2014年 · 第127卷第19期

Abstract：Background Large-scale clinical trials have shown that routine monitoring of the platelet function in patients after percutanous coronary intervention (PCI) is not necessary.However,it is still unclear whether patients received high-risk PCI would benefit from a therapy which is guided by a selective platelet function monitoring.This explanatory study sought to assess the benefit of a therapy guided by platelet function monitoring for these patients.Methods Acute coronary syndrome (ACS) patients (n=384) who received high-risk,complex PCI were randomized into two groups.PCI in the two types of lesions described below was defined as high-risk,complex PCI:lesions that could result in severe clinical outcomes if stent thrombosis occurred or lesions at high risk for stent thrombosis.The patients in the conventionally treated group received standard dual antiplatelet therapy.The patients in the platelet function monitoring guided group received an antiplated therapy guided by a modified thromboelastography (TEG) platelet mapping:If inhibition of platelet aggregation (IPA) induced by arachidonic acid (AA) was less than 50％ the aspirin dosage was raised to 200 mg/d; if IPA induced by adenosine diphosphate (ADP) was less than 30％ the clopidogrel dosage was raised to 150 mg/d,for three months.The primary efficacy endpoint was a composite of myocardial infarction,emergency target vessel revascularization (eTVR),stent thrombosis,and death in six months.Results This study included 384 patients; 191 and 193 in the conventionally treated group and platelet function monitoring guided group,respectively.No significant differences were observed in the baseline clinical characteristics and interventional data between the two groups.In the platelet function monitoring guided group,the mean IPA induced by AA and ADP were (69.2±24.5)％ (range,4.8％ to 100.0％) and (51.4±29.8)％ (range,0.2％ to 100.0％),respectively.The AAinduced IPA of forty-three (22.2％) patients was less than 50％ and the ADP-induced IPA of fifty-seven (29.5％) patients was less than 30％; therefore,their drug dosages were adjusted.The TEG was rechecked one to four weeks after PCI,and the results indicated that the IPAs had significantly improved (P ＜0.01).However,no significant differences were found in the rates of the primary efficacy endpoint.Rates in the conventionally treated group and platelet function monitoring guided group were 4.7％ and 5.2％,respectively (hazard ratio:1.13; P=0.79).Conclusion An antiplatelet therapy guided by TEG monitored platelet function could not improve clinical efficacy even in ACS patients treated with high-risk complex PCI。

Abstract：Background Preeclampsia (PE) is associated with abnormal fatty acid beta-oxidation (FAO),especially metabolic disorders of long-chain fatty acid oxidation.The role of FAO dysfunction in inadequate invasion is unclear.The aim of this study was to explore the influence of various lengths fatty acids oxidation on invasiveness of trophoblasts.Methods Primary human trophoblast cells and HTR8/SVneo cells were treated with fatty acids of various lengths.Morphological changes,lipid deposition and ultrastructure changes of trophoblast cells were detected.Cells invasiveness was determined by transwell insert.CPT1,CPT2 and long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) protein expression were analyzed.The correlation between intracellular lipid droplets deposition and cells invasiveness was evaluated.Results Cells treated with long-chain fatty acids showed significant increased lipid droplets deposition,severe mitochondrial damage,decreased CPT2 and LCHAD protein expression (P ＜0.05) but no significant difference in CPT1 protein expression (P ＞0.05).Invasiveness of the trophoblast cells of the LC-FFA group significantly decreased (P ＜0.05).Intracellular lipid droplets deposition was negatively correlated with invasivenss (R=-0.745,P ＜0.05).Conclusion Trophoblast cells after stimulation with long chain fatty acids exist fatty acid oxidation disorders,and reduce the ability of trophoblastic invasion。

