2014年 · 第127卷第05期

Abstract：Background A variety of inflammatory mediators and effector cells participate together in acute lung injury,and lead to secondary injury that is due to an inflammatory cascade and secondary diffuse lung parenchyma injury.Inflammation is associated with an oxidative stress reaction,which is produced in the development of airway inflammation,and which has positive feedback on inflammation itself.Resolvin D1 can reduce the infiltration of neutrophils,regulate cytokine levels and reduce the inflammation reaction,and thereby promote the resolution of inflammation.The purpose of this study is to investigate the effects of resolvin D1 on an inflammatory response and oxidative stress during lipopolysaccharide (LPS)-induced acute lung injury.Methods LPS (3 mg/kg) was used to induce the acute lung injury model.Pretreatment resolvin D1 (100 ng/mouse) was given to mice 30 minutes before inducing acute lung injury.Mice were observed at 6 hours,12 hours,1 day,2 days,3 days,4 days and 7 days after LPS was administrated,then they were humanely sacrificed.We collected bronchoalveolar lavage fluid (BALF) and the lung tissues for further analysis.Paraffin section and HE staining of the lung tissues were made for histopathology observations.Parts of the lung tissues were evaluated for wet-to-dry (W/D) weight ratio.tumor necrosis factor (TNF)-α,inter leukin (IL)-1β,IL-10 and myeloperoxidase (MPO) were detected by enzyme-linked immunosorbent assay (ELISA).A lipid peroxidation malondialdehyde (MDA) assay kit was used to detect MDA.A total superoxide dismutase assay kit with WST-1 was used to analyze superoxide dismutase (SOD).We determined the apoptosis of neutrophils by Flow Cytometry.A real-time quantitative PCR Detecting System detected the expression of mRNA for heme oxygenase (HO)-1.Results Pretreatment with resolvin D1 reduced the pathological damage in the lung,decreased the recruitment of neutrophils and stimulated their apoptosis.It markedly decreased the expressions of TNF-α,IL-1β and increased the expressions of IL-10,and decreased the production of MDA and increased the expressions of SOD.The mRNA expression of HO-1 was also significantly increased.Conclusions Resolvin D1 displays potent anti-inflammatory actions by regulating cytokines,inhibiting aberrant neutrophil recruitment and stimulating apoptosis of neutrophils.Resolvin D1 can also relieve the injury due to oxidative stress.The mechanisms might be related to increase HO-1 expression。

Abstract：Background Protectin D1 (PD1),derived from docosahexaenoic acid,has been shown to control and resolve inflammation in some experimental models of inflammatory disorders.We investigated the protective roles of protectin D1 in pulmonary inflammation and lung injury induced by lipopolysaccharide (LPS).Methods Mice were randomly assigned to six groups (n=6 per group):sham-vehicle group,sham-PD1 group,shamzVAD-fmk group,LPS-vehicle group,LPS-PD1 group,and LPS-PD1-zVAD-fmk group.Mice were injected intratracheally with 3 mg/kg LPS or saline,followed 24 hours later by intravenous injection of 200 μg/mouse PD1 or vehicle.At the same time,some mice were also injected intraperitoneally with the pan-caspase inhibitor zVAD-fmk.Seventy-two hours after LPS challenge,samples of pulmonary tissue and bronchoalveolar lavage fluid were collected.Optical microscopy was used to examine pathological changes in lungs.Cellularity and protein concentration in bronchoalveolar lavage fluid were analyzed.Lung wet/dry ratios and myeloperoxidase activity were measured.Apoptosis of neutrophils in bronchoalveolar lavage fluid (BALF) was also evaluated by flow cytometry.Results Intratracheal instillation of LPS increased neutrophil counts,protein concentration in bronchoalveolar lavage fluid and myeloperoxidase activity,it induced lung histological injury and edema,and also suppressed apoptosis of neutrophils in BALF.Posttreatment with PD1 inhibited LPS-evoked changes in BALF neutrophil counts and protein concentration and lung myeloperoxidase activity,with the outcome of decreased pulmonary edema and histological injury.In addition,PD1 promoted apoptosis of neutrophils in BALF.The beneficial effects of PD1 were blocked by zVAD-fmk.Conclusion Posttreatment with PD1 enhances resolution of lung inflammation during LPS-induced acute lung injury by enhancing apoptosis in emigrated neutrophils,which is,at least in part,caspase-dependent。

