Volume 122  ·  Issue 08  ·  2009

Abstract：Background Tradition treatment of sepsis and new therapies, including high dose corticosteroids and non-steroidal anti-inflammatory drugs, have proven unsuccessful in improving survival. This study aimed to evaluate the potential efficacy of immunomodulating therapy using Ulinastatin (UTI) plus Thymosin α1 (Tα1) for improving organ function and reducing mortality in patients with severe sepsis.Methods A prospective study was carried out with randomized and controlled clinical analysis of 114 patients conforming to the enrollment standard. All patients had severe sepsis and received standard supportive care and antimicrobial therapy. Fifty-nine patients were also administered UTI plus Tα1 (defined as Group A), 55 patients were given a placebo (defined as Group B). Clinical parameters were determined by evaluation with the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ), multiple organ failure (MOF) and the Glasgow Coma Scores (GCS) on entry and after therapy on the 3rd, 8th, and 28th day. By flow cytometery and ELISA lymphocyte subsets and cytokines were analyzed. Survival analysis was determined by the Kaplan-Meier method at 28, 60, and 90 days. Results Based on comparison of the two groups, patients in Group A exhibited a better performance in organ failure scores which was noticeable soon after initiation of treatment. Patients in Group A also demonstrated a better resolution of pre-existing organ failures during the observation period. After initiation of treatment, significant improvements in the CD4+/CD8+ ratio, a quicker balance between proinflammatory mediators such as tumor necrosis factor a, interleukin 6 and anti-inflammatory cytokines including interleukin 4 and interleukin 10 were found. This was followed by cumulative survival increases of 17.3% at 28 days, 28.9% at 60 days, and 31.4% at 90 days in Group A. The reduction in mortality was accompanied by a considerably shorter stay in the ICU and a shorter length of supportive ventilation, antimicrobial and dopamine therapy.Conclusion UTI plus Tα1 has a beneficial role in the treatment of severe sepsis。

Abstract：Background Radiofrequency ablation (RFA) followed by transartedal chemoembolization (TACE) for unresectable primary liver cancer (PLC) has not been widely discussed. In this study, the outcome of the combination of RFA with TACE was retrospectively evaluated.Methods From May 2003 to March 2008, 127 consecutive PLC patients with a median age of 56.4±8.8 years underwent RFA plus TACE. All patients were deemed to have unresectable PLC based on their tumor characteristics. The maximal diameter of the tumor was between 1.5 cm and 10.0 cm. Twenty-six cases with small (≤3.0 cm), 33 with medium (3.1-5.0 cm), and 68 with large (>5.0 cm) tumors were included in this study. RFA was performed using a RITA Medical Systems expandable electrode device, which was followed by first-time TACE administration one to two months later.Results Technical success of RFA was achieved in all 127 patients with no severe treatment-related complications. RFA was performed percutaneously in 16 (13.5%) cases, by laparoscopic approach in 19 (15.7%), and through laparotomy in the remaining 92 (72.4%). RFA response was classified as complete ablation in 48 cases, nearly complete ablation in 28, and partial ablation in 51. The total 1-, 2-, and 3-year survival rates after RFA were 83.1%, 55.7%, and 43.7%, respectively. The survival rates at 3 years were 78.6%, 28.1%, and 0 for complete ablation, nearly complete ablation, or partial ablation groups, respectively. Three-year disease-free survival rates for the complete ablation and nearly complete ablation groups were 50.3% and 21.3%, respectively. RFA response and liver function were significant variables influencing survival time as analyzed using the Cox regression model.Conclusion RFA could be the first-line exterminate treatment for unresectable PLC, and TACE following RFA may assist in eradicating the peripheral viable tissue and micro-metastasis。

