1999年 · 第112卷第04期

OBJECTIVE To elucidate the diagnosis, treatment and prognosis of medulloblastoma in both children and adults. METHODS A retrospective review was conducted in 80 patients with medulloblastoma confirmed pathologically during the period of 1984 and 1995. Multivariate analysis and comparison were made of the therapeutic effects of operation, radiotherapy and chemotherapy as well as the survival period. RESULTS There were 42 males and 38 females with average age at diagnosis being 9.1 years in children and 25.1 years in adults. All patients were operated on to remove the tumour. Cerebral aqueduct re-opening was got through in 54 cases (67.5%), and Torkilsen's shunt was carried out at the same time for the rest patients. Seventeen patients had ventriculoperitoneal shunt, and 13 of them were performed after surgical excision of the tumour. Complete follow-up information was obtained in 61 patients (76%) for a period of 6 months to 14 years. During the follow-up, 27 patients received postoperative craniospinal irradiation, and 27 local radiation. Fourteen patients were subjected to adjuvant chemotherapy. The overall 5-year and 10-year survival rates were 50.5% and 27.89% respectively. The 5-year survival rate was higher in adults than in children (P<0.05), whereas the 10-year survival rate was similar. Thirty-two patients died of relapse or metastasis between 6 months and 10 years after initial surgical therapy, and the mean recurrence time was 3.5 years. CONCLUSIONS Operation and postoperative regular radiotherapy were important therapeutic modalities for medulloblastoma. Total or subtotal removal of the tumour combined with craniospinal radiotherapy can improve patients' survival rate. The survival period of medulloblastoma patients is consistent with Collins' law, that is, the period of risk for survival is the age at initial diagnosis plus 9 months. Only few patients can gain long-term survival.

OBJECTIVE To determine the quality of life (QOL) of mild hypertensive patients treated with captopril as compared to placebo. METHODS This is a randomized, double-blind, placebo-controlled clinical trial held in the out-patient clinic of Zhong Shan Hospital. Adult patients aged from 28 to 75 years with mild hypertension defined as diastolic blood pressure from 90 to 105 mm Hg were the inclusion criteria of the study. There were 278 patients who were eligible to enter the study. They were randomized to receive captopril or placebo 25 to 50 mg bid for 12 weeks. Change of QOL was compared both quantitatively and qualitatively between captopril and placebo groups. Change of blood pressure and side effects were also compared. RESULTS With intention-to-treat analysis, significantly more improved QOL patients could be found qualitatively in patients with captopril treatment (45.3% vs 23.7%, P = 0.0002 for physical health domain; 48.9% vs 26.6%, P = 0.0002 for mental health domain; 33.8% vs 11.5%, P = 0.0001 for general function domain). Quantitatively, the change of score of mental health, general function and total QOL of captopril (3.18±5.90; 1.65±4.43; 7.84±11.03) were significantly higher than those of placebo (1.32±5.13, P = 0.00004; 0.64±3.45, P = 0.0008; 4.19±10.33, P = 0.0025 respectively), and the change of score of physical health domain (3.01±5.26 vs 2.23±4.79, P = 0.044) was of borderline statistical significant difference. Blood pressure was significantly lowered by captopril than by placebo (P = 0.000). CONCLUSIONS Compared with the placebo, captopril is not only effective in lowering blood pressure, as has been established, but also effective in improving QOL in mild hypertensives.

