2014年 · 第127卷第11期

Abstract：Background Breast cancer 2 (BRCA2) is an important breast cancer-susceptibility gene.Promoter polymorphisms in BRCA2 may affect its transcription and be associated with cancer prognosis.Methods We identified five polymorphisms of the BRCA2 promoter region by in silico searching and direct sequencing:-254A/G (rs3092989),-908A/G (rs206117),-1134A/G (rs206115),-1144C/T (rs206116),and-1260CTTAGA/-(rs3072036).The-908A/G,-1134A/G,-1144C/T,and-1260CTTAGA/-polymorphisms were genotyped by direct sequencing in 491 breast cancer patients,and the-254A/G polymorphism was genotyped by Sequenom.Results The-1144C/T polymorphism was associated with clinical outcome.Carriers of the TT genotype had longer disease-free intervals (DFIs,P=0.029),especially among patients with sporadic unilateral breast cancer (P=0.010).Linkage disequilibrium (LD) analysis showed that all the five single nucleotide polymorphisms (SNPs) were in LD (D'＞0.8).Carriers of haplotypes containing the-1144T allele showed longer DFIs (P=0.049),and the result was more significant in patients with sporadic unilateral cancer (P=0.018).There were no significant associations between the other polymorphisms and DFI.Conclusions The results of this study suggest that homozygosity for the BRCA2 T(-1144) allele is associated with a longer DFI in Chinese women with breast cancer.Further functional studies are warranted to clarify this relationship。

Abstract：Background Many studies have suggested that C-reactive protein (CRP) and blood lipids are associated with hypertension and cardiovascular disease (CVD).However,few studies discussed the combined action of CRP and blood lipids on the risk of hypertension and prehypertension.This study aimed to investigate the combined action of CRP and lipid profiles on the risk of hypertension and prehypertension in Mongolian adults from Inner Mongolia,China.Methods The systolic and diastolic blood pressure,height,weight and waist circumference were measured and factors such as smoking,alcohol intake,family history of hypertension,etc.,were investigated and CRP,low-density lipoprotein cholesterol (LDL-C),triglycerides (TG) were tested for 2 534 Mongolian adults aged ≥20 years.The subjects were divided into four subgroups,namely CRP ＜median and LDL-C (TG) ＜median subgroup,CRP ＜median and LDL-C (TG) ＞median subgroup,CRP ＞median and LDL-C (TG) ＜median subgroup and CRP ＞median and LDL-C (TG) ＞median subgroup.The ORs (95％ C/s) of hypertension and prehypertension for the subgroups were calculated by univariate and multivariate analysis.Results The multivariate adjusted ORs (95％CIs) of hypertension/prehypertension were 1.389 (0.979-1.970)/1.1 51(0.865-1.531),1.666 (1.159-2.394)/1.431 (1.060-1.930),1.756 (1.242-2.484)/ 1.770 (1.321-2.372),for CRP ＜median and LDL-C ＞median subgroup,CRP ＞median and LDL-C ＜median subgroup,and CRP ＞median and LDL-C ＞median subgroup,respectively,compared with CRP ＜median and LDL-C ＜median subgroup.Similarly,the multivariate adjusted ORs (95％ CIs) of hypertension/prehypertension were 2.032 (1.394-2.963)/1.442 (1.047-1.988),1.412 (0.960-2.079)/1.596 (1.166-2.184),and 2.197 (1.595-3.027)/1.730 (1.321-2.266) for CRP ＜median and TG ＞median subgroup,CRP ＞median and TG ＜median subgroup,and CRP ＞median and TG ＞median subgroup,respectively,compared with CRP ＜median and TG ＜median subgroup.The risks of hypertension and prehypertension were the highest in the CRP ＞median and LDL-C (TG) ＞median subgroup among the four subgroups.Conclusions Subjects with both CRP ＞median and LDL-C (TG) ＞median had highest risks of hypertension and prehypertension among all subjects.This study appeared to indicate that the combined action of elevated CRP and elevated LDL-C (TG) further increase the risks of hypertension and prehypertension among Mongolian population。

