[Potentiated effects of total saponins of Panax Ginseng on inhibition of leukemic cells by cytotoxic drugs]

OBJECTIVE

To investigate the potentiated effects of total saponins of Panax Ginseng (TSPG) on inhibition of leukemic progenitor cells by cytotoxic drugs in acute myelocytic leukemia.

METHODS

Using bone marrow culture of colony forming unite-acute myeloid leukemia (CFU-AML) method, the sensitivity of leukemic cells obtained from 18 patients to homoharringtonin (HHr), cytarabine (Ara), adriamycin (Adr) and etoposide (VP-16) were detected separately.

RESULTS

TSPG alone (20 micrograms/ml) could stimulate proliferation of CFU-AML obviously, and increase the colony numbers by 37.98% over the non-TSPG control (P < 0.01). In the presence of TSPG, the inhibition rates of CFU-AML of HHr, Ara, Adr and VP-16 were 51.2%-62.0% respectively, which were significantly higher than 30.4%-47.4% of non-TSPG control (all P < 0.01). In the combination of TSPG with cytotoxic drugs, the leukemic progenitor cells became more sensitive to cytotoxic drugs, CFU-AML colony numbers at 1.84-2.23 fold as more as those of non-TSPG control were inhibited by HHr, Ara, Adr and VP-16. Sensitivity test of 17 among 72 drugs reversed from resistant (suppression rate less than 30%) to sensitive (suppression rate more than 30%) by TSPG.

CONCLUSIONS

TSPG could drive non-cycling leukemic progenitors to enter cell cycle, and thereby enhance their susceptibility to cytotoxic drugs.

[The study of ultrastructure of retinal pigment epithelium of transplantation]

OBJECTIVE

To investigate the ultrastructure of retinal pigment epithelium (RPE) for the base of clinical application.

METHODS

Pigmented rabbit RPE was transplanted to the subretinal space of 10 unpigmented rabbits by internal route. The ultrastructure of transplanted RPE cells were observed by electron microscopy.

RESULTS

The transplantation of RPE was successful. It was shown that the transplanted cells had polarity and attached to Bruch's membrane to form basal infoldings, and the relationships between transplanted cells and the host photoreceptors were also seen.

CONCLUSIONS

The internal approach is a practical and useful method for transplantation of RPE. The transplanted RPE can vitalize, perform metabolism and form some normal ultrastructure.

Effects of chromophore dissociation on the optical properties of rare-Earth-doped polymers

The observed dissociation of tetrakis rare-earth chromophores in rare-earth-doped organic polymers is reported, and a time-resolved spectroscopic technique is presented to determine quantitatively the fractional concentrations of different chromophore species in various solvents. Based on this technique, the equilibrium constants of tetrakis rare-earth chromophores in rare-earth-doped polymers are determined. Thus, the equilibrium constants for tetrakis rare-earth compounds of benzoyltrifluoroacetonate (BTF), for example, Sm(BTF)(4)P and Eu(BTF)(4)P in methyl methacrylate monomer, are K = 4.7 ? 0.5 x 10(-4) M and K = 1.2 ? 0.5 x 10(-4) M, respectively. In contrast, the tetrakis rare-earth compounds of hexafluoroacetylacetonate (HFA), for example, Sm(HFA)(4)Net(4) and Eu(HFA)(4)Net(4), are quite stable and show no evidence of dissociation. We further characterize the dissociation of several chromophore systems and discuss the influence such dissociation has on overall optical performance. The results enable determination of optimal doping concentrations as well as preferred rare-earth chromophore preparation and doped polymer fabrication procedures.

Batch fermentation and optimization of media for Bacillus thuringiensis

The composition of No. II medium obtained with shaking cultivation contained three factors: nitrogen source, carbon source, and inorganic salts. The relationship between component factors (x(i)) of the media and spore numbers (y) of Bacillus thuringiensis (Bt) was demonstrated by the orthogonal-rotation-combination test. A response surface equation was formed as follows: y = 384 - 7.245x1 + 11.705x2 + 15.475x3 + 14.039x1(2) + 41.831x2(2) - 79.49x3(2) - 35.375x1x2 - 3.375x1x3 - 106.625x2x3. The results showed that this method is simple, practical, and rapid enough for selecting fermentation media for Bt. In addition, the whole course of batch fermentation was also investigated.

[Determination of organochlorine pesticide residues in herba Asari by GC]

OBJECTIVE

To provide a theoretical guide for the production and application of Herba Asari.

METHOD

A GC method for multiresidue analysis was used.

RESULT

Fifteen samples of Herba Asari were detected with the method for the first time. The contents of organochlorine pesticide residues in most of the samples were under the Chinese national limits for grains and green vegetables (GB 2707-2763-81). The other samples were polluted seriously.

CONCLUSION

Some suggestions have been put forward to help keep down pesticide residue pollution in Chinese herbal medicines.

Effects of random perturbations in plastic optical fibers

REVIEW The most important feature of an optical fiber waveguide is its bandwidth, which defines its information-carrying capacity. A major limitation on the bandwidth of multimode glass and plastic optical fibers is modal dispersion, in which different optical modes propagate at different velocities and the dispersion grows linearly with length. However, in plastic optical fibers, experimental and theoretical results indicate that the modes are not independent but are highly coupled, which leads to a characteristic square-root length dependence and an unanticipated large enhancement of the bandwidth to gigahertz levels. The ever increasing demands for low-cost, high-bandwidth communications media for voice, video, and data transmission in short- and medium-distance applications are generating a new assessment of multimode optical fibers to serve as high-speed fiber links.

[The application of retinotomy and retinectomy for complicated retinal detachment]

OBJECTIVE

To investigate the techniques, therapeutic effects, indications, complications and control of retinotomy and retinectomy for complicated retinal detachment.

METHODS

Based on the preliminary report of retinotomy and retinectomy, 36 eyes of 36 patients of complicated retinal detachment were operated on and followed-up for 3-12 months. The operative technique included buckling, vitrectomy, peeling, retinotomy and retinectomy, intraocular tamponade and laser treatment.

