Transitional mucosa at anastomosis. A cause of local tumor recurrence in patients with rectal cancer after anterior resection

Transitional mucosa adjacent to colorectal cancers is essentially characterized by an excess of sialomucins at the expense of the normally predominant sulphomucins in epithelial cells lining the intestinal crypts which presents the early stage of oncogenic transformation of colorectal epithelium. The presence or absence of sialomucins at the resection margins was studied histochemically using the high iron diamine-alcian blue(HID-AB) stain in 64 rectal cancer patients in Dukes' B stage who underwent curative anterior resection. The correlation was revealed between the presence of sialomucins at the resection margins and subsequent development of local tumour recurrence. Fourteen of 27 patients (51.9%) with sialomucins predominant pattern at either resection margin developed local recurrence compared with 4 of 37 patients (10.8%) with sulphomucins predominant pattern (P less than 0.001). It is suggested that determination of the transitional mucosa around anastomosis in patients treated for the rectal carcinoma by anterior resection appears to identify those with a higher risk of local recurrence.

Migration, blood pressure pattern, and hypertension: the Yi Migrant Study

Rural-urban migration provides an ideal opportunity to examine the effects of environment and genes on blood pressure. The effect of migration on the Yi people of China was studied. The Yi people live in a remote mountain area in southwestern China. In 1989, blood pressure was measured in 14,505 persons (8,241 Yi farmers, 2,575 urban Yi migrants, and 3,689 Han urban residents) aged 15-89 years. Different patterns were seen for men and women. Among the men, Yi farmers had the lowest mean blood pressure, the least rise in blood pressure with age (systolic blood pressure, 0.13 mmHg/year; diastolic blood pressure, 0.23 mmHg/year), and the lowest prevalence of hypertension (0.66%). In contrast, both Yi migrant men and Han men had higher levels of mean blood pressure, rise in blood pressure with age (Yi migrants: systolic pressure, 0.33 mmHg/year; diastolic pressure, 0.33 mmHg/year; Han: systolic pressure, 0.36 mmHg/year; diastolic pressure, 0.23 mmHg/year), and prevalence of hypertension (Yi migrants, 4.25%; Han, 4.91%). Among the women, however, mean systolic pressure was higher in Yi farmers than in Yi migrants or in Han. Diastolic pressure was similar among the three groups. However, the Yi farmer women's age-related rise in blood pressure (systolic pressure, 0.06 mmHg/year; diastolic pressure, 0.14 mmHg/year) and their prevalence of hypertension (0.33%) were lower than those in the other two groups. Yi migrant women had an intermediate rise in blood pressure with age (systolic pressure, 0.37 mmHg/year; diastolic pressure, 0.23 mmHg/year) and prevalence of hypertension (2.40%). Han women had the greatest rise in blood pressure with age (systolic pressure, 0.56 mmHg/year; diastolic pressure, 0.36 mmHg/year) and the highest prevalence of hypertension (4.76%). For both men and women, the above differences were only partially explained by age, body mass index, heart rate, smoking, and alcohol use. This study, using standardized methods, demonstrates an important effect of migration on rise in blood pressure with age and on the prevalence of hypertension.

[The influence of Chinese Agkistrodon acutus enzyme (CAAE) on the functions of washed human platelets]

The effects of the activation and influence of CAAE on washed human platelets were investigated. Our findings were: (1) CAAE could induce aggregation and alpha-granule release reaction in the washed human platelet suspension; thus it could activate the platelets; (2) the aggregation effect of CAAE was inhibited by albumin and affected by Ca2+, Mg2+ concentration; (3) heparin and/or AT III did not inhibit the aggregation activation of CAAE, but alpha 2MG markedly inhibited it; (4) the aggregation activity of CAAE was associated with the serine protease activity. The mechanism of CAAE-induced aggregation mainly follows the prostaglandins-endoperoxides thromboxane A2 pathway.

[A dynamic change of serotypes of HFRS patients in mixed epidemic area]

In this paper, we have used HI assay in an observation of the dynamic changes of serotype of EHF patients in a mixed on demic area in Shaoxing, Zhejiang province. The results showed that serotypes of EHF patients were strongly correlated with different endemic areas and had obvious seasonal fluctuation in the incidence of the disease. This further demonstrates that the difference between the two serotypes (Apodemus type and Rattus type) in different geographic areas.

