham, Massachusetts. Coupled with the exceedingly low prevalence of hip OA in China, these results may suggest that the overall predilection for OA is less among subjects in China than among whites in the United States.

Diagnostic value of anti-cyclic citrullinated Peptide antibody in patients with rheumatoid arthritis.

Abstract: OBJECTIVE: To explore the diagnostic value of anti-cyclic citrullinated peptide antibody (anti-CCP) detected by ELISA in patients with rheumatoid arthritis (RA). METHODS: The synthesized cyclic citrullinated peptide was used as substrate for ELISA. Anti-CCP antibody was detected by ELISA in 191 patients with RA, 132 with rheumatic diseases other than RA, and 98 with nonrheumatic diseases. The antiperinuclear factor (APF), anti-keratin antibody (AKA), rheumatoid factor (RF), and HLA-DR4 gene complex were also tested in each RA patient. The results of these tests were compared with anti-CCP antibody to examine the correlation between them. RESULTS: Ninety (47.1%) patients with RA, 4 (3.0%) with other rheumatic diseases, and 2 (2.0%) with nonrheumatic diseases were found to be anti-CCP antibody positive by ELISA. The sensitivity of anti-CCP antibody was 47.1%, with a high specificity (97.4%) in RA. Anti-CCP antibody correlated with APF, AKA, RF, and HLA-DR4 gene complex. CONCLUSION: A new modified anti-CCP antibody test had a moderate sensitivity (47.1%) but a high specificity (97.4%) in patients with RA and was found as a valuable supplement to diagnosis of RA. Anti-CCP correlated with APF, AKA, RF, and HLA-DR4 gene complex, but did not completely overlap with them. Anti-CCP antibody could be regarded as a new diagnostic marker for RA.

Clinical Isolates of Enterobacteriaceae Producing Extended-Spectrum β-Lactamases: Prevalence of CTX-M-3 at a Hospital in China

Abstract: The prevalence of extended-spectrum beta-lactamase-producing strains was demonstrated in 5 of 44 (11.4%) Escherichia coli, 17 of 43 (39.5%) Klebsiella pneumoniae, 3 of 50 (6.0%) Enterobacter cloacae, and 2 of 25 (8.0%) Citrobacter freundii strains at a teaching hospital in China. Nineteen of these 27 strains expressed CTX-M-3 beta-lactamase (pI 8.6). A subset of the clinical isolates expressing the CTX-M-3 enzyme, tested by pulsed-field gel electrophoresis, revealed multiple clones. Five isolates expressed a novel enzyme, SHV-43 (pI 8.0), which had two substitutions (Leu113Phe and Thr149Ser) compared with SHV-1.

Pharmacokinetic Study on the Multi-constituents of Huangqin-Tang Decoction in Rats

Abstract: Using a validated high-performance liquid chromatographic (HPLC) method, the pharmacokinetics of multi-constituents in Huangqin-Tang decoction were simultaneously studied both in the compound prescription and in each single herb decoction. At different intervals (0, 1, 2, 4, 8, 12, 24, 36, 48 h) after oral administration of the Huangqin-Tang decoction or a single herb decoction at a dose of 10 g x kg(-1), the concentrations of the constituents and their metabolites: baicalin (BG), wogonoside (WG), oroxylin-A-glucuronide (OG), baicalein (B), wogonin (W), oroxylin-A (O), paeoniflorin (PF), paeonimetabolin-I (PM-I), liquiritin (LG), liquiritigenin (L), glycyrrhizic acid (GL) and glycyrrhetinic acid (GA), were detected in the rat plasma. A new metabolite-3,5,7,2',6'-penta hydroxy flavone (visidulin I, VD-I) was found in rat plasma after oral administration of Huangqin-Tang or a single herb Huangqin decoction, and the quality was identified by HPLC and LC/MS. The pharmacokinetic parameters of the constituents and metabolites in the compound prescription and single herb decoctions were compared. All concentration-time curves corresponded to the one-compartment model. The constituents of BG, WG, OG, VD-I and LG had higher C(max) and AUC(0-lim) in the compound prescription than in the single herb decoction, and WG had significant difference. The constituents of PF, W and O only had a higher AUC(0-lim) in the compound prescription, and O had a significant difference. It was concluded, in brief, that there were obvious differences in the pharmacokinetic parameters of most constituents (especially constituent WG) between the compound prescription and single herb decoction. The constituents in the compound prescription had delayed absorption and elimination, a longer residence time in the body, and higher C(max) and AUC(0-lim), than those in the single herb decoction. Therefore, they were more efficient and durable, making them promising to exerting pharmacological effects in vivo.