RESULTS

Retina was reattached in 32 eyes in operation. Retinal detachment was recurrent in 8 eyes in followed-up in which retina was reattached again in 3 eyes by second operation. The last successful rate was 75% (in 27 eyes). The visual acuity was worse than funger conter in 33 eyes and worse than 0.05 in 3 eyes before operation. The visual acuity was better than 0.05 in 20 eyes (55.5%) after operation. The complications included bleeding, retinotomy expanding, complicated cataract, hypotony and so on.

CONCLUSION

Retinotomy and retinectomy can improve the curative effect of complicated retinal detachment. But the complications of these operation were severe. The indications should be well controlled.

Characterization of three fibrinogenolytic enzymes from Chinese green tree viper (Trimeresurus stejnegeri) venom

From the venom of Chinese green tree viper (Trimeresurus stejnegeri), three distinct fibrinogenolytic enzymes: stejnefibrase-1, stejnefibrase-2 and stejnefibrase-3, were purified by gel filtration, ion-exchange chromatography and reverse-phase high-performance chromatography (HPLC). SDS-PAGE analysis of those three enzymes showed that they consisted of a single polypeptide chain with mol. wt of 50000, 31000 and 32000, respectively. Like TSV-PA (a specific plasminogen activator) and stejnobin (a fibrinogen-clotting enzyme) purified from the same venom, stejnefibrase-1, -2 and -3 were able to hydrolyze several chromogenic substrate. On the other hand, different from TSV-PA and stejnobin, stejnefibrase-1, -2 and -3 did not activate plasminogen and did not possess fibrinogen-clotting activity. The three purified enzymes directly degraded fibrinogen to small fragments and rendered it unclottable by thrombin. Stejnefibrase-2 degraded preferentially Bbeta-chain while stejnefibrase-1 and -3 cleaved concomitantly Aalpha and Bbeta-chains of fibrinogen. None of these proteases degraded the gamma-chain of fibrinogen. When correlated with the loss of clottability of fibrinogen, the most active enzyme was stejnefibrase-1. The activities of the three enzymes were inhibited by phenylmethylsulfonyl fluoride (PMSF) and p-nitrophenyl-p-guanidinobenzoate (NPGB), indicating that like TSV-PA and stejnobin, they are venom serine proteases.

The Quilty lesion enigma: focal apoptosis/necrosis and lymphocyte subsets in human cardiac allografts

Quilty lesions, as first described by Billingham in 1981, or 'Quilty Effect' (QE) are distinct endomyocardial mononuclear cell infiltrates that have been observed in human heart transplant recipients, as well as in experimental models of heart transplantation. In the present investigations, the pattern and extent of apoptosis (programmed cell death) and myocyte necrosis, as well as specific lymphocyte subsets in Quilty lesions was assessed. Endomyocardial biopsies obtained from 13 patients at 10-3362 days post-transplant were examined. Apoptosis, as identified by DNA nick end-labeling, was found in myocytes at the periphery of Quilty lesions in 11 of 13 cases (85%), and 'early' stages of myocyte necrosis, as demonstrated by specific staining with alpha light chain myosin monoclonal antibodies (mAb), was observed at the same sites in 10 of 13 cases (77%) of both Quilty type A and type B lesions. Apoptosis was not identified in the lymphocyte infiltrates of any of the lesions examined. Lymphocyte subsets were characterized using mAb for T cell receptor (CD3), for helper/inducer T cells (CD4), for cytotoxic/suppressor T cells (CD8) and for mature B cells (CD20). Immunostaining revealed separate clusters of T lymphocytes with less prevalent B cells within the Quilty lesions. CD4+ cells were found in larger numbers than CD8+ cells in all cases. Non-B, non-T large lymphocytes were occasionally present. Except for the extent of the cellular infiltrate, no major cytochemical lymphocyte distribution differences were found between Quilty type A and B lesions. Myocyte apoptosis and early necrosis at the periphery of Quilty lesions suggest that early myocyte injury occurring in B lesions may represent initial or 'abortive stages' of cardiac allograft rejection. Why these lesions do not progress to overt rejection indeed warrant further detailed studies.

Beneficial effects of early coronary reperfusion on left ventricular remodeling and systolic function in patients with acute myocardial infarction

OBJECTIVE

To evaluate the beneficial effects of early coronary reperfusion on left ventricular remodeling (LVRM) and systolic function in patients with acute myocardial infarction (AMI).

METHODS

Eighty-one patients with first AMI in the convalescent stage and having undergone left ventriculography (LVG) and coronary arteriography (CAG) were divided into four groups: the anterolateral wall (ALW) myocardial infarction (MI) non-reperfusion (n = 20) and reperfusion (n = 21), and inferoposterial wall (IPW) MI non-reperfusion (n = 20) and reperfusion (n = 20), according to infarct location and early treatment with or without successful coronary reperfusion therapy within 6 hours after onset of symptoms. By LVG, the parameters of LVRM and systolic function in the four MI groups were analyzed and compared with those in normal group (n = 25) and between the two reperfusion and non-reperfusion MI groups.

RESULTS

In both ALW and IPW MI non-reperfusion groups, the left ventricular (LV) end-diastolic volume (EDV), circumference (EDC), short-axis dimension (EDD), short to long axis ratio (ED-D/L), sphericity index (ED-SI) and end-systolic volume (ESV) were all significantly increased (P < 0.01-0.001), while LV ejection fractions (LVEF) were significantly decreased (both P < 0.001) when compared with those of normal group; and the increase in ESV and decrease in LVEF were both significantly greater in ALW than in IPW MI groups (both P < 0.01). In both ALW and IPW MI reperfusion groups, however, the EDV, EDD, ESV, as well as the extent and severity of regional wall motion abnormality (RW-MA) were significantly smaller (P < 0.05-0.001), while LVEF were significantly higher (P < 0.01-0.001) when compared with those in the two non-reperfusion MI groups respectively. There were no longer significant differences in LVEF and ESV between ALW and IPW MI groups (both P > 0.05). The EDC in IPW MI reperfusion group and the ED-D/L and ED-SI in ALW MI reperfusion group were also significantly reduced compared with those in the two non-reperfusion MI groups respectively (P < 0.05-0.001). All the above parameters in the two reperfusion MI group were decreased to the normal in comparison with normal group except ESV and LVEF, and ED-D/L and ED-SI in IPW MI group.

