2012年 · 第125卷第10期

Idiopathetic central diabetes insipidus (CDI) is a heterogeneous hypothalamus-pituitary disease due to the absence or deficiency of arginine vasopressin (AVP).Overexcretion of dilute urine causes body's hydration state and symptoms of extraordinary thirst,even with copious water intake (up to 20 L per day).The diagnosis of CDI is commonly confirmed with water deprivation test and vasopressin analog response.1 This disorder is usually caused by the destruction or degeneration of AVP-secreting magnocellular neurons in hypothalamic supraoptic and paraventricular nuclei.The classical radiological change of CDI is loss of "bright spot" in MRI image,but it is always not special for differential diagnosis of underlying causes。

Abstract：Background Smoking is related with insulin resistance and type 2 diabetes mellitus.Retinol-binding protein-4 is a new adipocytokine associated with insulin resistance.We investigated the serum levels of a series of adipocytokines including retinol-binding protein-4 in smokers and non-smokers to explore the possible roles of adipocytokines on smoking induced insulin resistance.Methods A total of 136 healthy male subjects (92 smokers and 44 non-smokers) with normal glucose tolerance were enrolled in the study.Adipocytokines including retinol-binding protein-4,visfatin,leptin,resistin,adiponectin were measured for the comparison between the two groups.Serum lipid profile,glucose,true insulin and proinsulin levels were measured as well in both groups.Food intake spectrum was also investigated.Results Both groups had similar profile of food consumption; visfatin,leptin,resistin and adiponectin,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,alanine aminotransferase,aspartate aminotransferase,as well as blood pressure and body mass index,were similar in both groups.Triglycerides,retinol-binding protein-4 and homeostatic model assessment index for insulin resistance were higher in smoker group ((2.58±2.53) vs.(1.60±0.94)mmol/L,(26.05±8.50) vs.(21.83±8.40) μg/ml,and 2.25±2.08 vs.1.58±1.15,respectively).Conclusion Smoking may have effect on insulin sensitivity,which is correlated with retinol-binding protein-4。

Abstract：Background Well designed randomized trials and meta-analyses have clearly shown that statins reduce the risk of major vascular events,including ischemic stroke,in a wide range of patients and their routine use is recommended for patients at an increased cardiovascular risk.Survivors of a first ischemic stroke are at a risk of recurrence and of other vascular events and statins are generally recommended to reduce this risk.This study investigated how widely statins were being used for such patients in China.Methods Totally 6422 patients with a history of ischemic stroke were identified by reviewing medical records at 51 highest-ranking hospitals in 14 cities in China,and invited to attend a screening clinic to assess eligibility for a randomized trial.Their current statin and other drug uses were recorded alongside clinical and demographic characteristics.Univariate chi-square test and multivariate Logistic regression were used to determine the factors associated with treatment.Results Only 24％ of these patients reported currently taking a statin.The most important predictor of statin use among these patients was prior history of coronary heart disease.History of diabetes or hypertension,as well as treated in university affiliated hospitals is related to increased use.The status had improved significantly during a 2-year period.Atorvastatin (40％) and simvastatin (39％) were the most commonly used.Conclusions In China,statins are still underused for secondary prevention among survivors of ischemic stroke.Reasons for this poor use need to be understood in order to increase use of these evidence based therapies。

Abstract：Background Studies have shown that increased levels of serum uric acid (SUA) are associated with atrial fibrillation (AF).However,less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure (CHF).The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF.Methods Sixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed.Patients were categorized into AF group and non-AF group,death group,and survival group according to the results of the patients' medical records and follow-up.Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF.The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic (ROC) curves.Results The results of univariate predictors in overall patients showed that the higher SUA level was associated with AF.SUA level (HR,1.084; 95％ CI,1.017-1.144; P＜0.001),diuretics (HR,1.549; 95％ CI,1.246-1.854; P＜0.001),and New York Heart Association (NYHA) (HR,1.237; 95％ CI,1.168-1.306; P＜0.001) function class were the independent risk factors for AF.The sensitivity and specificity of the models were 29.6％ and 83.8％ respectively for predicting AF.When SUA level was added to these models,it remained significant (Wald x2,1494.88; P ＜0.001 for AF); 58.8％ (95％ CI,57.7％-60.0％) of the observed results were concordant with the separate model.Conclusion Higher SUA level is associated strongly with AF in patients with CHF.SUA level can increase the sensitivity and specificity in predicting AF。

