1997年 · 第110卷第01期

A National Symposium on Reperfusion Treatment for Acute Myocardial Infarction (AMI) organized by the Editorial Board of the Chinese Medical Journal and the Chinese Journal of Cardiology was held through July 1-3, 1996 in Taiyuan City, Shanxi Province. 179 participants from different parts of country attended the symposium.

OBJECTIVE To evaluate the initial experience with the use of percutaneous transluminal coronary angioplasty (PTCA) in the set of acute myocardial infarction (AMI). METHODS Between October 1993 and April 1996, PTCA was performed in 43 patients (34 male, 9 female) with initial onset of AMI. These patients ranged in age from 40 to 74 years (mean±SD, 60.3±9.2). Primary PTCA was performed in 16, rescue PTCA in 8, and semi-elective PTCA in 19 patients. RESULTS The initial success was achieved in 95.3% (41/43). Failed angioplasty occurred in 2 patients, with acute reocclusion after rescue PTCA (this patient died of cerebral stroke 3 days later) in one patient, and small local intimal dissection during semi-elective PTCA in another patient. CONCLUSIONS PTCA was a safe and effective approach in the treatment of AMI in the present study patients, with a high primary success and low acute complication rate.

OBJECTIVE To investigate the effects of thrombolytic therapy on recanalization in different starting time of treatment after acute myocardial infarction. METHODS 172 cases with intravenous thrombolytic agents were divided into 4 groups:≤2 hours,>2-4 hours,>4-6 hours and>6-12 hours, according to the different starting time of therapy after onset of symptoms. RESULTS The recanalization rates were 78.6%, 74%, 39. 6% and 14.3% in≤2 hours,>2-4 hours,>4-6 hours and>6-12 hours, respectively. The recanalization rate within 4 hours was significantly higher than those in the groups of>4-6 hours AND>6-12 hours. The time interval from the initiation of thrombolytic therapy to reperfusion was increased as the starting time of thrombolysis after onset of symptoms was delayed. CONCLUSIONS Starting time of thrombolysis within 4 hours after onset of acute myocardial infarction is of the best effect on recanalization.

OBJECTIVE To evaluate the efficacy and safety of intravenous recombinant streptokinase (r-SK), produced in China, in the treatment of acute myocardial infarction (AMI). METHODS One hundred and seventy-three patients with AMI admitted to seven hospitals from February to October 1995 were conformed to the inclusion and exclusion criteria of thrombolytic therapy. The patients were divided into two groups. One hundred and two patients in the Group A were randomized to receive r-SK (n=51) or SK (n=51). Seventy-one patients were treated with r-SK in the Group B. One and half million units of r-SK or SK were given intravenously over 60 minutes and the clinical criteria of reperfusion were evaluated. Coronary angiography was performed 90 minutes after thrombolytic therapy with r-SK in 34 patients and recanalization of infarct-related arteries was determined using the TIMI criteria. RESULTS The reperfusion rate was 80.4% in 51 patients receiving r-SK and 74.5% in 51 patients receiving SK (P>0.05). The total reperfusion rate was 77.1% in 122 patients treated with r-SK. Ninety minutes after the initiation of thrombolytic therapy, the occluded infarct-related arteries were patent in 70.6% (24/34) of patients treated with r-SK. Chill, hypotension and mild bleeding occurred respectively in 4.1%, 5.7% and 16.4% of patients with r-SK. CONCLUSIONS China-made r-SK is a safe and effective thrombolytic agent.

OBJECTIVE To investigate the influence of different starting time of intravenous urokinase after onset of acute myocardial infarction on the efficacy of thrombolysis. METHODS One thousand one hundred and thirty eight cases of acute myocardial infarction admitted in 37 collaborative hospitals were given intravenous urokinase with a standard program. Patency of infarct-related coronary artery was assessed by uniform clinical criteria. Patency rate and 4-week mortality in groups of different starting time of urokinase administration after acute onset were compared. RESULTS According to the starting time of urokinase administration after acute onset, the 1138 cases were divided into 4 groups: 128 cases were within 2 hours (H), 461 Within 2-4h, 434 within 4-6h and 115 within 6-12h. The patency rates were 71.9%, 70.1%, 63.6% and 40.0%, respectively and 4-week mortalities were 7.0%, 6.5%, 12.2% and 13.9%, respectively in the four groups. The difference of patency rates and 4-week week mortalities between the groups within 2 hours and within 2-4 hours were not statistically significant, so these two groups were combined into one, i.e. within 4 hours. The patency rate of the group within 4 hours (70.5%) was significantly higher than those of the groups within 4-6 hours (P<0.025) and within 6-12 hours (P<0.001); the 4-week mortality of the former (6.6%) was obviously lower than those of the latter two (all P<0.01). The patency rate of the group within 4-6 hours was higher (P<0.001), than that of the group within 6-12 hours but the 4-week mortalities were not statistically different between the two groups. CONCLUSIONS Intravenous urokinase starting within 4 hours after onset of acute myocardial infarction is of the best efficacy.

