巨屌 自慰 [进展翻译]国表里有名期刊心血管贪图进展及加分指南

Incidence， time course， and predictors of early malignant ventricular arrhythmias after non-ST-segment elevation myocardial infarction in patients with early invasive treatment The First Three Authors： Kazem Rahimi1，2，*， Stefan Watzlawek1， Holger Thiele1， Maria-Anna Secknus1， Corresponding Author and Address:Tel: +49 341 865 1428; fax: +49 341 865 1177. E-mail address: krahimi@freenet.de Aims The incidence of non-ST-segment elevation myocardial infarction (NSTEMI) is increasing. With the limited intensive care facilities， knowledge of the total risk and predictors of acute life-threatening arrhythmias is of major interest to guide the decision on the intensity of care at the time of admission.Methods and results We continuously monitored 588 consecutive patients with NSTEMI admitted to the coronary care unit of a primary and tertiary care centre for malignant ventricular arrhythmias requiring defibrillation. Ninety-seven per cent of the patients underwent coronary angiography during the index hospital admission. Total rate of malignant ventricular arrhythmias and mortality was 2.6% (n=15) and 3.6% (n=21)， respectively. More than two-thirds of arrhythmias occurred within the first 12 h after onset of symptoms. In a bootstrapped multivariable regression analysis， the only factor associated with the occurrence of malignant ventricular arrhythmia was higher white blood cell count on admission. Popular risk assessment tools such as Thrombolysis in Myocardial Infarction， Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy， and Predicting Risk of Death in Cardiac disease Tool were predictive of mortality but not of early arrhythmia.Conclusion Patients with NSTEMI treated aggressively with early revascularization are at low risk for developing life-threatening arrhythmias. The occurrence of such events remains difficult to predict. The role of baseline inflammatory status as a determinant merits further investigations.European Heart Journal Volume 27， Number 14 Pp. 1706-1711 非ST段举高性心肌梗死病东说念主早期介入颐养后早期恶性室性心律失常的事件、时辰过程和瞻望因子目的：非ST段举高心肌梗死事件的发生增长。由于重症监护开发的有限性，对于急性生命威迫的心律失常的总体危机和瞻望因子的毅力主要与率领入院时作出重症监护决定干系。 方法与收尾：咱们捏续监护了588个一语气的NSTEMI的病东说念主，这些病东说念主由于恶性心律失常需要除颤而参加一、三级监护中心的冠心病监护病房。97％的病东说念主在入院时期进行了冠状动脉造影检查。恶性心律失常发生率与耗损率分辩是2.6% (n=15) 和 3.6% (n=21)。多于三分之二的恶性心律失常发生在症状出现12小时内。在多身分回首分析中，与恶性心律失常干系的唯沉静分是入院时白血球升高。流行的风险评估器具举例心梗的血栓熔化，不稳宽解绞痛的血小板糖卵白IIb/IIIa：用Integrilin扼制受体，瞻望腹黑疾病耗损危机的器具可瞻望耗损但不行瞻望早期心律失常的发生。 论断：NSTEMI病东说念主积极的再血管化颐养可减低出现发生生命威迫的心律失常的危机。那些事件的发生依然难以瞻望，是否能以为基线炎症气象有决定性的价值仍需进一步的贪图。　　　　为了进一步便捷各人有目的、有办法性地查阅，本栏将以前的依期刊汇总改为按疾病种类进行汇总，初步分为“冠心病、高血压、心律失常和其它”四个分版，每2月汇总1次。届时咱们会在本栏目的首贴给出这四个分版的王人集，各人点击王人集即可分辩参加各个版本，浏览干系疾病的最新文件。　　需要持重的是将翻译贴入此栏的时候，请在“Title”前用红色黑体字表明该文件所属的疾病类别。如下：〔高血压〕Title：The First Three Authors：Corresponding Author and Address （Institution， Hospital， University， Country）:Abstract:Journal Name (Full name) and Publication Year， Volume， PagesRecently updated Impact Factor文题：节录：　　为了进一步擢升战友们参与的积极性，将给予翻译的战友一定的加分奖励！在保证翻译样式和质料的前提下，20分以下的战友翻译1篇加1分，20-40分的战友翻译2篇加1分，40分以上的战友翻译3篇加1分。 （要是样式或质料不行得到保证，可能将不赐与得分奖励）（冠心病）Title: Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarctionThe First three authors: Paolo Ortolani1， Antonio Marzocchi1， Cinzia Marrozzini1，Corresponding author and Address:. Paolo Ortolani1， Institute of Cardiology， Azienda Ospedaliera S. Orsola-Malpighi Hospital， University of Bologna， Italy.Abstract:Aims Treatment delay is a powerful predictor of survival in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated effectiveness of pre-hospital diagnosis of STEMI with direct referral to PCI， alongside more conventional referral strategies.Methods and results From January 2003 to December 2004， 658 STEMI patients were referred for primary PCI at our intervention laboratory. Three predefined referral routes were compared: (1) for patients within 90 min drive of the PCI centre， pre-hospital diagnosis and direct transportation (n =166)， (2) diagnosis at the interventional hospital emergency department (n = 316)， (3) diagnosis at local hospitals before transportation (n =176). Pre-hospital diagnosis was associated with more than 45 min reduction in treatment delay (P = 0.001). No significant difference in in-hospital mortality was apparent in the overall study population. In the cardiogenic shock subgroup (n = 80)， pre-hospital diagnosis was associated with a two-thirds reduction in in-hospital mortality (P = 0.019); mortality was only 6.2% in shock patients who underwent PCI in ＜2 h.Conclusion This study shows that pre-hospital diagnosis can provide a reduction in primary PCI treatment delay， and suggests the hypothesis that this referral strategy might provide survival benefits to patients with cardiogenic shock.European Heart Journal (2006) 27， 1550–1557Impact factor: 7.341文题：入院前确诊ST举高心肌梗身后平直奉行平直经皮冠状动脉介入颐养的临床影响节录：目的 剿袭平直经皮冠状动脉介入颐养（percutaneous coronary intervention PCI）的ST举高心肌梗死（ST-elevation myocardial infarction STEMI）患者存活率的一个有劲的瞻望因子是颐养蔓延。咱们造访了入院前确诊STEMI并平直奉行PCI及更传统的颐养政策的作用。方法和收尾 从2003年1月到2004年12月，咱们的介入颐养室对658例STEMI患者奉行了平直PCI。比较3个事前界说的颐养历程：（1）患者入院前确诊，平直转送，90分钟内转入PCI中心（n=166）。（2）患者在可进行介入颐养病院的急诊室确诊（n=316）。（3）患者转送前在当地病院确诊（n=176）。入院前确诊STEMI并平直奉行PCI与颐养蔓延减少大于45分钟干系（P=0.001）。在悉数贪图东说念主群中，入院时期的耗损率无统计学各别。在心源性休克亚组中（n=80），入院前确诊STEMI并平直奉行PCI与入院时期耗损率减少2/3干系（P=0.019）；在2h内剿袭PCI的休克患者中耗损率仅6.2%。论断 这项贪图露馅入院前确诊STEMI可减少平直PCI的颐养蔓延，并请示这种颐养政策可擢升心源性休克患者存活率。（冠心病）Title: Comparative Effects of Paclitaxel and Rapamycin on Smooth Muscle Migration and Survival：Role of Akt-Dependent SignalingThe First three authors: Cam Patterson， Sabeen Mapera， Hui-Hua Li，Corresponding author and Address: . Cam Patterson， Division of Cardiology and Carolina Cardiovascular Biology Center， University of North CarolinaAbstract:Objective—Advances in stent technology have enabled the delivery of drugs to improve outcomes after stent deployment. However， the optimal payloads for stents are not clear， and the appropriate stent-based therapies for high-risk patients， such as diabetics， have not been clearly established.Methods and Results—We used smooth muscle cell culture models to compare the activities of rapamycin and paclitaxel. Smooth muscle cells were grown in normal or high glucose to induce insulin resistance. Both paclitaxel and rapamycin activate mitogen-activated protein kinase pathways similarly. However， rapamycin potently activates AKT-dependent signaling， an effect that overrides the downregulation of this pathway by insulin resistance and that causes phosphorylation of the AKT-dependent transcription factor FOXO1. This effect is associated with attenuation of the anti-migratory effects of rapamycin under high glucose conditions that are not observed with paclitaxel， as well as with increased protection against ceramide-induced cytotoxicity， both of which are dependent on FOXO1 phosphorylation.Conclusions—Differences between the ability of rapamycin and paclitaxel to activate AKT may account for their differential cell survival and antichemotactic activities. These observations may provide a basis for understanding clinical differences between rapamycin- and paclitaxel-coated stents. The approaches used in these studies can be expanded to other candidate stent payloads as a method for triage in preclinical studies.Arterioscler Thrombosis Vascular Biology. 2006;26:1473-1480.Impact factor:.7.053文题：紫杉醇和雷帕酶素对平滑肌升值和存活率影响的比较: Akt-依赖的信号传导的作用节录：目的 支架本领的进展可使支架输送药物，改善支架植入的预后。关联词，最好的支架负载药物还不了了，对于高危患者，如糖尿病患者，合适的支架颐养尚未明确。方法和收尾 咱们用平滑肌细胞培养的样式比较雷帕酶素和紫杉醇的活性。平滑肌细胞在普通环境或高糖中孕育以迷惑产生胰岛素扞拒。紫杉醇和雷帕酶素都激活细胞分裂素活化卵白激酶阶梯，收尾不异。关联词，雷帕酶素激烈激活AKT-依赖的信号传导，这对消了胰岛素扞拒导致的AKT-依赖的信号传导阶梯的下调，并导致了AKT-依赖的转录因子FOXO1的磷酸化。雷帕酶素对AKT-依赖的信号传导的激活与雷帕酶素在高糖气象下的抗挪动作用减弱干系，而在紫杉醇中却不雅察不到这种情况，此外这种作用还与雷帕酶素对神经酰胺介导的细胞毒性的保护作用加多干系，二者都依赖于FOXO1的磷酸化。论断 雷帕酶素和紫杉醇激活AKT技艺的不同可解释二者影响细胞寿命和抗趋化活性的各别。这项不雅察可为兼并雷帕酶素和紫杉醇涂层支架不同的临床作用提供基础。这项贪图领受的样式四肢一种分类方法可在临床前实验中延用于对其他支架负载药物的分析。〔其它〕Title: Advancing age has differential effects on DNA damage， chromatin integrity， gene mutations， and aneuploidies in spermThe First three authors: A. J. Wyrobek， B. Eskenazi， S. YoungCorresponding author and Aderess: D. Evenson. Life Sciences Division， Lawrence Berkeley National Laboratory， Berkeley，Abstract:This study compares the relative effects of advancing male age on multiple genomic defects in human sperm [DNA fragmentation index (DFI)， chromatin integrity， gene mutations， and numerical chromosomal abnormalities]， characterizes the relationships among these defects and with semen quality， and estimates the incidence of susceptible individuals for a well characterized nonclinical nonsmoking group of 97 men (22–80 years). Adjusting for confounders， we found major associations between age and the frequencies of sperm with DFI and fibroblast growth factor receptor 3 gene (FGFR3) mutations associated with achondroplasia (P < 0.01) with no evidence for age thresholds. However， we found no associations between age and the frequencies of sperm with immature chromatin， aneuploidies diploidies， FGFR2 mutations (Apert syndrome)， or sex ratio in this cohort. There were also no consistent correlations among genomic and semen-quality endpoints， except between DFI and sperm motility (r 0.65， P < 0.001). These findings suggest there are multiple spermatogenic targets for genomically defective sperm with substantially variable susceptibilities to age. Our findings predict that as healthy males age， they have decreased pregnancy success with trends beginning in their early reproductive years， increased risk for producing offspring with achondroplasia mutations， and risk of fatheringoffspring with Apert syndrome that may vary across cohorts， but with no increased risk for fathering aneuploid offspring (Down， Klinefelter， Turner， triple X， and XYY syndromes) or triploid embryos. Our findings also suggest that the burden of genomic damage in sperm cannot be inferred from semen quality， and that a small fraction of men are at increased risk for transmitting multiple genetic and chromosomal defects.PNAS. 2006;103: 9601–9606Impact factor:23.332文题：年齿对精子DNA毁伤、染色质完好性、基因突变和异倍体的不同影响节录：本文旨在比较男性年齿对东说念主类精子多种基因症结的相对影响，这些基因症结包括DNA断裂指数（DFI），染色质完好性、基因突变和染色体很是。