2012年 · 第125卷第23期

Diabetes mellitus (DM) is one of the most common metabolic disorders in the world,in which more than 90％ are grouped to type 2 DM (T2DM).1 T2DM is characterized by decreased insulin sensitivity and impaired insulin secretion2 leading to hyperglycemia,and the serum glucose has been used as a golden standard for diabetes diagnosis.However,T2DM is a kind of disease involving defects of multiple organs,which cannot be distinguished through the measurement of the serum-glucose level.In addition,T2DM is a multiple-stage disease,which usually covers several decades from impaired plasma glucose to various complications.The serum-glucose level only reflects the consequence of multiple physiological disorders in the given stage。

Glucose monitoring is an important component in diabetes treatment and management.The results of blood glucose monitoring are useful for determining the degree of glucose metabolic disturbance,evaluating therapeutic outcomes,and guiding adjustments of treatment regimens.1 Self-monitoring of blood glucose (SMBG) still remains the most common form of in-home blood glucose monitoring with the glycosylated hemoglobin (HbA1c) as the "gold standard" for understanding the patients' average glucose over the last 3 months.However,both HbA 1 c and SMBG have certain limitations:HbA1c represents the average blood glucose level over the previous 2-3 months;therefore there may be a "delayed effect" when using it to guide therapy adjustments.Additionally,HbA1c does not provide information of hypoglycemia,nor does it reflect glycemic variability。

Abstract：Background Diabetes management could be improved by diabetes education,through influencing attitudes towards diabetes,knowledge and behaviors of patients.The purpose of this study was to characterize the impact of diabetes education on glycemic control,and to assess the attitude,knowledge and self-care behavior in patients with type 2 diabetes in China.Methods This questionnaire-based survey was conducted in 50 medical centers across China from April to July of 2010.The patients with type 2 diabetes were eligible for the study.The information of glycemic control and diabetes education was collected.The diabetes attitude scale-3 formulae,a questionnaire of diabetes knowledge and Summary of Diabetes Self-care Activities scale were used to assess attitude,knowledge and the self-care of patients,respectively.Results Among the 5961 eligible respondents (3233 males; mean age (59.50±12.48) years; mean hemoglobin A1c (HbA1c) (8.27±2.23)％),most patients (79.8％) considered themselves educated on diabetes.Compared with patients without diabetes education,their educated counterparts showed significant lower value of HbA1c,after controlling for age,gender,body mass index and duration of diabetes (P ＜0.01).The patients who received diabetes education also performed significant higher scores on attitude,knowledge and self-care than their uneducated counterparts.Patients with lower income or education level tended to have higher glucose levels,and showed lower percentage of patients received diabetic education.Conclusions Chinese patients with diabetes education achieved better glycemic control than un-educated patients.Our study indicates effort is required to provide professional education to patients,with emphasis on lower income and lower education level populations。

Abstract：Background Coronary heart disease is the main complication of type 2 diabetes mellitus; its incidence is closely related to microalbuminuria.The aim of this study was to investigate the correlation between the urinary albumin excretion rate and the incidence and severity of coronary heart disease in elderly type 2 diabetes mellitus patients.Methods A total of 612 hospitalized type 2 diabetes mellitus patients aged 60 years or older,who were given coronary angiography for diagnosis of possible coronary heart disease,participated.Their urinary albumin excretion rate was measured,and the severity of coronary artery stenosis was quantified with the Gensini scoring system to analyze the incidence of coronary heart disease and the severity of coronary artery stenosis.The optimal urinary albumin excretion rate predictive value for coronary heart disease incidence in elderly type 2 diabetes mellitus patients was determined.Results The incidence of coronary heart disease,the number of patients with coronary vascular disease and the Gensini scores were significantly different between the microalbuminuria group and the normal albuminuria group (P ＜0.05).The urinary albumin excretion rate was independently correlated with the occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients (odds ratio (OR) =1.058,P ＜0.0001,95％ confidence interval (CI): 1.036-1.080).Urinary albumin excretion rate and the Gensini score were independently correlated in elderly type 2 diabetes mellitus patients (β=0.476,P ＜0.0001).The best predictive value of urinary albumin excretion rate was 10.45 μg/min for elderly type 2 diabetes mellitus patients.The area under the curve was 0.764,with a sensitivity and specificity of 70.0％ and 72.2％,respectively.Conclusions The occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients with microalbuminuria was higher than that in patients with normal albuminuria,and the severity of the disease also increased in patients with microalbuminuria.In elderly type 2 diabetes mellitus patients,urinary albumin excretion rate was positively correlated with the incidence and severity of coronary heart disease and was also an independent factor contributing to coronary heart disease。

