2013年 · 第126卷第09期

Coronary lesions of intermediate severity,defined as 50％-70％ luminal diameter narrowing by visual estimation at angiography,are frequently encountered in patients with stable or unstable coronary artery disease.Clinical decision making for patients with intermediatecoronary stenosis is still challenging,but may be facilitated by assessing the morphology and physiological significance of these lesions.1 It is clear that angiographic stenosis is a highly unreliable surrogate for myocardial ischemia,as a significant proportion of anatomically high-grade lesions do not cause ischemia.Conversely,even for anatomically mild coronary lesions,a non-negligible rate of myocardial ischemia is consistently noted.Because the physiological significance of a lesion is mainly determined by both the severity of a stenosis and the amount of myocardium supplied,coronary angiography alone does not accurately predict the functional significance of intermediate coronary lesions。

Abstract：Background Coronary artery disease is the leading cause of death in China.Percutaneous coronary intervention is a recent milestone technology for treatment coronary artery disease.However,clinical decision making for patients with intermediate coronary stenosis is still controversial.We designed this study to assess the optimal intravascular ultrasound (IVUS) criteria for predicting functional significance of intermediate coronary lesions.Methods We enrolled 141 patients with 165 intermediate coronary lesions located in vessels with a diameter ≥2.50 mm.IVUS of intermediate coronary lesions were performed before intervention.Pressure-derived fractional flow reserve (FFR) was measured at maximal hyperemia induced by adenosine infusion.An FFR ＜0.80 was considered as abnormal functional significance.Results For the overall 165 lesions,the mean FFR value was 0.84±0.09.The diameter of the stenosis by visual estimation on angiogram was (59.63±11.29)％.Minimum lumen diameter (MLD),minimum lumen area (MLA) and plaque burden (PB) were (2.00±0.36) mm,(3.88±1.34) mm2,(67.28±9.89)％ respectively by IVUS measurements.An FFR ＜0.80 was seen in 43 lesions (30.5％).There was a moderate correlation between IVUS parameters and FFR,including MLD (r=0.372,P ＜0.001),MLA (r=0.442,P ＜0.001) and PB (r=-0.172,P ＜0.05).MLA was a predictor for FFR as a continuous variable independent of possible confounding variables (P ＜0.05),and MLA and PB,were predictors for FFR ＜0.80 as binary variables (P ＜0.05).The best cutoff value of MLA to predict FFR ＜0.80 was ＜3.15 mm2,with a 73.6％ diagnostic accuracy; sensitivity 71.4％,specificity 67.0％,AUC=0.709,and P ＜0.001.The cutoff value of the PB to predict FFR ＜0.80 was 65.45％; sensitivity 82.6％,specificity 41.2％,AUC=0.644,and P ＜0.01.If both MLA and PB were taken into account,the negative predictive value and the positive predictive value were 88.7％ and 64.8％ respectively.Conclusions Anatomic measurements of intermediate coronary lesions obtained by IVUS showed a moderate correlation to FFR values.IVUS-derived MLA ≥3.15 mm2 may be useful to exclude FFR ＜0.80,but poor specificity limits its applicability for physiological assessment of lesions ＜3.15 mm2.MLA was one of many factors affecting coronary flow hemodvnamics.Both MLA and PB should be taken into account when determining functional ischemia。

Abstract：Background Statins and ezetimibe have been reported to change the balance of cholesterol metabolism,but few studies have been performed on Chinese patients.The aim of this study was to evaluate changes in cholesterol metabolism markers in patients with coronary heart disease.Methods Forty-five patients with coronary heart disease were treated with 20 mg/d of simvastatin for four weeks.Subjects were then divided into two different therapy groups according to whether they reached the target values for total cholesterol and low density lipoprotein cholesterol level.Patients who reached the target values remained on simvastatin and those who did not reach the target values took a combination of simvastatin plus 10 mg/d ezetimibe until the 12th week.The concentrations of cholesterol synthesis markers (lathosterol and desmosterol) and absorption markers (campesterol and sitosterol) were measured on the 1st,4th,and 12th week of the study by gas chromatography.Results After treatment with simvastatin for four weeks,the levels of total cholesterol and low density lipoprotein cholesterol decreased significantly compared to levels measured during the 1st week (P ＜0.05).On the 12th week the levels of total cholesterol and low density lipoprotein cholesterol had decreased significantly (P ＜0.001) compared to levels during the 4th week.By the 12th week the levels of campesterol and sitosterol in the combination group had decreased significantly (P＜0.05) compared with levels measured during the 4th week.Conclusions Coronary heart disease patients with high cholesterol synthesis at baseline might gain a greater benefit from simvastatin treatment.Combination therapy with simvastatin plus ezetimibe in patients with low cholesterol synthesis at baseline might increase the success rate of lipid-lowering through decreasing the absorption of cholesterol。