OBJECTIVE To investigate the effects of different doses of intravenous domestic urokinase. METHODS One thousand and twenty three cases of acute myocardial infarction within 6 hours after acute onset were divided randomly into two groups with 539 cases in the low dose group (urokinase 22,000IU/kg, total dose not lower than 1.2 million) and 484 in the high dose group (30,000IU/kg, total dose not more than 2.4 million). The patency of infarct-related coronary artery was assessed by uniform clinical criteria. RESULTS In the low and high dose groups the patency rates were 67.3% and 67.8% respectively (P>0.05); 4-week mortalities were 9.5% and 8.7% respectively (P>0.05). Frequency of severe complications had no statistically significant difference between the two groups. Adverse bleeding was a little more frequent in the high than in the low dose group, and fatal cerebral hemorrhage in 2 cases occurred in the high dose group. CONCLUSIONS Low dose urokinase, 22,000 IU per kg body weight with a total dose not lower than 1.2 million IU, is not only equally effective as high dose but also safer.

OBJECTIVE To investigate the relationship between the clinical outcome of childhood acute lymphoblastic leukemia and the status of minimal residual disease after termination of therapy. METHODS A total of 18 children with acute lymphoblastic leukemia were studied. Eleven cases were treated with chemotherapy, the other 7 with autologous peripheral blood stem cell transplantation (ABSCT) or autologous bone marrow transplantation (ABMT). The outcome of the 18 patients was obtained by clinical follow-up. Minimal residual disease was detected by means of the polymerase chain reaction (PCR) and restriction analysis. RESULTS Minimal residual disease was detected in 9 patients after completion of therapy. Three out of the 9 patients relapsed within 3 to 6 months. Among the other 9 patients with no detectable minimal residual disease, no one relapsed. CONCLUSIONS PCR detection of minimal residual disease after termination of therapy can identify patients at risk for relapse in future. Minimal residual disease that cannot be detected after termination of therapy may be one of the important factors for long-term disease-free survival.

OBJECTIVE To evaluate the usefulness of 99mTc labelled monoclonal antifibrin antibody SZ-63 for the detection of vascular thrombi, and to investigate the feasibility of thrombus imaging 99mTc-SZ-63. METHODS The monoclonal antibody SZ-63 (Mab SZ-63), which reacts with D-dimer, XLFN and fibrin monomer was produced and labelled with 99mTc using pretinning procedure. After that, the femoral arterial or venous thrombus model was prepared in dogs and injected with 99mTc-SZ-63 intravenously. Both arterial and venous thrombus models were imaged. RESULTS Both the arterial and venous thrombi were clearly visible within 2.5 hours after injection of99mTc-SZ-63. Quantitative imaging analysis showed that the ratios between the thrombus and the opposite vessel increased with time extension. The ratios of thrombus to blood or surrounding muscle were 2.56±0.83 and 13.40±5.10 for arterial thrombi and 3.34±1.06 and 22.40±6.40 for venous thrombi after the canines were killed. CONCLUSIONS 99mTc-SZ-63 is a useful imaging agent for thrombus detection in vivo.