Abstract：Background The definitive treatment for myocardial ischemia is reperfusion.However,reperfusion injury has the potential to cause additional reversible and irreversible damage to the myocardium.One likely candidate for a cardioprotection is adenosine.The present study aimed at investigating the effect of intravenous adenosine on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods Patients with STEMI within 12 hours from the onset of symptoms were randomized by 1:1:1 ratio to receive either adenosine 50 μg·kg-1·min-1 (low-dose group,n=31),or 70 μgkg-1·min-1 (high-dose group,n=32),or saline 1 ml/min (control group,n=27) for three hours.Drugs were given to the patients immediately after the guide wire crossed the culprit lesion.Recurrence of no-reflow,TIMI flow grade (TFG) and TIMI myocardial perfusion grade (TMPG),and collateral circulation were recorded.The postoperative and preoperative ST segment elevation sum of 18-lead electrocardiogram (ECG) and their ratio (STsum-post/STsum-pre) were recorded,as well as the peak time and peak value of CK-MB enzyme.Serial cardiac echo and myocardial perfusion imaging were performed at 24 hours and 6 months post-stenting.The primary endpoint was left ventricular function,and infarct size.The secondary end-point was the occurrence of cardiac and non-cardiac death,non-fatal myocardial infarction,and heart failure.Results A total of 90 STEMI patients were studied.No-reflow immediately after stent procedure was seen in 11 (35.5％)patients in the control group,significantly different from 6.3％ in the low-dose group or 3.7％ in the high-dose group (both P=0.001).STsum-post/STsum-pre in the low-dose and high-dose groups was significantly different from the control group (low-dose group vs.control group,P=0.003 and high-dose group vs.control group,P=0.001),without a dose-dependent pattern (P=0.238).The peak value of CK-MB enzyme was significantly reduced in the high-dose group compared to the control group (P=0.024).Compared to the left ventricular ejection fraction (LVEF) in control group,LVEF in the low-dose group increased by 5.8％ at 24 hours (P=0.012) and by 10.9％ at 6 months (P=0.007),LVEF in the high-dose group increased by 9.5％ at 24 hours (P=0.001) and by 10.0％ at 6 months (P=0.001),respectively.Significant reduction of infarct size by 24.2％ was detected in the high-dose group vs.low-dose or control groups (P=0.008).There was no significant difference regarding secondary endpoints at 6 months among the treated groups.Cardiac function by NYHA classification in both the low-dose and the high-dose groups was improved significantly (P=0.013,P=0.016).Conclusion Intravenous adenosine administration might significantly reduce the recurrence of no-reflow,with resultant improved left ventricular systolic function.High-dose adenosine was further associated with significant reduction of infarct size。

Abstract：Background Fluid dynamic mechanisms attributed to coronary bifurcation lesions remain a subject of study.The present study aimed at investigating the hemodynamic change of wall shear stress (WSS) in patients with coronary bifurcation lesions treated by double kissing (DK) crush or one-stent with final kissing balloon inflation (FKBI).Methods Eighty-one patients with bifurcation lesions treated by stenting who had 3-D model reconstruction were studied.The bifurcation vessels were divided into main vessel (MV),main branch (MB),side branch (SB),and polygon of confluence (POC).MB and SB were classified by internal- and lateral-subsegments,respectively.Results The baseline magnitude of WSS in proximal MV,POC-MV,POC-MB,POC-SB and MB-internal segments increased significantly,compared to MB-lateral,SB-internal and SB-lateral.DK crush had the potential of uniformly reducing WSS,turbulent index and the WSS gradient.The WSS value at the POC-SB and SB in the one-stent group remained higher.The turbulent index and WSS gradient between the POC-SB minus the SB-lateral had equal predictive values for in-stent restenosis (ISR).Conclusion Fluid dynamic results favor the use of DK crush over the one-stent technique。

