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紫绀型先天性心脏病成人患者的血液黏度及其与铁缺乏症、症状和运动耐量的关系

世界核心医学期刊文摘（心脏病学分册） 2006年第12期2卷 52-页

作者： Broberg C.S. Bax B.E. Okonko D.O. 黄浙勇 Adult Congenital heart Centre Royal Brompton Hospital and National Heart Lung Institute London England United Kingdom Dr.

Objectives: This study sought to determine the relationship between blood viscosity and iron deficiency and their impact on symptoms and exercise function in adults with cyanotic congenital heart disease. Background: Iron deficiency is believed to raise whole blood viscosity in cyanotic congenital heart disease, although available data are inconsistent. Methods: Thirty-nine cyanotic adults were prospectively assessed for iron deficiency(transferrin saturation ≤5%), hyperviscosity symptoms, and exercise capacity. Same-day measurement of whole blood viscosity and hematocrit(Hct) adjusted viscosity(cells resuspended in autologous plasma to Hct of 45%) was performed at shear rates ranging from 0.277 s-1 to 128.5 s-1. Results: Viscosity did not differ between patients with iron deficiency(n=14) and those without(n=25). Whole blood viscosity correlated with Hct(r=0.63, p< 0.001 at low shear and r=0.84, p< 0.001 at high shear) but not with red blood cell size or iron indices. Hyperviscosity symptoms were independent of iron indices but directly correlated with increased Hct-adjusted viscosity(r=0.41, p=0.01). Exercise capacity did not differ in iron-deficient patients. However, peak oxygen consumption was higher in those with Hct ≥65%(12.6±3.4 ml/kg/m2 vs. 9.8±2.6 ml/kg/m2,mean±SD, p=0.036) despite higher whole blood viscosity in these same individuals(p< 0.01 for all shear rates). Conclusions: Iron deficiency is common in cyanotic adults but does not alter viscosity. Hyperviscosity symptoms are associated with a higher Hct-adjusted viscosity independent of cell size or iron stores. Higher Hct is associated with better exercise capacity. Further work to understand the origin of hyperviscosity symptoms is warranted.

关键词：运动耐量铁缺乏症血液黏度成人患者紫绀型先天性心脏病心脏先天畸形

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艾森门格综合征患者肺动脉血栓形成与左右心室功能不全和肺动脉血流速度减慢有关

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世界核心医学期刊文摘（心脏病学分册） 2007年第12期3卷 54-页

作者： Broberg C.S. Ujita M. Prasad S. 黄欣 Adult Congenital heart Disease Centre Royal Brompton Hospital National Heart Lung Institute London England United Kingdom.Dr

目的:确定哪些因素与艾森门格综合征患者肺动脉血栓形成有关。背景:肺动脉血栓形成在艾森门格综合征患者中很常见,对其潜在的病理生理机制还知之甚少。方法:对成年艾森门格综合征患者进行CT肺动脉造影、心脏磁共振成像以及超声心动图检... 详细信息

目的:确定哪些因素与艾森门格综合征患者肺动脉血栓形成有关。背景:肺动脉血栓形成在艾森门格综合征患者中很常见,对其潜在的病理生理机制还知之甚少。方法:对成年艾森门格综合征患者进行CT肺动脉造影、心脏磁共振成像以及超声心动图检查,以测定心室功能、肺动脉大小和肺动脉血流速度。此外还进行高凝状态的筛查和血小板功能测定。

关键词：肺动脉艾森门格综合征血流速度血栓形成血栓栓塞右心室功能不全患者

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为地区综合医院中的先天性心脏病成人患者建立联合门诊是一种可选的治疗模式

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世界核心医学期刊文摘（心脏病学分册） 2006年第1期2卷 56-56页

作者： Shirodaria C. C. Gwilt D. J. Gatzoulis M. A. 张宪伟 Adult Congenital heart Program Royal Brompton Hospital Imperial College Sydney Street SW3 6NP LondonUnited Kingdom