OBJECTIVE To investigate the protective effects of Salvianolic acid A against impairment of memory induced by cerebral ischemia-reperfusion in mice and the relationship between antioxidant activity of salvianolic acid A and its protective effects on brain injury caused by reperfusion. METHODS Step down and step through tests were used to examine the function of memory in the model of impairment of memory induced by cerebral ischemia-reperfusion in mice. RESULTS Salvianolic acid A (Sal A) at the dosage of 3 and 10 mg·kg-1 iv. could improve the impaired memory function induced by cerebral ischemia-reperfusion as shown in step down and step through tests. In step down tests, the mean number of errors of Sal A 3 and 10 mg·kg-1 treated group were 1.29, 1.15 and that of control group was 3.8 (P<0.01). The latencies of these tests were longer than those of the control group. Meanwhile, 3 and 10 mg·kg of Sal A iv. were found to reduce the malondialdehyde contents in the cortex, hippocampus and corpus striatum of cerebral ischemia-reperfusion rat in vivo. Sal A 10-100 nmol·L-1 was also shown to inhibit lipid-peroxidation of the brain and scavenge the free hydroxyl radicals in vitro. CONCLUSIONS These indicate that the ameliorating effect of Sal A on learning and memory impairment caused by cerebral ischemia reperfusion may be related to its anti-oxidant activity.

This year is the centenary of the publisication of the original articles of Scipione Riva-Rocci, which led to the use of the sphygmomanometer in clinical practice. Perhaps, the best way for us to celebrate a century of world-wide achievement is to summarize Chinese experiences in hypertension (HT) research and to find out what remains for us to achieve.

Ten years have elapsed since our celebration of the centenary of the Chinese Medical Journal and we are greeting the one hundred and tenth anniversary with this issue, which incorporates a series of commemorative scientific papers.

OBJECTIVE To determine the relationship between gut-derived endotoxemia and tumor necrosis factor (TNF), neopterin/biopterin formation following hemorrhage, trauma and burns. METHODS Rats were subjected to hemorrhagic shock (30 mmHg, 90-180 min) and 40% III degrees thermal injury. Circulating endotoxin, TNF, biopterin levels and liver TNF mRNA expression were measured in animals following acute insults. Also, the subjects of this study included 35 patients with burn size greater than 30%, and 25 patients with multiple injuries (n=18) and major surgery (n=7). RESULTS It was found that significant portal and systemic endotoxemia took place in the control animal after hemorrhagic shock and thermal injury, but almost not in the animals that treated by measures aiming at controlling endotoxin/bacteria translocation, including polymyxin B, monoclonal antibody against core lipopolysaccharide, and selective decontamination of the digestive tract (SDD). Concomitantly, hemorrhage and thermal injury resulted in significant increases in systemic plasma TNF level together with tissue TNF mRNA expression, which were associated with the initial appearance of endotoxin in portal vein. However, anti-endotoxin treatment markedly decreased circulating TNF level as well as peak TNF mRNA expression caused by acute insults. There were also lower serum biopterin values in the SDD-treated group as compared with the control group on day 5 postburn. On the other hand, the results showed that the amounts of plasma endotoxin in patients increased during the early stages following major burns, which was significantly correlated with plasma TNF levels, particularly in patients who developed sepsis and multiple organ failure. Although the presence of early endotoxemia did not influence the alterations in serum neopterin, patients with endotoxemia had much higher neopterin values than those who showed no endotoxemia from the second week onward. CONCLUSIONS These results suggest that gut-derived endotoxemia could account, at least in part, for the inflammatory mediators formation and release, which might be involved in the pathogenesis of sepsis and multiple organ dysfunction following severe hemorrhage, trauma and burns.

Ginsenoxides, being the main active components of ginseng, have widespread influence on the human organism. In the last 10 years, many experiments demonstrated that ginsenosides have calcium channel blockage and anti-free radical actions.

In this review, attempts have been made to present summarized results collected from some representative Laboratories that have devoted to basic research of the most prevalent malignant diseases in China for decades. However, achievements from other laboratories are not covered due to limited space.

In recent 10 years, along with the rapid progress of molecular cytobiology and genetics as well as the improvement of precision technology for microanalyses of proteins and peptides, the pathogenesis of atherosclerosis have been further realized.

Research in contraceptive technology in China has gone through several stage according to the need of women in the reproductive age. Various types of steroid contraceptive were developed: daily oral pill, once-a-month pill, monthly injectable, "visiting pill", vaginal ring, subdermal implant and steroid releasing intrauterine devices.

Condyloma acuminatum (CA) is a common and refractory disease which tends to recur. It is usually treated topical chemical agents such as podophyllin and trichloroacetic acid, or by physical destruction, like carbon dioxide (CO2) laser, microwave, liquid nitrogen and electrocoagulation.