BACKGROUND & AIMS: PURPOSE:The issue of unidentified volume expansion is well recognized as a cause for resistance to antihypertensive therapy. The aim of study is to identify contribution of negative fluid balance to hypertension control and impact on endothelial and cardiac functions among primary hypertensive patients who do not have kidney failure. MATERIALS AND METHODS:This is a prospective interventional study with one-year follow-up. Preceded by volume status measurements were performed by a body composition monitor (BCM), the patients were put on ambulatory blood pressure monitoring for 24 hours. Then, echocardiographic assessments and flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) measurements were completed. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. RESULTS:At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower CIMT, left ventricle mass index, left ventricular end-diastolic diameter, mean systolic and diastolic BP, non-dipper patient ratio, and higher FMD. In negatively hydrated group, target organ damage significantly reduced during trial. CONCLUSIONS:The significance of negative hydration status with respect to blood pressure control, endothelial and cardiac functions within primary hypertensive patients who do not suffer from kidney failure has been demonstrated.

背景与目标： 目的：不明原因的体积膨胀问题已被公认为是抗高血压治疗耐药的原因。研究的目的是在没有肾衰竭的原发性高血压患者中确定负流体平衡对高血压控制的贡献以及对内皮和心脏功能的影响。
材料与方法：这是一项为期一年的随访的前瞻性干预研究。在通过身体成分监测仪（BCM）进行体积状态测量之前，将患者进行动态血压监测24小时。然后，完成了超声心动图评估以及血流介导的扩张（FMD）和颈动脉内膜中层厚度（CIMT）的测量。两组中的一组患者在利尿剂治疗试验期间保持负水分状态。
结果：在一年的随访结束时，负水合组患者的CIMT，左心室质量指数，左心室舒张末期直径，平均收缩压和舒张压，非北斗星患者比率显着降低，和更高的FMD。在负水合组中，试验期间靶器官损伤显着减少。
结论：在没有肾脏衰竭的原发性高血压患者中，负水合状态对血压控制，内皮和心脏功能的重要性已得到证实。

BACKGROUND & AIMS: BACKGROUND:Reductions in admissions for myocardial infarction (MI) have been reported in locales where smoke-free workplace laws have been implemented, but no study has assessed sudden cardiac death in that setting. In 2002, a smoke-free restaurant ordinance was implemented in Olmsted County, Minnesota, and in 2007, all workplaces, including bars, became smoke free. METHODS:To evaluate the population impact of smoke-free laws, we measured, through the Rochester Epidemiology Project, the incidence of MI and sudden cardiac death in Olmsted County during the 18-month period before and after implementation of each smoke-free ordinance. All MIs were continuously abstracted and validated, using rigorous standardized criteria relying on biomarkers, cardiac pain, and Minnesota coding of the electrocardiogram. Sudden cardiac death was defined as out-of-hospital deaths associated with coronary disease. RESULTS:Comparing the 18 months before implementation of the smoke-free restaurant ordinance with the 18 months after implementation of the smoke-free workplace law, the incidence of MI declined by 33% (P < .001), from 150.8 to 100.7 per 100,000 population, and the incidence of sudden cardiac death declined by 17% (P = .13), from 109.1 to 92.0 per 100,000 population. During the same period, the prevalence of smoking declined and that of hypertension, diabetes mellitus, hypercholesterolemia, and obesity either remained constant or increased. CONCLUSIONS:A substantial decline in the incidence of MI was observed after smoke-free laws were implemented, the magnitude of which is not explained by community cointerventions or changes in cardiovascular risk factors with the exception of smoking prevalence. As trends in other risk factors do not appear explanatory, smoke-free workplace laws seem to be ecologically related to these favorable trends. Secondhand smoke exposure should be considered a modifiable risk factor for MI. All people should avoid secondhand smoke to the extent possible, and people with coronary heart disease should have no exposure to secondhand smoke.

背景与目标： 背景：在已实施无烟工作场所法律的地区，已有报道称心肌梗死（MI）的住院人数有所减少，但尚无研究评估该地区的突发性心脏病死亡。 2002年，明尼苏达州的奥尔姆斯特德县实施了无烟餐厅条例，2007年，包括酒吧在内的所有工作场所都实现了无烟。
方法：为了评估无烟法律对人口的影响，我们通过罗切斯特流行病学项目测量了在实施每项无烟条例前后的18个月内，奥尔姆斯特德县的心肌梗死和心源性猝死的发生率。使用严格的标准化标准（依赖于生物标志物，心脏疼痛和心电图的明尼苏达州编码），对所有MI进行连续提取和验证。猝死定义为与冠心病相关的院外死亡。
结果：与实施无烟餐厅条例之前的18个月与实施无烟餐厅工作场所法之后的18个月相比，心梗的发生率下降了33％（P <.001），从每15万人的150.8下降到100.7心脏猝死的发生率下降了17％（P = 0.13），从每10万人口中的109.1下降到92.0。在同一时期，吸烟率下降，而高血压，糖尿病，高胆固醇血症和肥胖症的发生率则保持不变或上升。
结论：实施无烟法律后，心肌梗死的发生率显着下降，除吸烟率外，社区共同干预措施或心血管危险因素的变化均不能解释其严重程度。由于其他危险因素的趋势似乎无法解释，因此，无烟工作场所法律似乎与这些有利趋势在生态上相关。二手烟暴露应被视为可改变的心梗危险因素。所有人都应尽可能避免二手烟，患有冠心病的人也不应接触二手烟。

