Showing papers in "National Medical Journal of China in 2002"

[Expression of fusion proteins in beta(2)GP I gene-transfected HEp-2 cells and its clinical application].

Abstract: OBJECTIVE To establish an indirect immunofluorescent test so as to improve the sensitivity and specificity of examination of antibodies to beta(2)-glycoprotein METHODS Full-length beta(2)GP cDNA was obtained from human hepatocellular cancer cell line HepG2 by RT-PCR and cloned into the mammalian expression vector pEGFP-C1 The recombinant plasmid pEGFP-beta(2)GP was transfected into HEp-2 cells RT-PCR, immunoblotting (IBT), confocal fluorescence microscopy, and indirect immunofluorescent test (IIF) were used to confirm the expression, localization, and antigenicity of fusion protein of green fluorescent protein (GFP) Serum specimens from 19 patients suspected as with secondary antiphospholipid syndrome (APS), 1 patient diagnosed as with primary APS, and 10 normal persons were detected with IIF-IgG-beta(2)GP1, ELISA-IgG-ACL, and ELISA-IgG-beta(2)GP I simultaneously RESULTS (1) The HEp-beta(2)GP I cells thus obtained retained their ability of expression of beta(2)GP-I-GFP for more than ten generations This beta(2)GP-I-GFP showed the antigenicity of beta(2)GP-I with a characteristic feature (2) Seven of the 20 serum specimens from APS patients showed characteristic immunofluorescent pattern No serum specimen from normal persons showed immunofluorescent staining The comparison of results of the three methods showed that the concordance between IIF-IgG-beta(2)GP I and ELISA-IgG-beta(2)GP I was the most perfect (Kappa = 0886) (3) HEp-beta(2)GP I retained the immunofluorescent property of HEp-2 cell CONCLUSION As a new kind of substrate of IIF, beta(2)GP I transfectant can be used to detect anti-beta(2)GP-I antibodies Transfeted HEp-2 cells keep the immunofluorescent property of HEp-2 cells in IFANA test and can be used as substrate for routine IFANA detection

[Association of 5-HT(2A) receptor polymorphism and attention deficit hyperactivity disorder in children].

Abstract: OBJECTIVE To stude the association of 5-HT(2A) receptor polymorphism and attention deficit hyperactivity disorder (ADHD) in children. METHODS Blood samples were taken from 323 6 approximately 17.5-year-old children with ADHD disgnosed based on the DSM-IV criteria, 182 healthy 18 approximately 49-year-old controls, and 195 pairs of parents of affected children, all of Han nationality. DNA was extracted. PCR was performed to examine the 5-hydroxytryptamine (5-HT)(2A) receptor T102C polymorphism. Transmission disequilibrium test (TDT) was used to test the association of alleles of 5-HT(2A) T102C polymorphic sites and AFDHD. RESULTS The frequency of T102T in patients with ADHD combined subtype was lower than that in the controls (22.35 vs 33.5%, OR = 0.569, P = 0.028, 95% CI 0.344 - 0.943), and the frequency of T102C in patients with ADHD combined subtype was higher than that in the controls (64.0% vs 47.3%, OR = 1.987, P = 0.003, 95% CI 1.264 approximately 3.124). TDT showed biased transmission of the alleles of T102C polymorphism among families of girl patients with ADHD combined subtype (P = 0.031). CONCLUSION For the ADHD combined subtype, the T102T genotype is a protective factor and the T102C genotype is a risk factor. For the girl with ADHD combined subtype, the allele C102 is a disease-predisposing gene.

[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.

A randomized control trial of mycophenolate mofeil treatment in severe IgA nephropathy

Abstract: Objective To investigate the effectiveness,safety and tolerance of mycophenolate mofeil(MMF) in severe IgA nephropathy and evaluate the dosage adjustment and course for clinical treatment Methods 62 patients with IgA nephropathy diagnosed by renal biopsy as Lee′s grade IV and V with urinary protein 2 0 g/d were enrolled randomly in the trial The initial dosage of MMF was 1 0 g/d(body weight 50 kg)or 1 5 g/d(body weight 50 kg) The dosage was reduced to 0 75～1 0 g/d after 6 months treatment, the maintaining dosage was 0 5～0 75 g/d after 12 months The total course of treatment lasted at least 12 months Another 31 patients matched with age,gender and severity of renal damage were given prednisone orally (0 8 mg·kg·d) (control group) Blood and urinary tests,hepatic and renal function,plasma albumin,serum triglyceride and cholesterol,24 h protein excretion,urinary NAG enzyme, creatinine clearance(Ccr) were performed before and 3,6,12,18 months after treatments in both groups.5 patients in MMF group received repeated renal biopsy Results (1) After 3 months treatment, decrease of urinary protein (1 9 g/24 h±1 6 g/24 h vs 3 2 g/24 h±1 7 g/24 h, P 0 01)and improvement of plasma albumin (41 g/L±6 g/L vs 37 g/L±6 g/L, P 0 01)were observed in MMF groups,while in control group, no significant changes were found in urinary protein(2 3 g/24 h±1 8 g/24 h vs 2 9 g/24 h±1 5 g/24 h, P 0 05)and plasma albumin(40 g/L±6 g/L vs 37 g/L±6 g/L, P 0 05). After treatment for 6, 12 and 18 months, both group showed obvious alleviation of proteinuria and albumin At the 12th and 18th month, the proteinuria in MMF group was significantly improved than that in control group(0 8 g/24 h±0 8 g/24 h vs 1 4 g/24 h±1 6 g/24 h and 0 6 g/24 h±0 7 g/24 h vs 1 4 g/24 h±1 3 g/24 h, P 0 05 respectively) The remission rate and total effective rate of MMF group were higher than those of the control group (44 4% vs 19 1% and 88 9% vs 61 9%, P 0 05 respectively) Patients were administered with MMF for 13 8±6 3 months (6～30 m) (2) Serum cholesterol and triglyceride were remarkably reduced after 6,12 and 18 months treatment in MMF group, no significant difference was found in control group( P 0 05) (3) For the 6 patients with renal insufficiency in MMF group, MMF treatment was significantly effective in 1 patient, effective in 2 patients, not effective in 3 patients with an overall effective rate of 50% For the 7 patients with renal insufficiency in control group, the treatment was significantly effective in 1 patient, effective in 1 patient, not effective in 5 patients and total effective rate is 28 6% (4) 5 patients in MMF group received repeated renal biopsy after 7～12 months treatment (mean 9 8±2 3 m) The results showed that the interstitial lesions were alleviated No special drug induced renal damage was obtained (5) Side effects: 3 patients in MMF group suffered from slight diarrhea, 1 patient herpes zoster, all of them got remission without drug withdrawal 1 patient suffered nausea in the first weeks No significant change was found in hepatic function ( P 0 05) Conclusions MMF is more effective in reducing proteinuria and serum lipid than the currently widespread use of prednisone therapy in IgA nephropathy patients with Lee SMK's grade IV～V and urinary protein2 0 g/d Treatment with MMF associates with less adverse effect and good tolerance

