复方丹参滴丸治疗缺血性心脏病心绞痛、室性早搏的临床研究

目的探讨复方丹渗滴丸对缺血性心脏病心绞痛、心肌缺血、室性早搏的疗效及相关心电图变化。方法按照随机方法将70例缺血性心脏病患者分为观察组和对照组，观察组36例用复方丹渗滴丸10粒／次，口服每日3次，心绞痛发作时加用一次舌下含服10粒。对照组34例用地奥心血康，每次0．2g，每日3次，两组病例均用药8周。两组病例心绞痛缓解症状疗效和心电图改善疗效，按全国疗效标准评定心绞痛疗效和心电图疗效对比分析。结果（1）观察组心绞痛总有效率为91．7％，对照组为70．6％（P〈0．05）。（2）观察组心肌缺血及室性早搏总有效率为66．7％，对照组为47．1％（P〈0．05）。组间比较总有效率及显效率差异有显著性（P均〈0．05）。结论两药均可改善心肌缺血、抗心绞痛，对心肌缺血所致的心电图改变，室性早博有效，但复方丹参滴丸疗效更为优越，在用药过程中未见不良反应及副作用。而地奥心血康组部分病人有头晕头痛及胃部着胀不适。     

Genetic analysis of carcinogen enhancement of type 5 adenovirus transformation of cloned fischer rat embryo fibroblast cells

Pretreatment of CREF cells with methyl methanesulfonate (MMS) before infection with the host-range cold-sensitive type 5 adenovirus (Ad5) mutant H5hr1 results in a dose-dependent carcinogen enhancement of viral transformation (CET). The properties of CET observed with H5hr1, which include both an MMS dose-dependent enhancement in the number of transformed foci and an increase in transformation frequency after correction for cell toxicity, are not observed in carcinogen-pretreated wild-type (wt) Ad5 (H5wt)-infected CREF cells. This study was conducted to determine the role of the viral E1A and E1B transforming genes of H5hr1 in mediating the unique CET phenotype of H5hr1. Coinfection of MMS-pretreated CREF cells with H5wt or H5sub309 (which displays a wt Ad5 phenotype) and H5hr1 resulted in a suppression of the unique CET phenotype that was directly related to the multiplicity of infection with wt Ad5. Suppression of the unique H5hr1 CET phenotype was also apparent in MMS-pretreated CREF cells coinfected with H5hr1 and an Ad5 mutant expressing either a wt 13S E1A-encoded 289 amino-acid (aa) protein and an intact wt E 1B gene or a wt 13S E1A-encoded 289-aa protein and a 22S E1B-encoded 495-aa protein. In contrast, the unique H5hr1 CET phenotype was not suppressed in MMS-pretreated CREF cells coinfected with H5hr1 and Ad5 or Ad2 mutants expressing either a wt 12S E1A-encoded 243-aa protein and both wt E1B gene products or an intact wt E1A gene and a wt E1B 13S-encoded 175-aa protein. That genetic changes in both the E1A and E1B viral regions of H5hr1 were required to induce the unique CET phenotype was also indicated by the inability of a recombinant Ad5 containing the 0—4.5 map-unit region of H5hr1 and the 4.5–100 map-unit region of H5sub309 to display the H5hr1 unique CET phenotype. Direct confirmation of the requirement for both gene regions of H5hr1 to mediate its unique CET was obtained by generating CREF cells stably expressing a wt Ad5 E1A 13S-encoded 289-aa protein and a wt E1B 22S-encoded 495-aa protein. In these CREF transformants (which displayed a CREF-like morphology), transformation by H5hr1 was not reduced, but the unique CET phenotype after MMS pretreatment was eliminated. These results suggest that alterations in both the 13S-encoded E1A and 22S-encoded E1B gene products of H5hr1 contribute to its unique CET.     