Chromosome 9 deletion mapping reveals interferon alpha and interferon beta-1 gene deletions in human glial tumors

We have applied restriction fragment length polymorphism analysis to a 30-member panel of primary glioma DNAs, which had been previously examined for loss of genetic information (C. D. James, E. Carlbom, J. P. Dumanski, M. Hansen, M. Nordenskjold, V. P. Collins, and W. K. Cavenee, Cancer Res., 48:5546-5551, 1988), to determine the frequency and sublocalization of loss of genetic information from chromosome 9. We have also utilized scanning densitometry for dosage determination of the 9p-localized interferon alpha and interferon beta-1 genes among these same tumors. Our results reveal the following: (a) for those cases in which loss has occurred, the region of common loss lies on the short (p) arm of the chromosome; (b) loss of genetic information from the short arm of chromosome 9 occurs frequently in glial tumors of intermediate (anaplastic, grade III) and high (glioblastoma, grade IV) histological malignancy (10 of 20 cases) but not in tumors of low (grade II) histological malignancy (0 of 10 cases); (c) tumors with 9p deletions are hemi- or nullizygous for interferon beta-1 and the interferon alpha gene cluster; (d) cases of interferon nullizygosity occur exclusively among tumors of highest histological malignancy (glioblastoma). These data, especially the determination of a region of nullizygosity, suggest proximity to or residence within a gene(s) whose function(s) is (are) critical to the suppression of the malignant evolution of glial tumors.

Effect of migration on blood pressure: the Yi People Study

The Yi People Study was conducted in Puge County, Sichuan Province, People's Republic of China. Four population groups were surveyed for risk factors for cardiovascular disease. Included were two groups of Yi farmers living either in a high mountainous area in extremely remote villages at or above 2,750 meters elevation, or in a mountainside area at about 1,800 meters elevation. A third study group consisted of Yi farmers who migrated to the county seat during the 1950s. Local residents of the county seat, the Han people, constituted the fourth group. Blood pressure rises very little with age after puberty in Yi farmers, but there was a trend of increasing blood pressure with age in Yi migrants and Han. Mean body mass index (kg/m2) and heart rate were higher in Yi migrants than in Yi farmers. For men, both systolic and diastolic blood pressure were greater among Yi migrants than among Yi farmers. These differences persisted after adjusting for age and body mass index. Among women, after adjusting for age, BMI, and altitude, only diastolic blood pressure was lower among Yi farmers than Yi migrants. Yi migrants and Han had similar blood pressures. In 1986, a sample of men participated in more detailed studies of diet, serum, and urine. The proportion of energy from fat ranged from less than 10% among high-mountain Yi farmers to almost 40% among Yi migrants and Han. Compared with Yi farmers, Yi migrants consumed more sodium and less potassium, calcium, and magnesium, had lower serum potassium, and a greater sodium/potassium ratio. Urinary excretion of sodium, calcium, and the sodium/potassium ratio were all greater in Yi migrants than in Yi farmers, while the reverse was seen for potassium. These data suggest that changes in life-style, including dietary changes, contribute importantly to the higher blood pressure among Yi migrants.

Relation of electrolytes to blood pressure in men. The Yi people study

The relations of sodium, potassium, calcium, and magnesium to blood pressure were investigated in four groups of men (119 high-mountain Yi farmers, 114 mountainside Yi farmers, 89 Yi migrants, and 97 Han people) with a wide range of electrolyte intake in Puge County, Sichuan Province, People's Republic of China. Electrolytes were measured in diet, serum, and urine. Sodium excretion was 73.9 mmol/24 hr in high-mountain Yi farmers, 117.9 mmol/24 hr in mountainside Yi farmers, 159.4 mmol/24 hr in Yi migrants, and 186.0 mmol/24 hr in the Han people. In ecological correlation analysis, dietary and urinary sodium were significantly and positively correlated with both systolic and diastolic pressure, whereas serum sodium showed no relation with blood pressure. In diet, serum, and urine, potassium was negatively related to systolic and diastolic pressure, whereas the sodium/potassium ratio showed a positive association. With regard to calcium, only urinary excretion was significantly and positively related to blood pressure. No relation was found between magnesium and blood pressure. Analyses at the individual level confirmed the results for sodium and potassium seen at the ecological level, but in addition, dietary calcium and magnesium were significantly and negatively correlated to both systolic and diastolic pressure, and urinary magnesium was inversely related to diastolic pressure. These relations persisted after controlling for age, body mass index (kg/m2), heart rate, alcohol, and total energy intake in multiple regression analysis performed separately for electrolytes in diet, serum, and urine. In multiple regression analysis, an increase in sodium intake of 100 mmol/day corresponded to an increase of 2.3 mm Hg systolic blood pressure and 1/8 mm Hg diastolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

