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口服抗凝与抗血小板治疗对外周动脉疾病的影响

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世界核心医学期刊文摘（心脏病学分册） 2007年第11期3卷 10-11页

作者： Anand s. Yusuf s. 吴超能 Hamilton General Hospital Hamilton Health Sciences 237 Barton St. East Hamilton Ont. L8L 2X2 Canada Dr.

背景:粥样硬化性外周动脉疾病(PAD)与心肌梗死(MI)、卒中、心血管性死亡的风险增加有关。抗血小板药物能降低上述风险,但口服抗凝药物用于预防PAD患者心血管并发症的疗效仍不清楚。

关键词：外周动脉抗凝药物心血管并发症并发病抗血小板药物疾病

Fondaparinux对急性sT段抬高型心肌梗死患者死亡率和再梗死的影响:OAsIs-6随机试验

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世界核心医学期刊文摘（心脏病学分册） 2006年第9期2卷 3-4页

作者： Yusuf s. 任付先 McMaster University McMaster ClinicHamilton General Hospital237 Barton St EHamiltonOnt.L8L 2X2CanadaDr

Context: Despite many therapeutic advances, mortality in patients with acute s T-segment elevation myocardial infarction(sTEMI) remains high. The role of addi tional antithrombotic agents is unclear, especially among patients not receiving reperfusion therapy. Objective: To evaluate the effect of fondaparinux, a facto r Xa inhibitor, when initiated early and given for up to 8 days vs usual care(pl acebo in those in whom unfractionated heparin[UFH] is not indicated[stratum 1] o r unfractionated heparin for up to 48 hours followed by placebo for up to 8 days [stratum 2]) in patients with sTEMI. Design, setting, and Participants: Randomiz ed double-blind comparison of fondaparinux 2.5 mg once daily or control for up to 8 days in 12 092 patients with sTEMI from 447 hospitals in 41 countries(septe mber 2003-January 2006). From day 3 through day 9, all patients received either fondaparinux or placebo according to the original randomized assignment. Main O utcome Measures: Composite of death or reinfarction at 30 days(primary) with sec ondary assessments at 9 days and at final follow-up(3 or 6 months). Results: Death or reinfarction at 30 days was significantly reduced from 677(11.2%) of 6056 patients in the control group to 585(9.7%) of 6036 patients in the fondaparin ux group(hazard ratio[HR], 0.86; 95%confidence interval[CI], 0.77-0.96; P=.008 ); absolute risk reduction, 1.5%; 95%CI, 0.4%-2.6%). These benefits were ob served at 9 days(537[8.9%] placebo vs 444[7.4%] fondaparinux; HR, 0.83; 95%CI , 0.73-0.94; P=.003), and at study end(857[14.8%] placebo vs 756[13.4%] fonda parinux; HR, 0.88; 95%CI, 0.79-0.97; P=.008). Mortality was significantly redu ced throughout the study. There was no heterogeneity of the effects of fondapari nux in the 2 strata by planned heparin use. However, there was no benefit in tho se undergoing primary percutaneous coronary intervention. In other patients in s tratum 2, fondaparinux was superior to unfractionated heparin in preventing deat h o

关键词： Fondaparinux 心肌梗死患者 sT段抬高型 fondaparinux 死亡率再梗死随机试验直接经皮冠状动脉介入治疗

比较胺碘酮加β受体阻断剂、单用索他洛尔与单用β受体阻断剂预防埋藏式复律除颤器电击的随机试验:OPTIC研究

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世界核心医学期刊文摘（心脏病学分册） 2006年第5期2卷 11-12页

作者： Connolly s.J Dorian P Roberts R.s. 黄浙勇 Department of Medicine McMaster University 237 Barton St E Hamilton Ont. L8L 2X2 CanadaDr.