Abstract：Background Major atrial coronary arteries,including the sinus node artery (SNA),were commonly found in the areas involved in atrial fibrillation (AF) ablation and could cause difficulties in achieving linear block at the left atrial (LA) roof.The SNA is a major atrial coronary artery of the atrial coronary circulation.This study aimed to determine impact of the origin of SNA on recurrence of AF after pulmonary vein isolation (PVI) in patients with paroxysmal AF.Methods Seventy-eight patients underwent coronary angiography for suspected coronary heart disease,followed by catheter ablation for paroxysmal AF.According to the origin of SNA from angiographic findings,they were divided into right SNA group (SNA originating from the right coronary artery) and left SNA group (SNA originating from the left circumflex artery).Guided by an electroanatomic mapping system,circumferential pulmonary vein ablation (CPVA) was performed in both groups and PVI was the procedural endpoint.All patients were followed up at 1,3,6,9 and 12 months post-ablation.Recurrence was defined as any episode of atrial tachyarrhythmias (ATAs),including AF,atrial flutter or atrial tachycardia,that lasted longer than 30 seconds after a blanking period of 3 months.Results The SNA originated from the right coronary artery in 34 patients (43.6％) and the left circumflex artery in 44 patients (56.4％).Freedom from AF and antiarrhythmic drugs (AADs) at 1 year was 67.9 ％ (53/78) for all patients.After 1 year follow-up,79.4％ (27/34) in right SNA group and 59.1％ (26/44) in left SNA group (P=0.042) were in sinus rhythm.On multivariate analysis,left atrium size (HR=1.451,95％CI:1.240-1.697,P ＜0.001) and a left SNA (HR=6.22,95％CI:2.01-19.25,P=0.002)were the independent predictors of AF recurrence.Conclusions The left SNA is more frequent in the patients with paroxysmal AF.After one year follow-up,the presence of a left SNA was identified as an independent predictor of AF recurrence after CPVA in paroxysmal AF。

Abstract：Background Percutaneous coronary intervention (PCI) is indicated for angina with coronary stenosis.However,PCI for asymptomatic coronary stenosis remains controversial.We prospectively followed a group of patients for four years who underwent coronary computed tomography angiography (CCTA) for major adverse cardiac events (MACE).We hypothesized that the results of this trial would reliably reflect the natural outcome of the coronary disease.Methods Consecutive patients who underwent CCTA from June 2008 to May 2009 were selected.Those who could not be reached by telephone,had significant angina,had CT images that were not interpretable,or poor kidney and left ventricular (LV) function were excluded.The patients were divided into five groups:group A normal CCTA without stenosis,group B mild stenosis (1％-49％),group C moderate stenosis (50％-74％),group D severe stenosis (≥75％) and they were treated with optimal medical therapy (OMT) or PCI.The group E had PCI before the CCTA examination.The patients were then followed for MACE after different treatments.MACE included acute myocardial infarction (MI),heart failure (HF) and death.Results The patient population consisted of 419 patients.The follow-up time was (51±5) months.The age was (60±31)years.Male made up 67.78％ of the population (n=284).A total of 51 cases of MACE occurred including 25 MI,eight HF and 18 all-cause deaths.There was no MACE in group A.Although MACE occurred in two patients in group B,they were not attributed to cardiac death.We further compared the MACE in groups C-E and no significant difference was found (P ＞0.05).However,a difference was detected among patients with unstable angina pectoris (UAP),stable angina pectoris (SAP),re-hospitalization,and cerebrovascular events from groups A-E (P ＜0.05).The plaque scores were used to predict MACE.The scores progressively increased significantly with lesion severity (P ＜0.05).Receiver operating curve (ROC) was performed to determine the sensitivity and specificity in predicting MACE.Our scores predicted MI with area of 0.76,predicted HF with area of 0.77,and predicted death with area of 0.70.Conclusions Normal and mild lesions had very few events.With increased stenosis the MACE rate increased progressively.PCI did not significantly reduce the MACE in comparison with OMT in asymptomatic patients.Furthermore,UAP,re-hospitalization,and re-PCI were significantly increased in patients who were treated with PCI。

