2012年 · 第125卷第16期

Abstract：Background The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation.Methods Atotal of 191 patients with acute STEMI undergoing PCI from Jan.2005 to Dec.2007 were enrolled.Patients received DES (n=83) or BMS (n=108) implantation in the infarction related artery according to physician's discretion.The primary outcome was the occurrence of major adverse cardiac events (MACE),which was defined as a composite of death,myocardial infarction (MI),target vessel revascularization (TVR) and stent thrombosis.The difference of MACE was observed between DES and BMS groups.Results The clinical follow-up duration was 3 years ((41.7±16.1) months).MACE occurred in 20 patients during three years follow-up.Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P=0.0301).There was no significant difference in all-cause mortality (3.61％vs.7.41％,P=0.2647),the incidence of myocardial infarction (0 vs.0.93％,P=0.379) and stent thrombosis (1.20％ vs.1.85％,P=0.727) between the DES group and BMS group.The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82％ vs.14.81％,P=0.0253).The rate of TVR was also lower in the DES group (0 vs.5.56％,P=0.029).In the DES group,there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES,n=73) and paclitaxel-eluting stents (PES,n=10) subgroups (2.74％ vs.20.00％,P＞0.05).Conclusions This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI,without increasing the incidence of death or myocardial infarction.Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up。

Abstract：Background Transcatheter aortic valve implantation (TAVI) is a rapidly evolving strategy for therapy of aortic stenosis.We presented the procedural results and analyzed the death causes of 30-day mortality and clinical events in patients who underwent TAVI with Edwards prosthetic valves in University Hospital of Caen,France.Methods The patients with severe aortic stenosis but at high surgical risk or inoperable were considered as candidates for TAVI.Forty-eight patients undergoing TAVI from July 2010 to September 2011 were enrolled in this registry.The Edwards prosthetic valves were solely used in this clinical trial.Results Overall 48 patients underwent TAVI,28 of which accepted TAVI by trans-femoral (TF) approaches,20 by trans-apical approaches (TA).The aortic valve area (AVA) was (0.70±0.23) cm2,left ventricular ejection fraction (LVEF)was (57.4±17.6)％,Log EuroSCORE was (19.2±15.8)％,mean gradient was (47.0±16.6) mmHg.There were no significant differences between TF and TA groups in all these baseline parameters.Device success rate was 95.8％,and procedural success rate was 93.7％ in total.Procedural mortality was 6.7％ (3/48):two deaths in TA group (10％),and one death in TF group (3.6％).Forty-six Edwards valves were implanted:10 Edwards Sapien and 36 Edwards XT.Procedure-related complications included cardiac tamponade in 2 cases (4.2％),acute myocardial infarction (AMI) in 1 case (2.1％),permanent pacemaker implantation in 1 case (2.1％),life-threatening and major bleeding in 3 cases; access site related major complication in 1 case,AKI stage 3 in 3 cases (6.3％),minor stroke in 1 case (2.1％).Thirty-day survival rate was 89.6％.There were 5 deaths in total (10.4％):4 in TA group (20％) and 1 in TF group (3.6％).Conclusion The procedural success rate and 30-day mortality were acceptable in these high risk patients with Edwards prosthetic valves in the first 48 TAVI。

Abstract：Background The prognostic relevance of World Health Organization (WHO) subtypes within type B thymomas is still controversial.Understanding of the molecular characteristics of the different histologic types of thymomas will provide meaningful information for diagnosis and therapeutic management in type B thymoma.Methods Proteins extracted from twelve type B thymoma tissue specimens (six type B1 and six type B2) were analyzed by two-dimensional electrophoresis (2-DE) coupled with MALDI-TOF-MS.Differentially expressed proteins were then assayed in sixty-nine type B thymoma tissues (including B1,B2 and B3) by tissue array analysis with immunohistochemistry staining.The relationship of their expression with clinicopathological parameters,such as tumor stage or WHO classification,was estimated by Spearman's Rank Correlation Test.Results Sixteen differentially expressed proteins between type B1 and B2 thymoma tissues were identified.The differential levels of ezrin and glutathione S-transferase pi (GSTP1) were validated using immunohistochemistry staining.A statistically significant difference was observed in the positive rate of ezrin expression between type B1 thymoma and type B3 thymoma (Z=-2.963,P ＜0.01).Ezrin showed a tendency to be expressed in higher classification tumors from type B1 to B3.A statistical analysis demonstrated that type B2 and B3 tumors had significantly higher positive expression of GSTP1 than the B1 group (type B2 vs.B1:Z=-2.582,P ≤0.01; type B3 vs.B1:Z=-4.012,P≤0.001).The results also showed a strong correlation between GSTP1 and WHO type staging of B1 to B3 tumors (Spearman's correlation coefficient:0.633,P≤0.001).Statistical analysis showed that there was close correlation between GSTP1 and ezrin expression with the clinical stage (Spearman's correlation coefficients,ezrin:0.481,P ＜0.05; GSTP1:0.484,P ＜0.01).Conclusions Differentially expressed proteins between type B1 and B2 thymoma tissues were analyzed by comparative proteomic analysis.The techniques of proteomic analysis and tissue array provide a potential tool for screening of key molecules in type B thymoma histological sub-classifications.The statistical analysis of ezrin and GSTP1 expression by immunohistochemistry,especially GSTP1,may be a useful approach for type B thymoma classification。