Context: Implantable cardioverter defibrillator(ICD) therapy is effective but is associated with high-voltage shocks that are painful. Objective: To determine whether amiodarone plus β -blocker or sotalol are better than β -blocker alone for prevention of ICD shocks. Design, setting, and Patients: A randomized controlled trial with blinded adjudication of events of 412 patients from 39 outpatient ICD clinical centers located in Canada, Germany, United states, England, sweden, and Austria, conducted from January 13, 2001, to september 28, 2004. Patients were eligible if they had received an ICD within 21 days for inducible or spontaneously occurring ventricular tachycardia or fibrillation. Intervention: Patients were randomized to treatment for 1 year with amiodarone plus β -blocker, sotalol alone, or β -blocker alone. Main Outcome Measure: Primary outcome was ICD shock for any reason. Results: shocks occurred in 41 patients(38.5% ) assigned to β -blocker alone, 26(24.3% ) assigned to sotalol, and 12(10.3% ) assigned to amiodarone plus β -blocker. A reduction in the risk of shock was observed with use of either amiodarone plus β -blocker or sotalol vs β -blocker alone(hazard ratio[HR], 0.44; 95% confidence interval[CI], 0.28- 0.68; Ps β -blocker significantly reduced the risk of shock compared with β -blocker alone(HR, 0.27; 95% CI, 0.14- 0.52; Psotalol(HR, 0.43; 95% CI, 0.22- 0.85; P=.02). There was a trend for sotalol to reduce shocks compared with β -blocker alone(HR, 0.61; 95% CI, 0.37- 1.01; P=.055). The rates of study drug discontinuation at 1 year were 18.2% for amiodarone, 23.5% for sotalol, and 5.3% for β -blocker alone. Adverse pulmonary and thyroid events and symptomatic bradycardia were more common among patients randomized to amiodarone. Conclusions: Despite use of advanced ICD technology and treatment with a β -blocker, shocks occur commonly in the first year after ICD implant. Amiodarone plus β -blocker is effective f

关键词： β受体阻断剂复律除颤器索他洛尔胺碘酮埋藏式单用电击随机试验预防门诊患者

低分子量肝素——瑞肝素——对急性心肌梗死伴sT段抬高患者的死亡率、再梗死和脑卒中的作用

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世界核心医学期刊文摘（心脏病学分册） 2005年第6期1卷 22-23页

作者： Yusuf s. 张迎捷 Population Health Research Institute Hamilton General Hospital McMaster University 237 Barton St E Hamilton Ont. L8L 2X2 Canada

Context: Although reperfusion therapy, aspirin, β-blockers, and angiotensin-converting enzyme inhibitors reduce mortality when used early in patients with acute myocardial infarction(MI), mortality and morbidity remain high. No antithrombotic or newer antiplatelet drug has been shown to reduce mortality in acute MI. Objective: To evaluate the effects of reviparin, a low-molecular-weight heparin, when initiated early and given for 7 days in addition to usual therapy on the primary composite outcome of death,myocardial reinfarction, or strokes at 7 and 30 days. Design, setting, and Patients: A randomized, doubleblind, placebo-controlled trial(Clinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation [CREATE]) of 15570 patients with sT-segment elevation or new left bundle-branch block, presenting within 12 hours of symptom onset at 341 hospitals in India and China from July 2001 through July 2004. Intervention: Reviparin or placebo subcutaneously twice daily for 7 days. Main Outcome Measure: Primary composite outcome of death, myocardial reinfarction, or stroke at 7 and 30 days. Results: The primary composite outcome was significantly reduced from 854(11.0%) of 7790 patients in the placebo group to 745(9.6%) of 7780 in the reviparin group(hazard ratio [HR], 0.87; 95%CI, 0.79-0.96; P=.005). These benefits persisted at 30 days(1056 [13.6%] vs 921 [11.8%] patients; HR, 0.87; 95%CI, 0.79-0.95; P=.001) with significant reductions in 30-day mortality(877 [11.3%] vs 766 [9.8%]; HR, 0.87; 95%CI, 0.79-0.96; P=.005) and reinfarction(199 [2.6%] vs 154 [2.0%]; HR, 0.77; 95%CI, 0.62-0.95; P=.01), and no significant differences in strokes(64 [0.8%] vs 80 [1.0%]; P=.19). Reviparin treatment was significantly better when it was initiated very early after symptom onset at 7 days(s: HR, 0.70; 95%CI, 0.52-0.96; P=.03; 30/1000 events prevented; 2 tos: HR, 0.81; 95%CI, 0.67-0.98; P=.03; 21/1000 events prevented; 4 tos:

关键词：再梗死低分子量肝素急性心肌梗死 sT段抬高再灌注治疗左束支传导阻滞卒中发生率 β受体阻断剂安慰剂对照代谢调节

南亚人与其他国家个体相比早发心肌梗死的危险因素

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世界核心医学期刊文摘（心脏病学分册） 2007年第7期3卷 6-7页

作者： Joshi P. Islam s. Pais P. s. Yusuf 黄浙勇 Population Health Research Institute McMaster Clinic Hamilton General Hospital 237 Barton St E Hamilton Ont. L8L 2X2 Canada Dr.

背景：南亚人中年轻时急性心肌梗死（AMI）的发生率高于其他国家个体，但原因不明。目的：评价并比较南亚本地人和来自其他国家的个体中危险因素与AMI的关系，尤其关注较年轻AMI。设计、地点和参与者：此标准化病例对照研究于1999年2月... 详细信息

背景：南亚人中年轻时急性心肌梗死（AMI）的发生率高于其他国家个体，但原因不明。目的：评价并比较南亚本地人和来自其他国家的个体中危险因素与AMI的关系，尤其关注较年轻AMI。设计、地点和参与者：此标准化病例对照研究于1999年2月至2003年3月间纳入研究对象，包括来自5个南亚国家15所医学中心的1732例首发AMI患者和2204例年龄、性别匹配的对照者，以及来自其他国家的10728例患者和12431例对照者。主要观察指标：AMI与危险因素的关系。结果：南亚首发AMI患者的平均年龄低于其他国家（53．0±11．4岁 vs 58．8±12．2岁；P〈0．001）。

关键词：急性心肌梗死危险因素南亚人个体 AMI患者病例对照研究平均年龄原因不明

极化液输注对急性sT段抬高心肌梗死患者死亡率的影响:CREATE-ECLA随机对照试验

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世界核心医学期刊文摘（心脏病学分册） 2005年第6期1卷 23-24页

作者： Mehta s.R. 张迎捷 Dr.McMaster Univ.Hamilton Hlth. sci. 237 Barton St E HamiltonOnt.L8L 2X2 Canada

Context: Glucose-insulin-potassium(GIK) infusion is a widely applicable, low-cost therapy that has been postulated to improve mortality in patients with acute sT segment elevation myocardial infarction(sTEMI). Given the potential global importance of GIK infusion, a large, adequately powered randomized trial is required to determine the effect of GIK on mortality in patients with sTEMI. Objective: To determine the effect of high-dose GIK infusion on mortality in patients with sTEMI. Design, setting, and Participants: Randomized controlled trial conducted in 470 centers worldwide among 20201 patients with sTEMI who presented within 12 hours of symptom onset. The mean age of patients was 58.6 years, and evidence based therapies were commonly used. Intervention: Patients were randomly assigned to receive GIK intravenous infusion for 24 hours plus usual care(n=10091) or to receive usual care alone(controls; n=10110). Main Outcome Measures: Mortality, cardiac arrest, cardiogenic shock, and reinfarction at 30 days after randomization. Results: At 30 days, 976 control patients(9.7%) and 1004 GIK infusion patients(10.0%) died(hazard ratio [HR], 1.03; 95%confidence interval [CI], 0.95-1.13; P=.45)-. There were no significant differences in the rates of cardiac arrest(1.5%[151/10107] in control and 1.4%[139/10088] in GIK infusion; HR, 0.93; 95%CI, 0.74-1.17; P=.51), cardiogenic shock(6.3%[640/10107] vs 6.6%[667/10088]; HR, 1.05; 95%CI, 0.94-1.17; P=.38), or reinfarction(2.4%[246/10107] vs 2.3%[236/10088]-; HR, 0.98; 95%CI, 0.82-1.17; P=.81). The rates of heart failure at 7 days after randomization were also similar between the groups(16.9%[1711/10107] vs 17.1%[1721/ 10088]; HR, 1.01; 95%CI, 0,95-1.08; P=.72). The lack of benefit of GIK infusion on mortality was consistent in prespecified subgroups, including in those with and without diabetes, in those presenting with and without heart failure, in those presenting early and later after symptom onset, and in those receiving an