Abstract：Background The perioperative aortic dissection (AD) rupture is a severe event after endovascular stent graft placement for treatment of type B AD.However,this life-threatening complication has not undergone systematic investigation.The aim of the study is to discuss the reasons of AD rupture after the procedure.Methods The medical record data of 563 Stanford type BAD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed.Double entry and consistency checking were performed with Epidata software.Results Twelve patients died during the perioperation after thoracic endovascular repair,with an incidence of 2.1％,66.6％ were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD.In our study,74％ of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted,compared with 100％ of the aortic rupture patients (74％ vs.100％,P=-0.213).The aortic rupture patients are more likely to have ascending aortic diameters ≥4 cm (62.5％ vs.9.0％,P=-0.032),involvement the aortic arch concavity (62％ vs.27％,P=0.041) and have had multiple stents placed (P=0.039).Conclusions Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative lowin-hospital mortality.AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter ≥4 cm and with severe dissection that needs multi-stent placement.Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture.Post balloon dilation should be performed with serious caution,particularly for the migration during dilation。

Abstract：Background Since Macao's return of sovereignty to China in December 1999,the life style of Macao residents has changed.The aim of this study was to investigate changes of death patterns in Macao residents from 1986 to 2006 in order to identify the trends and patterns of major public health problems,which could provide the guidance for developing public health policies.Methods A retrospective study was conducted for this investigation.Research data were collected from official websites and statistical yearbooks and classified by the International Classification of Diseases (ICD)-9.Results It was observed that mortality from the three major causes of (1) infectious,maternal and childhood diseases,(2) chronic non-communicable diseases,and (3) injury and poisoning were 17.7,298.2 and 26.0 per 100 000,respectively.The largest decrease in death rate over the 21-year study-period was from infectious,maternal and childhood diseases (62.5％).The highest mortality rate was ischemic heart diseases (37.0％).The largest increase in mortality rate was lung cancer (46.9％).Conclusions Mortality rate of Macao residents progressively decreased,but the constituent ratio of death from chronic non-communicable diseases was increasing.The mortality rate of lung cancer was clearly ascending,so emphasis should be put on tertiary prevention in future。

Abstract：Background Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in chronic hemodialysis (CHD) patients.It remains unclear whether efforts to correct fluid overload in young CHD can reverse LVH.This prospective single-center cohort study evaluated left ventricular masses index (LVMI) evolution in fluid overloaded young CHD patients with or without water-sodium control.Methods A total of t06 young patients aged between 22 and 44 years on CHD were enrolled in this prospective,control study.Patients were divided into three groups according to the percentage of interdialytic weight gain (PIDWG (％) =100％ × (predialysis weight-dry weight)/dry weight) at baseline.Thirty-six patients with PIDWG more than 5％ received health education to restrict water-sodium intake strictly (Group I).Other 36 patients with comparable fluid status levels (the PIDWG more than 5％) did not receive health education to restrict water-sodium intake strictly (Group Ⅱ) and those with PIDWG less than 5％ (Group Ⅲ,n=34) were served as controls.Echocardiographic studies were performed to evaluate LVMI at baseline and then after 1,3 and 6 months.The total follow-up time was 6 months.Results There was no significant difference in clinical data (such as age,gender,aetiology of renal failure and nutritional state,etc.) among the three groups at baseline.At baseline,the prevalence of LVH in Group Ⅰ,Ⅱ and Ⅲ was 75.0％,72.2％ and 55.9％,respectively.LVMI was directly correlated with PIDWG (r =0.779,P ＜0.01).After 6 months,the PIDWG in Group I decreased in mean by (3.77±1.09)％,and LVMI decreased in mean by (27.59±12.15) g/m2.The prevalence of LVH decreased in mean by 25.0％,and the blood pressure decreased in mean by (14.69±11.50) mmHg/(7.14±7.51) mmHg.The medication category and total medication frequency of hypotensive drugs significantly decreased in Group I at 6 months.However the urine volume and the levels of serum creatinine and serum albumin in Group I were not significantly different compared to the baseline.The level of LVMI in Group II was significantly increased after 6 months compared with the baseline.After 6 months,the level of LVMI in Group Ⅲ were not significantly different compared with the baseline.Conclusions A high prevalence of LVH was present in young CHD patients,and was associated with fluid overload.Reduction fuild overload with water-sodium control can reverse LVH in young CHD patients。