Abstract：Background A proinflammatory milieu emerging in the lung due to neutrophil accumulation and activation is a key in the pathogenesis of acute lung injury (ALI).15-deoxy-△12,14-prostaglandin J2 (15d-PGJ2),one of the terminal products of the cyclooxygenase-2 pathway,is known to be the endogenous ligand of peroxisome proliferator-activated receptor y (PPAR-y) with multiple physiological properties.Growing evidence indicates that 15d-PGJ2 has anti-inflammatory,antiproliferative,cytoprotective and pro-resolving effects.We investigated whether 15d-PGJ2 has a protective effect against endotoxin-induced acute lung injury in rats.Methods Twenty-four male Wistar rats were randomly assigned into four groups (n=6 per group):sham+vehicle group,sham+15d-PGJ2 group,LPS+vehicle group,and LPS+15d-PGJ2 group.The rats were given either lipopolysaccharide (LPS,6 mg/kg intravenously) or saline,and pretreated with 15d-PGJ2 (0.3 mg/kg intravenously) or its vehicle (dimethyl sulphoxide) 30 minutes before LPS.Histological alterations,wet/dry weight (W/D) ratio and myeloperoxidase (MPO) activity as well as tumor necrosis factor (TNF)-α and cytokine-induced neutrophil chemoattractant-1 (CINC-1) levels were determined in lung tissues four hours after LPS injection.Immunohistochemical analysis for intercellular adhesion molecule-1 (ICAM-1) expression and Western blotting analysis for nuclear factor (NF)-κB p65 translocation and IκBα protein levels were also studied.Results 15d-PGJ2 pretreatment significantly attenuated LPS-induced lung injury,and reduced the increased W/D ratio,MPO activity,TNF-α,CINC-1 levels,and ICAM-1 expression in the lung.15d-PGJ2 also suppressed the nuclear NF-ΚB p65 translocation and increased cytosolic IKBα levels.Conclusions 15d-PGJ2 protects against endotoxin-induced acute lung injury,most likely through the reduction of proinflammatory protein levels during endotoxemia subsequent to the inhibition of NF-ΚB activation。

Abstract：Background Recurarization has previously been described in the context of acute normovolemic hemodilution.The aim of this study was to investigate the impairment of recovery of neuromuscular function after re-transfusion of intraoperative salvaged blood in patients treated with rocuronium.Methods We enrolled 50 patients undergoing general anesthesia for lumbar surgery.Intraoperative blood salvage (IBS) was used in 30 patients (group Ⅰ); the remaining 20 comprised a control group (group C).Anesthesia was induced with fentanyl,midazolam,propofol and rocuronium.Rocuronium was infused to maintain neuromuscular blockade during surgery.Blood was collected from the operative field and re-transfused in the post-anesthesia care unit (PACU).Neuromuscular function was monitored using the train-of-four ratio (TOFr).Once the train-of-four ratio exceeded 90 in the PACU,neuromuscular function was evaluated every 5 minutes for 30 minutes.The TOFr and incremental recovery of TOFr from baseline were recorded.Salvaged blood was re-transfused at the beginning of the evaluation for patients in group Ⅰ,and afterwards for patients in group C.Blood gas analysis was assessed before anesthesia and in the PACU.Results Incremental recovery of TOFr from baseline was significantly less in group Ⅰ than controls at 25 minutes (6.1±3.2vs.9.1±3.2,respectively; P=0.001) and 30 minutes (7.1±3.2 vs.10.0±2.2,respectively; P=-0.001).There were no significant differences in gas exchange between the groups.Conclusions In patients who had received a rocuronium infusion during anesthesia,re-transfusion of salvaged blood significantly impaired recovery of neuromuscular function recovery in the PACU,but without significant impairment of respiratory function。