CONCLUSION

It was indicated that in both ALW and IPW MI non-reperfusion groups, LVRM had occurred in convalescent stage of AMI with an increase in EDV and EDC, spherical change in LV shape, and accompanying reduction in LV systolic function; and early coronary reperfusion in AMI could reduce the extent and severity of RWMA, prevent from LV enlargement and remodeling, and preserve or improve LV systolic function with more prominence in ALW MI.

Hydrogen radicals, nitrogen radicals, and the production of O3 in the upper troposphere

The concentrations of the hydrogen radicals OH and HO2 in the middle and upper troposphere were measured simultaneously with those of NO, O3, CO, H2O, CH4, non-methane hydrocarbons, and with the ultraviolet and visible radiation field. The data allow a direct examination of the processes that produce O3 in this region of the atmosphere. Comparison of the measured concentrations of OH and HO2 with calculations based on their production from water vapor, ozone, and methane demonstrate that these sources are insufficient to explain the observed radical concentrations in the upper troposphere. The photolysis of carbonyl and peroxide compounds transported to this region from the lower troposphere may provide the source of HOx required to sustain the measured abundances of these radical species. The mechanism by which NO affects the production of O3 is also illustrated by the measurements. In the upper tropospheric air masses sampled, the production rate for ozone (determined from the measured concentrations of HO2 and NO) is calculated to be about 1 part per billion by volume each day. This production rate is faster than previously thought and implies that anthropogenic activities that add NO to the upper troposphere, such as biomass burning and aviation, will lead to production of more O3 than expected.

Characterization of a fibrinogen-clotting enzyme from Trimeresurus stejnegeri venom, and comparative study with other venom proteases

Trimeresurus stejnegeri venom which contains TSV-PA (a specific plasminogen activator sharing 60-70% sequence homology with venom fibrinogen-clotting enzymes), also possesses fibrinogen-clotting activity in vitro. A fibrinogen-clotting enzyme (stejnobin) has been purified to homogeneity by gel filtration and ion-exchange chromatography on a Mono-Q column. It is a single-chain glycoprotein with a mol. wt of 44,000. The NH2-terminal amino acid sequence of stejnobin shows great homology with venom fibrinogen-clotting enzymes and TSV-PA. Like TSV-PA, stejnobin was able to hydrolyse several chromogenic substrates. Comparative study of substrate specificities of stejnobin and other venom proteases purified in our laboratory was carried out on five chromogenic substrates. Stejnobin clotted human fibrinogen with a specific activity of 122 NIH thrombin-equivalent units/mg protein. However, stejnobin did not act on other blood coagulation factors, such as factor X, prothrombin and plasminogen. Diisopropyl fluorophosphate and phenylmethanesulfonyl fluoride inhibited its activity, whereas ethylenediamine tetracetic acid had no effect on it, indicating that it is a serine protease. Although stejnobin showed strong immunological cross-reaction with polyclonal antibodies raised against TSV-PA, it was interesting to observe that, unlike the case of TSV-PA, these antibodies did not inhibit the amidolytic and fibrinogen-clotting activities of stejnobin.

Effects of Pallas' viper (Agkistrodon halys pallas) venom on blood coagulation and characterization of a prothrombin activator

The action of Pallas' viper (Agkistrodon halys pallas) venom on blood coagulation was examined in vitro and a strong anticoagulant effect was observed. This action was abolished after treatment with a specific inhibitor of phospholipase A2 activity (p-bromophenacyl bromide), revealing a procoagulant action in low concentrations of treated venom (around 1 microgram/ml). The effect of the venom on haemostasis was further characterized by measuring its ability to activate purified blood coagulation factors. It is concluded that A. halys pallas venom contains prothrombin activation activity. A prothrombin activator (aharin) was purified from the venom by Sephadex G-75 gel filtration and ion-exchange chromatography on a Mono-Q column. It consisted of a single polypeptide chain, with a mol. wt of 63,000. Purified aharin possessed no amidolytic activity on chromogenic substrates. It did not act on other blood coagulation factors, such as factor X and plasminogen, nor did it cleave or clot purified fibrinogen. The prothrombin activation activity of aharin was readily inhibited by ethylenediamine tetracetic acid (a metal chelator), but specific serine protease inhibitors such as diisopropyl fluorophosphate and phenylmethanesulfonyl fluoride had no effect on it. These observations suggest that, like those prothrombin activators from Echis carinatus and Bothrops atrox venoms, the prothrombin activator from A. halys pallas venom is a metalloproteinase.

[Pseudohypopyon after vitrectomy for vitreous hemorrhage]

OBJECTIVE

To describe an uninfective hypopyon phenomenon after vitrectomy (pseudohypopyon).

METHODS

1,250 cases (consecutive cases) who had undergone vitrectomy were collected. Among them, 418 cases were vitreous hemorrhage due to various disorders. Pseudohypopyon was found in 7 cases. All of them were the patients with vitreous hemorrhage.

RESULTS

Pseudohypopyon occurred in 3-5 days after vitrectomy, like precipitation of muddy sand; systemic and local treatment of antibiotic and steroid were not effective, intraocular centesis for smear and culture could not find any germs; and the patients were painless and no irritation in the eyes. The relatively effective method for this kind of hypopyon was paracentesis of anterior chamber and its natural absorption. After a follow-up period of 3 months, 3 cases obtained the vision above 0.05.

CONCLUSIONS

Pseudo-hypopyon might happen after vitrectomy for vitreous hemorrhage, and it should be differentiated from infective ophthalmitis.

Long-term prognosis of percutaneous transluminal coronary angioplasty in 229 cases

OBJECTIVE

To evaluate long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA) and the factors affecting its efficacy in Chinese patients.

METHODS

Two hundred and twenty-nine patients who underwent successful PTCA in this institution were followed-up by direct interview or letters. The rate of follow-up was 95%. The period of follow-up were 0.5-8.4 (with mean of 2.3 +/- 1.8 years).