Abstract：Background The nocturnal nondipping and elevated morning blood pressure (BP) in patients with obstructive sleep apnea syndrome (OSAS) have not yet been well investigated in Chinese patients.This study aimed to describe the BP profile,and to elucidate the relationships between daytime BP and nighttime BP,and between evening BP and morning BP in patients with OSAS.Methods Twenty teaching hospital sleep centers in China were organized by the Chinese Medical Association to participate in this study and 2297 patients were recruited between January 2004 and April 2006.BP assessments were made at four time points (daytime,evening,nighttime and morning) and polysomnography (PSG) was performed and subjects were classified into four groups by their apnea-hypopnea index (AHI):control,n=213 with AHI＜5; mild,n=420 with AHI ≥5 and＜15; moderate,n=460 with AHI≥15 and＜30; and severe,n=1204 with AHI ＞30.SPSS 11.5 software package was used for statistical analysis and figure drawing.Results All the average daytime,nighttime,evening and morning BPs were positively correlated with AHI and negatively correlated with nadir nocturnal oxygen saturation.The ralios of nighttime/daytime and morning/evening average BP were positively correlated with AHI.The ratio of nighttime/daytime systolic BP became a “reversed BP dipping” pattern until the classification reached severe,while the ratio of nighttime/daytime diastolic BP became reversed at moderate.Similarly,the ratio of morning/evening diastolic BP becomes reversed even at mild.Conclusions OSAS may result in higher BP levels at all four time points.The ratios of nighttime/daytime and morning/evening BP increase with increased AHI.The increasing of diastolic BP,which is inclined to rise more quickly,is not parallel with increasing systolic BP。

Abstract：Background Bacterial lipopolysaccharide (LPS) can activate immunological cells to secrete various proinflammatory cytokines involved in the pathophysiological process of disseminated intravascular coagulation (DIC) during infection.In recent years,it has been found that bone marrow-derived mesenchymal stem cells (BMSCs) can affect the activity of these immune cells and regulate the secretion of proinflammatory cytokines.Here,we report the possible protective effect of BMSCs pre-treatment in LPS-induced DIC rat model and the mechanism.Methods Forty-eight adult male rats were divided into five experimental groups and one control group with eight animals in each group.In the treatment groups,0,1×106,2×106,3×106,and 5×106 of BMSCs were injected intravenously for 3 days before LPS injection,while the control group was treated with pure cell culture medium injection.Then,the LPS (3 mg/kg) was injected via the tail vein in the treatment groups,while the control group received 0.9％ NaCl.Blood was withdrawn before and 4 and 8 hours after LPS administration.The following parameters were monitored:platelets (PLT),fibrinogen (Fib),D-dimer (D-D),activated partial thromboplastin time (APTT),prothrombin time (PT),tumor necrosis factor-o (TNF-α),interferon-γ (IFN-γ),interleukin-1β (IL-1β),creatinine (Cr),alanine aminotransferase (ALT),creatinine kinase-MB (CK-MB),and endothelin (ET).Results Compared with the control group,a significant change of coagulation parameters were found in the experimental groups.The plasma level of the inflammatory mediator (TNF-α,IFN-γ,IL-1β),organ indicator (Cr,ALT,and CK-MB),and ET in the experimental groups were much lower (P ＜0.05) than that in the control group.Furthermore,some of these effects were dose-dependent; the statistical comparison of the plasma levels between the groups (from group 2 to group 5) showed a significant difference (P＜0.05),except the ALT and CK-MB levels (P＞0.05).Conclusion Pre-treatment with BMSCs can attenuate organ dysfunction and inhibit systemic intravascular coagulation effectively via the regulatory effect on immune ceils and proinflammatory cytokines in LPS-induced DIG rat model。

