BACKGROUND & AIMS: :The aim of this pilot study was to investigate anaesthetists' assessment of the ability of patients to increase cardiac output over a range of clinical scenarios and of their perceived 'likelihood of transfusion' in these scenarios. Specialist anaesthetists were given a questionnaire with clinical cues in the form of diagnoses about theoretical patients. They were asked to use 100 mm visual analogue scales (VAS) for their assessments of each patient's cardiac reserve and their 'likelihood of transfusion' of these patients; the endpoints of the VAS being 'Very low' (0 mm) to 'High' (100 mm), and 'Do not transfuse' (0 mm) to 'Transfuse' (100 mm) respectively. The assessment of patients' cardiac output reserve by anaesthetists (n = 54) showed great variation; for example, a patient with severe aortic stenosis was perceived overall to have a limited ability to increase cardiac output (mean VAS 16 mm) but there was considerable variation between anaesthetists (25-75 percentiles 10 mm to 21 mm). Assessment of 'likelihood of transfusion' (n = 42) also had great variation; as an example a patient with 'angina' with a haemoglobin of 95 g l(-1) was perceived overall to have an average likelihood of transfusion of 50 mm, but the 25-75 percentiles ranged from 33 mm to 71 mm. This study suggests that inter-anaesthetist variability in the assessment of a patient's 'cardiac output reserve' and his 'likelihood of transfusion' is large.

背景与目标： ：这项初步研究的目的是调查麻醉师对患者在一系列临床情况下增加心输出量的能力以及他们在这些情况下感知的“输血可能性”的评估。专家麻醉师接受了有关临床线索的问卷调查，形式是对理论患者的诊断。他们被要求使用100 mm视觉模拟量表（VAS）评估每个患者的心脏储备和这些患者的“输血可能性”。 VAS的端点分别为“非常低”（0毫米）至“高”（100毫米）和“请勿输液”（0毫米）至“输液”（100毫米）。麻醉师对患者心输出量储备的评估（n = 54）显示出很大的差异。例如，总的来说，严重的主动脉瓣狭窄患者的心输出量增加能力有限（平均VAS 16毫米），但是麻醉师之间的差异很大（10毫米至21毫米为25-75％）。对“输血可能性”的评估（n = 42）也有很大差异。例如，患有“心绞痛”且血红蛋白为95 g l（-1）的患者总体上被认为平均输血的可能性为50 mm，但25-75％的范围为33 mm至71 mm。这项研究表明，麻醉师之间在评估患者的“心输出量储备”和“输血可能性”方面存在很大差异。

BACKGROUND & AIMS: OBJECTIVE:To compare prostate carcinoma, with and with no lymph node metastasis, to benign prostatic hyperplasia (BPH) tissue for lymphatic vessel density (LVD) and the expression of the lymph-endothelial specific growth factor, vascular endothelial growth factor C (VEGF-C), to determine their role in lymphogenic metastasis. PATIENTS, MATERIALS AND METHODS:Lymphatic vessels were stained using lymphatic vessel endothelial hyaluronan receptor 1 and assessed in standard areas. The expression of VEGF-C was assessed by the number of positive epithelial cells. The data were compared with the clinical staging. RESULTS:The lowest LVD was found in tumorous areas as opposed to periphery and nontumorous tissue (P = 0.007; P < 0.001). The highest LVD was in BPH tissue (P < 0.001). There was no correlation with clinical staging. There was more VEGF-C staining in pN1 than in pN0 and in BPH specimens (P = 0.002). CONCLUSION:LVD is not a prognostic variable for the process of lymphogenic metastasis in prostate cancer. VEGF-C is up-regulated in prostate cancer and its correlation with lymph node status suggests a role for the development of lymph node metastasis, e.g. via an increased permeability of lymphatic vessels.

背景与目标： 目的：比较有无淋巴结转移的前列腺癌与良性前列腺增生（BPH）组织的淋巴管密度（LVD）以及淋巴内皮特异性生长因子，血管内皮生长因子C（VEGF- C），确定其在淋巴转移中的作用。
患者，材料和方法：使用淋巴管内皮透明质酸受体1对淋巴管进行染色，并在标准区域进行评估。通过阳性上皮细胞的数量评估VEGF-C的表达。将数据与临床分期进行比较。
结果：与周围和非肿瘤组织相比，在肿瘤区域发现的LVD最低（P = 0.007； P <0.001）。 LVD最高的是BPH组织（P <0.001）。与临床分期无关。 pN1和BPH标本中的VEGF-C染色要多于pN0和PPH（P = 0.002）。
结论：LVD不是前列腺癌淋巴转移的预后变量。 VEGF-C在前列腺癌中被上调，并且其与淋巴结状态的相关性暗示了淋巴结转移的发展，例如肝癌的发生。通过增加淋巴管的通透性