RESULTS

Angina Pectoris recurred in 76 (33.2%) of the patients. Cox regression analysis revealed that the relative risk of recurrence of angina pectoris was increased among the patients with triple vessel disease and with history of hypertension. During the period of follow-up, 2 (0.9%) patients died, 6 (2.6%) had non-fatal acute myocardial infarction, 4 (1.7%) had coronary artery bypass graft surgery and 29 (12.7%) had repeat PTCA. The cardiac event-free survival rate calculated by Kaplan-Meier method was 84.8% at the first year and 70.5% at the eighth year. Cox regression analysis revealed that there were positive correlation between the relative risks of cardiac events and stenosis of lesions before PTCA and residual stenosis of LAD after PTCA.

CONCLUSION

The long-term efficacy of PTCA in Chinese patients was good. The results of this study suggest that to decrease the residual stenosis of LAD during procedures could probably decrease the relative risk of cardiac events during follow-up.

[Character of emergence for the seeds of Ephedra sinica]

The experimental results on the germinating of Ephedra sinica seeds and sowing show: the seeds of E. sinica are not sensitive to illumination, but very sensitive to humidity; the effects of soil, the depth of sowing and irrigation on emergence are very notable, but not remarkable to covering which can be used to prevent measure.

[Long-term prognosis of percutaneous transluminal coronary angioplasty in 229 cases]

In order to approach long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA) and the factors affecting its efficacy in Chinese patients, 229 patients who underwent successful PTCA in this institution were followed by direct interview or letters. The rate of follow-up was 95% for the patients who should be followed. The period of follow-up was 0.5-8.4 (mean 2.3 +/- 1.8) years. Angina pectoris recurred in 76 (33.2%) of the patients. In 76% of the patients with recurrence, angina developed within 6 months after PTCA. Cox regression analysis revealed that the relative risk of recurrence of angina pectoris was increased among the patients with triple vessel disease and hypertension. During the period of follow-up, 2 (0.9%) patients died, 6 (2.6%) had non-fatal acute myocardial infarction, 4 (1.7%) had coronary artery bypass graft surgery, and 29 (12.7%) had repeat PTCA. The cardiac event free survival rate calculated by Kaplan-Meier method was 84.8% at 1 year and 70.5% at 8 years. Cox regression analysis revealed that there were positive correlations between stenosis of lesions before PTCA and residual stenosis of LAD after PTCA and the relative risks of cardiac events. In conclusion, the long-term efficacy of PTCA in Chinese patients was good. We suggest that to decrease the residual stenosis of LAD during procedure could probably decrease the relative risk of cardiac events during follow-up.

[Photocoagulation and scleral cryotherapy for Coat's disease]

PURPOSE

To evaluate the results and significance of Coat's disease with argon laser photocoagulation and cryotherapy.

METHODS

22 patients (23 eyes) were treated by argon laser (German Opton Meditek 40 E, 0.2w power, 100-500 um spot, 0.1-0.2 second exposure and grade II reaction) and or scleral cryotherapy (-60 to approximately -80 degrees C, 5 second duration per time, repeating treatment if necessary until pale edema was seen in retina).

RESULTS

18 eyes in all (78.2%) had good results with visual acuity improvement and the lesion of fundus had been seen decreased in varient degrees. The follow-up ranged from 1 to 3 years.

CONCLUSION

Photocoagulation and scleral cryotherapy are effective for those patients with Coat's disease. It is very important to treat them promptly so as to prevent the damage of visual function progressively.

[The relation between coronary vasospasm and coronary obstructive lesions in patients with variant angina]

A series of 38 patients with variant angina in whom coronary arteriography was performed was reviewed to investigate the relation between coronary vasospasm and coronary obstructive lesions. 10 of the 38 (26.3%) patients had completely normal coronary arteriograms; 4 (10.5%) had insignificant coronary artery disease (< 50% stenosis); 24 (63.2%) had significant (> or = 50% stenosis) coronary artery disease, including single vessel disease in 12 cases, multiple vessel disease in 11 cases and left main trunk disease in one case. The results of this study showed that the incidence of coronary vasospasm increased with the severity of coronary stenosis and was highest at 75%-90% stenosis of the ischemia-related artery in those patients with significant coronary disease. In this study of 38 patients, coronary vasospasm involved the left anterior descending artery (LAD) in 25 patients (65.8%), right coronary artery (RCA) in 10 (26.3%) and left circumflex artery (LCX) in 2 (5.3%), but in patients with in significant stenosis (< 50%), LAD was involved in 50.0%, RCA in 42.9% and LCX in 7.1%. These results indicate that coronary vasospasm occurs frequently in patients with severe stenosis of the LAD.

Left ventricular diastolic dysfunction in patients with angina decubitus

OBJECTIVE

To investigate the relationship between left ventricular diastolic dysfunction and episodes of angina decubitus.

METHODS

The study population consisted of three groups, groups I (20 controls) had no cardiovascular diseases. Group II (20 patients) had coronary artery disease (CAD) without angina decubitus. Group III (24 cases with ejection fraction (EF) > 45%) were selected from 26 patients with angina decubitus.

RESULTS

Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction (1/3FF) was significantly reduced in groups III as compared with groups II and I (P < 0.01). Left ventricular end-diastolic pressure (LVEDP) significantly increased in patients with angina decubitus after LVG as compared with that before LVG (P < 0.01). However, there were no statistically differences in LVEDP, before and after LVG in both groups II and I.

CONCLUSIONS

Patients with angina decubitus have abnormalities of LV diastolic filling and decrease in LV compliance.

[The study on changes of macular light sensitivity before and after photocoagulation for diabetic macular edema]

OBJECTIVE

The study was designed to determine whether laser photocoagulation could damage macular visual function in treatment of diabetic macular edema.

METHODS

A prospective clinical trial was taken to determine the effects of argon green (514.5nm) laser photocoagulation on macular light sensitivity (MLS) by comparing the self MLS pairing data collected from a Humphrey automatic visual field analyzer before and after the procedure. Nineteen eyes of 15 patients with diabetic macular edema consistent with its diagnostic criteria were enrolled in this study, a follow-up period being 3 months.