BACKGROUND & AIMS: :Purpose: Investigate the role of regulator of chromosome condensation 2 (RCC2) on lung adenocarcinoma (LUAD) metastasis.Experimental Design: Clinical specimens were used to assess the impact of RCC2 on LUAD metastasis. Mouse models, cytobiology, and molecular biology assays were performed to elucidate the function and underlying mechanisms of RCC2 in LUAD.Results: RCC2 expression was frequently increased in LUADs (88/122, 72.13%). It was confirmed by analysis of a larger cohort of TCGA RNA-seq data containing 488 LUADs and 58 normal lung tissues (P < 0.001). Importantly, increased level of RCC2 was significantly associated with T status of tumor (P = 0.002), lymph node metastasis (P = 0.004), and advanced clinical stage (P = 0.001). Patients with LUAD with higher expression of RCC2 had shorter overall survival. Cox regression analysis demonstrated that RCC2 was an independent poorer prognostic factor for patients with LUAD. Moreover, forced expression of RCC2 promoted intrapulmonary metastasis in vivo and significantly enhanced LUAD cell migration, invasion, and proliferation in vitro Further study found that RCC2 induced epithelial-mesenchymal transition (EMT) and also stimulated the expression of MMP-2 and MMP-9. In addition, RCC2 was able to activate JNK, while inhibition of JNK suppressed the effect of RCC2 on LUAD cell migration, invasion, EMT, and the expression of MMP-2 and MMP-9.Conclusions: RCC2 plays a pivotal role in LUAD metastasis by inducing EMT via activation of MAPK-JNK signaling. Clin Cancer Res; 23(18); 5598-610. ©2017 AACR.

背景与目标： 目的：研究染色体凝集2调节剂（RCC2）在肺腺癌（LUAD）转移中的作用。实验设计：临床标本用于评估RCC2对LUAD转移的影响。进行了小鼠模型，细胞生物学和分子生物学实验，以阐明RCC2在LUAD中的功能及其潜在机制。结果：RCA2在LUAD中的表达频繁增加（88 / 122，72.13％）。通过分析大量包含488 LUAD和58正常肺组织的TCGA RNA-seq数据证实了这一点（P <0.001）。重要的是，RCC2水平的升高与肿瘤的T状态（P = 0.002），淋巴结转移（P = 0.004）和晚期临床阶段（P = 0.001）显着相关。具有较高RCC2表达的LUAD患者的总生存期较短。 Cox回归分析表明，RCC2是LUAD患者的独立不良预后因素。此外，RCC2的强制表达在体内促进肺内转移，并在体外显着增强LUAD细胞的迁移，侵袭和增殖。进一步的研究发现RCC2诱导上皮-间质转化（EMT）并刺激MMP-2和MMP-9的表达。 。此外，RCC2能够激活JNK，而抑制JNK则抑制了RCC2对LUAD细胞迁移，侵袭，EMT以及MMP-2和MMP-9表达的影响。结论：RCC2在LUAD转移中起关键作用。通过激活MAPK-JNK信号传导来诱导EMT。临床癌症研究； 23（18）; 5598-610。 ©2017 AACR。

BACKGROUND & AIMS: UNLABELLED:Auscultation skills are in decline, but few studies have shown which specific aspects are most difficult for trainees. We evaluated individual aspects of cardiac auscultation among pediatric residents using recorded heart sounds to determine which elements pose the most difficulty. METHODS:Auscultation proficiency was assessed among 34 trainees following a pediatric cardiology rotation using an open-set format evaluation module, similar to the actual clinical auscultation description process. RESULTS:Diagnostic accuracy for distinguishing normal from abnormal cases was 73%. Findings most commonly correctly identified included pathological systolic and diastolic murmurs and widely split second heart sounds. Those least likely to be identified included continuous murmurs and clicks. Accuracy was low for identifying specific diagnoses. CONCLUSIONS:Given time constraints for clinical skills teaching, this suggests that focusing on distinguishing normal from abnormal heart sounds and murmurs instead of making specific diagnoses may be a more realistic goal for pediatric resident auscultation training.

