2014年 · 第127卷第12期

Abstract：Background Venous thromboembolism (VTE) is an important complication after major orthopedic surgery.Pharmaceutical methods represent the main strategy of VTE prevention.The use of aspirin in VTE prevention is still controversial worldwide,especially in China.The purpose of this study was to evaluate the role of aspirin combined with mechanical measures in the prevention of VTE after total knee arthroplasty (TKA).Methods Between January 2012 and May 2013 and in accordance with the inclusion criteria,120 patients undergoing TKA were randomly allocated to two groups.To prevent VTE,patients in group A received aspirin combined with mechanical measures postoperatively,while patients in group B received low-molecular-weight heparin (LMWH) sodium and rivaroxaban sequentially in combination with mechanical measures postoperatively.All surgeries were performed by one surgeon using a posterior-stabilized cemented prosthesis.The two groups were followed up and compared for the incidence of deep vein thrombosis (DVT) by duplex ultrasound scan and clinical VTE events.The adverse events,the blood loss index,and the cost of VTE prevention were also compared.Results DVT was detected in 10 of 60 patients in group A (16.7％,95％ CI:7.3％-26.1％) compared with 11 of 60 in group B (18.3％,95％ CI:8.5％-27.8％) (P=0.500).There is no statistical evidence supporting the inferior effect of aspirin in preventing DVT as compared with the other medications.There were no cases of symptomatic VTE or death during the follow-up period.Area of ecchymosis was lower in group A than in group B,and the differences were statistically significant.Patients in group A had the lower blood loss index as compared with patients in group B.No transfusion cases were found in both groups.The differences were statistically significant.The cost of VTE prevention analysis indicated a cost reduction using aspirin in group A compared with using LMWH and rivaroxaban in group B.Conclusion Aspirin combined with mechanical measures had a good effect on prevention of VTE after TKA and resulted in lower cost,less blood loss,and less subcutaneous ecchymosis。

Abstract：Background Rapidly progressive pneumonia infection with H7N9 virus is a novel disease,and limited information is available concerning serial chest radiographic and computed tomography (CT) findings.The aim of this study was to evaluate the changes in serial radiologic findings in patients with H7N9 pneumonia.Methods The two institutional ethics review boards approved this retrospective study.This study included 10 patients with H7N9 pneumonia.All patients underwent chest radiologic examinations at different time points.Serial radiologic images were systematically analyzed.Results All patients showed abnormal results on initial chest radiography and CT.The initial radiographic abnormalities were unilateral (n=9) and bilateral (n=1),including ground-glass opacities (GGOs) (n=5) and consolidation (n=5).The initial CT findings consisted of unilateral (n=6) and bilateral (n=4),including consolidation (n=10),GGOs (n=10),reticular opacities (n=2),and pleural effusion (n=3).Follow-up radiologic findings showed rapid development of consolidation or GGOs within two weeks after illness onset.Pneumomediastinum with secondary subcutaneous emphysema and pneumothorax were noted in two patients.Follow-up high resolution computed tomography (HRCT) after two weeks showed slow improvement in both size and opacity of the lesions.On HRCT after discharge,patients had substantial residual lesions such as irregular linear opacities,reticular opacities,parenchymal bands,traction bronchiectasis,and cystic lesions.Conclusions The most common radiologic findings at presentation are multifocal or diffuse areas of consolidation and GGOs in H7N9 pneumonia.HRCT in sequence can show more changes in rapid progression of disease and a slow decrease of both size and opacity of the lesions plays an important role in the evaluation of H7N9 pneumonia。

