1997年 · 第110卷第11期

OBJECTIVE To assess the efficacy of captopril on mortality and morbidity after acute myocardial infarction (AMI). METHODS A total of 14,962 patients entering 650 hospitals from 30 provinces and autonomous regions of China up to 36 hours (mean 16.6±10.2 hours) after the onset of suspected acute myocardial infarction (MI) with no clear contraindications or indications to the study treatments (in particular, no persistent hypotension or hypovolemia due to long-term use of large dose of diuretics) were randomized to use either 4 weeks of oral captopril (6.25 mg initial dose, 12.5 mg 2 hours later, and then 12.5 mg three times daily) or matching placebo. RESULTS Captopril was associated with a non-significant reduction in 4-week mortality (9.12% vs 9.74%; P=0.20); but incidence of heart failure was significantly reduced among captopril group (17.0% vs 18.7%; P=0.01). The combined end point (death + heart failure) was 1680 (21.5%) in captopril group and 1733 (23.1%) in placebo group (P=0.02). Anterior wall infarction of captopril treated group was found to have lower mortality (8.6% vs 10.2%, P=0.02). Captopril treated group with a heart rate (HR)≥60/min at entry showed significantly lower mortality than placebo group (9.2% vs 10.7%; P=0.01). There was a significant excess of hypotension, mostly after the start of treatment, but no evidence of any adverse effect on early mortality. CONCLUSIONS The angiotensin converting enzyme inhibitors (CEI) therapy started early in acute MI prevents about 6 deaths per 1000 treated, and about 15 deaths due to heart failure per 1000 in the 1st 4 weeks with greater benefits. In anterior myocardial infarction group it prevents 16 deaths per 1000 with nearly no benefit for the inferior infarction group. Due to the parasympathetic mimic effect, CEI should be used carefully in inferior infarction patients especially when HR is slow or heart block and hypotension are present.

OBJECTIVE To investigate the clinical efficacy and safety of intravenous thrombolytic therapy of Urokinase Tech-Pool (UKTP) in acute myocardial infarction (AMI). METHODS The data were collected from the 148 participating hospitals from November, 1994 to April, 1996. A total of 1,406 patients with AMI were analyzed to evaluate the clinical efficacy, side effects and mortality of UKTP. The patency of the infarct-related artery (IRA) was evaluated in 124 patients by coronary artery angiography (CAG) 90 minutes after the onset of UKTP infusion. RESULTS The reperfusion rate in IRA was 73.5% by clinical standards. The patency rate was 72.6% by CAG. The total mortality during the first 5 weeks was 7.8% (109/1,406). The rate of minor bleeding was 10.2% (143/1,406), of major bleeding 0.43% (6/1,406) and of intracranial hemorrhage 0.50% (7/1,406). In elderly patients (>75 years old), UKTP was as effective and safe as in younger patients (<65 years old). Late thrombolytic therapy with UKTP (>6 hours after the onset of symptom) was still effective. The appropriate dosage of UKTP might be 150 million units of infusion within 30 minutes. CONCLUSIONS UKTP is an effective, reliable and safe agent in the thrombolytic therapy of AMI.

OBJECTIVE To evaluate the effects of removing circulatory tumor necrosis factor (TNF) by immunoadsorption on endotoxin shock animals. METHODS Sixty New Zealand white rabbits were injected intravenously with lethal dose of endotoxin (10 Billion cfu/kg E. Coli endotoxin) and randomly divided into 3 groups: perfusion group, hemoperfusion started at 1 hour after injecting endotoxin through immunoadsorbent columns against TNF; pseudoperfusion group, hemoperfusion through blank columns; and control group, injected with endotoxin only. The arterial pressure, microcirculation of the mesentery, plasma levels of TNF, IL-1, IL-6, IL-8, nitrite, endothelin-1 (ET-1), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine were measured and analyzed and finally the survival rate was observed. RESULTS Plasma levels of TNF were sharply reduced after immunoadsorption. Moreover, release of IL-1, IL-6, IL-8, NO and ET-1 were also attenuated. Hemodynamic abnormalities could be improved and survival rate ameliorated significantly. CONCLUSIONS Specific immunoadsorption of circulating TNF might be a new and effective therapy for endotoxin shock.