OBJECTIVE To investigate the inhibitory effects of aqueous turmeric extract (AqT) and serum of rats orally treated with ethanol extract of turmeric (SeT) on proliferation of vascular smooth muscle cells (VSMC) and its effects on the expression of low density lipoprotein receptor (LDL-R) antigen on the surface of smooth muscle cells. METHODS Enzyme-linked immunosorbent assay (ELISA) for the expression of LDL-R protein and thiazolyl blue (MTT) assay for the proliferation of VSMC were used in this study. RESULTS Both aqueous turmeric extract (AqT) and serum of rats orally treated with ethanol extract of turmeric (SeT) could inhibit 10% serum activated proliferation of VSMC. The inhibition shown in both experiments was dose-dependent with an inhibitory rate of 18.9% at 20 mg/ml AqT and rate of 20.1% at 10% SeT respectively. AqT up-regulated the expression of LDL-R protein with a highest rate at 5 mg/ml AqT in 3% lipoprotein deficient serum (LPDS). SeT did not show significant effect on the expression of LDL-R on the surface of VSMC. CONCLUSIONS The extracts of turmeric may be extended to decrease the risk of atherosclerosis (AS).

OBJECTIVE To develop an agarose electrophoretic method for creatine kinase (CK) isoforms, using highly sensitive fluorescence scanning. METHODS A discontinuous buffer system was used. Electrophoresis on agarose gel was performed under constant current and low voltage. CK isoforms were separated within 30 minutes and detected by fluorescence scanning. RESULTS There were no significant differences when the activities of CK-MM were between 853.0 U/L and 14.0 U/L and those of CK-MB between 152.0 U/L and 2.4 U/L. The detection limits of stain method for CK-MM and CK-MB isoforms were 36.0 U/L and 12.3 U/L, respectively; while those of fluorescence method were 12.0 U/L and 2.1 U/L. The experimental results showed good precision for CK-MM isoforms, as well for CK-MB isoforms and isoenzymes. CONCLUSIONS An agarose electrophoretic method has been developed to measure CK isoenzymes and isoforms clinically. This method is rapid, simple, sensitive, highly reproducible and inexpensive. It is suitable for general laboratories.

OBJECTIVE To clarify the segment and sequence in mouse α2(I) procollagen gene which are responsible for high transcriptional activity during fibrogenesis. METHODS This study was focused on further fractional analysis of 2 kb-length mouse α2(I) procollagen gene promoter activity. Six chimeric genes were constructed in which various lengths of sequences between 2000 bp upstream of the start of transcription of the mouse α2 (I) procollagen gene and 54 bp downstream of this site were fused to chloramphenicol acetyltransferase (CAT) reporter gene. These recombinant plasmids were transfected transiently to collagen-producing cells (NIH/3T3) and non-collagen-producing cells (COS7) with liposomal transfection method. The activities of putative promoters were observed and compared by means of CAT measurement in the transfected cells. RESULTS The highest and partial cell specific CAT expression was observed in construction driven by -780 to bp fragment. The construction containing sequence deleted the proximal 500 bp from the transcription start site and part of exon I, and resulted in the lowest CAT expression. CONCLUSIONS Some essential elements might exist in the 500 bp fraction proximal to transcription start site and part of exon I in mouse α2(I) procollagen gene. The high potential promoter sequence between -780 bp from the start of transcription site and bp from this site is of great significance in our following study of searching for specific DNA-binding proteins in activated collagen-producing cells.

OBJECTIVE To investigate whether PreS1 antigen and/or anti-PreS1 antibody in serum might have some significance different from routine hepatitis B virus (HBV) markers in hepatitis B virus infection. METHODS Forty-six acute hepatitis B patients and 377 chronic persistent hepatitis patients were examined to assess the clinical significance of serum PreS1/anti-PreS1. HBV family clustering analysis was carried out in a village in Shanghai suburb area, and case-control study on role of PreS1 in HBV spreading was undertaken in Tangshan, Hebei province. RESULTS PreS1 in HBsAg positive sera from chronic persistent hepatitis patients correlated with HBV DNA (P<0.05), while the presence of PreS2 in HBsAg positive sera was much more common than that of PreS1 and had no correlation with HBeAg or HBV DNA. Among 46 patients with acute hepatitis B, the appearance of anti-PreS1 antibody in serum correlated with the disappearing or decreasing of both PreS1 and ALT. In antiviral treatment, PreS1 antigen turned negative much earlier than PreS2 and HBsAg in acute hepatitis B patients' sera. Family clustering analysis suggested that people with PreS1 positive in serum were more infective than those with HBsAg positive alone (P<0.01). The case-control study showed that chronic hepatitis B patients with PreS1 positive in serum played a much more important role in HBV spreading than those with PreS1 negative (P<0.01) and asymptomatic HBsAg carriers (P<0.01), and the odds ratios (OR) were 3.8 and 3.2, respectively. CONCLUSIONS Serum PreS1 closely correlates with active virus replication, and PreS1/anti-PreS1 status indicates the outcome of acute hepatitis B. The serum PreS1/anti-PreS1 marker is of some significance in HBV epidemiology as well.