Abstract：Background Orthotopic liver transplantation (OLT) has become the therapeutic option of choice for end-stage liver disease.The aim of this study was to investigate the changes of splenic morphology,signal-to-noise ratio (SNR),contrastto-noise ratio (CNR),apparent diffusion coefficient (ADC) values and explore their value in evaluating the therapeutic effects of orthotopic liver transplantation (OLT) on portal hypertension at 1.5 Tesla MRI.Methods Twenty patients with portal hypertension undergoing OLT were included in this study.Conventional MRI and diffusion-weighted image (DWI) (b value=600 s/mm2) sequences were applied on each patient before and after OLT,and these patients were referred to as the preoperative and postoperative groups.Twenty healthy individuals were selected as the normal group.After image acquisition,the splenic width (W),thickness (T),length (L),the diameter of the portal vein (PD) and splenic vein (SD) were measured and the splenic volume (V) was calculated.The SNR and CNR were measured on T2WI.The ADC maps were calculated using the b600 in DWls and the ADC values were measured.Results Compared with the preoperative group,the splenic V,PD and SD decreased significantly in the postoperative group (P ＜0.05).All splenic morphological values were significantly different between preoperative and normal groups (P ＜0.05).The splenic L and V were significantly different (P ＜0.05) between postoperative and normal groups.The SNR and CNR values were 17.66±4.62 and 13.18±3.12,11.50±1.64 and 7.44±4.32,4.24±1.24 and 3.03±2.41 in the preoperative,postoperative and normal groups,respectively.Both SNR and CNR decreased after OLT,but they was still higher than the normal values.The SNR was significantly different between any two groups (P ＜0.05).The CNR was significantly different (P ＜0.05) between the preoperative and postoperative groups,preoperative and normal groups.The splenic ADC values were (1.339±0.482)×103 mm2/s,(1.120±0.254)x10-3 mm2/s and (0.997±0.447)×10-3 mm2/s in the preoperative,postoperative and normal groups,respectively.The difference of ADC values were significant (P ＜0.05) between the preoperative and postoperative groups,and the preoperative and normal groups.Conclusions OLT is an effective method of treatment for portal hypertension.In addition to dramatically decreasing the splenic V,it can also decrease the splenic SNR,CNR and ADC values in patients with portal hypertension.The changes of splenic SNR,CNR and ADC after OLT may be helpful in providing noninvasive supplementary information in assessing the therapeutic effect of OLT on portal hypertension。

Abstract：Background While echocardiography has been a pivotal screening test in pulmonary arterial hypertension (PAH),the presence of structural cardiac defects may affect the ability to reliably predict pulmonary artery pressures (PAPs).This study sought to evaluate the accuracy of Doppler echocardiography (DE) for estimating PAPs in adult atrial septal defect (ASD) patients with PAH.Methods A prospective study was carried out to compare the echocardiographic assessment of PAP with the same pressures obtained by right heart catheterization (RHC) in adult ASD patients with PAH who underwent simultaneous DE and RHC.Bland-Altman analyses were performed to evaluate the agreement between DE and RHC measurements of PAPs.Results Two hundred and fifty-seven patients were included in the study.A significant overestimation of the systolic pulmonary arterial pressure (sPAP) and mean pulmonary artery pressure (mPAP) was reported by echocardiography compared with those by catheterization ((81.8±26.9) mmHg vs.(72.9±26.9) mmHg,P ＜0.01; (51.9±16.4) mmHg vs.(41.4±17.2) mmHg,P ＜0.01,respectively).Twenty-one percent (55/257) of the patients had PAH when estimated by echocardiography whereas showed normal results in the subsequent catheterization test.Using Bland-Altman analytic methods,the bias for the echocardiographic assessment of the sPAP was 9.1 mmHg with 95％ limits of agreement ranging from-24.4 to 42.6 mmHg.For mPAP measurement,the bias was 10.5 mmHg with 95％ limits of agreement ranging from-12.4 to 33.4 mmHg.On multiple linear regression analysis,age,gender,body surface area,ASDs' diameter,PVR,diastolic blood pressure,and echocardiographic assessment of right atrial pressure (RAP) explained 68.8％ of the total variability in the model (r2=0.688,P ＜0.01).Conclusion Inaccuracy was frequently reported in Doppler echocardiographic assessment of the PAP in adult ASD patients with PAH and was often associated with age,gender,body surface area,ASDs' diameter,pulmonary vascular resistance,diastolic blood pressure and echocardiographic estimation of RAP。

