Impact of obstructive sleep apnea on the long-term cardiovascular outcomes in patients with acute coronary syndrome / 中华心血管病杂志

Objective: To investigate the impact of obstructive sleep apnea (OSA) on long-term cardiovascular outcomes in patients with acute coronary syndrome (ACS). Methods: This is a single-center, prospective cohort study. Between June 2015 to January 2020, consecutive ACS patients hospitalized at Beijing Anzhen Hospital, Capital Medical University were enrolled. All patients underwent portable sleep breathing monitoring, and they were then divided into moderate/severe OSA group (apnea-hypopnea index (AHI)≥15 events/hour) and no/mild OSA group (AHI<15 events/hour). The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, ischemia-driven revascularization and hospital admission for unstable angina or heart failure. MACCE were compared yearly by the log-rank test. Multivariable Cox regression analyses were performed to determine the independent predictors of MACCE. Results: A total of 1 927 patients with ACS were enrolled, including 1 629 males (84.5%), aged (56.4±10.5) years. Moderate/severe OSA was present in 1 014 (52.6%) patients. Compared with no/mild OSA group, moderate/severe OSA group exhibited a higher body mass index (P<0.05). Hypertension, prior PCI were more prevalent in moderate/severe OSA group (both P<0.05). The difference of ACS category between the two groups was statistically significant (P=0.021). The rate of patients who underwent PCI and the number of stents were higher in the moderate/severe OSA group. During a 5-year follow-up (median 2.9 years (IQR 1.5-3.6 years)), the cumulative incidence of MACCE was significantly higher in the moderate/severe OSA group than in the no/mild OSA group (34.0% vs. 24.0%, HR=1.346, 95%CI 1.100-1.646, log-rank P=0.004). The cumulative incidence of MACCE remained statistically higher at 4 and 5 year in the moderate/severe OSA group as compared to the no/mild OSA group (33.3% vs. 22.9%, HR=1.397, 95%CI 1.141-1.710, log-rank P=0.001; 34.0% vs. 24.0%, HR=1.341, 95%CI 1.096-1.640, log-rank P=0.004, respectively). Multivariate analysis showed that moderate/severe OSA (HR=1.312, 95%CI 1.054-1.631, P=0.015) was an independent predictor of long-term MACCE in ACS patients. Conclusions: Moderate/severe OSA is observed in more than 52% ACS patients. Moderate/severe OSA is an independent predictor of long-term MACCE.

Effect of minimally invasive anterior lateral approach for total hip arthroplasty on serum type I collagen propeptide, tartrate-resistant acid phosphatase 5b and hip joint function in patients with femoral neck fracture / 中国骨伤

OBJECTIVE@#To analyze the level of serum N-terminal propeptide of type I precollagen (PINP) and tartrate resistant acid phosphatase 5b(TRACP-5b) in patients with femoral neck fracture(FNF) after minimally invasive anterior lateral approach with total hip arthroplasty and the effects of hip function.@*METHODS@#From September 2016 to May 2017, 98 cases of femoral neck fracture were divided into control group and observation group, 49 cases in each group. There were 49 patients in control group, including 30 males and 19 females, ranging in age from 63 to 72 years old, who underwent minimally invasive anterolateral total hip arthroplasty. There were 49 patients in observation group, including 29 males and 20 females, ranging in age from 62 to 73 years old, who underwent minimally invasive anterolateral total hip arthroplasty. The perioperative conditions(operation time, bleeding volume, incision length, hospitalization time), bone metabolism indexes including PINP, TRACP-5b, fibroblast growth factor(FGF), bone gla-protein(BGP), propetide carboxy-terminal procollagen (PICP), bone-specific alkaline phosphatase(BAP), and pain mediators such as prostaglandin E2 (PGE2) and 5-hydroxytrytamine (5-HT) levels were compared between the two groups. The hip joint function and complications were evaluated.@*RESULTS@#The operation time of the observation group was longer than that of the control group(0.05). PINP, fibroblast growth factor, BGP, PICP and BAP in observation group were higher than those in control group 1 month after operation, and TRACP-5b was lower than those in control group(0.05).@*CONCLUSIONS@#Minimally invasive anterolateral approach total hip arthroplasty is safe and reliable, and can improve hip function, improve bone metabolism, promote fracture healing, alleviate pain in patients with femoral neck fracture, which is worthy of promotion.

Expression of androgen receptor in breast carcinoma and its relationship with estrogen receptor, progesterone receptor and HER2 status / 中华病理学杂志

<p><b>OBJECTIVE</b>to investigate the expression of androgen receptor (AR) in breast carcinoma and its relationship with estrogen receptor (ER), progesterone receptor (PR) and HER2 status, and to discuss its potential as treatment target.</p><p><b>METHODS</b>immunohistochemical method was used to detect AR, ER, PR and HER2 expression in 175 cases of invasive ductal carcinoma of breast, which were divided into four groups: luminal A, luminal B, HER2(-) overexpression and triple negative group.</p><p><b>RESULTS</b>eighty-eight cases (50.3%) were AR positive in 175 cases, the expression of AR was positively correlated with ER, PR and HER2 status. All the cases were grouped as follows: 53 cases (30.3%) were luminal A, 33 cases (18.9%) were luminal B, 23 cases (13.1%) were HER2(-) overexpression and 66 cases (37.7%) were triple negative, the AR expression rate was 56.6% (30/53), 75.8% (25/33), 47.8% (11/23), 33.3% (22/66), respectively. There was significant difference among the four groups' AR expression rates. With respect to the clinico-pathological features, AR positive cases were younger in luminal A and had lower mitosis rate in triple negative subgroups than the negative cases (χ(2) = 4.567, P = 0.033; χ(2) = 5.140, P = 0.023, respectively).</p><p><b>CONCLUSION</b>AR has a high positive rate in breast carcinoma, and may be an ideal therapeutic target for breast carcinoma, especially for the triple negative subtype.</p>