Abstract：Background Previous studies have shown evidence of health-related risk behaviors among women who have sex with women (WSW),such as sex with men,multiple bisexual partners,and drug use.Women who have sex with women have also been known to avoid routine physical examinations and conceal their same-sex history from physicians,which can affect their ability to receive an accurate diagnosis and treatment.No previous research has targeted women who have sex with women in China.We sought to describe women who have sex with women in China and explore risk factors for their reproductive tract infections (RTI)/sexually transmitted infections (STI).Methods Participants were recruited through outreach in venues and online for a cross-sectional study.Data were collected using interviews and laboratory tests.Results We recruited 224 women who have sex with women.In the year preceding their participation in the study,92％ (206/224) of women reported sexual relations with women.The RTI rates were:gonorrhea (15.8％),chlamydia (3.5％),syphilis (0.5％),bacterial vaginosis (14.4％),hepatitis B virus (HBV) (0.9％),hepatitis C virus (HCV) (0.5％),and candidiasis (6.9％).No HIV or herpes simplex virus (HSV) positive cases were detected.Factors associated with gonorrhea infection were non-Beijing local residency (odds ratio (OR)=2.1,95％ confidence interval (Cl):1.2-3.8) and genital-genital contact (OR=3.1,95％ Cl:1.3-7.2); factors associated with curable STI (excluding bacterial vaginosis,candidiasis,HBV and HCV) were non-Beijing local residency (OR=1.9; 95％ Cl:1.2-3.0) and bleeding during or after sex (OR=18.1; 95％ CI:5.2-62.6); and the factor associated with RTI (including all the infections tested) was bleeding during or after sex (OR=37.8,95％ Cl:11.2-127.4).Conclusions Behaviors that may cause RTI/STI exist among Chinese women who have sex with women.Researchers should consider these behaviors when planning corresponding prevention and interventions。

Abstract：Background Iloprost has been used to test acute pulmonary vasoreactivity in idiopathic pulmonary arterial hypertension (PAH).We aimed to investigate the acute hemodynamic and oxygenation responses and tolerability to 20 μg aerosolized Iloprost in Chinese patients with pulmonary hypertension.Methods Between March 2005 and May 2010,212 pulmonary hypertension patients inhaled a single dose of 20 μg Iloprost over 10-15 minutes for vasoreactivity testing.The acute hemodynamic and oxygenation responses and adverse events were recorded.Results lioprost decreased total pulmonary resistance ((1747±918) dyn.s.cm-5 vs.(1581±937) dyn.s.cm-5,P ＜0.001),increased stroke volume ((45.0±22.1) ml vs.(47.0±24.2) ml,P=0.002),and cardiac output ((3.7±1.7) L/ml vs.(3.9±1.9)L/min,P=0.009).Heart rate and systemic vascular resistance remained stable during inhalation.However,systemic arterial blood oxygen saturation fell slightly ((91.0±6.8)％ vs.(90.3±6.7)％,P=0.002).Pulmonary and systemic arterial blood pressures declined within 1-3 minutes after inhalation initiation and reached their lowest levels within 10-15 minutes.Idiopathic PAH responded more favorably than pulmonary hypertension due to other causes (P≤0.001) and patients with less severe pulmonary hypertension have better responses to Iloprost.No adverse events requiring medical care or leading to termination of inhalation occurred.Conclusions Inhalation of 20 μg Iloprost showed potent and selective pulmonary hemodynamic effects and was well tolerated in the Chinese pulmonary hypertension patients.Patients with idiopathic PAH and less severe pulmonary hypertension responded more favorably to inhalation of Iloprost。

