2012年 · 第125卷第12期

Abstract：Background The predictive value of bifurcation angle (BA) for worse events after stenting bifurcation lesions remains to be unknown.The present study was to investigate the dynamic change of BA and clinical relevance for patients with coronary bifurcation lesions treated by drug-eluting stent (DES).Methods BA was calculated by 3-D quantitative coronary analysis from 347 patients in DKCRUSH-Ⅱ study.Primary endpoint was the occurrence of composite major adverse cardiac events (MACE) at 12-month,including cardiac death,myocardial infarction (MI) and target vessel revascularization (TVR).Secondary end points were the rate of binary restenosis and stent thrombosis at 12-month.Results Stenting was associated with the reduction of distal BA.The cut-off value of distal BAfor predicting MACE was 60° Distal BA in ＜60° group had less reduction after stenting ((-1.96±13.58)° vs.(-12.12±23.58)°,P ＜0.001 ); two-stent technique was associated with significant reduction of distal BA (△(-4.05±14.20)°),compared to single stent group (△+1.55±11.73,P=0.003); the target lesion revascularization (TLR),TVR and MACE rate was higher in one-stent group (16.5％,19.0％ and 21.5％),compared to two-stent group (3.8％,P=0.002; 7.5％,P=0.016; and 9.8％,P=0.024),respectively.Among patients in ≥60° group,there were no significant differences in distal BA,stent thrombosis (ST),MI,MACE,death,TLR,TVR between one- and two-stent groups; after stenting procedure,there was only slight change of distal BA in left anterior descending (LAD)-Ieft circumflex (LCX) subgroup (from (88.54±21.33)° at baseline to (82.44±31.72)° post-stenting),compared to either LAD-diagonal branch (Di),or LCX-obtuse marginal branch (OM),or RCA distal (RCAd) (all P ＜0.001 ).Conclusion Two-stent technique was associated with significant reduction of distal BA.DK crush stenting had reduced rate of MACE in patients in ＜60° group,compared to one-stent technique。

Abstract：Background The incidence and mortality rate of pancreatic cancer have increased dramatically in China over recent decades.Focused ultrasound (FU) has been somewhat successful in treating pancreatic cancer.The purpose of this study was to investigate apoptosis in pancreatic cancer cells induced by FU.Methods Suspension of human pancreatic carcinoma cell line PaTu 8988t was radiated by FU,using five doses with different radiation parameters and patterns,including one blank control.Temperature increase of the cell suspension was monitored.Cell apoptosis and death after FU radiation was observed using fluorescence microscopy and was tested by flow cytometer at 3,6,12,24,and 48 hours after ultrasound radiation.Results The maximum cell suspension temperatures following five radiation doses were 28°C,(42.20±2.17)°C,(50.80±0.84)°C,(55.80±2.17)°C,and (65.20±3.11)°C; differences between the doses were statistically significant (P ＜0.05).The apoptosis rate peaked at 24 hours after radiation,at (0.56±0.15)％,(1.28±0.16)％,(1.84±0.29)％,(5.74±1.15)％,and (2.00±0.84)％ for the five doses; differences between the doses were statistically significant (P ＜0.05).Between doses 1-4,cell apoptosis rates increased as the Tmax increased.In dose 5,as the Tmax was above 60°C,the apoptosis rate decreased.Conclusion Sub-threshold thermal exposures of FU radiation with a continuous radiation pattern could result in higher oercentage of apoptosed cells。

Abstract：Background Obstructive sleep apnea hypopnea syndrome (OSAHS) is regarded as a disease with strong genetic background and associated with hypoadiponectinemia.It is worthwhile to investigate the possible correlation between the single nucleotide polymorphisms (SNPs) in the adiponectin gene and OSAHS.Methods With the TaqMan polymerase chain reaction (PCR) method,the SNPs at positions 45 and 276 in the adiponectin gene were determined in Chinese of Han nationality in Nanjing district consisting of 103 OSAHS patients (OSAHS group) and 67 normal controls (control group).The association of adiponectin genotype polymorphisms at positions 45 and 276 with OSAHS was analyzed.Results No evidence of a direct association was found between OSAHS and adiponectin genotype SNP at positions 45 and 276 (P ＞0.05).However,compared with those OSAHS patients having G/T+T/T genotype at position 276,the OSAHS patients with G/G genotype showed a longer neck circumference,a prolonged duration of the longest apnea event,and an elevated level of blood cholesterol and low-density lipoprotein cholesterol (P ＜0.05).Conclusions No direct association was suggested between OSAHS and adiponectin genotype distribution at positions 45 and 276 in Chinese of Han nationality in Nanjing district.However,in OSAHS patients,those with adiponectin G/G genotype at position 276,seemed to have a higher potential risk in development of OSAHS than those having adiponectin SNP276 G/T +T/T genotype。