Abstract：Background The techniques of resection and repair of large lesions in the abdominal wall are very challenging in the area of gynecology.We explored the techniques of resection and plastic surgical repair of large abdominal wall lesions in gynecologic patients.Methods Twenty-six patients with large lesions in the abdominal wall underwent resection by the gynecologists and repair through abdominal plasty and V-Y plasty with or without fascia patch grafting by the gynecologists or plastic surgeons from March 2003 to October 2010.Results All patients had a history of cesarean section.One patient had an infected sinus tract after cesarean section,one patient had an inflammatory nodule,and the others had lesions of endometriosis,including one cancer.The average largest lesion diameter was (4.79 ± 4.18) cm according to the ultrasonography results.The lesions of all patients were completely resected with pretty abdominal contour.A polypropylene biological mesh was added to the fascia in 20 patients.One patient underwent groin flap repair,and one underwent V-Y advanced skin flap repair on the left of the incision to relieve the suture tension.Conclusions Multi-department cooperation involving the gynecology and plastic surgery departments,and even the general surgery department,is essential for patients with large lesions in the abdominal wall.This cooperative effort enabled surgeons to completely resect large lesions.Abdominal wall plastic surgical repair can ameliorate large wounds of the abdominal wall。

Abstract：Background Congenital heart defects with intractable hypoplasia of the pulmonary arteries without intercourse or with intercourse stenosis is unsuitable for surgical correction or regular palliative procedures.We reported our experience with combined palliative procedures for congenital heart defects with intractable hypoplasia pulmonary arteries.Methods From 2001 to 2012,a total of 41 patients with cyanotic congenital heart defects and intractable hypoplasia of the pulmonary arteries underwent surgical procedures.From among them,31 patients had pulmonary atresia with ventricular septal defect (VSD) and the other 10 cases had complicated congenital heart defects with pulmonary stenosis.Different kinds of palliative procedures were performed according to the morphology of the right and left pulmonary arteries in every patient.If the pulmonary artery was well developed,a Glenn procedure was performed.A modified Blalock-Taussi9 shunt or modified Waterston shunt was performed if pulmonary arteries were hypoplastic.If the pulmonary arteries were severely hypoplastic,a Melbourne shunt was performed.Systemic pulmonary artery shunts were performed bilaterally in 25 cases.A systemic-pulmonary shunt was performed on one side and a Glenn procedure was performed contralaterally in 16 cases.Major aortopulmonary collateral arteries were unifocalized in six cases,ligated in two cases and interventionally embolized in two cases.There was one early death because of cardiac arrest and the hospital mortality was 2.4％.Results Five patients suffered from postoperative low cardiac output syndrome,three had perfusion of the lungs,and two pulmonary infections.Systemic pulmonary shunts were repeated after the original operation in three cases due to the occlusion of conduits.The mean follow-up time was 25 months.The pre-and the post-operation left pulmonary indices were (8.13±3.68) vs.(14.9±6.21) mm2/m2.The pre-and post-operation right pulmonary indices were (12.7±8.13) vs.(17.7±7.78) mm2/m2.The pre-and post-operational pulmonary indices were (20.87±9.43) vs.(32.6±11.7) mm2/m2.They were all significantly increased (P ＜0.001).The diameter of the pulmonary artery increased after the modified Blalock-Taussig shunt ((5.51±0.94) mm2/m2 pre-operation vs.(7.01±1.97) mm2/m2 post-operation),the modified Waterston shunt ((5.70±3.96) mm2/m2 pre-operation vs.(9.17±3.62) mm2/m2 post-operation) and the Melbourne shunt ((2.17±0.41) mm2/m2 pre-operation vs.(7.35±2.49) mm2/m2 post-operation) (all P ＜0.05).Bilateral pulmonary arteries developed well as compared to their pro-operation development.Hemoglobin decreased from (194±27) to (174±24) g/L (P ＜0.05) and peripheral oxygen saturation increased from (65±11)％ to (84±6)％ (P ＜0.001).During the follow-up of 27 to 49 months,ultimate complete repair was performed in four cases and one patient underwent a Glenn procedure.Conclusions The procedures should be considered on a case to case basis in patients having hypoplasia of the pulmonary arteries with cyanotic congenital heart defects.Combined palliative operations could be an adequate strategic treatment。

