2012年 · 第125卷第11期

Abstract：Background Tumor necrosis factor-α is a key mediator in the pathogenesis of psoriasis.Infliximab is a monoclonal antibody that specifically binds to tumor necrosis factor-a.The purpose of this study was to validate the efficacy and safety of 5 mg/kg infiiximab therapy in Chinese patients with moderate to severe plaque psoriasis.Methods In this multicenter,double-blind,placebo-controlled trial,129 patients with moderate-to-severe psoriasis were randomized to the induction therapy (weeks 0,2 and 6) with infliximab 5 mg/kg (n=84) or placebo (n=45),followed with infliximab 5 mg/kg scheduled at week 14 and week 22 in the infliximab group,and infliximab 5 mg/kg scheduled at weeks 10,12 and 16 in the placebo group,The primary end point was the proportion of patients who achieved at least 75％improvement in Psoriasis Area and Severity Index (PASI 75 response rate) from baseline at week 10.Results At week 10,B1.0％ of patients treated with infliximab (5 mg/kg) achieved a 75％ or greater improvement compared with 2.2％ of patients treated with placebo (P ＜0.001).A significant improvement in PASI,Physician's Global Assessment (PGA) and Dermatology Life Quality Index (DLQI),was seen from week 6 through week 14 in the infliximab group compared with the placebo group.Through week 22,PASI,PGA,DLQI were well maintained.The incidence of adverse events for the infliximab treatment group was slightly higher in comparison to the placebo treatment group during the first 10 weeks without statistical significance.However,there were 3 cases of tuberculosis that developed during the 26 weeks treatment with infliximal.Conclusions Infliximab treatment was effective as induction and maintenance treatments for Chinese patients with moderate to severe plaque psoriasis.Most drug-induced adverse events were mild to moderate,and well tolerated.Screening for tuberculosis is essential and prophylactic treatment should be given if necessary。

Abstract：Background Men who have sex with men (MSM) have been impacted by HIV and now as an important driver of the HIV/AIDS epidemic in China.This study collected HIV sentinel surveillance system data on the MSM population to describe the characteristics and trends of the HIV epidemic among MSM in China from 2003 to 2011.Methods Data on HIV prevalence and risk behaviors from 2003 to 2011 were obtained from the national HIV sentinel surveillance database.Results MSM sentinel surveillance data for 2011 showed that proportions of MSM who consistently used condoms during anal sex in the last six months and at last anal sex encounter were 43.3％ and 74.1％,respectively.Between 2005 and 2011 there were no significant changes in the proportion of consistent condom use.The proportion of MSM who had multiple male sex partners in the last six months increased.Overall HIV prevalence over the years showed a rising trend from 0.9％ in 2003 to 6.3％ in 2011.The syphilis antibody positive rate was 7.8％ in 2011.In addition,the proportion of MSM in heterosexual marriages was rising,AIDS awareness was also increasing,and the proportion of MSM who had taken an HIV test in the last year and was aware of the results rose.The proportion who had received intervention services in the last year stabilized.Conclusions HIV prevalence in MSM populations is rapidly and widely distributed.MSM who are in heterosexual marriages may be a bridge group transmitting HIV to their heterosexual partners.The risky sexual behavior among MSM will remain a serious and important driver of China's AIDS epidemic over the next period of time.Intervention need to be strengthened,as does the effective implementation of measures to control AIDS and prevent it from spreading further。

Abstract：Background Recurrent stroke following a transient ischemic attack or minor stroke is frequent but potentially preventable.The prevention outcome is,by and large,dependent on how well physicians understand and implement prevention guidelines.Yet,little is known about the scope of physicians' awareness and implementation of secondary stroke prevention guidelines in the mainland of China.This study aimed to identify the gaps between physicians' clinical practice and guidelines for secondary stroke prevention in China.Methods A nation-wide online survey with a 16-item questionnaire that reflects major components of the Chinese National Secondary Stroke Prevention Guidelines was performed between September 1,2009 and October 31,2009.Results A total of 3489 neurologists from third tier hospitals completed the survey.The percentage of the physicians who were aware of the control targets and prevention measures recommended in the Chinese national guidelines was generally lower than reported for developed countries.Conclusions Physicians in the mainland of China lack sufficient awareness of secondary stroke prevention guidelines.Continuing education is highly recommended。