Abstract：Background Diabetes has become one of the most common chronic diseases and the third leading cause of death in China.Many programs have been initiated at national and local levels to address the illness.However,the effect of these programs in daily outpatient clinics is still unclear.The objective of this study was to investigate the management status of type 2 diabetes mellitus (T2DM) and factors associated with it in diabetes clinics of tertiary hospitals in Beijing.Methods A cross-sectional survey was conducted in six tertiary hospitals in Beijing.Control criteria were defined based on 2007 China guideline for type 2 diabetes (CGT2D).Results A sample of 1151 patients,age (60.8±9.2) years,and with a median disease duration of 7.3 years was included.The hemoglobin A1c (HbA1c) mean level was (7.15±1.50)％,the percentage of patients achieving the targets for HbA1c was 37.8％,blood pressure 65.6％,triglyceride (TG) 48.8％,high-density lipoprotein (HDL) 59.2％,low-density lipoprotein (LDL) 34.0％,and total cholesterol (TC) 42.0％ The factors independently associated with glycemic control were diabetes duration (odds ratio (OR) =0.95; 95％ confidence interval (C/): 0.919-0.982,P ＜0.01),body mass index (BMI) (OR=0.914,95％ CI: 0.854-0.979,P=0.01) and smoking (OR=0.391,95％ CI: 0.197-0.778,P＜0.01).The factors independently associated with blood pressure control were BMI (OR=0.915,95％ CI: 0.872-0.960,P ＜0.01) and male gender (OR=0.624,95％ CI: 0.457-0.852,P ＜0.01).The factor independently associated with LDL control was education level (OR=1.429,95％ CI: 1.078-1.896,P=0.013).Conclusions The management status of T2DM patients in tertiary hospitals in Beijing has improved remarkably.However,there is still room for further improvement to reach the guideline target.Long diabetes duration,high BMI,smoking,male gender and low education level were independently associated with poor metabolic control。

Abstract：Background With economic growth and urbanization there have been significant changes in the life style and diet of urban residents in large cities of China,which is experiencing a rapid increase in the prevalence of diabetes.While high prevalence of diabetes has been reported,little is known of the long-term effects of diabetes in such a large population.The aim of this study was to estimate the morbidity rate of diabetic peripheral neuropathy (DPN) in a Chinese urban diabetic population with more than 10 years' disease duration,and evaluate the relevant risk factors.The clinical manifestation of DPN and pain status was also assessed.Methods Five hundred and sixty-five diabetes patients were recruited into the study.Symptoms and examination helped diagnose neuropathy.The clinical manifestation of DPN was assessed with a visual analog pain score (VAS).Diabetic complication status was determined from medical records.Serum lipids and lipoproteins,glycosylated hemoglobin (HbA1c),and the urinary albumin excretion rate were measured.Results The morbidity rate of DPN was 46.6％.HbA1c,hyperlipidemia,and retinopathy were significantly associated with neuropathy,and these risk factors were correlated with other diabetic micro and/or macrovascular complications.The average VAS pain score of the DPN patients was 4.12±2.07.Severe and moderate pain was experienced by 11.4％ and 40.5％ respectively of DPN patients.About 3.7％ of diabetic subjects had lower limb ulcer or amputation.Conclusions The morbidity rate of DPN for diabetic patients with ＞10 years duration is very high compared to the range reported for other populations in the world.The risk factors for DPN include HbA1c,hyperlipidemia,and retinopathy.In long-standing diabetic patients,DPN was not associated with diabetic duration,and half of the DPN patients experienced considerable daily suffering。