通过以上比较进而形色这些症结与精子质料的有计划和评估易感东说念主群发生上述症结的几率。录取年齿在22至80岁之间无临床疾病不抽烟的97名男性。通过比较，本文发现了年齿和带有症结精子的有计划，这些带有症结的精子包括未熟谙染色体、异倍体/二倍体、FGFR2突变（阿佩尔概述征）。DFI和精子活力存在显著有计划（P＜0.001），除此除外，基因与精子质料之间无显著有计划。以上发现请示对年齿有不同易理性的基因症结精子而言有着多种产生精子的指标。根据本文收尾可瞻望对健康男性而言，在早期育龄阶段，其生殖技艺即在爽快下落，后代软骨发育不全和阿佩尔概述征的发生率在约束加多，但异倍体和三倍体胚胎并不随之加多。本文收尾也请示不行由精子的质料推断基因毁伤的进程，一小部分男性传递多重基因和染色体症结的危机在爽快加多。〔其它〕Title: Combination of In Vivo Angiopoietin-1 Gene Transfer and Autologous Bone Marrow Cell Implantation for Functional Therapeutic AngiogenesisThe First three authors: Koichi Kobayashi， Takahisa Kondo， Natsuo InoueCorresponding author and Aderess: Toyoaki Murohara， Department of Cardiology， Nagoya University Graduate School of Medicine， Japan. Abstract:Objective—Autologous bone marrow mononuclear cell (BM-MNC) implantation into ischemic tissues promotes angiogenesis， but a large amount of marrow aspiration is required， which is a major clinical limitation. Angiopoietin-1 (Ang-1) is requisite for vascular maturation during angiogenesis. We examined the impacts of combinatorial Ang-1 gene transfer and low-dose autologous BM-MNC implantation on therapeutic angiogenesis in a rabbit model of hind limb ischemia.Methods and Results—Rabbits were divided into 4 groups: phosphate-buffered saline (control)， 500 μg Ang-1 plasmid (Ang-1)， 1×106 autologous BM-MNCs (BMC)， and Ang-1 plasmid plus BM-MNCs (combination). The Ang-1 group had a greater angiographic score and capillary density compared with the control (P＜0.05)， but the Ang-1 gene therapy alone did not improve transcutaneous oxygen pressure (TcO2) and skin ulcer score. However， the combination group showed a significant improvement in not only angiographic score and capillary density (P＜0.05) but also TcO2 (P＜0.05) and skin ulcer score. These efficacies were greater in the combination group compared with the BMC group.Conclusions—This Ang-1 gene and BM-MNC combination therapy enhances not only quantitative but also qualitative angiogenesis in ischemic tissues. Moreover， the combination therapy will enable a reduction in the amount of BM aspiration required for significant therapeutic angiogenesis.Arteriosclerosis Thrombosis and Vascular Biology. 2006;26:1465-1472 Impact factor:7.053文题：体内Ang-1和自体骨髓干细胞移植的结伙颐养可促进血管形成节录：目的：自体骨髓单核细胞（BM-MNC）移植入缺血组织可促进血管生成，然则需要抽取大量的骨髓，这使临床的应用受到一定的适度。血管生成素-1（Ang-1）对血管形成过程中血管熟谙必不可少。本文旨在贪图兔后肢缺血模子中Ang-1基因转动和低剂量自体BM-MNC移植结伙应用对血管生成的作用。方法和收尾：实验分为4组，磷酸盐缓冲生理盐水组（对照组）、500μg Ang-1组（Ang-1）、1×106 自体BM-MNC组和Ang-1＋BM-MNC组。与对照组比拟，Ang-1组的血管造影刻痕和毛细血管密度显著增多，关联词并未擢升经皮氧分压（TcO2）和皮肤溃疡刻痕。关联词，结伙组不仅促进了血管造影刻痕和毛细血管密度显著增多(P＜0.05)，同期擢升经皮氧分压和皮肤溃疡刻痕(P＜0.05)，增幅比BMC组更为显著。论断：Ang-1和BM-MNC的结伙颐养在定性和定量上均不错促进缺血组织的血管形成。而且巨屌 自慰，结伙颐养不错减少骨髓抽取的颐养需求量。〔冠心病〕Title: Factors explaining the under-use of reperfusion therapy among ideal patients with ST-segment elevation myocardial infarctionThe First three authors: David A. Alter1， Dennis T. Ko1， Alice NewmanCorresponding author and Aderess: David A. Alter1， Institute for Clinical Evaluative Sciences， G106-2075 Bayview Avenue， Toronto， Ontario， CanadaAbstract:Aims To determine the relative impact of time to hospital arrival， baseline cardiovascular risk (i.e.TIMImortality risk index)， intracerebral haemorrhage risk， and comorbid disease burden on the likelihood of not receiving reperfusion therapy among ST-segment elevation myocardial infarction (STEMI) patients without contraindications to treatment.Methods and results Retrospective population-based cohort of 3994 patients admitted to 103 acutecare hospitals with chest pain and STEMI within 12 h of symptom onset in Ontario， Canada， between 1999 and 2001. Patients with one or more documented absolute or relative contraindication (n = 909) were excluded from the analyses. Reperfusion therapy was defined as the receipt of either fibrinolysis or primary percutaneous coronary intervention. Multivariable analysis and likelihood χ2 was used to quantify the importance of each factor in predicting the non-utilization of therapy. In total， 23.1% of patients received no reperfusion therapy. Listed in order from greatest to least importance， predictors of non-utilization of reperfusion therapy included increasing time to hospital presentation (likelihoodχ2 31.6， P ＜0.001)， higher intracerebral haemorrhage risk (likelihoodχ2 27.1， P＜0.001)， higher baseline cardiovascular risk (likelihoodχ2 25.4， P ＜0.001)， and greater number of chronic comorbid conditions (likelihood x2 15.4， P ＜0.001). The importance of each factor on non-utilization was independent， additive， not explained by age effects alone， or driven by subgroups traditionally under-represented in clinical trials.Conclusion Care gaps in the use of reperfusion therapy widen with both increasing baseline cardiovascular risk and increasing intracerebral haemorrhage risk. Future studies should examine whether the implementation of clinical decision tools which allow for more accurate risk–benefit tradeoff predictions improve the treatment gaps when using life-saving therapies in this patient population.European Heart Journal (2006) 27， 1539–1549 Impact factor: 7.341文题：影响ST段举高型心肌梗死未剿袭再灌输颐养的身分节录：目的：本文目的在于明确入院时辰、基础心血管风险、脑出血风险和合并的疾病对ST段举高型心肌梗死（STEMI）患者无显著禁忌症而未剿袭再灌输颐养比率的影响。布景：植入埋藏式复律除颤器的比率正以很快的速率高涨。对非聘任东说念主群植入埋藏式复律除颤器后并发症的破耗咫尺尚无贪图。方法和收尾：领受追想型贪图的样式对加拿大安大要省103家病院3994名STEMI 12小时以内的患者进行贪图。909名有全都或相对禁忌症的患者拆除在外。再灌输颐养包括容栓颐养和经皮冠状动脉介入颐养。多变量χ2分析用于定量多样身分对未剿袭灌输颐养的影响巨屌 自慰，其中23.1D％的患者未剿袭再灌输颐养。瞻望身分弥留性从高至低排序为入院时辰、脑出血危机、基础心血管疾病和多样慢性合并疾病。以上分钟瞻望身分相对并立，与年齿和分组无关。论断：再灌输颐养的限制被爽快加多的基线心血管疾病和大脑出血的风险加多。需要进一步的贪图检测多样精准探究利害瞻望的临床决策的实施是否改进颐养的应用限制。（冠心病）Title: A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST (Which Early ST-elevation myocardial infarction Therapy) studyThe First three authors: WEST Steering Committee Corresponding author and Address: Paul W. Armstrong， Canadian VIGOUR Centre， University of Alberta Edmonton， Canada Abstract:Aims Uncertainty exists as to which reperfusion strategy for ST-elevation myocardial infarction (MI) is optimal. We evaluated whether optimal pharmacologic therapy at the earliest point of care， emphasizing pre-hospital randomization and treatment was non-inferior to expeditious primary percutaneous coronary intervention (PCI).Methods and results Which Early ST-elevation myocardial infarction Therapy (WEST) was a four-city Canadian， open-label， randomized， feasibility study of 304 STEMI patients (＞4 mm ST-elevation/deviation) within 6 h of symptom onset， emphasizing pre-hospital ambulance treatment and participation of community and tertiary care centres. All received aspirin， subcutaneous enoxaparin (1 mg/kg)， and were randomized to one of three groups: (A) tenecteplase (TNK) and usual care， ( TNK and mandatory invasive study ≤24 h， including rescue PCI for reperfusion failure， and (C) primary PCI with 300 mg loading dose of clopidogrel. Time from symptom onset to treatment was rapid (to TNK for A = 113 and B= 130 min and for PCI in C = 176 min). The primary outcome， a composite of 30-day death， re-infarction， refractory ischaemia， congestive heart failure， cardiogenic shock， and major ventricular arrhythmia， was 25% (Group A)， 24% (Group ， and 23% (Group C)， respectively. However， there was a higher frequency of the combination of death and recurrent MI in Group A vs. Group C (13.0 vs. 4.0%， respectively， P-logrank =0.021)， yet no difference between Group B (6.7%， P-logrank = 0.378) and C.Conclusion These data suggest that a contemporary pharmacologic regimen rapidly delivered， coupled with a strategy of regimented rescue and routine coronary intervention within 24 h of initial treatment， may not be different from timely expert PCI.European Heart Journal (2006) 27， 1530–1538Impact factor:7.341文题：ST举高心肌梗身后早期有/无实时冠状动脉介入加药物颐养与原发经皮介入颐养的比较：WEST（ST举高心肌梗死早期颐养）贪图节录：目的 对于ST举高心肌梗死（myocardial infarction MI）最好的再灌输政策仍存在省略情味。咱们评估了是否在颐养的初期（重点对入院前的颐养随即抽样）给与最好的药物颐养和责罚不劣于马上的原发经皮介入颐养（percutaneous coronary intervention PCI）。方法和收尾 ST举高心肌梗死早期颐养（WEST）是在加拿大的4个城市进行的一项盛开、随即的可行性贪图，有304例STEMI患者（ST举高/偏移＞4mm），症状发作在6h之内，重点在入院前救护车给予的责罚及社区和三级医疗中心给予的颐养。悉数的患者剿袭阿司匹林，皮下打针伊诺肝素（1mg/kg），随即参加以下3组中的一组：（A）替奈普酶（TNK）和老例照拂 （B）TNK和24h专家强制侵入颐养，包括再灌输失败进行的救助PCI （C）原发PCI并给与300mg负荷剂量的氯吡格雷。从症状发作到剿袭颐养很马上（从症状发作到剿袭TNK A组=113分钟，B组=130分钟，C组从症状发作到剿袭PCI=176分钟）。主要收尾为（MI后）30天的耗损、再梗死、刚劲性缺血、充血性心力阑珊、心源性休克和严要点律失常的复合事件，分辩为25%（A组），24%（B组），和23%（C组）。关联词，A组与C组比拟，耗损和再发心肌梗死的结伙发生率更高（分辩为13.0VS4%，P-logrank=0.021），关联词，在B组和C组间无各别（6.7%，P-logrank=0.378）。论断 这些府上表明快速给予当代药物颐养，同期在开动颐养的24小时内给予救助和老例冠脉介入颐养，和实时熟练的PCI颐养政策无各别。