2002年 · 第115卷第04期

Objective To examine long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA),coronary stenting and to assess the factors affecting its efficacy. Methods A total of 790 patients who underwent successful PTCA and PTCA + stent in this hospital were followed by direct interview or letter. The rate of follow-up was 84.2%and the period of follow-up was 0.9-12.7 (3.5±2.4) years. Results During follow-up, 4 (0.5%) patients died, 22 (2.8%) had nonfatal acute myocardial infarction,10(1.3%) had coronary artery bypass surgery, and 98 (12.4%) had repeat PTCA. The rate of recurrent angina pectoris was 31 .1 %. The cardiac event-free survival rate calculated by the Kaplan-Meier method was 88.2%at 1 year and 80.6%at 12.7 years. Cox regression analysis showed that there was a positive correlation between AMI history, stent implantation and the risk of cardiac events, and there was a negative correlation between the number of diseased arteries and the risk of cardiac events. Compared to the PTCA group, patients with PTCA+ stent had significantly lower rates of total cardiac events. Conclusion The long-term efficacy of PTCA, especially PTCA + stent in Chinese patients was very satisfactory, suggesting that PTCA + stent therapy should be the major treatment for revascularization in patients with coronary heart disease. Chin Med J 2002; 115(4): 483-486

Objective To determine the feasibility and accuracy of high-frequency ultrasound in evaluating the left ventricular (LV) structure and function in normal and pressure overload rats and to examine the changes of the left ventricle during its transition from hypertrophy to heart failure. Methods Thirty-eight female rats were randomly assigned to normal (n=10), operated (n=16) and sham-operated (n=12) groups. Parasternal long axis and short axis images were acquired by a 7.5 mHz linear ultrasound probe at 12 weeks and 20 weeks after the operation respectively. Results Left ventricular structure and function could be satisfactorily imaged for dimensions and mass. Compared to the sham-operated groups, at 12 weeks after the operation, the operated rats had increased LV wall thickness and mass (P <0.01) with normal cavity and FS%(P> 0.05). At 20 weeks after the operation, the LV wall thickness showed no further progressive change and the LV mass increased greatly with slightly dilated LV cavity and decreased FS%(P <0.05). Conclusions High-frequency echocardiography provides a useful means to noninvasively evaluate LV dimensions, mass and function in rats. It will have great value for evaluating LV remodeling during the transition from LV hypertrophy to heart failure, as well as the effects of intervening drugs. Chin Med J 2002; 115(4): 487-490

Objective To investigate clinical implications of expression of CD40L in monocytes and changes in serum soluble CD40L in patients with acute coronary syndromes (ACS). Methods Sixteen control and 56 patients, including 24 with stable angina (SA), 20 with unstable angina(UA) and 12 with acute myocardial infarction (AMI) enrolled in this study. Expression of CD40L in monocytes was analyzed by flow cytometry and sCD40L levels were measured by ELISA. Results Expression of CD40L in monocytes and serum levels of sCD40L in UA and AMI patients were higher than in SA patients and controls. In patients with AMI, sCD40L levels showed no significant increase when compared to patients with UA, while AMI patients had a peak level of sCD40L at 24 hours after AMI . PTCA induced a marked rise in sCD40L levels in all patients, while CD40L expression in monocytes showed no difference between patients with PTCA, before and after. Conclusion Enhanced level of serum sCD40L may be a reliable prognostic indicator for ACS and may represent a marker of coronary disease activity. Chin Med J 2002; 115(4): 491-493

