Objective To explore the efficacy and safety of fondaparinux combined with tirofiban in patients with high risk unstable angina (UA) undergoing complex percutaneous coronary intervention (PCI).Methods A total of 389 patients were enrolled and randomized into two groups receiving either fondaparinux with tirofiban or enoxaparin with tirofiban.Bleeding,thrombosis and main adverse cardiovascular events (MACE) were compared between the two groups during hospitalization,at week 2 and week 4 after discharge.Results No severe bleeding was observed during hospitalization in the both groups,while lower rate of mild and minor bleeding was shown in the fondaparinux group (0 vs 1.5％ and 18.2％ vs 34.5％,P =0.04 and P ＜0.001 respectively).No difference was found between the two groups in the rate of MACE during hospitalization,at week 2 and week 4 weeks after discharge.The rates of death,recurrent myocardial infarction,refractory myocardial ischemia and target vessel revascularization were 0.5％ vs 1.0％,0.5％ vs 1.0％,1.6％ vs 1.0％ and 2.1％ vs 1.5％ during hospitalization;0 vs0,1.0％ vs 0.5％,1.0％ vs 1.5％,0.5％ vs 1.0％ at week2 after discharge; 0.5％ vs0.5％,0.5％ vs0.5％,2.6％ vs 2.0％,0 vs 0.5％ at week 4 after discharge (all P values ＞ 0.05).Conclusion The combination therapy of fondaparinux and tirofiban is of good safety and efficacy in high risk UA patients undergoing complex PCI.

Objective To identity whether there is muscle atrophy phenomenon in end-stage kidney disease patients and to detect the level of transcription factor Foxo1 and the activity of ubiquitin-proteasome system.Methods Twenty-two patients in chronic kidney disease (CKD) stage 5 were selected and their mean muscle cross sectional area was measured.mRNA and protein levels of Foxo1,Atrogin-1,MuRF1 in rectus abdominis biopsies obtained from consecutive patients were detected.Control biopsies were obtained from 8 healthy subjects during elective surgery for abdominal wall hernias and 6 subjects during elective surgery for adenomyosis.Results Compared with the control group,cross sectional area of muscle fibers decreased and the transcription and protein levels of Foxo1,Atrogin-1,MuRF1 were upregulated in CKD group(P＜0.05).Protein level of p-Foxo1 decreased in CKD group(P＜0.05).Conclusion There exist muscle atrophy phenomenon in CKD patients,which may associate with the upregulation of Foxo1 and activation of ubiquitin-proteasome system.

Objective To study the ocular manifestations in patients with Behcet's disease (BD).Methods Medical records at Peking Union Medical College Hospital from 2002 to 2012 were reviewed to identify the patients who were diagnosed as BD with ocular involvement.Results One hundred and eleven BD patients developed ocular involvement.Males were more frequently involved,and the male/female ratio was 2.08∶ 1.The age at the onset of BD and the time of ocular involvement were (27.6-± 10.8) and (31.5 ± 10.7) years,respectively.The median interval between the diagnosis of BD and ocular disease was 24 (0,372) months.Ocular involvement was bilateral in 85.6％ patients.About two thirds patients (66.7％) had impaired vision,for example,visual acuity of 0.1 or less was detected in 60.4％ patients.Uveitis (90.1％) was the most common findings in BD patients with ocular involvement and the most frequent type of uveitis in both sexes was panuveitis (62.16％).Vision loss,proliferative retinopathy and cataract were more common in men.There was a statistically significantly higher frequency of positive human leukocyte antigen(HLA)-B51 in the male BD with ocular involvement than in the female.All BD patients with uveitis were given systemic corticosteroid or combined immunosuppressive agents.The improvement of visual acuity was seen in 77％ BD patients,but the recurrent attacks occurred in 49％ patients,resulting in blindness in 25.5％ of them.TNFα blockers were given to 19 recurrent uveitis patients,12 patients improved while two had no response.Conclusions The most common ocular involvement in BD was uveitis.Males were more frequently involved with a more severe disease,higher complications and positive HLA-B51 than in females.Glucocorticoids and immunosuppressants were effective to uveitis,but high rate of recurrent inflammatory ocular attacks led to high risk of blindness.TNFα blockers may improve the outcome of recurrent BD uveitis.