（心律失常)Title: Autonomic Innervation and Segmental Muscular Disconnections at the Human Pulmonary Vein-Atrial Junction：Implications for Catheter Ablation of Atrial-Pulmonary Vein Junction The First three authors: Alex Y. Tan， Hongmei Li， Sebastian Wachsmann-HogiuCorresponding author and Address: Dr. Michael C. Fishbein， Department of Pathology and Laboratory Medicine， UCLA School of Medicine， Room 13-145H， 10833 Le Conte Avenue， Los Angeles， California 90095-1732.Abstract:OBJECTIVES This study sought to examine the muscle connections and autonomic nerve distributions at the human pulmonary vein (PV)-left atrium (LA) junction.BACKGROUND One approach to catheter ablation of atrial fibrillation (AF) is to isolate PV muscle sleeves from the LA. Elimination of vagal response further improves success rates.METHODS We performed immunohistochemical staining on 192 circumferential venoatrial segments (32 veins) harvested from 8 autopsied human hearts using antibodies to tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT).RESULTS Muscular discontinuities of widths 0.1 to 5.5 mm (1.1±1.0 mm) and abrupt 90° changes in fiber orientation were found in 70 of 192 (36%) and 36 of 192 (19%) of PV-LA junctions， respectively. Although these anisotropic features were more common in the anterosuperior junction (p <0.01)， they were also present around the entire PV-LA junction. Autonomic nerve density was highest in the anterosuperior segments of both superior veins (p<0.05 versus posteroinferior) and inferior segments of both inferior veins (p<0.05 vs. superior)， highest in the LA within 5 mm of the PV-LA junction (p<0.01)， and higher in the epicardium than endocardium (p<0.01). Adrenergic and cholinergic nerves were highly co-located at tissue and cellular levels. A significant proportion (30%) of ganglion cells expressed dual adrenocholinergic phenotypes.CONCLUSIONS Muscular discontinuities and abrupt fiber orientation changes are present in ＞50% of PV-LA segments， creating significant substrates for re-entry. Adrenergic and cholinergic nerves have highest densities within 5 mm of the PV-LA junction， but are highly co-located， indicating that it is impossible to selectively target either vagal or sympathetic nerves during ablation procedures. (J Am Coll Cardiol 2006;48:132– 43) Recently updated Impact Factor：9.200文题：东说念主体肺静脉—心房勾通处自主神经分散及节段性肌肉离断：导管对肺静脉－心房勾通处消融颐养的启示。节录：目的：本贪图旨在探讨东说念主体肺静脉(PV)－左心房(LA)勾通处肌肉勾通及自主神经分散。布景：房颤（AF）经导管消融离断PV与LA勾通处的肌袖。去除迷跑神经影响更进一步加多告捷率。方法：贪图者应用酪氨酸羟化酶（TH）及乙酰胆碱转动酶（ChAT）抗体对从8名尸解的东说念主体腹黑中收罗的192例肺静脉同左心房勾通处周缘的肌肉片段（32个静脉）进行免疫组织化学染色。收尾：肌肉断裂的宽度从0.1到5.5mm不等（1.1±1.0mm）以及纤维定位发生90°急转改变，分辩在192例PV-LV勾通处中的70例（36%）及192例PV-LV勾通处中的36例（19%）中发现。尽管这些不同的特征在前上勾通处更浩荡（P＜0.01），然则它们也在通盘PV-LV勾通处均出现。自主神经密度在两条上部静脉中的前上段（较后下段P＜0.05）及两条下部静脉中的下段（较上段P＜0.05）最高，同期在PV-LV勾通处5mm领域内LA中最高（P＜0.01），心外膜自主神经密度高于心内膜（P＜0.01）。肾上腺素能及胆碱酯能神经在组织和细胞水平均***度结伙出现。30%的神经节细胞抒发肾上腺能及胆碱能神经的双重表型。论断：肌肉断裂及纤维定位的已而改变在约50%的PV-LV勾通处肌肉片段中出现，形成显著的折返底物。在PV-LV勾通处5mm领域内肾上腺能及胆碱能神经有最高密度抒发，而且是高度结伙抒发，启示在消融时期不可能有聘任的定位迷跑神经或交感神经。（冠心病）Title: The Role of Clopidogrel in Early and Sustained Arterial Patency After Fibrinolysis for ST-Segment Elevation Myocardial Infarction：The ECG CLARITY–TIMI 28 StudyThe First three authors: Benjamin M. Scirica， Marc S. Sabatine， David A. MorrowCorresponding author and Address: Dr. Benjamin M. Scirica， The TIMI Study Group， Cardiovascular Division， Brigham and Women’s Hospital， 350 Longwood Avenue， 1st Floor， Boston， Massachusetts 02115.Abstract:OBJECTIVES This study was designed to determine the relationship between clopidogrel and early ST-segment resolution (STRes) and the interaction of the two with clinical outcomes after fibrinolysis.BACKGROUND ST-segment resolution is an early noninvasive marker of coronary reperfusion.METHODS The CLARITY–TIMI 28 (Clopidogrel as Adjunctive Reperfusion Therapy–Thrombolysis in Myocardial Infarction 28) trial randomized 3，491 patients with ST-segment elevation myocardial infarction (STEMI) undergoing fibrinolysis to clopidogrel versus placebo. ST-segment resolution was defined as complete (>70%)， partial (30% to 70%)， or none (<30%).RESULTS Electrocardiograms were valid for interpretation in 2，431 patients at 90 min and 2，087 at 180 min. There was no difference in the rate of complete STRes between the clopidogrel and placebo groups at 90 min (38.4% vs. 36.6% at 90 min). When patients were stratified by STRes category， treatment with clopidogrel resulted in greater benefit among those with evidence of early STRes， with greater odds of an open artery at late angiography in patients with partial (odds ratio [OR] 1.4， p = 0.04) or complete (OR 2.0， p <0.001) STRes， but no improvement in those with no STRes at 90 min (OR 0.89， p=0.48) (p for interaction=0.003). Clopidogrel was also associated with a significant reduction in the odds of an in-hospital death or myocardial infarction in patients who achieved partial (OR 0.30， p = 0.003) or complete STRes at 90 min (OR 0.49， p =0.056)， whereas clinical benefit was not apparent in patients who had no STRes (OR 0.98， p=0.95) (p for interaction =0.027). By 30 days， the clinical benefit of clopidogrel was predominately seen in patients with complete STRes.CONCLUSIONS Clopidogrel appears to improve late coronary patency and clinical outcomes by preventingreocclusion of open arteries rather than by facilitating early reperfusion. (J Am Coll Cardiol 2006;48:37– 42)Recently updated Impact Factor：9.200文题：氯吡格雷在ST段举高心肌梗死溶栓后早期及捏续性动脉未闭中的作用：ECG CLARITY–TIMI 28 贪图。节录：目的：本贪图旨在探讨溶栓后氯吡格叠加早期ST段回落(STRes)之间的关系及它们之间相互作用对临床预后的影响。布景：ST段回落是早期冠脉再灌输的非侵入性标志。方法：CLARITY–TIMI 28（心梗后28天氯吡格雷四肢再灌输颐养-溶栓的辅助用药）磨砺随即抽取3491名ST段举高的心梗患者（STEMI）溶栓后分辩给予氯吡格雷和安危剂进行比较。ST段回落定位为完全回落（>70%），部分回落（30%到70%），无回落（<30%）。收尾：2431名患者90min时心电图四肢法式，2087名患者180min时心电图四肢法式。90min在氯吡格雷组和安危剂组完全STRes发生率并无显著区别（90min时38.4%比36.6%）。患者依照STRes进行分层，用氯吡格雷进行侵扰在那些早期STRes患者中获益更大，对部分（上风比[OR]为1.4，P=0.04）或完全（上风比[OR]为2.0，P<0.001）STRes的患者后期经血管造影术检查发现动脉盛开的比率更高，但90min时无STRes的患者氯吡格雷侵扰收尾无任何变化（OR值为0.89，P=0.48）（相互作用的P=0.003）。氯吡格叠加90min时部分（[OR]为0.30，P=0.003）或完全（[OR]为0.49，P=0.056）STRes的患者入院耗损及心梗发生率呈负干系。而对于90min时无STRes的患者（OR值为0.89，P=0.95）（相互作用的P=0.027）无显著临床获益。30天时，氯吡格雷的临床获益主要出当今完全STRes患者中。论断：氯吡格雷通过扫视盛开的动脉再闭而欠亨过使早期再灌输容易的阶梯改善后期冠脉盛开。Title：Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experienceThe First Three Authors：Chieffo， A.Morici， N. Maisano， F.Corresponding Author and Address nterventional Cardiology， San Raffaele Scientific Institute， Milan， Italy.Abstract:BACKGROUND: Improvements in results with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may extend their use in patients with left main coronary artery (LMCA) stenosis. METHODS AND RESULTS: Two hundred forty-nine patients with LMCA stenosis were treated with PCI and DES implantation (n=107) or coronary artery bypass grafting (CABG) (n=142)， in a single center， between March 2002 and July 2004. A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 1 year， there was no statistical difference in the occurrence of death in PCI versus CABG both for the unadjusted (OR=0.291; 95% CI=0.054 to 1.085; P=0.0710) and adjusted analyses (OR=0.331; 95% CI=0.055 to 1.404; P=0.1673). PCI was correlated to a lower occurrence of the composite end points of death and myocardial infarction (unadjusted OR=0.235; 95% CI=0.048 to 0.580; P=0.0002; adjusted OR=0.260; 95% CI=0.078 to 0.597; P=0.0005) and death， myocardial infarction， and cerebrovascular events (unadjusted OR=0.300; 95% CI=0.102 to 0.617; P=0.0004; adjusted OR=0.385; 95% CI=0.180 to 0.819; P=0.01). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular event at the unadjusted (OR=0.675; 95% CI=0.371 to 1.189; P=0.1891) and adjusted analyses (OR=0.568; 95% CI=0.229 to 1.344; P=0.2266). CONCLUSIONS: At 1 year， in this single-center， retrospective experience， there was no difference in the degree of protection against death， stroke， myocardial infarction， and revascularization between PCI with DES and CABG for LMCA disease.Circulation. 2006;113:2542-2547)Impact Factor:12.563文题：无保护左骨干褊狭的颐养：药物洗脱支架照旧搭桥手术？—— 一项单中心的贪图节录： 布景：跟着经皮介入颐养本领的发展和药物洗脱支架的应用，介入颐养依然扩展到了冠状动脉左骨干(LMCA)褊狭病变的患者。方法和收尾：本贪图为单中心磨砺，共纳入2002年3月到2004年7月间的249例LMCA褊狭患者，其中107例剿袭了PCI下的药物洗脱支架植入颐养，另142例患者剿袭冠状动脉搭桥术。随访一年后，PCI组和CABG组的耗损率并无统计学各别(OR=0.291；95% CI=0.054 - 1.085；P=0.0710)；使用倾向分析方法调整两组患者颐养前的基线各别后，两组间也无耗损率的各别(OR=0.331；95% CI=0.055 - 1.404；P=0.1673)。但PCI组具有较低的耗损和心肌梗死结伙的止境事件发生率(调整前：OR=0.235；95% CI=0.048 - 0.580；P=0.0002；调整后：OR=0.260；95% CI=0.078 - 0.597；P=0.0005)；PCI组也具有较低的耗损、心肌梗死和脑血劳动件结伙的止境事件发生率 (调整前：R=0.300；95% CI=0.102 - 0.617；P=0.0004；调整后：OR=0.385；95% CI=0.180 - 0.819；P=0.01)。主要不良心脑血劳动件(MACCE)的发生率在两组间莫得各别(调整前：OR=0.675；95% CI=0.371 - 1.189；P=0.1891；调整后：OR=0.568；95% CI=0.229 to 1.344；P=0.2266) 。论断：在这项单中心追想性贪图中，对于LMCA褊狭行PCI下药物洗脱支架植入颐养或搭桥手术，随访一年后两组在耗损、中风、心肌梗死和再次型血运重建颐养方面的发生率并无显著各别。