OBJECTIVE To study the effects of triglyceride, very low-density lipoprotein (VLDL), and Kupffer cell-conditioned medium (KCCM) derived from triglyceride and VLDL treatment on proliferation of rat hepatic stellate cells (HSC). METHODS HSC and Kupffer cells were isolated and cultured from liver of Wistar rats by in situ perfusion with proteinase and collagenase, and density gradient centrifugation with Nycodenz; HSC and Kupffer cells were identified by immunohistochemistry, endocytosis, and ultrastructure, etc. Kupffer cells were incubated with triglyceride (25 micrograms/ml) and VLDL (25 micrograms/ml) for 24 hours, KCCM were prepared, and MTT colorimetric assay was detected for HSC proliferation. RESULTS HSC proliferation was 0.1894±0.0316 (12.5 micrograms/ml), 0.1637±0.0243 (25 micrograms/ml), 0.1450±0.0264 (50 micrograms/ml), 0.1212±0.0275 (100 micrograms/ml), 0.1226±0.0138 (200 micrograms/ml) and 0.0990±0.0163 (400 micrograms/ml) in the presence of triglyceride and was 0.1583±0.0314 (6.25 micrograms/ml), 0.1642±0.0269 (12.5 micrograms/ml), 0.1834±0.0498 (25 micrograms/ml), 0.1964±0.0287 (50 micrograms/ml) and 0.2202±0.0284 (100 micrograms/ml) in presence of VLDL, respectively. Compared with the control, HSC proliferation at 400 micrograms/ml of triglyceride was lower (P<0.01), but at 12.5 micrograms/ml of triglyceride and 25, 50, 100 micrograms/ml of VLDL higher (P<0.05 or 0.01); HSC proliferation was 0.1569±0.0144, 0.1924±0.0113 and 0.1871±0.0116 in the presence of KCCM, KCCM + triglyceride and KCCM + VLDL, respectively. Compared with the control and KCCM, KCCM + triglyceride and KCCM + VLDL might promote HSC proliferation (P<0.01); there was no statistical significance between KCCM + triglyceride and KCCM + VLDL (P>0.05); KCCM was greater in HSC proliferation than the control, but there was no significant change (P>0.05). CONCLUSIONS Triglyceride, VLDL, and KCCM stimulated by triglyceride and VLDL might promote HSC proliferation and be associated with fatty liver and hepatic fibrogenesis.

OBJECTIVE To investigate the expression of autotaxin (ATX) mRNA existed in the human hepatocellular carcinoma (HCC), and whether there is relation between the level of ATX expression and clinicopathological features of HCC. METHODS Five normal liver tissues and 32 histologically verified HCC specimens were obtained. Semi-quantitative reverse transcription polymerase chain reaction was used to detect mRNA expression of ATX. RESULTS ATX was expressed in all 32 HCC and 5 normal liver tissues. The mean expression level of ATX gene in HCC samples was higher than that in normal liver tissues (68.23%±15.31% vs. 31.97%±8.05%, P<0.001). Patients were divided into two groups: low ATX HCC (15 cases) and high ATX HCC (17 cases) by the cutoff point of median value. Intrahepatic metastasis, vascular invasion and poor differentiation were more frequently noted in HCC patients with high ATX expression than in patients with low ATX expression. CONCLUSIONS ATX gene was found to be overexpressed in some HCC and correlated with HCC development and metastases.

