篇新英格兰英文医学摘要修改版带音标

1、1.绝经后骨质疏松症妇女中Strontium Ranelate对椎体骨折的影响The Effects of Strontium Ranelate on the Risk of Vertebral Fracture in Women with Postmenopausal Osteoporosissrontium:锶 vertebral :脊骨的,脊椎的,椎骨的ranelate:硬脂酸 osteoporosis:骨质疏松症postmenopausal:经绝后的,停经后 背景 骨质疏松性结构破坏和骨质脆弱是骨质形成减少而骨质吸收增加的结果。在一项2期临床试验中，strontium ranelate

2、,一种通过增加骨质形成和减少骨质吸收来解除骨质重塑的口服活性药物，已经显示可降低椎体骨折危险而增加骨矿密度。Background: Osteoporotic structural damage and bone fragility result from reduced bone formation and increased bone resorption. In a phase 2 clinical trial, strontium ranelate, an orally active drug that dissociates bone remodeling by increasing

3、bone formation and decreasing bone resorption, has been shown to reduce the risk of vertebral fractures and to increase bone mineral density. fragility:脆弱,脆性,易碎性 resorption:吸收dissociate:分离,离解,分裂 orally:经口的,口服的density:密度方法 为了在一项3期临床试验中评估strontium ranelate对预防椎体骨折的疗效，我们将1649例患有骨质疏松症(低骨矿密度)并至少有一个椎体骨折的绝经

4、后妇女随机分成两组，使她们分别接受每天2g口服strontium ranelate或安慰剂治疗共3年。我们在研究前和研究期间给两组病人都补充钙质和维生素D。每年1次进行椎体X线检查，每6个月1次进行骨矿密度测定。Methods To evaluate the efficacy of strontium ranelate in preventing vertebral fractures in a phase 3 trial, we randomly assigned 1649 postmenopausal women with osteoporosis (low bone mineral de

5、nsity) and at least one vertebral fracture to receive 2 g of oral strontium ranelate per day or placebo for three years. We gave calcium and vitamin D supplements to both groups before and during the study. Vertebral radiographs were obtained annually, and measurements of bone mineral density were p

6、erformed every six months. placebo：n. 安慰剂radiograph:x射线照片,放射显影图,放射线照片,放射线照相片,射线照结果 Strontium ranelate组比安慰剂组较少病人发生新的椎体骨折，骨折发生危险下降在治疗的第1年中为49%，在3年研究期间为41%(相对危险为0.59，95%可信区间为0.480.73)。Strontium ranelate使36个月时的腰椎骨矿密度增加14.4%，股骨颈骨矿密度增加8.3%(两项比较均P0.001)。两组之间的严重不良事件发生率没有显著差异。Results: New vertebral fractures

7、 occurred in fewer patients in the strontium ranelate group than in the placebo group, with a risk reduction of 49 percent in the first year of treatment and 41 percent during the three-year study period (relative risk, 0.59; 95 percent confidence interval, 0.48 to 0.73). Strontium ranelate increase

8、d bone mineral density at month 36 by 14.4 percent at the lumbar spine and 8.3 percent at the femoral neck (P<0.001 for both comparisons). There were no significant differences between the groups in the incidence of serious adverse events. spine:n. 脊骨;脊柱 lumbar:腰,腰部的,腰的,腰椎,腰椎;腰部femoral:大腿的,大腿骨的,股

9、的,股动脉,股骨的结论采用strontium ranelate治疗绝经后骨质疏松症可使椎体骨折危险早期出现持久下降Conclusions Treatment of postmenopausal osteoporosis with strontium ranelate leads to early and sustained reductions in the risk of vertebral fractures. 2.渗出性缩窄性心包炎 EffusiveConstrictive Pericarditis effusivea.流出的；溢出的；喷出的;喷发岩;热情洋溢的；溢于言表的;constr