The cytochemical changes and the adherence of neutrophil during cross-linked agarose encapsulated activated charcoal hemoperfusion

After one hour cross-linked agarose encapsulated activated charcoal hemoperfusion, there was slight increase of total white cells and neutrophil count, but the neutrophil adherence was 16.87 +/- 5.26% and marked lower than that before hemoperfusion (59.91 +/- 5.26%, p less than 0.05). Using glassball hemoperfusion as control, the neutrophil adherence also decreased but not so obvious as the former. Adherence is a cell property that may affect granulocyte margination, diapedesis, chemotaxis and phagocytic function, so the above investigations showed that both the hemoperfusion process and the charcoal itself may reduce the host defence mechanism. There were no change of the peroxidase and alkaline phosphatase activities of neutrophils during one hour cross-linked agarose encapsulated activated charcoal hemoperfusion.

[Long-term prognosis after recovery from acute myocardial infarction]

754 cases of acute myocardial infarction survivors were followed up for 28 days to 14 years, the missing rate was 1.86%. The factors influencing long-term prognosis were analyzed. Single factor analysis revealed sex, occupation, age, amount of cigarette smoked, history of stroke, and COPD, complications of heart failure, and arrhythmia, stroke and COPD, heart rate higher than 110/min, lung rales, frequency of infarction, quit smoking after infarction exerted significant influence on over all and cardiac death rate. Multiple factors Cox model analysis revealed quit smoking, complications of stroke heart failure, arrhythmia and occupation were the independent predicting factors for over-all causes of death. Frequency of myocardial infarction, quit smoking, amount of cigarette smoked, occupation, stroke were the independent prognostic factors of cardiac death.

Loss of genetic information in central nervous system tumors common to children and young adults

The clonal loss of genetic information as revealed by the comparison of normal and tumor DNA restriction fragment length alleles has permitted the determination of the genomic positions of cancer-recessive mutations. Here we have applied this approach to the analysis of 19 central nervous system tumors that constitute four histologic groups and occur most frequently in children and young adults. The detectable loss of genetic information from cases of medulloblastoma (11 examined) indicates that among such tumors, loss occurs most frequently from the short arm of chromosome 17. For the ependymomas examined (four cases), chromosome 22 was the preferred site for detectable loss. Analysis of pilocytic astrocytomas of the cerebellum (three cases) failed to reveal genetic alterations of any type among such tumors, a finding unique to this histologic group. The single choroid plexus papilloma examined demonstrated loss of genetic information from chromosome 3. Among the 19 tumors, multiple cases of loss were observed from chromosomes 10, 11, 13, and 22, and from the short arm of chromosome 17. Therefore, with regard to the chromosomal locations of implied tumor suppressor genes, these results are consistent with those described for intracranial tumors occurring more commonly in adults of middle to advanced age.

[The clinical feature and angiographic diagnosis in Klippel-Trenaunay syndrome]

Eight cases (9 limbs including 8 lower extremities and 1 upper extremity) of the Klippel-Trenaunay Syndrome (KTS) are reported Among 8 cases, 7 cases were proved by surgery KTS is basically a sort of congenital venous dysplasia including venous atresia, aplasia, valvular anomalies, and external compression by a fibrovascular band or surrounded by a fibrous sheath. The basic clinical triad (vascular nevus, varicosities and limb hypertrophy) suggests the characteristic clinical diagnosis. KTS may be divided into four types. Orthodromic, deep venography is the most important examination in diagnosing KTS. Selective arteriography and direct puncture venography may be also used if necessary. The clinical features, angiographic characteristics, surgical problems, and the nomenclature, type and differential diagnosis of KTS were discussed.