OBJECTIVE To evaluate the relationship between the parameters of 24-hour esophageal pH monitoring and gastroesophageal reflux disease (GERD) among elderly subjects. METHODS Twenty-four-hour esophageal pH monitoring was carried out in 20 elderly subjects without apparent GERD symptoms (controls) and 69 suspected GERD subjects. RESULTS Normal values of the parameters from 20 elderly controls were obtained. Percent of total time, percent of supine time and percent of upright time in which the pH was<4 (indicating reflux) were less than 3.3%, 1.4%, 5.5%, respectively. The number of reflux episodes and episodes lasting longer than 5 minutes were less than 65 and 2 times respectively. The values obtained in 66 GERD suspected subjects were significantly different from those in normal controls. The differences of reflux parameters between the esophagitis group and non-esophagitis group, such as percent of total time with pH<4, percent of supine time with pH<4 and number of reflux lasting longer than 5 minutes were also significant. CONCLUSIONS About 51.6% patients (34/66) with reflux symptoms but without endoscopic evidence of esophagitis were definitely diagnosed as GERD by esophageal pH monitoring. Duration of esophageal acid exposure correlated with the severity of GERD.

OBJECTIVE To study the schedule-dependent reversion of cis-diamminedichloroplatinum (CDDP) resistance by 5-fluorouracil (5-Fu) in a CDDP resistant human lung adenocarcinoma cell line A549DDP. METHODS Dimethylthiazol dipheryltetrazolium bromide (MTT) assay and immunocytochemistry were used. RESULTS After the A549DDP was treated with CDDP, followed immediately by exposure to 5-Fu, cytotoxicity of CDDP increased 1.8 fold. After pretreatment of A549DDP with 5-Fu, followed immediately by exposure to CDDP, the cytotoxicity of CDDP increased 3.9 fold. After pretreatment of A549DDP with 5-Fu, after a 24- or 48-hour drug-free interval, followed by exposure to CDDP, the cytotoxicity of CDDP increased 20 and 250 fold, respectively, and the A549DDP was rendered more sensitive than its parental cell line A549. In parallel with the increased cytotoxicity, the cellular GSH content was significantly reduced at 24 or 48-hour after 5-Fu pretreatment. However, depletion of GSH by buthionine sulfoximine (BSO) only resulted in partial reversion of CDDP resistance. 5-Fu could also inhibit the expression of MRP, but had no effect on the expression of GST pi. The effect of 5-Fu on the parental cell line A549 was much smaller than that in A549DDP. CONCLUSIONS Scheduled administration of 5-Fu can reverse CDDP resistance completely through reduction of GSH and inhibition of MRP expression.

Purpose Both oncogenic viruses and cell cycle control proteins are fast-growth research areas. More and more evidence indicates that virus infection and replication are often associated with apoptosis and interfere with cell cycle pathways. To understand the mechanisms by which viral proteins regulate apoptosis and target the cellular pathways may lead to the development of new remedies for some cancers. Data source English literature searched by MEDLINE from January 1995 to August 1998. Study selection and data extraction More than one hundred research papers published in these areas over the past three years. Only new and important breakthroughs in these papers are selected. The review focuses on DNA viruses associated with the development of human cancers. Results and conclusions Some DNA viruses contain oncogenic proteins which transform normal cells in vitro and induce tumors in animals. These viral proteins target the cellular pathways and block apoptosis induced by receptors or in response to signal transduction. Viral interference with host cell apoptosis leads to enhanced viral replication and may promote carcinogenesis. Oncogenes and tumor suppressor genes, such as Retinoblastoma (RB) and p53, play important roles in regulation of these interactions.