Abstract：Background Endothelial cells derived microRNAs can be detected in plasma and serum and there is evidence that inflammatory disease states may affect the levels of circulating microRNAs.However,there is no direct proof that inflammation induces endothelial cells to release microRNAs into circulation.This study aimed to explore whether inflammation could induce endothelial cells to release microRNAs into circulation and to investigate whether these released microRNAs derived from endothelial cells were transported in microparticles.Methods Microparticles were isolated from human atherosclerotic plaques with an active inflammatory phenotype and normal vascular tissue.Flow cytometry and real-time PCR were used to detect the levels of microparticles and microRNAs.Human umbilical vein endothelial cells (HUVEC) was treated with tumour necrosis factor α (TNF-α,10 ng/ml) for 24 hours,and then HUVEC and the culture medium were respectively collected.Results By comparing microparticles isolated from human atherosclerotic plaques with an active inflammatory phenotype (n=9) and those from normal vascular tissues (n-9),we found levels of annexin V+ microparticles and annexin V+ CD144+ microparticles were significantly increased in plaques and angiogenesis associated microRNAs (106b,25,92a and 21) were also significantly increased in microparticles from plaques.After exposure to TNF-α at a concentration of 10 ng/ml (TNF-α group,n=3) or DMEM (control group,n=3) for 24 hours,counts of microparticles and expressions of microRNAs 106b,25,92a and 21 in microparticles isolated from medium significantly increased.However,there were no differences in the intracellular levels of microRNAs 25,92a or 21 isolated from HUVEC between TNF-α group and control group,while microRNA 106b decreased in TNF-α group.Conclusion Inflammation could induce endothelial cells to release angiogenesis associated microRNAs into circulation,causing higher levels of circulating endothelial cells derived microRNAs in atherosclerosis。

Abstract：Background Recently,studies have disclosed soluble CD40 ligand (sCD40L) during atherosclerosis development and plaque destabilization.The objective of the present study was to test the hypothesis that sCD40L levels are higher in acute coronary syndrome (ACS) patients with a greater extent of angiographic coronary involvement.Methods This cross-sectional study examined ACS patients who underwent coronary angiography by measuring their sCD40L levels.In order to estimate the serum levels of sCD40L,10 ml of peripheral venous blood was drawn within 24 hours of admission.sCD40L levels were measured using an enzyme-linked immunosorbent assay (ELISA,RapidBio,West Hills,CA,USA).Demographic data,presence of concomitant diseases,ACS characteristics,and angiographic findings were evaluated.A review of medical records and patient interviews were conducted to assess coronary risk factors.And the severity of coronary artery disease was evaluated using the Gensini score index.Results Two hundred and eighty-nine patients were included in the study,of whom 186 were male,with an average age of 64.1±10.0 years.Median sCD40L levels were 1.7 ng/ml (0.3-7.3 ng/ml) and Gensini scores were 50 (0-228).After adjusting for demographic variables and cardiovascular risk factors,the Gensini score was associated with the natural logarithm of the sCD40L level (Coefficient b=0.002,95％ CI 0.000-0.003,P=0.029).Conclusion sCD40L levels were independently associated with angiographic severity of coronary artery disease in patients with ACS。

Abstract：Background Under the circumstance of the New Medical Reform in Mainland of China,lowering drug prices has become an approach to relieving increase of medical expenses,and lowering brand-name medication price is a key strategy.This study,by comparing and analyzing brand-name medication prices between Mainland of China and Taiwan,explores how to adjust brand-name medication prices in Mainland of China in the consideration of the drug administrative strategies in Taiwan.Methods By selecting brand-name drug with generic name and dose types matched in Mainland and Taiwan,calculate the average unit price and standard deviation and test it with the paired t-test.In the mean time,drug administrative strategies between Mainland and Taiwan are also compared systematically.Results Among the 70 brand-name medications with generic names and matched dose types,54 are at higher prices in Mainland of China than Taiwan,which is statistically significant in t-test.Also,among the 47 medications with all of matched generic names,dose types,and manufacturing enterprises,38 are at higher prices in Mainland than Taiwan,and the gap is also statistically significant in t-test.In Mainland of China,brand-name medication took cost-plus pricing and price-based price adjustment,while in Taiwan,brand-name medication took internal and external reference pricing and market-based price adjustment.Conclusions Brand-name drug prices were higher in Mainland of China than in Taiwan.The adjustment strategies of drug orices are scientific in Taiwan and are worth reference by Mainland of China。