OBJECTIVE To examine the effect of recombinant human transforming growth factor-β1 (rhTGF-β1) alone or recombinant human interleukin 6 (rhIL-6) alone or in combination on proliferation inhibition of the human leukaemia cell line. METHODS In the present study, using the human monoblastic cell line (U937) and human promyelocytic cell line (HL60) as an in vitro model, we analyzed the effect of two cytokins on proliferation inhibition with rate of 3H-TdR incorporation, the cellular content of DNA, DNA indices, the cell cycle and the expression of c-myc mRNA. RESULTS With administration of rhTGF-β1 and rhIL-6, U937 cell growth was inhibited and the rate of 3H-TdR incorporation inhibition was increased. There was a decrease in the cellular content of DNA and DNA indices. And no change in the cell cycle was observed after administration of rhTGF-β1 or rhIL-6. However, there was an increase in G0/G1 phase cells and a decrease in G2M + S phase cells after administration of combination of rhTGF-β1 and rhIL-6. It was also found that rhIL-6 could inhibit proliferative responses of HL60 cells, meanwhile the inhibition could be enhanced by rhTGF-β1. The rate of 3H-TdR incorporation inhibition rose up to 39.89%, and DNA index fell to 1.00 following induction by rhIL-6 plus rhTGF-β1. Furthermore, G0/G1 phase cells increased while G2M + S cells decreased. CONCLUSIONS These RESULTS suggest that combination of rhTGF-β1 and rhIL-6 acted in synergy to inhibit proliferation of both U937 and HL60 cell lines. Molecular hybridization test show that rhTGF-β1 alone, rhIL-6 alone or rhTGF-β1 and rhIL-6 in combination can inhibit U937 and HL60 cells expression of c-myc mRNA in a time and dose dependent manner. rhTGF-β1 and rhIL-6 in combination synergistically inhibited c-myc expression, which may be one of the machanisms for the actions of the two cytokines.

OBJECTIVE To study the clinical, pathological and genetic characteristics of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). METHODS Eight cases of MELAS (6 of them were from 2 families) underwent clinical study, muscle biopsy, autopsy on one patient, brain biopsy on one patient and genetic research. RESULTS In clinical report the average age of onset was 10-22 years old. Four cases from one family were 3 brothers and their nephew (sister's son). The death age of the three brothers was 16-20 years. Two cases from another family were a brother and a sister. The six patients of the two families showed the typical inherited characters of MELAS. The symptoms were myoclonic epilepsy, stroke-like episodes, paralysis of limbs, progressive mental retardation and neurological deaf. CT showed calcification in globus pallidus and MRI demonstrated clearly the abnormal prolongation of T2-weighed signals that distributed in frontal, parietal, occipital and temporal cortex as multiple focal, cystic and laminar necrotic areas. Pathological studies on brain showed multi-focal, cystic, and laminar or spongy necrotic abnormality primarily in gray matter of frontal, parental, temporal and occipital cortex. Decrease and loss of nerve fibers of the sub-cortical white matters of the lesion areas of cortex and calcification of globus pallidus were also observed. Red ragged fibers (RRF) and abnormal mitochondron were found by muscle biopsies. A point mutation (A-G transition) at nt 4243 in the mitochondrial tRNA Leu (UUR) was confirmed by using PCR and Southern Blot. CONCLUSIONS Although great progress has been made in the clinical, pathological and genetic research of MELAS, the pathogenesis of the disease remains further research.

OBJECTIVE To recognize different forms of Guillain-Barre syndrome (GBS) in northern China. METHODS Twenty-one cases were found in two counties of Beijing suburb from January 1993, to December, 1994. Multiple electrophysiological studies including magnetic motor evoked potential, F-wave, motor and sensory conduction velocity, blink reflex and needle electromyography were conducted on nineteen cases of them. Twelve cases accepted electrophysiological follow-up study. RESULTS Altogether 17 cases showed demyelination features in multiple electrodiagnosis. Ten cases of them were accompanied by different extent of axonal lesion. Only one case showed main or primary axonal lesion. CONCLUSIONS Demyelination is the main type of pathophysiological lesion of GBS in Beijing suburb. Different extent of axonal lesion can appear in some cases, but primary and main axonal type is rare in this area.

OBJECTIVE To evaluate the results of primary surgical treatment of carcinoma of oral tongue in Hong Kong. METHODS Patients who had undergone primary surgical treatment of oral tongue carcinoma in Queen Mary Hospital were reviewed. RESULTS There were 112 patients in this study. The first sites of tumor recurrence were 10 (9%) local, 25 (22%) nodal, 3 (3%) locoregional, 5 (5%) distant, 1 (1%) local and distant, 3 (3%) nodal and distant, and 1 (1%) neck extranodal site. Of the 63 T1-2 N0 M0 patients, the regional recurrence rate was 9% for elective neck dissection compared with 47% for "watchful waiting" (Chi-square test, P=0.0008). The regional recurrence related mortality was 3% for elective neck dissection compared with 23% for "watchful waiting" (Fisher's test, P=0.02). The 5-year actuarial survival rate was 86% for elective neck dissection compared with 55% for "watchful waiting" (Wilcoxon, P=0.01). CONCLUSIONS Local and regional recurrences were the main sites of treatment failure. Elective neck dissection has significant benefits in the reduction of regional failure and improvement of survival. Elective selective I-III neck dissection have to be considered in patients with stage I and stage II oral tongue carcinoma.