Abstract：Background Sirtuin 1 (SIRT1) has been reported to have diverse roles in various biological processes through deacetylation of histone and nonhistone proteins.However,the correlations among SIRT1 protein expression,clinicopathological parameters,and survival of colorectal cancer patients remain unclear.Methods SIRT1 protein expression was measured by immunohistochemistry in a paraffin-embedded tissue microarray,including 120 paired colorectal cancer and normal mucosa tissues.The correlations among SIRT1 protein expression,clinicopathological features,and prognosis were analyzed.Results All samples (100％) were positive for SIRT1,with variable staining in the cytoplasm rather than in the nucleus.There was significant difference in SIRT1 overexpression between adenocarcinomas and normal mucosal tissue (P＜0.01,x2 test).SIRT1 overexpression was more frequently observed in advanced-stage tumors (P=0.046,0.002,x2test).SIRT1 overexpression was significantly correlated with poor overall survival (P=0.013,log-rank test) and diseasefree survival (P=0.012,log-rank test).Conclusions SIRT1 overexpression correlated with advanced stage and poor prognosis.SIRT1 may play an important role in the progression of colorectal cancer。

Abstract：Background It is known that the main role of D-dimer has been as an exclusionary test in patients with suspected venous thromboembolism.However,the D-dimer is increasingly beginning to find clinical utility as a marker in the evaluation of the extent of the embolic disease.The aim of the study was to determine whether D-dimer levels predict the radiological markers of pulmonary embolism (PE) severity using Mastora score.Methods This prospective study involved 69 patients with acute PE proved by computed tomography pulmonary angiography (CTPA).The D-dimer level was noted.A pulmonary artery obstruction index (PAOI; Mastora score) ≥21.3％ indicated severe obstruction of PE.A right ventricle/left ventricle (RV/LV) ratio ＞0.9 indicated RV dysfunction.Results The median D-dimer level and PAOI were 765 μg/L (95％ C/:750-1 205 μg/L) and 16.77％ (95％ CI:16.32％-23.06％),respectively.The D-dimer level was positively correlated with PAOI (r=0.417,P ＜0.000 1).PAOI ≥21.3％ was associated with high D-dimer levels (median,993 μg/L (95％ C/:856-1 841 μg/L),Z=-2.991,P=0.003).The D-dimer level was correlated with the RV/LV ratio (r=0.272,P=0.024).RV/LV ratios ＞0.9 were associated with high D-dimer levels (median,880 μg/L (95％ CI:764-1 360 μg/L),Z=-2.070,P=0.038).PAOI was positively correlated with the RV/LV ratio (r =0.390,P=0.001).After three months,both the PAOI and D-dimer levels decreased (Z=-7.009,P ＜0.000 1; Z=-6.976,P＜0.000 1,respectively).Conclusion D-dimer levels are positively correlated with PE burden and right ventricle dysfunction on CTPA,and can help monitor the therapeutic response。

Abstract：Background Ossification of the ligamentum flavum (OLF) has been widely recognized as one of the main causes of thoracic spinal canal stenosis and thoracic myelopathy.Decompression is the only effective strategy for treating thoracic myelopathy caused by OLF.The purpose of this study was to describe the clinical outcomes of computer-assisted minimally invasive spine surgery (CAMISS) for posterior decompression in patients with thoracic myelopathy caused by OLF.Methods In all cases,the surgical procedure was performed with the assistance of an intraoperative three-dimensional navigation system.Decompression of the spinal cord was performed with a high-speed drill; the supraspinal ligaments and spinous process were partially preserved.The outcomes were evaluated by a modified Japanese Orthopedic Association (JOA) scoring system and recovery rates.Results The mean duration of follow-up for the 14 cases was 3.9 years.All patients experienced neurological recovery,the mean JOA score improving from 6.1 points preoperatively to 8.6 points at final follow-up and the mean rate of recovery being 52.7％ (excellent in two cases,good in eight,fair in three,and unchanged in one).Conclusion CAMISS is a safe and effective procedure for resection of the OLF in the thoracic spine。