Abstract：Background An early identification of the composition of arterial thrombus may have diagnostic,therapeutic,and prognostic implications.The variation of magnetic resonance (MR) signal intensity between white and red thrombi,especially in the susceptibility sensitive MR sequence,remains unknown.Our research was to evaluate the feasibility of MRI in differentiating of white and red thrombi with a phantom study.Methods A total of 12 red and 12 white thrombi were prepared with the venous blood.Examination of the phantom was completed using a 3.0T MR unit,including fluid attenuated inversion recovery (FLAIR) T1,T2-weighted imaging (T2WI),FLAIR T2,T2* gradient echo (T2*GRE) imaging,and susceptibility weighted angiography sequences (SWAN).MR signal intensity patterns of the thrombi were objectively classified as hyperintensity,isointensity and hypointensity,compared with the background agar.The volume of thrombus was calculated and correlated with its signal intensity.Results For white thrombi,11/12 clots showed hyperintensity and 1/12 showed isointensity in FLAIR T1 images.In T2WI,6/12 clots showed hyperintensity,3/12 isointensity,and 3/12 hypointensity.In FLAIR T2,8/12 clots showed hyperintensity and 4/12 showed isointensity.In T2*GRE,3/12 clots showed hyperintensity and the remaining 9/12 clots showed isointensity.In SWAN,5/12 clots demonstrated hyperintensity and 7/12 isointensity.For the red thrombus,12/12 clots demonstrated hyperintensity in FLAIR T1,T2WI,and FLAIR T2 sequences.In T2*GRE and SWAN sequences,3/12 clots displayed hypointensity and the remaining 9/12 clots showed slight hyperintensity.Thrombi with hypointensity displayed in T2*GRE and SWAN sequences were significantly larger than those with hyperintensity.Conclusions Differentiation of white and red thrombi with conventional MR sequence is unreliable,because both kinds of thrombi do not possess unique signal intensity features in these sequences.Red thrombus may or may not show hypointensity in the susceptibility sensitive MR sequences,depending on its size and time course。

Abstract：Background Intra-abdominal hypertension (IAH) is a recognized prognostic marker for severity of severe acute pancreatitis (SAP) and has a strong impact on the clinical course of SAP.Previous studies indicate that a Da-Cheng-Qi Decoction (DCQD) is beneficial in the treatment of SAP.The purpose of this study was to evaluate the effect of modified DCQD on IAH in patients with SAP.Methods Between January 2008 and December 2008,42 patients from the West China Hospital were randomized into either the DCQD or control group (n=21 in each group).Mortality,intra-abdominal pressure (lAP),Acute Physiology and Chronic Health Evaluation II (APACHE II) score,C-reactive protein (CRP),oxygenation index,Balthazar CT score,rate of renal failure,decompression rate,intensive care unit (ICU) transfer rate,and length of hospital stay (LOS) were compared between the two groups.Results Compared to the control group,the modified DCQD treatment significantly decreased lAP (P ＜0.05) and APACHE Ⅱ (P ＜0.05) scores on days 4-8,CRP on day 8 (P ＜0.01 ),renal failure rate (P ＜0.05),and LOS (P ＜0.05).The oxygenation index was significantly improved in the DCQD group compared with the control group (P ＜0.05).No significant differences in the Balthazar CT score,shock rate,ICU transfer rate,or mortality occurred between the two groups.Conclusions The modified DCQD can effectively relieve IAH and decrease LOS for patients with SAP.Larger clinical trials are needed to confirm these findings。