Objective To study the effects of focal adhesion kinase (FAK) phosphorylation on smooth muscle cells(SMCs) adhesion and migration stimulated by fibronectin. Methods Adhesion and migration of cultured SMCs were stimulated by different concentrations of fibronectin (FN), FAK and its phosphorylation were detected by immunoprecipitation and Western blot. FAK antisense oligodeoxynucleotides (ODNs) were transfected into SMCs by cationic lipid to investigate its modulatory effects on tyrosine phosphorylation. SMCs adhesion and migration were also measured by morphological enumeration and modified Boyden Chambers, respectively. Results FAK were expressed when SMCs adhesion and migration were successfully simulated by different concentrations of FN. FAK phosphorylation were detected only at 20 μg/ml FN or more. FAK antisense ODNs were transfected efficiently by cationic lipid and FAK phosphorylation was inhibited substantially. The SMCs migration rate in the 5-60 μg/ml FN groups was reduced by 17.89%- 27.67%. Cell migration stimulated by FN at 10, 20, 40 and 60 μg/ml were reduced by 23.26%, 21.63%, 19.31 %and 17.88%,respectively (P <0 .05) . Conclusions FAK phosphorylation and FAK-mediated signal transduction play important roles in SMCs adhesion and migration stimulated by ECM. The process can be inhibited effectively by FAK antisense ODNs. Chin Med J 2002; 115(4): 494-497

Objective To assess the epidemiology features of hypertension in Heilongjiang Province, China. Methods From 1959 to 1999, 289 157 people in total, ages ≥ 15-year old (male 154 091, female 135 066) were investigated four times by a stratified chunk method in rural and urban areas in Heilongjiang Province. After a staff training program, this survey on blood pressure and risk factors was carried out under a worldwide uniform protocol with standardized method and interrelated quality control regulation. Among these samples, 1615 people (male 824, female 791) received blood-lipid analysis. Results The hypertensive incidence of Heilongjiang was much higher than the average level in China(P <0.01) and it has gotten higher from 1959 to 1999, especially in the last ten years. It increased more in males than in females (P <0.01). It was also higher with age. The mean age of hypertensive onset became ten years younger recently. It is different in different areas and professions. Age, BMI (body mass index), drinking alcohol, gender, history of maternal hypertension, high salt diet and professional status were the main risk factors for hypertension in Heilongjiang Province in China. Conclusion The prophylaxis and treatment of hypertension should be enhanced in this area. Chin Med J 2002; 115(4): 498-501

Objective To explore the mechanism underlying the prolongation of action potential and delayed inactivation of the L-type Ca2+(lCa, L) current in a feline model of left ventricular system hypertension and concomitant hypertrophy. Methods Single Ca2+ channel properties in myocytes isolated from normal and pressure overloaded cat left ventricles were studied, using patch-clamp techniques. Left ventricular pressure overload was induced by partial ligation of the ascending aorta for 4 - 6 weeks. Results The amplitude of single Ca2+channel current evoked by depolarizing pulses from - 40 mV to 0 mV was 1 .02 ± 0.03 pA in normal cells and 1 .05 ± 0.03 pA in hypertrophied cells, and there was no difference in single channel current-voltage relationships between the groups since slope conductance was 26.2± 1 .0 pS in normal and hypertrophied cells, respectively. Peak amplitudes of the ensemble-averaged single Ca2+channel currents were not different between the two groups of cells. However, the amplitude of this averaged current at the end of the clamp pulse was significantly larger in hypertrophied cells than in normal cells. Open-time histograms revealed that open-time distribution was fitted by a single exponential function in channels of normal cells and by a two exponential function in channels of hypertrophied cells. The number of long-lasting openings was increased in channels of hypertrophied cells, and therefore the calculated mean open time of the channel was significantly longer compared to normal controls. Conclusion Kinetic changes in the Ca2+ channel may underlie both hypertrophy-associated delayed inactivation of the Ca2+ current and, in part, the pressure overload-induced action potential lengthening in this cat model of ventricular left systolic hypertension and hypertrophy. Chin Med J 2002; 115(4): 502-508

Objective To investigate the relationship between the U wave on electrocardiogram and the midmyocardium in rabbit left ventricle free wall in vivo. Methods The monophasic action potentials in the epicardium, midmyocardium, and endocardium of the left ventricle free wall were recorded simultaneously in 16 rabbits. The rabbits were then given an intravenous injection of Sotalol (1, 1.5 and 2.0 mg/kg) in 30 minutes intervals, and measurements were taken. Results In the basic condition, there were no U wave on electrocardiogram. The U wave appeared after the intravenous Sotalol at 1 .5 mg/kg, and the U wave became greater with increased dosage of intravenous Sotalol (2 mg/kg) . The repolarization duration of the midmyocardium was prolonged longer than that of the epicardium and endocardium by Sotalol, and the repolarization duration of the epicardium coincided with the apex of the T wave, The repolarization duration of the midmyocardium coincided with the end point of the U wave. Conclusion The U wave may originate from the delayed repolarization of the midmyocardium. Chin Med J 2002; 115(4): 509-512