New trends in myofascial pain syndrome.

Abstract: This review article summarizes recent studies on myofascial trigger point (MTrP) to further clarify the mechanism of MTrP. MTrP is the major cause of muscle pain (myofascial pain) in clinical practice. There are multiple MTrP loci in an MTrP region. An MTrP locus contains a sensory component (sensitive locus) and a motor component (active locus). A sensitive locus is the site from which pain, referred pain (ReP), and local twitch response (LTR) can be elicited by needle stimulation. Sensitive loci are probably sensitized nociceptors based on a histological study. They are widely distributed in the whole muscle, but are concentrated in the endplate zone. An active locus is the site from which spontaneous electrical activity (SEA) can be recorded. Active loci are dysfunctional endplates since SEA is essentially the same as endplate noise (EPN) recorded from an abnormal endplate as reported by neurophysiologists. Both ReP and LTRs are mediated through spinal cord mechanisms, demonstrated in both human and animal studies. The pathogenesis of MTrPs appears to be related to the integration in the spinal cord (formation of MTrP circuits) in response to the disturbance of the nerve endings and abnormal contractile mechanism at multiple dysfunctional endplates. Methods usually applied to treat MTrPs include stretch, massage, thermotherapy, electrotherapy, laser therapy, MTrP injection, dry needling, and acupuncture. The mechanism of acupuncture is similar to dry needling or MTrP injection. The new technique of MTrP injection can also be used to treat neurogenic spasticity.

Risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess.

Abstract: Background. To identify the risk factors for endogenous endophthalmitis secondary to Klebsiella pneumniae (KP) liver abscess. Methods. Retrospective chart review of 200 patients with KP liver abscess from 1990 to 2000 wasperformed. Data variables included age, sex, past history, systemic condition, initial and final visual acuity, slit lamp biomicroscopy, intraocular pressure, fundus, course and treatment. Results. Extrahepatic metastasis developed in 44 patients, including 18 cases (23 eyes) of endophthalmitis. Seventeen eyes had final vision less than counting fingers. Diabetes had significant association with the development of extrahepatic metastasis (p = 0.045) and the poor visual outcome of endophthalmitis (p = 0.022), whereas, neither the initial vision nor vitrectomy was significantly related to the outcome of endophthalmitis. Conclusions. The visual prognosis of endogenous endophthalmitis secondary to KP liver abscess is generally poor, and diabetes might be a significant risk factor for the poor visual outcome. Even when the initial vision is as bad as light perception only, some eyes can be saved. Both internists and ophthalmologists should be alert enough to detect and treat these patients early.

Aggressive natural killer cell lymphoma/leukemia.

Abstract: We report a case of aggressive natural killer (NK) cell lymphoma/leukemia in a 70-year-old woman presenting with fever, hepatosplenomegaly, retroperitoneal lymphadenopathy, and elevated serum CA19-9. The patient died 4 days after diagnosis. Neoplastic NK cells were identified in the blood and retroperitoneal lymph node biopsy. Their phenotypes were confirmed by extensive flow cytometric and immunohistochemical studies. In situ hybridization for Epstein-Barr virus (EBV)-associated RNA (EBER) was positive. Various forms of NK cell neoplasm were reviewed and discussed.

[The relationship between human serum resistin level and body fat content, plasma glucose as well as blood pressure].

Abstract: OBJECTIVE: To investigate serum resistin concentration in essential hypertension patients and the relationship between serum resistin level and body fat content, plasma glucose concentration, and blood pressure. METHODS: Fasting serum resistin concentrations were measured with enzyme immunoassay in 71 cases (including 33 men and 38 women), and oral glucose tolerance test and insulin release test were performed in all cases for calculating glucose area under the curve (AUC(G)), the ratio of change in insulin to change in glucose during the first 30 min after glucose ingestion (Delta I(30)/Delta G(30)) and insulin sensitivity index (ISI) according to Cederholm's formula. Systolic pressure (SBP), diastolic pressure (DBP), height, body weight, waist circumference and hip circumference were measured to calculate body mass index (BMI), body fat percentage (BF%) and waist-hip ratio (WHR). RESULTS: Pearson analysis showed that fasting serum resistin concentrations were correlated with AUC(G) (r = 0.380, P < 0.001), BF% (r = 0.353, P < 0.01), ISI (r = -0.242, P < 0.05) and Delta I(30)/Delta G(30) (r = -0.298, P < 0.05), but not correlated with SBP, DBP, BMI and WHR. After adjustment for age and BMI, partial correlation analysis showed that fasting serum resistin concentrations were correlated with AUC(G) (r = 0.268, P < 0.05), Delta I(30)/Delta G(30) (r = -0.247, P < 0.05) and not correlated with ISI. A stepwise multiple linear regression analysis showed that resisitin was a significant independent predictor of AUC(G). CONCLUSION: The strong correlation between fasting serum resistin levels and AUC(G), and BF% suggests a possibility that resistin link obesity to diabetes in humans.