Abstract：Background A link between postoperative pain intensity and heart rate variability (HRV) had not been well established.This study aimed to investigate the correlation between post-operative pain intensity and HRV.Methods The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009-November 2009.The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain.HRV was measured as the standard deviation of normal RR interval,and by power spectral analysis that included high frequency (HF),low frequency (LF),very low frequency power,and LF/HF ratio.Results Atotal of 34 subjects were included in this study.We found that the day after the surgery,the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90,indicating a moderate degree of pain.Moderate to severe degrees of tenderness were reported by 70.6％ of the patients,moderate to severe degrees of gnawing pain were experienced by 67.7％ of the patients,moderate to severe degrees of tiring-exhaustion pain were reported by 64.7％ of the patients,and 41.2％ of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel.The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P ＜0.05).The correlation of the standard deviation of normal RR interval,high frequency,very low frequency value and patient's age were negative (p ＜0.05).The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P ＜0.05).Conclusions The multidimensional pain assessment tool (SF-MPQ) reflects better the patients' post-operative pain than the single-dimensional assessment tool (VAS).HRV positively correlated with SF-MPQ scores in patients after abdominal surgery。

Abstract：Background Few studies have given suggestions on appropriate individual progesterone dosage in patients with progesterone deficiency.This study was designed to provide a reference for the clinical use of oral progesterone by exploring the relationship among Body Mass Index (BMI),dosage of progesterone,and serum progesterone concentration.Many gynecology and obstetrics doctors are unfamiliar with progesterone Ireatment.Our study is intended to help determine the dosage of oral progesterone.Methods This was a block randomized,open-label,prospective clinical trial.Eighty women undergoing cessation of menses were recruited,given oral progesterone therapy for 10 consecutive days.They were randomly assigned to four groups (four different doses of progesterone,n=20):group A 100 mg/d,group B 200 mg/d,group C 300 mg/d,and group O 400 mg/d.Results Seventy-four patients (92.5％,74/80) completed the study.It was observed that administration of progesterone significantly increased serum progesterone concentration in the four groups (all P ＜0.001).And there is a positive correlation between the increase and dosage (rp=0.613,P ＜0.001).A further linear regression analysis found the major regression equation:when 18.5 kg/m2 ≤BMI ＜24 kg/m2,Y=8.4820×10~003x (R2=0.425,P ＜0.001); Y was the increase of serum progesterone concentration in nmol/L,and X was the dosage of oral progesterone in mg/d.Conclusions Serum progesterone levels went up linearly as the dosage increased.The higher the patient's BMI,the higher dosage would be needed to achieve the same serum progesterone concentration.The appropriate dosage of oral progesterone for different patients can be roughly calculated in light of the results of this study。

Abstract：Background In China,patients with hepatitis C virus (HCV)-associated liver disease are getting older,and thus the number of deaths due to such disease is increasing.The efficacy of combination therapy with ribavirin and interferon for chronic HCV infection in elderly patients has not been fully clarified.The aim of the present study was to evaluate the efficacy and tolerability of the combination therapy in the elderly patients.Methods Sixty-eight chronic hepatitis C patients,who received the combination therapy,were classified into two age groups:elderly group (＞60 years,n=25) and non-elderly group (＜60 years,n=43).Rapid virological response,complete early virological response,sustained virological response,relapse,non-response rate,and safety were compared between the elderly group and non-elderly group.Results Overall sustained virological response was lower in the elderly group than non-elderly group (44％ vs.75％,P=0.012,OR=0.270,and 95％ C/ 0.095-0.768).Among patients with HCV genotype 1,sustained virological response was lower in the elderly group than non-elderly group (45％ vs.77％,P=0.015,OR=0.247,95％ C/ 0.078-0.781).The proportions of dose reduction due to laboratory abnormalities were significantly higher in the elderly group than non-elderly group (60.0％ vs.32.6％,P=0.027).Multiple binary Logistic regression analysis confirmed that patient age was an associated factor for sustained virological response.Conclusion Among patients with HCV genotype 1,the elderly patients had lower sustained virological response than non-elderly patients during pegylated interferon-alpha-2a plus ribavirin combination therapy。