Abstract：Background This study aimed to develop features related to the lesion margin and enhancement pattern,which are very important in the radiologic diagnostic process.We also aimed to implement and investigate these features in the computeraided diagnosis (CAD) of hepatic diseases using computed tomography (CT).Methods We retrospectively analyzed 378 lesions with 1 512 multi-phase CT images of liver lesions.We used ensemble methods to create classification models.Two types of features were developed and used as predictors,namely,margin features and relative spatial intensity ratio (RSIR) features.Margin features were extracted using Gabor transformation and the sigmoid function whereas RSIR features were obtained by calculating the concentration and distribution of the contrast in the lesion against the surrounding hepatic parenchyma.To assess these two types of features and compare them with other features used in previous studies,we created models for multi-class classification using different feature subsets.Accuracy,kappa,and AUC were calculated.The importance and interactions of predictors were also estimated.Results The classification model with margin features exhibited the best performance (accuracy:0.89±0.04; kappa:0.85±0.06),followed by that with RISR features (accuracy:0.85±0.05; kappa:0.79±0.07).The plots for variable importance and interactions also showed these two types of features were important in classification models and that they interacted with other features.Conclusions Lesion margin and enhancement pattern are helpful in CAD.The features we have developed are general and can be easily adapted to other diagnostic scenarios in which CT and other imaging modalities are used。

Abstract：Background The treatment of the patient with pelvic fracture urethral disruption defects (PFUDD) remains controversial especially in pediatric urology.Debate continues in regarding the advisability of immediate repair versus delayed repair.The aim of this study was to analyze our experience in the outcomes of immediate and delayed repair of pelvic fracture urethral distraction defects in young boys.Methods We retrospectively reviewed the records of 210 boys with posterior urethral disruption after pelvic injury between 1992 and 2012.Exclude partial urethral injury,a total of 177 cases acquired follow-up.All patients were evaluated by plain radiography,ultrasonography,or a computed tomography scan to assess the conditions of the upper urinary tract and to exclude other severe injuries.Data on 35 patients who underwent immediate repair were compared to those on 142 treated with delayed urethroplasty.After the diagnosis of a complete urethral injury,the immediate repair group underwent urethroplasty via the perineal approach if the patient's condition was stable,and serious complications were treated.The delayed repair group patients with the delayed urethroplasty average 6 months after injury.All patients were evaluated postoperatively for urethral strictures,incontinence and impotence.The patients were assessed by uroflowmetry and renal ultrasonography with evaluation of the postmictional residue every 3 months during the first year of follow-up.We assessed incontinence and erectile function by questioning the parents or the children themselves.Statistical analysis with the chi-square test was performed using SPSS software.Results One hundred and seventy-seven patients were followed up with an average 58 months (range 6 to 192 months).Strictures developed in 3 (9％) patients in immediate repair group; two required direct visual internal urethrotomy (DVIU),the other patient required dilatation.Strictures developed in 11.9％ of the delayed repair group,17 patients need visual internal urethrotomy or urethroplasty.Incontinence (11.4％) and impotence (8.6％) seem less frequent in the immediate repair group than in the delayed reconstruction group (17.7％ and 21.8％,respectively).However,the results showed that there was no statistical difference between the two groups in strictures after first surgery,incontinence and impotence.Patients with delayed reconstruction underwent an average of 2.6 procedures compared with an average of 1.1 in the immediate repair group.Conclusions Immediate repair of urethral disruption is possible when the patient's condition was stable.It may decrease the requirement for subsequent urethral surgeries.Immediate repair does not appear to increase the rate of impotence or incontinence.The strictures after immediate repair also may be easier to treat.Although immediate repair could be inconvenient in the massively iniured patient,it is still a worthwhile maneuver in dealing with PFUDD。