Serum procalcitonin and interleukin-6 levels may help to differentiate systemic inflammatory response of infectious and non-infectious origin.

Abstract: Objective To evaluate the efficacy of using procalcitonin (PCT) and interleukin-6 (IL-6) to differentiate sepsis from non-infectious systemic inflammatory response syndrome (SIRS). Methods We made a prospective study in a general intensive care unit at Peking Union Medical College Hospital. Twenty patients with sepsis and 31 patients with non-infectious SIRS were enrolled in this study. Serum concentrations of PCT, IL-6 and C-reactive protein (CRP) were determined within 24 h after clinical onset of sepsis or non-infectious SIRS. Leukocyte count, percentage of neutrophils, and absolute neutrophil count, as well as maximal body temperature were also recorded. Results Serum concentrations of PCT, IL-6, and CRP, as well as maximal body temperature, were significantly higher in septic patients [3.6 (1.8, 27.5) micro g/L, 810 +/- 516 ng/L, 180 +/- 108 g/L, 38.6 +/- 1.2 degrees C] than non-infectious SIRS patients [0.5 (0.2, 1.8) micro g/L, 235 +/- 177 ng/L, 109 +/- 70 g/L, 37.9 +/- 0.9 degrees C]. IL-6 and PCT exhibited the best discriminative power between sepsis and non-infectious SIRS, with sensitivity above 80% and specificity above 70%. A sepsis score with combination of IL-6 and PCT showed the best discriminative power with the area under the receiver operating characteristic curve of 0.923. Conclusions Assessing IL-6 and PCT levels are more reliable ways to differentiate sepsis from non-infectious SIRS, compared with conventional inflammatory parameters.

Prevalence of Parkinson's disease and related disorders in the elderly population of greater Beijing, China.

Abstract: A lower prevalence of Parkinson's disease (PD) has been reported for Chinese populations, but it is unclear whether this observation reflects a lower disease risk or is an artifact of case finding. We ascertained the prevalence of PD in elderly residents of an area that was a composite of 27 urban and rural communities of Greater Beijing, China. A team of university neurologists went door-to-door throughout the study area, examining 5,743 residents (at age 55 years or older) and made preliminary determinations of which residents had PD or other types of parkinsonism. Final determinations were made after follow-up and reevaluation of those persons who were either deemed to have parkinsonism or were suspected of having the condition (n = 144; median follow-up = 40 months). Based on stringent diagnostic criteria, 110 persons were identified to have parkinsonism, of whom 64 (58%) had PD. The prevalence of PD increased with advancing age and was about 1% overall and for each gender. In rural communities, 22 persons had PD, but 20 persons (91%) were first diagnosed for this condition by the study neurologists. The prevalence figures obtained in this study are similar to some of the highest prevalence figures reported in the West.

Rapid loss of both CD4+ and CD8+ T lymphocyte subsets during the acute phase of severe acute respiratory syndrome.

Abstract: Objective To study the alteration of peripheral lymphocyte subsets in severe acute respiratory syndrome (SARS) patients and to help improve the early diagnosis of the disease. Methods Anti-coagulating blood samples from 98 SARS patients in the acute phase, 56 normal healthy blood donors, and from patients infected by HIV, CMV and EBV were collected. The T lymphocyte subsets were counted by flow cytometry using fluorescence-labeled specific monoclonal antibodies. Results A significant decrease was observed in all SARS patients in their peripheral CD4(+) and CD8(+) T lymphocyte absolute counts [256 (104) x 10(6)/L and 256 (117) x 10(6)/L, respectively], which were also lower than those of the patients infected with HIV, CMV and EBV. All patients infected with HIV, CMV and EBV had significantly higher CD8(+) T lymphocyte counts in comparison with normal controls. Conclusions Decrease of both CD4(+) and CD8(+) T lymphocytes of patients is related to onset of SARS. T lymphocyte subset analysis would help improve the early diagnosis of the disease.