Abstract：Background Accurate evaluation of response following chemotherapy treatment is essential for surgical decision making in patients with breast cancer.Modalities that have been used to monitor response to neo-adjuvant chemotherapy (NAC) include physical examination (PE),ultrasound (US),and magnetic resonance imaging (MRI).The purpose of this study was to evaluate the accuracy of PE,US,and MRI in predicting the response to NAC in patients with breast cancer.Methods According to the response evaluation criteria in solid tumors guidelines,the largest unidimensional measurement of the tumor diameter evaluated by PE,US,and MRI before and after NAC was classified into four grades,including clinical complete response,clinical partial response,clinical progressive disease,clinical stable disease,and compared with the final histopathological examination.Results Of the 64 patients who received NAC,the pathologic complete response (pCR) was shown in 13 of 64 patients (20％).The sensitivity of PE,US,and MRI in predicting the major pathologic response was 73％,75％,and 80％,respectively,and the specificity was 45％,50％,and 50％ respectively.For predicting a pCR,the sensitivity of PE,US,and MRI was 46％,46％,and 39％,respectively,and the specificity was 65％,98％,and 92％ respectively.Conclusions Compared with final pathologic findings,all these three clinical and imaging modalities tended to obviously underestimate the pCR rate.A more appropriate,universal,and practical standard by clinical and imaging modalities in predicting the response to neo-adjuvant chemotherapy in vivo is essential。

Abstract：Background Brucellosis can mimic various multisytem diseases,showing wide clinical polymorphism that frequently leads to misdiagnosis and treatment delay,further increasing the complication rates.In this study,we aimed to examine bone marrow biopsy findings in brucellosis cases presenting with hematologic abnormalities.Methods Forty-eight brucellosis cases were prospectively investigated.Complaints and physical examination findings of patients were recorded.Patients' complete blood count,routine biochemical tests,erythrocyte sedimentation rate,C-reactive protein and serological screenings were performed.Bone marrow biopsy and aspiration was performed in patients with cytopenia,for bone marrow examination and brucella culture,in accordance with the standard procedures from spina iliaca posterior superior region of pelvic bone.Results Of the 48 patients,35 (73％) were female and 13 (27％) were male.Mean age was (34.8±15.4) years (age range:15-70 years).Anemia,leukopenia,thrombocytopenia and pancytopenia were found in 39 (81％),28 (58％),22 (46％) and 10 patients (21％),respectively.In the examination of bone marrow,hypercellularity was found In 35 (73％) patients.Increased megacariocytic,erythroid and granulocytic series were found in 28 (58％),15 (31％) and 5 (10％) patients,respectively.In addition,hemophagocytosis was observed in 15 (31％) patients,granuloma observed in 12 (25％) and increased eosinophil and plasma cells observed in 9 (19％) patients.Conclusion According to the results of our series,hemophagocytosis,microgranuloma formation and hypersplenism may be responsible for hematologic complications of brucellosis。

Abstract：Background The optimal endpoint for catheter ablation of persistent atrial fibrillation (AF) remains ambiguous.This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome.Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion (CV) group.Subgroups were also analyzed based on different termination modes.Follow-up assessment included early recurrence and sinus rhythm (SR) maintenance.Results During initial ablation,33 patients (11.3％) were directly converted to SR,166 patients (56.7％) were converted to atrial tachycardia (AT) that subsequently restored SR with further ablation in 98 patients (33.4％),and a total of 162 patients (55.3％) underwent cardioversion due to persistent atrial arrhythmias.Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence (38.2％ vs.43.8％,P=0.328) and SR maintenance (67.2％ vs.59.8％,P=0.198) during the (23±7) months follow-up.Even after repeat ablation,the SR maintenance continued to exhibit no statistical difference in above two groups (72.5％ vs.70.4％,P=0.686).Further analysis of subgroups,however,demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups (P ＜0.05).Furthermore,atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode:AF or AT (P ＜0.05).Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF.AF methods that convert arrhythmia directly to SR have,however,been linked with improved clinical outcomes,although conversions to AT may not be correlated.Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode。