Epidemiological survey on epilepsy among rural populations in five provinces in China

Abstract: OBJECTIVE To investigate the prevalence of epilepsy and its treatment gap in rural areas of China. METHODS A door-to-door epidemiological survey on epilepsy was conducted among 55616 rural residents in 5 counties, each in a province (Heilongjiang, Ningxia, Shanxi, Henan, and Jiangsu) selected by random cluster sampling. All people diagnosed or suspected as epileptic during the screening phase were rechecked by neurologists. RESULTS A definite diagnosis of epilepsy was made among 387 people with a prevalence rate 7.0 per thousand (age-adjusted rate 6.8 per thousand). The prevalence of active epilepsy was 4.6 per thousand, and the incidence of epilepsy was 28.8/100 000. Of the people with epilepsy, 40.6% had not been treated, 35.4% were treated irregularly. The treatment gap of active epilepsy was 62.6%. CONCLUSION The prevalence of epilepsy in the rural areas in China was much higher than it was reported previously. About two thirds of the patients with epilepsy has not received regular treatment. A rational intervention strategy should be developed as soon as possible.

Utilization of psychotropic drugs in Taiwan: an overview of outpatient sector in 2000.

Abstract: Background Development of pharmacological treatment in mental disorders has risen drastically over the past decade in Taiwan. We performed a survey of the National Health Insurance claims for outpatient psychiatric services to study the utilization of psychotropic drugs. The analysis followed the drug classification and standardized measurements proposed by the World Health Organization. Methods The sampling datasets from the National Health Insurance Research Database served as data sources. They represented 0.2% of the entire claims for outpatient medical services in 2000. The measurement units used for psychotropic drugs were either prescription volumes (drug items) or the number of defined daily doses (DDDs). To estimate the proportion of the population treated daily with psychotropic drugs, numbers of DDDs per 1000 inhabitants per day were also calculated. Beside overall description, the data of psychotropic substance prescriptions were analyzed by stratifying patient's age, physician's specialty, accreditation status of hospital, and chemical subgroup of psychotropic drugs. Results Prescription of psychotropic drug items (n = 63,539) was 3.24% of the total drug items (n = 1,958,820) claimed. The psychotropic drugs were prescribed to 9.2% of the total patients and in 9% of the total visits. Major consumers of psychotropic drugs were between 35-74 years of age and there were more women than men. The psychiatrist was the largest group of physicians who had prescribed psychotropic drugs and contributed 18.5% of all drug items and 38.3% of total DDDs of psychotropic drugs. The number of DDDs per 1000 inhabitants per day for all kinds of psychotropic drugs was estimated to be 32.94 in Taiwan, where anxiolytics accounted 14.30, hypnotics and sedatives 10.64, antipsychotics 3.41, antidepressants 3.06 and mood stabilizers 1.43. Ordered by total DDDs, the top 10 most frequently used chemical substances were flunitrazepam, alprazolam, fludiazepam, oxazolam, lorazepam, diazepam, zolpidem, estazolam, zopiclone, and haloperidol. Conclusions The usage level of psychotropic drugs in Taiwan was lower than in most industrialized countries, especially for antidepressants. The future goals are to focus on the longitudinal analysis of general trend for each psychotropic substance and to associate the pharmacoepidemiological data in parallel with the upcoming epidemiological study of mental disorders in Taiwan.

[Microarray study of vasculogenic mimicry in bi-directional differentiation malignant tumor].

Abstract: OBJECTIVE To explore if vasculogenic mimicry (VM) exists in bi-directional differentiation malignant tumor. METHODS New sections were made from 158 paraffin sections of bi-directional malignant tumors, including malignant melanoma (n = 60), synoviosarcoma (n = 39), rhabdomyosarcoma (n = 29), malignant mesothelioma (n = 26), and epithelioid sarcoma (n = 4). The representative points in the paraffin sections were labeled and two tissue microarrays were made, one including 60 cases of malignant melanoma, and the other including the other tumors. Immunohistochemical staining of platelet-endothelial cell adhesion molecule (CD31 antigen) and periodic acid Schiff (PAS) staining were conducted. Microscopy was made and the areas of vessel-like channels consisted of CD31 antigen-positive tumor cells and of PAS positive material were calculated. RESULTS PAS positive material or CD31 positive material were observed in these bi-directional tumor cells. In the tumors vessel-like channels could be found, made of PAS positive material lined with CD31 negative tumor cells and red blood cells inside the channel, or made of tumor cells with CD31 positive material. The area of the former vessel-like channels was significantly smaller than that of the latter (P < 0.01). VM was found in 16 of the 39 cases of the highly malignant synoviosarcoma and acinar type rhabdomyosarcoma, a ratio higher than that among the cases of synoviosarcoma and acinar type rhabdomyosarcoma with lower malignancy (5/29) (P < 0.05). CONCLUSION VM exists in bi-directional differentiation malignant tumors.

Antihypertensive effect of stevioside in different strains of hypertensive rats.