Abstract：Background Though drug-eluting stent (DES) almost solved a problem of restenosis,safety issues related to stent thrombosis are still the major concern of DES.We hypothesized that hybrid stent implantation may decrease the use of DES,probably improving the long-term safety but not affecting efficacy adversely when treating multilesion coronary artery disease in the DES era.Methods From April 2004 to October 2006,848 patients with multilesion disease underwent hybrid stent implantation.During the same period 5647 patients with multilesion coronary heart disease were treated by exclusive DES implantation in Fu Wai Hospital.According to propensity score matching,we chose 823 pairs of patients with multileison coronary artery disease for inclusion into our study.We obtained the 24-month clinical outcome including death,myocardial infarction (MI),thrombosis,target lesion revascularization (TLR),target vessel revascularization (TVR),and major adverse cardiac events (MACE,the composite of death,MI,and TVR).We used Cox's proportional-hazard models to assess relative risks of all the outcome measures after propensity match.Results At 24 months,patients in the hybrid stent implantation group showed a significantly higher risk of TLR (8.39％vs.3.28％,HR2.38,95％ CI:1.50-3.70),TVR (11.07％ vs.6.32％,HR 1.61,95％ CI:1.15-2.27) and MACE (13.75％ vs.8.75％,HR 1.37,95％ CI:1.02-1.85).No significant difference was apparent in terms of mortality (1.22％ vs.1.70％,HR 0.55,95％ CI:0.24-1.25),MI (1.95％ vs.2.31％,HR0.73,95％ CI:0.37-1.42),or thrombosis (definite+probable) (0.73％ vs.1.58％,HR0.40,95％ CI:0.15-1.05).Conclusions In patients with multilesion coronary artery disease,the exclusive DES implantation was associated with significantly lower risks of TLR,TVR and MACE,and the hybrid stent implantation did not result in any significant improvements regarding safety issues.Prospective studies are needed to confirm our results。

Abstract：Background Gambogic acid is a pure active compound isolated from the traditional Chinese medicinal plant gamboge (Garcinia morella Desv.).Based on the preliminary results of a phase I study,this phase Ila study compared the efficacy and safety of different dosage schedules of gambogic acid in patients with advanced malignant tumors.Methods Patients with advanced or metastases cancer who had not received any effective routine conventional treatment or who had failed to respond to the existing conventional treatment were randomly assigned to receive either 45 mg/m2 gambogic acid intravenously from Days 1 to 5 of a 2-week cycle (Group A),or 45 mg/m2 every other day for a total of five times during a 2-week cycle (Group B).The primary endpoint was objective response rate (ORR).Results Twenty-one patients assigned to Group A and 26 to Group B were included in the final analysis.The ORRs were 14.3％ in Group A and 0％ in Group B.It was not possible to analyze the significant difference because one of the values was zero.The disease control rates (DCRs) were 76.2％ in Group A and 61.5％ in Group B (P=-0.0456).The observed adverse reactions were mostly Grades Ⅰ and Ⅱ,and occurred in most patients after administration of the trial drug.There was no significant difference in the incidence of adverse reactions between the two arms.Conclusions The preliminary results of this phase Ila exploratory study suggest that gambogic acid has a favorable safety profile when administered at 45 mg/m2.The DCR was greater in patients receiving gambogic acid on Days 1-5 of a 2-week cycle,but the incidence of adverse reactions was similar irrespective of the administration schedule。