Objective To investigate if tumor necrosis factor-a (TNF-α) could induce phenotypic transformation or the associated cell function changes of human peritoneal mesothelial cells (HPMCs). Methods All tests were performed on the human peritoneal mesothelial cell line (HMrSV5, kindly donated by Prof. Pierre RONCO). Morphological changes of HPMCs were observed by phase contrast microscopy. The expressions of cytokeratin 8, cytokeratin 18 and vimentin were detected by immunocytochemistry. mRNA expressions of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases(TIMPs) were detected by semiquantitative reverse transcription polymerase chain reaction (RT-PCR). Production of MMP-9 and type I collagen was measured by enzyme-linked immunosorbent assays. Results TNF-a (1-10 ng/ml) induced morphological changes in about 50%- 60%of human peritoneal mesothelial cells (HPMCs). The original polygonal cobblestone monolayer was changed into elongated,spindle-shape characteristic of fibroblasts. The original strong positive expression of cytokeratin 8 and cytokeratin 18 was changed in all morphologically changed HPMCs to negative, but the expression of vimentin maintained positive. By 4-hour treatment with TNF-a (1-10 ng/ml), mRNA expression of MMP9 was significantly up-regulated, and mRNA expression of TIMP-1 and TIMP-2 were down-regulated. We also observed that the production of MMP-9 and type I collagen increased significantly after 24-hour treatment with TNF-α. Conclusion 24-hour treatment with TNF-α, produced a partial transformation of HPMCs into the fibroblast phenotype. TNF-a treatment of HPMCs up-regulated the synthesis of MMP-9 and type I collagen, which may facilitate peritoneal extracellular matrix remodeling and fibrogenesis. Chin Med J 2002; 115(4): 513-517

Objective To detect the function of proteolipid protein (PLP) peptide (residues 56 - 70)-specific CD4+ T cells in experimental allergic encephalomyelitis (EAE) in Biozzi AB/H mice (H-2A97). Methods Biozzi AB/H mice were immunized by synthetic PLP56-70 peptide (DYEYLINVIHAFQYV) which was emulsified by sonication with complete Freund's adjuvant, a EAE model proven histologically and clinically. Murine splenocytes and spinal cord infiltrated (SCI) T cells were stimulated by PLP56-70, then the CD4+ T cells were isolated by Dynabeads, and confirmed by staining with anti-CD4 antibody. Finally, the IL2 bioassay and IFN-γ/IL4 ELISA were done to detect T cell proliferation and cytokine secretion after PLP56-70 stimulation. Results The histology of murine spinal cord showed a great number of lymphocytes infiltrated the spinal cord; the clinical signs showed high scores (4.3) on the peak, as well as a good EAE model. After being isolated by Dynabeads, CD4+ T cells showed high purification (> 99%) by staining with anti-CD4 antibody. IL2 bioassay showed that those T cells were PLP56-70-specific T cells. ELISA showed that those T cells had high IFN-γ/IL4 ratio, indicating that they are T helper 1 (Th1) cells. Conclusions PLP56-70-specific splenocytes and SCI CD4+ T cells in EAE from Biozzi AB/H mice were detected and showed that both of them were PLP56-70-specific Th1 cells. It is beneficial to understand what kind of role these T cells play in the development of EAE. Chin Med J 2002; 115(4): 521-524

