BACKGROUND & AIMS: The projection point of the axis of the anterior column of the acetabulum on the outer table of the iliac wing was determined in 15 adult bony hemipelves. The optimal entry point for lag screw fixation in the anterior column was located 16 +/- 3.9 mm superior to the midpoint of the line connecting the apex of the sciatic notch with the notch between anterior superior iliac spine and anterior inferior iliac spine, and 46 +/- 5.9 mm superior to the acetabular rim. The mean inclination of the projected axis was 90.6 degrees +/- 5.0 degrees in the sagittal plane and 29.0 degrees +/- 4.4 degrees in the transverse plane. These data may facilitate insertion of a lag screw into the anterior acetabular column and minimize the risk of articular violation or cortical penetration because there is a narrow margin of safety. The lag screw placement also may be aided by palpating the anterior column with a finger and by intraoperative fluoroscopy for visualization of the hip joint and the anterior column in the obturator or pelvic outlet views.

背景与目标： 在15个成年的骨性半骨中确定了髋臼前柱的轴在the骨翼外表上的投影点。滞后螺钉固定在前柱的最佳进入点位于坐骨神经切迹的顶点与with前上棘和and下前棘之间的切线的连接线的中点上方16 /-3.9 mm，和46 / -比髋臼边缘高5.9 mm。投影轴的平均倾斜度在矢状面中为90.6度/-5.0度，在横断面中为29.0度/-4.4度。这些数据可能有助于将方头螺钉插入髋臼前柱，并且由于狭窄的安全范围，因此使关节侵犯或皮质穿透的风险降到最低。还可以通过用手指触诊前柱和术中透视检查，以在填孔器或骨盆出口视图中可视化髋关节和前柱来辅助放置拉力螺钉。

BACKGROUND & AIMS: CONTEXT:In animal models, estrogen inhibits atherogenesis by inhibiting many of the early steps of atherosclerotic plaque formation. However, the lack of cardioprotective effect by postmenopausal hormone replacement therapy and possible increase in cardiovascular events observed during the first year after the initiation of hormone replacement therapy may suggest that once the plaque is formed, estrogen may have additional effects that may counteract its beneficial outcomes. Indeed, the effect of estrogen on plaque stability has not been identified. OBJECTIVE:We hypothesized that 17beta-estradiol (E2) may cause increased apoptosis in human coronary artery endothelial cells (HCAECs). This effect would explain an adverse effect on plaque stability in vivo. INTERVENTION(S) AND MAIN OUTCOME MEASURE(S):The effect of E2 on apoptosis, cell proliferation, and expression of proapoptotic molecules Fas and Fas ligand (FasL) in cultured HCAECs was evaluated. RESULTS:HCAECs in culture treated with E2 showed an increase in DNA strand breaks and nuclear fragmentation indicative of apoptosis. E2 treatment also induced a significant concentration-dependent increase in Fas mRNA and protein expressions in HCAECs. Moreover, the expression of FasL mRNA and secretion of FasL protein by HCAECs were enhanced in response to E2 treatments. CONCLUSIONS:E2 increases the apoptosis in cultured HCAECs. Enhanced Fas and FasL expressions in response to E2 suggest that activation of the Fas/FasL pathway may be a mediator of the proapoptotic effects of E2 in these cells.

背景与目标： 背景：在动物模型中，雌激素通过抑制动脉粥样硬化斑块形成的许多早期步骤来抑制动脉粥样硬化。然而，绝经后激素替代疗法缺乏心脏保护作用，并且在开始激素替代疗法后的第一年观察到的心血管事件可能增加，这可能表明一旦形成斑块，雌激素可能会产生额外的作用，从而抵消其有益的结果。 。实际上，尚未确定雌激素对斑块稳定性的作用。
目的：我们假设17β-雌二醇（E2）可能导致人冠状动脉内皮细胞（HCAEC）凋亡增加。该作用将解释对体内斑块稳定性的不利影响。
干预和主要观察指标：评估了E2对培养的HCAEC中细胞凋亡，细胞增殖以及促凋亡分子Fas和FasL配体（FasL）表达的影响。
结果：用E2处理的培养物中的HCAECs显示DNA链断裂的增加和核碎裂指示凋亡。 E2处理还诱导了HCAECs Fas mRNA和蛋白表达的浓度依赖性显着增加。而且，响应于E2处理，HCAECs的FasL mRNA的表达和FasL蛋白的分泌得到增强。
结论：E2增加了培养的HCAECs的细胞凋亡。响应E2增强的Fas和FasL表达表明Fas / FasL途径的激活可能是这些细胞中E2促凋亡作用的介质。

BACKGROUND & AIMS: Focal and segmental sclerosed lesions in the glomeruli are found in several pathological entities and more often are found in the corticomedullary junction where renal blood flow and filtration pressure is maximal. Experimental data suggest that hyperfiltration injury results in focal and segmental glomerulosclerosis (FSGS). In keeping with this concept, malignant hypertension is a known cause of nephrotic-range proteinuria and nephrotic syndrome pathalobically represented by FSGS. We report a case of unilateral renal artery stenosis associated with nephrotic syndrome and FSGS in the contralateral kidney only. The kidney with the stenosed renal artery showed normal glomeruli with juxtaglomerular hyperplasia, suggesting that protection from hyperfiltration injury was provided by the presence of high-grade stenosis. Serum creatinine concentration, blood pressure, and proteinuria normalized after aorto-renal bypass surgery. This case shows the importance of hemodynamic factors on the pathogenesis of secondary FSGS and the progression of renal disease.