Abstract：Background Preoperative incisional local anaesthesia with ropivacaine is a common method of providing postlaparoscopy pain relief.The pulmonary recruitment manoeuvre also provides pain relief,but the combined effect of these two methods on pain following laparoscopic procedures has not been reported.We investigated the efficacy of combining local anaesthetic infiltration of ropivacaine with pulmonary recruitment manoeuvre on postoperative pain following diagnostic hysteroscopy and laparoscopy.Methods This prospective,randomized,controlled study involved 60 patients divided into two groups (n=30,each).Group 1 received 20 ml of 0.5％ ropivacaine injected peri-incisionally preoperatively,with intra-abdominal carbon dioxide removed by passive deflation.Group 2 received 20 ml of 0.5％ ropivacaine injected peri-incisionally with five manual inflations of the lungs with a positive-pressure ventilation of 40 cmH2O at the end of surgery.The last inflation was held for 5 seconds.The intensity of postoperative incisional and shoulder pain was evaluated using a numerical rating scale at 0,2,4,8,12,24 and 48 hours postoperatively by an independent blinded anaesthesiologist.Tramadol was given postoperatively for analgesia.Results Compared with group 1,incisional ropivacaine infiltration combined with pulmonary recruitment manoeuvre significantly reduced dynamic pain at 0 hour,4 hours,and 24 hours postoperatively (4.1 ± 2.2 vs.2.1 ± 1.9,P=0.002;2.7 ± 2.7 vs.1.2 ± 1.3,P=0.035; and 3.5 ± 2.1 vs.2.1 ± 1.8,P=0.03,respectively).Static incisional pain was significantly relieved at 0 hour,2 hours,and 24 hours postoperatively (3.1 ± 1.7 vs.1.6 ± 1.3,P=0.001; 1.4 ± 1.3 vs.0.5 ± 0.8,P=0.012;and 2.3 ± 1.9 vs.1.0 ± 1.5,P=0.038,respectively).Group 2 had more patients without shoulder pain (P＜0.05) and fewer requiring tramadol (P＜0.05).Conclusion Ropivacaine with pulmonary recruitment manoeuvre provided simple and effective pain relief after diagnostic hysteroscopy and laparoscopy。

Abstract：Background People's attitude toward organ donation after cardiac death (DCD) has not come to an agreement in different countries and regions.Influenced by the local culture in China for thousands of years,the general public has different ideas about this issue.The purpose of this study was to investigate the current attitudes trend and characteristics of transplantation with organs donated after cardiac death in northwest China.Methods This largest single-center cohort study was performed by an interview or by telephone using a questionnaire.The family members of potential DCD donors were recruited from the First Affiliated Hospital,medical college of Xi'an Jiaotong University located in a metropolitan area of northwest China.The 12-item attitude questionnaire was specifically developed from the literature review with coordinator,physician,and donor's family feedback.The participants were asked to rate the queries on a 5-point Likert intensity scale.Results The 174 participants included 56 (32.2％) women and 118 (67.8％) men.Most people were aged between 41 and 50 years (n=63,36.2％),31 and 40 years (n=59,33.9％),and less than 30 years (n=36,20.7％).The top five attitudes of participants were the best person to suggest organ donation to a family was ranked as the DCD coordinator of Red Cross Organization (RCO,n=160,92％),donor is a hero (n=143,82.2％),honor to be a donor's family member (n=136,78.2％),improved relationship with colleagues (n=124,71.3％),and with recipient after donation (n=123,70.7％).The best person to suggest organ donation to a family was ranked as the coordinator of RCO (n=160,92％),doctor unrelated to transplantation (n=104,59.8％),social worker (n=36,20.7％),and doctor related to transplantation (n=25,14.4％).The top two reasons for non-consent to donation were that the family insisted on intact body after patient death and did not want to have surgery again (n=51,41.5％),and feared that they would be misunderstood by neighbors,relatives,and friends about donation (n=28,22.8％).Conclusions This study revealed initial attitudes toward DCD in China.Some data afford insight into the decision-making procedure.The concerns of potential DCD donors and their families may help professionals provide better interventions in the future。

Abstract：Background Congenital heart disease with severe pulmonary arterial hypertension (SPAH),previously thought to have irreversible pulmonary vascular disease (PVD),has been recently successfully corrected using diagnostic treatment and repair strategy by our surgery team.This study aimed to evaluate the midterm results of a selected cohort of older patients with nonrestrictive ventricular septal defect (VSD) and SPAH using diagnostic treatment and repair strategy.Methods The records of 56 patients older than six years with nonrestrictive VSD and SPAH undergoing diagnostic treatment and repair strategy from 2006 to 2012 were retrospectively reviewed.All patients received advanced pulmonary arterial hypertension (PAH) therapy and radical repairs were performed when transcutaneous oxygen saturation (SPO2) increased up to 93％.Results There were no operative deaths.SPO2 and baseline six-minute walk test (SMWT) distance of all selected patients increased significantly and mean pulmonary artery pressure (MPAP) regressed significantly after diagnostic treatment and at late follow-up (P ＜0.01).The incidence of late postoperative PAH was seen in six (10.7％) patients and by Logistic regression analysis,early postoperative PAH was an independent risk factor related to late postoperative PAH.Conclusions Diagnostic treatment and repair strategy was effective and safe for treatment of nonrestrictive VSD and SPAH and the midterm results were excellent.Diagnostic treatment strategy was effective in assessing the reversibility of SPAH in older patients associated with nonrestrictive VSD and the PVD in these selective patients is generally reversible。