Objective To investigate the predictive value of mild renal insufficiency on the endpoint events in patients with acute coronary syndrome (ACS).Methods A total of 552 patients with ACS were enrolled in the present study.According to the levels of estimated glomerular filtration rate (eGFR),patients were divided into two groups,normal renal function (eGFR≥90 ml · min-1 · 1.73 m-2) and mild renal insufficiency (60≤eGFR ＜90 ml · min-1 · 1.73 m-2).The primary and secondary events were collected and analyzed through the present prospective follow-up study.Results The patients in mild renal insufficiency group had a higher incidence of the primary endpoint events than normal renal function group [31 cases (12.6％) vs 15 cases (4.9％),P =0.001].There was no difference of the secondary endpoint events incidence in the two groups.The incidence rate of all-cause mortality [8.9％ (22 cases) vs 2.2％ (7 cases),P ＜0.001] and cardiac death [6.5％ (16 cases) vs 1.3％ (4 cases),P =0.001] was higher in mild renal insufficiency group,but there was no statistical difference of incidence rate of no fatal stroke and myocardial infarction in the two groups.The results of COX regression analysis showed that the incidence of primary endpoint events in patients with mild renal dysfunction was 2.265 folds (95％ CI 1.076-4.771,P=0.031) of patients with normal renal function.Further analysis indicated that the predictive value of mild renal insufficiency was only for all-cause mortality (HR 3.118,95％ CI 1.197-8.125,P =0.020),not for heart failure and revascularization.According to the Kaplan-Meier curves results,the incidences of the primary endpoint events (P =0.004) and all-cause mortality (P =0.001) were higher in mild renal insufficiency group than in normal renal function group.Conclusion Mild renal insufficiency has important predictive value for primary endpoint events in patients with ACS.

Objective To summarize the clinical features of the third portion of duodenum (PATD) for improving the understanding of PATD.Methods Sixteen cases with PATD in Peking Union Medical College Hospital(PUMCH) were retrospectively analyzed.Results The most common symptoms of PATD were upper abdominal pain(12/16),vomiting (9/16) and distention (7/16).On average,the disease had progressed 5.5 months (including 2.5 months of diagnostic workup) before the diagnosis was established.Patients with pathologically poorly differentiated PATD had shorter course of disease (6.5 vs 16.6 months,P =0.56) and lower chance of cancer-directed surgery (1/8 vs 6/8,P =0.04) than those with well differentiated PATD.The diagnostic rate was 11/14 by CT scan while only 2/7 by upper gastrointestinal radiography.Three cases were misdiagnosed as superior mesenteric artery syndrome by barium examination.Conclusions PATD should be considered in patients presenting upper abdominal symptoms with negative gastmendoscopy and barium examination.Overall,CT scan plays a pivotal role in diagnosing PATD.Making a correct diagnosis timely can improve the outcome of PATD patients,particularly,in those with poorly differentiated pathology.

Objective To investigate the effects of cyclooxygenase-2 (COX-2) inhibitor on peritoneal lymphangiogenesis and peritoneum function in uremic rat.Methods Uremic rats treated by peritoneal dialysis were intragastric administration celecoxib.Structures of peritoneum,peritoneal function,peritoneal lymphatic vessel density (LVD) were detected in every group.The mRNA of vascular endothelial growth factor-C (VEGF-C),lymphatic vessel endothelial hyluronan receptor-1 (LYVE-1) and COX-2 were tested by RT-PCR.The protein expressions of LYVE-1,VEGF-C,COX-2 were tested by western blot.Results With the extension of the duration of dialysis,the peritoneum thickness was increasing,inflammatory cell infiltrated obviously,uhrafiltration volume decreased significantly.But the celecoxib could increase uhrafiltration volume and reduce the glucose transport rate(P ＜0.05).Compared with the normal group,the levels of LVD,COX-2,VEGF-C,and LYVE-1 mRNA and protein were significantly up-regulated in uremic and dialysis groups (P ＜0.05).Compared with the uremic dialysis group,the levels of LVD,COX-2,VEGFC and LYVE-1 mRNA and protein were significantly down-regulated in the celecoxib group.There was a positive correlation between COX-2 and VEGF-C,LVD in protein levels,as well as VEGF-C and LVD (all P values ＜ 0.05).Conclusions Hyper glucose dialysis solution and uremic condition could up-regulate the expression of COX-2,VEGF-C,LYVE-1 in gene and protein level and stimulate lymphangiogenesis.COX-2 inhibitor could delay the change of peritoneal structures and function.COX-2 inhibitor could prevem the lymphangiogenesis in uremic rat treated by peritoneal dialysis,which might down-regulate the expression of VEGF-C by COX-2 depended manner.