Abstract：Background Medial patellofemoral ligament (MPFL) reconstruction is the preferred operative treatment for recurrent patellar dislocation.The purpose of this study was to report a novel suture-tie technique of patellar side fixation in medial patellofemoral ligament reconstruction for recurrent patellar dislocation,and to evaluate the intermediate-term results.Methods We retrospectively reviewed the results of 22 MPFL reconstructions in 21 patients (6 male and 15 female)with a suture-tie technique performed by a single surgeon between March 2004 and July 2009.All patients had been diagnosed with recurrent patellar dislocation.Outcomes were assessed preoperatively and postoperatively by physical and radiographic examination as well as with Kujala and Lysholm scores.Results At the mean follow-up month 37.5 (range:24-56 months),there was no graft failure.Primary healing was achieved in all cases.At the final follow-up,the mean Kujala score improved from 53.9 (range:46-62 points) to 84.1(range:78-90 points) postoperatively (P ＜0.05),and the mean Lysholm score improved from 47.2 points (range:37-57points) to 82.8 points (range:76-89 points) postoperatively (P ＜0.05).To date,no patients have reported redislocation or subluxation; however,there is one patient with a positive apprehension test.Conclusion A suture-tie technique in medial patellofemoral ligament reconstruction can restore patella stability without significant complication。

Abstract：Background The prognostic power of n-terminal pro-brain natriuretic peptide (NT-proBNP) in sepsis is disputable and unstable among different models.We attempt to evaluate the prognostic potential of NT-proBNP in combination with the sequential organ failure assessment (SOFA) score in sepsis.Methods In this retrospective study,100 consecutive sepsis patients were enrolled.Clinical data such as admission SOFA,the Acute Physiologic and Chronic Health Evaluation score,shock prevalence,use of lung protective ventilation,vasopressors,and glucocorticoids were recorded.Additionally,serum creatinine (Scr1 and Scr3) and NT-proBNP (NT-proBNP1 and NT-proBNP3) were assayed and evaluated at admission and on day 3 respectively.Results △NT-proBNP (NT-proBNP3 minus NT-proBNP1) (P ＜0.001,Hazard ratio (HR)=1.245,95％ confidence interval (C/),1.137-1.362) and admission SOFA (P ＜0.001,HR=1.197,95％ C/,1.106-1.295) were independently related to in-hospital mortality.Their combination was a more robust predictor for in-hospital mortality than either of them individually.Patients with high △NT-proBNP and SOFA had the poorest prognosis.Conclusions In our study,both △NT-proBNP and SOFA were independent predictors of septic patients' prognosis.Moreover,the combination of △NT-proBNP and admission SOFA provided a novel strategy that contained information regarding both the response to treatment and sepsis severity。

Abstract：Background Roux-en-Y gastric bypass (GBP) is the main surgical procedure used in type 2 diabetes.The objective of this study was to evaluate the different types of GBP in treatment of type 2 diabetes.Methods Patients with type 2 diabetes were randomly divided into two groups:those who underwent gastrojejunal loop anastomosis bypass and those who underwent gastrojejunal Roux-en-Y bypass.Blood glucose alterations,operation time,and operation complicatiors were observed.Results Gastrojejunal loop anastomosis bypass and gastrojejunal Roux-en-Y bypass were both effective in the treatment of selected patients with type 2 diabetes.Compared with gastrojejunal Roux-en-Y bypass,gastrojejunal loop anastomosis bypass had the advantages of easier implementation,shorter operation time,and fewer operation complications.Conclusions Gastrojejunal loop anastomosis is effective in treatment of type 2 diabetes.It is safe,easy to implement,and worthy of clinical popularization。