背景与目标： 在几个病理实体中发现了肾小球的局灶性和节段性硬化病变，更常见于肾肾血流和滤过压力最大的皮质肾交界处。实验数据表明，超滤损伤可导致局灶性和节段性肾小球硬化（FSGS）。与这个概念一致，恶性高血压是FSGS病态性代表的肾病范围蛋白尿和肾病综合征的已知病因。我们报道了仅在对侧肾脏中伴有肾病综合征和FSGS的单侧肾动脉狭窄的病例。肾动脉狭窄的肾脏显示肾小球正常，并伴有肾小球增生，提示存在高度狭窄可防止过度滤过损伤。主动脉-肾脏搭桥手术后，血清肌酐浓度，血压和蛋白尿恢复正常。该病例表明血液动力学因素对继发性FSGS的发病机理和肾脏疾病进展的重要性。

BACKGROUND & AIMS: Rupture of atheromatous plaques leading to acute coronary syndromes usually occur in lipid-reach and well-developed coronary lesions. We describe 2 unusual patients with acute coronary syndromes in whom there was angiographic and intravascular ultrasound evidence of an intraluminal thrombus overlying a small, nonocclusive plaque in an enlarged coronary artery.

背景与目标： 导致急性冠状动脉综合征的动脉粥样斑块破裂通常发生在脂质接触和发展良好的冠状动脉病变中。我们描述了2例急性冠状动脉综合征的不寻常患者，其中有血管造影和血管内超声证据显示腔内血栓覆盖在扩大的冠状动脉中的小块非闭塞性斑块上。

BACKGROUND & AIMS: BACKGROUND:Although the benefit of thrombolytic therapy in reducing mortality in acute myocardial infarction is well established, the types of bleeding and risk factors for bleeding are less well described in large trials.

METHODS AND RESULTS:We analyzed the baseline characteristics, outcomes, and incidence of bleeding by location, severity, and treatment assignment among 41,021 patients in the GUSTO-I trial of thrombolysis for acute myocardial infarction. Of the 40,903 patients for whom there were complete data, 1.2% suffered severe bleeding and 11.4% experienced moderate hemorrhage at a variety of sites. The most common sources of bleeding were procedure related. The thrombolytic regimen was strongly related to the incidence of bleeding; comparatively more bleeding was seen with the therapies of streptokinase plus intravenous heparin and the streptokinase and tissue plasminogen activator plus intravenous heparin combination. In multivariate analysis, the four most powerful independent predictors of hemorrhage were older age, lighter body weight, female sex, and African ancestry; they remained the most important predictors of bleeding when multivariate analysis was performed on patients who did not undergo invasive procedures. The presence of serious hemorrhage was associated with other undesirable outcomes (recurrent events, left ventricular dysfunction, arrhythmia, or stroke).

CONCLUSIONS:Important predictors of bleeding in this population are increased age, lighter weight, female sex, African ancestry, and experiencing invasive procedures. Other nonhemorrhagic adverse clinical outcomes were associated with moderate and severe bleeding, which was in turn associated with increased length of hospital stay and mortality at 30 days.

背景与目标： 背景：尽管溶​​栓治疗在降低急性心肌梗死死亡率方面的益处已广为人知，但在大型试验中对出血的类型和出血的危险因素的描述却很少。

< strong>方法和结果：我们在GUSTO-I急性心肌梗塞溶栓试验的GUSTO-I试验中，对41,021例患者的基线特征，结局和出血发生率，位置，严重程度和治疗方案进行了分析。在有完整数据的40,903名患者中，有1.2％出现严重出血，11.4％的患者在不同部位出现中度出血。最常见的出血来源与手术有关。溶栓方案与出血发生率密切相关。链激酶加静脉肝素，链激酶和组织纤溶酶原激活剂加肝素联合治疗的出血量相对较多。在多变量分析中，出血的四个最有力的独立预测因子是年龄大，体重轻，女性和非洲血统。当对未进行侵入性治疗的患者进行多变量分析时，它们仍然是出血的最重要预测指标。严重出血的存在与其他不良后果（复发事件，左心室功能障碍，心律不齐或中风）相关。

结论：该人群出血的重要预测因素是年龄增加，体重减轻，女性性别，非洲血统和经历侵入性程序。其他非出血性不良临床预后与中度和重度出血有关，这又与住院天数的延长和30天病死率有关。