Abstract：Background The spread of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the worldwide trend is not contained effectively.The pregnant women infected HIV seriously in the high HIV epidemic areas in China.The transmission of HIV to child may be cut off if HIV positive mother was found early by HIV testing.Pregnant women mandatorily received the HIV counseling and testing services.Most of them did not know the knowledge about HIV prevention and were not willing to receive HIV testing actively.Willingness for HIV testing among pregnant women was investigated,which can help to promote them to take up HIV testing actively.This study assessed the prevalence of the willingness for HIV testing and cognitive factors associated with it.Methods A cross-sectional survey was conducted to 500 pregnant women via face-to-face interviews with anonymous structured questionnaire guided by the Health Belief Model (HBM).Results The prevalence of the willingness for HIV testing was 58.60％.Perceived higher susceptibility to HIV (multivariateadjusted odds ratio (ORm)=2.02,95％ confidence interval (CI):1.40-5.06),more knowledge for HIV (ORm=1.92,95％ CI:1.11-3.87) and perceived less social stigma (ORm=0.80,95％ CI:0.34-0.91) were associated with higher willingness for HIV testing among pregnant women.Conclusion To prevent HIV mother to children transmission,it is necessary to enhance knowledge for HIV,change cognitive factors and increase willingness for HIV testing among pregnant women。

Abstract：Background Glaucoma secondary to systemic lupus erythematosus (SLE) (") an uncommon but serious complication that threatens vision and therefore cannot be neglected.A few cases of secon(ca)ry glaucoma resulting from lupus-induced or iatrogenic ocular impairments have been reported in association with SLE.However,a systematic analysis of the diagnosis and treatment of glaucoma secondary to SLE has not been reported in the literature.The aim of this study is to further investigate the relationship between glaucoma and SLE.Methods In this study,we reviewed nine eyes of five patients diagnosed with secondary glaucoma associated with SLE,including one case of neovascular glaucoma and four cases of steroid-induced glaucoma.Results Neovascular glaucoma was successfully treated by Ahmed glaucoma valve implantation surgery with adjunctive ranibizumab intravitreal injection,followed by panretinal photocoagulation (PRP).The steroid-induced glaucoma in eight eyes of four cases were controlled by trabeculectomy along with antiproliferative agents.Conclusion Regular follow-up ocular examinations should be conducted to ensure early diagnosis and treatment of secondary glaucoma in SLE patients to improve the prognosis of vision。

Abstract：Background The choice of a defibrillation or a cardiopulmonary resuscitation (CPR)-first strategy in the treatment of prolonged cardiac arrest (CA) is still controversial.The purpose of this study was to compare the effects of defibrillation or CPR administered first on neurological prognostic markers in a porcine model of prolonged CA.Methods After 8 minutes of untreated ventricular fibrillation (VF),24 inbred Chinese Wuzhishan minipigs were randomized to receive either defibrillation first (ID group,n=12) or chest compression first (IC group,n=12).In the ID group,a shock was delivered immediately.If defibrillation failed to attain restoration of spontaneous circulation (ROSC),manual chest compressions were rapidly initiated at a rate of 100 compressions/min and a compression-to-ventilation ratio of 30:2.If VF persisted after five cycles of CPR,a second defibrillation attempt was made.In the IC group,chest compressions were delivered first,followed by a shock.After successful ROSC,hemodynamic status and blood samples were obtained at 0.5,1,2,4,6,and 24 hours after ROSC.Porcine-specific neuron-specific enolase (NSE) and S100B were measured from sera using enzyme-linked immunosorbent assays.Porcine cerebral performance category scores were used to evaluate preliminary neurological function following 24 hours recovery.Surviving pigs were sacrificed at 24 hours after ROSC and brains were removed for electron microscopy analysis.Results The number of shocks,total defibrillation energy,and time to ROSC were significantly lower in the ID group compared with the IC group.Compared with the IC group,S100B expression was decreased at 2 and 4 hours after ROSC,and NSE expression decreased at 6 and 24 hours after ROSC in the ID group.Brain tissue analysis showed that injury was attenuated in the ID group compared with the IC group.There were no significant differences between 6 and 24 hours survival rates.Conclusion Defibrillation first may result in a shorter time to ROSC and lower biochemical markers of brain injury in a porcine model of 8-minute CA due to VF,but the choice of different resuscitation strategies did not affect the rate of ROSC and 24-hour survival。