增强磁共振成象动态扫描显示心绞痛病灶的初步研究

通过总结22例心绞痛患者经钆－二乙烯三胺五乙酸（Gd－DTPA）增强磁共振成象（MRI）动态扫描的研究结果，提出Gd－DTPA增强MRI动态扫描可以显示心绞痛病灶。22例心绞涌患者均为临床证实。增强检查方法为ECG门控，同一检查区域连续扫描4次，时间间隔为5、10、20和30min。信号测量由MRI机内在测量功能完成。结果：22例中有18例表现为增强后心肌局灶性高信号区。通过分析病灶区动态信号变化曲线并与正常心肌对比，发现其特点为病灶区增强后10min最高，信号增强率和信号对比率的最高峰也都在10min左右。而正常心肌的最高峰出现在5min时。这个结果与急、慢性心肌梗死MRI动态曲线的变化情况也不相同。表示心绞痛病灶区增强的原理和心肌梗死的增强原理并不完全相同。结论：Gd－DTPA增强MRI动态扫描完全可以定位和定量地显示心绞痛的病灶，但对它的增强原理目前尚不完全了解。     

地尔硫治疗冠心病心绞痛180例

用随机、双盲、交叉对照法,以戊四硝酯片作为对照药,评定盐酸地尔硫(艹卓)治疗冠心病心绞痛180例的疗效。显示用中等剂量、1个月的疗程,症状总有效率为94.9％,静息心电图总有效率为49.7％,心电图运动试验总有效率为52.2％.此外心率减慢、血压降低、心率收缩压二重乘积和左心室收缩时间间期改善,全血粘度和血小板聚集可能降低。而不良反应发生率不高。经配对X~2检验,其效果优于戊四硝酯片。     

The importance of pre- and postinfarction angina on timolol-related reduction in mortality and reinfarction

The importance of a history of angina pectoris on long-term timolol treatment after myocardial infarction was studied with respect to mortality and reinfarction. The analyses were performed retrospectively using cohorts from the Norwegian timolol multicenter study. In patients without angina pectoris prior to the infarction, timolol treatment reduced mortality by 61% and the occurrence of first nonfatal reinfarction by 16.9% as compared with placebo. Patients with preinfarction angina had a reduction in mortality of 21.8% and in first nonfatal reinfarction of 48.6%. The frequency of angina pectoris increased from 38% in both treatment groups before the infarction to 59% in the placebo group and 52% in the timolol group the first 6 months after the infarction. In patients without postinfarction angina pectoris, timolol treatment reduced mortality by 30.7% and the number of first nonfatal reinfarctions by 22.7%. The reductions in mortality and reinfarction in patients with postinfarction angina were 43.8% and 38.5%, respectively. Thus, the decision for timolol treatment after myocardial infarction should not be dependent on pre- and postinfarction angina.     

Time Dependent Variations of Stimulus Requirements in Spinal Cord Stimulation for Angina Pectoris

The aim of the study was to observe changes over time of the stimulation requirements in spinal cord stimulation (SCS). Of 60 patients treated with SCS, 25 patients were selected because they had neurostimulators capable of measuring impedance noninvasively, and had not experienced electrode displacement. All 25 patients had Medtronic Pisces Quad 3487A (Medtronic, Inc.) neuroelectrodes with the tip positioned in the thoracic epidural space. The accuracy of the neurostimulators impedance measuring circuit was investigated in a test circuit. The error was < 11%. Stimulus requirements and impedance were recorded at the implantation and at follow-ups during a period of 24 months. During the first month after implantation, the stimulus requirements for satisfactory effect varied between +406% and -34%. After that period, only minor deviations were observed in most patients. To optimize the pain reducing effect of the spinal cord stimulation, frequent follow-ups are recommended during the first month; later on, the follow-up intervals can be extended. No tolerance development or pain resistance developed during SCS treatment     

Twenty-four hour plasma profile of sustained-release isosorbide mononitrate in healthy volunteers and in patients with chronic stable angina. Two open label trials

Aims The plasma profile of a single dose of isosorbide mononitrate 25  mg (Elantan LA25) in healthy volunteers and in angina patients was examined.
Methods In volunteers and patients, blood samples for pharmacokinetics were obtained pre-dosing and at intervals for 24  h after dosing.
Results This formulation exhibited rapid absorption and plasma levels were maintained at >100  ng  ml⁻¹ for up to 9 to 12  h.
Conclusions A comparison of the pharmacokinetics of Elantan^® LA25 in volunteers and patients indicates that the profiles are similar.     