Abstract: Background Stevioside is a natural sweet-tasting glycoside isolated from the herb Stevia rebaudiana, composed of stevia, a diterpenic carboxylic alcohol with three glucose molecules, mainly used commercially as sugar substitute. Previous study has shown that it can lower blood pressure in anesthetized spontaneously hypertensive rats (SHR). This study was undertaken to evaluate the antihypertensive effect of stevioside in different strains of hypertensive rats and to observe whether there is difference in blood pressure lowering effect. Methods Noninvasive tail-cuff method was employed to measure blood pressure. Stevioside at the concentrations of 50, 100 and 200 mg/kg were administered intraperitoneally (ip) to normotensive Wistar-Kyoto rats (NTR), SHR, deoxycorticosterone acetate-salt (DOCA-NaCl) sensitive hypertensive rats (DHR) and renal hypertensive rats (RHR). Results Significant hypotensive effect of stevioside administered ip was noted in different strains of rats at the dose of 50 mg/kg. When stevioside was increased to the concentrations of 100 and 200 mg/kg, ip, it also caused slow and persistent lowering of blood pressure in SHR and NTR. Data also showed that stevioside given at the concentrations of 100, 200 and 400 mg/kg ip resulted in lowering of blood pressure in SHR dose-dependently. Blood pressure returned to previous levels after the drug was discontinued for 2-3 days. Drinking of 0.1% stevioside solution in mature SHR could have antihypertensive effect and also prevented hypertension in immature SHR. Conclusions This study reconfirmed stevioside has hypotensive effect and the effect is more prominent in hypertensive rats.

The local mechanism of acupuncture.

Abstract: Scientific development of acupuncture is described to increase its therapeutic efficacy and ultimate utilization. Acupuncture may have central, local and placebo effects. Little is known about the local effects of acupuncture specific to needle penetration and/or movement. Acupuncture points, muscle trigger points and motor end-plate zones are identical. Therefore, the benefit of acupuncture in musculoskeletal pain relief for which it is most commonly used, would not be limited to classical acupuncture points on the meridians. Intramuscular movements of the needle causes insertional activity which can be recorded on electromyography (EMG). The insertional activity occurs from depolarization of innervated single or grouped muscle fiber discharges which are micro-twitches and this is the basis of pain relief with EMG and intramuscular stimulation methods. Occasionally, needle penetration or manipulation in classical or electrical acupuncture may also evoke small local twitches. These observations suggest that needle induced local muscle twitches mediate musculoskeletal pain relief in acupuncture. These micro-twitches are capable of producing micro stretch effects on the adjacent shortened muscle fibers undergoing varying stages of denervation. This reduces the mechanical traction effect produced by these shortened muscle fibers on pain sensitive structures including intramuscular nerves and blood vessels. This theory of stretching shortened muscle fibers to produce pain relief would be justified when even more significant musculoskeletal pain relief can be obtained through inducing larger force twitches. Therefore, automated and electrical twitch-obtaining intramuscular stimulation methods were invented to elicit larger twitches. These methods allow the objective localization of the motor end-plate zones and allow recording of the number, frequency and force of the twitches. Therefore, by mechanism of action and associated therapeutic relief, the twitch may be the local key to pain relief, notjust a diagnostic sign for the localization of myofascial trigger points.

Substitution of porcine small intestinal submucosa for rabbit Achilles tendon, an experimental study.

Abstract: OBJECTIVE To study the effect of substitution of porcine small intestinal submucosa (SIS) for rabbit Achilles tendon. METHODS Porcine SIS was taken out and processed. Part of Achilles tendons of 20 rabbits' right legs were removed and substituted by porcine SIS and the Achilles tendon of the left legs were used as controls. One, four, eight, twelve, and sixteen weeks after the operation 4 rabbits were killed and their right Achilles tendons were taken out to be examined histologically and their maximum load was tested. RESULTS One week after the operation, the porcine SIS was already fused with the remaining part of rabbit Achilles tendon. Sixteen weeks after all the Achilles tendons looked like normal one. The maximum load of experimental Achilles tendon was 48 N +/- 9 N one week after the operation, and increased gradually. In the 16th week after the operation, the maximum load was 178 N +/- 6 N for the experimental Achilles tendon and 174 N +/- 10 N for the control tendon. The differences of maximum load between different weeks after operation, except that between one week and 4 weeks after, were statistically significant (P < 0.01). CONCLUSION Substitution of porcine SIS for injured Achilles tendon is effective, thus proving the feasibility of in vivo tissue engineering technology.

Correlation between polymorphism of il-4 and il-10 gene promoter and childhood asthma and their impact upon cytokine expression

Abstract: OBJECTIVE: To investigate the correlation between the polymorphism of IL-4 and IL-10 gene promoters and the susceptibility of Chinese children to asthma and to study the impact of such polymorphism upon cytokine production. METHODS: The data of medical history, pulmonary function, hypersensitive test, and serum IgE were recorded among 168 unrelated Chinese children with asthma aged 5 approximately 15. Four polymorphism sites of IL-4 and IL-10 gen promoter regions were determined by PCR/RFLP. The peripheral blood monocyte (PBMC) was cultured and stimulated by lipopolysacchride (LPS). Then the contents of IL-4 and IL-10 gene promoter regions were determined by ELISA. 53 age-matched children without asthma were used as control. RESULTS: (1) The allele frequencies of-598 (C/T) site of IL-4 gene promoter was significantly different between Chinese children and children of Caucasian and Afro-American origin (P = 0.01). The allele frequency of -1082 (G/A) site, -819 (C/T) site, and -592 (A/C) site in IL-10 gene promoter was significantly different between Chinese children and their British counterparts (P = 0.01). (2) The serum total IgE level was significantly different among children with different allelic sites in IL-4 and IL-10 gene promoters. A allele in IL-10 - 1082 (G/A) site and T allele in IL-10 - 819 (C/T) site -1082 were associated with elevated total serum IgE (P < 0.01, OR = 3.16; P < 0.05, OR = 1.84). (3) The IL-10 level in the supernatant of PBMC culture of children with homozygous genotypes of -819 TT and ATA/ATA in IL-10 gene promoter after stimulation of LPS was the lowest in comparison with those in the supernatant of PBMC culture of children with other genotypes (all P < 0.05). (4) No correlation was found between -589 (C/T) site in IL-4 gene promoter and asthma. There was no significant difference between the increase of IL-4 level in the supernatant of PBMC culture of children with the two different homozygous genotypes of IL-4 gene promoter. CONCLUSIONS: (1) There is no significant correlation between the polymorphism sites in IL-4 and IL-10 gene promoters and the susceptibility to asthma among Chinese. (2) The polymorphism of IL-10 gene promoter may be an important candidate gene for severity of asthma. The allele -819T plays an important role in increase of the total serum IgE by reducing the upregulation of IL-10 gene expression.