背景与目标： 没标签：听诊技能在下降，但是很少有研究表明哪些方面对受训者最困难。我们使用记录的心音评估了小儿居民心脏听诊的各个方面，以确定哪些元素构成了最大困难。
方法：采用开放式格式评估模块，对34名受过小儿心脏病学培训的学员进行听诊能力评估，与实际临床听诊描述过程相似。
结果：区分正常与异常病例的诊断准确性为73％。最常正确识别的发现包括病理性收缩期和舒张期杂音和广泛分裂的第二心音。那些最不可能被识别出的声音包括连续的杂音和咔嗒声。识别特定诊断的准确性较低。
结论：鉴于临床技能教学的时间限制，这表明着眼于区分正常和异常的心音和杂音而不是进行特定的诊断可能是儿科住院医师听诊培训的一个更现实的目标。

BACKGROUND & AIMS: The hemorheological effects of autologous blood storage with or without the use of erythropoietin were examined before surgery for valvular disease. There was no rheological difference between patients with aortic (16 cases) or mitral (10 cases) valve disease. Before storage, the levels of hematocrit, whole blood viscosity, and especially coefficient of rheology, were lower (p < 0.05) in the blood stored with erythropoietin, but this difference disappeared after storage. The plasma viscosity of both groups did not change before and after storage. The viscosity of blood was equalized after the storage of blood, irrespective of the use of erythropoietin.

背景与目标： 在进行瓣膜疾病手术之前，先检查自体血液储存在有或没有使用促红细胞生成素的血液流变学效应。主动脉瓣膜病变（16例）或二尖瓣瓣膜病变（10例）的患者在流变学上没有差异。储存前，用促红细胞生成素储存的血液中的血细胞比容，全血粘度，尤其是流变系数较低（p <0.05），但这种差异在储存后消失。两组的血浆粘度在储存前后都没有改变。不论是否使用促红细胞生成素，都可以在储存血液后使血液的粘度达到均衡。

BACKGROUND & AIMS: :A case with brain metastasis involving bilateral middle cerebellar peduncles (bMCP) was reported. A 71-year-old male with gastric cancer was treated for multiple brain metastasis by gamma knife radiosurgery (GKR) in September, 2004. Two months after the initial GKR, MRI showed asymmetrical enhanced lesions involving bMCP. A few months later, MRI revealed an expansional infiltration of bMCP lesions. The patient had presented with headache loss of appetite, cerebellar ataxia, diplopia and slight dysmetria. PET showed 2-deoxy-2- [18F] fluoro-D-glucose (FDG) uptake of the bMCP lesions. The lesions were diagnosed as brain metastasis of gastric cancer. The patient underwent his second GKR (marginal dose : 19Gy, maximum dose 38Gy) MRI revealed the disappearance of the tumors 3 months after the second GKR. One year later, the patient showed no evidence of recurrence. For the last time, our case was diagnosed as brain metastasis from gastric cancer without meningeal carcinomatosis. It was suggested that FDG-PET can provide additional information about the lesion of bMCP. GKR may be useful to treat the tumor in bMCP.

背景与目标： ：报告了一例涉及双侧中小脑梗（bMCP）的脑转移病例。一名71岁的患有胃癌的男性于2004年9月通过伽玛刀放射手术（GKR）治疗了多发性脑转移。在首次GKR的两个月后，MRI显示涉及bMCP的非对称性增强病灶。几个月后，MRI显示bMCP病变扩散浸润。该患者出现头痛，食欲不振，小脑共济失调，复视和轻度不典型。 PET显示bMCP病变被2-脱氧-2- [18F]氟-D-葡萄糖（FDG）摄取。病变被诊断为胃癌的脑转移。患者接受了第二次GKR（边缘剂量：19Gy，最大剂量38Gy），MRI显示第二次GKR后3个月肿瘤消失。一年后，患者未见复发迹象。上一次，我们的病例被诊断为胃癌脑转移而无脑膜癌。有人提出，FDG-PET可以提供有关bMCP病变的更多信息。 GKR对于治疗bMCP中的肿瘤可能有用。