Abstract：Background Hemifacial spasm (HFS) is a facial nerve disorder characterized by episodic involuntary ipsilateral facial muscle contraction.Information on Chinese patients with HFS has not been well-characterized.This study aimed to evaluate the clinical feature and the treatment status of HFS across China.Methods A cross-sectional study including 1003 primary HFS patients had been carried out in 15 movement disorder clinics in China in 2012.The investigated information was acquired from questionnaires and medical records including demographic data,site of onset,aggravating and relieving factors,treatments prior to the investigation,etc.Results In this study,the ratio of male to female was 1.0:1.8,the mean age at onset was (46.6±11.5) years.About 1.0％ patients were bilaterally affected.The most often site of initial onset was the orbicularis oculi muscle.The most often affected sites were orbicularis oculi,zygomatic,and orbicularis oris muscles.Stress/anxiety and relaxation were most often aggravating and relieving factors,respectively; 2.3％ patients had family history,28.4％ cases were combined with hypertension,and 1.4％ patients were with trigeminal neuralgia.Botulinum toxin type A (BTX-A) injection was the most commonly used treatment,followed by acupuncture and oral medication.BTX-A maintained the highest repeat treatment ratio (68.7％),while 98.4％ patients gave up acupuncture.The mean latency of BTX-A effect was (5.0±4.7) days,the mean total duration of the effect was (19.5±11.7) weeks,and 95.9％ patients developed improvements no worse than moderate in both severity and function.The most common side effect was droopy mouth.Conclusions The onset age of HFS in China is earlier than that in western countries.The most often used two treatments are BTX-A injection and acupuncture,while the latter kept the poor repeat treatment ratio because of dissatisfactory therapeutic effect。

Abstract：Background Obstructive sleep apnea syndrome (OSAS) is strongly associated with obesity and with cardiovascular disease.Ghrelin and obestatin are two peptides from the same source but have opposite roles.Both of them can affect feeding and regulate vascular tune.The aim of this study was to investigate the relationship between plasma ghrelin,obestatin,the ratio of ghrelin and obestatin (G/O) and sleep parameters and blood pressure circadian rhythms in patients with OSAS.Methods This study enrolled 95 newly diagnosed over-weight OSAS patients (OSAS group),30 body mass index (BMI)-match non-OSAS adults (over-weight group) and 30 non-OSAS normal weight adults (control group).Polysomnography (PSG) was performed in the OSAS group and over-weight group.Blood pressure of all subjects was monitored by means of 24-hour ambulatory blood pressure monitoring.The concentration of plasma ghrelin and obestatin was detected by enzyme-linked immunosorbent assay (ELISA).Results Plasma ghrelin levels in the OSAS group and over-weight group were significantly lower than that of the control group (P ＜0.05).Plasma obestatin levels were lower in the over-weight group and OSAS group,but there was no significant difference among the three groups.The blood pressure in OSAS patients was higher,and there was a significant difference in all blood pressure parameters compared to the control group,and in the daytime average diastolic blood pressure (DBP),nocturnal average systolic blood pressure (SBP) and DBP,DBP variability values as compared to over-weight subjects.Furthermore,there were significantly more non-dipper patterns of blood pressure (including hypertension and normotension) in the OSAS group than in the other two groups (P ＜0.01).Correlation analysis showed that ghrelin levels had a significant correlation with BMI and nocturnal average DBP but not with PSG parameters.In contrast,the G/O ratio had a negative correlation with apnea-hypopnea index (AHI) (P ＜0.05),as well as a strong positive correlation with the blood pressure variability values (P ＜0.01).In multivariate analyses,AHI (P ＜0.05) and G/O (P ＜0.05)were independently related to SBP variability changes,while AHI (P ＜0.05),G/O (P ＜0.01) and BMI (P ＜0.05) were independently related to DBP variability changes.Conclusions Our data show plasma ghrelin and obestatin levels were related to obesity in OSAS.Sleep apnea in OSAS patients could have led to an imbalance in G/O in the basis of obesity.Moreover,the imbalance may promote nighttime blood pressure elevation and affect blood pressure circadian disorder。