A risk of malignancy index in preoperative diagnosis of ovarian cancer.

Abstract: Objective To evaluate the ability of a risk of malignancy index (RMI), based on serum CA125 level, ultrasound findings and menopausal status, to discriminate benign from malignant pelvic mass. Methods One hundred and forty women with pelvic masses, at age 30 of years or more were admitted to the Peking Union Medical College Hospital between January 1998 and June 1999. The sensitivity, specificity and positive predictive value of serum CA125 level, ultrasound findings and the menopausal status in diagnosis of ovarian cancer were evaluated separately or combined into the RMI. Results RMI was more accurate than any individual criterion in diagnosing cancer. Using an RMI cutoff level of 200 to indicate malignancy, the RMI derived from this data set gave a sensitivity of 87.3%, a specificity of 84.4%, and a positive predictive value of 82. 1 %. Conclusions RMI is able to correctly discriminate malignant from benign pelvic mass. It can be introduced easily into clinical practice to facilitate the selection of patients for primary surgery.

Association Analysis of a Polymorphism of Interleukin 1β (IL‐1β) Gene with Temporal Lobe Epilepsy in a Chinese Population

Abstract: Summary: Purpose: Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS+) is one of the most common medically intractable epilepsies. Although the pathogenesis of HS+ still remains highly controversial, genetics may play a role as a predisposing factor. Previous evidence in a Japanese population shows that the homozygotes for allele 2 at position –511 of the interleukin (IL)-1β gene promoter region (IL-1β-511*2/2) confers susceptibility to the development of HS. However, this result has not been confirmed in populations of European ancestry. Given that the discrepancy may be attributed to ethnic differences, our aim in this study was to test the validity of a previous report in another Asian population. Methods: This study consisted of total 112 nonlesional TLE patients of Chinese ancestry, and 115 ethnically matched control subjects. A 304-base pair fragment in position of IL-1β-511 was amplified by polymerase chain reaction (PCR). The PCR products were digested with restriction enzyme AvaI, and run on a 12% polyacrylamide gel. We compared the frequency of this gene variation among 67 refractory TLE-HS+ patients, 45 patients without HS (TLE-HS−), and normal control subjects. Results: The heterozygous type (−511*1/2) is the most common genotype in our patient groups and controls. Allele 1 (−511C) and allele 2 (−511T) showed equal frequency (∼50%), which is similar to that (46%) in Japanese. Analysis of genotype and allele distribution showed no significant difference among the three groups (p > 0.05). Conclusions: In contrast with the lower frequency in the white population (35 and 34%) and higher rate in the population of African ancestry (60%), the allele –511T frequency in our present study is ∼50%, indicating differences in the distribution of allele frequencies in IL-1β-511 among different ethnic groups. In this Chinese population, however, we still did not find a strong association between IL-1β-511 polymorphism and the development of HS.

Restriction of third-generation cephalosporin use decreases infection-related mortality.

Abstract: Objective: To determine the effect of restriction of third-generation cephalosporin use on antibiotic resistance and the outcome of patients with infection. Design: A prospective, before-after comparative study. Setting: A general intensive care unit with 14 beds at a university-affiliated teaching hospital. Patients: All patients admitted to the intensive care unit within 2 yrs. Interventions: A new antibiotic treatment strategy was implemented during phase II. All patients with confirmed or suspected Gram-negative bacterial infections were treated mainly with antibiotics other than third-generation cephalosporins. Measurements and Main Results: Antibiotic resistance among common Gram-negative bacilli and infection-related hospital mortality during phase I were compared with phase II. A 26.6% reduction in third-generation cephalosporin use (from 168.2 ± 48.0 to 123.5 ± 39.3 g/month, p = .021), accompanied by a 277.7% increase in cefepime use (from 10.3 ± 19.2 to 38.9 ± 31.7 7 g/month, p = .014) occurred in phase II compared with phase I. This was accompanied by a significant decrease in reduced susceptibility of Gram-negative bacilli to third-generation cephalosporins (p <.05), mainly because of the improved susceptibility of Escherichia coli and Klebsiella species (p <.05). Infection-related hospital mortality was significantly lower in phase II (19.3% vs. 36.3%, p =.014). Multiple logistic regression analysis demonstrated lower respiratory tract infection, the status of immunocompromise, and continuous veno-venous hemofiltration as independent risk factors for infection-related hospital mortality (p <.05), whereas infection with E. coli or Klebsiella species (p = .039) and restriction of third-generation cephalosporin use (p = .025) were associated with a significantly lower mortality rate. Conclusions: Restriction of third-generation cephalosporin use may improve the antibiotic susceptibility and reduce infection-related hospital mortality in critically ill patients.