Abstract：Background Endothelial progenitor cells (EPCs) are used in vascular tissue engineering and clinic therapy.Some investigators get EPCs from the peripheral blood for clinic treatment,but the number of EPCs is seldom enough.We have developed the cultivation and purification of EPCs from the bone marrow of children with congenital heart disease,to provide enough seed cells for a small calibre vascular tissue engineering study.Methods The 0.5-ml of bone marrow was separated from the sternum bone,and 5-ml of peripheral blood was collected from children with congenital heart diseases who had undergone open thoracic surgery.CD34+ and CD34+/VEGFR+cells in the bone marrow and peripheral blood were quantified by flow cytometry.CD34+NEGFR+ cells were defined as EPCs.Mononuclear cells in the bone marrow were isolated by Ficoll(R) density gradient centrifugation and cultured by the EndoCult Liquid Medium KitTM.Colony forming endothelial cells was detected.Immunohistochemistry staining for Dil-ac-LDL and FITC-UEA-1 confirmed the endothelial lineage of these cells.Results CD34+ and CD34+NEGFR+ cells in peripheral blood were (0.07±0.05)％ and (0.05±0.02)％,respectively.The number of CD34+ and CD34+NEGFR+ cells in bone marrow were significantly higher than in blood,(4.41±1.47)％ and (0.98±0.65)％,respectively (P ＜0.0001).Many colony forming units formed in the culture.These cells also expressed high levels of Dil-ac-LDL and FITC-UEA-1.Conclusion This is a novel and feasible approach that can cultivate and purify EPCs from the bone marrow of children with congenital heart disease,and provide seed cells for small calibre vascular tissue engineering。

Abstract：Background Anxiety and fear frequently causes an aversion to applying a face mask and increases difficulty during pediatric induction.There is at present little study of this problem.Therefore,the aim of this study was to investigate the effect of the combination of mask preconditioning and midazolam pretrealment on mask acceptance during pediatric induction and on postoperative mask fear.Methods One hundred and sixty children were randomly assigned into four groups:the mask preconditioning group (MaG),the midazolam pretreatment group (MiG),the mask/midazolam combination group (Ma/MiG),and the saline group (SaG).The Modified Yale Preoperative Anxiety Scale (m-YPAS) was employed to assess the anxiety in the operation room (OR).A Mask Acceptance Score (MAS) was measured during inhalational induction and the incidence of mask fear (MAS ≤2) was evaluated postoperatively.Results The MaG and Ma/MiG groups had the highest mask acceptance scores but there were no differences between these two groups (P ＜0.05).The average anxiety level of children entering the OR was much lower in the MaG and Ma/MiG groups than in the SaG group (P ＜0.05).During induction,the anxiety level increased in the SaG and MaG groups but decreased in the MiG and Ma/MiG groups (P ＜0.05).At the postoperative third day,the incidence of mask fears was as high as 23％ in the SaG group,15％ in the MiG group,but only 2.5％ in the MaG and Ma/MiG groups.Conclusions The single use of mask preconditioning has a better influence than midazolam for increasing mask acceptance during inhalational induction and reducing postoperative mask fear,reducing the anxiety level during induction,improving induction compliance and shortening the total mask time.A mask preconditioning and midazolam combination did not increase mask acceptance during inhalational induction,reduce mask fears postoperatively,improve induction compliance,nor shorten the total mask time.But it can better reduce the anxiety level during induction。

Abstract：Background In cardiology,it is controversial whether gender influences prognosis after acute myocardial infarction (MI).We examined the 30-day and 1-year prognosis for female patients with ST-elevation myocardial infarction (STEMI)in Liaoning province,and we analyzed factors that influenced these outcomes.Methods This was a prospective,multicenter,observational study in which patient data were collected by questionnaire at the time of diagnosis and at approximately 30 days and 1 year later by telephone inquiries.Patients were diagnosed with STEMI between June 1,2009 and June 1,2010 at any of the 20 hospitals that gave treatment representative of current STEMI treatment in Liaoning Province.Unified follow-up questionnaire was used to visit the STEMI patients.Results We analyzed data from a total of 1429 consecutive patients with STEMI in Liaoning province.Female patients were older (70.0 vs.60.3,P ＜0.001) and were less likely to receive emergency reperfusion therapy than male ones (39.2％ vs.58.0％,P ＜0.001).Female gender was associated with higher unadjusted 30-day mortality rates (HR=2.118,95％C/:1.572-2.854,P ＜0.001) and higher unadjusted 1-year mortality rates (HR=2.174,95％C/:1.659-2.848,P ＜0.001).Multivariate Cox regression analysis showed that female gender was not an independent predictor of 30-day mortality rates (HR=1.273,95％C/:0.929-1.745,P=0.133) nor of 1-year mortality rates (HR=1.112,95％C/:0.831-1.487,P=0.475).Conclusions Women with STEMI appear to be at increased risk of 30-day and 1-year mortality compared with male STEMI patients,but this difference may be explained by older age and less frequent receipt of reperfusion therapy among the women。