Abstract：Background Alcohol dependence (AD) is a serious and common public health problem.The identification of genes that contribute to the AD variation will improve our understanding of the genetic mechanism underlying this complex disease.Previous genome-wide association studies (GWAS) and candidate gene genetic association studies identified individual genes as candidates for alcohol phenotypes,but efforts to generate an integrated view of accumulative genetic variants and pathways under alcohol drinking are lacking.Methods We applied enrichment gene set analysis to existing genetic association results to identify pertinent pathways to AD in this study.A total of 1 438 SNPs (P ＜1.0×10-3) associated to alcohol drinking related traits have been collected from 31 studies (10 candidate gene association studies,19 GWAS of SNPs,and 2 GWAS of copy number variants).Results Among all of the KEGG pathways,the calcium signaling pathway (hsa04020) showed the most significant enrichment of associations (21 genes) to alcohol consumption phenotypes (P=5.4×10-5).Furthermore,the calcium signaling pathway is the only pathway that turned out to be significant after multiple test adjustments,achieving Bonferroni P value of 0.8×10-3 and FDR value of 0.6×10-2,respectively.Interestingly,the calcium signaling pathway was previously found to be essential to regulate brain function,and genes in this pathway link to a depressive effect of alcohol consumption on the body.Conclusions Our findings,together with previous biological evidence,suggest the importance of gene polymorphisms of calcium signaling pathway to AD susceptibility.Still,further investigations are warranted to uncover the role of this pathway in AD and related traits。

Abstract：Background In-stent restenosis caused by airway granulation poses a challenge due to the high incidence of recurrence after treatment.Weekly applications of anti-proliferative drugs have potential value in delaying the recurrence of airway obstruction.However,it is not practical to subject patients to repeated bronchoscopy and topical drug applications.We fabricated novel pacilitaxel-eluting tracheal stents with sustained and slow pacilitaxel release,which could inhibit the formation of granulation tissue.And we assessed the quality and drug release behaviors of drug-eluting stents (DESs) in vitro.Methods Stents were dipped vertically into a coating solution prepared by dissolving 0.5 g (2％ w/v) of poly lactic acid-coglycolic acid (PLGA) and 0.025 g (0.1％ w/v) of pacilitaxel in 25 ml of dichloromethane.DES morphology was examined by scanning electron microscopy (SEM).Pacilitaxel release kinetics from these DESs was investigated in vitro by shaking in PBS buffer followed by high performance liquid chromatography (HPLC).Results Using an orthogonal experimental design,we fabricated numerous pacilitaxel/PLGA eluting tracheal stents to assess optimum coating proportions.The optimum coating proportion was 0.1％ (w/v) pacilitaxel and 2％ (w/v) PLGA,which resulted in total pacilitaxel loading of (16.380 6±0.002 1) mg/stent.By SEM the coating was very smooth and uniform.Pacilitaxel released from DES was at (0.376 3±0.003 8) mg/d,which is a therapeutic level.There was a prolonged,sustained release of pacilitaxel of ＞40 days.Conclusions Paclitaxel-loaded PLGA coating tracheal stents were successfully developed and evaluated.Quality assessments demonstrated favorable surface morphology as well as sustained and effective drug release behavior,which provides an experimental reference for clinical practitioners。