Abstract：Background Pancreatic cancer is a lethal disease that is often diagnosed at an advanced stage.There is a lack of information to predict the prognosis of pancreatic cancer.Krüppel-like factor (KLF) 8 has been found to be deregulated in multiple cancers,and its high expression was correlated with poor prognosis.However,so far,no information was reported about the expression of KLF8 in pancreatic cancer.In the present study,we investigated,possibly for the first time,the expression of KLF8 in pancreatic cancer samples and analyzed its correlation with clinical parameters and overall survival (OS) rate.Methods We used immunohistochemical staining to detect KLF8 in 68 samples from patients who underwent surgery and its correlation with the clinicopathological characteristics.We used Kaplan-Meier curve to analyze the relationship between KLF8 expression and the OS time.Univariate analysis was performed in addition to multivariate hazard models with clinicopathological features to assess KLF8 as an independent prognostic factor.Results KLF8 was present in the cytoplasm of pancreatic cancer cells and 52.9％ of the 68 cases had positive expression.KLF8 expression was not associated with sex,age,tumor location,lymph node stage,and metastasis stage,but was associated with tumor stage (P=0.04).Kaplan-Meier method demonstrated that patients with negative expression of KLF8 had a better prognosis.In univariate and multivariate models,KLF8 was a significant predictor of OS in pancreatic cancer.Conclusion Our results revealed that KLF8 may be a potential prognostic factor for pancreatic cancer。

Acute lung injury (ALI) and its more severe form acute respiratory distress syndrome (ARDS) are acute clinical complications,which cause significant morbidity and mortality.1 Despite recent advances in our understanding of the pathophysiology and diagnosis of ALI and ARDS,the clinical strategies are restricted to mechanical ventilation and supportive treatments,such as fluid conservative management and glucocorticoids (GCs).Mechanical ventilation is a common and life-saving strategy for the patients with ARDS.Lung protective ventilation strategy with lower tidal volumes can improve hypoxia and reduce the mortality in patients with ARDS。

Abstract：Background Pain physicians pay close attention to neuropathic pain (NP),since there is currently no ideal treatment.Radial shock wave therapy (RSWT) is a noninvasive treatment to chronic pain of soft tissue disorders.So far,there is no information on the use of RSWT for the treatment of NP.Therefore we observe the effects of RSWT on a NP model induced by chronic constriction injury (CCI) in rats.Methods Four different energy densities (1.0,1.5,2.0 and 2.5 bar) RSWT administered as a single session or repeated sessions in rats with NP induced by CCI of the sciatic nerve.The analgesic effect was assessed by measuring mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL).The safety was assessed through calculating sciatic functional index (SFI).Results MWT and TWL increased after a single session of RSWT from day 1 to day 5 but retumed to baseline levels by day 10.Following repeated sessions of RSWT,both the MWT and TWL were significantly higher than NP group (P ＜ 0.01)for at least 4 weeks.In addition,no significant changes of SFI were observed in any groups after repeated sessions of RSWT and no increased pain or other side effects in any animals.Conclusions A single session of RSWT is rapidly effective in the treatment of CCI,but the efficacy maintained in a short period.However,repeated sessions of RSWT have prolonged efficacy。

Abstract：Background Parkinson's disease (PD) is an extrapyramidal neurological disorder.Urinary symptoms are frequently present in patients affected by PD.Symptoms such as urgency,frequency,nocturia,and urge incontinence significantly impact the patient's quality of life.We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review.Methods Comprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction.Appropriate treatments were given to subgroups that were divided based on test results,and the changes in urodynamic parameters as well as the treatment efficacy were observed.Results Detrusor hyperreflexia without bladder outlet obstruction (BOO) was observed in 35 patients,who exhibited significant improvements in the international prostate symptom score (IPSS),maximum flow rate (Qmax),bladder volume at the first desire to void,post-void residual (PVR),and bladder compliance.Detrusor hyperreflexia associated with BOO was observed in 59 patients.The patients exhibited significant improvements in IPSS,Qmax,PVR,and bladder compliance.Detrusor dysfunction without BOO was observed in 19 patients,for whom the IPSS and the bladder volume at the first desire to void were improved after treatment.Detrusor dysfunction with BOO was found in 28 patients,with no significant improvement in the urodynamic parameters after the treatment.Conclusions Urodynamic examination is recommended for male Parkinson's disease patients with voiding dysfunction.Early and effective treatment can improve the bladder function and quality of life of these patients。

Abstract：Background The radial artery (RA) is becoming a popular conduit for coronary artery bypass grafting (CABG),yet data reporting the long-term results are rare.We reported our clinical,angiographic and intravascular ultrasound findings on 93 patients who had the RA used as part of the conduit for the CABG procedures during a 12-year period from June 2001 to June 2013.Methods A total of 118 radial artery conduits were harvested in 87 males and 6 females,age from 28 to 66 (mean 49.9) years.An "intra-operative Allen's test" was developed to safeguard blood supply to the arm and hand.A "double-clip & scissors-cut" technique was carried out to minimize the thermal injury to the radial artery from the diathermy.The left radial artery was used in 67 patients,the right in one,and bilateral radial arteries in 25 patients.One hundred and twenty-two out of 272 distal anastomoses (44.9％) were constructed with radial arteries,with an average of 2.9 grafts per patient (range 2-6).Results Follow-up angiography and intravascular ultrasound study at 3-139 postoperative months (mean 59 months) revealed a 93.1％ RA patency.String sign occurred in one patient in whom the RA was directed to a big right coronary artery with a stenosis of around 50％.The patency for the internal mammary artery was 96.4％.Conclusions The RA is an excellent conduit that broadens the options for total arterial CABG surgery.Good graft patency could be achieved through careful harvesting techniques and choice of proper target coronary vessels。