Objectives To determine the relative value of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in exploring the potential embolic source (PES) in heart and aortic arch and to study the clinical significance of aortic arch athersclerosis (AAA). Methods Forty-nine patients with cerebral embolism were included in this study. TEE and TTE were used to evaluate the potential source of emboli in aortic arch, heart and duplex in the carotid artery. An atherosclerotic lesion of the aortic arch was defined as normal, mild plaque, moderate plaque, and protruding plaque or mobile plaque. Results Of the 49 patients, 31 (63%) patients showed evidence of AAA: 7 (14.1 %) patients were mild,9 (18.4%) were moderate and 15 (30.6%) were severe. In those 15 patients, 11 had neither severe ICAA nor heart disease. Thirty-three patients had internal carotid arterial atherosclerosis (ICAA) . The potential sources of embolization of heart and aortic arch is 48.98%by TEE, but only 18.4%by TTE; 9 patients had heart disease. Age and ICAA were significantly correlated with AAA. Conclusion At present, TEE is a better method for exploring atherosclerotic lesions in the thoracic aorta. AAA is an important potential source of cerebral embolic stroke. Chin Med J 2002; 115(4): 525-528

Objective To investigate the feasibility and features of 3 catheter-mediated approaches of gene transfer into heart, including direct myocardial injection (DMI), coronary artery perfusion (CAP), and intrapericardial cavity injection (ICI). Methods Fifteen dogs were used, and 0.3 ml (1 x 109 pfu) of an adenovirus (Adex1SR LacZ) was injected into the heart by 3 methods. The dogs were killed 5 days following injection, and gene expressions in heart and liver were evaluated by histochemical analysis. Results The results showed that ① the CAP method was relatively less damaging and induced sparse LacZ expression in the myocardium, and the gene expression was also found in both vessels within the myocardium and liver; ② gene transfer by DMI resulted in intense LacZ expression around the injection accompanied by a local inflammatory response; ③ LacZ expression elicited by ICI was detected in either the inner surface of the parietal pericardium or epicardial surface of the heart, and also in the myocardium underlying the visceral pericardium. Conclusion Three catheter-mediated methods of gene transfer into the heart may be used and a reasonable approach should be chosen according to purpose. Chin Med J 2002; 115(4): 612-613

Objective To investigate the effect of polysaccharide sulfate 916 (PS916) on the production of nitric oxide(NO) in ECV304 cells induced by tumor necrosis factor-a (TNFcx), interleukin-iβ (IL-1β) and H2O2 in vitro. Methods Production of NO in ECV304 cells was measured by the Griess method and the proliferation of cells was tested by the MTT method. The activity of NO synthase was detected spectrophotometrically. Results Production of NO in ECV304 cells decreased after treatment with 40 ng/ml IL-1β and 40 ng/ml TNFα, but increased in the presence of H2O2 0.1 mmol/L. PS916 significantly enhanced NO production in ECV304 cells in a dose-dependent manner in the TNFα and IL-1β treated groups and decreased it in the H2O2 treated group. Proliferation of ECV304 cells was inhibited by TNFβ and H2O2 and no effect was found in the IL-1β treated group. PS916 increased the proliferation of cells treated with TNFα and H2O2 dose-dependently. In vitro, PS916 has no effect on the activity of NO synthase. Conclusion PS916 has a protective effect on ECV304 cells exposed to IL-1β, TNFα and H2O2. Chin Med J 2002; 115(4): 614-616

Objective To study the influence of intranasal medication on the structure, pathology and reversibility of the nasal mucosa to provide a basis for the feasibility of intranasal route of drug administration. Methods Nasal drops of gentamicin were placed in the nasal cavity of rabbits for 3, 5, 7, 14 and 28 days. After that, the drops were stopped and drugs protecting the nasomucosa were used for one and three weeks. After being sacrificed over time, the nasomucosa of the rabbit was observed under optical and electron microscopes. Results Damage to the nasal mucosa appeared to different extents with prolonged use of nasal drops. Within 3-7 days of applying the drug, damages to the nasal mucosa gradually appeared, and after two and four weeks, were most serious. After stopping the drug, the nasal mucosa was gradually restored. Conclusion Damages of drugs to the nasal mucosa could be restored. The intranasal route of drug administration would be feasible and clinically applicable. Chin Med J 2002; 115(4): 617-619