BACKGROUND & AIMS: BACKGROUND:Brain metastasis (BM) is associated with poor prognosis in patients with non-small cell lung cancer (NSCLC). Recent studies demonstrated that microRNA-330-3p (miR-330-3p) was involved in NSCLC brain metastasis (BM). However, the exact parts played by miR-330-3p in BM of NSCLC remain unknown. Discovery and development of biomarkers and elucidation of the mechanism underlying BM in NSCLC is critical for effective prophylactic interventions. Here, we evaluated the expression and biological effects of miR-330-3p in NSCLC cells and explored the underlying mechanism of miR-330-3p in promoting cell migration and invasion in NSCLC. METHODS:Stable over-expression and knockdown of miR-330-3p in NSCLC cells was constructed with lentivirus. Expression levels of miR-330-3p in NSCLC cells were quantified by quantitive real-time PCR (qRT-PCR). The effects of miR-330-3p on NSCLC cells were investigated using assays of cell viability, migration, invasion, cell cycle, apoptosis, western blotting, immunohistochemical, and immunofluorescence staining. A xenograft nude mouse model and in situ brain metastasis model were used to observe tumor growth and brain metastasis. The potential target of miR-330-3p in NSCLC cells was explored using the luciferase reporter assay, qRT-PCR, and western blotting. The miR-330-3p targets were identified using bioinformatics analysis and verified by luciferase reporter assay. The correlation between GRIA3 and DNA methyltransferase (DNMT) 1 and DNMT3A was tested by RT-PCR, western blotting, and co-immunoprecipitation (IP). RESULTS:miR-330-3p was significantly up-regulated in NSCLC cell lines. MTT assay, transwell migration, and invasion assays showed that miR-330-3p promoted the growth, migration, and invasion of NSCLC cells in vitro and induced tumor growth and metastasis in vivo. Luciferase reporter assays showed that GRIA3 was a target of miR-330-3p. qRT-PCR and western blotting exhibited that miR-330-3p promoted the growth, invasion, and migration of NSCLC cells by activating mitogen-activated protein kinase (MAPK)/extracellular-regulated protein kinases (ERK) signaling pathway. Furthermore, miR-330-3p up-regulated the total DNA methylation in NSCLC cells, and co-IP-demonstrated GRIA3 was directly related with DNMT1 and DNMT3A. CONCLUSIONS:miR-330-3p promoted the progression of NSCLC and might be a potential target for the further research of NSCLC brain metastasis.

背景与目标： 背景：脑转移（BM）与非小细胞肺癌（NSCLC）患者预后差有关。最近的研究表明，microRNA-330-3p（miR-330-3p）参与了NSCLC脑转移（BM）。但是，miR-330-3p在NSCLC的BM中发挥的确切作用仍然未知。发现和开发生物标志物以及阐明NSCLC中BM的潜在机制对于有效的预防性干预至关重要。在这里，我们评估了miR-330-3p在NSCLC细胞中的表达和生物学效应，并探讨了miR-330-3p在促进NSCLC细胞迁移和侵袭中的潜在机制。
方法：用慢病毒构建稳定表达miR-330-3p的NSCLC细胞。通过定量实时PCR（qRT-PCR）定量检测NSCLC细胞中miR-330-3p的表达水平。使用细胞活力，迁移，侵袭，细胞周期，凋亡，蛋白质印迹，免疫组织化学和免疫荧光染色的方法研究了miR-330-3p对NSCLC细胞的影响。用异种移植裸鼠模型和原位脑转移模型观察肿瘤的生长和脑转移。使用荧光素酶报告基因分析，qRT-PCR和Western印迹探索了NSCLC细胞中miR-330-3p的潜在靶标。使用生物信息学分析鉴定了miR-330-3p靶标，并通过萤光素酶报告基因检测法对其进行了验证。通过RT-PCR，蛋白质印迹和免疫共沉淀（IP）测试了GRIA3与DNA甲基转移酶（DNMT）1和DNMT3A之间的相关性。
结果：miR-330-3p在NSCLC细胞系中显着上调。 MTT测定，穿孔迁移和侵袭测定显示，miR-330-3p在体外促进NSCLC细胞的生长，迁移和侵袭，并在体内诱导肿瘤生长和转移。萤光素酶报告基因检测表明GRIA3是miR-330-3p的靶标。 qRT-PCR和蛋白质印迹显示miR-330-3p通过激活有丝分裂原激活的蛋白激酶（MAPK）/细胞外调节的蛋白激酶（ERK）信号通路来促进NSCLC细胞的生长，侵袭和迁移。此外，miR-330-3p上调了NSCLC细胞中的总DNA甲基化，并且共同IP展示的GRIA3与DNMT1和DNMT3A直接相关。
结论：miR-330-3p促进了非小细胞肺癌的发展，可能是进一步研究非小细胞肺癌脑转移的潜在靶标。