Abstract：Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by progressive death of the upper and lower motor neurons.Transgenic mice over-expressing a mutant form of the human SOD1 gene develop an ALS-like phenotype.Currently,there is no effective treatment or drug for the fatal disease.Previous studies reported potent efficacy of dl-3-n-butylphthalide (DL-NBP) for several neurodegenerative disorders and cerebral ischemia.SOD1-G93A mice are a mouse model of ALS.In this study,we investigated the efficacy of DL-NBP on this ALS mouse model.Methods Sixty SOD1-G93A female mice were divided into four groups.The vehicle control group received 0 mg·kg-1·d-1 DL-NBP.The experimental groups received DL-NBP with doses of 30,60 or 120 mg·kg-1d-1,respectively.For measurement of motor activity,the hanging wire test and rotarod test were performed.Survival statistics were analyzed by Kaplan-Meier survival curves.The body weight of each mouse was recorded twice per week.The statistical motor unit number estimation (MUNE) technique was used to estimate the number of functioning motor units in gastrocnemius muscle.Muscle morphology was evaluated by hematoxylin and eosin staining.Motor neuron quantitation was performed by Nissl staining and microglia activation was observed by immunohistochemistry.Results Oral administration of 60 mg·kg-1-d-1 DL-NBP significantly prolonged survival ((164.78±16.67) days) of SOD1-G93A mice compared with vehicle control ((140.00±16.89) days).Treating mice with DL-NBP (60 mg·kg-1·d-1)significantly decreased the progression rate of motor deficits and suppressed body weight reduction.Furthermore,we found that treating SOD1-G93A mice with DL-NBP (60 mg·kg-1·d-1) slowed the rate of MUNE reduction (P＜0.01).Motor neurons were remarkably preserved in the anterior horns in mice treated with DL-NBP (60 mg·kg-1·d-1) at the stage of 19 weeks (P＜0.01).Treating mice with DL-NBP (60 mg·kg-1·d-1) significantly reduced CD11b immunoreactivity compared with vehicle control mice (P＜0.05).No significant effect was observed in mice treated with DL-NBP of 30 or 120 mg·kg-1·d-1.Conclusions The post-disease-onset administration of DL-NBP significantly prolonged survival and improved motor performance in SOD1-G93A mice.DL-NBP may be a potential therapeutic agent for ALS。

Abstract：Background Previous researches about necrotic pancreatic tissue infections are numerous,but the study on systemic infection related to the severe acute pancreatitis (SAP) treatment period is limited.This study aimed to investigate the distribution and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP during the past three years.Methods A retrospective study was conducted on the distribution,category and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP from 2008 to 2011.Results A total of 594 pathogenic bacteria samples were isolated.Among them 418 isolates (70.4％) were Gram bacteria negative,142 isolates (23.9％) were Gram bacteria positive,and 34 isolates (5.7％) were found fungi.The most common Gram negative bacteria were Escherichia coli (19.8％),and the dominant Gram positive pathogenic bacteria were Enterococcus faecium.The distribution of SAP-related infectious pathogens was mainly in peritoneal drainage fluid,sputum,bile,and wound secretions.Almost all the Gram negative pathogenic bacteria were sensitive to carbapenum.Extended-spectrum β-lactamases (ESBLs) producing strains were more resistant to penicillins and cephalosprins than the ESBLs non-producing strains.Staphylococcus was sensitive to vancomycin and linezolid.The drug resistance of meticillin-resistant staphylococcus (MRS) to commonly used antibiotics was higher than meticillin-sensitive streptococcus (MSS).Enterococcus sp.exhibited lower drug-resistance rates to vancomycin and linezolid.Conclusions Gram negative bacteria were the dominant SAP-related infection after hepatobiliary surgery.A high number of fungal infections were reported.Drug resistant rates were high.Rational use of antibiotics according to the site of infection,bacterial species and drug sensitivity,correctly executing the course of treatment and enhancing hand washing will contribute to therapy and prevention of SAP-related infection and decrease its mortality。