RESULTS

The mean MLS at the photocoagulation area, non-photocoagulation area, 5 degrees and 13 degrees eccentricity were significantly decreased within 1 week after the treatment, the drops of MLS were 1.85 dB, 1.05 dB, 0.99 dB, 1.66 dB respectively (P < 0.05). The mean reduction of MLS at the fovea within 1 week after the treatment has no statistical significance. The MLS gradually recovered at the 1st and 3rd month after photocoagulation, and the visual acuities in most of the cases were stable or increased.

CONCLUSIONS

MLS is affected little by laser photocoagulation, and photocoagulation can reduce the risk of visual loss or increase visual acuity in an eye with diabetic macular edema.

Emergency percutaneous transluminal coronary angioplasty in acute myocardial infarction complicated with cardiogenic shock

OBJECTIVE

To approach the efficacy of emergency percutaneous transluminal coronary angioplasty (PTCA) in Chinese patients with acute myocardial infarction (MI) complicated by cardiogenic shock.

METHODS

Twelve patients with cardiogenic shock treated by emergency PTCA in this institution from January 1990 to May 1994 were retrospectively reviewed. There were anterio-lateral MI in 4 cases, inferio-posterial MI in 7, anterial and inferial MI in I, of which triple vessel disease in 4 cases, double vessel disease in 6, single vessel disease in I and left main coronary artery (LM) disease in 1. PTCA was performed under assistance of IABP in 7 cases and of centrifugal pump in 1. Only infarct-related Coronary artery (IRCA) was dilated during acute phase. Direct PTCA was done in 7 cases and rescue PTCA after failure of thrombolytic therapy in 5.

RESULTS

PTCA was successful in 11 (91.7%) of the 12 cases, in 1 case with failure of PTCA the IRCA was reperfused by intracoronary thrombolytic therapy. Cardiogenic shock was reverted in 7 (63.6%) of the 11 cases reperfused by PTCA, among whom 6 (54.5%) survived. Four died of irreversible shock after 3 hours-9 days and 1 case with reversed shock died of cardiac rupture after 4 days. During a period of 13-55 months follow-up, long-term survivals were obtained in 4 cases.

CONCLUSIONS

Emergency PTCA can achieve a high success rate and significantly decrease the mortality rate to less than 50% in Chinese patients with acute MI complicated with cardiogenic shock. The patients tolerate the PTCA procedure very well under the assistance of intra-aortic balloon counterpulsation (IABP) even in very severe condition.

[Vitreous surgery for subretinal neovascular membrane and hemorrhage]

OBJECTIVE

To study the indications, techniques and therapeutic effects of vitreous surgery for subretinal neovascular membranes.

METHODS

6 cases of subretinal neovascularization and subretinal hemorrhage were treated by vitreoretinal surgery. The surgical techniques consisted of three port pars plana vitrectomy, intraocular laser, retinotomy, subretinal neovascular membrane resection or hemorrhage removal, air-fluid exchange, etc. The pre and post-operative examinations included fundus fluorescein angiography (FFA), Humphry visual field to evaluate the therapeutic effects of the surgery.

RESULTS

The postoperative follow-up ranged from 4 to 7 months. The visual acuities of 4 cases improved, 0.3 or over in 2 cases and unchanged in 2 cases.

CONCLUSION

Subretinal operation may be a safe and effective method to treat subretinal neovascularization if the indication was well mastered.

[Study of pathogenesis of age-related macular degeneration]

OBJECTIVES

To explore the pathogenesis of age-related macular degenerastion (AMD) for its early prevention and treatment.

METHODS

The enzymes of red blood cells, levels of serum mineral elements and antiretinal antibodies were determined in AMD and controls. Electronic microscopy, immunohistochemical survey of the AMD patient subretinal neovascular membrane were performed. The light exposure of animal experiment was also made.

RESULTS

The levels of superoxide dismutase and catalase as well as serum zinc were decreased in AMD patients, the ratio of copper and zinc was increase. The retinal antibody reaction was higher than that of controls, and the subretinal neovascular membrane showed inflammatory granulomatous appearance.

CONCLUSIONS

In addition to age, AMD may be related to light damage, change in human defense system and chronic inflammatory process.

Re-evaluation of the mechanism and treatment of angina decubitus

30 patients with angina decubitus (AD) were studied during hospitalization. These patients were found to have severe coronary artery obstructive lesions and an increase of myocardial oxygen consumption (MOC) before the onset to AD, indicating that AD belongs to the category of effort angina. 18 patients were investigated by continuous hemodynamic monitoring. Three patients had significant increase in pulmonary artery diastolic pressure (PADP) before the onset. In the other 15 patients, PADP increased slightly in 12 and remained unchanged in 3 cases before the onset. Left ventriculography showed ejection fraction (EF) > 45% in 25 of the 27 patients. These results indicate that left ventricular (LV) systolic dysfunction is not a major factor in the pathogenesis of AD. The patients with LVEDP > 12 mmHg constituted 60% of 25 patients with EF > 45%, suggesting that these patients had obvious LV diastolic dysfunction, which may be the major factor in the pathogenesis of AD. According to the results of our treatment, beta blockers may be used as the major form of treatment in the patients with AD.

Macrophages in human epiretinal and vitreal membranes in patients with proliferative intraocular disorders

PURPOSE

Macrophages are versatile cells and have been known as a cellular component of epiretinal membranes of proliferative intraocular disorders (PID). However, the origin and functions of these cells in the membranes are not yet clear. In the present study we investigated the characterization of macrophages/monocytes in various types of human epiretinal membranes from patients with proliferative vitreortinopathy (PVR), proliferative diabetic retinopathy (PDR) and ocular perforating injury by means of immunohistochemical techniques.

METHODS

A total of 49 epiretinal membranes of PID in which 24 were PDR specimens, 17 were PVR and 8 were proliferations after perforating eye injury were studied. Monoclonal antibodies against human macrophages, monocytes, HLA-DR antigen and interleukin-1 (IL-1) were used. The alkaline phosphatase anti-alkaline phosphatase (APAAP) technique was performed.

RESULTS

The results showed that 19 out of 24 PDR specimens (79%), 15 out of 17 PVR specimens (88%) and 7 out of 8 traumatic specimens (87%) contained macrophages, HLA-DR antigen was detected in 20 out of the 24 PDR membranes (83%), 14 out of 17 PVR membranes (82%) and 5 out of 8 traumatic membranes (63%); monocytes were only detected in 10 out of the 24 PDR specimens (41%). In addition, in a group of PDR specimens, interleukin-1 (IL-1) was detected in 8 out of 13 tested specimens (62%).

