1997年 · 第110卷第03期

OBJECTIVE To understand the rapid increase of benign prostatic hyperplasia (BPH) in China by a comparative study of the nutrition status and BPH morbidity between urban and rural areas. METHODS A study was conducted in 1993-1995 in Beijing on the influence of diet on the prevalence of BPH in 413 rural and 419 urban male inhabitants over 40 years of age. RESULTS The results indicated distinctive differences in dietary patterns and the prevalence of BPH between rural and urban inhabitants. CONCLUSIONS The changing prevalence of BPH in China can be attributed to the increased daily intake of total calories, fat and animal protein, and the decreased daily intake of vegetables and whole grain, the sources of phytoestrogens.

OBJECTIVE To establish a doxorubicin-resistant human bladder cancer cell line, BIU-87/ADMR, and to study its biological characteristics and mechanism of drug resistance. METHODS A human bladder cancer cell line resistant to doxorubicin, BIU-87/ADMR, has been established in vitro by exposing BIU-87 parent cells to progressively increasing concentrations of the drug over a period of 8 months. The cell line has been characterized in terms of growth kinetics, morphology, cross-resistance to other anticancerous agents, pharmacokinetics of daunorubicin and expression of P-glycoprotein (P-gp) which is closely related to the MDR phenotype. RESULTS The BIU-87/ADMR cell line was 6.3 times more resistant to doxorubicin than the parent BIU-87. It exhibited cross-resistance to doxorubicin derivatives (epirubicin, daunorubicin), vincristine and etoposide, but not to cisplatin and mitomycin C. Compared to the parent cells, the resistant cells have a slower growth rate and lower confluent density. Unlike the parent BIU-87, about 75% of the BIU-87/ADMR cells showed a positive reaction with monoclonal antibody against P-gp, JSB-1. Intracellular drug accumulation studies with fluorescence spectrometry indicated that the resistance exhibited by the BIU-87/ ADMR line was mainly caused by an increased active efflux. CONCLUSIONS The results suggest that MDR is an important phenomenon in bladder cancer and that more than one pathway of MDR may be present in human bladder cancer cell lines. BIU-87/ADMR may be a useful model for the development of new chemotherapeutic strategies in overcoming drug-resistance in the treatment of bladder cancer.

OBJECTIVE To investigate the effects of autonomic drugs on the in vivo bladder base and proximal urethra in order to provide some reference materials for clinical usage of these drugs in the treatment of bladder outlet dysfunction. METHODS In 35 dogs, the bladder base was separated from the bladder body and closed to constitute a small chamber. The changes of the pressure in the bladder base chamber and proximal urethra were recorded synchronously before and after administration of autonomic drugs. All data were analyzed with Student's t test. RESULTS The bladder base had little response to acetylcholine (Ach) which however promoted a contraction of the proximal urethra. The effect of Ach on the proximal urethra was antagonized by phentolamine, but not by atropine. Isoprenaline resulted in relaxation of the bladder base, though it had little effect on the urethra. Norepinephrine (NE) produced contraction of the bladder base and urethra, while phentolamine caused a reduction in the bladder base and urethral pressure, and blocked the response of the bladder outlet region to NE. Angiotensin amide (AII) caused contraction of the bladder base and urethra, which was not obliterated by phentolamine. CONCLUSIONS The cholinergic drug has no influence on the in vivo canine bladder base, but causes a contraction of the proximal urethra through indirect activation of alpha-receptors. The alpha-adrenergic agents have great effects on the bladder base and urethra by acting on alpha-receptors within the musculature in the outlet region. The beta-adrenoceptor agonist results in relaxation of the bladder base, but it has no effect on the urethra.