10、ictive狭窄的,缩窄的 constrictionn n 狭窄pericarditis心包炎背景 渗出性缩窄性心包炎是一种罕见心包综合征，其特征为伴有由紧张性心包渗出引起的心脏填塞和由脏层心包引起的缩窄。我们进行了一项有关该病的临床演变和处理的前瞻性研究。Background Effusiveconstrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constric

11、tion, caused by the visceral pericardium. We conducted a prospective study of its clinical evolution and management. concomitant伴发的,伴行的,并发的,副,副的,附随的,相伴的tamponade填塞,压塞effusionn.U(液体等)流出；溢出；喷出;C流出物；溢出物；喷出物;方法 从1986年至2001年，所有渗出性缩窄性心包炎病人都接受前瞻性评估。对所有病人都联合进行心包穿刺和心脏导管插管，对持续缩窄病人进行心包切开。随访时间范围是从1个月至15年(中位数为7年

12、)。Methods From 1986 through 2001, all patients with effusiveconstrictive pericarditis were prospectively evaluated. Combined pericardiocentesis and cardiac catheterization were performed in all patients, and pericardiectomy was performed in those with persistent constriction. Follow-up ranged from 1

13、 month to 15 years (median, 7 years). pericardiocentesis心包穿刺术catheterization插入导管术,导管插入术,导尿术pericardiectomy心包切除术medianadj. 中间的,n. (三角形)中线结果 我们共对1184例心包炎病人进行了评估，其中218例有心脏填塞。在这218例病人中，190例接受了联合心包穿刺和心脏导管插管。这些病人中有15例为渗出性缩窄性心包炎，这15例病人被纳入研究。所有病人都有心脏填塞的临床表现，但是，只有7例病人确认伴发缩窄。在进行导管插管时，所有病人的心包内压都升高(中位数为12mmHg，四

14、分位数间距为718mmHg)，右房压以及左室和右室舒张期末压也都升高。在心包穿刺后，心包内压力下降(中位数为5mmHg，四分位数间距为50mmHg)，而右房压及左室和右室舒张期末压虽然有轻微下降但仍然较高，形态上表现为倾角平台状。原因是多方面的，死亡与基础疾病相关。7例病人需要心包切开，所有这些病人都累及了脏层心包。3例病人自发缓解。Results A total of 1184 patients with pericarditis were evaluated, 218 of whom had tamponade. Of these 218, 190 underwent combined p

15、ericardiocentesis and catheterization. Fifteen of these patients had effusiveconstrictive pericarditis and were included in the study. All patients presented with clinical tamponade; however, concomitant constriction was recognized in only seven patients. At catheterization, all patients had elevate

16、d intrapericardial pressure (median, 12 mm Hg; interquartile range, 7 to 18) and elevated right atrial and end-diastolic right and left ventricular pressures. After pericardiocentesis, the intrapericardial pressure decreased (median value, 5 mm Hg; interquartile range, 5 to 0), whereas right atrial

17、and end-diastolic right and left ventricular pressures, although slightly reduced, remained elevated, with a dipplateau morphology. The causes were diverse, and death was mainly related to the underlying disease. Pericardiectomy was required in seven patients, all of whom had involvement of the visc

18、eral pericardium. Three patients had spontaneous resolution. intrapericardial心包内的 interquartile四分位atrial房的,前房的 diastolica.心脏舒张的ventricular室的,心室的,腹的,胃的 visceral内脏的morphology形态；形态学，形态论 pericardium心包underlying基础的；潜在的,根本的,下面的；结论 渗出性缩窄性心包炎是一种罕见心包综合征，在一些表现为心脏填塞的病人中可能被漏诊。虽然演变为持续性缩窄很常见，但一些特发性病例可能自发缓解。我们认为，广

19、泛心外膜切除术是需要手术病人的首选治疗措施。Conclusions Effusiveconstrictive pericarditis is an uncommon pericardial syndrome that may be missed in some patients who present with tamponade. Although evolution to persistent constriction is frequent, idiopathic cases may resolve spontaneously. In our opinion, extensive epi