CONCLUSION

The results revealed that the macrophages in the membranes were in an active stage and may play a significant role in the development of proliferative intraocular disorders through either inducing inflammatory reactions or immune responses, or the effects of their cytokines.

[Cataract after silicone oil tamponade and its surgical treatment]

Twelve eyes of twelve cases of cataract after complicated retinal detachment surgery and silicone oil tamponade were treated in this report. Successful extracapsular cataract extraction (ECCE) was performed on 10 of the 12 cases, no oil escape occurred in any of the operation and in one eye an intraocular lens was implanted. Intraoperatively, loss of large amount of silicone oil occurred and it was removed completely in ECCE in 2 cases. After the follow-up periods of 3 approximately 30 months (mean, ten months), ten cases with the intact posterior capsule and silicone oil in place had a good view of the fundus, their retinae were attached and visual acuities were recovered above the best levels after retinal detachment surgery. Two cases with silicone oil removal suffered from retinal re-detachment. The main points of the surgery were discussed, and the effective method of prevention from silicone oil escape and maintenance of the transparency of the posterior capsule after ECCE were proposed.

[Left ventricular diastolic dysfunction in patients with angina decubitus]

Our study population consisted of three groups: 1. 24 cases with ejection fraction (EF) > 45% in 26 patients with angina decubitus (AD) were studied as group A. 2. 20 patients had coronary artery disease without AD as group B. Group B and A were matched for age, EF and coronary artery obstructive lesions. 3. 20 cases without cardiovascular diseases as group C. Left ventriculography (LVG) was performed in these patients. The results showed that left ventricular (LV) early 1/3 filling fraction (1/3FF) was significantly reduced in group A as compared with that in group B and C (both P < 0.001). The findings suggest that patients with AD have abnormalities of LV diastolic filling. Left ventricular end diastolic pressure (LVEDP) significantly increased in patients with AD after LVG as compared with before LVG (P < 0.01). However, there was no statistically difference in LVEDP before and after LVG in both group B and C, indicating that the compliance of LV was also decreased in patients with AD. The increase of LV volume after recumbency would cause increase of LV wall tension and myocardial contraction and aggravate the LV diastolic dysfunction, resulting in a progressive increase in myocardial oxygen consumption. Therefore, we consider that on the basis of severe coronary artery obstructive lesions, LV diastolic dysfunction is a significant pathologic factor in the pathogenesis of AD.

Isolation and properties of a blood coagulation factor X activator from the venom of king cobra (Ophiophagus hannah)

A specific blood coagulation factor X activator was purified from the venom of Ophiophagus hannah by gel filtration and two steps of FPLC Mono-Q column ion-exchange chromatography. It showed a single protein band both in sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and alkaline polyacrylamide gel electrophoresis. The mol. wt was estimated to be 62,000 in non-reducing conditions and 64,500 in reducing conditions by SDS-PAGE. The isoelectric point was found to be pH 5.6. The enzyme had weak amidolytic activities toward CBS 65-25, but it showed no activities on S-2266, S-2302, thrombin substrate S-2238, plasmin substrate S-2251 or factor Xa substrate S-2222. It had no arginine esterase activity toward substrate benzoylarginine ethylester (BAEE). The enzyme activated factor X in vitro and the effect was absolutely Ca2+ dependent, with a Hill coefficient of 6.83. It could not activate prothrombin nor had any effect on fibrinogen and thus appeared to act specifically on factor X. The procoagulant activity of the enzyme was almost completely inhibited by serine protease inhibitors like PMSF, TPCK and soybean trypsin inhibitor; partially inhibited by L-cysteine. Metal chelator EDTA did not inhibit its procoagulant activity. These results suggest that the factor X activator from O. hannah venom is a serine protease.

Impact of family history of colon cancer on development of multiple primaries after diagnosis of colon cancer

PURPOSE

The purpose of this study was to assess risk of developing multiple primaries after a diagnosis of colon cancer and to determine the impact that having a family history of cancer has on cancer risk.

METHODS

Data from the Utah Cancer Registry and the Utah Population Database were used. A cohort of 2,236 first primary colon cancers were observed for the subsequent development of additional primary cancers.

RESULTS

We observed a greater than expected incidence of colon, rectal, and pancreatic cancers among the cohort. The standardized incidence ratios were 2.77 (95 percent confidence interval (CI), 2.07-3.70), 2.26 (95 percent CI, 1.34-3.81), and 2.38 (95 percent CI, 1.32-4.30), respectively. Having a family history of colon or rectal cancer did not greatly influence risk of having a multiple primary. However, there was a trend toward increased risk of pancreatic cancer (hazard rate ratios, 1.99; 95 percent CI, 0.67-5.90) and bladder cancer (hazard rate ratios, 2.35; 95 percent CI, 0.77-7.18) among patients with a family history of rectal cancer. We also observed that risk of uterine cancer in the cohort was positively associated with family history of uterine cancer, risk of breast cancer was positively associated with family history of breast cancer, and risk of prostate cancer was positively associated with family history of prostate cancer.

CONCLUSIONS

People with colon cancer are at a greater risk of developing colon, rectal, and possibly pancreatic cancer. Although a family history of colon or rectal cancer did not have a large impact on developing other cancers, a family history of other primary cancers did influence risk of other cancers.