(其他)Title: Intracerebral Hemorrhage Elicits Aberration in Cardiomyocyte Contractile Function and Intracellular Ca2+ TransientsThe First three authors: Cindy X. Fang， Shan Wu， Jun RenCorresponding author and Address:. Dr Jun Ren， Division of Pharmaceutical Sciences， University of Wyoming， LaramieAbstract:Background and Purpose：The sequelae of intracerebral hemorrhage involve multiple organ damage including electrocardiographic alteration， although the mechanism behind myocardial dysfunction is unknown. The aim of this study was to examine the impact of intracerebral hemorrhage on cardiomyocyte contractile function， intracellular Ca2+ handling， Ca2+ cycling proteins， I kappa B beta protein (Iκ phosphorylation， hypoxia-inducible factor 1α (HIF-1α)， and nitrosative damage within 48 hours of injury.Methods：Mechanical and intracellular Ca2+ properties were evaluated including peak shortening (PS)， maximal velocity of shortening/relengthening (±dL/dt)， time-to-PS (TPS)， time-to-90% relengthening (TR90)， fura-2 fluorescence intensity (FFI)， and intracellular Ca2+ decay.Results：Myocytes from intracerebral hemorrhage rats exhibited depressed PS， dL/dt， prolonged TPS and TR90， as well as declined baseline FFI and slowed intracellular Ca2+ decay between 12 and 24 hours after injury. Most of these aberrations returned to normal levels 48 hours after hemorrhage with the exception of -dL/dt and TR90. Myocytes from 24-hour posthemorrhage rats exhibited a stepper negative staircase in PS with increased stimulus frequency. Cardiac expression of sarco(endo)plasmic reticulum Ca2+-ATPase 2a and phospholamban was enhanced， whereas that of Na+- Ca2+ exchanger and voltage-dependent K+ channel was decreased. IκB phosphorylation， HIF-1α， inducible NO synthase， and 3-nitrotyrosine were enhanced 12 hours after injury.Conclusions：These data demonstrated that intracerebral hemorrhage initiates cardiomyocyte contractile and intracellular Ca2+ dysregulation possibly related to altered expression of Ca2+ cycling proteins， nitrosative damage， and myocardial phosphorylation of IκB.Stroke 2006;37;1875-1882 ISSN 1524-4628Impact factor: 5.855文题：脑出血不错引起心肌细胞收缩功能的改变和细胞内钙瞬变节录：布景和目的：脑出血的后遗症波及多器官的损害包括心电图的改变，尽管心功能不全的潜在机制还不了了。这一贪图的目的是检测脑出血对心肌收缩功能，细胞内Ca2+独揽，Ca2+轮回卵白，IκB磷酸化，低氧迷惑因子1α（HIF-1α）和毁伤48小时内硝硫氰酯碎裂的影响。方法：测定机械的和细胞内Ca2+的性质，包括裁减的峰值（PS），裁减/再伸长的最大速率（±dL/dt），达PS的时辰（TPS），再伸长达90%的时辰（TR90），fura-2荧光强度（FFI）和细胞内Ca2+衰减。收尾：脑出血大鼠的心肌细胞PS，±dL/dt贬抑，TPS和TR90延长，同期，FFI基线水平也下落，且毁伤后12-24小时细胞内Ca2+衰减。除了-dL/dt和TR90，这些改变大部分在出血后48小时规复普通水平。加多的通常的刺激可对大鼠出血后24小时的心肌细胞的PS产生负性影响。腹黑肌浆网膜（内）Ca2+-ATPase 2a和受磷卵白的抒发是加多的，而Na+-Ca2+交换器和电压驯从性K+通说念是贬抑的。IκB磷酸化，HIF-1α，迷惑型NO合酶和3-硝基酪氨酸在毁伤后12小时是加多的。论断：这些府上露馅脑出血不错引起心肌细胞收缩和细胞内Ca2+失调，这可能与改变Ca2+轮回卵白的抒发，硝硫氰酯碎裂和心肌IκB磷酸化干系。（冠心病）Title: Prediction of Coronary Heart Disease in a Population With High Prevalence of Diabetes and AlbuminuriaThe Strong Heart StudyThe First three authors: Elisa T. Lee， Barbara V. Howard， Wenyu WangCorresponding author and Address: . Elisa T. Lee， Center for American Indian Health Research， College of Public Health， University of Oklahoma Health Sciences CenterAbstract:Objectives The present article presents equations for the prediction of coronary heart disease (CHD) in a population with high rates of diabetes and albuminuria， derived from data collected in the Strong Heart Study， a longitudinal study of cardiovascular disease in 13 American Indian tribes and communities in Arizona， North and South Dakota， and Oklahoma.Methods and Results Participants of the Strong Heart Study were examined initially in 1989–1991 and were monitored with additional examinations and mortality and morbidity surveillance. CHD outcome data through December 2001 showed that age， gender， total cholesterol， low-density lipoprotein (LDL) cholesterol， high-density lipoprotein cholesterol， smoking， diabetes， hypertension， and albuminuria were significant CHD risk factors. Hazard ratios for ages 65 to 75 years， hypertension， LDL cholesterol ≥160 mg/dL， diabetes， and macroalbuminuria were 2.58， 2.01， 2.44， 1.66， and 2.11 in men and 2.03， 1.69， 2.17， 2.26， and 2.69 in women， compared with ages 45 to 54 years， normal blood pressure， LDL cholesterol <100 mg/dL， no diabetes， and no albuminuria. Prediction equations for CHD and a risk calculator were derived by gender with the use of Cox proportional hazards model and the significant risk factors. The equations provided good discrimination ability， as indicated by a c statistic of 0.70 for men and 0.73 for women. Results from bootstrapping methods indicated good internal validation and calibration.Conclusions A “risk calculator” has been developed and placed on the Strong Heart Study Web site， which provides predicted risk of CHD in 10 years with input of these risk factors. This may be valuable for diverse populations with high rates of diabetes and albuminuria.Circulation 2006;113;2897-2905Impact factor:.11.632文题：在糖尿病和白卵白尿高发东说念主群中冠心病的瞻望 Strong Heart 贪图节录：布景：这一贪图是提议一个在糖尿病和白卵白尿高发的东说念主群中瞻望冠心病的方程，府上源于Strong Heart 贪图，这一贪图是在13个好意思国印地安东说念主部落以及亚利桑纳州，南北达科他州和俄克拉荷马州的社区中进行的心血管疾病的纵向贪图。方法和收尾：Strong Heart贪图的参与者从1989-1991年开动剿袭检查，并检测其他的检查技俩，耗损率和发病率。2001年12月冠心病收尾府上露馅年齿，性别，总胆固醇，LDL-c，HDL-c，抽烟，糖尿病，高血压和白卵白尿是冠心病的显著的危机身分。65-75岁，高血压，LDL-c≥160mg/dL，糖尿病和大量白卵白尿与45-54岁，普通血压，LDL-c＜100mg/dL，无糖尿病和无白卵白尿患者比拟的危机比在男性分辩为2.58，2.01，2.44，1.66和2.11，在女性分辩是2.03，1.69，2.17，2.26和2.69。冠心病的瞻望方程和危机筹办器是通过性别并用Cox比例危机率模子和弥留的危机因子得出的。这一方程有很好的阔别技艺，瞻望c值在男性为0.70，在女性为0.73。用率领的方法得出的收尾请示这在体内不错得到很好的阐明和校准。论断：这提供了一个“危机筹办器”并放弃在the Strong Heart网站，输入这些危机身分就不错提供10年内冠心病的危机瞻望。这对于糖尿病和白卵白尿高发的不同的东说念主群可能有用。(高血压)Titlempact of Increased Heart Rate on Clinical Outcomes in Hypertension: Implications for Antihypertensive Drug Therapy.The First three authorsalatini， Paolo. Benetos， Athanase. Julius， Stevo.Corresponding author and Addressepartment of Clinical and Experimental Medicine， University of Padova， Padova， Italy. palatini@unipd.itAbstract:Thirty-eight studies have been published to date on the association between elevated heart rate and mortality. After adjustment for other risk factors， only two studies for all-cause mortality and four studies for cardiovascular mortality reported an absence of association between heart rate and mortality in male populations. This relationship has been found to be generally weaker among females. Most of these studies investigated samples of general populations. The four studies performed in hypertensive men found a positive association between heart rate and all-cause mortality (hazard ratios ranging from 1.9 to 2.0) or cardiovascular mortality (hazard ratios ranging from 1.3 to 1.7). In spite of this evidence， elevated heart rate remains a neglected cardiovascular risk factor in both genders.The pathogenetic mechanisms connecting high heart rate， hypertension， atherosclerosis and cardiovascular events have also been explicated in many studies. Elevated heart rate is due to an increased sympathetic and decreased parasympathetic tone. This altered balance of the autonomic nervous system tone could explain the increase in events with the increased heart rate. However， it has also been proved that blood flow changes associated with high heart rate favour both the formation of the atherosclerotic lesion and the occurrence of the cardiovascular event。Reduction of heart rate in hypertensive patients with increased heart rate could be an additional goal of antihypertensive therapy. Several trials retrospectively showed the beneficial effect of cardiac-slowing drugs， such as [beta]-adrenoceptor antagonists ([beta]-blockers) and non-dihydropyridine calcium channel antagonists， on mortality， notably in patients with coronary heart disease， but no published data are available in patients with hypertension free of coronary heart disease. Other antihypertensive drugs that have been shown to reduce the heart rate are centrally acting drugs and angiotensin II receptor antagonists， but their bradycardic effect is rather weak. The f-channel antagonist ivabradine is a selective heart rate-lowering agent with no effect on blood pressure.Although it has not been proven in existing trials， it would seem reasonable to recommend antihypertensive agents that decrease the heart rate in hypertensive patients with a heart rate higher than 80-85 beats per minute. Since the fast heart rate per se causes cardiovascular damage， all drugs that lower the heart rate have the potential of further reducing cardiovascular events in patients with elevated heart rate. Unfortunately， lowering of the heart rate is not a clinically recognised goal. Prospective trials investigating whether treatment of high heart rate can prevent cardiovascular events， notably in hypertensive patients， are warranted.Drugs. 66(2):133-144， 2006文题：心率增快对高血压患者临床预后的影响：抗高血压药物颐养的启示。节录:已有38项贪图表明心率增快与耗损率干系。对其他危机身分进行创新以后，唯有探讨悉数原因耗损的两项贪图和心血管病耗损的四项贪图报说念在男性东说念主群中心率与耗损率无关，但在女性东说念主群中有较弱的干系性。这些贪图大部分都不雅察了总体东说念主群样本。在男性高血压患者中实施的四项贪图发现心率与悉数原因引起的耗损率和心血管病耗损率呈正干系（HR分辩为1.9-2.0，1.3-1.7）。尽管存在这些笔据，然则在男女东说念主群中心率增快仍是被暴戾的心血管危机因子。心率增快、高血压、动脉粥样硬化和心血劳动件的发病机理在许多贪图中依然陈诉。心率增快是由于交感神经开心同期副交感神经扼制变成的。自主神经系统改变均衡碎裂变有利率增快心血事件加多。另外还表明，与心率增块干系的血流改变与动脉粥样硬化的形成和心血劳动件的发生涯在密切关系。在心率增快的高血压患者中贬抑心率是抗高血压颐养的一个特别指标。几项追想性贪图表明贬抑心率药物如：β-肾上腺素受体组织剂和非二氢吡啶类钙通说念阻碍剂能显耀贬抑冠心病患者的耗损率，而对莫得冠心病的高血压患者却无数据表明存在作用。其他已说明能贬抑心率的抗高血压药物有核心作用降压药和血管焦躁素Ⅱ受体拮抗剂，然则它们引起心动过缓的作用却很弱。F通说念阻碍剂伊伐布雷定是一个聘任性贬抑心率况兼对血压莫得作用的药物。固然当今的实验还没说明这个药物的临床收尾，但用它来贬抑心率增快（心率80-85次/分以上）患者的心率是不错的。因为每秒钟的快速心率不错引起心血管损坏，悉数贬抑心率的药物对心率增快的患者贬抑心血劳动件都有潜在益处。难熬的是，贬抑心率不是临床所公认的指标。许多前瞻性贪图通过不雅察贬抑心率是否不错扼制心血劳动件的发生表明在高血压患者中贬抑心率的收尾是显耀的。