Abstract：Background The aim of this study was to investigate the potential relationship between the dynamic expression of Toll-like receptor 2 and 4 (TLR2/4) in peripheral blood mononuclear cells as well as changes in serum concentration of inflammatory factors and acute lung injury (ALl) in patients after orthotopic liver transplantation (OLT).Methods The peripheral blood samples of 27 patients (23 men and 4 women with ASA Ⅲ to Ⅳ) who received OLT were collected for measurement of TLR2/4 at T1 (after induction of anesthesia), T2 (25 minutes after anhepatic phase), T3 (3 hours after graft reperfusion) and T4 (24 hours after graft reperfusion). The expression of TLR2/4 in mononuclear cells was measured by flow cytometry. The serum concentrations of tumor necrosis factor (TNF)-a, intedeukin (IL)-113 and IL-8 were measured by enzyme-linked irnmunosorbent assay (ELISA). Twenty-seven patients were assigned to ALI group (n=9) and non-ALI group (n=18) according to the diagnostic criteria of ALI. The expression of TLR2/4 in the ALl group or non-ALI group was analyzed.Results Compared to the non-ALI group, the volumes of blood loss, ascites, total output and transfused red blood cells were higher in the ALI group, and the anhepallc phase lasted longer (P<0.05, P<0.01). The expression of TLR2/4 in mononuclear cells increased significantly at T3 and T4, and serum concentrations of TNF-α, IL-1β and IL-8 increased significantly too. There was no significant difference in Child-Turcotte-Pugh (CTP) scores between the ALI group and non-ALl group (P>0.05). The expression of TLR2/4 in mononuclear cells increased significantly at T3 and 14 in the ALI group (P<0.05, P<0.01). A positive correlation was noted between the expression of TLR4 in mononuclear cells and the serum concentrations of TNF-α, IL-1β (P=0.041, P=0.046) in the ALl group. In the non-ALI group, statistical results showed that the expression level of TLR2/4 in mononuclear cells was not significantly different during the peri-operative period of OLT (besides TLR4 expression at T4). Compared to the non-ALI group, the increasing amplitude of TLR2/4 expression in mononuclear cells was more significant in the ALI group. The patients whose TLR2/4 expression in mononuclear cells exceeded that at T1 by one time were more likely to suffer from ALI (P=0.013), with a relative risk of 16。

Abstract：Background Local recurrence remains a serious problem among patients undergoing breast conservative surgery. This study aimed at identifying risk factors for residual disease after breast conservative surgery.Methods This retrospective study was based on patients with invasive breast cancer who have received breast conservative surgery and subsequent completion mastectomy. All patients had a clear resection margin in the initial operation. We analyzed the association between the presence of residual disease during completion mastectomy and the following risk factors: T staging, young age, and presence of extensive intraductal component (EIC), a close margin, lymphovascular permeation (LVP), positivity of estrogen receptor, progesterone receptor, and c-erbB-2.Results Residual disease was encountered in 21 (45.7%) of 46 patients; EIC was present in 28 patients (60.9%), of whom 17 had residual disease. Presence of EIC during breast conservation surgery was associated with a higher risk of residual disease during completion mastectomy (P=0.011). Other variables were not statistically significant risk factors for presence of residual disease. No local recurrence was recorded in our cohort, and the disease-free survival and overall survival after completion mastectomy were similar for patients who had residual disease and those who had not.Conclusions The presence of EIC is a significant risk factor for residual disease in patients after breast conservative surgery. Our findings may suggest the indicated value of completion mastectomy in patients with EIC during initial breast conservative surgery to decrease the risk of subsequent local failure。