Abstract：Background Preeclampsia,characterized by hypertension and proteinuria,is a multifactorial disease associated with shallow invasion of trophoblast cells and inadequate spiral artery remodeling.Trophoblast and tumor cells have similar invasion mechanism.Prostasin is closely related to tumor development,invasion and metastasis and influences blood pressure through activating epithelial sodium channel.The effect of prostasin on the pathogenesis of preeclampsia remains unclear.This study investigated the association of prostasin gene at rs12597511 with severe preeclampsia.Methods A single nucleotide polymorphism,rs12597511,was tested with polymerase chain reaction and restrictionfragment length polymorphism analyses in 179 severe preeclampsia patients and 222 normal pregnant women.Results The frequencies of TC + CC genotypes were significantly higher in severe preeclampsia group compared with in control group (the adjusted odds ratio was 2.030,95％ confidence interval 1.195-3.449,P=0.009).The C allele of rs12597511 was present significantly more often among women with severe preeclampsia (P=0.001).Genotyping analysis showed that the C allele of rs12597511 could confer a risk for severe preeclampsia.Conclusion The higher frequency of C allele of prostasin gene at rs12597511 is associated with severe preeclampsia。

Abstract：Background Intravitreal ranibizumab injection is effecitve on treating myopic CNVs,but it could be a risk factor for developing more severe retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane.This study aimed to explore the incidence and features of retinoschisis after intravitreal ranibizumab injection for myopic choroidal neovascularization.Methods Eighty-three eyes of 81 patients with choroidal neovascularization secondary to pathologic myopia were treated with intravitreal ranibizumab injection.The best corrected visual acuity and optical coherence tomography (OCT) images were recorded at baseline and every month thereafter.Central retina thickness and maximal retina thickness were measured.The subjects were divided into three groups.Eleven eyes that had retinoschisis and epiretinal membrane were in group 1,six eyes that had simple epiretinal membrane were in group 2,and 66 eyes that had neither retinoschisis nor epiretinal membrane were in group 3.Six contralateral eyes in group 1 which had retinoschisis and epiretinal membrane but were not treated with intravitreal ranibizumab injection were set as the control group.Results Seven of the 11 eyes in group 1 developed more severe retinoschisis,the mean maximal retinal thickness increased from (380.28±90.13) to (467.00±70.20) μm (P ＜0.05).The retinoschisis of all 6 eyes of the control group did not aggravate.Compared with the control group,the aggravation ratio of retinoschisis increased significantly (P ＜0.05).No new onset of retinoschisis took place in group 2 and group 3.Conclusion Intravitreal ranibizumab injection may be a risk factor for aggravation of retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane。

Abstract：Background It is desirable to minimize the risk of adverse radiation effects associated with percutaneous coronary intervention.The aim of this study was to determine the impact of prolonging the interval between coronary angiography and percutaneous coronary intervention on X-ray-induced DNA double-strand breaks in blood lymphocytes using γ-H2AX immunofluorescence microscopy.Methods Blood samples of eight patients were taken before the first exposure to ionizing radiation,10 minutes,20 minutes,30 minutes,1 hour,and 24 hours after the last exposure to determine the γ-H2AX foci repair kinetics.Fifty-eight patients undergoing percutaneous coronary intervention were randomized to an intermittent radiation exposure group and a continuous radiation exposure group.Blood samples were taken before coronary angiography and 15 minutes after the last exposure.By enumerating γ-H2AX foci,the impact of prolonging the interval on DNA double-strand breaks was investigated.Student t-test was used to compare the difference in DNA double-strand breaks between the two groups.Results An increase in foci was found in all patients received percutaneous coronary intervention.The maximum number of γ-H2AX foci was found 10-20 minutes after the end of the last exposure.There was no statistically significant difference between the two groups in γ-H2AX foci at baseline.On average there were (0.79±0.15) γ-H2AX foci induced by interventional X-rays per lymphocyte in the continuous radiation exposure group and (0.66±0.21) in the intermittent radiation exposure group after exposure (P＜0.05).Conclusions A significant number of γ-H2AX foci develop following the percutaneous coronary intervention procedures.The number of X-ray-induced DNA double-strand breaks may be decreased by prolonging the interval time between coronary angiography and percutaneous coronary intervention to 30 minutes。

