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世界核心医学期刊文摘（妇产科学分册） 2005年第7期1卷 54-55页

作者： Sheffield J.S. Andrews W.W. Klebanoff M.A. 张丽娟 Department of Obstetrics Univ. Texas Southwestern Med. Ctr. 5323 Harry Hines Boulevard Dallas TX 75390-9032 United States Dr

OBJECTIVE: We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution. METHODS: A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 160/7 and 236/7 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow- up ligase chain reaction was performed between 240/7 and 296/7 weeks. RESULTS: A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79% ) had ligase chain reaction performed both at randomization and follow- up. Women receiving antibiotics effective against Chlamydia between randomization and follow- up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9% ) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44% ) had spontaneous resolution of Chlamydia by the follow- up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow- up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater- than- 5- week follow- up interval remained significant; for every 5- year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow- up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4- 0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow- up also were not associated. CONCLUSION: The prevalence of asymptomatic C trachomatis in pregnancy was 9% ; infection

关键词：沙眼衣原体感染无症状性连接酶链反应队列研究细菌性阴道炎冰冻保存随机治疗阳性诊断随机检测检测提示

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维普期刊数据库

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急性冠状动脉综合征患者辛伐他汀早期强化与晚期保守治疗的比较:A-Z试验的Z阶段

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世界核心医学期刊文摘（心脏病学分册） 2005年第2期1卷 4-5页

作者： De Lemos J.A. Blazing M.A. Wiviott S.D. 任付先 Cardiology Division Univ. Texas Southwestern Med. Ctr. 5 323 Harry Hines Blvd Dallas TX 75390-9047 United States Dr.

Context: Limited data are available evaluating how the timing and intensity of statin therapy following an acute coronary syndrome (ACS) event affect clinical outcome. Objective: To compare early initiation of an intensive statin regimen with delayed initiation of a less intensive regimen in patients with ACS. Design , Setting, and Participants: International, randomized, double blind trial of p atients with ACS receiving 40 mg/d of simvastatin for 1 month followed by 80 mg/ d thereafter (n=2265) compared with ACS patients receiving placebo for 4 months followed by 20 mg/d of simvastatin (n=2232), who were enrolled in phase Z of the A to Z trial between December 29, 1999, and January 6, 2003. Main Outcome Measu re: The primary end point was a composite of cardiovascular death, nonfatal myoc ardial infarction, readmission for ACS, and stroke. Follow up was for at least 6 months and up to 24 months. Results Among the patients in the placebo plus sim vastatin group, the median low density lipoprotein (LDL) cholesterol level achi eved while taking placebo was 122mg/dL (3.16 mmol/L) at 1 month and was 77mg/dL (1.99 mmol/L) at 8 months while taking 20 mg/d of simvastatin. Among the patient s in the simvastatin only group, the median LDL cholesterol level achieved at 1 month while taking 40 mg/d of simvastatin was 68mg/dL (1.76 mmol/L) and was 63 m g/dL (1.63 mmol/L) at 8 months while taking 80 mg/d of simvastatin. A total of 3 43 patients (16.7%) in the placebo plus simvastatin group experienced the prima ry end point compared with 309 (14.4%) in the simvastatin only group (40 mg/80 mg) (hazard ratio [HR], 0.89; 95%confidence interval [Cl] 0.76-1.04; P=.14 ). C ardiovascular death occurred in 109 (5.4%) and 83 (4.1 %) patients in the 2 gr oups (HR, 0.75; 95%Cl, 0.57-1.00; P=.05) but no differences were observed in other individual components of the primary end po int. No difference was evident during the first 4 months between the groups for the primary end point (HR, 1.0

关键词： A-Z试验早期强化致命性心肌梗死他汀类药物双盲试验心血管事件终点事件低密度脂蛋白肌病安慰剂

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维普期刊数据库

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美国城市人口中肝脏脂肪变性的发病率:种族的影响

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世界核心医学期刊文摘（胃肠病学分册） 2005年第5期1卷 33-34页

作者： Browning J.D. Szczepaniak L.S. DobbinsR. H.H. Hobbs 李翔 Department of Molecular Genetics Univ. of TX Southwestern Med. Ctr. 6000 Harry Hines Blvd. Dallas TX 75390-9046 United States Dr.

Despite the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), its pathogenesis and clinical significance remain poorly defined. In this study, we examined and compared the distribution of hepatic triglyceride content (HTGC) in 2,287 subjects from a multiethnic, population-based sample (32.1%white, 48.3%black, and 17.5%Hispanic) using proton magnetic resonance spectroscopy. HTGC varied over a wide range (0.0%-41.7%; median, 3.6%) in the population. Almost one third of the population had hepatic steatosis, and most subjects with hepatic steatosis had normal levels of serum alanine aminotransferase (79%). The frequency of hepatic steatosis varied significantly with ethnicity (45%in Hispanics; 33%in whites; 24%in blacks) and sex (42%in white men; 24%in white women). The higher prevalence of hepatic steatosis in Hispanics was due to the higher prevalence of obesity and insulin resistance in this ethnic group. However, the lower frequency of hepatic steatosis in blacks was not explained by ethnic differences in body mass index, insulin resistance, ethanol ingestion, or medication use. The prevalence of hepatic steatosis was greater in men than women among whites, but not in blacks or Hispanics. The ethnic differences in the frequency of hepatic steatosis in this study mirror those observed previously for NAFLD-related cirrhosis (Hispanics >whites >blacks). In conclusion, the significant ethnic and sex differences in the prevalence of hepatic steatosis documented in this study may have a profound impact on susceptibility to steatosis-related liver disease.