Estrogen receptor in pelvic floor tissues in patients with stress urinary incontinence

Abstract: Our study is to investigate the presence of estrogen receptor (ER) and its possible etiological relationship with the development of stress urinary incontinence (SUI). Thirty-one biopsy specimens from pelvic floor tissues were obtained from 31 patients categorized into three groups: pelvic organ prolapse (POP), SUI and control groups. ER in the pelvic muscles tissues was evaluated quantitatively after immunohistochemical staining to visualize the ER in the tissue. The sampling rate of levator ani (striated) muscle was 6.7% in total sample from the pelvic floor tissues, with the remaining showing connective tissues, smooth muscles and nerve fibers. ER positive staining was found in the in the nuclei of connective tissue, smooth muscles and nerve fibers. The positive rates of ER staining in tissues were 1.4%, 4.7% and 5.7%, respectively in control group versus 1.1%, 2.8% and 2.7% in SUI group and 4.1%, 9.5% and 11.6% in POP group. The positive rates of ER staining in connective tissue, smooth muscle and nerve fibers in SUI group were significantly lower than that in control and POP group (P<0.01). Our study suggests that a decrease of ER in the pelvic floor tissues might be related to the occurrence of SUI and implies that hormone replacement therapy might not be effective in treatment for SUI.

A double-blind, randomized, placebo-controlled multicenter study of oseltamivir phosphate for treatment of influenza infection in China.

Abstract: Objective To evaluate the efficacy and safety of oseltamivir phosphate as treatment for naturally acquired influenza infection. Methods This study was conducted as a double-blind, randomized, placebo-controlled, multicenter trial during the influenza epidemic season from January to April 2001 at 7 centers in China. A total of 478 adults without other medical history, aged 18 to 65 years, were enrolled into the study. All subjects demonstrated febrile respiratory illness of no more than 36 hours' duration with a temperature of 37.8 degrees C or more plus at least two of the following symptoms: coryza/nasal congestion, sore throat, cough, myalgia/muscles aches and pain, fatigue, headache or chills/sweats. Individuals were randomized into either the oseltamivir phosphate or placebo group with identical-looking capsules. Either oral oseltamivir phosphate, 75 mg twice daily, or placebo was administered to the subjects for 5 days. Results A total of 451 individuals were analyzed for efficacy as the intent-to-treat population (ITT) (216 oseltamivir and 235 placebo) and 273 individuals were identified as influenza-infected through laboratory test, who were then defined as the intent-to-treat infected population (ITTI) (134 oseltamivir and 139 placebo). Four hundred and fifty nine individuals were included in the safety analysis. In the ITTI population, the cumulative alleviation proportion of oseltamivir group was significantly higher than that of the placebo group (P = 0.0466)). The median duration of illness was 91.6 h [95% confidence interval (CI) = 80.2 - 101.3 h] in the oseltamivir group and 95 h (95% CI = 84.5 - 105.3 h) in the placebo group. The median area under the curve of decreased total score was significantly higher in the oseltamivir group than in the placebo group, 1382.9 and 1236.7 score-hours, respectively (P = 0.0196). For the ITT population, similar results were observed. Adverse events (AE) were similarly reported in both the oseltamivir group and the placebo group. The main adverse events following test drug were gastrointestinal symptoms, neurological symptoms and rashes. Conclusion Oseltamivir was effective and well tolerated as treatment of early naturally acquired influenza.