OBJECTIVE To evaluate the sensitivity and specificity of polymerase chain reaction (PCR) technique in comparison with diethylaminoethyl-dextran (DEAE-dextran)-treated HeLa cell culture method for detection of chlamydia trachomatis in nonbacterial prostatitis. METHODS Thirty patients had symptoms of prostatitis for at least three months. None of them had evidence of urethritis on urethral Gram stain or recurrent bacteria. Routine localization of bacteria was negative. White blood cell count in expressed prostatic secretion (EPS) was more than 10 per high-power field (10/HPF). None of these patients had received antibiotics during the six weeks before the study, although all had received multiple courses of antibiotics for treatment of prostatitis syndrome. The EPS specimens from these patients were placed in 0.5-ml Eppendorf tubes and stored at -70 ℃ until they were processed for PCR and DEAE-dextran-treated HeLa cell culture. RESULTS Six specimens were positive for C. trachomatis by both PCR and culture, and 21 were negative by both tests. There were three specimens with discrepant results, including two that were positive by PCR and negative by culture, and one that was positive by culture and negative by PCR. Comparing PCR technique with culture method, the sensitivity, specificity, positive predictive value and negative predictive value of the former were 85.7%, 91.3%, 75.0% and 95.5% respectively. CONCLUSIONS PCR analysis of EPS is a highly sensitive and specific noninvasive technique for detection of chlamydia trachomatis. It provides a unique opportunity for early identification of or rapid screening for chlamydia trachomatis infection in patients with nonbacterial prostatitis. The reliability of PCR assay offers clinicians a clear indication for the initiation of treatment of chlamydia trachomatis infection.

OBJECTIVE To investigate the effects of interleukin-2 (IL-2) combined with either tumor necrosis factor-α (TNF-α) or α-interferon (IFN-α) on the proliferation and cytolysis to bladder tumor cells of lymphokine-activated killer (LAK) cells in patients with bladder cancer. METHODS LAK cells were generated by ficoll-paque density-centrifugation from 21 patients with bladder cancer and cultured in medium containing IL-2. LAK cell proliferation was assayed in the presence of various concentrations of either TNF-α or IFN-α by cell count in 96-well plates. Bladder cancer cell lines BIU-87 and EJ were cultured as target cells and the cytotoxicity of LAK cells was determined by 3-(4,5-dimethylthiazol-2-yl)-2, 5 diphenyltetrazolium bromide (MTT) assay. RESULTS The proliferation of LAK cells induced by IL-2 was enhanced by TNF-α in a dose-responsive fashion. The direct growth support for the LAK cells was also observed with IFN-α at the concentration of 1000 U/ml after 48 hours of culture. TNF-α (5000 U/ml) resulted in an increase in the cytotoxicity of LAK cells to BIU-87 and EJ cells. However, the change of cytotoxicity of LAK cells treated with IFN-α was not statistically significant. CONCLUSIONS TNF-α and IFN-α enhance the proliferation and activation of LAK cells and influence their antitumor cytotoxicity in patients with bladder cancer.

OBJECTIVE To evaluate the efficacy of intravenous (i.v.) thrombolytic therapy on acute myocardial infarction (AMI) and to evaluate the sensitivity and specificity of clinical criteria in deciding reperfusion rate by using 90 minutes angiography after initiation of the i.v. urokinase (UK). METHODS Coronary artery angiography (CAG) was performed in 124 out of 1406 patients with AMI receiving i.v. UK (UKTP) (Guangdong Techpool Biochemical Pharmaceutical Co. Ltd. Guangzhou, China) from November 1994 to April 1996. 1.5 million units of UKTP were infused in 111 patients, 2.0 million units in 10 patients and 1.0 million in 3 cases within 30 minutes. CAG was performed 90 minutes after the initiation of thrombolytic therapy. RESULTS Fifty-two patients had coronary flow grade of TI-MI-3 and 38 patients TIMI-2 90 minutes after the onset of thrombolytic therapy. The total patency rate of infarct related artery (IRA) was 72.6%. There was no significant difference (P>0.05) in the patency rate of IRA of various locations. The patency rate of LAD was 71.6% (53/74), of RCA was 71.4% (30/42), of LCX was 85.7% (6/7) and effective patency in one patient with left main artery occlusion. Although there was a tendency that the earlier the thrombolytic therapy, the higher the patency rate of IRA patency, the results did not meet the statistically significant level (P>0.05). Using CAG as the gold standard, the clinical criteria used for evaluation of reperfusion rate had a sensitivity of 88%, specificity of 69% and accuracy of 83% in prediction of the reperfusion of IRA. CONCLUSIONS UK is effective and reliable in i.v. thrombolytic therapy of AMI. The clinical criteria used to predict reperfusion of IRA have a higher sensitivity and relatively lower specificity.