Abstract：Background Pulmonary hypertension (PH) is a common complication of congenital heart disease (CHD).Although risk stratification is vital for prognosis and therapeutic guidance,the need for understanding the role of novel biomarkers cannot be overlooked.The aim of the present study was to investigate the changes of homocysteine and hydrogen sulfide levels and find potential biomarkers for early detection and treatment.Methods Between September 2012 and April 2013,we prospectively collected data on 158 pediatric patients with left to right shunt CHD at our institution.Standard right heart catheterizations were performed in all cases.Seventy-seven cases were associated with PH.The levels of homocysteine and hydrogen sulfide were detected with fluorescence polarization immunoassay and a sensitive silver-sulphur electrode,respectively.Enzyme-linked immunosorbent assay was used to determine the expression of methylenetetrahydrofolate reductase (MTHFR),cystathionine β-synthase (CBS),and cystathionine gamma-lyase (CSE).Radioimmunoassays were used to obtain folic acid and vitamin B12 levels.Results The difference in the levels of homocysteine,folic acid,vitamin B12,hydrogen sulfide,as well as the MTHFR and CSE expression between patients with PH and without PH were statistically significant (all P ＜0.05).Homocysteine had the best sensitivity and specificity to predict PH (P ＜0.001).Subgroup analysis showed that the levels of homocysteine and hydrogen sulfide,and the expression of CSE and MTHFR between patients with dynamic and obstructive PH were significantly different (all P ＜0.05).Based on the ROC curve,homocysteine had the best sensitivity and specificity to predict obstructive PH (P=0.032),while CSE had the most significant sensitivity and specificity to predict the dynamic PH (P=0.008).Conclusions Increased levels of homocysteine and decreased levels of hydrogen sulfide were significantly negatively correlated in PH associated with CHD.The underlying mechanism involved the decreased expression of MTHFR and CSE along with vitamin B12 deficiency.Homocysteine and hydrogen sulfide are potential biomarkers to predict PH。

Abstract：Background Reduced endometrial receptivity in hyperstimulated cycles may lead to a lower implantation rate and a lower clinical pregnancy rate,but it is unclear if it is also associated with an increase in pregnancy loss rate.The aim of this study was to compare the implantation,miscarriage,and pregnancy rates between fresh and frozen thawed transfer of one or two day-3 embryos,with a view to understanding whether or not reduced endometrial receptivity encountered in hyperstimulated cycles is associated with an increase in miscarriage rate.Methods This study involved a consecutive series of 1 551 single day-3 embryo transfer cycles and consecutive 5 919 double day-3 embryo transfer cycles in the Assisted Reproductive Unit of the Sir Run Run Shaw Hospital,Hangzhou,China,between January 2010 and December 2012.Results The implantation and clinical pregnancy rates (single embryo 30.7％ and double embryos 33.4％ and 51.4％)using fresh cycle were both significantly lower than that of frozen-thawed cycles (single embryo 35.8％ and double embryos 38.1％ and 57.8％).There was no difference in biochemical loss or clinical miscarriage rates between the two groups.Conclusions Impairment of endometrial receptivity associated with ovarian hyperstimulation leads to implantation failure at a very early stage,resulting in an increased number of non-pregnancy.It does not lead to increase in biochemical or clinical losses.The significantly reduced ongoing pregnancy rates in both fresh single and double embryo transfer are therefore due to failure to achieve a pregnancy,rather than pregnancy loss after conception。