20、cardiectomy is the procedure of choice in patients requiring surgery. idiopathic特发性的,原发性的,自发性的epicardiectomy心外膜切除术3.Eculizumab对阵发性夜间血红蛋白尿病人的溶血和输血需要的影响Effect of Eculizumab on Hemolysis and Transfusion Requirements in Patients with Paroxysmal Nocturnal Hemoglobinuriahemolysisn.溶血 transfusionn.输血;倾注；转移

21、；nocturnal夜间的;夜行的 paroxysmal阵发的；突发性,hemoglobinurian.血红蛋白尿背景 阵发性夜间血红蛋白尿(PNH)起源于造血干细胞PIGA基因的体细胞突变和随后生成了缺乏表面蛋白(能保护细胞免除补体系统攻击)的血细胞。我们在PNH病人中检验了eculizumab(一种抑制终末补体成分活化的人化抗体)的临床疗效。Background Paroxysmal nocturnal hemoglobinuria (PNH) arises from a somatic mutation of the PIG-A gene in a hematopoietic stem

22、cell and the subsequent production of blood cells with a deficiency of surface proteins that protect the cells against attack by the complement system. We tested the clinical efficacy of eculizumab, a humanized antibody that inhibits the activation of terminal complement components, in patients with

23、 PNH. somatica. cell体细胞.身体的，肉体的;【生】体的;mutationn. 突变,变异hematopoietic定向造血干细胞,血球生成的,造血的方法 11例依赖输血的PNH病人连续4周每周接受eculizumab(600mg)输注治疗，在1周后改为900mg，然后每隔1周900mg，连续12周。在整个临床试验期间测定有关溶血的临床和生化指标。Methods Eleven transfusion-dependent patients with PNH received infusions of eculizumab (600 mg) every week for four

24、 weeks, followed one week later by a 900-mg dose and then by 900 mg every other week through week 12. Clinical and biochemical indicators of hemolysis were measured throughout the trial. infusionn. 输注；灌输,激励结果 平均乳酸脱氢酶水平从治疗前的3111IU/L下降到治疗期间的594IU/L(P0.002)。PNH型红细胞的平均百分数从占全部红细胞的36.7%增加到占59.2%(P0.005)。输

25、血率的平均数和中位数分别从每例病人每月2.1个和1.8个单位下降到每例病人每月0.6个和0.0个单位(输血率中位数的比较P0.003)。血红蛋白尿的发作次数减少了96%(P0.001)，生活质量指标发生了显著改善。Results Mean lactate dehydrogenase levels decreased from 3111 IU per liter before treatment to 594 IU per liter during treatment (P=0.002). The mean percentage of PNH type III erythrocytes incr

26、eased from 36.7 percent of the total erythrocyte population to 59.2 percent (P=0.005). The mean and median transfusion rates decreased from 2.1 and 1.8 units per patient per month to 0.6 and 0.0 units per patient per month, respectively (P=0.003 for the comparison of the median rates). Episodes of h

27、emoglobinuria were reduced by 96 percent (P<0.001), and measurements of the quality of life improved significantly. lactate n.乳酸盐v.分泌乳汁, 授乳; dehydrogenase脱氢酶erythrocyte红细胞结论 在PNH的病人中，eculizumab是安全的，并能被良好耐受。这种抗终末补体蛋白C5的抗体可以减少PNH病人的血管内溶血、血红蛋白尿和对输血的需要，并伴有生活质量的相应改善。Conclusions Eculizumab is safe and

28、well tolerated in patients with PNH. This antibody against terminal complement protein C5 reduces intravascular hemolysis, hemoglobinuria, and the need for transfusion, with an associated improvement in the quality of life in patients with PNH. intravascular血管内的4.改变HLA配型优先级对少数民族病人肾脏移植率和转归的影响Effect o