Association between HLA-DQA1, -DQB1 gene polymorphisms and susceptibility to asthma in northern Chinese subjects.

Abstract: Objective Human leukocyte antigen ( HLA) class II genes, especially HLA-DQ genes, which are highly polymorphic, have been thought to be candidate loci for the etiology of asthma, and shown to be involved in antigenic presentation. This study was conducted to investigate whether susceptibility or resistance to asthma is associated with HLA-DQA1 and DQB1 genes polymorphism. Methods Venous blood samples were collected from northern Chinese population with Han ethnic. (1) One hundred and twenty-five unrelated asthmatic individuals and 52 subjects from 12 asthmatic pedigrees. (2) Ninety-six healthy controls without asthma and atopy with the same ethnic. Genomic DNA was extracted using standard phenol-chloroform method. The second exon of HLA-DQA1 and DQB1 genes were amplified by sequence-specific primer-polymerase chain reaction (SSP-PCR) method. All asthmatics had their serum IgE (total and specific) antibody or skin-prick test measured, bronchial reactivity to methacholine (Mch) and bronchial reversibility by β 2 -agonist evaluated. Results HLA-DQA1 * 0104 allele and HLA-DQB1 * 0201 allele were significantly higher in asthmatics than those in healthy controls (0. 408 vs 0. 177, P <0.01; 0. 568 vs 0. 198, P <0.01). Odds ratios (ORs) were 3. 203 (95% CI 1. 699 - 6. 037), 5. 328 (95% CI 2. 883 - 9. 849) respectively. Conversely, HLA-DQA1 * 0301 allele and HLA-DQB1 * 0301 were significantly decreased in asthmatics compared to healthy controls (0.296 vs 0. 50, P < 0. 01; 0. 4 vs 0. 563, P < 0. 05); Logistic regression analysis showed that HLA-DQA1 * 0104 allele was associated independently with asthma etiology, OR [ represented by Exp (B) was 5. 0942 with 95% CI 2. 2520-21. 1813; Spearman's analysis showed that HLA-DQA1 * 0104 allele and HLA-DQB1 * 0201 allele were positively associated with atopy, the correlation coefficient were 0. 183 and 0. 289 respectively, P < 0. 01. By contrast, HLA-DQA1 * 0301 allele was negatively related to atopy, the correlation coefficient was -0.168, P<0. 05; linkage analysis did not support the view that HLA-DQA1/DQB1 genes were linked to asthma with LOD value being 0. 72. Conclusions HLA-DQA1 * 0104 allele and HLA-DQB1 * 0201 allele were implicated in susceptibility to asthma and atopy, HLA-DQA1 * 0301 allele and HLA-DQB1 * 0301 might be protective factor against asthma. Asthma and atopy are multifactorial disorders, HLA-DQA1 and DQB1 genes are involved in the regulation of immune specific response to common allergen.

Evaluation of quality of life in Chinese patients with gynaecological cancer: Assessments by patients and nurses

Abstract: Quality of life (QOL) has recently become one of the most important focuses in oncology nursing practice and research. The aims of this study were to evaluate the QOL in Chinese cancer patients under chemotherapy and to explore the discrepancy between patients' and nurses' assessments of the patients' conditions. The study participants included gestational trophoblastic disease patients (n = 68), ovarian cancer patients (n = 105), patients with other gynaecological cancer (n = 18), and their attending nurses (n = 25) at hospitals affiliated with universities in Beijing. The high level of some symptom subscales/items in patients suggested that innovative and more effective interventions should be developed and utilised in nursing practice. Patients with metastasis reported lower levels of QOL than those without metastasis. The nurses in this study tended to estimate the patients' QOL inaccurately, except for a few objective aspects. The results of this study can help nurses in planning interventions to enhance the QOL of patients with gynaecological cancer undergoing chemotherapy. The nurses need to be trained to become more sensitive and competent in assessing patients' subjective information.