[Prognostic factors in the acute stage of myocardial infarction: analysis of 893 cases]

The prognostic factors in the acute stage of 893 myocardial infarction patients, admitted during a period from 1970 to 1986, were analysed. The overall mortality was 15.6%, including 14.4% cardiac death and 1.1% non-cardiac death. Single factor analysis indicated that age, sex, occupation, history of hypertension, chest pain during the episode, systolic blood pressure, heart rate and site of infarction at the time of admission, presence of complications such as cardiogenic shock, arrhythmias, stroke and monitoring in CCU or not were related to the overall mortality and cardiac death. Multiple factor logistic regression analysis indicated that for the overall mortality, the independent prognostic factors included presence of cardiogenic shock, heart rate and chest pain at the time of admission; for the cardiac death, the independent factors included age, occupation, history of hypertension, heart rate and chest pain at the time of admission, involvement of anterior wall and presence of cardiogenic shock and arrhythmias. Basing on the above findings we establish a risk factors predicting prognostic model of acute myocardial infarction in its acute stage.

[Relation of changes in plasma TXB2 PGF1alpha and differentiation of signs and symptoms in traditional Chinese medicine in severe icteric hepatitis]

Clinical observations and experimental studies were made in 52 cases of chronic cholestatic hepatitis, 30 cases of chronic severe hepatitis, 30 healthy control persons, and 30 animals with experimental intrahepatic cholestasis. The results were as follows: Plasma TXB2 and PGF1 alpha were higher than their normal values both in cases of chronic cholestatic hepatitis and in cases of chronic severe hepatitis (P less than 0.01), the ratio of TXB2 and PGF1 alpha was normal in cases of chronic severe hepatitis and lower than normal value in cases of chronic cholestatic hepatitis (P less than 0.01). The cases were divided into 4 types (hepatitis due to blood stasis and blood heat, blood stasis and blood heat accompanying symptoms of fluid retention in the epigastrium, damp-heat, and composite factors) according to differentiation of symptoms and signs on the basic theories of TCM. Significant difference was found in TXB2, PGF1 alpha, PGF1 alpha/TXB2 and bilirubin when compared with each other in the 4 types of hepatitis patients (P less than 0.01). Bilirubin, TXB2, PGF1 alpha and PGF1 alpha/TXB2 in the survivors became normal or close to normal after they were treated with blood-cooling and circulation-promoting Chinese herbal medicine and prescriptions by changing their dosages according to differentiation of symptoms and signs on the basic theories of TCM. The therapeutic effect of prescription II was more satisfactory than that of prescription I. Changes of plasma TXB2 and PGF1 alpha in the experimental animals were more significant than those both in the control group and in the group treated with prescriptions I and II (P less than 0.01), but in the liver only the ratio of TXB2 and PGF1 alpha was lower than that in normal animals (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Sialomucin at the resection margins and likelihood of local recurrence of carcinoma of the rectum after anterior resection

The histochemical changes in mucin at the postoperative resection margins in carcinoma of the upper and middle third of the rectum after anterior resection were studied retrospectively in 52 patients. The sialomucinous change was most likely to occur at the intestinal margins of those patients who had tumour recurrence (P less than 0.001). The histological types of tumour, degree of differentiation, Dukes' stages and their distance from the anal verge were virtually the same in patients with and without tumour recurrence. By using high iron diamine-alcian blue staining technique we identified patients with higher risk conditions of tumour recurrence after anterior resection. This technique should increase the likelihood of a cure for patients with recurrent carcinoma of the rectum after anterior resection.