29、f Changing the Priority for HLA Matching on the Rates and Outcomes of Kidney Transplantation in Minority Groups背景 HLA分型和病人等待移植的时间，是美国在分配尸体肾进行肾移植时所采用的主要标准。HLAA、B和DR都匹配的等待移植病人享有最高优先级，然后是HLAB和DR位点最少不匹配的病人。这个政策使白人中的移植率高于非白人。我们假设，改变这种分配政策将影响移植物的生存率和移植受者中的种族平衡性。Background HLA typing and the time a patient

30、 has spent on the waiting list are the primary criteria used to allocate cadaveric kidneys for transplantation in the United States. Candidates with no HLA-A, B, and DR mismatches are given top priority, followed by candidates with the fewest mismatches at the HLA-B and DR loci; this policy contribu

31、tes to a higher transplantation rate among whites than nonwhites. We hypothesized that changing this allocation policy would affect graft survival and the racial balance among transplant recipients. cadaveric尸体的 graftn移植物;locus部位,部位、场所,场所,轨迹,基因座,位点,座位loci是locus的复数形式方法 我们采用Cox模型，针对从被列入等待名单到接受移植的时间，按照

32、种族的情况计算了当前分配政策下的相对肾移植率和HLA抗原谱的种族差异。我们还采用另一个模型，在校正HLAB和DR抗原谱后，计算了在各民族和种族中这些抗原谱分布一致时将发生的相对肾移植率。我们还采用Cox模型，针对第一次移植到移植物失败的时间，研究了HLA配型对移植物失败的影响。我们采用这两项分析的结果来估计，在取消HLAB配型或HLAB和DR配型作为分配优先级的方式后，移植种族平衡性和移植物失败率将发生的改变。Methods We estimated the relative rates of kidney transplantation according to race resulting

33、 from the current allocation policy and racial differences in HLA antigen profiles, using a Cox model for the time from placement on the waiting list to transplantation. Another model, also adjusted for HLA-B and DR antigen profiles, estimated the relative rates of kidney transplantation that would

34、result if the distribution of these antigen profiles were identical among the racial and ethnic groups. We also investigated the effect of HLA matching on the risk of graft failure, using a Cox model for the time from the first transplantation to graft failure. The results of the two analyses were u

35、sed to estimate the change in the racial balance of transplantation and graft-failure rates that would result from the elimination of HLA-B matching or HLA-B and DR matching as a means of assigning priority. antigenn. 抗原 assign分配,指定,赋予 结果 取消HLAB配型作为优先级但保留HLADR配型作为优先级，使白人中的移植数减少4.0%(在1年内移植数减少了166例)，而

36、使非白人中的移植数增加6.3%，并使移植物损失率增加2.0%。Results Eliminating the HLA-B matching as a priority while maintaining HLA-DR matching as a priority would decrease the number of transplantations among whites by 4.0 percent (166 fewer transplantations over a one-year period), whereas it would increase the number amon

37、g nonwhites by 6.3 percent and increase the rate of graft loss by 2.0 percent.结论 取消HLAB配型作为尸体肾分配的优先级可以通过增加非白人中的移植数而减轻种族之间的分配失衡，而移植物损失的发生率只有轻微增加。 Conclusions Removing HLA-B matching as a priority for the allocation of cadaveric kidneys could reduce the existing racial imbalance by increasing the numb

38、er of transplantations among nonwhites, with only a small increase in the rate of graft loss. 5. 在2型糖尿病病人的对胰岛素抵抗的后代中存在线粒体活性受损Impaired Mitochondrial Activity in the Insulin-Resistant Offspring of Patients with Type 2 Diabetes impairvt.削弱；损伤；损害; insulin胰岛素mitochondrial线粒体的 diabetesn. 糖尿病背景 在2型糖尿病病人的子女