BACKGROUND & AIMS: BACKGROUND:Central venous oxygen saturation (ScvO2) remains the gold standard surrogate for tissue oxygen extraction in paediatric cardiac surgery. Near-infrared spectroscopy (NIRS) has been developed as a non-invasive diagnostic tool for regional oxygen saturation. The aim was to compare regional oxygen saturation measured by NIRS with ScvO2 in postoperative paediatric cardiac patients. METHODS:In this prospective study, we included newborns and infants younger than 45 days undergoing heart surgery. We recorded continuous ScvO2 and NIRS regional saturation placed on the forehead (B) and right flank (S) for 48 h postoperatively. A Bland-Altman's analysis was used to assess the agreement between these measurements. RESULTS:A total of 23 patients were included with a median age of 12 days (2-46) and median weight of 3.1 kg (2.3-4.47). The mean difference (MD) ScvO2- B NIRS was 10.45% with limits of agreement (LOA) -17.23 to 38.13% and ScvO2- S NIRS MD 7.16% with LOA: -25.51 to 39.84%. The single ventricle ScvO2- S NIRS subgroup had MD within ± 5%; however, wide LOA was observed. The remaining subgroups showed MD nearly above ± 5%, with wide LOA. CONCLUSIONS:The regional oxygen saturation of brain and kidney did not match ScvO2 as estimation of global tissue perfusion. Nevertheless, NIRS may still provide information regarding regional circulation that may help in the management of neonatal cardiac surgery patients.

背景与目标： 背景：中央静脉血氧饱和度（ScvO2）仍然是小儿心脏外科手术中组织氧提取的金标准。近红外光谱法（NIRS）已被开发为一种用于区域血氧饱和度的非侵入性诊断工具。目的是比较由NIRS和ScvO2测得的小儿心脏术后患者的局部血氧饱和度。
方法：在这项前瞻性研究中，我们纳入了接受心脏手术的45天以下的新生儿和婴儿。我们记录了连续的ScvO2和NIRS区域饱和度放置在术后48 h的前额（B）和右胁（S）上。用布兰德-奥特曼（Bland-Altman）分析来评估这些测量之间的一致性。
结果：总共纳入23名患者，中位年龄为12天（2-46），中位体重为3.1 kg（2.3-4.47）。 ScvO2-B NIRS的平均差异（MD）为10.45％，协议限制（LOA）为-17.23至38.13％，Slovo2- S NIRS MD的7.16％LOA为-25.51至39.84％。单心室ScvO2-S NIRS亚组的MD≤±5％。但是，观察到广泛的LOA。其余亚组的MD值接近±5％，LOA较宽。
结论：脑和肾脏的局部血氧饱和度与ScvO2不符，无法估计整体组织灌注。尽管如此，NIRS仍可能提供有关区域循环的信息，这可能有助于新生儿心脏外科手术患者的管理。

BACKGROUND & AIMS: :Myocardial extracellular volume fraction (ECV) reflecting diffuse myocardial fibrosis can be measured with T1 mapping cardiovascular magnetic resonance (CMR) before and after the application of a gadolinium-based extracellular contrast agent. The equilibrium between blood and myocardium contrast concentration required for ECV measurements can be obtained with a primed contrast infusion (equilibrium contrast-CMR). We hypothesized that equilibrium can also be achieved with a single contrast bolus to accurately measure diffuse myocardial fibrosis in patients with congenital heart disease (CHD). Healthy controls (n = 17; median age 24.0 years) and patients with CHD (n = 19; 25.0 years) were prospectively enrolled. Using modified Look-Locker inversion recovery T1 mapping before, 15 min after bolus injection, and during constant infusion of gadolinium-DOTA, T1 values were obtained for blood pool and myocardium of the left ventricle (LV), the interventricular septum (IVS), and the right ventricle (RV) in a single midventricular plane in short axis or in transverse orientation. ECV of LV, IVS and RV by bolus-only and bolus-infusion correlated significantly in CHD patients (r = 0.94, 0.95, and 0.74; p < 0.01, respectively) and healthy controls (r = 0.96, 0.89, and 0.64; p < 0.05, respectively). Bland-Altman plots revealed no significant bias between the techniques for any of the analyzed regions. ECV of LV and RV myocardium measured by bolus-only T1 mapping agrees well with bolus-infusion measurements in patients with CHD. The use of a bolus-only approach facilitates the integration of ECV measurements into existing CMR imaging protocols, allowing for assessment of diffuse myocardial fibrosis in CHD in clinical routine.