Abstract：Background Dipeptidyl peptidase-Ⅳ (DPP-4) inhibitors are now used to improve postprandial glycemic control in type 2 diabetes.However,their effects on hepatic glucose production (HGP) in obesity are not clear.This study was designed to test the hypothesis that gluconeogenesis and HGP can be modulated by DPP-4 inhibitors in obesity.Methods Sprague Dawley male rats were divided into four groups,each on a different diet:general rat chow,n=10 (G);G+sitagliptin,n=10; high fat chow (obesity),n=10 (55％ fat calories,HFO); HFO+sitagliptin,n=10.After 10 weeks,the rats were fasted overnight and glucose metabolism was determined using 3-3H-glucose and 14C-glycerol as tracers.Results Glycerol rate of appearance (P＜0.00001),plasma glycerol (P＜0.05) and free fatty acid (FFA) (P＜0.05)concentrations,and HGP (P＜0.05) were decreased in HFO+sitagliptin group compared with HFO group,but there was no significant difference between G and G+sitagliptin groups (P＞0.05).Gluconeogenesis in HFO group was five times of that in G rats (P＜0.01),but was significantly declined in HFO+sitagliptin group (P＜0.0001).Conclusions Gluconeogenesis and HGP were inhibited by sitagliptin in high fat-induced obese rats due to decreased glycerol availability,which was a result of reduced glycerol release from adipose tissues.The finding suggests that sitagliptin is potentially useful for controlling fasting glucose in obesity,thereby delaying or preventing the development of diabetes。

Abstract：Background Pancreatic β cells are susceptible to fatty acid-induced apoptosis.The 17β-estradiol (E2) protects pancreatic β cells from apoptosis,mediated by the estrogen receptor-α (Erα).The mRNA level and promoter activity of leukemia-related protein (LRP) 16 were significantly increased by E2 in ER-α and LRP16 was a co-activator of ER-α.The aim of the study was to assess the effects of LRP16 on fatty acid-induced apoptosis in MIN6 cells.Methods Cells with over-expressing LRP16 were obtained by lipidosome transfection.Insulin content and glucose-stimulated insulin secretion (GSIS) were examined by radioimmunoassay.Western blotting was applied to detect protein expression.Apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)and flow cytometry.The forkhead boxO1 (FoxO1) subcellular localization was determined by immunocytochemical analysis.Results MIN6-LRP16 cells with overexpression of LRP16 were successfully established,and protein expression of LRP16 was 2.29-fold of that of control cells (MIN6-3.1,P＜0.05).Insulin content and GSIS in MIN6-LRP16 were substantially increased compared with those in control cells.When cells were stimulated with glucose,increased phosphorylation of extracellular signal-regulated kinase (ERK) 1/2 and serine-threonine kinase (Akt) were observed in MIN6-LRP16.When cells were under palmitate pressure,the TUNEL-positive rate in MIN6-LRP16 was (17.0±0.5)％,while it in MIN6-3.1 was (22.0±0.4)％.In palmitate-treated cells,attenuated Akt phosphorylation was observed,but the attenuation in Akt activity was partially restored in MIN6-LRP16 cells.Meanwhile,nuclear localization of FoxO1 in MIN6-LRP16 was apparently reduced compared with that in control cells.Conclusions LRP16 regulated insulin content and GSIS in MIN6 cells by ERK1/2 and Akt activated way.Meanwhile,LRP16 overexpression protected MIN6 cells from fatty acid-induced apoptosis by partially restoring Akt phosphorylation and inhibiting FoxO1 nuclear redistribution.Therefore,LRP16 played important roles not only in insulin content and GSIS but also in the antilipotoxic effect mediated by Akt/FoxO1 signaling。

Abstract：Background Wilms' tumor (nephroblastoma) is a cancer of the kidneys that occurs typically in children and rarely in adults.Early diagnosis is very important for the treatment and prognosis of the disease.The aim of our study was to discover and identify potential non-invasive and convenient biomarkers for the diagnosis of Wilms' tumor.Methods Nude mice were used to construct a Wilms' tumor model by injecting nephroblastoma cells into their bilateral abdomen.We collected 94 serum samples from mice consisting of 45 samples with Wilms' tumor and 49 controls.The serum proteomic profiles of the samples were analyzed via surface-enhanced laser desorption/ionization time-of-flight mass spectrometry.The candidate biomarkers were purified by high-performance liquid chromatography,identified by liquid chromatography-mass spectrometry,and validated using ProteinChip immunoassays.Results We finally retrieved two differential proteins (m/z 4509.2; 6207.9),which were identified as apolipoprotein A-Ⅱ and polyubiquitin,respectively.The expression of apolipoprotein A-Ⅱ was higher in the Wilms' tumor group than in the control group (P＜0.01).By contrast,the expression of polyubiquitin was lower in the Wilms' tumor group than in the control group.Conclusion Apolipoprotein A-Ⅱ and polyubiquitin may be used as potential biomarkers for nephroblastoma in children,and the analysis of apolipoprotein A-Ⅱ may help diagnose and treat Wilms' tumor。