（其他）Title: Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort studyThe First three authors: Gillian L Booth， Moira K Kapral， Kinwah FungCorresponding author and Address: . Dr Gillian L Booth， Division of Endocrinology and Metabolism， St Michael’s Hospital， Toronto， Ontario， CanadaAbstract:Background Adults with diabetes are thought to have a high risk of cardiovascular disease (CVD)， irrespective of their age. The main aim of this study was to fi nd out the age at which people with diabetes develop a high risk of CVD， as defi ned by: an event rate equivalent to a 10-year risk of 20% or more; or an event rate equivalent to that associated with previous myocardial infarction.Methods We did a population-based retrospective cohort study using provincial health claims to identify all adults with (n=379 003) and (n=9 018 082) without diabetes mellitus living in Ontario， Canada， on April 1， 1994. Individuals were followed up to record CVD events until March 31， 2000. Findings The transition to a high-risk category occurred at a younger age for men and women with diabetes than for those without diabetes (mean diff erence 14•6 years). For the outcome of acute myocardial infarction (AMI)， stroke， or death from any cause， diabetic men and women entered the high-risk category at ages 47•9 and 54•3 years respectively. When we used a broader defi nition of CVD that also included coronary or carotid revascularisation， the ages were 41•3 and 47•7 years for men and women with diabetes respectively.Interpretation Diabetes confers an equivalent risk to ageing 15 years. However， in general， younger people with diabetes (age 40 or younger) do not seem to be at high risk of CVD. Age should be taken into account in targeting of risk reduction in people with diabetes.Lancet 2006; 368: 29–36.Impact factor:.23.407文题：糖尿病患者与非糖尿病患者比拟在男性和女性年齿与心血管病之间的有计划：一个东说念主群的追想性队伍贪图节录：布景：东说念主们以为患有糖尿病的成年东说念主心血管疾病（CVD）发病风险高，不管年齿大小均如斯。这一贪图的目的是发现糖尿病患者CVD高危的年齿，CVD高危界说为：10年事件发生率达20%或更高；或事件发生率与以往有心肌梗死者相等。方法：咱们作念了一个东说念主群的追想性队伍贪图，府上源于1994年4月1日加拿大生活在安大要省的全省性的健康检查详情的有糖尿病（n=379003）和无糖尿病（9018082）的患者。悉数东说念主均随访至2000年3月31日，并纪录CVD事件。收尾：参加高危组的患者中患有糖尿病的男性和女性较莫得糖尿病者年齿小（平均差14.6岁）。不雅察急性心肌梗死，中风或任何原因的耗损这些预后，收尾糖尿病男性和女性患者参加高危组的年齿分辩是47.9岁和54.3岁。当咱们不雅察广义的CVD（也包括冠脉和颈动脉的血管成形术）时，男性和女性糖尿病患者参加高危组的年齿分辩是41.3岁和47.7岁。解释：糖尿病患者与较其苍老15岁的非糖尿病患者有沟通的CVD发病危机。关联词，一般而言，年青的糖尿病患者（40岁或更小）并不发扬为CVD高危。可能不错用年齿来解释糖尿病患者的发病危机减小。（冠心病）Title: Association between plasma levels of heat shock protein 60 and cardiovascular disease in patients with diabetes mellitusThe First three authors: Brian Henderson， Alireza Shamaei-Tousi1， Jeffrey W. Stephens， Ren Bin1Corresponding author and Address:. School of Medicine， University of Wales Swansea， UK.Abstract:Aims Evidence is accumulating to support the hypothesis that the release of heat shock protein (Hsp)60 into the circulation is associated with the development of coronary heart disease (CHD). As diabetes is a risk factor for CHD， it was of interest to determine Hsp60 blood levels in a cross-sectional cohort of diabetic patients， some of whom had cardiovascular disease， and relate levels to relevant biochemical markers.Methods and results A total of 855 patients with T1DM or T2DM， recruited as part of the UCL Diabetes and Cardiovascular disease Study (UDACS)， were assayed for plasma levels of Hsp60. Immunoreactive Hsp60 was detected in 54% of the samples， with 26% having plasma levels .1 mg/mL. Levels of Hsp60 were higher in Caucasians than in other ethnic groupings， with 56.5% of Caucasian subjects， 37.5% of African-Caribbean subjects， and 47.1% of Indian subjects having detectable levels (P ¼ 0.007)， and with a higher proportion of non-smokers having detectable Hsp60 levels than smokers (54.9 vs. 43.5%， P ¼ 0.01). Of note was the finding of an association between higher mean plasma levels of Hsp60 in subjects with clinically manifest cardiovascular disease and those with a history of myocardial infarction having an adjusted odds ratio of having detectable Hsp60 of 2.17 (CI 1.26–3.73).Conclusion This is the first report of circulating Hsp60 levels in diabetic patients， which suggests that this secreted mitochondrial cell stress protein may be playing an unexpected role in the cardiovascular pathology associated with diabetes.European Heart JournalImpact factor: 7.341文题：糖尿病患者血浆腹黑热休克卵白60水平与心血管疾病间的有计划节录：目的：腹黑热休克卵白（HSP）60开释到轮回中与冠心病（CHD）发生发展干系的假说得到越来越多的笔据支持。因为糖尿病是CHD的危机身分，是以咱们的兴味是在一个糖尿病患者（其中部分合并冠心病）的横断面贪图中详情血中Hsp60水平，以及对应于干系的生化标志物的干系水平。方法和收尾：T1MD和T2MD患者共855例进行了血浆Hsp60水平测定，这些患者是UCL糖尿病和心血管管病贪图（UDACS）的一部分。在54%的样本中发生了Hsp60免疫反映，26%血浆水平>1μg/mL。在高加索东说念主中Hsp60水平高于其他种族，达到可检测水平的百分率在高加索受试者中为56.5%，在非洲家勒比受试者中为37.5%，在印度受试者中为47.1%（p=0.007），而且，在非抽烟者中Hsp60达到可检测水平的百分比高于抽烟者（54.9% vs.43.5%，p=0.01）。收尾很显著，在有临床发扬的心血管病患者中高的平均血浆Hsp60水平与心肌梗死病史干系，达到可检测水平的Hsp60的创新的上风比为2.17（CI 1.26-3.73）。论断：这是第一次对于糖尿病患者轮回中Hsp60水平的报说念，这请示了由线粒体开释的细胞应激卵白在与糖尿病干系的心血管病理中阐发着出东说念主预思的作用。〔其它〕Title: A Controlled Trial of Homocysteine Lowering and Cognitive PerformanceThe First three authors: Jennifer A. McMahon， Timothy J. Green， C. Murray SkeaffCorresponding author and Aderess: C. Murray Skeaff， Department of Human Nutrition， University of Otago P.O. Box 56， Dunedin， New ZealandAbstract:BackgroundThe results of observational studies suggest that plasma homocysteine concentrations are inversely related to cognitive function in older people. Our objective was to test the hypothesis that lowering the plasma homocysteine concentration improves cognitive function in healthy older people.MethodsWe conducted a two-year， double-blind， placebo-controlled， randomized clinical trial involving 276 healthy participants， 65 years of age or older， with plasma homocysteine concentrations of at least 13 μmol per liter. Homocysteine-lowering treatment was a daily supplement containing folate (1000 μg) and vitamins B12 (500 μg) and B6 (10 mg). Tests of cognition were conducted at baseline and after one and two years of treatment. Treatment effects were adjusted for baseline values， sex， and education.ResultsOn average， during the course of the study， the plasma homocysteine concentration was 4.36 μmol per liter (95 percent confidence interval， 3.81 to 4.91 μmol per liter) lower in the vitamin group than in the placebo group (P<0.001). Overall， there were no significant differences between the vitamin and placebo groups in the scores on tests of cognition.ConclusionsThe results of this trial do not support the hypothesis that homocysteine lowering with B vitamins improves cognitive performance.The new england journal o f medicine. 2006;354:2764-72Impact factor:44.046文题：干系血浆同型半胱氨酸浓度贬抑与理会技艺关系的对照磨砺节录：布景：多项贪图露馅血浆同型半胱氨酸的浓度与老年东说念主的理会技艺呈负干系。本文旨在考证贬抑血浆同型半胱氨酸的水平可擢升老年东说念主的理会技艺这一假说。方法：领受为期2年、双盲、空缺对照、随即临床磨砺，录取276名年齿大于65岁血浆同型半胱氨酸浓度在13 umol/L以上的老年东说念主为贪图对象。每天补充100ug叶酸和500ugB12四肢贬抑同型半胱氨酸的颐养。分辩在基线水平、颐养1年后和颐养2年后测量同型半胱氨酸的血浆浓度。对基线水平、性别和受解说进程进行评估以调整颐养收尾。收尾：维生素组的血浆同型半胱氨酸浓度比对照组显耀性贬抑4.36 umol/L（P<0.001).而2组在理会技艺评分上无显著各别。论断：本文收尾并不支持贬抑血浆同型半胱氨酸的水平可擢升老年东说念主的理会技艺这一假说。〔其它〕Title: Specific and sustained down-regulation of genes involved in fatty acid metabolism is not a hallmark of progression to cardiac failure in miceThe First three authors: K.F.J. de Brouwer， H. Degens， W.M. AartsenCorresponding author and Aderess: M. van Bilsen， Department of Physiology， Cardiovascular Research Institute Maastricht (CARIM)， Maastricht University， The NetherlandsAbstract:Preferential and specific down-regulation of genes involved in fatty acid (FA) uptake and metabolism is considered a hallmark of severe hypertrophic remodeling and progression to cardiac failure. Therefore， we investigated the time course of changes in cardiac metabolic gene expression (1) in mice subjected to regional myocardial infarction (MI) for 4 days， 1 month， or 3 months and (2) in mice overexpressing calcineurin (Cn) which initially develop concentric hypertrophy progressing after the age of 4 weeks to dilated cardiomyopathy and failure. In both models， hypertrophy was characterized by increased expression of β-myosin heavy chain protein and atrial natriuretic factor mRNA， indicative of marked structural remodeling. Fractional shortening progressively decreased from 31% to 15.1% and 3.7% 1 and 3 months after MI， respectively. One month post-MI， the expression of several metabolic genes， i.e.， acyl-CoA synthetase (−50%)， muscle-type carnitine palmitoyl transferase 1 (−37%) and citrate synthase (−28%)， was significantly reduced in the surviving myocardium. Despite overt signs of cardiac failure 3 months post-MI， the expression of these genes had returned to normal levels. In hearts of both 4- and 6-week-old Cn mice， genes involved in both FA and glucose metabolism and mitochondrial citrate synthase were down-regulated， reflecting an overall decline in metabolic gene expression， rather than a specific and preferential down-regulation of genes involved in FA uptake and metabolism. These findings challenge the concept that specific and sustained down-regulation of genes involved in FA uptake and metabolism represents a hallmark of the development of cardiac hypertrophy and progression to failure.Journal of Molecular and Cellular Cardiology 40 (2006) 838–845 Impact factor:3.872文题：波及脂肪酸（FA）接管和代谢干系特异基因的下调不行四肢肥平定构严重化和心衰出现进展的标志节录：波及脂肪酸（FA）接管和代谢干系特异基因的下调被以为是肥平定构严重化和心衰出现进展的标志。因此，本文旨在测量腹黑代谢基因抒发的时程。领受2种小鼠模子。一为心肌梗死模子，分辩在心肌梗身后4天、1月和3月测量腹黑基因的抒发。二为过度抒发神经钙卵白（Cn）的小鼠模子，这种神经钙卵白可促使向心性肥厚发展至彭胀性心肌病和心衰。在这2模子里，选择β肌球卵白重链和心房利钠肽mRNA绮丽魁梧。裁减分数在心肌梗死1月和3月后分辩从31%减少至15.1%和3.1%。存活心肌里多种代谢基因、酰基辅酶A合成酶、肌样肉毒碱脂酰转动酶和柠檬酸合成酶的抒发在心肌梗死1月后显耀性贬抑，别离有统计学意思。心肌梗死3月后，尽管小鼠已出现心衰的体征，但上述基因的抒发却回至普通。在Cn小鼠第4周和第6周腹黑FA、葡萄糖代谢和线粒体柠檬酸合成酶均下调，反映了举座代谢基因的下调，而不是只波及FA接管和代谢基因的下调。