Abstract：Background The initial osteoblastic adhesion to materials characterizes the first phase of cell-material interactions and influences all the events leading to the formation of new bone.In a previous work,we developed a novel amorphous calcium phosphate (ACP)/poly(L-lactic acid) (PLLA) material that demonstrated morphologic variations in its microstructure.The aim of this study was to investigate the initial interaction between this material and osteoblastic cells.Cellular attachment and the corresponding signal transduction pathways were investigated.Methods A porous ACP/PLLA composite and PLLA scaffold (as a control) were incubated in fetal bovine serum (FBS) containing phosphate-buffered saline (PBS),and the protein adsorption was determined.Osteoblastic MG63 cells were seeded on the materials and cultured for 1,4,8,or 24 hours.Cell attachment was evaluated using the MTS method.Cell morphology was examined using scanning electron microscopy (SEM).The expression levels of the genes encoding integrin subunits α1,α5,αv,β1,focal adhesion kinase (FAK),and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) were determined using real-time reverse transcription polymerase chain reaction (RT-PCR).Results The ACP/PLLA material significantly increased the protein adsorption by 6.4-fold at 1 hour and 2.4-fold at 24 hours,compared with the pure PLLA scaffold.The attachment of osteoblastic cells to the ACP/PLLA was significantly higher than that on the PLLA scaffold.The SEM observation revealed a polygonal spread shape of cells on the ACP/ PLLA,with the filopodia adhered to the scaffold surface.In contrast,the calls on the PLLA scaffold exhibited a spherical or polygonal morphology.Additionally,real-time RT-PCR showed that the genes encoding the integrin subunits α1,αv,β1,and FAK were expressed at higher levels on the ACP/PLLA composite.Conclusions The ACP/PLLA composite promoted protein adsorption and osteoblastic adhesion.The enhanced cell adhesion may be mediated by the binding of integrin subunits α1,αv,and β1,and subsequently may be regulated through the FAK signal transduction pathways。

Abstract：Background The treatment strategies for multilevel thoracic ossification of the posterior longitudinal ligaments (T-OPLL) were rarely reported.The aim of this study was to investigate the clinical outcomes and complications of circumferential decompression for multilevel T-OPLL and compare two different methods in the management of the OPLL (resection or floating).Methods Data of sequentially treated patients who received surgical treatment for thoracic spinal stenosis caused by multilevel T-OPLL from January 2005 to February 2012 were retrospectively reviewed.Based on the surgical approaches applied,the patients were divided into two groups.Group A consisted the patients who received posterior decompression and group B consisted the patients who received circumferential decompression via the posterior approach.Group B was further divided into two subgroups:subgroup 1 (the resection group) where the OPLL was completely resected and subgroup 2 (the floating group) where the OPLL was floated.Results A total of 49 patients were included in the study.Fourteen patients with single posterior decompression were included in group A and 35 patients who received circumferential decompression were included in group B.In group B,29 patients had complete resection of the ossified posterior longitudinal ligaments,while the other six underwent a flotation procedure.The follow-up data were available in 39 patients.Mean JOA scores improved from 5.4 ± 1.8 to 7.5 ± 2.8 in group A and from 3.7 ± 1.8 to 7.9 ± 2.4 in group B.The main complications included cerebrospinal fluid (CSF) leakage and postoperative neurologic deterioration (ND).Twenty-three of the 25 cases with postoperative CSF leakage achieved a complete recovery at the last follow-up and 12 of the 15 cases with ND achieved some neurological improvement at the last follow-up.Conclusions Circumferential decompression via the posterior approach is an effective surgical method for thoracic spinal stenosis caused by multilevel OPLL of the thoracic spine.Patients who receive complete resection of the ossified posterior longitudinal ligaments may have better recovery rate than the "floating" group。