Abstract：Background Wilms' tumor (nephroblastoma) is the most common pediatric kidney cancer.Only one Wiims' tumor gene is known,WT1 at 11 p 13,which is mutated in 5％-10％ of Wilms' tumors.Recently,mutations were reported in WTX at Xq11.1 in Wilms' tumors.This study investigated the mutation proportion,type,and distribution in WTX and WT1 in children with Wilms' tumor.The role of WTX/WT1 in the development of Wilms' tumor,and the relationship between clinical phenotype and genotype,were also studied.Methods Wilms' tumor specimens (blood samples from 70 patients and tumor tissue samples from 52 patients) were used.A long fragment of WTX and 10 exons and intron sequences of WT1 were amplified by polymerase chain reaction (PCR) from extracted genomic DNA and sequenced.A chi-square test compared the difference between the WTX mutation group and the no mutation group.The relationship between the mutations and clinical phenotype was analyzed.Results WTX mutations were found in 5/52 tumor tissues and in 2/70 peripheral blood samples (five cases in total,all point mutations).Two patients had a WTX mutation in both samples.WT1 mutations were found in 2/52 tumor tissues and in 4/70 peripheral blood samples (five cases in total,all point mutations).One patient had a WT1 mutation in both samples.Ten cases had WTX or WT1 mutation (19.2％ of Wilms' tumors).No overlapping WTXand WT1 mutations were found.No significant differences in clinical parameters were found between patients with and without a WTX mutation.Conclusions WTX mutations occur early in Wilms' tumor development,but at e low proportion.There was no evidence that WTX is the main cause of Wilms' tumor.Clinical parameters of patients with WTX mutations are not related to the mutation,indicating a limited impact of WTX on tumor progression.WTX and WT1 mutations occur independently,suggesting a relationship between their gene products。

Abstract：Background Muscles present different responses to muscle relaxants,a mechanism of importance in surgeries requiring facial nerve evoked electromyography under general anaesthesia.The non-depolarizing muscle relaxants have multiple reaction formats in the neuromuscular junction,in which pre-synaptic quantal release of acetylcholine was one of the important mechanisms.This study was to compare the pre-synaptic quantal release of acetylcholine from the neuromuscular junctions innervated by normal/damaged facial nerves and somatic nerve under the effect of rocuronium in rats in vitro.Methods Acute right-sided facial nerve injury was induced by nerve crush axotomies.Both sided facial nerve connected orbicularis oris strips and tibial nerve connected gastrocnemius strips were isolated to measure endplate potentials (EPP) and miniature endplate potentials (MEPP) using an intracellular microelectrode gauge under different rocuronium concentrations.Then,the pre-synaptic quantal releases of acetylcholine were calculated by the ratios of the EPPs and the MEPPs,and compared among the damaged or normal facial nerve innervated orbicularis oris and tibial nerve innervated gastrocnemius.Results The EPP/MEPP ratios of the three neuromuscular junctions decreased in a dose dependent manner with the increase of the rocuronium concentration.With the concentrations of rocuronium being 5 μg/ml,7.5 μg/ml and 10 μg/ml,the decrease of the EPP/MEPP ratio in the damaged facial nerve group was greater than that in the normal facial nerve group.The decrease in the somatic nerve group was the biggest,with significant differences.Conclusions Rocuronium presented different levels of inhibition on the pre-synaptic quantal release of acetylcholine in the three groups of neuromuscular junctions.The levels of the inhibition showed the following sequence:somatic nerve ＞damaged facial nerve ＞ normal facial nerve.The difference may be one of the reasons causing the different sensitivities to rocuronium among the muscles innervated by the normal/injured facial nerves and the somatic nerve.The results may provide some information for the proper usage of muscle relaxants in surgeries requiring electromyographic monitoring for the pre-surgically impaired facial nerves。