本文的贪图收尾对波及脂肪酸（FA）接管和代谢干系特异基因的下调是肥平定构严重化和心衰出现进展的标志这一不雅点提议了质疑。〔其它〕Title: Increased cell-to-cell variation in gene expression in ageing mouse heartThe First three authors: Rumana Bahar， Claudia H. Hartmann， Karl A. RodriguezCorresponding author and Aderess: Jan Vijg， Buck Institute for Age Research， California， USA. Abstract:The accumulation of somatic DNA damage has been implicated as a cause of ageing in metazoa1，2. One possible mechanism by which increased DNA damage could lead to cellular degeneration and death is by stochastic deregulation of gene expression. Here we directly test for increased transcriptional noise in aged tissue by dissociating single cardiomyocytes from fresh heart samples of both young and old mice， followed by global mRNA amplification and quantification of mRNA levels in a panel of housekeeping and heart-specific genes. Although gene expression levels already varied among cardiomyocytes from young heart， this heterogeneity was significantly elevated at old age. We had demonstrated previously an increased load of genome rearrangements and other mutations in the heart of aged mice3，4. To confirm that increased stochasticity of gene expression could be a result of increased genome damage， we treated mouse embryonic fibroblasts in culture with hydrogen peroxide. Such treatment resulted in a significant increase in cell-to-cell variation in gene expression， which was found to parallel the induction and persistence of genome rearrangement mutations at a lacZ reporter locus. These results underscore the stochastic nature of the ageing process， and could provide a mechanism for age-related cellular degeneration and death in tissues of multicellular organisms.nature 2006;441:1011–1014 Impact factor: 29.273文题：老年小鼠腹黑基因抒发变异加多节录：体细胞DNA损害被看作念多细胞老化的原因之一。DNA损害爽快加多可能的导致细胞变性和耗损的可能机制是基因抒发变异。本文分辩将后生小鼠和老年小鼠的心肌细胞分离出来，检测其加多的很是转录子，并精腹黑特异基因独揽板扩增mRNA和定量mRNA的水平。尽管后生小鼠的心肌基因抒发水平依然出现不同，但这种异质性在老年小鼠显著加多。既往的贪图依然说明老年小鼠有更多的基因重组和突变。为了阐明基因抒发由染色体损坏加多所导致，本文领受过氧化氢培养基培养小鼠胚胎成纤维细胞，收尾露馅细胞之间基因抒发突变显耀加多，其迷惑作用和捏久性与lacZ基因重组突变不异。本文对老化过程进行了推断，并为老年多细胞组织的细胞变性和耗损提供了机制。〔心律失常〕Title: Effect of Amiodarone and Sotalol on Ventricular Defibrillation Threshold：The Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) Trial The First three authors: Stefan H. Hohnloser，Paul Dorian， Robin RobertsCorresponding author and Address: Stefan H. Hohnloser， MD， J.W. Goethe University， Department of Medicine， Division of Cardiology， Theodor-Stern-Kai 7， 60590 Frankfurt， Germany.Abstract:Background—Many patients with implanted cardioverter defibrillators (ICDs) receive adjunctive antiarrhythmic drug therapy， most commonly amiodarone or sotalol. The effects of these drugs on defibrillation energy requirements have not been previously assessed in a randomized controlled trial.Methods and Results—The Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) trial was a randomized clinical trial evaluating the efficacy of amiodarone plus β- blocker and sotalol versus β-blocker alone for reduction of ICD shocks. Within OPTIC， a prospectively designed substudy evaluated the effects of the 3 treatment arms on defibrillation energy requirements. Defibrillation thresholds (DFTs) were measured (binary step-down protocol) at baseline and again after 8 to 12 weeks of therapy in 94 patients， of whom 29 were randomized to receiveβ-blocker therapy (control group)， 35 to amiodarone plus β-blocker， and 30 to sotalol. In the control group， the mean DFT decreased from 8.77±5.15 J at baseline to 7.13±3.43 J (P=0.027); in the amiodarone group， DFT increased from 8.53±4.29 to 9.82±5.84 J (P=0.091). In the sotalol group， DFT decreased from 8.09±4.81 to 7.20±5.30 J (P=0.21). DFT changes in the β-blocker and the amiodarone group were significantly different (P=0.006). In all patients， adequate safety margins for defibrillation were maintained. No clinical variable predicted baseline DFT or changes in DFT on therapy.Conclusion—Although amiodarone increased DFT， the effect size with modern ICD systems is very small. Therefore， DFT reassessment after the institution of antiarrhythmic drug therapy with amiodarone or sotalol is not routinely required. (Circulation. 2006;114:104-109.)Recently updated Impact Factor：11.632文题：胺碘酮及索他洛尔对室颤阈值的影响：室颤患者的最好药物颐养磨砺 (OPTIC)。节录：布景： 好多植入腹黑复律除颤器（ICDs）的患者剿袭辅助抗心律失常药物颐养，浩荡服用胺碘酮或索他洛尔。在以前的随即对照磨砺中，上述药物对于除颤能量需求的收尾尚未得到评估。方法和收尾：对植入腹黑复律除颤器（ICDs）的患者进行的最好药物颐养磨砺（OPTIC)是一项随即的临床磨砺，其目的在于比较胺碘酮加β阻断剂颐养，索他洛尔颐养同单独应用β阻断剂颐养对于减少ICD电轰动的收尾。OPTIC中，一项预期想象的亚磨砺用来评估3种颐养决议对于除颤能量需求的影响。（通过二元递减模式）测量94名患者基础除颤阈值(DFTs)，8-12周后再次测量除颤阈值，其中随即抽取29名患者剿袭β阻断剂颐养（对照组），35名患者剿袭胺碘酮加β阻断剂颐养，30名患者剿袭索他洛尔颐养。在对照组中，平均DFT基础值从8.77±5.15 J减少到7.13±3.43 J (P=0.027)；在胺碘酮颐养组中，DFT从8.53±4.29升高到9.82±5.84 J (P=0.091)。在索他洛尔颐养组中，DFT从8.09±4.81减少到7.20±5.30 J (P=0.21)。在β阻断剂颐养组和胺碘酮颐养组中DFT变化各别显耀(P=0.006)。悉数患者中，除颤保管满盈的安全域。无临床变量瞻望DFT基础值或颐养中的DFT变化。论断：尽管胺碘酮加多DFT，然则当代ICD系统作用限制相等小。因此，应用胺碘酮或索他洛尔抗心律失常药物颐养后的DFT再评估并不是鄙俗所必需的。（心律失常）Title: Somatic Mutations in the Connexin 40 Gene (GJA5) in Atrial FibrillationThe First three authors: Michael H. Gollob， Douglas L. Jones，Andrew D. KrahnCorresponding author and Address: Dr. Gollob at the Arrhythmia Research Laboratory and Division of Cardiology， University of Ottawa Heart Institute， Rm. H350， 40 Ruskin St.， Ottawa， ON K1Y 4W7， Canada.Abstract:BackgroundAtrial fibrillation is the most common type of cardiac arrhythmia and a leading cause of cardiovascular morbidity， particularly stroke. The cardiac gap-junction protein connexin 40 is expressed selectively in atrial myocytes and mediates the coordinated electrical activation of the atria. We hypothesized that idiopathic atrial fibrillation has a genetic basis and that tissue-specific mutations in GJA5， the gene encoding connexin 40， may predispose the atria to fibrillation.MethodsWe sequenced GJA5 from genomic DNA isolated from resected cardiac tissue and peripheral lymphocytes from 15 patients with idiopathic atrial fibrillation. Identified GJA5 mutations were transfected into a gap-junction–deficient cell line to assess their functional effects on protein transport and intercellular electrical coupling.ResultsFour novel heterozygous missense mutations were identified in 4 of the 15 patients. In three patients， the mutations were found in the cardiac-tissue specimens but not in the lymphocytes， indicating a somatic source of the genetic defects. In the fourth patient， the sequence variant was detected in both cardiac tissue and lymphocytes， suggesting a germ-line origin. Analysis of the expression of mutant proteins revealed impaired intracellular transport or reduced intercellular electrical coupling.ConclusionsMutations in GJA5 may predispose patients to idiopathic atrial fibrillation by impairing gap-junction assembly or electrical coupling. Our data suggest that common diseases traditionally considered to be idiopathic may have a genetic basis， with mutations confined to the diseased tissue.N Engl J Med 2006;354:2677-88.Recently updated Impact Factor:44.016.节录：房颤患者体细胞connexin40基因（GJA5）突变。布景：房颤是腹黑心律失常最浩荡的类型，是心血管病耗损率的主要原因，卓绝易于形成中风。腹黑瑕玷勾通卵白connexin40在心房肌中有聘任的抒发，转折的改变节房的电激活。贪图者假定特发性房颤有其遗传基础：GJA5（GJA5基因编码connexin40）的组织特异性突变，能使心房易于产生房颤。方法：贪图者对从15名特发性房颤患者心肌组织及外周淋巴细胞切割分离出的基因组DNA上的GJA5进行排序。将经武断的GJA5变异基因转染给瑕玷勾通穷乏的细胞株，评估对于卵白质输送及细胞内电偶联的功能影响。收尾：在15名患者中的4名武断出了4种新式的杂合子错义突变。在3名患者中发现变异存在于心肌组织样本中，而在淋巴细胞中并无存在，表明一种体细胞源性的基因症结。在4名患者中发现心肌组织及淋巴细胞中均能检测到基因序列变异，表明一种生殖源性的基因症结。对突变卵白抒发的分析揭示细胞内卵白转运受损或细胞内电偶联减少。论断：GJA5突变通过损害瑕玷勾通组件或电偶联使患者易于发生特发性心房颤动。本贪图数据表明鄙俗探究为特发性的常见病可能均存在一个遗传基础，即变异放荡在疾病组织。（其他）Title: Effectiveness and Safety of Sirolimus Stent Implantation for Coronary In-Stent Restenosis：The TRUE (Tuscany Registry of Sirolimus for Unselected In-Stent Restenosis) RegistryThe First three authors: Francesco Liistro，Massimo Fineschi，Paolo AngioliCorresponding author and Address: Dr. Francesco Liistro， Department of Cardiovascular Disease， San Donato Hospital， Via Pietro Nenni 22， Arezzo， 52100， Italy.AbstractOBJECTIVES This study sought to evaluate the effectiveness and safety of the sirolimus-eluting stent in the treatment of in-stent restenosis (ISR) in consecutive unselected patients undergoing coronary intervention in a real-world scenario.BACKGROUND Restenosis after bare metal stenting is characterized by a high rate of re-restenosis once treated with repeated percutaneous coronary intervention.METHODS The study was designed as a prospective two-center registry. We enrolled 244 patients with ISR in a native coronary artery or saphenous vein graft who had clinical indication for repeat intervention.RESULTS Sirolimus stent implantation was successful in all lesions. At 9-month follow-up， death occurred in 4 (1.6%) patients， myocardial infarction in 4 (1.6%)， and ischemia-driven target lesion revascularization (TLR) in 12 (4.9%)， for a cumulative event-free survival of 227 (93%). Although 9-month follow-up angiography was planned in all patients， only 150 (62%) patients completed it， and restenosis was present in 13 (8.7%) patients. Diabetes and non–ST-segment elevation acute coronary syndrome at presentation were the only independent predictors of freedom from ischemia-driven TLR and major adverse cardiac events.CONCLUSIONS Sirolimus stent implantation for the treatment of ISR is effective and safe. In diabetic patients and in those with acute coronary syndrome， the higher rate of recurrence requires further evaluation. (J Am Coll Cardiol 2006;48:270 –5)Recently updated Impact Factor：9.200文题：雷帕霉素支架植入对于冠脉支架内再褊狭的灵验性及安全性：TRUE注册（非聘任性支架内再褊狭的雷帕霉素Tuscany注册）节录：目的：本贪图旨在评估试验寰球中雷帕霉素洗脱支架对经过冠脉侵扰的序列非聘任性患者支架内再褊狭（ISR）颐养的灵验性及安全性。