Abstract：Background Subdural hematoma (SDH) is a common complication of spontaneous intracranial hypotension (SIH).To date,the management of SDH caused by SIH remains controversial.In this paper,we reviewed the clinical course of SDH in patients with SIH,and discuss the underlying mechanism and attributing factors for rapid resolution of subdural hematomas after epidural blood patch (EBP) surgery.Methods We retrospectively reviewed a cohort of seventy-eight SIH patients diagnosed and treated with targeted EBP in our neurology center.Patients who received early CT/MRI follow-up after EBP operation were included.Results A series of four cases of SIH complicated with SDHs were evaluated.Early follow-up neuroimages of these patients revealed that SDHs could be partially or totally absorbed just two to four days after targeted epidural blood patch treatment.Conclusion Targeted epidural blood patch can result in rapid hematoma regression and good recovery in some patients with a combination of SDH and SIH。

Abstract：Background A causal link between the metatarsus adductus and hallux valgus is not clear.The aim of this study was to investigate the configurations of the metatarsus adductus deformity by radiological measurements and reappraise the relationship between hallux valgus and metatarsus adductus.Methods The first step was evaluation of the relationship between metatarsus adductus and hallux valgus on 143 dorsoplantar weight-bearing radiographs diagnosed as hallux valgus which was also known as bunions.Measurements including the hallux valgus angle (HVA),the intermetatarsal angle (IMA),the Kilmartin angle (KA),the tibial sesamoid position (TSP),and metatarsus adductus angle were taken.The metatarsus adductus angle is defined by Sgarlato's angle (SMA) and Engel's angle (EMA) respectively.Results The metatarsus adductus angle positively correlates with the HVA (r=0.590,P=0.000) and KA (r=0.601,P=0.000),yet negatively correlates with the grade of TSP,(r=-0.348,P=0.000).Contradiction of diagnosis existed in 22 (22/100) subjects diagnosed as metatarsus adductus by SMA yet normal by EMA.In this group,the correlation between HVA and metatarsus adductus angle was negative (r=-0.472,P=0.027).Conclusions EMA and SMA defined metatarsus adductus by different deformity apexes.Metatarsus adductus configurations in that the apex of the deformity lay in either the base of metatarsals or tarsus.They respectively correlate positively or negatively to the HVA。

Abstract：Background Short-segment U-shaped pedicle screw fixation has been widely used to treat thoracolumbar burst fracture.Some studies have reported the disadvantages of traditional U-shaped pedicle screw,which included a relatively high rate of adjacent segment degeneration and screw failure,including screw pullout and breakage.The purpose of this study was to assess the efficacy of open reduction and fixation using KumaFix fixation system in treatment of thoracolumbar burst fractures.Methods From June 2011 to June 2012,45 consecutive patients with thoracolumbar burst fractures were enrolled.They were randomly assigned to treatment with KumaFix (the treatment group,n=23) or traditional U-shaped pedicle screw (the control group,n=22).The patients were followed up postoperatively and were assessed with regard to radiologic and clinical outcomes.Radiologic outcomes were assessed mainly on the basis of Cobb angle and vertebral wedge angle.Clinical outcomes were evaluated mainly with use of Visual Analog Scale (VAS) for pain and the Oswestry Disability Index (ODI) Questionnaire.Results All patients were followed up from 9 to 22 months.There were no significant differences between the two groups with regard to preoperative indices.The operation time in the treatment group was significantly lower than that in the control group.Preoperative Cobb angles and vertebral wedge angles in two groups were significantly decreased after surgery,and these have been well maintained at the last follow-up with mild correction losses.The results of clinical outcome showed lower VAS and ODI scores in two groups compared with those preoperative,and the treatment group had greater improvement on the ODI compared with the control group at the last follow-up.Conclusions Compared with traditional U-shaped pedicle screw,KumaFix fixation system can achieve gradual,controlled reduction,provide enough space for bone implantation,and avoid acceleration of adjacent segment degeneration.It is an effective and reliable technique to treat thoracolumbar burst fractures。