Abstract：Background Danshen (Radix Salvia miltiorrhizae) has been used as a traditional medicine in Asia for treatment of various microcirculatory disturbance related diseases.Tanshinones are mainly hydrophobic active components,which have been isolated from Danshen and show various biological functions.In this study,we observed the neuroprotective effect of tanshinone Ⅰ (Tsl) against ischemic damage in the gerbil hippocampal CA1 region (CA1) after transient cerebral ischemia and examined its neuroprotective mechanism.Methods The gerbils were divided into vehicle-treated-sham-group,vehicle-treated-ischemia-group,Tsl-treated-shamgroup,and Tsl-treated-ischemia-group.Tsl was administrated intraperitoneally three times (once a day for three days) before ischemia-reperfusion.The neuroprotective effect of Tsl was examined using H&E staining,neuronal nuclei (NeuN) immunohistochemistry and Fluoro-Jade B staining.To investigate the neuroprotective mechanism of Tsl after ischemiareperfusion,immunohistochemical (IHC) and Western blotting analyses for Cu,Zn-superoxide dismutase (SOD1),Mnsuperoxide dismutase (SOD2),brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-I (IGF-I) were performed.Results Treatment with Tsl protected pyramidal neurons from ischemia-induced neuronal death in the CA1 after ischemia-reperfusion.In addition,treatment with Tsl maintained the levels of SOD1 and SOD2 as determined by IHC and Western blotting in the CA1 after ischemiareperfusion compared with the vehicle-ischemia-group.In addition,treatment with Tsl increased the levels of BDNF and IGF-I determined by IHC and Western blotting in the Tsl-treated-sham-group compared with the vehicle-treatedsham-group,and their levels were maintained in thestratum pyramidale of the ischemic CA1 in the Tsl-treatedischemia-group.Conclusion Treatment with Tsl protects pyramidal neurons of the CA1 from ischemic damage induced by transient cerebral ischemia via the maintenance of antioxidants and the increase of neurotrophic factors。

Abstract：Background In a previous study,we demonstrated that ephrin-A2 and-A3 negatively regulate the growth of neural progenitor cells in the central nervous system.Adult mice deficient in ephrin-A2 and-A3 (A2-/-A3-/-) displayed active ongoing neurogenesis throughout the brain,and mice deficient in ephrin-A3 alone showed increased proliferation of ciliary epithelium derived retinal stem cells.This study aimed to detect that the increase in proliferation and neurogenic potential of Müller cells is influenced by the absence of ephrin-A2 and-A3.Methods We assessed the retinal and Müller cell expression of ephrin-As and their receptor and neural progenitor cell markers by immunostaining and real-time PCR.We cultured purified primary Müller cells derived from wild-type and A2-/-A3-/-mice in a defined culture medium that enables trans-differentiation of Müller cells into retinal neurons.To evaluate proliferating Müller cells in vivo,we injected 5'-ethylnyl-2'-deoxiuridine (EdU) intraperitoneally to adult mice.Results Expression of ephrin-A2/A3 and their receptor EphA4 were detected in the retinas of adult mice,with EphA4 expression particularly enriched in Müller cells.Müller cells of A2-/-A3-/-mice exhibited significantly elevated expression of retinal progenitor cell markers,Pax6 and Chx10,when compared with those from wild-type mice.Moreover,a higher percentage of Müller cells of A2-/-A3-/-mice trans-differentiated and became recoverin+ and β-Ⅲ-tublin+ in the culture than those from wild type mice.Strikingly,an increased number of EdU+ retinal cells was detected in the retinas of adult A2-/-A3-/-mice as compared with wild-type mice.Conclusions Ephrin-A2 and-A3 are negative regulators of the proliferative and neurogenic potentials of Müller cells.Manipulating ephrin-A signaling may thus represent a novel strategy for stimulating neuroregeneration from endogenous progenitors to participate in retinal repair in case of disease or damage。