关键词：肝脏脂肪变性城市人口甘油三酯含量酒精摄入量胰岛素抵抗质子磁共振疾病易感性西班牙人差异相光谱法

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维普期刊数据库

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低恶性卵巢肿瘤的手术分期

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世界核心医学期刊文摘（妇产科学分册） 2005年第9期1卷 36-36页

作者： Skinner E. Gehrig P.A. J.O. Schorge 张丽娟 Division of Gynecolo gic Oncology Department of Obstetrics Univ. Texas Southwestern Med. Ctr. 5323 Harry Hines Boulevard Dallas TX United States Dr.

OBJECTIVE: Women diagnosed with ovarian tumors of low malignant potential ha ve an excellent prognosis. Because few will receive adjuvant therapy, the benefit of surgical staging has recently been challenged. The purpose of this study was to compare the outcome of surgically staged patients with low malignant potentia l tumors with those who were not staged. METHODS: Between 1984 and 2003, all wom en with ovarian low malignant potential tumors were identified at 3 institutions . Data were extracted from clinical records. RESULTS: One hundred eighty-three (74%) of 248 women were surgically staged. Forty of 183 staged patients had cli nically obvious extraovarian disease. Forty (28%) of the remaining 143 women wi th disease apparently confined to the ovary were upstaged. Cytologic washings we re positive in 28 cases, 10 had microscopic implants detected by peritoneal or o mental biopsy, and 2 were upstaged to stage IIIC solely on the basis of nodal me tastases. One hundred eighteen women underwent pelvic node dissection (median: 5 nodes), and 86 underwent paraaortic node dissection (median: 2 nodes). Overall, 9 (1%) metastases were detected in 832 submitted pelvic nodes. All 314 paraaor tic nodes were negative. Intraoperative blood loss (P ut gross disease who were surg ically staged. Eight (3%) of 248 patients received adjuvant platinum-based che motherapy, but neither of the women upstaged to IIIC based on the results of the ir nodal dissection were treated. Fifteen (6%) recurrences developed and 1 (0.4 %) death occurred after a median follow-up of 28 (range, 1-208) months. CONCL USION: Routine pelvic and paraaortic lymph node dissection is not necessary in t he majority of women with ovarian low malignant potential rumors.

关键词：恶性卵巢肿瘤手术分期盆腔淋巴结清扫临床病历辅助化疗淋巴结转移术中失血量医疗机构中有

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维普期刊数据库

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7例甲单元原位黑色素瘤的临床表现、组织病理和临床预后

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世界核心医学期刊文摘（皮肤病学分册） 2005年第2期1卷 4-4页

作者： High W.A. Quirey R.A. Guillén D.R R.S. Taylor 刘超 Department of Dermatology Cutaneous Oncology Division Univ. Texas Southwestern Med. Ctr. 5323 Harry Hines Blvd Dallas TX 75390-9192 United States Dr.

Objective: To report on the presentation, histopathologic findings, and clinical outcomes for a case series of MIS of the nail apparatus because melanoma in situ (MIS) of the nail unit has not been well characterized in the literature. Setting: A division of a tertiary academic center specializing in micrographic excision of cutaneous neoplasms. Design: Surgical records were searched for cases of MIS of the nail unit for the period of January 1, 1997, to December 31, 2002. The patient demographics and disease presentation, treatment, and clinical course were reviewed. Results: Seven cases of MIS of the nail unit in white patients were identified. Longitudinal melanonychia was present in all cases, but dyspigmentation of the proximal nail fold and onychodystrophy were uncommon. Histopathologic analysis revealed poorly circumscribed proliferations of single cells over nests with variable pagetoid spread. Atypia was variable. Mitotic activity was low. All cases were treated with micrographic surgery. Amputation was avoided in 3 cases and was limited to partial distal interphalangeal amputation in the remainder. Six cases did not recur locally after initial surgical intervention. With an average of 24 months of follow-up, all patients were free of disease. Conclusions: Longitudinal melanonychia in a white patient mandates consideration of MIS of the nail unit. Given the nondescript clinical presentation, the threshold for biopsy should be low. The histopathologic findings appear similar to those of MIS in other areas, with asymmetry and poor circumscription predominating. With additional study and further acceptance, micrographically controlled excision has the potential to minimize morbidity. Further investigation is warranted.

关键词：黑色素瘤皮肤肿瘤色素沉着异常甲营养不良核分裂手术记录复发率截肢手术黑甲病理发现

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维普期刊数据库

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