Abstract：Background Percutaneous vertebroplasty (PVP) has become a popular procedure for painful vertebral osteoporotic fracture (VOF),with immediate pain relief and improved mobility; however,polymethylmethacrylate (PMMA) injected into the vertebral body is not absorbable and little information is available concerning the long-term results.In this retrospective study,we evaluated the long-term clinical results and radiological changes after PVPs for VOFs.Methods Fifty-one patients with VOFs were treated by PVPs with PMMA between 2000 and 2004.After ＞7 years of follow-up,eight patients had died from causes unrelated to the intervention and 12 patients were lost to follow-up,thus leaving 31 patients available for evaluation with an average length of follow-up of 9.2 years (follow-up rate,72.1％).Among these 31 patients,the PMMA was injected at 43 levels with a mean volume of 4.3 ml per level (range,2-6 ml).The pain was assessed with a visual analog scale (VAS),and the mobility was graded as walking without difficulty (grade 1),walking with assistance (grade 2),and bedridden (grade 3).Plain radiographs and computed tomography (CT) were obtained and assessed pre-operatively,immediately post-operatively,and after 7 years of follow-up.The PMMA,vertebral height,and Cobb angle were assessed and compared.Results All of the patients experienced pain relief and improved mobility after intervention and during the follow-up period.Cement leakage was detected in post-operative CT scans in 9 of 51 patients,but without neurological compromise.For the 31 patients followed up over 7 years,the VAS decreased from 8.3±2.6 pre-operatively,to 2.1±1.6 immediately post-operatively,and 1.0±0.9 at the final follow-up evaluation,with significantly improved mobility.Additional compression fractures occurred at adjacent levels in three patients,and there were no new fractures at the augmented vertebrae.Based on a review of the radiographs,neither loose nor displaced cement was detected.The changes in vertebral height and Cobb angle were not significant.On CT scans,the cement closely contacted or infiltrated the trabecular bone.The boundary between the cement and trabecular bone was indistinct and there was no evident radiolucent gap between the cement and trabecular bone.Conclusions At an average follow-up of 9.2 years,PVPs provided sustained pain relief and improved mobility in patients with VOFs.The PMMA injected into the vertebral body combined closely with the host trabecular bone without adverse reactions。

Abstract：Background The successful end-point of in vitro fertilization (IVF) treatment is for a woman to give live birth.This outcome is based on various factors including adequate number of retrieved eggs.Failure to recruit adequate follicles,from which the eggs are retrieved,is called a "poor response".How to improve the clinical pregnancy rates of poor responders was one of the tough problems for IVF.Methods The study involved 51 patients who responded poorly to high dose gonadotropin treatment in their previous cycles at our reproductive center,between April 2010 and February 2012.The previous cycle (group A) received routine long protocol; the subsequent cycle (group B) received modified super-long down-regulation protocol.The primary outcome of the study was the number of oocytes fertilized.The increase in the pregnancy rate was the secondary outcome.Differences between the groups were assessed by using Student's t test and x2 test where appropriate.Results The patients' average age was (36.64±3.85) years.The mean duration of ovarian stimulation cycles of the group A patients was longer than those of the group B patients.The total dose of follicle-stimulating hormone (FSH) was significantly lower in the subsequent cycle.The peak value of serum estradiol on human chorionic gonadotrophin (hCG) day was lower in group A as compared with group B.The number of metaphase Ⅱ oocytes recovered was significantly higher in group B.The cleavage rate in group A was significantly lower than in group B,49 patients in group B reached embryo transfer stage,while 46 patients in group A reached this stage.Patients in group B received significantly more embryos per transfer as compared with group A.More pregnancies and more clinical pregnancies with fetal heart activity were achieved in group B.Conclusions This comparative trial shows that poor responder women undergoing repeated assisted reproduction treatment using modified super-long down-regulation protocol achieve more oocytes,leading to higher fertilization rate,compared to women receiving routine long protocol.Our study also showed that clinical pregnancy rate was significantly improved。

Abstract：Background Loss of carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) expression is an adverse prognostic factor in hepatocellular carcinoma (HCC).The purpose of this study was to investigate the expression of CEACAM1 and its effect on relapse-free survival (RFS) following liver transplantation (LT) for HCC.Methods Expression of CEACAM1 was immunohistochemically detected in HCC specimens from 48 patients.The relationship between CEACAM1 expression and clinicopathologic variables,as well as tumor recurrence,was further analyzed.Results Of the 48 HCC specimens,membranous CEACAM1 expression was detected in 25 specimens and cytoplasmic CEACAM1 expression was detected in 19 specimens.Four specimens had loss of CEACAM1 expression.Loss of membranous CEACAM1 expression was significantly associated with tumor size,tumor number,and serum α-fetoprotein levels (all P ＜0.05).Patients with loss of membranous CEACAM1 had significantly poorer RFS than patients with membranous expression,determined via Kaplan-Meier analysis (P=0.027).Multivariate analysis revealed that loss of membranous CEACAM1 expression might be an independent prognostic factor of RFS for HCC patients after liver transplantation (P=0.037).Conclusion Loss of membranous CEACAM1 expression in HCC was closely associated with aggressive tumor biology and might be a relapsing biomarker of HCC treated with LT。