Abstract：Background Increased risk of bladder cancer has been reported in diabetic patients.This study was to investigate the roles of mitogen-activated protein kinase kinase (MEK) 1 and 2 in the regulation of human insulin-and insulin glargine-induced proliferation of human bladder cancer T24 cells.Methods In the absence or presence of a selective inhibitor for MEK1 (PD98059) or a specific siRNA for MEK2 (siMEK2),with or without addition of insulin or glargine,T24 cell proliferation was evaluated by cell counting kit (CCK)-8 assay.Protein expression of MEK2,phosphorylation of ERK1/2 and Akt was analyzed by Western blotting.Results T24 cell proliferation was promoted by PD98059 at 5-20 μmol/L,inhibited by siMEK2 at 25-100 nmol/L.PD98059 and siMEK2 remarkably reduced phosphorylated ERK1/2.Insulin-and glargine-induced T24 cell proliferation was enhanced by PD98059,suppressed while not blocked by siMEK2.Insulin-and glargine-induced ERK1/2 activation was blocked by PD98059 or siMEK2 treatment,whereas activation of Akt was not affected.Conclusion MEK1 inhibits while MEK2 contributes to normal and human insulin-and insulin glargine-induced human bladder cancer T24 cell proliferation。

Abstract：Background Glucagon-like peptide-1 (GLP-1) reduces fatty acid-induced beta-cell lipotoxicity in diabetes; however,the explicit mechanisms underlying this process are not fully understood.This study was designed to investigate the involvement of microRNA,which regulates gene expression by the sequence-specific inhibition of mRNA transcription in the GLP-1 mediation of beta-cell function.Methods The cell viability and apoptosis were determined using an methyl thiazoleterazolium (MTT) assay and flow cytometry.The expression of genes involved in beta-cell function,including microRNA-34a and sirtuin 1,were investigated using real-time PCR.The underlying mechanisms of microRNA-34a were further explored using cell-transfection assays.Results A 24-hours incubation of INS-1 cells with palmitate significantly decreased cell viability,increased cell apoptosis and led to the activation of microRNA-34a and the suppression of sirtuin 1.A co-incubation with GLP-1 protected the cells against palmitate-induced toxicity in association with a reduction in palmitate-induced activation of microRNA-34a.Furthermore,palmitate-induced apoptosis was significantly increased in cells that were infected with microRNA-34a mimics and decreased in cells that were infected with microRNA-34a inhibitors.Conclusion MicroRNA-34a is involved in the mechanism of GLP-1 on the modulation of beta-cell growth and survival。

Abstract：Background Diabetic cardiomyopathy is the major cause of morbidity and mortality in diabetic patients.Oxidative stress plays an important role in diabetic cardiomyopathy.This study aimed to investigate the effects of adiponectin on oxidative stress and apoptosis in human cardiac myocytes (HCM) cultured with high glucose.Methods The cells were assigned to three group: control group,high glucose group and high glucose plus adiponectin group.After culture for 24,48,72 hours,oxidative stress was evaluated by detecting levels of malondialdehyde (MDA)and superoxide dismutase (SOD) in the supernatant of culture media.The expression of p66Shc and Heme oxygenase-1 (HO-1) was detected by real-time polymerase chain reaction (PCR).Flow cytometry was designed to observe and detect cellular apoptosis.Results Our findings showed significant increase in MDA levels and decrease in SOD activity in the high glucose group compared with the control group (P ＜0.05).However,MDA levels were significantly decreased and SOD activity was significantly increased in the adiponectin group compared with those in the high-glucose group (P ＜0.05).The mRNA expression of HO-1 in the high glucose group was significantly increased in a time-dependent manner compared with that in the control group (P ＜0.05).Adiponectin further increased the mRNA expression of HO-1 induced by high glucose in a time-dependent manner (P ＜0.05).The expression of p66Shc was significantly increased in high glucose group compared with that in the control group (P ＜0.05).Adiponectin significantly suppressed the upregulation of p66Shc induced by high glucose (P ＜0.05).The apoptotic rate of cardiomyocytes was significantly increased in the high glucose group compared with that in the control group while the apoptotic rate in the adiponectin group was remarkably declined in comparison with that in the high glucose group.Conclusion Adiponectin reduces high glucose-induced oxidative stress and apoptosis and plays a protective role in myocardial cells by upregulating the HO-1 expression and downregulating p66Shc expression。