Congenital heart disease(CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertiary care expertise and facilities for this growing cardiovascular field in the UK and around the world. We aimed to report our experience with a joint adult CHD clinic run in a district general hospital with regular input from the local cardiology team and a visiting adult CHD specialist. In total, 148 patients aged 33.6+/-14.1 years were seen once or more in 12 clinics over the study period(September 1999 to January 2003). Diagnostic case mix consisted of 2.9%complex, 67.9%moderate and 29.2%minor cases of CHD. Twenty percent of patients visited the counterpart tertiary center for additional investigations(mostly MRI) and 8%for intervention(with no operative mortality). There was one death during the study period giving an overall mortality of 0.2%/year. Patients were referred to the clinic from tertiary centres, the local cardiology and paediatric clinics and with time from obstetric and community sources. Nonattendance rates were relatively low, comparing favourably with tertiary care. This model of joint care for the adult CHD patient at a general district hospital with regular onsite specialized input appears to be effective and highlights the need for additional resource allocation to provide optimal care for these patients. Our data may be useful in future planning for CHD services.

关键词：先天性心脏病成人患者门诊接诊治疗模式综合医院联合三级医疗中心专科医生 CHD 心血管病

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Fonton术后的预防性抗凝措施

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世界核心医学期刊文摘（心脏病学分册） 2005年第12期1卷 46-46页

作者： Walker H. A. Gatzoulis M. A. 滕增辉 Adult Congenital heart Programme Department of CardiologyRoyal Brompton Hospital Sydney Street London SW3 6NP United Kingdom

Is it possible to advise either for or against prophylactic anticoagulation in patients following Fontan surgery? Certainly, the evidence suggests that thromboembolism is a major risk factor and it may therefore be considered reasonable to anticoagulate all patients. However, key information is missing regarding the safety and benefit from aspirin and warfarin treatment, as well as target international normalised ratio(INR) levels and timing of therapy. Consequently, if we are to subscribe to an evidence based approach, a blanket recommendation cannot be given. Nevertheless, if a high risk group is to be identified, patients with progressive right atrial dilatation and/or a history of atrial arrhythmia would appear, albeit anecdotally, to present the strongest case for prophylactic anticoagulation. Clearly, prospective controlled studies are required before definitive recommendations can be made.

关键词：房性心律失常目标水平术后抗凝治疗国际标准化比值循证治疗 Fonton 血栓栓塞

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Jarvik 2000轴流左心室辅助装置的中期经验

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世界核心医学期刊文摘（心脏病学分册） 2007年第10期3卷 57-页

作者： Haj-Yahia S. Birks E.J. Rogers P. 韩瑞娟 Cardiothoracic Transplantation and Mechanical Circulatory Support Royal Brompton and Harefield HospitalLondonUnited Kingdom Dr.

目的:旋转的轴流泵与搏动泵相比有一些潜在的优缺点。Jarvik2000的独特之处在于其置入心内。本文报道关于22例患者的经验。

关键词： Jarvik 2000 传动轴

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欧洲稳定型心绞痛的初期治疗:欧洲心脏调查的稳定型心绞痛项目中,就诊于心脏病学专家的第1个月内开始的药物治疗和血运重建策略

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世界核心医学期刊文摘（心脏病学分册） 2005年第10期1卷 46-46页

作者： Daly C. A. Clemens F. Lopez Sendon J. L. 郭战宏 royal brompton hospital Sydney Street London SW3 6NP United Kingdom

In order to assess adherence to guidelines and international variability in management, the Euro heart Survey of Newly Presenting Angina prospectively studied medical therapy, percutaneous coronary intervention(PCI), and surgery in patients with new-onset stable angina in Europe. Methods and results: Consecutive patients, 3779 in total, with a clinical diagnosis of stable angina by a cardiologist were enrolled. After initial assessment by a cardiologist, 78% were treated with aspirin, 48% with a statin, and 67% with a beta-blocker. ACE inhibitors were prescribed by the cardiologist in 37% overall. Revascularization rates were low, with only 501(13% ) patients having PCI or coronary bypass surgery performed or planned. However, when restricted to patients with coronary disease documented within 4 weeks of assessment, over 50% had revascularization performed or planned. Among other factors, the national rate of angiography and availability of invasive facilities significantly predicted the likelihood of revascularization, OR 2.4 and 2.0, respectively. Conclusion: This survey shows a shortfall between guidelines and practice with regard to the use of evidence- based drug therapy and evidence that revascularization rates are strongly influenced by non-clinical, in addition to clinical, factors.