OBJECTIVE To assess the existence of a possible infectious factor in varicocele-related infertility. METHODS A total of 925 seminal plasmas from 590 infertile men with varicocele and 335 infertile patients without palpable varicocele were cultured for Ureaplasma urealyticum infection, and routine semen analysis was made. RESULTS The infection rate of Ureaplasma urealyticum in seminal plasmas was 48.22%. The asymptomatic genital infection of Ureaplasma urealyticum was traced in 329 (55.76%) varicocele men and 117 (34.93%) infertile patients without varicocele (control group). A significant quantitative difference in the incidence of genitalUreaplasma urealyticum infection between the varicocele and control group was observed (P<0.005) and asthenozoospermia was significantly more prevalent in the patients with varicocele than in the other patients (P<0.05). CONCLUSIONS Genital Ureaplasma urealyticum infection may play a role in varicocele-related infertility. To prevent future infertility, men with both varicocele and genital Ureaplasma urealyticum infection may benefit from early evaluation and treatment.

OBJECTIVE To investigate, at transcriptional and translational level in situ, whether the gene expression of the Ki-67 protein in pancreatic carcinoma specimens is altered to get insight of the gene structure and function. METHODS Forty pancreatic cancer, 5 normal pancreatic and 4 chronic pancreatitis tissues were used in this experiment. A 435 bp cDNA fragment located in codon 2, exon 13 of Ki-67 antigen gene was amplified by the polymerase chain reaction (PCR). The DIG-labeled cRNA probes were transcribed using a commercial DIG RNA labeling kit. Localization of the Ki-67 protein and the specific mRNA was performed by combining immunohistochemistry (ICH) with DIG-labeled in situ hybridization (ISH). RESULTS Successful localization of the Ki-67 protein mRNA in pancreatic tissue sections, routinely formalin-fixed and paraffin-embedded, was first accomplished in this experiment. Analysis of the Ki-67 mRNA transcription in 17 pancreatic cancer specimens with Ki-67 ICH labeling index>20% revealed stronger mRNA signals in poorly differentiated specimens with Ki-67 index>50% than in well differentiated cases with the ICH labeling index of 20%-50%. A high expression of both the mRNA and the protein was observed in pancreatic adenocarcinomas with poor differentiation. CONCLUSIONS This is the first study in which the abnormal overexpression of the gene encoding Ki-67 protein was detected not only at the protein level, but also at the mRNA level in pancreatic tumours. The abnormal overexpression of the Ki-67 protein might be correlated with the central part, exon 13, of the gene.

OBJECTIVE To evaluate the effect of early intervention on the intellectual development in asphyxiated newborn infants. METHODS Full term asphyxiated infants (Apgar score ≤6 at 5 minutes after birth) were randomly assigned to early intervention group (34 cases) and conventional care (30 cases) group. The normal control group consisted of 38 infants. Sex, mother's educational background, environmental condition and physical development were not significantly different in the 3 groups. Zero to two years early intervention program was compiled on basis of the national and foreign material about 1 month ahead of average development of the child. It included motor, cognitive, speech development and social behavior. Parents were instructed to carry out early intervention. RESULTS At the age of 1.5 years, average score of mental development index (MDI) in early intervention group was 14.6 higher than that in conventional care group (F=18.86, P<0.0001). MDI score in early intervention group caught up with that in normal control group (F=2.17, P>0.05). Conventional care group was 9.7 lower than normal control group (F=10.14, P<0.01). Two of 30 cases (6.7%) in conventional care group was mentally retarded while none was mentally retarded in the early intervention group. CONCLUSIONS The results showed that the early intervention could promote intellectual development of asphyxiated infants and be of much benefit to the prevention of mental retardation.

Purpose To review the current status of multimodality treatment and lymphadenectomy in the management of esophageal cancer. Data source Literature review. Study selection Multimodality treatment and lymphadenectomy in esophageal cancer. Data extraction Results in research papers published selected by literature search. RESULTS Numerous studies have been carried out attempting to define the roles of various neoadjuvant or adjuvant regimens in the treatment of esophageal cancer. These included the use of radiotherapy or chemotherapy alone or in different combinations, with or without surgical resection. Randomized trials have failed to show significant improvement compared with surgical resection alone, although downstaging of disease and benefits on subgroups of patients could be demonstrated. Whether the extent of resection can influence outcome was tested by varying the surgical approach, and by increasing the extent of lymphadenectomy. Although indirect evidence exists suggesting more extensive resection may improve long term prognosis, definitive proof is lacking. CONCLUSIONS More well organized randomized controlled trials are needed to further elucidate the roles of these approaches in the treatment of esophageal cancer.

OBJECTIVE To review the research carried out in Hong Kong on nasopharyngeal carcinoma (NPC) over the past 10 years. METHODS The literature published in Hong Kong over the past 10 years on nasopharyngeal carcinoma were reviewed in the light of other important international publications on the same subject. RESULTS The research carried out in Hong Kong covers etiology, natural behavior, treatment and prognosis of NPC. These studies not only elucidated the different aspects of NPC, many of these new findings will also guide future directions of research. CONCLUSIONS Major efforts have been made to research into the various aspects of NPC with important findings which will translate into better treatment results. As this tumor is uncommon in other parts of the world, continued efforts to improve the prevention, early diagnosis, treatment and care of this tumor are required in China.