Abstract：Background Intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs and corticosteroids are being widely used to treat diabetic macular edema (DME).The purpose of this study was to evaluate further the efficacy and safety of intravitreal bevacizumab (IVB) alone in comparison with intravitreal bevacizumab combined with triamcinolone acetonide (IVB/IVr) in the treatment of DME.Methods Pertinent publications were identified through CNKI,PubMed,Medline,EMBASE,and the Cochrane Controlled Trials Register up to November 30,2013.Two investigators independently assessed the quality of the trials,and changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) were extracted at 6 weeks and 3,6,12,and 24 months after the initial treatment.A meta-analysis was carried out to compare the results between the groups receiving IVB and IVB/IVT using the software RevMan 5.0.Results A total of six randomized controlled trials (RCTs) were identified and included.The meta-analysis revealed that a significant reduction of the CMT was observed at 3 months after the initial treatment in the IVB/IVT group compared to the IVB group (P=0.001).Also,changes in CMT at 6 weeks and 6,12,and 24 months did not vary significantly between the IVB and IVB/IVT groups (P=0.53,0.76,0.34,and 0.09,respectively).Similarly,changes in BCVA at 6 weeks and 3,6,12,and 24 months also did not vary significantly between the two groups (P=0.66,0.98,0.81,0.07,and 0.80,respectively).The results were robust to sensitivity analyses.However,the rate of intraocular pressure (lOP) rise after intravitreal injections varied significantly between the IVB and IVB/IVT groups (P ＜0.01).A publication bias was not detected by funnel plots,the Egger method,or the Begg method.Conclusions Results of this meta-analysis showed that the treatments with IVB alone and combined IVB/IVT were similarly effective in improving the visual acuity,and,to some degree; combined IVB/IVr appeared to offer a marginal advantage over IVB in decreasing CMT in patients with DME.However,the addition of IVT resulted in intraocular pressure rise in some treated patients。

Abstract：Background Several previous studies have shown that diffusion-weighted imaging (DWI) can provide additional information for focal pancreatic lesions by demonstrating more restricted diffusion in solid malignant tumors than in chronic pancreatitis,which can be indicated by a decreased apparent diffusion coefficient (ADC).However,these studies have a modest sample size and convey inconclusive results.The aim of this study was to determine,in a meta-analysis,the diagnostic performance of quantitative diffusion-weighted magnetic resonance imaging in distinguishing pancreatic carcinoma from mass-forming chronic pancreatitis.Methods We determined the sensitivities and specificities across studies.A summary receiver operator characteristic (sROC) curve was constructed to calculate the area under the curve (AUC).Results The pooled sensitivity of DWI was 0.86 (95％ CI:0.80-0.91) and the pooled specificity was 0.82 (95％ CI:0.72-0.89).The AUC of the sROC was 0.91 (95％ CI:0.88-0.93).Conclusions DWI may be a potentially technically feasible tool for differentiating pancreatic carcinoma from massforming chronic pancreatitis.However,large-scale randomized control trials are necessary to assess its clinical value。

Abstract：Background Balanced steady-state free precession MR angiography (b-SSFP MRA) has shown great promise in diagnosing renal artery stenosis (RAS) as a non-contrast MR angiography (NC-MRA) method.However,results from related studies are inconsistent.The purpose of this meta-analysis was to assess the accuracy of b-SSFP MRA compared to contrast-enhanced MR angiography (CE-MRA) in diagnosing RAS.Methods English and Chinese studies that were published prior to September 4,2013 and that assessed b-SSFP MRA diagnostic performance in RAS patients were reviewed.Quality of the literature was assessed independently by two observers.The statistical analysis was adopted by the software of Meta-Disc version 1.4.Using the heterogeneity test,a statistical effect model was chosen to calculate different pooled weighted values.The receiver operator characteristic (ROC) space and Spearman correlation coefficient were to explore threshold effect.Sensitivity analysis and the publication bias were performed to demonstrate if the pooled estimates were stable and reliable.We produced forest plots to calculate the pooled values and corresponding 95％ confidence interval (C/) of sensitivity,specificity,positive likelihood ratio (PLR),negative likelihood ratio (NLR),diagnostic odds ratio (DOR),and constructed a summary receiver operating characteristic curve (SROC) to calculate the area under the curve (AUC).Results A total of 10 high quality articles were used in this meta-analysis.The studies showed a high degree of heterogeneity.The "shoulder-arm" shape in the ROC plot and the Spearman correlation coefficient between the log(SEN) and log(1-SPE) suggested that there was a threshold effect.Sensitivity analysis demonstrated that the actual combined effect size was equal to the theoretical combined effect size.The publication bias was low after quality evaluation of the literature and the construction of a funnel plot.The pooled sensitivity was 0.88 (95％ CI,0.83-0.91) and pooled specificity was 0.94 (95％ CI,0.93-0.95); pooled PLR was 14.57 (95％ C/,9.78-21.71]) and pooled NLR was 0.15 (95％ CI,0.11-0.20).The AUC was 0.964 3.Conclusion In contrast to CE-MRA,the b-SSFP MRA is more accurate in diagnosing RAS,and may be able to replace other diagnostic methods in patients with renal insufficiency。