[Effects of low dose aspirin on platelet function and prostaglandins metabolism in systemic and coronary circulation in patients with ischemia heart disease]

Eleven patients with ischemia heart disease (IHD) were treated with low dose aspirin (ASA, 50mg/day) for more than two weeks (ASA group). 29 cases with IHD not taking ASA served as patient control (NASA group) and 13 cases without IHD not taking ASA as normal control. Blood samples for measurement of plasma (serum) TXB2 and 6-keto-PGF1 alpha were simultaneously taken from aortic root (AO) and coronary sinus (CS). The results showed: ASA group had lower plasma TXB2 level in AO blood than NASA group (P < 0.05), but there was no significant difference in plasma 6-keto-PGF1 alpha level between the two groups. Both of plasma and serum TXB2/6-keto-PGF1 alpha ratios in AO blood in ASA group were significantly lower than those in NASA group (P < 0.05 and P < 0.0005 respectively). Plasma TXB2 CS/AO ratio and 6-keto-PGF1 alpha CS/AO ratio in ASA group were significantly lower than those in NASA group (P < 0.05), but not different from those in control group. Both ASA and NASA groups had lower serum TXB2 CS/AO ratios than control group (P < 0.05). The results suggest that low dose aspirin inhibits selectively TXA2 synthesis in systemic circulation and inhibits synthesis and/or release of TXA2 and PGI2 equally (no selectivity) in coronary circulation, but could not completely inhibit intracoronary platelet activation.

[Vitrectomy for treatment of vitreous hemorrhage associated with age-related macular degeneration]

Age-related macular degeneration (AMD) is an aging disorder which has been a leading cause for blindness among old people. The wet type AMD is the main cause which deteriorates visual function rapidly because of the complications including detachment of retinal pigment epithelium, formation of subretinal neovascular membrane and scar, subretinal and vitreous hemorrhage. This assay reports the results of vitrectomy for treatment of 10 cases with vitreous hemorrhage associated with AMD. The follow-up periods ranged from 1/2 to 28 months. The visual acuities in 9 cases were increased and in 1 case decreased. The factors affecting the postoperative visual acuity, operative complications and therapeutic prospects of the surgery were discussed.

Beneficial effects of NTG on left ventricular volumes and systolic function in patients with myocardial infarction

The effect of sublingual administration and intravenous drip of nitroglycerin (SLNTG and IVNTG) on left ventricular volumes (LVVs) were studied and systolic function was quantitatively assessed with two-dimensional echocardiography (2DE) in 28 patients with myocardial infarction (MI), including 13 cases without heart failure (MI-NHF) in one group and 15 with heart failure (MI-HF) in another. The results showed that after SLNTG and IVNTG in both groups the heart rate (HR) increased significantly (P < 0.05-0.001); the systolic blood pressure (SBP) decreased significantly (P < 0.05-0.001); the diastolic blood pressure (DBP) was not significantly changed (all P > 0.05); the left ventricular end-diastolic and end-systolic volumes (EDV and ESV) both significantly reduced [EDV: decreased by 5.8-11.6% (-13.2-19.0 ml), P < 0.05-0.001; ESV: decreased by 9.6-16.6% (-8.6-17.3 ml), P < 0.05-0.001)]; the left ventricular ejection fraction (LVEF) all significantly elevated (increased by 6.6%-9.4% (3.2%-3.4%), P < 0.05-0.001] except in MI-NHF group after IVNTG; the segmental EF of normal and hypokinetic segments also significantly increased (P < 0.05-0.001). The results suggest that NTG could beneficially reduce left ventricular EDV and ESV; and improve or strengthen its global and segmental systolic function in MI patients, particularly noticeable in patients with heart failure.

Modified vitreous surgery for subretinal neovascularization and hemorrhage

PURPOSE

To modify vitreous surgery for subretinal neovascularization (SRNV) and to determine the effects of this operation.

METHODS

Six patients with SRNV were performed with this operation. The methods of examination before and after operation included: testing the best-corrected visual acuity before operation and 1, 3 or 6 months after operation; 30 degrees and macular 10 degrees Humphrey visual field examination; FFA examination preoperatively and 1, 3 or 6 months postoperatively. Modified surgery procedure is: a preventive buckling; pars plana vitrectomy; peeling the vitreous cortical; no intraocular diathermy; small retinotomy; subretinal surgery; air-fluid exchange.

RESULTS

SRNV was taken off in 4 cases. Subretinal hemorrhage was washed in 2 cases. After 4 to 7 months follow-up, the visual acuity was improved in 4 cases, unchanged in 2 cases. The visual field was improved in 4 cases, unchanged in 1 case, decraesed in 1 case. The complications included macular hole due to surgery in 1 case and subretinal hemorrage in 1 case.

CONCLUSION

The surgery criteria were: 1) massive subretinal hemorrhage; 2) some patients of SRNV included: FFA evidence they showed the membrane is beneath fovea, the best V. A is 20/100 or lower, and can't be treated by laser and the patient consent. This modified subretinal operation is safe, and effective for massive hemorrhage and some SRNVS.

[Argon laser photocoagulation in the treatment of central serous chorioretinopathy]

Thirty-six cases (41 eyes) with central serous chorioretinopathy were treated by using argon laser photocoagulation. The results showed that the number of eyes with vision equal to or more than 1.0 increased from 7 (17.1%) pre-laser to 26 (63.4%) post-laser, while the number of eyes with vision less than 1.0 decreased from 25 (61%) pre-laser to 6 (14.6%) post-laser. The subretinal fluid was almost entirely absorbed from 1 week to 1 month after, and central fovea reflex could be seen in some cases. The results indicate that the vision prognosis is strongly related to the duration of the disease, but the direction of leakage to the fovea, the distance between the leakage and the fovea, and the dimension of sensory retina detachment are factors which weakly affect the post-laser vision.

Evaluating for vitreous surgery used in proliferative vitreoretinopathy grade D3

Proliferative vitreoretinopathy (PVR) is one of the main failure causes of retinal detachment repair. In this paper, 25 cases of vitreous surgery used in the PVR D3 are analyzed. The diagnosis of PVR depended on the classification of the American Retina Society Terminology Committee. Vitrectomy and peeling were carried out in all of the patients. Intraocular tamponade included silicone oil and gas tamponade. Follow-up is more than 3 months. The anatomic successful rate was 68% and 11 cases arrived 20/400 or better. The complications included vitreous hemorrhage, cataract, silicone oil into anterior chamber, PVR recurrent and so on. The authors suggest that vitrectomy combined with peeling and intraocular tamponade be key for the treatment of PVR D3. Silicone oil tamponade may improve the patients' prognosis. PVR formation is connected with the operative irritation, giant tear, trauma and vitreous hemorrhage. Adaptation and time of the vitreous surgery are discussed in this paper, too.