背景与目标： ：应用基于g的细胞外造影剂前后，可通过T1映射心血管磁共振（CMR）来测量反映弥漫性心肌纤维化的心肌细胞外体积分数（ECV）。 ECV测量所需的血液和心肌造影剂浓度之间的平衡可通过灌注造影剂（平衡造影剂CMR）获得。我们假设通过单次对比推注也可以达到平衡，以准确测量先天性心脏病（CHD）患者的弥漫性心肌纤维化。前瞻性纳入健康对照组（n = 17）；中位年龄24.0岁； CHD患者（n = 19； 25.0岁）。使用改良的Look-Locker反转恢复T1映射，在推注大剂量，之后15分钟以及在持续输注--DOTA期间，获得了左心室（LV），心室间隔（IVS）的血池和心肌的T1值，右心室（RV）在短心轴或横向方向的单个心室中平面内。仅推注和推注输注的LV，IVS和RV的ECV在CHD患者（分别为r = 0.94、0.95和0.74； p <0.01）和健康对照者（r = 0.96、0.89和0.64； p中显着相关）分别<0.05）。布兰德-奥特曼（Bland-Altman）图显示，任何被分析区域的技术之间均无明显偏差。通过仅推注T1测绘测得的LV和RV心肌的ECV与CHD患者的推注量测量非常吻合。仅推注方法的使用有助于将ECV测量值集成到现有的CMR成像协议中，从而可以在临床常规中评估CHD中弥漫性心肌纤维化。

BACKGROUND & AIMS: OBJECTIVE:Echocardiography is used for the detection of cardiac sarcoid involvement in patients with non-cardiac sarcoidosis. Little information is available regarding temporal changes in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVDd) in non-cardiac sarcoidosis patients. METHODS AND RESULTS:Fifty-four sarcoidosis patients who received periodic follow-up with echocardiography at our institute were enrolled in this study. At the time of initial ultrasonography, 13 patients were diagnosed with cardiac sarcoid involvement. All of the remaining 41 patients with extra-cardiac sarcoidosis only had a LVEF of >50%. During the median follow-up period of 39 months, two (4.9%) of the non-cardiac sarcoidosis patients were diagnosed with cardiac sarcoid involvement; one patient showed a progressive decline in the LVEF over a short period of time. It was also found that two of 41 non-cardiac sarcoidosis patients showed declines in the LVEF of >10% per year; however, they were not diagnosed with cardiac sarcoidosis during the follow-up period. CONCLUSION:Rapid deterioration of left ventricular function may increase the suspicion of sarcoid involvement of the heart in non-cardiac sarcoidosis patients; however, we must be aware that a certain subfraction of patients may not demonstrate significant abnormalities in LVEF or LVDd on periodic echocardiographic follow-up.

背景与目标： 目的：超声心动图用于检测非心脏结节病患者的心脏结节样病变。关于非心脏结节病患者左心室射血分数（LVEF）和左心室舒张末期尺寸（LVDd）随时间变化的信息很少。
方法与结果：54例结节病患者在我院接受了定期超声心动图随访。在初次超声检查时，有13例患者被诊断出患有心脏结节样病变。其余所有41例心外结节病患者的LVEF均仅> 50％。在39个月的中位随访期内，有2名（4.9％）非心脏结节病患者被诊断出患有心脏结节病。一名患者在短时间内LVEF逐渐下降。还发现41例非心脏结节病患者中有2例的LVEF下降每年> 10％。但是，在随访期间并未诊断出他们患有心脏结节病。
结论：非心脏结节病患者左心功能的迅速恶化可能增加对心脏结节累及的怀疑。但是，我们必须意识到，在定期超声心动图随访中，患者的某些亚分类可能未显示LVEF或LVDd的明显异常。

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。