BACKGROUND & AIMS: :Purpose of this study was to assess the additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress Cardiac-MR (CMR). Dobutamine Stress CMR was performed in 115 patients with an inconclusive diagnosis of myocardial ischemia on a 1.5 T system (Magnetom Avanto, Siemens Medical Systems). Three short-axis cine and grid series were acquired during rest and at increasing doses of dobutamine (maximum 40 microg/kg/min). On peak dose dobutamine followed immediately by a first pass myocardial perfusion imaging sequence. Images were graded according to the sixteen-segment model, on a four point scale. Ninety-seven patients showed no New (Induced) Wall Motion Abnormalities (NWMA). Perfusion imaging showed absence of perfusion deficits in 67 of these patients (69%). Perfusion deficits attributable to known previous myocardial infarction were found in 30 patients (31%). Eighteen patients had NWMA, indicative for myocardial ischemia, of which 14 (78%) could be confirmed by a corresponding perfusion deficit. Four patients (22%) with NWMA did not have perfusion deficits. In these four patients NWMA were caused by a Left Bundle Branch Block (LBBB). They were free from cardiac events during the follow-up period (median 13.5 months; range 6-20). Addition of first-pass myocardial perfusion imaging during peak-dose dobutamine stress CMR can help to decide whether a NWMA is caused by myocardial ischemia or is due to an (inducible) LBBB, hereby preventing a false positive wall motion interpretation.

背景与目标： ：本研究的目的是评估在多巴酚丁胺应激性心肌病（CMR）峰值剂量期间首次通过心肌灌注显像的附加价值。多巴酚丁胺应激CMR在115例1.5 T系统（Magnetom Avanto，西门子医疗系统）上诊断为心肌缺血的患者中进行。在休息期间和增加剂量的多巴酚丁胺（最大40微克/千克/分钟）下获得了三个短轴电影和栅格系列。在多巴酚丁胺达到峰值剂量后，立即进行首遍心肌灌注成像序列。图像根据十六段模型以四点标度进行分级。 97位患者未显示新的（诱发的）壁运动异常（NWMA）。灌注成像显示这些患者中有67位（69％）没有灌注不足。 30名患者（31％）发现可归因于先前已知的心肌梗塞的灌注不足。 18例患者有NWMA，提示有心肌缺血，其中14例（78％）可通过相应的灌注不足来确认。 NWMA的四名患者（22％）没有灌注不足。在这四例患者中，NWMA是由左束支传导阻滞（LBBB）引起的。在随访期间（中位数13.5个月；范围6-20），他们没有发生心脏事件。在峰值剂量多巴酚丁胺应激CMR期间增加首过心肌灌注显像可以帮助确定NWMA是由心肌缺血引起还是由（诱导性）LBBB引起，从而避免了假阳性的壁运动解释。

BACKGROUND & AIMS: :Sleep-disordered breathing often presents as a cardiac or psychiatric problem. Such presentation may lead to suboptimal diagnostic and therapeutic decisions. The authors present a case in which a patient's condition improved only after the primary disorder was diagnosed and properly managed.

背景与目标： ：睡眠呼吸障碍通常表现为心脏或精神疾病。这样的表现可能导致次优的诊断和治疗决策。作者介绍了一种情况，只有在诊断出原发性疾病并妥善处理后，患者的病情才会改善。

BACKGROUND & AIMS: AIMS:to report the incidence, characteristics, and outcome of in-hospital cardiac arrest (IHCA) in a large Italian region. SETTING:all hospitals participating in the IHCA Registry Initiative of Piedmont. METHODS:observational cohort study in adult (>18year old) inpatients resuscitated from IHCA during three consecutive years (2012-2014). The main outcome measures were IHCA incidence and survival to hospital discharge. RESULTS:A total of1539 arrests in adult inpatients were recorded in the study period, yielding an overall incidence of 1.51 arrests/1000 admissions. The incidence was highest at day 1 after hospital admission and in the morning hours, with a peak at 9.00 a.m. Median age was 77 (interquartile range 68-83) years. The presenting rhythm was ventricular fibrillation/pulseless ventricular tachycardia in 291/1539 (18.9%) cases. A total of 549/1539 (35.7%) patients achieved recovery of spontaneous circulation (ROSC) and 228/1539(14.8%) survived hospital discharge, with 207 (90.8%) of the latter having good neurological outcome (Cerebral Performance Categories [CPC] 1 or 2).After adjustment for major confounders, a pre-arrest CPC=1, a cardiac cause of arrest, a shockable presenting rhythm, and a shorter duration of resuscitation were independently associated with a higher likelihood of survival to discharge. CONCLUSIONS:in this Italian registry the incidence of IHCA and its circadian distribution were comparable to those in the NCAA registry in the UK. Patients were older and had a lower ROSC rate than these observed in other large IHCA registries, but post-ROSC survival rate and factors affecting survival to discharge were similar.