Abstract：Background Little is known about the value of 31P-magnetic resonance spectroscopy (31P-MRS) in in vivo assessment of exhaustive exercise-induced injury in skeletal muscle.We aimed to evaluate the value of a 31P-MRS study using the quadriceps femoris after a single bout of acute exhaustive swimming in rats,and the correlation between 31P-MRS and histological changes.Methods Sixty male Sprague-Dawley rats were randomly assigned to control,half-exhaustive,and exhaustive exercise groups.31P-MRS of the quadriceps femoris of the right lower limb was performed immediately after swimming exercise to detect Pi,PCr,and β-ATP.The Pi/PCr,Pi/β-ATP,PCr/β-ATP,and PCr/(PCr+Pi) were calculated and pH measured.Areas under the receiver operating characteristic curve (AUCs) were calculated to evaluate the diagnostic potential of 31P-MRS in identifying and distinguishing the three groups.HE staining,electron microscopy and desmin immunostaining after imaging of the muscle were used as a reference standard.The correlation between 31P-MRS and the mean absorbance (A value) of desmin staining were analyzed with the Pearson correlation test.Results Pi,PCr,Pi/PCr,and PCr/(PCr+Pi) showed statistically significant intergroup differences (P＜0.05).AUCs of Pi,PCr,Pi/PCr,and PCr/(PCr+Pi) were 0.905,0.848,0.930,and 0.930 for the control and half-exhaustive groups,while sensitivity and specificity were 90％/85％,95％/55％,95％/80％,and 90％/85％,respectively.The AUCs of Pi,PCr,Pi/PCr and PCr/(PCr+Pi) were 0.995,0.980,1.000,and 1.000 for the control and exhaustive groups,while sensitivity and specificity were 95％/90％,100％/90％,100％/95％,and 100％/95％,respectively.The AUCs of Pi,PCr,Pi/PCr,and PCr/(PCr+Pi) were 0.735,0.865,0.903,and 0.903 for the half-exhaustive and exhaustive groups,while sensitivity and specificity were 80％/60％,90％/75％,95％/65％,and 95％/70％,respectively.In the half-exhaustive group,some muscle fibers exhibited edema in HE staining,and the unclear Z-discs and the mitochondria with vacuolar degeneration under electron microscopy.Compared with the half-exhaustive group,muscle fiber edema was increased in the exhaustive group,and the Z-discs were broken and the mitochondria exhibited marked vacuolar degeneration under electron microscopy.There were significant difference in A values of desmin staining in the right vastus lateralis among the control,half-exhaustive,and exhaustive groups with 0.58±0.06,0.30±0.04,and 0.21±0.02,respectively (P＜0.05).Histological examination also showed injury-induced changes in the vastus lateralis among the different intensities groups.Statistically a moderate correlation between 31P-MRS and desmin was observed,the correlation coefficients of Pi,PCr,Pi/PCr,and PCr/(PCr+Pi) were-0.706,0.709,-0.726,and 0.791,respectively (P＜0.01).Conclusions 31P-MRS can effectively reflect the changes in energy metabolism in the skeletal muscle after a single bout of acute exhaustive swimming in rats.Based on the significant correlation between 31P-MRS parameters and histological changes,the changes of Pi,PCr,Pi/PCr,and PCr/(PCr+Pi) can indirectly reflect the degree of exercise-induced injury。

Abstract：Background Small case series have suggested an association of coronary myocardial bridge (MB) with myocardial infarction (MI).However,the relationship between MB and major adverse cardiac events (MACE) remains largely unknown.The aim of this study was to assess the relationship between MB and MACE involving MI.Methods We performed a systematic search of MEDLINE,PreMEDLINE,and all EMB Reviews as well as a reference list of relevant articles according to the SPICO (Study design,Patient,Intervention,Control-intervention,and Outcome) criteria using the following keywords:myocardial bridging,myocardial bridge,intramural coronary artery,mural coronary artery,tunneled coronary artery,coronary artery overbridging,etc.Bibliographies of the retrieved publications were additionally hand searched.Studies were included for the meta-analysis if they satisfied the following criteria:(1) they evaluate the association of MB with cardiovascular endpoint event; (2) they included individuals with MB and those without MB; 3) they excluded individuals with obstructive coronary artery disease (CAD).Studies were reviewed by a predetermined protocol including quality assessment.Dates were pooled using a random effect model.Results Seven observational studies that followed 5 486 patients eligible for the enrolled criteria were included from 7 136 initially identified articles.The prevalence of MB was 24.8％ (1 363/5 486).During 0.5-7.0 years of follow-up of this cohort of population,crude outcome rates were 8.0％ in the MB group and 7.7％ in the non-MB group.The odds ratio of overall MACE and MI were 1.34 (95％ confidence interval (CI):0.57-3.17,P=0.51,n=7 studies) and 2.75 (95％ CI:1.08-7.02,P ＜0.03,n=5 studies) respectively for subjects of MB compared to non-MB.Conclusion Relationship between MB and MI appears to be a real one,although the study did not reveal a connection of MB to MACE,suggesting whether the necessity of antiplatelet therapy needs to be further studied in a larger cohort of patients with MB prospectively。