[Relation of changes in plasma cAMP, cGMP and the clinical conditions, pathology and the type of traditional Chinese medicine in 50 cases of chronic severe icteric hepatitis]

Plasma of cAMP and cGMP in 30 cases of chronic active hepatitis (group of cholestatic patients) as well as in 20 cases of chronic hepatitis with submassive or massive necrosis (group of chronic severe hepatitis patients) were studied with 125I-marked radioimmunoassay. 50 cases with their serum bilirubin levels higher than 171 mumol/L were selected as subjects for this study. Among them, 42 were diagnosed as hepatitis B, 6 as coinfection of hepatitis A and B. According to differentiation of symptoms and signs of TCM, 24 were diagnosed as simple hepatitis due to blood stasis and blood heat, 17 as hepatitis due to blood stasis and blood heat accompanying symptoms of Yang deficiency of the Spleen and Kidney. 20 healthy persons were selected as controls. The results were as follows: cAMP was 56.82 +/- 25.54 ng/L and 80.32 +/- 20.73 ng/L, and cGMP was 9.07 +/- 6.56 ng/L and 19.49 +/- 9.34 ng/L in the group of cholestatic patients and in the group of chronic severe hepatitis patients respectively. Both were higher than those in the control group whose cAMP was 14.12 +/- 3.25 ng/L and cGMP was 5.87 +/- 1.44 ng/L (P less than 0.01). Increase in cGMP and decrease in the ratio of cAMP and cGMP in the cases accompanying symptoms of Yang deficiency of the Spleen and Kidney were much higher than those in the other two types of hepatitis patients (P less than 0.01 and 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[A quantitative study of pulmonary artery systolic pressure in patients with tricuspid regurgitation using continuous wave Doppler]

Pulmonary artery systolic pressure (PASP) was assessed with simultaneous continuous wave Doppler echocardiography (CW) and cardiac catheterization (CATH) in 33 cases. There was a close correlation between CW-estimated peak pressure gradient of tricuspid regurgitation (TRPGp) and CATH-measured PASP (r = 0.96, P less than 0.0001). Excellent correlation (r = 0.96, P less than 0.0001) between CW-estimated PASP and CATH-measured PASP was also obtained. The derived regression equation was PASP = TRPGp + 1.33 kPa. When the patients had relative or pathologic pulmonic stenosis, the regression equation was corrected by pulmonary artery pressure gradient (PAPG). The regression equation became PASP = TRPGp + 1.33-PAPG.

Spinal Cord Circuits

Over the past decade, research at three different levels of sensorimotor control has revealed a degree of complexity that challenges traditional hypotheses regarding servocontrol of individual muscles: (a) The connectivity of spinal circuits is much more divergent and convergent than expected. (b) The normal and reflex-induced recruitment of individual muscles and compartments of muscles is more finely controlled than was noted previously. (c) The mechanical interactions among linked skeletal segments and their often multiarticular muscles are neither simple nor intuitively obvious. We have developed a mathematical model of the cat hind limb that permits us to examine the influence of individual muscles on posture and gait. We have used linear quadratic control theory to predict the optimal distribution of feedback from a hypothetical set of proprioceptors, given different assumptions about the behavioral goals of the animal. The changes in these predictions that result from changes in the structure and control objectives of the model may provide insights into the functions actually performed by the various circuits in the spinal cord.

Photoinhibition at low temperature in chilling-sensitive and -resistant plants

Photoinhibition resulting from exposure at 7 degrees C to a moderate photon flux density (300 micromoles per square meter per second, 400-700 nanometers) for 20 hours was measured in leaves of annual crops differing widely in chilling tolerance. The incidence of photoinhibition, determined as the decrease in the ratio of induced to total chlorophyll fluorescence emission at 693 nanometers (F(v)/F(max)) measured at 77 Kelvin, was not confined to chilling-sensitive species. The extent of photoinhibition in leaves of all chilling-resistant plants tested (barley [Hordeum vulgare L.], broad bean [Vicia faba L.], pea [Pisum sativum L.], and wheat [Triticum aestivum L.]) was about half of that measured in chilling-sensitive plants (bean [Phaseolus vulgaris L.], cucumber [Cucumis sativus L.], lablab [Lablab purpureus L.], maize [Zea mays L.], pearl millet [Pennisetum typhoides (Burm. f.) Stapf & Hubbard], pigeon pea [Cajanus cajun (L.) Millsp.], sesame [Sesamum indicum L.], sorghum [Sorghum bicolor L. Moench], and tomato [Lycopersicon esculentum Mill.]). Rice (Oryza sativa L.) leaves of the indica type were more susceptible to photoinhibition at 7 degrees C than leaves of the japonica type. Photoinhibition was dependent both on temperature and light, increasing nonlinearly with decreasing temperature and linearly with increasing light intensity. In contrast to photoinhibition during chilling, large differences, up to 166-fold, were found in the relative susceptibility of the different species to chilling injury in the dark. It was concluded that chilling temperatures increased the likelihood of photoinhibition in leaves of both chilling-sensitive and -resistant plants. Further, while the photoinhibition during chilling generally occurred more rapidly in chilling-sensitive plants, this was not related directly to chilling sensitivity.