OBJECTIVE To study the effects of patency of infarct-related coronary artery on acute outcome in cases of acute myocardial infarction undergoing urokinase therapy. METHODS One thousand one hundred and thirty-eight cases of acute myocardial infarction admitted in 37 collaborative hospitals were given urokinase intravenously with a standard program. Patency of infarct-related coronary artery assessed by uniform criteria occurred in 757 patients (66.5%) and non-patency in 381 patients (33.5%). Four-week mortality and frequency of various severe complications were compared between patency patients and non-patency patients. RESULTS The 4-week mortality in patients with patency was 3.4% versus 21.8% in those without patency (P<0.001). Frequencies of various severe complications, such as heart failure, shock, ventricular fibrillation, bundle branch blocks and mechanical complications (P<0.01), and complete atrioventricular block (P<0.05) were much higher in patients without than in those with patency. In large sized infarcts such as high lateral plus anterior wall infarction the difference in 4 week mortality was even more obvious between patients with and without patency (2.6% vs 32.7%, P<0.001). Using Cox proportional hazards regression model analysis, patency of infarct-related coronary artery was defined as the most important independent predictor of 4-week mortality. The risk ratio for occluded versus patent infarct-related coronary artery was 6.69. CONCLUSIONS On univariate and multivariate analyses, patency of the infarct-related coronary artery was the most important prognostic factor for acute outcome in acute myocardial infarction.

OBJECTIVE To investigate the long-term prognostic influence of patency of the infarct-related coronary artery. METHODS One thousand two hundred and sixty seven cases of acute myocardial infarction with thrombolytic treatment between July 1991 and January 1995 in 36 collaborative hospitals were followed-up after discharge with a total follow-up rate of 84.5%. Patency of infarct-related coronary artery was assessed by uniform clinical criteria. Eight hundred and forty three patients with patency were followed up for 16.0±10.4 months and 424 patients without patency for 19.2±12.22. Death or up to the end of March, 1995 was used as the end point. RESULTS Comparisons of patients with patent versus nonpatent infarct-related coronary artery during follow-up showed: (1) Cardiac death rate was 2.85% in patients with patency while 4.72% in those without patency (logrank test, P>0.1). (2) Three-year survival rates calculated by Kaplan-Meier curve were 91.6% and 73.9% respectively (logrank test, P<0.001). (3) Incidence of reinfarction were 5.7% and 5.9% respectively (P<0.05). (4) Patients with class III-IV NYHA cardiac function occurred in 11.3% and 17.9% respectively (P<0.01). (5) By Cox regression model analysis patency of infarct-related coronary artery, recurrent infarction, age and infarct sites were independent prognostic factors. Survival probability increased by 33.5% in patients with patency compared to those without patency. CONCLUSIONS It is evident that patency of infarct-related coronary artery could improve long-term survival.

OBJECTIVE To study the manifestations of Behcet's disease (BD) in the digestive tract and its differential diagnosis from common inflammatory bowel diseases. METHODS The symptoms and endoscopic, X-ray's or surgical characteristics of 24 cases of Behcet's disease with digestive tract manifestations were analysed. RESULTS The lesions mainly occurred in tileocecum, and frequently led to hemorrhage that required surgery. The recurrent rate was as high as 77.7%. CONCLUSIONS Importance should be attached to early diagnosis of BD of the digestive tract to prevent serious complications.

OBJECTIVE To measure serum 7S collagen (7S-C) and type VI collagen (VI-C) levels by radioimmunoassay (RIA) in Chinese patients with various liver disorders and in CCl4-treated SD rats, and to investigate the significance of the elevated levels of serum 7S-C and VI-C. METHODS Serum 7S-C and VI-C levels were measured in 40 healthy control subjects, 168 patients with various liver disorders and non-hepatic diseases, and 52 CCl4-treated SD rats by using RIA which was developed in our hospital. RESULTS Serum 7S-C and VI-C were significantly elevated in patients with chronic active hepatitis (CAH), liver cirrhosis (LC), hepatic cellular carcinoma (HCC) (P<0.01 respectively), chronic persistent hepatitis (CPH), and some with non-hepatic diseases (P<0.05). Serum 7S-C, serum laminin and hyaluronic acid were well correlated. Serum 7S-C and VI-C were not closely correlated. Both collagens were correlated with serum albumin/globulin ratio, aminotransferase and total bilirubin, not with alkaline phosphatase. In CCl4-treated SD rats, serum 7S collagen and type VI collagen levels were correlated with the degree of hepatic fibrosis. CONCLUSIONS Serum 7S collagen and type VI collagen are useful markers for diagnosing liver fibrosis. And the combined measurement of IV-C, VI-C and other markers of connective tissue metabolism or biochemical data seems to provide additional information to predict progressive hepatic fibrosis.