Abstract：Background Studies have shown that irinotecan can improve survival in patients with advanced or recurrent gastric cancer,but the overall benefit of irinotecan in the treatment of advanced or recurrent gastric cancer remains controversial.The aim of this study was to evaluate the benefits and risks of irinotecan for survival in patients with advanced or recurrent gastric cancer.Method We searched PubMed,EmBase,the Cochrane Central Register of Controlled Trials,reference lists of articles,and proceedings of major conferences for relevant clinical trials.We included randomized controlled trials that reported on the efficacy and safety of irinotecan in patients with advanced or recurrent gastric cancer.Outcomes were analyzed by survival rate,objective response rate (ORR),and toxicity.Furthermore,the analysis was further stratified by factors that could affect the treatment effects.Results Eight trials recruiting 1 546 patients with advanced or recurrent gastric cancer were included in the analysis.Overall,irinotecan therapy was associated with a 6％ improvement in survival rate,but this difference was not statistically significant (odds ratio (OR) 0.94; 95％ confidence interval (95％ CI) 0.70-1.27; P=-0.69).However,irinotecan therapy had more frequent ORR than irinotecan-free arm (OR 1.70; 95％ CI 1.34-2.17; P ＜0.001).Furthermore,irinotecan therapy was associated with a clinically and statistically significant increase in the risk for declined hemoglobin,hyponatremia,and diarrhea,but it also protected against thrombocytopenia risk when compared with irinotecan-free therapy.Conclusions There is no evidence to support the use of irinotecan therapy in patients with advanced or recurrent gastric cancer; however,given the significant advantage in ORR irinotecan therapy using combination regimens may be considered for further evaluation in subsets of patients who may benefit from this treatment。

The highly diagnostic performance of renal transstenotic pressure gradients (TSPG) and fractional flow reserve (FFR) has been well validated for assessment of the hemodynamic renal artery stenosis (RAS).1-4 Accordingly,an expert consensus panel of the American Heart Association recommended that a peak systolic gradient of at least 20 mmHg (1 mmHg=0.133 kPa),or a mean pressure gradient of 10 mmHg,be used to identify candidate lesions for revascularization in symptomatic patients with RAS。

A7.0-magnitude earthquake took place in Lushan county,Ya'an in southwest China's Sichuan Province at 8:02 a.m.Beijing time,April 20,2013.The epicenter was located approximately 110 km away from Chengdu,at 30.3 degrees north latitude and 103.0 degrees east longitude.The earthquake caused 196 deaths and left 21 missing and 11 470 injured。

Amyand's hernia refers to the presence of appendix within an inguinal hernia sac.In 1736,Claudius Amyand,a surgeon to King George Ⅱ,first reported this special type of inguinal hernia during a transherniotomy appendectomy of an 11-year-old boy with a right inguinal hernia.The finding of a normal appendix within an inguinal hernia sac is not uncommon.Its incidence is about 1％,whereas the presence of appendicitis within an inguinal hernia has an incidence of only 0.1％.1 Moreover,given the normal anatomical position of the appendix,most cases occur on the right side。

To the editor:Cancer metastasis has an overall incidence of 0.7％-4.4％,and cutaneous metastases accounts for 0.7％-9.0％ of all metastases.1 Time of cutaneous metastasis occurrence generally occurs within 5 years of initial carcinoma diagnosis.There is an association between estrogen receptors and time of metastasis occurrence,2 which can be explained by tumor dormancy.We report a case of cutaneous metastasis from breast cancer diagnosed 25 years ago。

To the editor:Aggressive angiomyxoma (AA) is a very rare soft tissue tumor which affects mainly the soft tissues of the pelvis and perineum in women.As a slow-growing mesenchymal neoplasm,AA tends to infiltrate locally and recur) Here we reported a case of AA of the vagina.The patient was a 36-year-old woman,who presented with a 10 cm×5 cm×5 cm myxoid,well-circumscribed,rubbery mass arising within the vaginal wall and extending to the perineum.Besides a routine clinical work-up,further examinations including ultrasonography and computed tomography (CT) were performed before the operation to evaluate the extent of the disease and reveal the location,relationship and degree of infiltration between tumor and pelvic organs。

To the editor:The prognosis of in-hospital and out-of-hospital cardiac arrest (CA) is awfully poor.Most causes are reported to thromboembolism diseases,i.e.massive pulmonary embolism (MPE)and acute myocardial infarction (AMI).Systemic thrombolysis during cardiopulmonary resuscitation (CPR) is still controversial,for fear of potentially lethal hemorrhage。