The risk of coronary artery disease in population of Taiwan is associated with Cys-Ser 311 polymorphism of human paraoxonase (PON)-2 gene.

Abstract: BACKGROUND Paraoxonase (PON), a high density lipoprotein (HDL)-associated enzyme, is capable of inhibiting low density lipoprotein (LDL) oxidation by destroying the biologically active phospholipids in oxidatively modified LDL. An increased risk of coronary artery disease (CAD) has shown to associate with polymorphisms of PON gene (PON1) in different population. The risk of CAD associated with the other PON1-like gene, designated PON2, which has a similar function and is structurally related to PON1, is least discussed. A population-based case-control study was conducted to investigate the association between CAD and the polymorphisms at two common codons 148 and 311 of PON2 in the population of Taiwan. METHODS Totally 364 unrelated, angiographically proved CAD-positive patients (338 male and 26 female) and 337 unrelated, CAD-free control subjects (249 male and 88 female) enrolled in this study. Lipids and lipoproteins profile and the association of PON2 genotypes and allele frequencies were analyzed in all study cohorts. RESULTS The plasma levels of HDL-cholesterol and apoA-I were significantly lower in patients with CAD than in control subjects (both p = 0.0001). There was no difference in the genotype frequency distribution at codon 148 of PON2 between CAD patients and the controls. However, age-, sex- and diabetes-adjusted odds ratios for individuals with the SS genotype of the codon 311 polymorphism (Cys --> Ser, PON2*C allele --> PON2*S allele) showed a 4.6-fold higher risk of CAD (95% CI = 1.6-15.3, p = 0.006) they ran. Also, in the control subjects, PON2*C allele carriers (CC and CS genotypes) had higher plasma levels of HDL than cases with the SS genotypes (p = 0.035 and p = 0.012, respectively). CONCLUSIONS Our data implicate that the genotypic variation at codon 311 of PON2 contributes to the susceptibility of CAD in the population of Taiwan.

Serum level of amylase and lipase in various stages of chronic renal insufficiency.

Abstract: BACKGROUND Twenty percent of pancreatic enzymes is excreted by the kidneys. Thus, patients with end stage renal disease (ESRD) have elevated levels of serum pancreatic enzymes. The purpose of this study was to evaluate the changes of serum pancreatic enzyme levels in patients with various stages of ESRD undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) as well as those treated conservatively. METHODS Serum pancreatic enzyme levels were determined in 96 cases, including 19 healthy controls, 28 cases of ESRD treated conservatively and 49 uremic cases receiving dialytic treatment (37 hemodialysis and 12 CAPD). RESULTS The mean activity of serum pancreatic enzymes was significantly higher in patients with ESRD compared to that in the healthy controls (p < 0.0001). Out of 28 patients, ESRD patients had serum amylase and lipase levels higher than normal in 17 (60.7%) and 16 (57.1%) cases respectively. Eight out of 12 CAPD cases (66.7%) had higher levels of both enzymes. However, 31/37 (83.7%) and 32/37 (86.5%) HD patients had elevated levels of serum amylase and lipase, respectively. Only 1 (1.3%) and 4(5.2%) out of 77 ESRD cases had threefold elevated levels of amylase and lipase, respectively. CONCLUSIONS Serum pancreatic enzymes are often elevated within threefold normal in ESRD patients. Thus, acute pancreatitis must be considered if enzyme levels are more than threefold normal in association with clinical manifestiations.

[Relationship between interleukin-1B and interleukin-1 receptor antagonist gene polymorphisms and susceptibility to gastric cancer].

Abstract: Objective To investigate the polymorphisms of interleukin-1B (IL-1B) promotor region 31 C/T and interleukin-1 receptor antagonist (IL-1RN) gene and the relationship between the genotype of IL-1 and IL-1RN and susceptibility to gastric cancer in Chinese population. Methods Genomic DNA was extracted from the juxta-cancerous normal mucosal biopsies of 50 patients with gastric cancer taken by endoscopy and from the peripheral lymphocytes of 50 normal controls and then was subjected to PCR amplification. The PCR product was digested by restriction endonuclease Alu I. The product of digestion was subjected to 2% agarose gel electrophoresis and ethidium bromide staining. Results The IL-1B -31C allele was detected in 75% of normal controls and 53% of patients, while the IL-1B -31T allele was detected in 25% of normal controls and 47% of patients. The frequency of -31C/-31C was 56% (28/56) and 30% (15/50) in normal controls and patients respectively. The frequency of -31C/-31T was 38% (19/56) and 46% (23/50) in normal controls and patients respectively. The frequency of -31T/-31T was 6% (3/56) and 24% (12/50) in normal controls and patients respectively. IL-1B -31T carriers were at increased risk of gastric cancer with an odds ratio of 7.5 for -31T/-31T homozygotes (95% CI, 2.0 approximately 27.6) and of 2.3 for -31C/-31T (95% CI, 0.9 approximately 5.4) respectively. Only three of the five kinds of polymorphism of IL-1RN (1/1, 1/2 and 2/2) were found in this study. The frequency of 1/1 was 54% (27/50) and 24% (12/50) in normal controls and patients respectively. The frequency of 1/2 was 38% (19/50) and 50% (25/50) in normal controls and patients respectively. The frequency of 2/2 was 8% (4/50) and 26% (13/50) in normal controls and patients respectively. The IL-1RN * 1 allele was detected in 73% of normal controls and 49% of patients; while the IL-1RN * 2 allele was detected in 27% of normal controls and 51% of patients. IL-RN * 2 carriers were at increased risk of gastric cancer with an odds ratio of 7.31 for 2/2 homozygotes (95% CI 2.13 approximately 25.09) and of 2.96for 1/2 heterozygotes (95% CI 1.22 approximately 7.21), respectively. Conclusion The polymorphism of promotor region -31C/T of IL-1B gene and the polymorphism of IL-1RN genes 1/2 and 2/2 are associated with the susceptibility of gastric cancer in Chinese. Carrying -31T allele increases the risk of gastric cancer. Polymorphism of IL-1RN and IL-1B gene may be used as indicators of susceptibility of gastric carcinogenesis.