Abstract：Background Patients with congenital scoliosis often also have intraspinaJ abnormalities and other organ defects, and few studies of the effects of congenital scoliosis on cardiac function and structure have been published.Methods A total of 215 adolescent patients with congenital scoliosis (average age, 13.58 years) underwent preoperative echocardiography and were then assigned to subgroups according to apex vertebral rotation, side of convexity, curvature severity in the coronal and sagittal planes, type of deformity, and sex. Differences between the subgroups were compared by independent-samples ttest or a one-factor analysis of variance.Results We observed statistically significant differences between patients with right-sided scoliosis curvature and those with left-sided scoliosis curvature, respectively, in left ventricular inner diameter at end-diastole ((39.39±4.66)mm vs (41.74±4.90)mm), left ventricular inner diameter at end-systole ((24.8±3.45)mm vs (25.92±3.07)mm), interventricular septum thickness at end-diastole ((5.66±0.98)mm vs (5.98±1.03)mm), and posterior wail of left ventricle at end-diastole ((5.61±0.98)mm vs (6.06±1.20)mm). When the patients were evaluated by coronal plane Cobb angle, significant differences were found between those with Cobb angle of 40Ω-80Ω and of >80Ω in left ventricular inner diameter at end-diastole ((40.97±5.06)mm vs (38.98±4.45)mm) and left ventricular inner diameter at end-systole ((25.53±3.39)mm vs (24.36±3.14)mm), respectively. When the patients were evaluated by sagittal plane Cobb angle (<20Ω, group 1; 20Ω40Ω, group 2; >40Ω, group 3), significant differences were found in right ventricular diameter between those with Cobb angle of <20Ω and of 20Ω-40Ω ((18.27±3.66)mm vs (16.54±3.57)mm) and in diameter of aortic root between those with Cobb angle of 20Ω-40Ω and of >40Ω ((23.83±3.39)mm vs (24.90±3.30)mm), respectively. No significant differences were found in ejection fraction and fractional shortening between patients according to apex vertebral rotation, side of convexity, coronal plane and sagittal plane Cobb angles, type of deformity, or sex.Conclusiona Congenital scoliosis influences cardiac structure, but not function。

Abstract：Background This study was to investigate the safety of two types of commercially available lumbar artificial discs (CHARITE and PRODISC -L) during a magnetic resonance imaging (MRI) procedure in a 1.5-Tesla MR system, and to evaluate the size of metal artifacts on the MR image for different sequences.Methods A 1.5-Tesla clinical MR imaging system was used. The degree of deflection of the endplates of two artificial discs was evaluated by an angle-measurement instrument at the portals of the MRI scanner. The heating effect of the radio frequency (RF) magnetic field was evaluated by using "worst-case" imaging sequences on a human cadaver implanted with an artificial lumbar disc at the L5/S1 intervertebral disc location. The temperatures of the tissue adjacent to the implant, and of the L4/L5 intervertebral disc (used as a control) were measured, respectively, using a digital probe thermometer before and after the MRI scan sequence. A rectangular water phantom was designed to evaluate the metal artifacts of these two artificial discs under different MR imaging sequences.Results The maximal deflection angle of the endplate of the implants under a static MR field was 7.5 and 6.0 degrees, for the CHARITE and PRODISC -L, respectively. The difference between temperature rise of tissue adjacent to the two types of artificial discs and the temperature rise of the L4/L5 control location was 0.4 and 0.6℃, respectively. The size of metal artifacts on images of TSE (T1/T2-weighted), STIR and Turbo Dark Fluid sequences were relatively less than those of TSE fat saturation, Flash and SE (T1-weighted) sequences.Conclusions The CHARITE and the PRODISC -L artificial disc do not present an additional hazard or risk to a patient undergoing an MRI procedure using a scanner operating with a static magnetic field of 1.5T or lower. Image artifacts from the implants may present problems if the anatomical region of interest is in or near the area where these implants are located (e.g., vertebral canal at affected segment)。

Abstract：Background The vertebral artery (VA) and atlantoaxial joint (AAJ), with complicated structures, are located in the depths of the head-neck boundary area, the regional anatomy of which cannot be shown globally and directly. This study aims to evaluate three-dimensional CT angiography (3DCTA) in displaying the AAJ, atlantoaxial segment of the vertebral artery (ASVA) and the identification of their interrelations.Methods Sixty-eight subjects without pathology of the ASVA and AAJ were selected from head-neck CTA examination. All the 3D images were formed with volume rendering (VR) together with techniques of separating, fusing, opacifying and false-coloring (SFOF). On the 3D images, the ASVA and AAJ were observed, and their interrelations were measured.Results All the 3DCTA images were of high quality and up to our requirements. They could cleady and directly show the ASVA, ascending along the AAJ. There were 5 curves in the course of the ASVA, of which 2 curves were away from the atlantoaxial joint, one in the 2nd curve of 0.0 mm-5.4 mm, the other in the 4th of 2.6 mm-9.2 mm. There was no significant difference in the measurements between left and dght (P>0.05). The curved parts of the ASVA slightly expanded, with the biggest diameter of 5.6 mm in the 4th curve. Statistical comparison shows that the left ASVA is larger than the right (P<0.05). Variations of the ASVA were found in 8 cases and of the AAJ in 12.Conclusions 3DCTA can globally and directly demonstrate the structures of the AAJ, ASVA and their interrelations. The 3D imaging data make up and enrich the research contents of regional anatomy and lay the foundation for related study and applications。