39、中,胰岛素抵抗似乎是发生糖尿病的最佳预测因素,但引起的机制尚不清楚。 Background Insulin resistance appears to be the best predictor of the development of diabetes in the children of patients with type 2 diabetes, but the mechanism responsible is unknown.方法 我们在2型糖尿病病人的健康、年轻、体瘦、对胰岛素抵抗的后代中,以及在年龄、身高和体力活动相匹配的对胰岛素敏感的对照研究对象中,联合注射6，6-2 H2葡萄

40、糖进行了高胰岛素-正常血糖钳夹研究,来评估肝脏和肌肉对胰岛素的敏感性。我们进行质子1H磁共振波谱检查研究来测量肌细胞内脂质和肝细胞内甘油三酯的含量。我们通过测定2H5甘油周转率并联用微量渗析法测定的皮下脂肪释放甘油指标来评估全身和皮下脂肪的脂解率。我们采用31P磁共振波谱检查研究来评估肌肉内的线粒体氧化磷酸化活性。 Methods We performed hyperinsulinemiceuglycemic clamp studies in combination with infusions of 6,6-2H2glucose in healthy, young, lean, insuli

41、n-resistant offspring of patients with type 2 diabetes and insulin-sensitive control subjects matched for age, height, weight, and physical activity to assess the sensitivity of liver and muscle to insulin. Proton (1H) magnetic resonance spectroscopy studies were performed to measure intramyocellula

42、r lipid and intrahepatic triglyceride content. Rates of whole-body and subcutaneous fat lipolysis were assessed by measuring the rates of 2H5glycerol turnover in combination with microdialysis measurements of glycerol release from subcutaneous fat. We performed 31P magnetic resonance spectroscopy st

43、udies to assess the rates of mitochondrial oxidative-phosphorylation activity in muscle. euglycemic血糖正常的 clampn.夹子 vt.夹住,夹紧glucose葡萄糖 protonn.质子magnetic磁的,有磁性的 spectroscopy光谱学intramyocellular肌蜂窝织炎内的 lipidn. 脂;脂质intrahepatic肝内的 triglyceride甘油三酯,subcutaneousadj. 皮下的 turnover更新,周转glycerol甘油 lipolysisn.

44、脂解(作用)microdialysis微量透析,微透析 oxidative氧化的phosphorylation磷酸化(作用),磷酸化作用结果 对胰岛素抵抗的研究对象与对胰岛素敏感的对照研究对象相比,前者的肌肉在胰岛素刺激下的葡萄糖摄取率要比后者低大约60%(P<0.001),并且与肌细胞内脂质含量增加大约80%相关(P=0.005)。肌细胞内脂质含量的这种增加最可能由线粒体功能障碍所致,反映在线粒体的磷酸化大约下降了30%(与对照者比较P=0.01),而全身或局部脂解率或肿瘤坏死因子、白介素6、抵抗素及脂联素都没有显著差异。 Results The insulin-stimulated

45、rate of glucose uptake by muscle was approximately 60 percent lower in the insulin-resistant subjects than in the insulin-sensitive control subjects (P<0.001) and was associated with an increase of approximately 80 percent in the intramyocellular lipid content (P=0.005). This increase in intramyo

46、cellular lipid content was most likely attributable to mitochondrial dysfunction, as reflected by a reduction of approximately 30 percent in mitochondrial phosphorylation (P=0.01 for the comparison with controls), since there were no significant differences in systemic or localized rates of lipolysi

47、s or plasma concentrations of tumor necrosis factor , interleukin-6, resistin, or adiponectin.necrosis坏死interleukin白细胞介素 resistin抵抗素adiponectin脂连素 plasman.血浆, 乳浆concentrations浓聚物结论 这些资料支持下列这种假设,即在2型糖尿病病人的对胰岛素抵抗的子女中,骨骼肌对胰岛素的抵抗与肌细胞内脂肪酸代谢的功能障碍相关,这种代谢障碍可能缘于线粒体氧化磷酸化的遗传性缺陷。 Conclusions These data support

48、the hypothesis that insulin resistance in the skeletal muscle of insulin-resistant offspring of patients with type 2 diabetes is associated with dysregulation of intramyocellular fatty acid metabolism, possibly because of an inherited defect in mitochondrial oxidative phosphorylation. metabolismn. 新