背景与目标： 目的：报告意大利大面积医院内心脏骤停（IHCA）的发生率，特征和结局。
地点：所有参加皮埃蒙特IHCA注册计划的医院。
方法：连续三年（2012-2014年）从IHCA复苏的成人（> 18岁）住院患者的观察性队列研究。主要结果指标是IHCA发生率和出院生存率。
结果：在研究期间，共记录了1539名成人住院病人的逮捕，总的发生率为1.51名逮捕/ 1000例入院。发病率最高的是入院后的第一天和早晨，最高时间是上午9.00点，中位年龄为77岁（四分位间距为68-83岁）。出现的节律为室颤/无脉性室性心动过速，发生在291/1539例中（占18.9％）。共有549/1539（35.7％）的患者实现了自发性循环（ROSC）的恢复，并且有228/1539（14.8％）的患者在出院后存活，其中207（90.8％）的患者具有良好的神经系统预后（脑功能分类[CPC] [1]或[2]）。在对主要混杂因素进行调整之后，逮捕前的CPC = 1，心脏骤停的原因，令人震惊的呈现节律和较短的复苏持续时间与更高的存活存活率独立相关。
结论：在该意大利注册中心中，IHCA的发生率及其昼夜节律分布与英国的NCAA注册中心相当。与其他大型IHCA登记处观察到的患者相比，患者年龄更大且ROSC率较低，但是ROSC后的存活率和影响出院存活率的因素相似。

BACKGROUND & AIMS: :Angiotensin II is involved in tumor growth; however, the precise mechanism is not known. Platelets also contribute to tumor growth, and angiotensin II type 1 receptor (AT1) is expressed on the platelet surface. We hypothesized that interaction of platelets with tumor cells through AT1 receptor signaling promotes tumor metastasis. B16F1 melanoma cells were intravenously injected into Agtr1a knockout mice (AT1a(-/-)) and wild-type littermates (WT); the AT1a(-/-) mice exhibited a reduction in lung colonies. Angiotensin II induced expression of P-selectin on platelets in WT but not in AT1a(-/-) mice. A selective P-selectin neutralizing antibody decreased lung colony numbers in WT but not in AT1a(-/-) mice. Levels of vascular endothelial growth factor (VEGF) and stromal cell-derived factor 1 (SDF-1) receptor in platelets at metastatic locus were lower in AT1a(-/-) mice. Treatment of neutralizing antibodies against VEGF and CXCR4 decreased lung colony numbers in WT but not in AT1a(-/-) mice. In AT1a(-/-) mice, and both mobilization of progenitor cells expressing CXCR4(+)VEGFR1(+) cells from bone marrow and their recruitment to lung tissues were suppressed. These results suggest that AT1A signaling plays a critical role in tumor metastasis through P-selectin-mediated interactions of platelets with tumor and endothelial cells and through the AT1A signaling-dependent production of VEGF and SDF-1, which may be involved in mobilization of CXCR4(+)VEGFR1(+) cells.

背景与目标： ：血管紧张素II参与肿瘤生长；但是，确切的机制尚不清楚。血小板也有助于肿瘤的生长，并且血管紧张素II 1型受体（AT1）在血小板表面表达。我们假设血小板与肿瘤细胞通过AT1受体信号传导的相互作用促进了肿瘤转移。将B16F1黑色素瘤细胞静脉内注射到Agtr1a基因敲除小鼠（AT1a（-/-））和野生型同窝小鼠（WT）中； AT1a（-/-）小鼠肺集落减少。血管紧张素II诱导WT中血小板上P-选择蛋白的表达，而AT1a（-/-）小鼠中没有。选择性P-选择素中和抗体可降低WT小鼠的肺菌落数量，但不会降低AT1a（-/-）小鼠的肺菌落数量。在AT1a（-/-）小鼠中，转移部位的血小板中血管内皮生长因子（VEGF）和基质细胞衍生因子1（SDF-1）受体的水平较低。抗VEGF和CXCR4的中和抗体的治疗可降低WT小鼠的肺菌落数量，但不会降低AT1a（-/-）小鼠的肺菌落数量。在AT1a（-/-）小鼠中，表达CXCR4（）VEGFR1（）的祖细胞从骨髓动员到肺组织的动员都受到抑制。这些结果表明，AT1A信号传导通过P-选择蛋白介导的血小板与肿瘤和内皮细胞的相互作用以及通过AT1A信号依赖的VEGF和SDF-1的产生在肿瘤转移中起关键作用，这可能与CXCR4的动员有关。 （）VEGFR1（）细胞。