Abstract：Background Many researches report that low socioeconomic status (SES) is associated with a higher risk of coronary heart disease (CHD).This study aimed to determine whether levels of education,family income,and other SES were associated with acute myocardial infarction (AMI) in the Chinese population,and to compare the difference in this association between northern and southern regions in China.Methods We conducted a case-control study.Cases were first AMI (n=2909).Controls (n=2947) were randomly selected and frequency matched to cases on age and sex.SES was measured using education,family income,possessions in the household,and occupation.Results Low levels of education (8 years) were more common in cases compared to controls (53.4％ and 44.1％;P=0.0001).After adjusting all risk factors,the level of education was associated with AMI risk in the Chinese population (P=0.0005).The odds ratio (OR) associated with education of 8 years or less,compared with more than 12 years (trade school/college/university) was 1.33 (95％ CI 1.12-1.59),and for education of 9-12 years 1.04 (95％ CI 0.88-1.33).The proportion of higher income population was more in controls than cases (39.4％ and 35.3％).Number of possessions and non-professional occupation were only weakly or not at all independently related to AMI.The adjusted OR associated with the lower education was 2.38 (95％ CI 1.67-3.39) in women,and 1.18 (95％ CI 0.99-1.42) in men (P=0.0001,for heterogeneity).The interaction between levels of education and different regions was significant (P=0.0206,for interaction).Conclusion Several socioeconomic factors including levels of education and income were closely associated with increase of AMI risk in China,most markedly in northeast and southern area.The effect of education was stronger towards AMI in women than men。

Abstract：Background Among patients with advanced multivessel coronary disease,left ventricular (LV) function is widely variable,and clinical and angiographic correlates of ventricular dysfunction remain to be defined.Methods Among 73 339 patients undergoing diagnostic cardiac catheterization at a single center in China,patients with left ventriculographic assessment were identified with three-vessel coronary disease with or without left main involvement.Clinical and angiographic characteristics were examined among patients with normal or varying extent of LV dysfunction,and predictors of LV impairment (ejection fraction (EF): ＜25％,25％-40％ or ＞40％) were determined.Results Among 11950 patients identified with three-vessel coronary disease,the sample distribution of LVEF was ＞40％,n=10776; 25％-40％,n=948; ＜25％,n=226.Patients with reduced LV function (＜40％) more commonly were male and had a history of myocardial infarction (MI),diabetes or unstable angina.Hypertension was more frequent in those with LVEF ≥40％.In a multivariate Logistic regression analysis,prior MI (odds ratio (OR),3.37; 95％ confidence interval (CI),2.96-3.84) was most predictive of LVEF ＜40％,followed by male gender,diabetes,and presentation with unstable angina.For LVEF ＜25％,only prior MI was identified as a significant correlate of severe LV dysfunction (OR 4.06,95％ CI 3.06-5.39).Following exclusion of patients with previous MI (n=7416),male gender and diabetes were predictive of LVEF ＜40％,yet presentation with unstable angina was the only factor significantly associated with LVEF ＜25％.Conclusion Among individuals identified with three-vessel coronary disease with or without left main involvement,previous MI was the most significant risk factor of LV dysfunction。

Abstract：Background Mycophenolic acid (MPA) as an anti-proliferative immune-suppressive agent is used in the majority of immunosuppressive regimens in solid organ transplantation.This study aimed to investigate the pharmacokinetic (PK)characteristics of enteric-coated mycophenolate sodium (EC-MPS) and area under the curve (AUC) from 0 to 12 hours with limited sampling strategies (LSSs) in Chinese renal transplant recipients.Methods This study was conducted in 10 Chinese renal transplant patients receiving living donor and treated with EC-MPS,cyclosporine,and corticosteroids.MPA concentrations were measured by enzyme multiplied immunoassay technique (EMIT).Whole 12-hour PK profiles were obtained on Day 4 after operation.LSSs with jackknife technique,multiple stepwise regression analysis,and Bland-Altman analysis were developed to estimate MPA AUC.Results The mean maximum plasma concentration,the mean time for it to reach peak (Tmax),and the mean MPA AUC were (11.38±2.49) mg/L,(4.85±3.32) hours,and (63.19±13.54) mg.h.L-1,respectively.Among the 10 profiles,MPA AUC of four patients was significantly higher than that of the other six patients,and the corresponding Tmax was significantly longer than that of the other six patients.No patient exhibited a second peak caused by enterohepatic recirculation.The best models were as follows: 27.46+0.94C3+3.24C8+2.81C10 (r2=0.972),which was used to predict AUC of fast metabolizer with a mean prediction error (MPE) of-0.21％ and a mean absolute prediction error (MAE) of 2.59％;36.65+3.08C8+5.30C10-4.04C12 (r2=0.992),which was used to predict AUC of slow metabolizer with a MPE of 0.58％ and a MAE of 1.95％.Conclusions The PKs of EC-MPS had a high variability among Chinese renal transplant recipients.The preliminary PK data indicated the existence of slow and fast metabolizer.These findings may be associated with the enterohepatic recirculation。