49、陈代谢,代谢6. 血循环中的血管生成因子与先兆子痫的发生危险Circulating Angiogenic Factors and the Risk of Preeclampsiaangiogenic血管原的,生成血管的preeclampsia先兆子痫背景 先兆子痫的原因仍然未明。有限的资料表明,可以与胎盘生长因子(PlGF)和血管内皮生长因子(VEGF)结合的血循环中可溶性fms样酪氨酸激酶1(sFlt-1)的过度增加,可能有致病作用。 Background The cause of preeclampsia remains unclear. Limited data suggest that

50、 excess circulating soluble fms-like tyrosine kinase 1 (sFlt-1), which binds placental growth factor (PlGF) and vascular endothelial growth factor (VEGF), may have a pathogenic role. tyrosine酪氨酸 kinase激酶placental胎盘的 endothelial内皮的pathogenic病原的,致病的方法 我们在纳入健康未产妇的钙预防先兆子痫临床试验中进行了一项嵌套病例对照研究。每例先兆子痫妇女都与一名正

51、常血压对照者进行配对。共随机选择了120对妇女。我们测定了整个妊娠期间的血清血管生成因子(总sFlt-1、游离PlGF和游离VEGF)浓度;共有655份血清标本。按照孕龄和先兆子痫发生前时间对资料进行了横向分析。Methods We performed a nested casecontrol study within the Calcium for Preeclampsia Prevention trial, which involved healthy nulliparous women. Each woman with preeclampsia was matched to one no

52、rmotensive control. A total of 120 pairs of women were randomly chosen. Serum concentrations of angiogenic factors (total sFlt-1, free PlGF, and free VEGF) were measured throughout pregnancy; there were a total of 655 serum specimens. The data were analyzed cross-sectionally within intervals of gest

53、ational age and according to the time before the onset of preeclampsia. normotensive血压正常的,血压正常者 control 对照标准;参照实验serum浆液,免疫血清,血清 gestationn. 怀孕,孕育时期结果 血压正常的对照研究对象在妊娠的最后2个月中出现sFlt-1水平的升高和PlGF水平的下降。在后来发生先兆子痫的妇女中,这些变化发生得更早并更突出。在先兆子痫发生前大约5周,Flt-1水平开始增加。在临床发病时,血清Flt-1的平均水平在先兆子痫病人中为4382 pg/ml,而在胎儿孕龄相似的对照者

54、中为1643 pg/ml(P<0.001)。对于PlGF水平,先兆子痫妇女在妊娠1316周开始低于对照者(平均值为90 pg/ml对142 pg/ml,P=0.01),最大差值发生在先兆子痫发病前的数周,与sFlt-1水平增加的时间一致。在较早发生先兆子痫的妇女中以及在先兆子痫伴小于胎龄儿的妇女中,sFlt-1和游离PlGF水平的变化较大。 Results During the last two months of pregnancy in the normotensive controls, the level of sFlt-1 increased and the level of

55、PlGF decreased. These changes occurred earlier and were more pronounced in the women in whom preeclampsia later developed. The sFlt-1 level increased beginning approximately five weeks before the onset of preeclampsia. At the onset of clinical disease, the mean serum level in the women with preeclam

56、psia was 4382 pg per milliliter, as compared with 1643 pg per milliliter in controls with fetuses of similar gestational age (P<0.001). The PlGF levels were significantly lower in the women who later had preeclampsia than in the controls beginning at 13 to 16 weeks of gestation (mean, 90 pg per m

57、illiliter vs. 142 pg per milliliter, P=0.01), with the greatest difference occurring during the weeks before the onset of preeclampsia, coincident with the increase in the sFlt-1 level. Alterations in the levels of sFlt-1 and free PlGF were greater in women with an earlier onset of preeclampsia and in women in whom preeclampsia was a