Abstract：Objective It is known that Siglec-8 is selectively expressed on human eosinophils at a high level and mediates eosinophil apoptosis when crosslinked with its antibody.The aim of our review is to elucidate the molecular and biological characteristic of Siglec-8 and then discuss the function and possible mechanisms of Siglec-8 in eosinophils.Thereby,we will expand our understanding to the regulation of eosinophil apoptosis,and provide important clues to the treatment of asthma and other hyper-eosinophilic diseases.Data sources Most articles were identified by searching of PubMed online resources using the key term Siglecs.Study selection Mainly original milestone articles and critical reviews written by major pioneer investigators in the field were selected.Results Siglec-8 is selectively expressed on human eosinophil and can specifically induce eosinophil apoptosis.Conclusion The restricted expression of Siglec-8 on human eosinophil and the rapid progress in understanding its role as cell signaling and activation of death receptors have made it an attractive target for treatment of asthma and other hyper-eosinophilic diseases。

Abstract：Background More and more Chinese drink hot water from water dispensers while many children were scalded due to this change.The present study aimed to propose a feasible strategy for prevention.Methods A retrospective study was conducted for all water dispensers related pediatric burns admitted to Changhai Hospital from January 2005 to December 2009.Results The number of new cases and incidences of pediatric burns due to hot water from water dispensers was significantly increasing year after year.In the total 238 involved cases,175 cases happened on males and 78.9％ were at the age of 1-4 years.The burn areas were mainly located in upper extremities.All water dispensers in the surveyed families had no isolate protection devices and 85.2％ of their locations were easy for children to reach.Nearly half of the children were in the same room with their guardians when injured.Total 196 burned children were playing the taps of water dispensers before injured,unfortunately,80.6％ of them have not been stopped until burned.Conclusion As the kind of bums is quite serious and with bad outcome,some recommendations should be followed,such as buying water dispensers with protection devices,keeping children from touching them and so on。

Abstract：Coronary artery bypass grafting (CABG) is a mature procedure in treating patients with coronary artery diseases.We report a patient undergoing CABG had history of esophageal cancer and multiple underlying diseases:hypothyroidism,type 2 diabetes mellitus and hypertension.A CABG with midline sternotomy was safely performed in the presence of thyroid replacement therapy and intensive control of blood pressure and blood glucose.The patient recovered postoperatively with supportive care。

Abstract：Bronchioloalveolar carcinoma is a subtype of the lung adenocarcinoma.Early stage bronchioloalveolar carcinoma is usually asymptomatic,especially in the peripheral lung.Rarely,urticaria has been described occurring with lung cancer,usually small-cell lung cancer,but no case has been reported of the bronchioloalveolar carcinoma yet.We report here a unique and initial urticaria on a patient,lasting for 6 months,who finally was diagnosed as early stage bronchioloalveolar carcinoma (T1aNOMo).After treatment of surgery,the symptom of urticaria disappeared and did not recur.Therefore,we consider that utricaria is a oossibly clinical manifestation in early stage bronchioloalveolar carcinoma。

Abstract：Preeclampsia is represented by hypertension and proteinuria in pregnancy.It usually occurs after 20 gestational weeks.There are few reports on preeclampsia before 20 gestational weeks.In this case,we report a patient with chronic hypertension superimposed with preeclampsia at 13 gestational weeks。

Abstract：We reported a case of multiple organ dysfunction syndrome (MODS) following about 300 wasp stings.The diagnosis was based on autopsy findings of acute pulmonary edema,acute kidney injury,hepatic and cardiac dysfunction,and cerebral edema.MODS is a life-threatening complication,and should be considered a possibility after multiple wasp stings.Our autopsy helped to establish the cause of unexpected death due to wasp stings and to elucidate a possible mechanism of MODS。