Abstract：Background For patients undergoing off-pump coronary artery bypass grafting (OPCABG),it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment.This study aimed to observe the clinical feasibility of artedal pressure-based cardiac output (APCO) for cardiac output (CO) monitoring and to evaluate the correlation between APCO and pulmonary artery catheter (PAC) for CO measurement for patients undergoing OPCABG intraoperatively.Methods Fifty patients of Amedcan Society of Anaesthesiologists (ASA) classification Ⅱ-Ⅲ,undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study.All patients were assigned to CO monitoring by PAC and APCO simultaneously.Patients with pacemaker,severe valvular heart disease,left ventdcular ejection fraction (EF) ＜40％,cardiac arrhythmias,peripheral vascular disease,application of intra-aortic balloon pump (IABP) and emergent diversion to cardiac pulmonary bypass were excluded.The radial artery wavaform was analyzed to estimate the stroke volume (SV) and heart rate (HR) continuously.CO was calculated as SV x HR; other derived parameters were cardiac index (CI),stroke volume index (SVI),systemic vascular resistance (SVR),and systemic vascular resistance index (SVRI).PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms.Continuous cardiac output (CCO),CI and other hemodynamic parameters were monitored at following 5 time points:immediate after anesthesia induction (baseline value),anastomosis of left intemal mammary artery to left anterior descending artery (LAD),anastomosis of left circumflex (LCX),anastomosis of posterior descending artery (PDA) and immediate after sternal closure.Results In the 50 patients,preoperative echocardiography measured left ventricular EF was (52.8±11.5)％,and 35 patients (70％) showed regional wall motion abnormalities.The correlation coefficient of CO monitored by APCO and PAC were 0.70,0.59,0.78,0.74 and 0.85 at each time point.The bias range of CI monitored from both APCO and PAC were (0.39±0.06) L·min-1·m-2,(0.48±0.12) L·min-1·m-2,(0.26±0,06) L·min-1·m-2,(0.27±0.06) L·min-1·m-2,(0.30±0.05)L·min-1·m-2 at each time point.The results of SVR by two hemodynamic monitoring techniques had good correlation during OPCABG.The variation trends of SVR were opposite comparing with the results of CO.SVR collected from PAC obtained the highest value of (1220.0±254.0) dyn·s·cm-5 at PDA anastomosis,but the highest value obtained from APCO was (1206.0±226.5) dyn·s·cm-5 in LCX anastomosis.Conclusions APCO is feasible in hemodynamic monitoring for patients undergoing OPCABG.The results of hemodynamic monitoring dedved from APCO and PAC are closely correlated.Its characterizations of timely,accurate and continuous display of hemodynamic parameters are also obviously demonstrated in the present study。

Abstract：Background Differential diagnosis of intracranial hemorrhage and calcification is a common problem encountered in clinical imaging diagnosis.The purpose of this study was to investigate the feasibility of T2* measurement on gradient echo (GRE) T2*-weighted imaging (T2*WI) in differential diagnosis of intracranial hemorrhage and calcification.Methods Thirty-eight hemorrhagic foci in 18 patients and 11 calcification foci in seven patients were included in this study.The diagnosis of hemorrhage and calcification was confirmed in all cases with enhanced T2* weighted angiography (ESWAN) magnetic resonance imaging (MRI) and CT respectively.The significance for the difference of T2* value between the central and peripheral areas of hemorrhage and calcification lesions was tested with univariate analysis of variance.Results The detection rate of GRE T2*WI on intracranial hemorrhage was 1.9-fold higher than that of CT,especially for the hemorrhage in the brainstem and cerebellum.However,GRE T2*WI was far less sensitive to calcification than CT.There was a significant difference in the T2* value between the central area of hemorrhage and calcification (P ＜0.001),though no difference in the T2* value was obtained between the peripheral area of hemorrhage and calcification (P＞0.05).Conclusions Quantitative measurement of T2* value on GRE T2*WI with a single MRI examination provides a fast,convenient,and effective means in differential diagnosis between intracranial hemorrhage and calcification,which may thus reduce the medical cost and save precious time for clinical management。