Abstract：Background Endovascular recanalization (EVR) is becoming the primary therapy for patients with central venous (brachiocephalic,subclavian,and superior vena cava) occlusion (CVO) caused by benign etiology.In this study,we retrospectively analyzed our experience in using EVR to treat benign CVO in 10 patients between April 2005 and September 2010.Methods The mean age of the patients was 65.3 years,2/10 cases were female,and the origin of cause of CVO in 7/10 cases was the hemodialysis access in the upper extremity.The patients were treated with primary stent placement and evaluated with immediate technical success rate and post-interventional patency rate after the procedure.Results Eight patients were treated successfully with stent placement and experienced symptomatic relief immediately.No technical complications were observed during EVR treatment.Patients were followed up by ultrasonography and venography.Median follow-up was 13 months,Three patients required secondary procedures to maintain patency.Conclusions EVR is an effective and safe treatment in patients with benign CVO.It provides immediate symptom relief and maintains a continuous access for hemodialysis。

Abstract：Background Coronary microcirculation reserve is an important field in the research of coronary artery disease,but it is difficult to identify clinically.Currently it is widely accepted that myocardial contrast echocardiography (MCE) is a safe,inexpensive method and has comparatively high image resolution.The present study used quantitative low-dose adenosine stress real-time (RT)-MCE to estimate myocardial perfusion and the coronary stenosis.Methods Forty-nine left ventricular (LV) segments from 14 unselected patients were divided into three groups according to the coronary angiography or CT angiography results:group 1 (n=20,41％) without significant stenosis (＜70％),group 2 (n=12,24％)with successful percutaneous coronary intervention (PCI),and group 3 (n=17,35％)with significant stenosis (＞70％).RT-MCE was performed in these patients with low-dose adenosine stress and continuous infusion of Sonovue.The replenishing curves were drawn according to the contrast density measured at the end-diastolic frame of every cardiac circle by ACQ software.Results Forty-nine LV segments with satisfactory image quality were picked for quantitative contrast echo analysis.The replenishing curves were analyzed at baseline and after stress.Perfusion of group 3 did not decrease significantly at baseline,and showed no improvement during adenosine stress and was significantly different from groups 1 and 2 (P ＜0.05).The A·β and β increased more significantly in group 1 than in groups 2 and 3 (P ＜0.05).In a receiver operating characteristic (ROC) curve analysis,A·β under adenosine stress ＜1.74 dB/s had a sensitivity and specificity of 71％ for diagnosis of coronary artery stenosis,reduced adenosine-induced rise (percentage of A·β ＜81％) had a sensitivity and specificity of 83％ and 79％ for the diagnosis of low-reserve,and β ＜54％ had a sensitivity of 86％ and specificity of 79％.Conclusions Rest perfusion of severely stenosed arteries may be normal,but adenosine stress can detect the impaired perfusion reserve.Low-dose adenosine stress RT-MCE provides good accuracy for the evaluation of coronary perfusion reserve and hence coronary stenosis。

Abstract：Background Developmental dysplasia encompasses a wide spectrum of hip pathology ranging from a shallow acetabulum to a completely dislocated ‘high-riding' hip.It is a common cause of secondary osteoarthritis in young adults and is the underlying diagnosis in up to 48％ of patients requiring total hip arthroplasty (THA) for coxarthrosis.The aim of this study was to evaluate efficiency and safety of THA using Zweymüller hip implant in the treatment of severe osteoarthritis secondary to developmental dysplasia of the hip (DDH) in adults.Methods From January 2000 to February 2008,35 patients (40 hips) with developmental dysplasia of the hip were included.Five were male and 30 were female,with ages ranging from 26 to 65 years and an average age of 45 years.According to Hartofilakidis classification,there were type Ⅰ in 5 hips,type Ⅱ in 20 hips,type Ⅲ in 15 hips.All the patients were performed the THA using the Zweymüller hip implant.The preoperative average Harris score was 44.The bilateral arthroplasty was performed in 5 patients and the unilateral arthroplasty in 30 patients.The patients mainly suffered from pain and claudication.Clinical and radiological results were analyzed.The Harris score was used for outcome measurement.Results Thirty five patients (40 hips) were followed and the mean follow-up period was 46 months (ranged from 24 months to 96 months).The latest follow-up average Harris score was 88.9 (97.1％ of good rate).All the patients were pain-free and there was no sign of infection,aseptic loosening and subsidence.Conclusions In summary,THA using Zweymüller hip implant is a good treatment method for severe osteoarthritis secondary to DDH in adults.The key techniques for the total hip replacement are as follows:good preoperative plan,firmly placing the acetabular component in the true acetabulum,proper preparation of proximal femur,suitable femoral component choosing and improving the techniques of the bone graft。