Objective To investigate the relationship between serum uric acid (UA) level and abdominal obesity or metabolic syndrome (MS).Methods A total of 875 subjects,with 350 males and 525 females,aged 40-65 years old,were enrolled in this study.The clinical and biochemical data were collected and MRI was used to assess the visceral and subcutaneous adipose tissues.The relationships between UA level and abdominal obesity or MS were analyzed,and the cut-off values of UA for abdominal obesity and MS were determined.Results Raised risks of abdominal obesity (OR =4.35,95％ CI 1.91-9.90 in males; OR =5.44,95％ CI 2.41-12.31 in females) and MS (OR =4.47,95 ％ CI 2.08-9.62 in males; OR =11.62,95％ CI 3.43-39.37 in females) were observed with the increase of UA level.The multiple logistic regression analysis showed that UA was an independent risk factor for hypertriglyceridemia (OR =2.23,95％ CI 1.02-4.87 in males ; OR =3.04,95％ CI 1.49-6.23 in females) in all subjects and for abdominal obesity(OR =3.23,95％ CI 1.32-7.91) and hypertension (OR =2.35,95％ CI 1.37-4.05)in the females.Among the females,the regression line analyzed by simple correlation indicated that the UA level of 244.0 μmol/L was corresponded to the visceral adipose tissue area of 80 cm2.The optimal cut-off point of UA for the diagnosis of MS was 258.8 μmol/L determined by the receiver operating characteristic curve.Conclusions The level of UA is closely correlated with abdominal obesity and MS in the middleaged Chinese.The elevated UA level is an independent risk factor for abdominal obesity and MS in the female.

Objective To explore the clinical features of patients with vertebrobasilar dolichoectasia (VBD).Methods Patients diagnosed with posterior circulation ischemia in our hospital from October 2008 to January 2012 were consecutively collected and were divided into the VBD group and the non-VBD (NVBD) group.Clinical manifestations,risk factors,hemodynamic parameters and neuroimaging features were collected.Results (1) Statistical difference was observed in dyslipidemia,hypertension and the history of diabetes in the two groups (P ＜ 0.05).(2) The cerebral hemodynamic features of the VBD patients were as the following:decreased peak systolic velocity of vertebral artery and basilar artery and decreased systolic/diastolic ratio.Statistical difference was showed in the average peak flow velocity(Vm),pulsatility index(PI) and resistance index(RI) (P =0.036,0.032,0.032,respectively).(3) The main clinical manifestations of VBD were ischemic cerebrovascular disease,hemorrhagic cerebrovascular disease,oppression,brain damage symptoms and hydrocephalus.(4) The diagnosis in most of the VBD patients was confirmed by neural imaging and MRI was the first choice.Conclusion The VBD patients have relative unique clinical features.MRI should be the first choice for neuroimaging.

Objective To explore the type and etiology of chronic pain in patients with Parkinson's disease (PD),and to assess the association between pain and cognitive function.Methods A total of 116 PD patients were enrolled in the study and assessed with the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn-Yahr Scale (H-Y),Hamilton Depression Rating Scale for Depression(HRSD),Visual Analogue Scale (VAS) and Montreal Cognitive Assessment (MoCA).Results Compared with PD patients without pain,PD patients with pain had higher scores of UPDRS,H-Y and HRSD rating scales.Depression(scores of HRSD) was the only factor associated with pain showed by the Logistic regression model (P =0.007).PD patients with pain had lower scores of delayed recall (P =0.020).PD patients with pain happened before their motor symptoms had a lower score of delayed recall (P =0.015).Conclusions Musculoskeletal pain is the most common type in PD patients with pain.Depression is probably an independent risk factor for pain in PD patients.Delayed recall is the dominant impaired cognitive function.

Objective To evaluate the effect of sucralfate and acid-suppressive drugs on preventing ventilator-associated pneumonia (VAP) in mechanically ventilated patients.Methods All randomized controlled trials (RCTs),which studied the effect of sucralfate and acid-suppressive drugs on the incidence of VAP in mechanically ventilated patients,were searched from PubMed,Embase and the Cochrane Library during January 1966 to March 2013 via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.2 and the quality of the RCTs was strictly evaluated with the methods recommended by the Cochrane Collaboration.Results A total of 15 RCTs involving 1315 patients in the sucralfate group and 1568 patients in the acid-suppressive drug group were included in this study.The incidence of VAP was significantly reduced in the sucralfate group (RR =0.81,95％ CI 0.7-0.95,P =0.008),while no difference was found between the two groups in the incidence of stress-related gastrointestinal bleeding (RR =0.96,95％ CI 0.59-1.58,P =0.88).No statistical difference was found in the days on ventilator,duration of ICU stay and ICU mortality in the two groups (all P values ＞ 0.05).Conclusion In patients with mechanical ventilation,sucralfate could decrease the incidence of VAP,while has no such effect on the stress-related gastrointestinal bleeding,the days on ventilator,duration of ICU stay and ICU mortality.