BACKGROUND & AIMS: :Excessive perioperative bleeding remains a substantial problem. Factor XIII (FXIII) contributes to clot stability, and it has therefore been suggested that supplementation with FXIII concentrate may improve perioperative hemostasis. We evaluated the effects of increasing doses of FXIII, alone or in combination with fibrinogen or platelet concentrate, in blood samples from 2 considerably different groups of surgical patients: cardiac and scoliosis surgery patients. Whole-blood samples were collected immediately after operation from cardiac and scoliosis surgery patients. The samples were supplemented with 3 clinically relevant doses of FXIII concentrate (+20%, +40%, and +60%), alone or in combination with a fixed dose of fibrinogen concentrate (+1.0 g/L) or fresh apheresis platelets (+92 × 109/L). Clot formation was assessed with rotational thromboelastometry (ROTEM). When the highest dose of FXIII concentrate was added, EXTEM clotting time was shortened by 10% in both cardiac and scoliosis surgery patients (95% confidence intervals: 2.4%-17% and 3.3%-17%, respectively), and FIBTEM maximum clot firmness was increased by 25% (9.3%-41%) in cardiac patients, relative to baseline. When fibrinogen was added, the dose-dependent effect of FXIII on clot stability was maintained, but the total effect was markedly greater than with FXIII alone, +150% (100%-200%) and +160% (130%-200%) for the highest FXIII dose in cardiac and scoliosis patients, respectively. Ex vivo supplementation with clinically relevant doses of FXIII improved clot formation moderately in blood samples from cardiac and scoliosis surgery patients, both alone and when given in combination with fibrinogen or platelet concentrate.

背景与目标： ：围手术期出血过多仍然是一个重大问题。因子XIII（FXIII）有助于血凝块稳定性，因此，建议补充FXIII浓缩物可改善围手术期止血。我们评估了增加剂量的FXIII单独或与纤维蛋白原或血小板浓缩剂联合使用对来自两组截然不同的外科手术患者（心脏和脊柱侧弯手术患者）的血液样本的影响。心脏和脊柱侧弯手术患者在手术后立即采集全血样品。样品中补充了3种临床相关剂量的FXIII浓缩物（20％，40％和60％），单独或与固定剂量的纤维蛋白原浓缩物（1.0 g / L）或新鲜的单采血小板（92×109 / L）。用旋转血栓弹力测定法（ROTEM）评估血凝块形成。当添加最高剂量的FXIII浓缩物时，心脏和脊柱侧弯手术患者的EXTEM凝血时间均缩短了10％（95％的置信区间：分别为2.4％-17％和3.3％-17％）和FIBTEM最大血凝块与基线相比，心脏病患者的硬度提高了25％（9.3％-41％）。当添加纤维蛋白原时，FXIII对血凝块稳定性的剂量依赖性作用得以维持，但总效果明显大于单独使用FXIII时，对于FXIII而言，分别为150％（100％-200％）和160％（130％-200％）分别在心脏和脊柱侧弯患者中使用最高的FXIII剂量。体外补充临床相关剂量的FXIII，可单独或与纤维蛋白原或血小板浓缩剂联合使用时，适度改善心脏和脊柱侧凸手术患者血液样本中的血凝块形成。

BACKGROUND & AIMS: CONCLUSION:Our findings show that copy number loss of FHIT is associated with lymph node metastasis (LNM) and suggest that the down-regulation of Fhit indicates poor prognosis in early oral squamous cell carcinoma (OSCC). OBJECTIVES:The purpose of this study was to identify alterations in genetic markers related to LNM in early OSCC. METHODS:Genome-wide copy number alterations were analyzed in 14 early OSCCs with (n = 7) or without (n = 7) cervical LNM using 180K array-comparative genomic hybridization. To explore the prognostic implications of the most significantly associated genetic alteration with cervical LNM, immunohistochemical analysis was conducted in 30 OSCCs. RESULTS:A total of 11 recurrently altered regions (RARs) were identified in the 14 OSCC cases. Six RARs on chromosomes 3p26-3p14, 5q22, and 9p21 were found to be significantly more common in early OSCC with LNM (p < 0.05). Among these, loss of 3p14.2 (where the FHIT gene is located) was the most frequent (five of seven patients with LNM, and none of seven without LNM), and most significantly associated with cervical LNM (p = 0.005). Fhit immunohistochemical staining of 30 OSCCs showed that Fhit negativity was associated with cervical LNM (p = 0.032) and poor disease-specific survival (p = 0.045).

背景与目标： 结论：我们的研究结果表明，FHIT的拷贝数丢失与淋巴结转移（LNM）有关，并且表明Fhit的下调表明早期口腔鳞状细胞癌（OSCC）的预后不良。
目的：本研究的目的是鉴定早期OSCC中与LNM相关的遗传标记的变化。
方法：采用180K阵列比较基因组杂交技术，分析了14例有（n = 7）有或无（n = 7）宫颈LNM的早期OSCC中全基因组拷贝数的变化。为了探讨与宫颈LNM最显着相关的遗传改变的预后意义，在30个OSCC中进行了免疫组织化学分析。
结果：在14例OSCC病例中共鉴定出11个反复改变的区域（RAR）。发现在LNM的早期OSCC中，染色体3p26-3p14、5q22和9p21上的六个RAR更为常见（p <0.05）。其中，3p14.2（FHIT基因所在的位置）的丢失最为频繁（7名LNM患者中有5名，而没有LNM的7名患者中没有一个），并且与宫颈LNM相关性最高（p = 0.005）。对30个OSCC进行Fhit免疫组织化学染色显示Fhit阴性与宫颈LNM（p = 0.032）和较差的疾病特异性存活率（p = 0.045）相关。