[Fundus fluorescein angiographic findings of sympathetic ophthalmia]

Eight cases of sympathetic ophthalmia diagnosed by histopathologic examinations of the enucleated exciting eyes were collected and the fundus fluorescein angiographic (FFA) findings of the sympathized eyes in acute stages were analyzed. The manifestations of the FFA were divided into three types. We suggest that if one eye has a history of trauma and the other eye loses visual acuity rapidly accompanied with uveitis signs after certain incubation period, the fundus fluorescein angiography should be examined to achieve a clinically objective diagnostic basis so that the patients are treated in time.

[Laser treatment for the membranous cataract: the significance of pre-laser interferometric acuity]

Laser interferometer was used for the detection of interferometric acuity before and after membranous cataract disruption by Q--switched Nd: YAG laser in 23 patients (23 eyes). There was no significant difference between the interferometric acuity before and after laser surgery (p < 0.05). The postoperative corrected acuity was related positively to the preoperative one (p < 0.05). 65.2% of the eyes had a postoperative corrected acuity better than the postoperative interferometric acuity. These results show that laser interferometric acuity is a valuable method in the evaluation of postoperative visual acuity, but false negative and false positive ones should be considered under some circumstances. The interferometric acuity can be affected by aphakia (high refractive error).

Study on application of the silicone oil in the reattachment of complicated retinal detachment

Sixty eyes with complicated retinal detachment were treated by vitrectomy combined with silicone oil tamponade (27 eyes of PVR grade D, 15 eyes of giant retinal tears with posterior flat folded-over, 13 eyes of posterior or macular hole, 5 eyes of traumatic PVR). After 3-24 months follow-up, the study showed retinal anatomic reattachment in 48 eyes in which the visual acuity of 32 eyes was 0.05 or better. The authors consider that vitrectomy and peeling make the silicone oil tamponade perfect the vitreous surgery and improve the successful rate. The theory of silicone oil tamponade, the indications, advantages and disadvantages of silicone oil tamponade are discussed in this paper.

Hemodynamic observation and treatment approach for patients with angina decubitus

In order to investigate the mechanism and treatment of angina decubitus, 20 patients (18 men and 2 women aged 36-70 years) were studied during hospitalization. All patients were found to have an increased heart rate x systolic blood pressure product before the onset of angina decubitus, indicating that this type of angina pectoris belongs to the category of effort angina. Of the 11 patients investigated by continuous hemodynamic monitoring, 3 had significant progressive increases in pulmonary artery systolic pressure (PASP) and pulmonary artery diastolic pressure (PADP) before onset: their episodes of angina could not be completely controlled by digoxin and diuretics, but quickly subsided after beta blockers were added. Among the other 8 patients, PADP increased slightly in 5 and remained unchanged in 3 cases before onset: these patients had no manifestations of LV dysfunction, and beta blockers combined with coronary vasodilators produced satisfactory effects. These results indicate that LV failure is not a major factor in the pathogenesis of angina decubitus. The LV diastolic dysfunction seen in 8/11 cases may have been related to LV hypertrophy caused by long-term hypertension or chronic persistent ischemia.

[Microvitreoretinal surgery for management of giant retinal tears with posterior flat folded-over]

Twelve cases (12 eyes) of giant retinal tears with posterior flat folded-over were treated using vitrectomy, membrane peeling, and air or silicone oil tamponade. The operations were successful in 4 of the 5 cases of silicone oil tamponade group and in 2 of the 7 cases of air tamponade group. All the successfully operated eyes (6 eyes) had a visual acuity of 0.05 or better. We believe that vitrectomy makes it possible for the folded-over and fixed retina to recover mobilization and return to its normal anatomic position.

[Vitreous surgery for retinal detachment with severe proliferative vitreoretinopathy and probe of failed cause]

Eighty-one cases (81 eyes) of retinal detachment with severe proliferative vitreoretinopathy were treated using vitrectomy, scleral buckling and air or silicone oil tamponade technique. After a follow-up period of 6-28 months, 54 cases obtained anatomic retinal attachment (66.7%). For the serious cases of PVR D3, we also gained a success rate of 50%. Vision improved in 50 cases, whereas 34 cases got a vision better than 0.05. For the failed cases, cause that prevent the retina from attachment was probed. We think that vitrectomy is an essential and important procedure for retinal detachment with severe PVR, membrane peeling is the key of success and prevention of reproliferation can avoid recurrent retinal detachment and further raise the success rate of treatment. A new classification is recommended in this article.

[Micro-vitreoretinal surgery for failed common retinal detachment repair]

In this paper we analyzed 49 cases (49 eyes) of micro-vitreoretinal surgery for failed common retinal detachment repair. Reattachment was achieved in 37 cases (75.51%) and final visual acuity of 10/200 or better was attained in 32 cases (65.31%). It was suggested that common operation failure in these patients was due to PVR. Cryopexy, diathermy and repeat operation can render the formation of the PVR. Micro-vitreoretinal surgery should be performed on these patients. There was a linear relationship between the effectiveness and the degree of PVR. It is best to perform the surgery 3 months after common operation. Finally, the authors discuss the reasons for failure of vitreoretinal surgery and conclude that the anterior PVR and the invalid fixing are the main reasons for failure of vitreoretinal surgery.

Quantitative assessment of regional wall motion abnormalities with 2DE in cases of myocardial infarction

The severity, extent and localization of regional wall motion abnormalities (RWMA) were quantitatively assessed with apical biplane two-dimensional echocardiography (2DE) using a fixed-axis system, ten-segment division area method in 56 patients with old myocardial infarction (OMI). RWMA were found to be more severe in the anterior wall MI (AWMI) group than in the inferoposterior wall MI (IWMI) group and most severe in the extensive AWMI with ventricular aneurysm (EAWMI with VA) group; the extent of RWMA was smallest in the IWMI group, significantly larger in the AWMI group, and largest in the EAWMI with VA group. The location of the RWMA segments showed group-specific tendencies. For example, both coronal and sagittal apices were much more frequently involved in both the EAWMI with VA and the AWMI groups than in the IWMI group (100%, 87% and 0%, respectively, all P < 0.001). The results demonstrated that quantitative analysis of RWMA using 2DE in cases of MI is accurate and feasible.