Abstract：Objective To investigate the current practice of pulmonary hypertension including current epidemiology,diagnosis and treatment.Data sources The review was based on data obtained from the published articles and guidelines.Study selection Articles with high level of evidence or current best evidence in each issue were selected to be reviewed.Results Overall prevalence of pulmonary hypertension was 0.3％ to 6％ with left heart disease occupying the most proportion,followed by pulmonary disease,pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.In diagnosis,a flow diagram of diagnosis of pulmonary hypertension,differential diagnosis of pulmonary hypertension and how to determine the severity of pulmonary hypertension are explained including recent development of magnetic resonance imaging and gene abnormality study on bone morphogenetic protein receptor Ⅱ.In treatment,newlydeveloped pulmonary vasodilators and the way to use them are shown to treat pulmonary hypertension.Conclusion Safer and more effective treatment algorithm and basic researches and clinical trials are warranted to be explored。

Abstract：Objective To review the development of T follicular helper (TFH) cells and their role in systemic lupus erythematosus (SLE) pathogenesis,the effect of dendritic cells (DCs) on TFH cells in SLE,as well as the potential use of TFH cells as a new therapeutic target in clinical practice.Data sources The data used in this review were retrieved mainly from the PubMed database (1989-2013).The terms used in the literature search were "T follicular helper cells," "systemic lupus erythematosus," and "dendritic cells." Study selection Relevant publications about the TFH cells development,the interaction between the TFH cells and the DCs,and the clinical applications of TFH cells were identified,retrieved,and reviewed.Results TFH cells,a novel distinct CD4+ T cell subset,are specialized in providing help to B cells in the formation of germinal centers (GCs) and long-term protective humoral immune responses.The development of TFH cells from na(i)ve CD4+ T cell is a multistep process.As the pivot of immunoregulation,DCs are indispensable for TFH cells generation.In addition to receptor-ligand interactions between TFH cells and DCs,the cytokines secreted by DCs are also necessary for TFH cell generation.TFH cell dysregulation has been implicated in the development of SLE.More evidence from animal models of SLE and SLE patients suggests that TFH cells are necessary for pathogenic autoantibody production.Therefore,therapeutically targeting TFH cells can be a promising approach to treat antibody-mediated autoimmune diseases including SLE.Conclusion TFH cells play a critical role in the pathogenesis of SLE,making them attractive therapeutic targets in clinical practice。

Abstract：Objective To summarize limitations involved in arsenic trioxide therapeutic effects in acute promyelocytic leukemia,because current studies show that some individuals of acute promyelocytic leukemia have relatively poor outcomes during treatment with arsenic trioxide.Data sources Most relevant articles were included in the PubMed database between 2000 and 2013 with the keywords "acute promyelocytic leukemia","arsenic trioxide","thiol" or "methylation".In addition,a few older articles were also reviewed.Study selection Data and articles related to arsenic trioxide effect in acute promyelocytic leukemia treatment were selected and reviewed.We developed an overview of limitations associated with arsenic trioxide therapeutic effect.Results This review focuses on the researches about the arsenic trioxide therapeutic effect in acute promyelocytic leukemia and summarizes three mainly limitations which can influence the arsenic trioxide therapeutic effect to different degrees.First,with the combination of arsenic and glutathione the therapeutic effect and cytotoxicity decrease when glutathione concentration increases; second,arsenic methylation,stable arsenic methylation products weaken the apoptosis effect of arsenic trioxide in leukemia cells; third,gene mutations affect the sensitivity of tumor cells to arsenic trioxide and increase the resistance of leukemia cells to arsenic trioxide.Conclusions The chief limitations are listed in the review.If we can exclude all of them,we can obtain a better therapeutic effect of arsenic trioxide in patients with acute promyelocytic leukemia。