Abstract：Background The effects of triterpenic acid from Prunella vulgaris L.(TAP) on diabetes and its mechanism are uncertain.The aim of this study was to investigate the effects of TAP on antihyperglycemic,antioxidant,and pancreas-protective in streptozotozin (STZ)-diabetic rats.Methods The diabetic model was produced by injection of 60 mg/kg STZ.Blood was drawn from the tail vein of rats after 72 hours.Rats with blood glucose ≥16.7 mmol/L were considered diabetic.Diabetic rats were randomly divided into four groups:(1) Diabetes rat (STZ),(2) Diabetic rats treated with 50 mg/kg of triterpenic acid from Prunella vulgaris L (STZ+TAP50),(3) Diabetic rats treated with 100 mg/kg TAP (STZ+TAP100),and (4) Diabetic rats treated with 200 mg/kg TAP (STZ+TAP200).Normal rats (n=10) acted as the control group (NC).TAP was administered by the intragastric route once each day for six weeks.Body weight and the concentration of blood glucose (BG) were measured after three and six weeks.Fructosamine (FMN),malondialdehyde (MDA),and nitric oxide (NO),and the activities of nitric oxide synthase (NOS) and superoxide dismutase (SOD) in serum were determined after six weeks using commercially available kits following the manufacturer's instructions.Pathologic changes in pancreatic β-cells were also investigated by microscopic examination after hematoxylin-eosin (HE) staining.The level of SOD mRNA in pancreatic β-cells was measured by polymerase chain reaction (PCR).Results The levels of BG,FMN,NO,and MDA and the activities of NOS in serum in the four diabetes groups were significantly increased compared with the control group (P ＜0.01).The activity of SOD in serum and the body weight was significantly decreased compared with the control group (P ＜0.01).After administration of TAP to diabetic rats for six weeks,the body weight and the levels of BG,FMN,MDA,NO and the activity of NOS in serum decreased significantly compared with the STZ group in a dose-dependent manner.The activity of SOD in serum and body weight increased significantly compared with the STZ group in a dose-dependent manner.In addition,diabetic rats showed a significant decrease in SOD mRNA expression in pancreatic β cells.However,these changes were reversed by TAP.Histopathological examination also showed the protective effect of TAP on pancreatic β cells.Conclusions Triterpenic acid from Prunel/a vulgaris L.has an anti-diabetic effect,by controlling blood glucose and antioxidants,and has a protective effect on the pancreas。

Abstract：Background The classification of Alzheimer's disease (AD) from magnetic resonance imaging (MRI) has been challenged by lack of effective and reliable biomarkers due to inter-subject variability.This article presents a classification method for AD based on kernel density estimation (KDE) of local features.Methods First,a large number of local features were extracted from stable image blobs to represent various anatomical patterns for potential effective biomarkers.Based on distinctive descriptors and locations,the local features were robustly clustered to identify correspondences of the same underlying patterns.Then,the KDE was used to estimate distribution parameters of the correspondences by weighting contributions according to their distances.Thus,biomarkers could be reliably quantified by reducing the effects of further away correspondences which were more likely noises from inter-subject variability.Finally,the Bayes classifier was applied on the distribution parameters for the classification of AD.Results Experiments were performed on different divisions of a publicly available database to investigate the accuracy and the effects of age and AD severity.Our method achieved an equal error classification rate of 0.85 for subject aged 60-80 years exhibiting mild AD and outperformed a recent local feature-based work regardless of both effects.Conclusions We proposed a volumetric brain MRI classification method for neurodegenerative disease based on statistics of local features using KDE.The method may be potentially useful for the computer-aided diagnosis in clinical settings。

Abstract：Background Poly(ADP-ribose) polymerase (PARP) plays an important role in the death of retinal capillary cells indiabetic retinopathy (DR) partly via its regulation of nuclear factor kappa B (NF-κB).The current study investigated theeffect of the regimen of Gaoshan Hongjingtian (RG) on the mechanism of PARP regulation of NF-KB,and demonstratedthe possible impact of the RG and Gaoshan Hongjingtian (Rhodiola sachalinensis,RS) on diabetic retinopathy.Methods Wistar rats were made diabetic by administering streptozotocin.They were then assigned to three groups atrandom.After 2 months,the three groups of these diabetic rats were treated with RS or RG,or untreated.Analyses ofexpression levels of PARP,NF-κB,and intercellular adhesion molecule-1 (ICAM-1) in the retinas of rats in differentgroups were performed by Western blotting and immunohistochemical assays,and mRNA levels of NF-κB and ICAM-1were determined by real-time polymerase chain reaction (PCR).In addition,the basement membranes of capillaries inthe rats' retinas were observed using electron microscopy,and diabetes-induced capillary degeneration (ghost pericytesand acellular capillaries) were quantitated.Results From the third month after the injection of streptozotocin,the diabetic rats were given daily RG,RS or tap water separately.The diabetic rats failed to gain weight compared with normal age-matched rats,whereas their glycated hemoglobin levels were significantly increased.After 5 months,the mRNA levels of NF-κB and ICAM-1 and the protein expression of PAPP,NF-κB,and ICAM-1 were significantly increased in the retinas of diabetic rats in the untreated group compared with the nondiabetic controls.After 8 months,the number of degenerated retinal capillaries (ghost pericytes and acellular capillaries) was significantly increased in the diabetic rats in the untreated group compared with normal age-matched rats.RG and RS inhibited diabetes-induced over-expression of PARP,NF-κB,and ICAM-1 in the retinas of diabetic rats at the end of 5-month diabetic duration.Treatment using RG and RS significantly inhibited increases in the number of acellular capillaries and pericyte ghosts and suppressed the basement membrane thickening in the retinas of rats with diabetes for 8 months compared with the control diabetic rats.Conclusions These results indicate that PARP plays an important role in the pathogenesis of diabetic retinopathy.RS and RG may have acted on the mechanism of PARP regulation of NF-κB,which suppressed the expression of NF-κB and ICAM-1,and led to the inhibition of retinal capillary degeneration。