Abstract：Background The global outbreak of influenza A (H1N1 ) has led to the Ministry of Health of China listing it as one of the A-class infectious diseases.Pneumonia is the most serious complication of influenza A,commonly causing death.Populations are ordinarily susceptible to influenza A.This study aimed to investigate the imaging manifestation features of cdtical influenza A (H1 N1 ) pneumonia and to improve its diagnostic techniques.Methods A total of seven death cases from critical influenza A (H1 N1 ) pneumonia were retrospectively analyzed on their imaging manifestations and autopsy data.Pulmonary CT scanning was performed for five cases,with one receiving additional chest X-ray and chest CT scanning,and chest postero-anterior position X-ray examination was performed for other two.Autopsy was performed for five cases and postmortem examinations were performed for other two cases.Results The seven cases of influenza A showed critical manifestations in 4-7 days after symptoms onset,with two having basic diseases of diabetes and one being pregnant.Extensive blurry high-density shadows of bilateral lungs were found in three cases,which were most obvious in middle and infedor parts of lungs.Pulmonary CT scanning revealed bilateral flaky parenchymal shadows in peripheral,dorsal and fundus segments of the middle-inferior parts of lungs,with one case of complicated pneumothorax,atelectasis and pleural effusion and another case of thin-walled cavity and dilated bronchi shadows in the superior parts of lungs.Conclusions Diagnostic imaging is an important assessing tool for cdtical influenza A (H1N1) pneumonia The imaging manifestations are characteristic instead of being specific.The definitive diagnosis can be made in combination with clinical examinations and laboratory tests。

Abstract：Background Although bronchoscopy has been widely performed in China,little has been known about its current state and development.In order to investigate the clinical application of bronchoscopy and make instructions for future education and development,the Chinese Society of Respiratory Diseases conducted postal surveys in both 2008 and 2010 in China.Method Questionnaires were sent to 40 tertiary grade A hospitals in 2008 and 58 tediary grade A hospitals in 2010 to investigate bronchoscopies performed in 2007 and 2009 respectively.Results Thirty (75％) hospitals returned the completed questionnaires in 2008 and forty-one (71％) hospitals in 2010.All the respondents possessed flexible bmnchoscopes.Fifty percent of the respondents had less than five in 2007,while more than 50％ of the respondents had 5-9 bronchoscopes in 2009.All the respondents performed a radiograph or CT scan before bronchoscopy.Percentage of general anesthesia and no pre-medication before bronchoscopy increased,while atropine usage decreased in 2009 compared to 2007.Dudng bronchoscopy,pulse oximetry was the most widely used monitoring method.Most respondents used the nasal route to perform routine bronchoscopy.After the procedure,they used sinks to wash and glutaraldehyde to disinfect the bronchoscopes.The total number of flexible bronchoscopies performed during 2007 was 37 874 and the average was 1262.Whereas in 2009,the total number was 60 178 and the average was 1468.Diagnostic bronchoscopy was more widely used than therapeutic bronchoscopy.The mortality rate was 0.076％ in 2007 and 0.032％ in 2009.Conclusions The two surveys,to some extent,reflected the current status and development of bronchoscopy in China.The results are worthy of future education and developing of new guidelines.Regular surveys and monitoring of bronchoscopies across China are needed。