布景：裸金属支架植入后的再褊狭（ISR）特质为反复经皮冠脉侵扰后反复再褊狭（ISR）的高发生率。方法：筹办在双中心注册处进行本磨砺。贪图者登记了244名ISR患者，在冠脉或隐静脉移植物中存在ISR，存在反复侵扰的临床妥当症。收尾：在悉数病变处植入雷帕霉素支架是安全的。9个月的随访后发现：4名患者耗损（1.6%），4名患者心肌梗死（1.6%），以及12名患者（4.9%）诱发缺血的靶病变再次血管重建（TLR），积累的无事件生涯患者为227名（93%）。尽管筹办在悉数患者9个月随访中均进行血管造影术，但只是150名患者（62%）完成了血管造影术，13名患者（8.7%）出现了再褊狭。咫尺，糖尿病及非ST段举高急性冠脉概述征是诱发缺血的TLR及主要严要点脏不测事件目田度的惟一并立瞻望因子。论断：雷帕霉素支架植入对于颐养ISR是安全和灵验的。在糖尿病患者及急性冠脉概述征患者中，再褊狭的高发生率需要进一步的评估。高血压HypertensionBone Morphogenic Protein-4 Induces Hypertension in MiceRole of Noggin， Vascular NADPH Oxidases， and Impaired VasorelaxationSumitra Miriyala， PhD*; Maria C. Gongora Nieto， PhD*; Christopher Mingone， PhD;Debra Smith， MS; Sergey Dikalov， PhD; David G. Harrison， MD; Hanjoong Jo， PhDBackground—Recent in vitro studies have shown that disturbed flow and oxidative conditions induce the expression ofbone morphogenic proteins (BMPs 2 and 4) in cultured endothelial cells. BMPs can stimulate superoxide production andinflammatory responses in endothelial cells， raising the possibility that BMPs may play a role in vascular diseases suchas hypertension and atherosclerosis. In this study， we examined the hypothesis that BMP4 would induce hypertensionin intact animals by increasing superoxide production from vascular nicotinamide adenine dinucleotide phosphate(NADPH) oxidases and an impairment of vasodilation responses.Methods and Results—BMP4 infusion by osmotic pumps increased systolic blood pressure in a time- and dose-dependentmanner in both C57BL/6 mice (from 101 to 125 mm Hg) and apolipoprotein E–null mice (from 107 to 146 mm Hg) after 4 weeks. Cotreatment with the BMP antagonist noggin or the NADPH oxidase inhibitor apocynin completely blocked the BMP4 effect. In addition， BMP4 infusion stimulated aortic NADPH oxidase activity and impaired vasorelaxation both of which were prevented either by coinfusing noggin or by treating the isolated aortas with apocynin. BMP4， however， did not cause significant changes in maximum relaxation induced by the endothelium-independent vasodilatornitroglycerin. Remarkably， BMP4 infusion failed to stimulate aortic NADPH oxidases， increase blood pressure， and impair vasodilation responses in p47phox-deficient mice. Conclusions—These results suggest that BMP4 infusion induces hypertension in mice in a vascular NADPH oxidase–dependent manner and the subsequent endothelial dysfunction. We suggest that BMP4 is a novel mediator of endothelial dysfunction and hypertension and that noggin and its analogs could be used as therapeutic agents for treating vascular diseases. (Circulation. 2006;113:2818-2825.)Key Words: blood flow _ blood pressure _ endothelium-derived factors _ free radicals _ hypertension_ nitric oxide _ vasodilation 骨头Morphogenic卵白质4导致老鼠高血压Noggin的作用， 血管NADPH氧化酶， 况兼被削弱的血管舒张反映 Sumitra Miriyala， PhD; 玛丽亚C。 Gongora Nieto， PhD; 克里斯托弗Mingone， PhD;Debra史姑娘， 女士; Sergey Dikalov， PhD; 大卫G。 哈里逊， MD; Hanjoong Jo， PhD要道词：血流，血压，内皮得回身分，目田基，高血压 ，一氮氧化，血管舒张背 景：最近体外贪图示意，被干扰的历程和氧化情况导致骨头morphogenic卵白质(BMPs 2和4)在被开化的内皮细胞的细胞抒发。 BMPs在内皮细胞的细胞可能刺激superoxide出产和慷慨反映， BMPs在血管病也许在高血压和动脉粥样硬化饰演一个脚色的可能性擢升。 在这项贪图中， 咱们审查了假说BMP4将通过加多superoxide出产从血管烟酰胺腺嘌呤二核苷酸磷酸盐(NADPH)氧化酶和血管舒张反映的毁伤在原始磨砺动物导致高血压。方法和收尾：BMP4由输注泵注入在4个星期以后，在C57BL/6老鼠(从101到125毫米Hg)和apolipoprotein E空老鼠加多了腹黑收缩的血压以时辰和dose-dependent样式(从107到146毫米Hg)。 Cotreatment与BMP拮抗因子noggin或NADPH氧化酶抗化剂apocynin完全地禁止了BMP4作用。 另外， BMP4注入刺激了大动脉NADPH氧化酶活性况兼削弱了血管舒张，两者均扫视通过noggin恰恰或通过对待被拆开的主动脉与apocynin。 BMP4，关联词， 莫得导致在endothelium-independent血管彭胀剂的硝化甘油导致的最大消弱上的要紧的变化。 在p47phox小老鼠，BMP4注入莫得显耀刺激大动脉NADPH氧化酶， 加多血压， 况兼削弱血管舒张反映。结 论：这些收尾建议BMP4注入在老鼠导致高血压以血管NADPH氧化酶依赖样式和随后内皮细胞的官能不良。 咱们建议BMP4是内皮细胞的官能不良和高血压一个新的改变因子，况兼noggin和它的访佛物可能用来颐养心血管病。 (轮回。 2006年; 113 ：2818-2825.)（其他）Title: Effect of perioperativeβblockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled， blinded multicentre trialThe First three authors: Anne Benedicte Juul， Jørn Wetterslev， Christian GluudCorresponding author and Address: Anne Benedicte Juul，Copenhagen Trial Unit， Centre for Clinical Intervention Research， Copenhagen University Hospital， DenmarkAbstract:Objectives To evaluate the long term effects of perioperative β blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. Design Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat.Setting University anaesthesia and surgical centres and one coordinating centre.Participants 921 patients aged > 39 scheduled for major non-cardiac surgery. Interventions 100 mg metoprolol controlled and extended release or placebo administered from the day before surgery to a maximum of eight perioperative days.Main outcome measures The composite primary outcome measure was time to all cause mortality， acute myocardial infarction， unstable angina， or congestive heart failure. Secondary outcome measures were time to all cause mortality， cardiac mortality， and non-fatal cardiac morbidity.Results Mean duration of intervention was 4.6 days in the metoprolol group and 4.9 days in the placebo group. Metoprolol significantly reduced the mean heart rate by 11% (95% confidence interval 9% to 13%) and mean blood pressure by 3% (1% to 5%). The primary outcome occurred in 99 of 462 patients in the metoprolol group (21%) and 93 of 459 patients in the placebo group (20%) (hazard ratio 1.06， 0.80 to 1.41) during a median follow-up of 18 months (range 6-30). All cause mortality was 16% (74/462) in the metoprolol group and 16% (72/459) in the placebo group (1.03， 0.74 to 1.42). The difference in risk for the proportion of patients with serious adverse events was 2.4% ( − 0.8% to 5.6%).Conclusions Perioperative metoprolol did not significantly affect mortality and cardiac morbidity in these patients with diabetes. Confidence intervals， however， were wide， and the issue needs reassessment.Trial registration Current Controlled TrialsISRCTN58485613.British Medical Journal. 2006;332:1482-1489Impact factor:9.052文题：围手术期应用β阻碍剂对剿袭非腹黑外科大手术糖尿病患者的影响：随即安危剂对照，双盲多中心磨砺节录：目的 评估围手术期应用β阻碍剂对剿袭非腹黑外科大手术糖尿病患者耗损率和腹黑病发病率的长期影响。想象 随即安危剂对照和双盲多中心磨砺。用intention to treat分析。贪图环境 大学的麻醉和外科中心及一个互助中心参加者921例年齿＞39岁，已列表排定法则进行非腹黑外科大手术的患者。侵扰 手术前1天开动给予 100mg好意思托洛尔控释和长效制剂或安危剂，最多给至围手术期的第8天。主要预后的测评纪律 复合的主要预后测评纪律为全因耗损、急性心肌梗死、不稳宽解绞痛或充血性心力阑珊。次要预后测评纪律为全因耗损率，腹黑耗损率和非致命性腹黑病发病率。收尾 平均侵扰时辰好意思托洛尔组为4.6天，安危剂组为4.9天。好意思托洛尔使平均心率显著减少11%（95%置信区间 9%～13%），平均血压减少3%（95%置信区间 1%～5%）。平均随访18个月（领域 6-30），好意思托洛尔组462例患者中99例患者（21%），安危剂组459例患者中93例患者（20%）发生了主要预后事件（危机比 1.06，1.08～1.41）。全因耗损率好意思托洛尔组为16%（74/462），安危剂组为16%（72/459）（危机比1.03，0.74～1.42）。患者发生严重不良事件危机的各别为2.4%（－0.8%～5.6%）。论断 围手术期应用好意思托洛尔对合并糖尿病手术患者的耗损率和腹黑病发病率无显著影响。关联词，置信区间很宽，这个问题还需要再评估。实验注册 现时对实在验ISRCTN58485613（其他）Title: Effect of perioperativeβblockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled， blinded multicentre trialThe First three authors: Anne Benedicte Juul， Jørn Wetterslev， Christian GluudCorresponding author and Address: Anne Benedicte Juul，Copenhagen Trial Unit， Centre for Clinical Intervention Research， Copenhagen University Hospital， DenmarkAbstract:Objectives To evaluate the long term effects of perioperative β blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. Design Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat.Setting University anaesthesia and surgical centres and one coordinating centre.Participants 921 patients aged > 39 scheduled for major non-cardiac surgery. Interventions 100 mg metoprolol controlled and extended release or placebo administered from the day before surgery to a maximum of eight perioperative days.Main outcome measures The composite primary outcome measure was time to all cause mortality， acute myocardial infarction， unstable angina， or congestive heart failure. Secondary outcome measures were time to all cause mortality， cardiac mortality， and non-fatal cardiac morbidity.Results Mean duration of intervention was 4.6 days in the metoprolol group and 4.9 days in the placebo group. Metoprolol significantly reduced the mean heart rate by 11% (95% confidence interval 9% to 13%) and mean blood pressure by 3% (1% to 5%). The primary outcome occurred in 99 of 462 patients in the metoprolol group (21%) and 93 of 459 patients in the placebo group (20%) (hazard ratio 1.06， 0.80 to 1.41) during a median follow-up of 18 months (range 6-30). All cause mortality was 16% (74/462) in the metoprolol group and 16% (72/459) in the placebo group (1.03， 0.74 to 1.42). The difference in risk for the proportion of patients with serious adverse events was 2.4% ( − 0.8% to 5.6%).Conclusions Perioperative metoprolol did not significantly affect mortality and cardiac morbidity in these patients with diabetes. Confidence intervals， however， were wide， and the issue needs reassessment.Trial registration Current Controlled TrialsISRCTN58485613.British Medical Journal. 2006;332:1482-1489Impact factor:9.052文题：围手术期应用β阻碍剂对剿袭非腹黑外科大手术糖尿病患者的影响：随即安危剂对照，双盲多中心磨砺节录：目的 评估围手术期应用β阻碍剂对剿袭非腹黑外科大手术糖尿病患者耗损率和腹黑病发病率的长期影响。想象 随即安危剂对照和双盲多中心磨砺。用intention to treat分析。贪图环境 大学的麻醉和外科中心及一个互助中心参加者921例年齿＞39岁，已列表排定法则进行非腹黑外科大手术的患者。侵扰 手术前1天开动给予 100mg好意思托洛尔控释和长效制剂或安危剂，最多给至围手术期的第8天。主要预后的测评纪律 复合的主要预后测评纪律为全因耗损、急性心肌梗死、不稳宽解绞痛或充血性心力阑珊。