关键词：稳定型心绞痛血运重建药物治疗欧洲心脏心脏病学初期治疗阿司匹林治疗他汀类药物介入治疗定距离

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艾森门格综合征的临床表现、生存前景和死亡预测因素:一项联合的回顾性病例对照研究

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世界核心医学期刊文摘（心脏病学分册） 2006年第12期2卷 37-页

作者： Diller G.-P. Dimopoulos K. Broberg C.S. M.A. Gatzoulis 刘少伟 Adult Congenital heart Centre Centre for Pulmonary Hypertension Royal Brompton Hospital Sydney Street London SW3 6NP United Kingdom

Aims: To characterize contemporary Eisenmenger patients at a large centre for adult congenital heart disease, assess survival prospects, and identify predictors of death in this population. Methods and results: All Eisenmenger patients under follow-up at our centre since 2000(n=171, mean age 37±12 years) were included. To identify predictors of mortality, a case-control study was performed. Data including symptoms, functional class, medication, laboratory, and electrocardiographic and echocardiographic parameters are presented. Iron deficiency was common and strongly related to phlebotomy(relative risk 4.1, Pheart failure, history of clinical arrhythmia, QRS duration and QTc interval, and low serum albumin and potassium levels. Conclusion: Despite good short-term prognosis, life expectancy is markedly reduced in Eisenmenger patients. Markers of heart failure and parameters associated with arrhythmia are of prognostic value in terms of mortality and may guide clinicians caring for Eisenmenger patients.

关键词：艾森门格综合征患者预测因素病例对照生存

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右心房血管肉瘤在诊断上的尴尬

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世界核心医学期刊文摘（心脏病学分册） 2007年第4期3卷 30-30页

作者： Keenan N. Davies S. Sheppard M.N. 郭俊 Department of Cardiology Royal Brompton HospitalSydney StreetLondonSW3 6NPUnited Kingdom

心脏血管肉瘤罕见但常致死。本文中描述1例患者,其心血管MRI对作出诊断至关重要。

关键词：血管肉瘤右心房组织学检查

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N末端脑利钠肽(NT-proBNP)对硬皮病相关性肺动脉高压的作用

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世界核心医学期刊文摘（心脏病学分册） 2006年第12期2卷 30-页

作者： Williams M.H. Handler C.E. Akram R. J.G. Coghlan 郭俊 Department of Cardiology Royal Free Hospital Pond Street London NW3 2QG United Kingdom

Aims: The aims of this study were to evaluate the diagnostic value and to explore the prognostic value of N-terminal brain natriuretic peptide(N-TproBNP) in patients with systemic sclerosis(SSc) both with and without pulmonary arterial hypertension(PAH). Methods and results: N-TproBNP, six minute walk distance(SMWD), haemodynamics(at right heart catheterization) or tricuspid gradient(by echocardiography), and survival were assessed in 109 patients with SSc. The study population included 68 individuals with PAH[mean pulmonary artery pressure(PAP) >25 mmHg and pulmonary capillary wedge pressure< 15 mmHg] and 41 individuals without PAH. In patients with PAH, the prognostic value of baseline and change in WHO functional class, N-TproBNP levels, and SMWD were compared using Kaplan-Meier survival curves and Cox proportional hazard analysis. The mean duration of follow-up was 10 months(range 1-18 months). One year survival in patients with normal PAP was 100%when compared with 83.5%in those with SSc-PAH(P< 0.05). The patients without PAH had a mean N-TproBNP level of 139 pg/mL(SD 151); those with SSc-PAH had a significantly higher mean NTproBNP level of 1474 pg/mL(SD 2642)(P=0.0002). Among patients with PAH for every order of magnitude increase in N-TproBNP level there was a four-fold increased risk of death(P=0.002 for baseline level and P=0.006 for follow-up level). Baseline N-TproBNP levels were correlated positively with mean PAP(r=0.62; P< 0.0001), pulmonary vascular resistance(PVR)(r=0.81; P< 0.0001), and inversely with SMWD(r=-0.46; P< 0.0001). Among patients with SSc-PAH, 13 patients(19%) were in WHO functional classes Ⅱ and had mean NTproBNP levels of 325 pg/mL(SD 388). Fifty-three patients(78%) were in WHO classes Ⅲ and IV and had significantly higher mean N-TproBNP levels of 1677 pg/mL(SD 2835)-(P=0.02). At an N-TproBNP level of 395 pg/mL, the sensitivity and specificity for predicting the presence of SSc-PAH were 56 and 95%respectively. Conclusion: Raised N-Tpr