Abstract：Background The ideal post-gastrectomy reconstruction procedure should maintain the normal digestive function and restore intestinal transit to improve the patient quality of life.The aim of this study was to evaluate the effects of integral continual jejunal interposition after subtotal gastrectomy on the nutritional status,glucose levels,and gastric-intestinal motility.Methods The study investigated the effects of the integral continual jejunal interposition,the Billroth Ⅰ and Billroth Ⅱ operations,and the isolated jejunal interposition following subtotal distal gastrectomy on the blood glucose,insulin,routine blood parameters,liver function,and myoelectrical activity in Beagle dogs.Results The weights of the dogs decreased during the first post-operative weeks.Dogs in the integral continual jejunal interposition,Billroth Ⅰ,and Billroth Ⅱ groups gained significantly more weight by 8 weeks.The prognosis nutrition index of the dogs decreased in the first 2 post-operative weeks and increased significantly by 4 weeks in the integral continual jejunal interposition and Billroth Ⅰ groups.The group with duodenal exclusion (Billroth Ⅱ) had significantly higher glucose levels compared to the normal control group.The insulin curve was much higher in dogs that underwent the Billroth Ⅰ,continual jejunal interposition,and isolated jejunal interposition than the Billroth Ⅱ and normal groups.The frequencies of fasting and postprandial jejunal pacesetter potentials (PPs) were greater in the continual jejunal interposition and Billroth Ⅰ groups than that in the isolated jejunal interposition and Billroth Ⅱ groups.The percentage of aboral propagation of PPs was greater in the continual jejunal interposition group than the Billroth Ⅰ,isolated jejunal interposition,and Billroth Ⅱ groups.Conclusion Continual jejunal interposition after subtotal gastrectomy avoids jejunal transection,maintains the duodenal passage and food storage bags,and reduces the influence of blood glucose and insulin。

Abstract：Background The term heart failure with normal ejection fraction (HFNEF) is often used to describe the syndrome of heart failure with normal ejection fraction.Based on the previous studies,HFNEF has a significant morbidity and mortality and is associated with a similar prognosis to heart failure with reduced ejection fraction (HFREF).The present study aimed to investigate the clinical characteristics and prognosis of HFNEF in elderly patients.Methods Consecutive elderly patients (≥60 years old) hospitalized for the first episode of heart failure (HF) in Beijing Hospital from January 2003 to December 2009 were retrospectively recruited.Three hundred and ten patients with HF were eligible for our study.As recently recommended,a cut-off value of 50％ was used to distinguish HFNEF (LVEF≥50％) from HFREF (LVEF＜50％).Data were retrospectively obtained from hospital records and databases.Follow-up data were obtained by telephone and from hospital records.For every eligible patient,the clinical characteristics and prognosis were collected and compared between the HFNEF and HFREF groups.Results Patients with HFNEF accounted for 54.5％ of all cases of elderly patients with HF.Compared with HFREF,the elderly patients with HFNEF had a higher proportion of females (62.1％ vs.32.6％,P＜0.001),higher body mass index (BMI) ((24.9±4.7) vs.(23.5±4.0) kg/m2,P=0.011),higher systolic blood pressure at admission ((141.5±22.6) vs.(134.3±18.6) mmHg,P=0.002),but lower hemoglobin levels ((118.3±22.7) vs.(125.8±23.8) g/L,P=0.005).The incidence of coronary heart disease (43.2％ vs.65.2％,P ＜0.001) and myocardial infarction (16.6％ vs.46.1％,P ＜0.001) were significantly lower in elderly patients with HFNEF than in those with HFREF (P＜0.001).With a mean follow-up of 33.5 (0.5-93) months,120 patients (38.7％) died,including 94 (30.3％) cardiac deaths.The HFNEF group had fewer deaths than the HFREF group at the end of the first follow-up (46/169 (27.2％) vs.58/141 (41.1％)) and at the end of the second follow-up (56/169 (33.1％) vs.64/141 (45.4％)).Kaplan-Meier survival analysis showed a significantly higher survival rate in elderly patients with HFNEF than those with HFREF (P=0.021 for total mortality and P ＜0.001 for cardiac mortality).Multiple Logistic regression analysis showed that LVEF ＜50％ was an independent risk factor for death in elderly patients with HF.Conclusions More than half of elderly patients with HF have a normal LVEF.The prognosis of the elderly patients with HFNEF is poor,though slightly better than the elderly patients with HFREF。