[Polymorphisms of ACE-1 and MTHFR genes and genetic susceptibility of ischemic stroke].

Abstract: OBJECTIVE To study the relationships between polymorphisms of angiotensin-converting enzyme 1 (ACE-1) gene and N(5),N(10) -methylene-tetra-hydrofolic acid reductase (MTHFR) gene and ischemic stroke (IS) METHODS The polymorphisms of ACE-1 and MTHFR genes in the peripheral white blood cells of 143 patients with IS and 154 controls were analyzed using PCR- RFLP RESULTS The frequencies of II, ID, and DD genotypes of ACE-1 gene were 371%, 483%, and 147% respectively in IS patients,and were 442%, 377%, and 182% respectively in the controls The relative risk of stroke in IS group was 12 times that in the control group The frequencies of TT, CT, and CC genotypes of MTHFR gene were 140%; 455%, and 405% respectively in the IS group, and 52%, 318%, and 630% respectively in the control group The frequency of TT genotype was 52% in the control group and 14% in the IS group (P < 005) The frequency of T allele was 2110% in the control group and 3665% in the IS group (P < 001) The individuals with TT + ID or CT + ID were more susceptible to IS The individuals with TT + ID were 43 times susceptible to IS than the controls, and the individuals with CT + ID were 163 times susceptible to IS than the controls However, the individuals with CC + ID were less susceptable to IS in comparison to the controls (P = 0003) CONCLUSION TT and CT genotypes of MTHFR gene may be the risk factors of IS There is a co-effective action between polymorphisms of ACE-1 gene and those of MTHFR gene in the pathogenesis of IS CC genotype may have a protective effect against IS

[Extended-spectrum beta-lactamase in Klebsiella pneumoniae and Escherichia coli isolates].

Abstract: Objective To investigate the prevalence, drug resistance, gene typing, and epidemicity of extended-spectrum beta-lactamases (ESBL) Klebsiella pneumoniae and Escherichia coli isolates. Methods 559 strains of K. pneumoniae and 427 strains of E.coli were isolated form Huanshan Hospital from 1 January to 31 December 1999. The ESBL-producing strains were detected by double disc test and confirmed by minimal inhibitory concentration (MIC). The MIC of ESBL-producing strains was detected by agar dilution test. The beta-lactamase genes were detected by PCR. DNA fingerprinting was made by pulsed-field gel electrophoresis (PFGE). Results The incidence of ESBL-producing strains was 51% among the isolated K. pneumoniae (285/559) and 23.6% among the isolated E. coli (101/427), most of which were collected from the patients in the intensive care unit and neurosurgical ward. 63.5% of the ESBL-producing K. pneumoniae strains were collected from sputum specimens, and 64.3% of the ESBL-producing E. coli strains were collected from the urine specimens. Most ESBL-producing strains were resistant to most beta-lactam antibiotics, including the third-generation cephalosporins, and non- beta-lactam antimicrobial drugs, such as fluoroquinolones, aminoglycosides, tetracycline, and chloramphenicol. Most of the ESBL-producing strains were susceptible to imipenam, cefmetazole, and beta-lactam antibiotic/clavulanic acid. TEM type beta-lactamase was the main type among those EBSL-producing strains, followed by SHV type and CTX-M type. Some ESBL-producing E. coli and most ESBL-producing K. pneumoniae produced more than one type of beta-lactamase. Conclusion ESBL-producing strains are common among hospital strains of E. coli and K. pneumoniae. Most of them are multidrug resistant. Prevalence and transmission of these strains exist in hospital.

[Anti-HBV efficacy of bifendate in treatment of chronic hepatitis B, a primary study].

Abstract: OBJECTIVE To investigate the anti-HBV efficacy of bifendate in treatment of chronic hepatitis B. METHODS A total of 119 patients with chronic hepatitis B were randomly divided into treatment group (n = 65, aged 24 +/- 12) and control group (n = 54, aged 25 +/- 11). In the treatment group every patient was given higher doses bifendate pills ( 12 age, 45 approximately 67.5 mg/d) for up to 12 months. Hepatic function test was performed and HBeAg, HBeAb and HBV DNA were detected at regular intervals in all patients. RESULTS The serum alanine amonotransferase (ALT) decreased to normal only one month later in 70.76% of patients in the treatment group and decreased to normal at least in 2 approximately 3 months in the control group (P < 0.01). The serum conversion rates of HBeAg, HBeAb and HBV DNA in the treatment group were 44.4%, 29.3%, 38.5%, respectively, which were significantly higher than those in the control group (P < 0.01). No noticeable side effect was observed. CONCLUSION Higher doses of bifendate taken for a long term has remarkable anti-HBV efficacy in treatment of chronic hepatitis B.