[Quantitative assessment of pulmonary arterial diastolic and mean pressure using continuous wave Doppler]

Continuous wave Doppler echocardiographic study was performed almost simultaneously with right heart catheterization in 24 patients with a variety of cardiovascular disorders and evidence of pulmonary regurgitation detected by pulsed wave Doppler. Their pulmonary arterial diastolic and mean pressure (PADP and PAMP) measured during catheterization were ranging from 5 to 70.6 (mean 30.26 +/- 18) mmHg and from 6.7 to 91.14 (mean 42.41 +/- 23.23) mmHg, respectively. The right ventricular end-diastolic pressure was within normal limit in all but one. The peak, mean and end-diastolic pressure gradients of pulmonary regurgitation (PPRPG, MPRPG and PRPGed) were calculated using simplified Bernoulli Equation and their correlations with PADP and PAMP were analysed using linear regression method. There were close correlations between all PRPGs and PADP or PAMP (r = 0.85 - 0.94, P less than 0.0001). The best equation for assessing PADP was MPRPG + 6 mmHg (r = 0.94, P less than 0.0001), for PAMP was PPRPG + 8 mmHg (r = 0.92, P less than 0.0001). It is evident that those constants in the equations should be adjusted in individual patient who has coexisting right heart failure.

Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients

Although obstructive sleep apnea (OSA) has been studied in detail for over a decade, the mortality of this disorder is unclear. We calculated cumulative survival in 385 male OSA patients. We found that those with an apnea index (AI) greater than 20 had a much greater mortality than those with AI = less than 20. The probability of cumulative eight-year survival was .96 +/- 0.02 (SE) for AI = less than 20 vs. 63 +/- 0.17 for AI greater than 20 (p less than .05). This difference in mortality related to AI was particularly true in the patients less than 50 years of age in whom mortality from other causes is not common. None of the patients treated with tracheostomy or nasal CPAP died. Eight of the patients treated with uvulopalatopharyngoplasty (UPPP) died and the cumulative survival of the UPPP-alone treated group was not different from the survival curve of untreated OSA patients with an apnea index of greater than 20. We conclude that OSA patients with an apnea index of greater than 20 have a greater mortality than those below 20 and that UPPP patients be restudied after therapy. If the latter patients are found not to have marked amelioration of their AI, then they should be treated by nasal CPAP or tracheostomy.

[Experience in the surgical treatment of 748 patients with lung cancer]

A series of 748 patients with lung cancer as treated by surgery from 1961 to 1984 is reported. Regular lobectomy was done in 445 (74%) patients, bronchoplastic lobectomy in 67 (11.2%), segmental or wedge excision in 15 (2.5%) and pneumonectomy in 74 (12.3%) in which the ratio of left to right pneumonectomy was 2.9:1. Overall resection rate was 80.4% (601/748) and resection mortality was 1.2% (7/601) (death within 30 days of operation). Overall 5 year survival rate was 42% (169/402). The 5 year survival rate was 35.3% for pneumonectomy, 54.1% for bronchoplastic lobectomy, 42.3% for regular lobectomy and 16.7% for segmental or wedge excision. In this analysis, emphasis is laid to the therapeutic validity of the different modes of surgery. Statistical data show that only when the indication of different surgical interventions are strictly adhered to and the reasonable procedures are carried out, could better results be obtained. In surgical treatment of lung cancer, it is an important principle to eradicate the tumor and its metastatic foci as thorough as possible and to conserve the respiratory function as much as possible. Regular lobectomy has now become the "standard" and first choice operation. Pneumonectomy should be reserved for the patients with absolute necessity due to the extent of the lesion, adequate cardiopulmonary function and possibility of a permanent cure. Pneumonectomy is substituted by bronchoplastic lobectomy to a certain degree, preserving more of the lung function and improving the living quality after operation and long term results. Extensive practice of this surgical modality is advised.