Abstract：Background Monoclonal antibodies (mAbs) such as DD3,raised against progastrin-releasing peptide(31-98) (ProGRP(31-98)) antigen,have been used to target small cell lung cancer (SCLC).However,as an intact mAb,DD3 is cleared slowly from the body,with an optimal radioimmunoimaging time of 72 hours.More recently,a singlechain antibody fragment has demonstrated reduced excretion time in blood and normal tissues and is increasingly used in diagnostic cancer research.Thereby,it potentially increases the radioimmunoimaging efficacy.However,there have been few studies with this antibody fragment.The aim of this study was to characterize the preliminary radioimmunoimaging and biodistribution of 1311I-anti-ProGRP(31-98)scFv in nude mice bearing SCLC xenografts.Methods Anti-ProGRP(31-98) scFv was used to detect ProGRP expression by flow cytometry analysis and immunohistochemistry.131I-anti-ProGRP(31-98) scFv was injected intravenously into healthy Kunming mice and the percentage injected dose per gram (％ID/g) in various organs was calculated.Similarly,the ％ID/g and tumor/non-tumor ratio in xenograft-bearing mice was calculated.After injection of 131I-anti-ProGRP(31-98) scFv,treated mice were imaged at 1,24,and 30 hours.Then the tumor/base ratios were calculated.Results ProGRP was highly expressed in NCI-H446 cells and xenograft tissue.The metabolism of 131I-anti-ProGRP(31-98) scFv in healthy mice was consistent with a first-order and two-compartment model; T1/2α and T1/2β were 10.2 minutes and 5 hours 18 minutes,respectively.The ％ID/g of 131I-anti-ProGRP(31-98) scFv in xenografts was much higher than in healthy tissues at 12 hours after injection,reaching a maximum of (5.38±0.92) ％ID/g at 24 hours.Successful imaging of xenograft tissue was achieved as early as 1 hour post-injection and persisted until 30 hours,with 24 hours proving optimal.Conclusion 131I-anti-ProGRP(31-98)scFv shows highly selective tumor uptake with low accumulation in normal tissues and rapid blood clearance,indicating thatit could be a promising agent for SCLC radioimmunoimaging。

Abstract：Background Little is known about asthma control and perception of asthma among asthmatic patients in China.This study marked the first survey conducted on a national scale that aimed at obtaining baseline information on asthma control and patients' perception of asthma and providing a point of reference for future studies.Methods This face-to-face,questionnaire-based survey was conducted from April 2007 to March 2008 with 3 069 asthmatic patients from the respiratory outpatient clinics of 36 general hospitals located in 10 geographically dispersed cities.Results Consistent with the Global Initiative for Asthma (GINA) guidelines,28.7％ and 45.0％ of our patients achieved control and partial control,respectively.Of the patients in the study,only 21.8％ had used a peak flow meter (PFM),and 6.6％ of these patients used it daily.Inhaled corticosteroids (ICS) plus a long-acting β2 agonist (LABA) and ICS were the two most common medication regimens and were used in 45.6％ and 30.4％ of patients,respectively.Asthma had a significant effect on the patients' life and work.A considerable number of hospitalizations,emergency department visits,and sick days were observed.Conclusion Despite improvements in asthma control and ICS and PFM compliance compared with past literature,the current level of asthma control countrywide continues to fall short of the goals set in the GINA。

Abstract：Background For young patients,the surgical method for lumbar disc herniation remains controversial.The aim of this study was to prospectively determine the short-term clinical outcome after surgery for young patients with lumbar disc herniation.Methods In this prospective comparative study between April 2010 and August 2011,a total of 80 patients underwent primary surgery at a single level for lumbar disc herniation.The patients were divided into two groups:decompression alone and decompression with instrumented fusion.An independent examiner clinically evaluated the patients at preoperation and at 1,3,6,and 12 months after surgery.The patients filled out the instruments for back and leg pain using a Visual Analog Scale (VAS),Oswestry Low Back Pain Disability Questionnaire (ODI),and Japanese Orthopaedic Association (JOA) scores.The differences between the two groups were analyzed.Results The mean age of all the patients at the time of surgery was 33.7 years.Of the 80 patients,38 patients underwent decompression alone and 42 patients underwent posterior lumbar interbody fusion.Increasing complexity of surgery was associated with a longer surgery time,greater blood loss,and a longer hospital stay after surgery.Both methods of surgery independently improved outcomes compared with baseline status based on VAS,ODI,and JOA scores (P ＜0.05),and no significant differences were found between the two groups at most of the measuring points in time,although patients with decompression alone had a higher JOA score (P=0.016) and higher JOA recovery rate (P=0.010) at the 3-month follow-up.Conclusions The short-term results of our study showed that both methods of surgery obtained effective clinical outcomes,but decompression alone had some advantages (shorter surgery time,less blood loss,shorter hospital stay,and lower cost) compared with decompression with instrumented fusion.Young patients with decompression alone could achieve great physical function earlier。