Clinical features of pheochromocytoma and perioperative anesthetic management

Abstract: OBJECTIVE To investigate clinical features of pheochromocytoma and summarize experiences of anesthetic management during the perioperative period. METHODS Two hundred and fifty eight patients who were diagnosed with pheochromocytoma in our hospital were reviewed retrospectively for clinical features. According to different preoperative pharmalogical preparations, perioperative mortalities were analyzed in three periods (Period 1: January 1955 - December 1975; Period 2: January 1976 - December 1994; Period 3: January 1995 - July 2001). In Period 3, hemodynamic changes in the patients undergoing different anesthetic methods were analyzed. RESULTS About 5.8% (15/258) of pheochromocytoma was an integral part of multiple endocrine neoplasia (MEN) type II or mixed type. Sixty percent (149/249) of the patients who had undergone surgery possessed evidence of catecholamine cardiac toxicity preoperatively. Impaired glucose tolerance was found in 59% (147/249) of the patients before surgery. Perioperative mortality was significantly decreased from 8% (5/60) in Period 1 to 1.2% (1/75) in Period 2 (P < 0.01). No perioperative deaths occurred in Period 3. The volume infused during the operation was significantly higher both in the epidural anesthesia group (3474 ml +/- 624 ml, P < 0.01) and in the epidural plus general anesthesia group (3654 ml +/- 475 ml, P < 0.01) than in the general anesthesia group (2534 ml +/- 512 ml). There were favorable hemodynamic characteristics in patients before removal of the tumor in the epidural anesthesia group and in the epidural plus general anesthesia group, as compared with the general anesthesia group. CONCLUSIONS A positive surgical outcome of the excision of pheochromocytoma depends on multiple factors, including careful assessment of potential vital organ damage before surgery and restoration of blood volume by establishing alpha-blockade preoperatively, meticulous anesthetic management of patients during surgery, and appropriate circulatory support after surgery.

Lower uterine segment pregnancy with placenta increta complicating first trimester induced abortion: diagnosis and conservative management.

Abstract: r Objective To discuss the diagnosis of and conservative management for lower uterine segment pregnancy with placenta increta complicating first trimester abortion Methods Four patients with previous caesarean section and severe hemorrhage in induced abortion in the first trimester were studied Uterine artery embolization (UAE) was used to control bleeding and preserve the uterus Results UAE controlled heavy uterine bleeding satisfactorily One of the four patients asked for a hysterectomy after UAE, and her pathology report confirmed “lower uterine segment pregnancy with placenta increta” Conclusion Previous caesarean section is a risk factor for lower uterine segment pregnancy with placenta increta UAE is one of the best conservative management methods for heavy hemorrhage, especially for women who desire future fertility

Morphological study of severe acute respiratory syndrome (SARS)

Abstract: Objective Seven cases of autopsy from SARS patients are studied to investigate the pathogenesis and the pathologic changes of the major organs. Methods Detailed gross and microscopic examination of the autopsy specimen is performed, including lung, heart, liver, kidney, spleen and lymph nodes. Results All of the lungs are markedly enlarged and consolidated. Microscopically, pulmonary edema is a prominent finding, especially at the early stage of the disease (5 days after the onset). The alveolar spaces are filled with fibrinous exudates and lined with hyaline membrane. In 5 cases that undergo over 3 weeks of the course, the main pattern is organization of intra-alveolar deposit, along with fibroblastic proliferation in the alveolar septa, which leads to obliteration of alveolar space and pulmonary fibrosis. All of the lungs show bronchopneumonia, scattered hemorrhage, and proliferation of alveolar epithelial cells with desquamation. Microthrombi are seen in 6 cases. Fungal infection is noted in 2 cases. One of them is disseminative, involving bilateral lungs, heart, and kidney; the other one is diagnosed in hilar lymph nodes. In immune system, hilar and abdominal lymph nodes are usually congested and hemorrhagic, with depletion of lymphocytes, and accompanied with subcapsular sinus histiocytosis. One of the cases shows enlargement of abdominal lymph nodes, which have reduced number of germinal centers. Spleen exhibits atrophy of white pulps, and even lost of white pulps in some areas. The red pulp is markedly congested and hemorrhagic. In 5 cases, cardiomegale is prominent. Thrombosis (2 cases), focal myocarditis (1 case), and fungal myocarditis (1 case) are observed. In addition, liver shows massive necrosis (1 case) and nodular cirrhosis (1 case). Conclusions Lung is the major organ affected by SARS, demonstrated as diffuse alveolar damage. It is postulated that viral infection induces severe damage of alveolar epithelial and capillary endothelial cells, leads to pulmonary edema, intra-alveolar fibrin deposit, and hyaline membrane formation. Consequently, intra-alveolar organization and alveolar septal fibrosis causes loss of alveolar spaces, eventually, pulmonary fibrosis and atelectasis. The immune system is often affected, and presented as depletion of lymphoid tissue in lymph nodes and spleen. Secondary infection is a common complication, which should be paid close attention in the management of SARS patients.