Abstract：Background Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery.Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few.The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) or GCS alone.Methods The study was performed on 108 patients who were randomly assigned to two groups.The first group received GCS before the operation and IPC during the operation (IPC+GCS group).The second group received GCS before the operation (GCS group).To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures,the incidence of adverse reactions was assessed.Results The morbidity associated with DVT was 4.8％ (5/104) in the IPC+GCS group and 12.5％ (14/112) in the GCS group.There were significant statistical differences between the two groups.There were no adverse effects in either group.Conclusions The therapeutic combination of GCS and IPC was more effective than GCS alone for thrombosis prevention in high-risk patients undergoing gynaecological pelvic surgery,and there were no adverse effects in either group.(No.ChiCTR-PRC-10000935)。

Abstract：Background The environmental sources associated with community-acquired or nosocomial legionellosis were not always detectable in the mainland of China and Hong Kong,China.The objective of this study was to illustrate the control measures implemented for nosocomial and community outbreaks of legionellosis,and to understand the environmental distribution of legionella in the water system in Hong Kong,China.Methods We investigated the environmental sources of two cases of legionellosis acquired in the hospital and the community by extensive outbreak investigation and sampling of the potable water system using culture and genetic testing at the respective premises.Results The diagnosis of nosocomial legionellosis was suspected in a patient presenting with nosocomial pneumonia not responsive to multiple beta-lactam antibiotics with subsequent confirmation by Legionella pneumophila serogroup 1 antigenuria.High counts of Legionella pneumophila were detected in the potable water supply of the 70-year-old hospital building.Another patient on continuous ambulatory peritoneal dialysis presenting with acute community-acquired pneumonia and severe diarrhoea was positive for Legionella pneumophila serogroup 1 by polymerase chain reaction (PCR) testing on both sputum and nasopharyngeal aspirate despite negative antigenuria.Paradoxically the source of the second case was traced to the water system of a newly commissioned office building complex.No further cases were detected after shock hyperchlorination with or without superheating of the water systems.Subsequent legionella counts were drastically reduced.Point-of-care infection control by off-boiled or sterile water for mouth care and installation of water filter for showers in the hospital wards for immunocompromised patients was instituted.Territory wide investigation of the community potable water supply showed that 22.1％ of the household water supply was positive at a mean legionella count of 108.56 CFU/ml (range 0.10 to 639.30 CFU/ml).Conclusions Potable water systems are open systems which are inevitably colonized by bacterial biofilms containing Legionella species.High bacterial counts related to human cases may occur with stagnation of flow in both old or newly commissioned buildings.Vigilance against legionellosis is important in healthcare settings with dense population of highly susceptible hosts。

Abstract：Background Amputation-free survival (AFS) has been recommended as the gold standard for evaluating No-Option Critical Limb Ischemia (NO-CLI) therapy.Early-phase clinical trials suggest that autologous bone-marrow derived cells (BMCs) transplantation may have a positive effect on patients with NO-CLI,especially decreasing the incidence of amputation.However,the BMCs therapeutic efficacy remains controversial and whether BMCs therapy is suitable for all CLI patients is unclear.Methods We conducted a meta-analysis using data from randomized controlled trials (RCTs) by comparing autologous BMCs therapy with controls in patients with critical limb ischemia,and the primary endpoint is the incidence of amputation.Pubmed,EBSCO and the Cochrane Central Register of Controlled Trials (to approximately July 25,2012) were searched.Results Seven RCTs with 373 patients were enrolled in the meta-analysis.Because serious disease was the main reason leading to amputation in one trial,six studies with 333 patients were finally included in the meta-analysis.Pooling the data of the final six studies,we found that BMCs therapy significantly decreased the incidence of amputation in patients with CLI (odds ratio (OR),0.37; 95％ confidence interval (CI),0.22 to 0.62; P=0.0002),and the efficacy had not significantly declined within 6 months after BMCs were transplanted; OR,0.33; 95％ CI,0.16 to 0.70; P=0.004 within 6 months and OR,0.30; 95％ CI,0.11 to 0.79; P=0.01 within 3 months.The rate of AFS after BMCs therapy was significantly increased in patients with Rutherford class 5 CLI (OR 3.28; 95％ CI,1.12 to 9.65; P=0.03),while there was no significant improvement in patients with Rutherford class 4 (OR 0.35; 95％ CI,0.05 to 2.33; P=0.28) compared with controls.The BMCs therapy also improved ulcer healing (OR,5.83; 95％ CI,2.37 to 14.29; P=0.0001).Conclusions Our analysis suggests that autologous BMCs therapy has a beneficial effect in decreasing the incidence of amputation and the efficacy does not decrease significantly within 6 months after BMCs transplantation.Patients with Rutherford class 5 are suitable for BMCs therapy,while the efficiency in patients with Rutherford 4 needs further evaluation。