Abstract：Background A large amount of biomechanical and clinical evidence from previous studies suggest the efficiency of the two different posterior lumber non-fusion methods,interspinous distraction device (ISDD) and facet screw fixation system (FSS),but the biomechanical comparison of ISDD and FSS has not been thoroughly clarified.Methods In the current study,finite element methods were used to investigate the biomechanical comparison of ISDD and FSS.The range of motion (ROM),intradiscal pressure (IDP) and the protective effects gained by maintaining disc heights were evaluated.Results The ROM was similar between the two non-fusion methods under static standing,flexion and lateral bending.The FSS appeared to be more effective in resisting extension.At the implanted level L3/4,FSS displayed better results for maintaining and increasing posterior disc heights.At the L4/5 level in extension and lateral bending,FSS was better than ISDD,with comparable results observed in other motions.Comparing the posterior and lateral disc heights,FSS appeared to be more effective than ISDD.FSS also had a minor effect on the inferior adjacent segment than ISDD.FSS was more effective in reducing IDP than ISDD in extension.Conclusion Through the finite element analysis study,it can be seen that FSS demonstrates more beneficial biomechanical outcomes than does ISDD,such as being more effective in resisting extension,maintaining and increasing lumbar disc heights and reducing the inferior adjacent IDP in extension。

Abstract：Background Hypertension (HTN) is a very prevalent public health problem and as the population ages,cognitive impairment (CI) is also going to be a public health burden.However,the relationship between hypertension duration and cognitive function declination worldwide is still unknown.The aim of the study was to investigate the effects of HTN duration on CI in Chinese population.Methods At baseline,1 386 HTN patients and 293 normotensive (NT) people were enrolled.The HTN patients were further divided into four subgroups (duration of HTN ＜6 years,6-10 years,11-20 years,and ＞20 years) according to the HTN duration and were screened for cognitive function with neuropsychological tests including mini-mental-state-examination (MMSE) and clock-drawing-test (CDT) in comparison with the NT group.Results More HTN patients had CI (45.3％) than NT subjects (30.4％),and increased with HTN duration (P＜0.000 1).Compared with the scores of MMSE and CDT in the NT group,the declines were higher in the HTN patients (P ＜0.000 1),and in the four HTN subgroups,both MMSE and CDT scores fall when the HTN duration increased (P ＜0.05).Furthermore,in the HTN population without CI,the trend in alteration of CI was relatively mild but still existed (P ＜0.05).Conclusion People with HTN are more likely to have CI and the possibility and aggravation increases the prolongation of HTN duration,both in amnesic and nonamnesic function。

Abstract：Background First generation drug-eluting stents (DES) were associated with a high incidence of late stent thrombosis (ST),mainly due to delayed healing and re-endothelization by the durable polymer coating.This study sought to assess the safety and efficacy of the Nano polymer-free sirolimus-eluting stent (SES) in the treatment of patients with de novo coronary artery lesions.Methods The Nano trial is the first randomized trial designed to compare the safety and efficacy of the Nano polymer-free SES and Partner durable-polymer SES (Lepu Medical Technology,Beijing,China) in the treatment of patients with de novo native coronary lesions.The primary endpoint was in-stent late lumen loss (LLL) at 9-month follow-up.The secondary endpoint was major adverse cardiac events (MACE),a composite of cardiac death,myocardial infarction or target lesion revascularization.Results A total of 291 patients (Nano group:n=143,Partner group:n=148) were enrolled in this trial from 19 Chinese centers.The Nano polymer-free SES was non-inferior to the Partner durable-polymer DES at the primary endpoint of 9 months (P ＜0.001).The 9-month in-segment LLL of the polymer-free Nano SES was comparable to the Partner SES (0.34±0.42) mm vs.(0.30±0.48) mm,P=0.21).The incidence of MACE in the Nano group were 7.6％ compared to the Partner group of 5.9％ (P=0.75) at 2 years follow-up.The frequency of cardiac death and stent thrombosis was low for both Nano and Partner SES (0.8％ vs.0.7％,0.8％ vs.1.5％,both P=1.00).Conclusions In this multicenter randomized Nano trial,the Nano polymer-free SES showed similar safety and efficacy compared with the Partner SES in the treatment of patients with de novo coronary artery lesions.Trials in patients with complex lesions and longer term follow-up are necessary to confirm the clinical performance of this novel Nano polymer-free SES。