Abstract：Background In the last few decades,there has been a delay in first-time pregnancies,and the average age of women at the time of delivery has increased in many countries.Advanced maternal age is associated with adverse pregnancy outcomes.This study aimed to determine the present trends and pregnancy outcomes related to maternal age in China.Methods Data were collected from 39 hospitals in mainland of China.All deliveries were performed after 28 completed weeks of gestation and between January 1 and December 31,2011.In total,110 450 of 112 441 cases were included in the study.All enrolled cases were divided into 6 age groups with 5-year intervals.The x2 test or Fisher's exact test and unadjusted binary-Logistic regression were used for statistical analysis.Results The mean age at the time of delivery was 28.18±4.70 years (range,14-52 years).The teenage group (15-19 years) had a higher risk than the 25-29-year old group for anemia (odds ratio (OR),1.4),preeclampsia (OR,1.6),preterm birth (OR,2.1),low birth weight neonates (OR,2.3),and perinatal mortality (OR,3.6).The 35-39-year old group and ≥40-year-old group had a higher risk than the 25-29-year-old group for leiomyoma (OR,4.2 vs.5.8),pregestational diabetes (OR,2.2 vs.3.8),chronic hypertension (OR,4.6 vs.6.5),gestational diabetes (OR,2.6 vs.3.5),preeclampsia (OR,2.5 vs.3.6),premature delivery (OR,1.8 vs.2.4),postpartum hemorrhage (OR,1.5 vs.1.7),placenta previa (OR,2.7 vs.4.0),placental abruption (OR,1.4 vs.2.5),cesarean delivery (OR,2.1 vs.2.5),macrosomia (OR,1.2 vs.1.2),low birth weight neonates (OR,1.6 vs.2.3),and perinatal mortality (OR,1.6 vs.3.7).Conclusion Maternal and neonatal risks are higher during the teenage years and at an advanced maternal age; 20-30 years of age is the lowest risk period for pregnancy and delivery。

Abstract：Background Although chest radiography is a useful examination tool,it has limitations.Because not all chest conditions can be detected on a radiograph,radiography cannot necessarily rule out all irregularities in the chest.Therefore,further imaging studies may be required to clarify the results of a chest radiograph,or to identify abnormalities that are not readily visible.The aim of this study was to compare traditional chest radiography with acoustic-based imaging (vibration response imaging) for the detection of lung abnormalities in patients with acute dyspnea.Methods The current investigation was a pilot study.Respiratory sounds throughout the respiratory cycle were captured using an acoustic-based imaging technique.Consecutive patients who presented to the emergency department with acute dyspnea and a normal chest radiograph on admission were enrolled and underwent imaging at the time of presentation.Dynamic and static images of vibration (breath sounds) and a dynamic image score were generated,and assessments were made using an evaluation form.Results In healthy volunteer controls (n=61),the mean dynamic image score was 6.3±1.9.In dyspneic patients with normal chest radiographs (n=51) and abnormal chest radiographs (n=48),the dynamic image scores were 4.7±2.7 and 5.1±2.5,respectively (P ＜0.05).The final assessment of the vibration images indicated abnormal findings in 15％,86％ and 90％ of the participants in the above groups,respectively (P ＜0.05).Conclusions In patients with acute dyspnea who present with normal chest radiographs,respiratory sound analyses often showed abnormal values.Hence,the ability of acoustic-based recordings to offer objective and noninvasive measurements of abnormal sound transmission may be useful in the clinical setting for patients presenting with acute dyspnea。