Abstract：Background Immune ce1ls within a tumor microenvironment have shown modulatory effects on tumor angiogenic activity.Renal cell carcinoma (RCC) is a hypervascular tumor that reportedly increases the frequency of regulatory T cells (Tregs) in tumor tissues.This study investigated the correlation between Tregs infiltration and angiogenic status in RCC.Methods Thirty-six patients with RCC were enrolled in the present study,and twenty age-matched healthy donors were included as the control.Tregs were defined as CD4+CD25highCD127low/- T cells.The frequency of Tregs in peripheral blood and tumor infiltrating lymphocytes (TILs) were determined by fiow cytometry.The expression of vascular endothelial growth factor (VEGF) in surgical resection specimens were measured with a commercial enzyme-linked immunosorbent assay (ELISA) kit.Microvessel density (MVD) was calculated on slides stained with CD34 antibody.Spearman's rank correlation was performed to evaluate the correlation between the frequencies of Tregs in TILs and VEGF values,as well as between frequencies of Tregs and MVD determinations.Results Compared to healthy controls,the frequency of peripheral blood Tregs was significantly increased in patients with RCC (P ＜0.05).The percentage of tumor-infiltrating Tregs was higher than that of peripheral blood Tregs in patients with RCC (,P ＜0.01).In addition,the frequency of tumor-infiltrating Tregs was shown to significantly correlate with the pathological stage (P ＜0.05) and nuclear grade (P ＜0.01).Importantly,a significant positive correlation was observed between the frequency of tumor-infiltrating Tregs and VEGF protein expression (r=0.51,P ＜0.05),as well as between frequencies of Tregs and MVD score (r=0.39,P ＜0.05).Conclusions These observations suggest that the high pro-angiogenic status of RCC may be associated with the accumulation of Tregs in the local microenvironment.Angiogenesis networks may be connected with immune tolerance units and cooperate with each other to facilitate tumor growth and progression。

Abstract：Background Determination of the proper orientation of the knee articular surface is required both for correction of knee malalignment by osteotomy and for correct component alignment in knee arthroplasty.We sought to determine whether the patients' sex and lower extremity alignment (hip-knee-ankle angle) affects proper knee realignment in osteotomy or component alignment in total knee arthroplasty.Methods We examined 199 healthy adult knees with malalignment of ＜5° to determine the mechanical medial distal femoral angle,mechanical medial proximal tibial angle,surgical transepicondylar axis angle,and discrepancies between bone-cut orientations of osteotomy or total knee arthroplasty and the joint line of the distal femoral condyles,posterior femoral condyles and proximal tibial plateaus,using a three-dimensional computed tomography model.Results The mean mechanical medial distal femoral angle and mean mechanical medial proximal tibial angle were (94.4±1.9)° and (87.6±1.8)° respectively for women and (93.8±2.0)° and (87.1±.1.4)° respectively for men.The surgical transepicondylar axis angle was (2.9±1.6)° for women and (3.2±1.7)° for men.Independent of sex,the hip-knee-ankle angle was closely related to the mechanical medial distal femoral angle and mechanical medial proximal tibial angle,but not to the surgical transepicondylar axis angle.A slightly more valgus alignment of the knee and a more valgus angulation of the distal femoral joint line were found in women,whereas a more varus angulation of the proximal tibial joint line was found in men.Sex had the greatest effect on knee joint line orientation when the lower extremity was valgus in alignment.Conclusions A more valgus femoral joint line can be expected in women and in persons with valgus lower extremity alignment; a more varus tibial joint line can be found in men and in persons with varus lower extremity alignment。

Abstract：Background Mutations in fumarylacetoacetate hydrolase (FAH) gene can lead to tyrosinemia type 1 (HT1),a relatively rare autosomal recessive disorder.To date,no molecular genetic defects of HT1 in China have been described.We investigated a Chinese family with a HT1 child to identify mutations in FAH.Methods DNA sequencing was used for mutations screening in FAH gene.Real-time polymerase chain reaction (PCR) was performed to determine the FAH gene expression level.To confirm the presence of degradation by the nonsense-mediated mRNA decay pathway (NMD),the fragments containing R237X mutations were analyzed by primer introduced restriction analysis-polymerase chain reaction (PIRA-PCR) and cDNA sequencing.Finally,the effects of the mutations reported in this study were predicted by online softwares.Results A boy aged 3 years and 8 months was diagnosed clinically with HT1 based on his manifestations and biochemical abnormalities.Screening of FAH gene revealed two heterozygous mutations R237X and L375P transmitted from his mother and father respectively.In this pedigree,the amount of FAH mRNA relative to a healthy control was 0.44 for the patient,0.77 for his mother and 1.07 for his father.Moreover,both PIRA-PCR and cDNA sequencing showed significant reduction of the FAH mRNA with R237X nonsense mutation.The missense mutation of L375P was not reported previously and prediction software showed that this mutation decreased the stability of protein structure and affected protein function.Conclusions This is the first case of HT1 analyzed by molecular genetics in China.The R237X mutation in FAH downregulates the FAH gene expression,and the L375P mutation perhaps interrupts the secondary structure of FAH protein。