次要预后测评纪律为全因耗损率，腹黑耗损率和非致命性腹黑病发病率。收尾 平均侵扰时辰好意思托洛尔组为4.6天，安危剂组为4.9天。好意思托洛尔使平均心率显著减少11%（95%置信区间 9%～13%），平均血压减少3%（95%置信区间 1%～5%）。平均随访18个月（领域 6-30），好意思托洛尔组462例患者中99例患者（21%），安危剂组459例患者中93例患者（20%）发生了主要预后事件（危机比 1.06，1.08～1.41）。全因耗损率好意思托洛尔组为16%（74/462），安危剂组为16%（72/459）（危机比1.03，0.74～1.42）。患者发生严重不良事件危机的各别为2.4%（－0.8%～5.6%）。论断 围手术期应用好意思托洛尔对合并糖尿病手术患者的耗损率和腹黑病发病率无显著影响。关联词，置信区间很宽，这个问题还需要再评估。实验注册 现时对实在验ISRCTN58485613（其他）Title: Heart and lung transplantation in childrenThe First three authors: Steven A Webber， Kenneth McCurry， Adriana ZeeviCorresponding author and Address: Steven A Webber， Division of Pediatric Cardiology， UPMC Children’s Hospital of Pittsburgh，USA.Abstract:During the past two decades， several advances have resulted in marked improvement in medium-term survival for infants and children undergoing heart transplantation. Unfortunately， progress has been less dramatic in the fi eld of lung and heart-lung transplantation， where there is little evidence of improved outcomes. The procedures remain palliative and all transplant recipients are at risk for the adverse eff ects of non-specifi c immunosuppression， including infections， lymphoproliferative disorders， and non-lymphoid malignancies. In addition， current immunosuppressive agents have narrow therapeutic windows and exhibit a wide array of organ toxicities， posing special challenges for the young patient who must endure life-long immunosuppression. New immunosuppressive regimens have lowered the rates of acute rejection but appear to have had relatively little impact on the incidence of chronic rejection， the principal cause of late graft loss. The ultimate goal is to induce a state of donor-specifi c tolerance， wherein the recipient will accept the allograft indefi nitely without the need for long-term immunosuppression. This quest is currently being realised in animal models of solid organ transplantation， and off ers great hope for children undergoing heart and lung transplantation in the future.Lancet 2006; 368: 53–69Impact factor:23.407.文题：儿童心肺移植节录：在昔时的二十年，几项进展使剿袭腹黑移植的婴儿和儿童的中期存活率显著擢升。难熬的是，在肺脏和心-肺移植限制却进展甚微，险些莫得笔据表明（肺脏和心-肺移植）不错改善预后。手术仍领受姑息性，悉数移植术的受者均有发生非特异性免疫扼制反作用的危机，包括感染，淋巴增生空泛和非淋巴性恶性肿瘤。此外，咫尺的免疫扼制剂颐养窗口很窄，具有多器官毒性，对那些必须剿袭终身免疫扼制颐养的年青患者提议了特殊的挑战。新的免疫扼制颐养方法贬抑了急性摈斥的发生率，然则对于慢性摈斥发生的影响相对较小，而慢性摈斥是晚期移植物丢失的主要原因。最终的目的是产生一种供体特异性耐受的气象，在这种气象下，受者不错不受适度地剿袭同种异体移植物而无需长期剿袭免疫扼制颐养。这个问题咫尺正在固体器官移植的动物模子中探讨，为将来剿袭心肺移植的儿童提供了高大的但愿。（其他）Title: Depression and Cardiovascular DiseaseHealing the Broken-HeartedThe First three authors: Mary A. WhooleyCorresponding author and Address: Mary A. Whooley， Veterans Affairs Medical Center and University of CaliforniaAbstract:Major depressive disorder is a risk factor for the development of incident coronary heart disease events in healthy patients and for adverse cardiovascular outcomes in patients with established heart disease. Depression is present in 1 of 5 outpatients with coronary heart disease and in 1 of 3 outpatients with congestive heart failure， yet the majority of cases are not recognized or appropriately treated. It is not known whether treating depression improves cardiovascular outcomes， but antidepressant treatment with selective serotonin reuptake inhibitors is generally safe， alleviates depression， and improves quality of life. This article evaluates the importance of major depression in patients with cardiovascular disease， and provides practical guidance for identifying and treating this disorder.Journal of American Medical Association. 2006;295:2874-2881Impact factor:23.332文题：抑郁症和心血管疾病颐养创伤的心灵节录：严重的抑郁症是健康东说念主发生冠心病事件和腹黑病患者发生不利心血管预后的危机身分。有1/5的冠心病患者和1/3的充血性心力阑珊患者存在抑郁症，关联词大部分患者未得到确诊和得当的颐养。颐养抑郁症是否可改善心血管预后还不了了，然则用聘任性5-羟色胺重招揽扼制剂鄙俗是安全的，可减轻抑郁，改善生活质料。这篇著作评价了严重抑郁症对心血管疾病患者的弥留性，为阔别和颐养这种疾病提供了实践率领。〔心肌梗死〕Ex Vivo Activated Human Macrophages Improve Healing， Remodeling， and Function of the Infarcted HeartThe First three authors: Jonathan Leor; Liat Rozen; Adi Zuloff-ShaniCorresponding author and Aderess: Jonathan Leor， Neufeld Cardiac Research Institute， Sheba Medical Center， Israel.Abstract:Background—Activated macrophages have a significant role in wound healing and damaged tissue repair. We sought to explore the ability of ex vivo activated macrophages to promote healing and repair of the infarcted myocardium.Methods and Results—Human activated macrophage suspension (AMS) was prepared from a whole blood unit obtained from young donors in a closed sterile system and was activated by a novel method of hypo-osmotic shock. The AMS (≈4×105 cells) included up to 43% CD14-positive cells and was injected into the ischemic myocardium of rats (n=8) immediately after coronary artery ligation. The control group (n=9) was treated with saline injection. The human cells existed in the infarcted heart 4 to 7 days after injection， as indicated by histology， human growth hormone-specific polymerase chain reaction， and magnetic resonance imaging (MRI) tracking of iron oxide–nanoparticle-labeled cells. After 5 weeks， scar vessel density (±SE) (25±4 versus 10±1 per mm2; P＜0.05)， myofibroblast accumulation， and recruitment of resident monocytes and macrophages were greater in AMS-treated hearts compared with controls. Serial echocardiography studies， before and 5 weeks after injection， showed that AMS improved scar thickening (0.15±0.01 versus 0.11±0.01 cm; P＜0.05)， reduced left ventricular (LV) diastolic dilatation (0.87±0.02 versus 0.99±0.04 cm; P＜0.05)， and improved LV fractional shortening (31±2 versus 20±4%; P＜0.05)， compared with controls.Conclusions—Early after myocardial infarction， injection of AMS accelerates vascularization， tissue repair， and improves cardiac remodeling and function. Our work suggests a novel clinically relevant option to promote the repair of ischemic tissue.Circulation. 2006;114[suppl I]-94–I-100Impact factor:11.632文题：体外活化的东说念主巨噬细胞促进梗殉难肌的愈合、扼制心室重构和改善左室功能节录：布景：活化的巨噬细胞对伤口愈合和组织诞生起着弥留的作用。本文旨在贪图体外活化的巨噬细胞对促进梗殉难肌愈合和诞生的作用。方法和收尾：在密闭无菌系统里将后生献血者的全血制备成东说念主类活化的巨噬细胞（AMS）悬液，并用一种新的低浸透压休克方法激活巨噬细胞。录取8只大鼠建立急性心肌梗死模子后，立即向缺血心肌注入包含43%的CD14阳性细胞的AMS。对照组（n=9）领受生理盐水打针。组织学、孕育激素PCR和MRI示踪经毫小型颗粒绮丽的三氧化二铁露馅AMS在梗殉难肌存留4-7天。5周后，与对照组比拟，AMS颐养组的瘢痕血管密度、肌纤维母细胞和单核细胞与巨噬细胞的召募均增多（P<0.05），请示AMS促进瘢痕增厚、减少左室彭胀和擢升左室裁减分数（P<0.05）。论断：心肌梗死早期打针AMS可加快血管形成、组织诞生和改善心室重构和功能。本文对促进缺血组织诞生提供了一个新的颐养方法。〔心肌梗死〕Title: Hospital Quality for Acute Myocardial InfarctionCorrelation Among Process Measures and Relationship With Short-term MortalityThe First three authors: Elizabeth H. Bradley， Jeph Herrin，Brian Elbel， MPHCorresponding author and Aderess: Harlan M. Krumholz， Yale University School of Medicine， New Haven，Abstract:Context The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) measure and report quality process measures for acute myocardial infarction (AMI)， but little is known about how these measures are correlated with each other and the degree to which inferences about a hospital’s outcomes can be made from its performance on publicly reported processes.Objective To determine correlations among AMI core process measures and the degree to which they explain the variation in hospital-specific， risk-standardized， 30-day mortality rates.Design， Setting， and Participants We assessed hospital performance in the CMS/ JCAHO AMI core process measures using 2002-2003 data from 962 hospitals participating in the National Registry of Myocardial Infarction (NRMI) and correlated these measures with each other and with hospital-level， risk-standardized， 30-day mortality rates derived from Medicare claims data.Main Outcome Measures Hospital performance on AMI core measures; hospitalspecific， risk-standardized， 30-day mortality rates for AMI patients aged 66 years or older.Results We found moderately strong correlations (correlation coefficients ≥0.40; P values ＜.001) for all pairwise comparisons between β-blocker use at admission and discharge， aspirin use at admission and discharge， and angiotensin-converting enzyme inhibitor use， and weaker， but statistically significant， correlations between these medication measures and smoking cessation counseling and time to reperfusion therapy measures (correlation coefficients ＜0.40; P values ＜.001). Some process measures were significantly correlated with risk-standardized， 30-day mortality rates (P values ＜.001) but together explained only 6.0% of hospital-level variation in riskstandardized， 30-day mortality rates for patients with AMI.Conclusions The publicly reported AMI process measures capture a small proportion of the variation in hospitals’ risk-standardized short-term mortality rates. Multiple measures that reflect a variety of processes and also outcomes， such as riskstandardized mortality rates， are needed to more fully characterize hospital performance.Journal of American Medical Association. 2006;296:72-78 Impact factor:23.332文题：病院质料与急性心肌梗死节录：布景：CMS和JCAHO测量和报说念了急性心肌梗死的质料设施纪律，然则这些纪律之间的相互有计划以及由此推断病院患者结局的准确性还未明确。目的：本文旨在明确AMI设施纪律和其可说明特定病院、法式化风险30天耗损率进程的有计划。想象、成就和参与者：录取2002至2003年参与NRMI的962所病院为贪图对象，评估其医疗行径在CMS/JCAHO AMI设施纪律中的发扬，评估这些纪律相互之间的有计划以及与病院水平、风险法式化30天耗损率之间的有计划。主要收尾测量：病院在AMI纪律中医疗行径发扬；66岁及以上的AMI患者的病院水平、风险法式化30天耗损率。收尾：本文收尾发现患者入院和出院所用β-受体阻碍剂、阿司匹林和血管焦躁素转机酶扼制剂之间存在中等强度的有计划（P<0.001）；这些医疗纪律与戒烟和再灌输时辰之间存在相对较弱但有统计学意思的有计划。一些颐养纪律与风险法式化30天耗损率之间存在统计学意思，然则只是在6.0％上解释了病院水平的各别。论断：已公开发表的AMI设施纪律发现了病院风险法式化短期耗损率的部分变化。为进一步反映病院的医疗行径发扬，还需多重纪律以反映多样医疗行径和结局，如风险法式化耗损率。狼国成人