Abstract：Background As the incidence of type 2 diabetes is rapidly increasing,prevention of the disease should be considered as a crucial objective in the near future.Several studies have shown angiotensin receptor blockers (ARBs) may contribute to the prevention of new-onset type 2 diabetes.This study was conducted to determine if ARBs as monotherapy or combination therapy may experience a decreased incidence of new-onset type 2 diabetes and prevent cardiovascular events.Methods Relevant experimental and clinical studies were identified by searching MEDLINE (1969 to May 30,2011) to extract a consensus of trial data involving the effect of ARBs on prevention of new-onset type 2 diabetes and cardiovascular events.Studies were included if they were randomized controlled trials versus placebo/routine therapy.A random-effects model was utilized.Subgroup and sensitivity analyses were conducted.Results Eleven trials were identified,including 82738 patients.ARBs prevented new-onset type 2 diabetes (odds ratio 0.8 (95％ CI 0.76,0.85)).Regardless of indication for use,essential hypertension (seven trials),impaired glucose tolerance (one trial),cardiocerebrovascular disease (two trials) or heart failure (one trial),reductions in new-onset type 2 diabetes were maintained (0.75 (0.69,0.82),0.85 (0.78,0.92),0.80 (0.76,0.85) and 0.80 (0.64,0.99),respectively).No statistical heterogeneity was observed for any evaluation.However,ARBs did not significantly reduce the odds of all-cause mortality,myocardial infarction and heart failure versus control therapy among all of these studies.But ARBs did reduce the odds of cardiac death and heart failure among the heart failure study versus control therapy.Conclusion ARBs have significant ability to reduce risk of developing new-onset type 2 diabetes but does not improve cardiovascular outcomes over the study follow-up periods among all of included studies。

Abstract：Objective To evaluate the safety and efficacy of stent placement for the treatment of complex intracranial aneurysms.Data sources We searched six databases,including Pubmed,Embase,SCI-expanded,the Cochrane Library,ISI Proceedings and ProQuest Dissertations & Theses for the relevant studies using multiple key words from December,1997 to February,2009.Study selection Thirty-three studies about stent placement for intracranial aneurysms were identified,which reported data from a total of 1069 patients with 1121 intracranial aneurysms.Data extraction We prepared a standardized data extraction form (DEF),which was used by two independent researchers to extract data from the included 33 studies.Results The overall initial complete occlusion rate was 52.5％ (456/869,95％ CI:49.2％-55.8％).The overall complication rate was 14.3％ (162/1130,95％ CI:12.3％-16.4％),of which 3.6％ (38/1044,95％ CI:2.5％-4.8％) were permanent.Clinical follow-up showed a dependence rate of 8.4％ (39/465,95％ CI:5.9％-10.9％).Angiographic follow-up showed an improvement rate of 24.3％ (117/481,95％ CI:20,5％-28.2％) and a recurrence rate of 12.9％ (62/481,95％ CI:9.9％-15.9％).Chi-squared tests were performed to compare the following subgroups:self-expandable vs.balloon-expandable stents,unruptured vs.acutely ruptured aneurysms,and with vs.without pre-medication.Statistical significance was reached in eight tests.Conclusions Intracranial stent is a safe and effective tool for embolizing complex intracranial aneurysms.Self-expandable stents are significantly easier and safer than balloon-expandable stents with respect to navigation and deployment through the tortuous cerebral vasculature.Patients with acutely ruptured aneurysms are more likely to be deoendent,but not more likely to suffer more procedure-related complications。