Left atrial myxoma presenting with erythematous macules and loss of memory

Abstract: Left atrial myxoma was diagnosed in a 42-year-old woman who had cutaneous and neurological manifestations without cardiac symptoms or signs. A two-dimensional echocardiogram revealed an orange-sized mobile mass in the left atrium. Magnetic resonance imaging showed multiple cerebral infarctions. Cardiac surgery for removal of the left atrial myxoma was successful and histopathology confirmed myxoma. Cutaneous and neurological manifestations were improved after the operation. Early surgical intervention may prevent the onset of severe neurological deficits in such patients.

[High prevalence of knee, but not hip or hand osteoarthritis in Beijing elders: comparison with data of Caucasian in United States].

Abstract: OBJECTIVE To investigate the prevalence of knee, hip and hand osteoarthritis (OA) in the elderly of Beijing and to compare the prevalence of OA between the Beijing elders and the US Caucasians. METHODS Using the same standardized instruments and protocol as those in the Framingham Osteoarthritis Study, home interview, clinical examination and radiography were conducted among 1012 males and 1507 females, all aged 60 and over, on 4 central districts of Beijing with informed consent. The data of survey were compared with those of the corresponding US study. RESULTS The prevalence of radiographic and symptomatic knee osteoarthritis was 42.8% and 15.4% respectively among the women aged 60 and over in Beijing, higher than those in Caucasian women of the same age. The prevalence of radiographic and symptomatic knee osteoarthritis were 27.6% and 7.1% respectively among the men aged 60 and over in Beijing, similar to those in the Caucasian men of the same age. The prevalence of radiographic hand osteoarthritis among the Beijing men and women aged 60 and over were 44.5% and 47.0% respectively, lower than those among the contemporary Caucasian in US. The prevalence of hip osteoarthritis among the men and women aged 60 and over were only 0.4% and 0.6%, significantly lower than those among the contemporary Caucasian in US. CONCLUSION Compared to the Caucasian contemporaries, fewer Beijing elderly suffer from hand and hip osteoarthritis. However, knee osteoarthritis is much more prevalent, affecting millions of elderly Chinese.

Right trisectionectomy for primary liver cancer

Abstract: AIM: To evaluate the value of right trisectionectomy, previously named right trisegmentectomy, in the treatment of primary liver cancer by summarizing our 13-year experience for this procedure. METHODS: Thirty three primary liver cancer patients undergoing right trisectionectomy from Apr. 1987 to Dec. 1999 were investigated retrospectively. The impacts in survival of patients by cancerous biological behavior, such as tumor thrombi and satellite nodules, were discussed respectively. All right trisectionectomies were performed under normothermic interruption of porta hepatis at single time. Ultrasonic dissector (CUSA system 200) was used in dissection of hepatic parenchyma from Nov. 1992, instead of finger fracture. RESULTS: 1-, 3- and 5-year survival rates were 71.9%, 40.6% and 34.4%, respectively. The longest survival term with free cancer was 150 months (alive). There were no significant differences in survival curves between cases with and without tumor thrombi (right branch of portal vein) and satellite nodules. Operative mortality was 3.0% (1/33). Main surgical complications occurred in 5 cases. CONCLUSION: Right trisectionectomy should be regarded as an effective and safe procedure for huge primary liver cancers and is worth using more widely.