Solubility properties of neuronal tubulin: Evidence for labile and stable microtubules

The solubility properties of tubulin and microtubules in pure cultures of sympathetic neurons were examined by electron microscopic and biochemical techniques. For morphological analyses, neurons were extracted with Triton X-100 in the presence or absence of 1 mM CaCl₂, and the resulting detergent-extracted residues were examined for microtubules. In parallel experiments, the solubility of tubulin was determined under various solution conditions.Detergent-extracted residues of neurons prepared without Ca²⁺ contained many microtubules. Neurite residues prepared in the presence of Ca²⁺ also contained microtubules, but at substantially lower numbers than in residues prepared without Ca²⁺. The biochemical data parallel the morphological observations. Following detergent-extraction under microtubule stabilizing conditions, 30% of the tubulin was detergent-soluble (i.e. unpolymerized), while 70% was detergent-insoluble (i.e. polymerized). A more detailed examination of the solubility properties of tubulin indicated that 62% was detergent-insoluble but soluble in buffers containing mM CaCl₂, while 5–8% was detergent and Ca²⁺ insoluble. A variety of control experiments indicated that non-specific adsorption of tubulin onto detergent-insoluble components of the cultures, assembly of tubulin onto pre-existing microtubules, and incomplete extraction of tubulin from cells contributed minimally to the levels of Ca²⁺-soluble and insoluble tubulin obtained with the extraction conditions used. These results indicate that (a) the majority of neuronal tubulin is assembled into microtubules which disassemble upon treatment with Ca²⁺ and (b) a portion of the neuronal tubulin is assembled into microtubules which show the unusual property of Ca²⁺- stability.     

Angina pectoris, one to 10 years after aortocoronary bypass surgery

The incidence of angina pectoris (AP) after bypass surgery wasassessed in 1041 patients operated on consecutively between1971 and 1980. Of the 977 survivors, 920 (94%) participatedin the study with a followup time varying from 1 to 10 years(mean 3.5 years). Post-operative angina pectoris was presentat 1 year in 277 patients (30%), at 3 years in 46%, at 8 yearsin 50%. The pain limited usual physical activities in 17.5%,30% and 25%, respectively at these times. Nonetheless, 89% ofthe respondents felt improved by surgery. Factors without predictivevalue for late outcome were sex, number of pre-operative diseasedvessels, and pre-operative ejection fraction. A correlationwas found between post-operative AP and younger age at surgeryin the males only (P< 0.001); between AP and patency rateof the bypass graft (P<0.005) and with the status of thecoronary arterial tree at three years post-operatively (P<0.001)in both sexes. The percentage of patients with recurrent APincreased with time after surgery up to 3 years, but remainedstable thereafter. In conclusion, post-operative AP seems initiallyrelated to decreased functioning of the bypass graft, laterto progression of coronary sclerosis in the native circulation.     

Pre-infarction angina secondary to calcific aortic stenosis with Bernheim's effect.

Pre-infarction angina, in the absence of coronary artery disease, was found in a 62 year-old man with severe calcific aortic stenosis. After application of intraaortic balloon pump counter-pulsation, the condition was stabilized, and coronary arteriograms were safely carried out. Interestingly, an elevated right atrial and right ventricular end-diastolic pressure with an associated Bernheim's effect was demonstrated by cardiac catheterization. The hemodynamics of the right heart returned to normal after surgical correction of the aortic stenosis. The clinical indications for intra-aortic balloon pump counterpulsation in this setting are discussed.