关键词：脑利钠肽患者肺动脉 NT-proBNP

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Lenvatinib plus Pembrolizumab for Advanced Endometrial Cancer

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四川生理科学杂志 2021年第11期43卷 1924-1924页

作者： Vicky Makker From the Department of Medicine Memorial Sloan Kettering Cancer Center Weill Cornell Medical Center New York (V.M.) the European Institute of Oncology IRCCS University of Milan–Bicocca Milan (N.C.) Istituto Nazionale Tumori IRCCS–Fondazione G. Pascale Naples (S.P.) and Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Catholic University of the Sacred Heart Rome (D.L.) — all in Italy San Carlos University Teaching hospital (A.C.H.) and hospital Universitario Ramón y Cajal (E.M.G.) — both in Madrid Yale University School of Medicine New Haven CT (A.D. Santin) Gustave Roussy Cancerology Institute Groupe d’Investigateurs Nationaux pour l’Étude des Cancers Ovariens (GINECO) Villejuif (E.C.) and Centre Léon-Bérard University Claude Bernard GINECO Lyon (I.R.-C.) — both in France the University of Texas Southwestern Medical Center Dallas (D.S.M.) Saitama Medical University International Medical Center Hidaka (K.F.) Kurume University School of Medicine Kurume (K.U.) Aichi Cancer Center Hospital Nagoya (J.S.) and National Cancer Center Hospital–Kokuritsu Gan Kenkyu Center Chuo Byoin Tokyo (K.Y.) — all in Japan royal North Shore hospital St. Leonards NSW Australia (S.B.-H.) Sheba Medical Center Ramat Gan Israel (R.S.-F.) Asan Medical Center University of Ulsan Seoul South Korea (Y.-M.K.) Ege University Izmir Turkey (U.A.S.) University College london hospitals NHS Foundation Trust London (M.M.M.) and Eisai Hatfield (A.D. Smith) — both in the United Kingdom and Merck Kenilworth (S.K. S.B. R.J.O.) and Eisai Woodcliff Lake (L.D.) — both in New Jersey.Dr. Makker can be contacted at or at the Memorial Sloan Kettering Cancer Center 300 E. 66th St. New York NY 10065. A list of the Study 309–KEYNOTE-775 investigators is provided in the Supplementary Appendix available at ***.

Background:Standard therapy for advanced endometrial cancer after failure of platinum-based chemotherapy remains ***:In this phase 3 trial,we randomly assigned,in a 1:1 ratio,patients with advanced endometrial cancer who had previously received at least one platinum-based chemotherapy regimen to receive either lenvatinib(20 mg,administered orally once daily)plus pembrolizumab(200 mg,administered intravenously every 3 weeks)or chemotherapy of the treating physician's choice(doxorubicin at 60 mg per square meter of body-surface area,administered intravenously every 3 weeks,or paclitaxel at 80 mg per square meter,administered intravenously weekly[with a cycle of 3 weeks on and 1 week off]).

关键词： chemotherapy intravenous cancer

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