关键词： CREATE-ECLA 极化液随机对照试验心源性休克再梗死再灌注治疗随机试验心脏停搏静脉内输注循证治疗

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现代毫米波雷达系统

航天电子对抗 1992年第4期 55-60页

作者： s. L. Johnston 殷善贤

1 引言 barton在1975年国际雷达会议(RADAR—75)上出色地评论了美国雷达技术,并提出了10 GHz的截止频率。在那时已有不少Ku、K和Ka波段的雷达满足“barton准则”。与常用微波雷达相比,尽管它们的数量不多,但那时就已有一些应用在军事

关键词：毫米波雷达微波雷达雷达波段毫米波辐射计

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***和当代有机化学

有机化学 1986年第1期 69-78页

作者： Desmond M.s.Wheeler 杨雪梅

Woodward 1917年生于美国波士顿,1933年16岁时进入麻省理工学院,1937年获得博士学位。以后,他在伊利诺斯大学的暑期讲习班任教一年,后作为Kohler的同工作者回到波士顿,在哈佛大学渡过一生,并一直工作到生命的最后一刻。1938年他已是哈... 详细信息

Woodward 1917年生于美国波士顿,1933年16岁时进入麻省理工学院,1937年获得博士学位。以后,他在伊利诺斯大学的暑期讲习班任教一年,后作为Kohler的同工作者回到波士顿,在哈佛大学渡过一生,并一直工作到生命的最后一刻。1938年他已是哈佛大学研究会的初级研究员,这个身份的职责仅是每星期与其他会员共同进餐一次。1941年提升为讲师,1950年成为教授,1953年被任命为Morris-Loeb衔称的化学教授。1960年为Donner衔称的科学教授。1979年7月在他去世后,人们对他的工作给了极高的评价。在barton,Wasserman以及其他知名的有机化学家的悼

关键词：有机化学 OCH R.B.Woodward 有机化学家

血管疾病患者应用叶酸及B族维生素降低同型半胱氨酸水平治疗

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世界核心医学期刊文摘（心脏病学分册） 2006年第7期2卷 5-6页

作者： Lonn E. Yusuf s. Arnold M.J. 罗亮 Population Health Research Institute Hamilton General Hospital 237 Barton St. East Hamilton Ont. L8L 2X2 Canada Dr.

BACKGROUND: In observational studies, lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B6 and B12 lower homocysteine levels. We assessed whether supplementation reduced the risk of major cardiovascular events in patients with vascular disease. METHODs: We randomly assigned 5522 patients 55 years of age or older who had vascular disease or diabetes to daily treatment either with the combination of 2.5 mg of folic acid, 50 mg of vitamin B6, and 1 mg of vitamin B12 or with placebo for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. REsULTs: Mean plasma homocysteine levels decreased by 2.4 μmol per liter(0.3 mg per liter) in the active-treatment group and increased by 0.8 μmol per liter(0.1 mg per liter) in the placebo group. Primary outcome events occurred in 519 patients(18.8 percent) assigned to active therapy and 547(19.8 percent) assigned to placebo(relative risk, 0.95; 95 percent confidence interval, 0.84 to 1.07; P=0.41). As compared with placebo, active treatment did not significantly decrease the risk of death from cardiovascular causes(relative risk, 0.96; 95 percent confidence interval, 0.81 to 1.13), myocardial infarction(relative risk, 0.98; 95 percent confidence interval, 0.85 to 1.14), or any of the secondary outcomes. Fewer patients assigned to active treatment than to placebo had a stroke(relative risk, 0.75; 95 percent confidence interval, 0.59 to 0.97). More patients in the active-treatment group were hospitalized for unstable angina(relative risk, 1.24; 95 percent confidence interval, 1.04 to 1.49). CONCLUsIONs: supplements combining folic acid and vitamins B6 and B12 did not reduce the risk of major cardiovascular events in patients with vascular disease.

关键词：血管疾病患者 B族维生素心血管事件观察性研究不稳定型心绞痛次要终点安慰剂终点事件随机分