Abstract：Background Mono-(2-ethylhexyl) phthalate (MEHP),the metabolite of di-(2-ethylhexyl) phthalate (DEHP),was suspected to be toxic to human embryos.This study contributes to investigating its toxic effects by an embryonic stem cell test (EST) based on two human embryonic stem cell (hESCs) lines.Methods CH1 established in our own lab and H1,a federally registered cell line were two human embryonic stem cell lines used in this test.Four endpoint measurements were performed consisting of cell viability,proliferation ability,apoptosis as well as changes of gene expression patterns after spontaneous differentiation were determined.For measuring effects on the first three endpoints,the cells were treated with various concentrations of MEHP dissolved in dimethyl sulfoxide (DMSO) and only with DMSO which served as control and harvested after 5 days.For measuring effects during spontaneous differentiation,the RNA of embryoid bodies (EBs) formed after 8 days' MEHP exposure was collected and changes in differentiation specific gene expression patterns were analyzed by quantitative real time RT-PCR.Results As a result the viability and proliferation ability of both cell lines decreased significantly at 1000 μmol/L MEHP,while there was no effect on apoptosis or cell morphology.In addition MEHP also changed the gene expression pattern in the EBs of both cell lines.Conclusion MEHP in a high dose was cytotoxic and affected the development of hESCs,which indicates its embryo toxicity in human embryos。

Abstract：Background Peg-lnterferon-α treatment is expensive and associated with considerable adverse effects,selection of patients with the highest probability of response is essential for clinical practice.The objective of this study was to assess the relationship between the gene polymorphisms of interleukin-28 (IL-28),p21-activated protein kinase 4 (PAK4) and the response to interferon treatment in chronic hepatitis B patients.Methods Two hundred and forty interferon-naive treatment HBeAg seropositive chronic hepatitis B patients were enrolled in the present prospective nested case-control study.Peripheral blood samples were collected,including 92 with favorable response and 148 without response to the interferon treatment.Rs8099917,rs12980602,and rs9676717 SNP was genotyped using matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS).Results IL-28 genotype was not associated with response to interferon treatment (OR for GT/GG vs.TT,0.881 (95％CI 0.388-2.002); P=0.762; OR for CT/CC vs.TT,0.902 (95％ CI 0.458-1.778); P=0.766).Rs9676717 in PAK4 genotype was independently associated with the response (OR for CT/CC vs.TT,0.524 (95％ CI 0.310-0.888); P=-0.016).When adjusting for age,gender,smoking,drinking,levels of hepatitis B virus DNA,and alanine aminotransferase (ALT),rs9676717 genotype TT appeared to be associated with a higher probability of response for interferon treatment (OR,0.155 (95％ CI 0.034-0.700); P=-0.015).Conclusion Genotype TT for rs9676717 in PAK4 gene and no drinking may be predictive of the interferon-α treatment success。

To the editor:Zhang et all have provided interesting data in their recent article.Topotecan may of clinical benefit in the management of other intra-cranial tumors especially glioblastomas.For instance,topotecan has a negative effect on intra-tumoral angiogenesis in glioblastomas.Hypoxia-inducible factor-1 (HIF-1)target genes are significantly inhibited at the same time thus further attenuating tumor growth.2 Addition of topotecan also is of additional clinical benefit when used in conjunction with radiotherapy in the management of glioblastomas.The six months progression free survival is augmented by almost 16％.Similarly the two year overall survival rates are augmented by 6％。