New methods of minimally invasive brain modulation as therapies in psychiatry: TMS, MST, VNS and DBS.

Abstract: Over the past 20 years, new methods have been developed that have allowed scientists to visualize the human brain in action. Initially positron emission tomography (PET) and now functional magnetic resonance imaging (fMRI) are causing a paradigm shift in psychiatry and the neurosciences. Psychiatry is abandoning the pharmacological model of 'brain as soup', used for much of the past 20 years. Instead, there is new realization that both normal and abnormal behavior arise from chemical processes that occur within parallel distributed networks in specific brain regions. Many of these pathological circuits are becoming well characterized, in disorders ranging from Parkinson's disease, to obsessive-compulsive disorder, to depression. Most recently, there has been an explosion of new techniques that allow for direct stimulation of these brain circuits, without the need for open craniotomy and neurosurgical ablation. The techniques include transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), vagus nerve stimulation (VNS), and deep brain stimulation (DBS). This review will describe these new tools, and overview their current and future potential for research and clinical neuropsychiatric use. The psychiatry of the future will be better grounded in a firm understanding of neuroanatomy and neurophysiology (as well as pharmacology). These brain stimulation tools, or their next iterations, will play an ever-larger role in clinical neuropsychiatric practice.

[Cloning of a novel gene, ANGPTL4 and the functional study in angiogenesis].

Abstract: OBJECTIVE: To clone a novel HCC-related gene and study its functions. METHODS: Using a combination of cell growth based functional screening of human placental cDNA library and RACE, a novel gene, angiopoietin-like 4 (ANGPTL4) was isolated. The gene was mapped by RH-PCR; also it was expressed with E. coli. Effects on angiogenesis was studied by MTT assay, in vitro wound migration assay, in vitro invasion assay, in vitro tube formation assay and in vivo mouse matrigel plug assay. RESULTS: ANGPTL4 was cloned and mapped in 19p13.3. ANGPTL4 had no significant effect on proliferation of PAEC (P = 0.0504), while it can significantly stimulate migration and invasion of PAEC with the dose of 2 microgram/ml (P < 0.05) and promote in vitro tube formation of PAEC and angiogenesis of mouse in vivo. CONCLUSIONS: ANGPTL4 can stimulate angiogenesis.

[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.

[Effect of local mild hypothermia on treatment of acute intracerebral hemorrhage, a clinical study].

Abstract: OBJECTIVE To observe the effect of local mild hypothermia on treatment of acute intracerebral hemorrhage. METHODS Forty patients with acute intracerebral hemorrhage were matched according to age and state of illness at a ratio of one to one and then randomly divided into two groups of 20 patients: routine group (dehydrant, antihypertensive agent, etc were given) and hypothermia group (in addition to the general treatment, controllable semiconductor brain-protecting freezer was used to produce local hyperthermia at temperature of 6 degrees C for 48 hours). Immediately after admission and one week and 2 weeks after treatment cranium CT was conducted and the volume of cerebral edema was calculated by Tada's formula. RESULTS There was no significant difference in the volume of edema and scores according to European Stroke Scale between the two groups at admission (P > 0.05). The volumes of edema one week and 2 weeks after therapy were 17.4 +/- 6.2 and 13.1 +/- 5.8 milliliter respectively in hypothermia group, both significantly lower than those in the routine group (33.8 +/- 16.0 and 22.4 +/- 12.2 milliliter respectively, P < 0.05). The scores according to European Stroke Scale one week and 2 weeks after therapy were 62.1 +/- 10.8 and 70.3 +/- 10.7 in hypothermia group, both significantly higher than those in the routine group (52.8 +/- 10.9 and 60.5 +/- 10.9 respectively, P < 0.05). No side effect caused by local hyperthermia was observed during the therapy. CONCLUSION A safe and reliable treatment, local mild hypothermia combined with routine therapy is effective in protecting the brain of patients with intracerebral hemorrhage.

[Immunogenicity and efficacy of two live attenuated hepatitis A vaccines (H(2) strains and LA-1 strains)]

Abstract: Objective To assess the efficacy and immunogenicity of two live attenuated hepatitis A vaccines. Methods Randomized and controlled clinical trials were conducted in Guanxi, Hebei and Shanghai, 457 251 children were enrolled. The efficacy for preventing clinical hepatitis A was calculated by the comparison of incidence rate of disease between vaccine group and control group. Susceptible subjects tested anti-HAV negative before the study were followed up after vaccination for determination of the immunogenicity and vaccine efficacy to prevent subclinical infection. Results The protective efficacy to prevent clinical infection by both H(2) and LA-1 vaccines were 95%. The peak of seroconversion was observed in 94.9% and 86.0% respectively for the two vaccines. The seroconversion rate decreased to 75% approximately 80% in the third year, but the vaccine protection against clinical hepatitis A has remained unchanged throughout the 3 years. Conclusion Both strains of the live attenuated hepatitis A vaccines have good immunogenicity and high protection against clinical disease, the efficacy to prevent subclinical infection is not significant. The subclinical HAV infection serves as a natural booster for the vaccinees.

The role of urotensin II gene in the genetic susceptibility to type 2 diabetes in Chinese population

Abstract: OBJECTIVE To investigate the relationship between the polymorphism of site rs228648 in urotensin II gene and the genetic susceptibility to type 2 diabetes in Han people. METHODS Genotyping was conducted to investigate the polymorphism of site rs228648 (G-A) in urotensin II gene among 166 unrelated type 2 diabetic subjects (case group 1), 87 probands from 87 families of type 2 diabetics (case group 2), and 121 non-diabetic normal controls (control group). RESULTS 1) The frequency of "G" allele of site rs228648 was 62.3% and 75.3% in case group 1 and case group 2 respectively, significantly higher than that in the control group (50.4%, P = 0.004 and P < 0.001). 2) The frequency of G/G genotype of rs228648 was 35% and 53% in case group 1 and case group 2 respectively, significantly higher than that in the control group (24%, P < 0.05 and P < 0.01). The odds ratio was 1.86, P = 0.041 in the case group 1 and 4.03, P < 0.001 in the case control 2 after adjustment by sex, age and BMI. CONCLUSION Urotensin II gene may contribute to the genetic susceptibility to type 2 diabetes in Han population.