BACKGROUND & AIMS: :Cardiac implantable electronic devices are increasing in prevalence. The post-implant follow-up is important for monitoring both device function and patient condition. However, practice is inconsistent. For example, ICD follow-up schedules vary from 3 monthly to yearly according to facility and physician preference and availability of resources. Recommended follow-up schedules impose significant burden. Importantly, no surveillance occurs between follow-up visits. In contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. Remote home monitoring reduces the volume of device clinic visits and provides early detection of patient and/or system problems.

背景与目标： ：心脏植入式电子设备的普及率不断提高。植入后的随访对于监测设备功能和患者状况都很重要。但是，实践是不一致的。例如，根据设施和医生的喜好以及资源的可用性，ICD的随访时间表从每月3次到每年3次不等。建议的后续时间表会带来很大的负担。重要的是，随访之间不进行监视。相反，具有自动远程监视功能的可植入设备提供了一种执行持续监视的方法，并具有快速识别突出问题的能力。远程家庭监控减少了设备诊所就诊的次数，并提早发现了患者和/或系统问题。

BACKGROUND & AIMS: BACKGROUND:Detecting myocardial ischemia in hemodialysis patients is crucial given the high incidence of silent ischemia and the high cardiovascular mortality rates. Abnormal myocardial fatty acid metabolism as determined by imaging with (123)I-labeled BMIPP (β-methyl iodophenyl-pentadecanoic acid) might be associated with cardiac-derived death in hemodialysis patients. STUDY DESIGN:Prospective observational study. SETTING & PARTICIPANTS:Asymptomatic hemodialysis patients with one or more cardiovascular risk factors, but without known coronary artery disease, were followed up for 3 years at 48 Japanese hospitals (406 men, 271 women; mean age, 64 years). PREDICTOR:Baseline BMIPP summed scores semiquantified using a 17-segment 5-point system (normal, 0; absent, 4). OUTCOMES:Cardiac-derived death, including cardiac and sudden death. MEASUREMENTS:HRs were estimated using a Cox model for associations between BMIPP summed scores and cardiac-derived death, adjusting for potential confounders of age, sex, body mass index, dialysis duration, and cardiovascular risk factors. RESULTS:Rates of all-cause mortality and cardiac-derived death were 18.5% and 6.8%, respectively. Cardiac-derived death (acute myocardial infarction [n = 10], congestive heart failure [n = 13], arrhythmia [n = 2], valvular heart disease [n = 1], and sudden death [n = 20]) accounted for 36.8% of all-cause deaths. Cardiac-derived death (n = 46) was associated with age, history of heart failure, and BMIPP summed scores of 4 or higher (HR, 2.9; P < 0.001). Three-year cardiac-derived death-free survival rates were 95.7%, 90.6%, and 78.8% when BMIPP summed scores were 3 or lower, 4-8, and 9 or higher, respectively. BMIPP summed score also was a predictor of all-cause death (HR, 1.6; P = 0.009). LIMITATIONS:Sudden death of unknown cause was considered to have been cardiac derived, although a coronary origin was not confirmed. CONCLUSIONS:Abnormal myocardial fatty acid metabolism is associated with cardiac-derived death in hemodialysis patients. BMIPP single-proton emission computed tomography appears clinically useful for predicting cardiac-derived death in this population.

背景与目标： 背景：鉴于无声缺血的发生率高和心血管死亡率高，检测血液透析患者的心肌缺血至关重要。通过用（123）I标记的BMIPP（β-甲基碘苯基-十五烷酸）成像确定的心肌脂肪酸代谢异常，可能与血液透析患者的心源性死亡有关。
研究设计：前瞻性观察研究。
地点和参与者：有一种或多种心血管危险因素但无已知冠心病的无症状血液透析患者，在日本的48家医院接受了3年的随访（男性406例，女性271例；平均年龄64岁）。
预测：使用17段5点制（正常，0；不存在，4）对BMIPP基线总和分数进行半定量。
结果：心脏源性死亡，包括心源性和猝死。
测量：使用Cox模型估算BMIPP总得分与心脏源性死亡之间的关联，并校正年龄，性别，体重指数，透析时间和心血管危险因素等潜在混杂因素，从而得出心率。
结果：全因死亡率和心源性死亡率分别为18.5％和6.8％。心源性死亡（急性心肌梗死[n = 10]，充血性心力衰竭[n = 13]，心律不齐[n = 2]，瓣膜性心脏病[n = 1]和猝死[n = 20]）全因死亡人数的36.8％。心脏源性死亡（n = 46）与年龄，心衰史和BMIPP总分4分或更高（HR，2.9； P <0.001）相关。当BMIPP总分分别为3或更低，4-8和9或更高时，三年的心脏衍生无死生存率分别为95.7％，90.6％和78.8％。 BMIPP总分也是全因死亡的预测指标（HR，1.6； P = 0.009）。
局限性：尽管未确认冠状动脉起源，但未知原因的猝死被认为是由心脏引起的。
结论：血液透析患者心肌脂肪酸代谢异常与心脏源性死亡有关。 BMIPP单质子发射计算机断层扫描在临床上可用于预测该人群的心脏源性死亡。