Abstract：Background Drug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes.However,the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial.Methods We searched Medline,the Cochrane Library and other internet sources,without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES.Safety endpoints were ST (definite,definite/probable),mortality,and myocardial infarction (MI).Efficacy endpoints were major adverse cardiac event (MACE) and target lesion revascularization (TLR).Results We identified 15 randomized controlled trials (n=17 068) with a weighted mean follow-up of 20.6 months.There was no statistical difference in the incidence of definite/probable ST between durable polymer-and biodegradable polymerDES; relative risk (RR) 0.83; 95％ confidence interval (CI) 0.62-1.11; P=0.22.Biodegradable polymer DES had similar rates of definite ST (RR 0.94,95％ CI 0.66-1.33,P=0.72),mortality (RR 0.94,95％ C/0.82-1.09,P=0.43),MI (RR 1.08,95％ CI 0.92-1.26.P=0.35),MACE (RR 0.99,95％ CI 0.91-1.09,P=0.85),and TLR (RR,0.94,95％ CI 0.83-1.06,P=0.30) compared with durable polymer DES.Based on the stratified analysis of the included trials,the treatment effect on definite ST was different at different follow-up times:≤1 year favoring durable polymer DES and ＞1 year favoring biodegradable polymer DES.Conclusions Biodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES.Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES。

Abstract：Objective To elaborate known and unknown aspects of radiation oncology.Data sources Data cited in this review were obtained mainly from PubMed and Medline in English from 1999 to 2013,with keywords "individualized medicine","personalized medicine","radiation dose","radiation target","molecular targeted therapy","molecular imaging" and "~nctional imaging".Study selection Articles regarding radiation target delineation,radiation doses,new technology and equipment,combination of radiotherapy and molecular targeted therapy as well as other aspects were identified,retrieved and reviewed.Results A larger radiation field and a higher radiation dose are not always better.New equipment and technology are also not always better than conventional equipment and technologies.Effectiveness of radiotherapy combined with molecular targeted therapy needs more data to verify.Conclusion Personalized radiotherapy is the direction for the future。

Abstract：Background Chronic kidney disease (CKD) is a common disorder associated with multiple adverse clinical consequences,especially cardiovascular risk and end-stage renal disease.A recent national survey demonstrated that CKD has become a leading health problem in China.There is an urgent need to implement an in-depth investigation of the CKD burden and also to explore underlying mechanisms of CKD progression and it association with adverse consequences.Methods The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is the first national CKD cohort in China.It will enroll approximately 3 000 pre-dialysis CKD patients aged between 18 and 74 years and follow-up for at least 5 years.Questionnaires,anthropometric measures,laboratory tests,and biomaterials will be collected at baseline and annually.The principal clinical outcomes of the C-STRIDE consist of renal disease events,cardiovascular events,and death.Based on the longitudinal clinical data and biomaterials,the risk factors with CKD progression and other outcomes will be analyzed,and candidate markers and predicted models will be established.Conclusion The C-STRIDE would provide important evidence for underlying mechanisms of CKD progression,valuable information for clinical guidelines,and healthcare policies in China。

Sanya is the one of most southern cities and tropical cities in China,situated on Hainan Island.It located between 18°09′ and 18°37′ latitude almost the same geographic position as Hawaii.Because of Sanya's location,it is a suitable habitat for snake to reproduce as other tropical areas。

The extracranial-intracranial (EC-IC) bypass surgery has been widely used in the treatment of cerebral ischemia,intracranial aneurysms,and other diseases for more than 40 years.In terms of treating atherosclerotic cerebral ischemia,the surgery is presumed to be helpful for the subgroup of hemodynamic compromise in prevention of subsequent stroke.However,two multicenter trials presented with high perioperative stroke rate and failed to demonstrate the profit of the surgery.1-3 On this point,one of the crucial issues currently is how to lower down the perioperative stroke rate,the centerpiece of which is early postoperative infarction (EPI).3

To the editor:A 27-year-old male admitted to our hospital with complaints of recurrent chest pain for 5 days.Precordial discomfort started during playing poker.The patient was a current smoker (2 packs per day) without past medical and family histories。