Effects of salvianolic acid-B on TGF-beta 1 stimulated hepatic stellate cell activation and its intracellular signaling.

Abstract: Objective To investigate hepatic stellate cells (HSC) responses at different differentiation stages on transforming growth factor-beta 1, and to elucidate the mechanisms of salvianolic acid - B (SA-B), a water soluble compound from Salvia miltiorrhiza, against hepatic fibrosis, relating to interference with TGF-beta 1 stimulated HSC activation and intracellular signal transduction via Smads. Methods HSC was isolated from rat by in situ perfusion of liver and 8.2% nycondenz gradient centrifugation, and primarily cultured on uncoated plastic for 1 d, 4 d and 7 d respectively, which represented quiescent, intermediate and activated phenotypes. The cells were stimulated with 100 pmol/L TGF-beta 1, cell phenotypes were observed under inverted microscope, alpha-actin expression was checked by Western blot, and collagen secretion was measured with [(3)H] proline incorporation and collangenase digestion, then HSC at one definite differentiation stage that responded most sensitively to TGF-beta 1 was selected as the cell model for the following study. 0.1 micromol/L - 1 mmol/L SA-B was incubated with HSC and the cell proliferation was measured by intracellular [(3)H] thymidine pulse. SA-B was also incubated with TGF-beta 1 stimulated HSC, the collagen secretion was measured as above, alpha-actin and plasmin activator inhibitor-1 (PAI-1) were checked with Western blot, and alpha1 (I) procollagen mRNA levels were analyzed with Northern blot. The cytoplasmic and nuclear proteins were extracted, and cytoplasmic and nuclear Smad2, 3 expression and phosphorylation levels were measured with Western blot. Results As culture duration prolonged, HSC phenotypes underwent activation gradually, accompanied by the increase of alpha-actin expression and collagen secretion. TGF-beta 1 increased the basal collagen levels at d1, d4 and d7 by 128.6%, 207.7% and 188.2% of the control respectively, while d4 HSC had the most sensitive response, and this intermediate HSC was used as cell model for the following study. Except 0.1 mmol/L-1 mmol/L SA-B caused parts of HSC death, 0.1 micromol/L-10 micromol/L SA-B had no influence on cell shape, but decreased HSC proliferation in a dose depend manner, by 76%, 60.1% and 47.8% of the control respectively. 1 micromol/L-10 micromol/L SA-B remarkably inhibited the collagen secretion of TGF-beta 1 stimulated HSC by 68.6% and 56.1% of the control, PAI-1 and alpha-actin expression, and down-regulated alpha 1 (I) pro-collagen gene expression. 0.1 micro mol/L approximately 10 micro mol/L SA-B decreased the cytoplasmic and nuclear Smad2, 3 protein expression, especially inhibited Smad2 phosphorylation and nuclear translocation. Conclusions SA-B obviously inhibits intermediate HSC proliferation, decreases TGF-beta 1 stimulated HSC activation and matrix protein and gene expression, and inhibited stimulated HSC Smad2, 3 protein expression, phosphorylation and nuclear translocation. The inhibition of TGF-beta 1 signaling in HSC and its biological responses is the important mechanism of SA-B against hepatic fibrosis.

Prophylactic antibiotics in cirrhotics with upper gastrointestinal hemorrhage: a prospective, controlled trial.

Abstract: Background Infections are a frequent complication in cirrhotics, and gastrointestinal bleeding may increase the infection rate Nonabsorbable antibiotics or quinolone have been employed to decrease the incidence of infection Since most of these studies were performed in western countries, it is still unclear whether this holds true in our Taiwan cirrhotic patients Thus we conducted this study using a different formula of antibiotics to evaluate the efficacy of reducing infection rates in cirrhotics with upper gastrointestinal bleeding Methods From July 1999 to August 2000, all cirrhotic in-patients presenting with upper gastrointestinal bleeding but without infection were enrolled The patients should not have received antibiotics within 2 weeks before admission and should have expected life expectance more than 7 days Eligible patients who had received endoscopy within 12 hours of hospitalization were randomly allocated into 2 groups Group A received intravenous cefazolin 1 gm every 8 hours started before endoscopy After 3 days of prophylactic parenteral antibiotics, antibiotics were shifted to oral cephalexin of 500 mg every 6 hours for 4 days Group B served as control subjects All patients received chest X-ray, blood and urine cultures, and ascites culture and sputum culture if ascites and sputum were found Patients were excluded when initial blood, urine or ascites culture was positive for bacterial growth Results Ninety-seven patients were included Group A was comprised of 47 patients and Group B comprised of 50 patients There was no significant difference in age, sex, Child-Pugh's score or initial hemoglobin between the 2 groups Proved infection developed in 6 patients of Group B By contrast, no proved infection was found in Group A Three organisms belonged to gram-negative bacilli and 3 organisms were gram-positive cocci The incidence of proved infection during hospitalization was 0% in Group A and 120% in Group B (p = 0027) If possible infection cases (patient's body temperature more than 38 degrees C for more than 2 days) were included, the infection rate was 64% in Group A and 26% in Group B (p = 0013) Infection-related mortality occurred in 2 patients in Group B, but none in Group A Conclusions Our prophylactic antibiotic treatment proved safe and effective in reducing the infection rate in cirrhotics with upper gastrointestinal bleeding