BACKGROUND & AIMS: BACKGROUND:The routine implementation of sternal precautions to prevent sternal complications that restrict the use of the upper limbs is currently worldwide practice following a median sternotomy. However, evidence is limited and drawn primarily from cadaver studies and orthopaedic research. Sternal precautions may delay recovery, prolong hospital discharge and be overly restrictive. Recent research has shown that upper limb exercise reduces post-operative sternal pain and results in minimal micromotion between the sternal edges as measured by ultrasound. The aims of this study are to evaluate the effects of modified sternal precautions on physical function, pain, recovery and health-related quality of life after cardiac surgery. METHODS/DESIGN:This study is a phase II, double-blind, randomised controlled trial with concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. Patients (n = 72) will be recruited following cardiac surgery via a median sternotomy. Sample size calculations were based on the minimal important difference (two points) for the primary outcome: Short Physical Performance Battery. Thirty-six participants are required per group to counter dropout (20%). All participants will be randomised to receive either standard or modified sternal precautions. The intervention group will receive guidelines encouraging the safe use of the upper limbs. Secondary outcomes are upper limb function, pain, kinesiophobia and health-related quality of life. Descriptive statistics will be used to summarise data. The primary hypothesis will be examined by repeated-measures analysis of variance to evaluate the changes from baseline to 4 weeks post-operatively in the intervention arm compared with the usual-care arm. In all tests to be conducted, a p value <0.05 (two-tailed) will be considered statistically significant, and confidence intervals will be reported. DISCUSSION:The Sternal Management Accelerated Recovery Trial (S.M.A.R.T.) is a two-centre randomised controlled trial powered and designed to investigate whether the effects of modifying sternal precautions to include the safe use of the upper limbs and trunk impact patients' physical function and recovery following cardiac surgery via median sternotomy. TRIAL REGISTRATION:Australian and New Zealand Clinical Trials Registry identifier: ACTRN12615000968572 . Registered on 16 September 2015 (prospectively registered).

背景与目标： 背景技术：正中胸骨切开术是目前世界范围内普遍采用的预防胸骨并发症限制上肢使用的胸骨预防措施的常规措施。但是，证据是有限的，主要来自尸体研究和骨科研究。胸骨预防措施可能会延迟康复，延长出院时间，并且限制过多。最近的研究表明，上肢锻炼可减轻手术后的胸骨疼痛，并通过超声测量使胸骨边缘之间的微动最小。这项研究的目的是评估改良的胸骨预防措施对心脏手术后身体机能，疼痛，恢复以及与健康相关的生活质量的影响。
方法/设计：该研究是一项II期，双盲，随机对照试验，具有隐蔽分配，患者和评估者盲目性和意向性治疗分析。心脏手术后，将通过正中胸骨切开术招募患者（n = 72）。样本量的计算是基于以下主要方面的最小重要差异（两点）：身体机能短。每个小组需要三十六名参与者来应对辍学（20％）。所有参与者将被随机分配接受标准或改良的胸骨预防措施。干预小组将收到指导原则，以鼓励安全使用上肢。次要结果是上肢功能，疼痛，运动恐惧症和与健康相关的生活质量。描述性统计将用于汇总数据。主要假设将通过重复测量方差分析进行检验，以评估与常规护理组相比，干预组从基线到术后4周的变化。在将要进行的所有测试中，p值<0.05（两尾）将被认为具有统计学显着性，并将报告置信区间。
讨论：胸骨管理加速恢复试验（SMART）是一项以两中心为中心的随机对照试验，旨在研究修改胸骨预防措施（包括安全使用上肢和躯干）的影响是否影响患者的身体功能和术后康复通过正中胸骨切开术进行心脏手术。
试验注册：澳大利亚和新西兰临床试验注册标识符：ACTRN12615000968572。已于2015年9月16日注册（可能已注册）。