Abstract：Background How the transcriptional factors regulated the innate and adaptive immune system in pregnancy and preeclampsia are less understood.Nevertheless,what the plasma work in the development of this disease was not sure.The present study was design to evaluate what the transcriptional factors change in innate and adaptive immune system and what the plasma do in this filed.Methods Peripheral blood mononuclear cells (PBMC) from non-pregnant women (n=18),women with clinically normal pregnancies (n=23) and women with pre-eclampsia (n=20) were separated from peripheral blood to isolate monocytes and T cells.The purity of monocytes and T cells were analysed by flow cytometry.Monocytes and T cells were stimulated in either lipopolysaccharides (LPS) or phorbol-myristate-acetate (PMA),respectively.Transcription Factor Arrays were used to screen the transcription factors of interest in comparing of different groups.PBMC were isolated from another 8 nonpregnant samples were co-incubated with different groups of plasma.Polymerase chain reaction (PCR) was performed using whole cell extractions of the samples.Results Nuclear factor of activated T-cells-1 (NFAT-1),signal transducers and activators of transcription-1 (STAT-1) and activator protein-1 (AP-1) are up-regulated in monocytes in pregnancy and more so in pre-eclampsia.On the the contrary,NFAT-1,STAT-1 and AP-1 are down-regulated in T cells in pregnancy and more so in pre-eclampsia.A reduction was observed in interferon (IFN)-y,interleukin (IL)-12 and IL-4 expression in T cells incubated with pre-eclamptic plasma.An elevation was observed in tumor necrosis factor (TNF)-α,IL-1 and IL-12 expression in monocytes incubated with preeclamptic plasma.Conclusions Innate immunity is over activated and adaptive immunity is over suppressed in the development of preeclampsia.NFAT-1,STAT-1 and AP-1 might be the central transcription factors in the pathogenesis of pre-eclampsia.They induced some changes in plasma and "educate" the monocytes and T cells for relevant cytokine production.Successful completion of this study will enhance our understanding of pre-eclampsia and will discover new knowledge beyond pregnancy.The work will inform future therapies for the treatment of a wide range of condition such as transplantation immunology and a wide range of immune and inflammatory conditions。

Abstract：Background The therapeutic success of renal transplantation has been largely attributable to the development of effective and balanced immunosuppressive treatment regimens.This study provides a meta-analysis of a series of randomized controlled trials that compared the effects of tacrolimus and cyclosporine on metabolic syndrome (MetS) and cardiovascular risk factors after renal transplantation.Methods We searched various electronic databases and bibliographies,including MEDLINE,the Cochrane Central Register of Controlled Trials,and EMBASE,for relevant studies published prior to October 2012.Results Our meta-analysis included five randomized controlled trials that examined a total of 923 patients.The tacrolimus group and the cyclosporine group exhibited no significant differences in MetS incidence after renal transplantation; risk ratio (RR):1.06,95％ confidence interval (C/):0.73-1.55,P=0.76.Cyclosporine treatment was associated with a higher incidence of hyperlipidemia (RR:0.50,95％ CI:0.39-0.64,P ＜0.01).Although there were no statistically significant differences,cyclosporine treatment was associated with a higher incidence of hypertension (RR:0.91,95％ CI:0.83-1.00,P=0.06) after renal transplantation compared to tacrolimus treatment,and tacrolimus treatment was associated with a higher incidence of diabetes after renal transplantation (RR:1.79,95％ CI:0.98-3.27,P=0.06) compared to cyclosporine treatment.Conclusions Compared to tacrolimus treatment,cyclosporine treatment was associated with a higher incidence of hyperlipidemia.Future large-scale studies are expected to be conducted to further confirm our findings。

Abstract：Background T8590C polymorphism of CYP4A11 has been associated with hypertension,though with conflicting results.The aim of this study was to quantitatively summarize the evidence for CYP4A 11 T8590C polymorphism and hypertension risk.Methods Electronic search of PubMed and the Chinese Biomedicine database was conducted to select studies.Casecontrol studies containing available genotype frequencies of T8590C were chosen,and odds ratio (OR) with 95％ confidence interval (CI) was used to assess the strength of this association.Results Seven case-control studies,including 3 295 cases and 3 192 controls,were identified.The meta-analysis,stratified by ethnicity,showed that individuals with the C allele carriers (CC+CT) had increased risk of hypertension in over all (OR=1.184,95％ CI:1.063-1.319,P=0.002) and in others (OR=1.217,95％ CI:1.045-1.419,P=0.012).The results among Asians did not suggest an association (OR=1.152,95％ CI:0.990-1.342,P=0.068).A symmetric funnel plot,the Egger's test (P=0.863),and the Begg test (P=0.393) were all suggestive of the lack of publication bias.Conclusions This meta-analysis suggests the CYP4A11 T8590C polymorphism may be a risk factor for hypertension.Future well-designed large studies might be necessary to validate this association in different populations incorporated with environmental factors in the susceptibility of hypertension。