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比较延期和立即支架植入术预防急性ST段抬高型心肌梗死无或低复流（DEFER-STEMI）的效果：一项随机试验 英文原标题： A Randomized Trial of Deferred Stenting versus Immediate Stenting to Prevent No-or Slow Reflow in Acute ST-Elevation Myocardial Infarction (DEFER-STEMI). 作者：David Carrick ,Keith G Oldroyd ,Margaret McEntegart ,Caroline Haig ,Mark C Petrie ,Hany Eteiba 期刊名称：J Am Coll Cardiol(JACC) 发表时间：2014-02-21 索引：J. Am. Coll. Cardiol..2014 Feb 21; 中文摘要来源：张旭翻译 董润审核 查看原始网页 中文摘要 目的：评估延期支架植入术是否降低ST段抬高型心肌梗死（STEMI）经皮冠脉介入治疗的无复流率和心肌存活率。
背景：无复流与STEMI的不良结局相关。
方法：这项单中心前瞻性随机对照试验在心肌再灌注后研究了具有1个以上无复流危险因素的STEMI患者。研究对象随机分为两组，一组在4-16小时后植入支架，另一组立即植入支架。主要结果为无复流/低复流（TIMI ≤ 2）的发生率。研究对象在心肌梗死后2日及6月接受心脏核磁检查。心肌存活率是梗死区的大小占初始危险区域的比例。
结果：411例STEMI患者中（2012年3月11日至2012年11月）的101例（平均年龄60岁，69%为男性）进入了随机分组（延期支架植入组n=52，立即支架植入组n=49）。前者的延迟时间中位数（IQR）为9（6，12）小时。延期支架植入组的无/低复流率 [14（29%）对3（6%）；p=0.006]、低复流率 [7（14%）对1（2%）；p=0.052]及术中血栓事件的发生率 [16（33%）对5（10%）；p=0.010]均较低。延期支架植入组PCI结束时的TIMI冠脉血流分级更高（p=0.018）。延期支架植入组有2名患者在植入支架前复发STEMI。延期支架植入组6月后的心肌存活率较高[68（54，82%）对56（31，72%）p=0.031]。
结论：对于高危STEMI患者，PCI后延期植入支架可降低无复流率，增加心肌存活率。 英文摘要 OBJECTIVES
To assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
目的：评估延期支架植入术是否降低ST段抬高型心肌梗死（STEMI）经皮冠脉介入治疗的无复流率和心肌存活率。
BACKGROUND
No-reflow is associated with adverse outcomes in STEMI.
METHODS
A prospective single center randomized controlled proof-of-concept trial in reperfused STEMI patients with ≥ 1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4-16 hours later or conventional treatment with immediate stenting. The primary outcome was the incidence of no/slow-reflow (TIMI ≤ 2). Cardiac magnetic resonance imaging (MRI) was performed 2 days and 6 months post-MI. Myocardial salvage was the final infarct size indexed to the initial area-at-risk.
RESULTS
Of 411 STEMI patients (11 March 2012 - 21 November 2012), 101 patients (mean age 60 years, 69% male) were randomized (n=52 deferred group, n=49 immediate stenting). The median (IQR) time to the second procedure in the deferred group was 9 (6, 12) hours. Fewer patients in the deferred stenting group had no/slow-reflow [14 (29%) vs. 3 (6%); p=0.006], no-reflow [7 (14%) vs. 1 (2%); p=0.052] and intra-procedural thrombotic events [16 (33%) vs. 5 (10%); p=0.010]. TIMI coronary flow grades at the end of PCI were higher in the deferred stenting group (p=0.018). Recurrent STEMI occurred in 2 patients in the deferred group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred group [68 (54, 82%) vs. 56 (31, 72%); p=0.031].
CONCLUSION
In high risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage.
CLINICAL TRIAL REGISTRATION
NCT01717573. 英文原标题： Towards a better life with Alzheimer's disease. 作者： The Lancet 期刊名称：柳叶刀杂志(Lancet) 发表时间：2014-03-29 索引：Lancet.2014 Mar 29;383(9923):1100. 下载PDF查看原始网页 英文摘要 On March 19, the US Alzheimer's Association released its 2014 Alzheimer's Disease Facts and Figures. According to the report, the disease currently affects about 5·2 million Americans, including 5 million people aged 65 years and older, a figure expected to increase to 13·8 million by 2050. Among people aged 65 years and older, mortality due to Alzheimer's disease in the USA is predicted to rise from 600 000 in 2010 to 700 000 in 2014. Worldwide, around 36 million people were living with Alzheimer's disease and other forms of dementia in 2010.
Alzheimer's disease is underdiagnosed. At least half of people with the disease are unaware that they have it. Despite intensive research on the mechanisms underlying Alzheimer's disease, specific treatments that could slow or stop neurodegeneration are not available yet. However, if prodromal Alzheimer's disease could be detected reliably before symptoms developed, opportunities to delay onset of clinical symptoms early could be created. In a report in The Lancet Neurology, Clifford Jack and colleagues have developed a hypothetical model that incorporates changes in biomarkers of prodromal Alzheimer's disease, such as brain deposition of amyloid. Longitudinal population studies of potentially diagnostic biomarkers will be needed to guide clinicians.
Much needs to be done to help the growing population with Alzheimer's disease around the world. A good life with dementia, a report published by the UK Alzheimer's Society on March 19, focuses on care for people with dementia and recognises the serious challenges that exist, whether patients are living in the community or in care facilities. The report describes six domains—respect for identity, remembering life experiences, sustaining relationships, enabling happiness, protecting people from risks, and maintaining health—to preserve a good quality of life for people with Alzheimer's disease and other forms of dementia, and for their families. According to the report, timely diagnosis, increased public awareness, and greater flexibility of care would help to address the challenges. A better life with Alzheimer's disease should not be an exception, but the norm across societies. 英文原标题： Thyroid hormone inactivation in gastrointestinal stromal tumors. 作者：Michelle A Maynard ,Adrian Marino-Enriquez ,Jonathan A Fletcher ,David M Dorfman ,Chandrajit P Raut ,Leila Yassa 期刊名称：新英格兰医学杂志(NEJM) 发表时间：2014-04-03 索引：N. Engl. J. Med..2014 Apr 3;370(14):1327-34. 查看原始网页 英文摘要 Gastrointestinal stromal tumors (GISTs) are resistant to traditional chemotherapy but are responsive to the tyrosine kinase inhibitors imatinib and sunitinib. The use of these agents has improved the outcome for patients but is associated with adverse effects, including hypothyroidism. Multiple mechanisms of this effect have been proposed, including decreased iodine organification and glandular capillary regression. Here we report the finding of consumptive hypothyroidism caused by marked overexpression of the thyroid hormone-inactivating enzyme type 3 iodothyronine deiodinase (D3) within the tumor. Affected patients warrant increased monitoring and may require supernormal thyroid hormone supplementation.
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