Abstract：Background The difference of cardiovascular effects between rosiglitazone and pioglitazone treatment for diabetic patients has not been thoroughly studied.We performed a meta-analysis to compare the risk of cardiovascular adverse effects in patients with type 2 diabetes treated with rosiglitazone compared to pioglitazone.Methods The Cochrane Library,PubMed,and Embase were searched to identify retrospective cohort studies assessing cardiovascular outcomes with rosiglitazone and pioglitazone.Meta-analysis of retrospective cohort studies was conducted using RevMan 5.0 software to calculate risk ratios.Results Of the 74 references identified,eight studies involving 945 286 patients fit the inclusion criteria for the analysis.The results of meta-analyses showed that,compared with pioglitazone,rosiglitazone therapy significantly increased the risk of myocardial infarction (risk ratios (RR) 1.17,95％ confidence interval (CI) 1.04-1.32; P=0.01),the risk of heart failure (RR 1.18,95％ CI 1.02-1.36; P=0.03),and total mortality (RR 1.13,95％ CI 1.08-1.20; P ＜0.00001).Conclusion Compared with pioglitazone,rosiglitazone was associated with an increased risk of myocardial infarction,heart failure,and all-cause mortality in diabetic patients。

Telehealth was defined as the use of information,computers and telecommunication technologies to provide health related services when health professionals and patients are separated by a distance.1 This new medical model involves video-conference,transmission of images,e-health portals,remote monitoring of vital signs,and continuing medical education as a whole to help patients to improve health care.It should consist of three parts,including the patient client,the specialist and the connector (platform and internet)。

Cirrhosis complicated by common bile duct stones is a common clinical finding.1 Currently,good therapeutic results occur in patients with cirrhosis complicated by moderate to severe gastroesophageal varices and common bile duct stones using endoscopic variceal ligation (EVL) and/or embolization followed two weeks later by calculus removal with endoscopic retrograde cholangiopancreatography (ERCP)。

Primary pulmonary amyloidosis is a rare disease.Most cases present as trachobronchial involvement or parenchymal nodules.Diffuse alveolar septal amyloidosis is almost always seen in systemic amyloidosis.Diffuse alveolar septal form of isolated pulmonary amyloidosis is extremely uncommon.We report a case of localized diffuse pulmonary amyloidosis presenting with organizing pneumonia pattern on the high resolution computed tomography (HRCT)。

Kawasaki disease (KD),first reported by Kawasaki in 1967,1 is an extremely rare clinical event with adults in China.Here we describe a 39-year-old man who requires bypass surgery because of the significant coronary arterial disease caused by assumed KD in childhood。

To the editor:Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by structural and functional abnormalities of the right ventricle due to replacement of the myocardium by fatty and fibrous tissue,often with involvement of the left ventricle (LV).ARVC has been recognized as a cause of sudden death,especially in the young.We present a case of sudden death due to ARVC based on autopsy findings。

The citation impact of scientific articles is highly uneven,even within the same journal,following a log-normal distribution where 20％ of articles account for 80％ citations (the "20/80 law").1 It has also been suggested that half the literatures published is redundant as it is never cited.2 Therefore,many non-cited articles are published in scientific journals.In this article,the distribution of non-cited articles published in the Chinese Medical Journal (CMJ) in 2010 is reported aiming to provide evidence to guide the editorial work。