To the editor:Abdominal hernias are relatively common in patients on continuous ambulatory peritoneal dialysis (CAPD),with a prevalence of 4％-14％.1,2 Failure to detect an occult contralateral hernia (OCH) may lead to the requirement of a second surgery repair and severe complications,such as dialysis inadequacy and strangulation of the herniated loop of intestine.Here we report a case on CAPD whose bilateral inguinal hernia was missed by routine examinations,but later correctly diagnosed by CT peritoneography (CTP)。

To the editor:Inflammatory linear verrucous epidermal nevus (ILVEN) is an epidermal nevus reflecting genetic mosaicism.1 It resembles linear psoriasis clinically and histologically,and there are no generally accepted pathognomonic features.2 Therefore differentiation of the two diseases has always been difficult in clinical settings。

Abstract：Background The combination of cilostazol,aspirin and clopidogrel (triple antiplatelet therapy,TAT) after a percutaneous coronary intervention has been used as an alternative therapy.We performed a meta-analysis to evaluate the efficacy and safety of TAT for patients after percutaneous coronary intervention (PCI).Methods We systematically searched Pubmed,Embase and Web of Science databases to identify all randomized controlled trials (RCTs) that compared dual antiplatelet therapy (DAT) with and without cilostazol after PCI.All analyses were conducted using Review Manager 5.0.Results The final analysis consisted of 4474 patients from ten studies.The combined results suggested that there was a lower risk of cardiac death (relative risk (RR)=0.55,95％ confidence interval (CI):0.31-0.98,P ＜0.05) and major adverse cardiac events (MACEs) (RR=0.63,95％ CI:0.54-0.74,P ＜0.05) in patients treated with TAT as compared to those with DAT follow-ups after six months to one year; no significant difference was observed in bleeding and non-fatal myocardial infarction (MI) (RR=1.14,95％ CI:0.80-1.64,P ＞0.05; RR=0.87,95％ CI:0.42-1.83,P ＞0.05).However,the rate of adverse drug reaction was higher in patients receiving TAT than in patients receiving DAT (RR=2.21,95％ CI:1.84-2.66,P ＜0.05).Moreover,there was a lower risk of stent thrombosis in patients treated with TAT as compared to those treated with DAT (RR=0.44,95％ CI:0.21-0.94,P ＜0.05).The TAT group had a reduced risk of target lesion revascularization (TLR) (RR=0.60,95％ CI:0.43-0.82,P=0.001) and target vessel revascularization (TVR) than the DAT group (RR=0.56,95％ CI:0.45-0.71,P ＜0.05).The number of MACEs was lower for patients in the TAT group than in the DAT group with diabetes mellitus sub-analysis (RR=0.41,95％ CI:0.28-0.61,P ＜0.05).But no significant difference was observed between the two groups regarding MACEs in patients with drug-eluting stent implantations (RR=0.82,95％ CI:0.65-1.03,P ＞0.05).Conclusion TAT could significantly reduce the rates of MACEs and cardiac death in comparison to DAT,but more attention should be paid to adverse side effects of the drugs。

Abstract：Background Successful revascularization of coronary artery disease,especially ST-elevation myocardial infarction (STEMI),does not always mean optimal myocardial reperfusion in a portion of patients because of no-reflow phenomenon.We hypothesized that statins might attenuate the incidence of myocardial no-refiow when used before percutaneous coronary intervention (PCI).The purpose of this study was to summarize the evidence of pre-procedural statin therapy to reduce myocardial no-reflow after PCI.Methods We searched the MEDLINE,Cochrane,and clinicaltrials.gov databases from inception to October 2012 for clinical trials that examined statin therapy before PCI.We required that studies initiated statins before PCI and reported myocardial no-reflow.A DerSimonian-Laird model was used to construct random-effects summary risk ratios.Results In all,7 studies with 3086 patients met our selection criteria.The use of pre-procedural statins significantly reduced post-procedural no-reflow by 4.2％ in all PCI patients (risk ratio (RR) 0.56,95％ confidence interval (CI) 0.35 to 0.90,P=0.016),and attenuated by 5.0％ in non-STEMI patients (RR 0.41,95％ CI 0.18 to 0.94,P=-0.035).This benefit was mainly observed in the early or acute intensive statin therapy populations (RR 0.43,95％ CI 0.26 to 0.71,P=-0.001).Conclusions Acute intensive statin therapy before PCI significantly reduces the hazard of post-procedural no-reflow phenomenon.The routine use of statins before PCI should be considered。