Abstract：Background Several isoforrns of p53 have been reported, which may have varying functions and expressions. This study aimed to analyze the expression patterns of p53 isoforms in renal cell carcinoma (RCC) at the mRNA and protein levels and their associations with clinical and pathologic factors to explore the mechanism of p53 isoforms' activity in RCC.Methods The specimens of tumours (T) and clinically normal tissues (N) adjacent to them were collected from 41 patients with RCC. mRNA expression levels of p53 isoforms were detected using RT-PCR followed by nested PCR. Protein expression levels were detected using immunohistochemisty and Western blotting with the anti-p53 antibodies DO-1 and DO-12. The data were analyzed with clinicopathological features by χ2 test or Fisher's exact test. Results p53 mRNA was expressed in all tumours and matched clinically normal tissue adjacent to the tumour. All six isoforms could be detected in tumour and normal tissues, with the exception of the △133p53β isoform, which was not detected in the normal tissue. Of the six isoforms, p53β mRNA was significantly overexpressed in tumour samples (P<0.001), and correlated with tumour stage. Nested PCR results consistently indicated the presence of p53γ (19T/22N), △133p53 (33T/26N), △133p53β (2T/0N), and △133p53y (13T/9N). Immunohistochemical analysis showed that p53 was expressed only in tumour tissues and correlated with tumour stage and grade. The results of Western blotting analysis were consistent with these findings.Conclusions Although all six isoforms are present in RCC, their function in tumour development or progression might be different. Our findings suggest that p53β might play an important role in the formation of RCC and it might be used as a new predictor and therapeutic target for RCC。

Abstract：Background Transparent dressings are commonly used to cover central venous catheter sites. However, it has been suggested that they might not allow adequate moisture vapor transmission, resulting in local moistness that promotes bacterial growth. We compared the moisture vapor transmission rates (MVI-Rs) of different, currently used transparent and traditional gauze dressings. We aimed to determine the MVTRs at different temperatures and humidities.Methods The dressings were used to seal 50-ml plastic centrifuge tubes containing 20 ml deionized water: Tubes in group 1 were covered with 12 layers of ordinary gauze, group 2 with IV3000, group 3 with OPSITE FLEXIGRID, group 4 with 3M HP Tegaderm, and group 5 with 3M Tegaderm. The tubes were placed upright in an artificial climate cabinet, so that the dressings were not touching the water, in order to simulate the conditions of medical dressings in contact with the skin. The average MVTRs were determined under different conditions. MVTRs were also determined with tubes from groups 2-5 laid on their sides, allowing the dressings to touch the water, so simulating contact of the dressings with sweating skin, or wounded skin with exudates. We also calculated the dressings' self-reactive abilities by comparing their MV-rRs in contact with the water surface with those when not in contact with the water surface.Results Group 1 demonstrated the highest MVTR, followed by groups 2, 4, 3 and 5 under conditions simulating contact of the dressings with normal skin at the following temperatures and humidities: 20℃C/30%, 20℃/60%, 20℃/90%, 37℃/30%, 37℃/60% and 37℃/90%. When the relative humidity (RH) increased, the MVTRs decreased. The MVTRs differed significantly among different dressings and RHs: At high temperature (37℃) and high humidity (90%), the MVTR of the transparent dressings in group 2 was higher than that of group 1 (P<0.01). The reactive MVTR was highest in group 2 (10.2-16.3 times>MVTR) while that of group 4 was second highest (2.6-9.6 times>MVTR).Conclusions RH and temperature had significant effects on the MVTRs of different dressings. The IV3000 transparent dressing used in group 2 was as effective as ordinary gauze. These results suggest that increased infection rates due to low MVTRs might not be a problem. The clinical implications of these observations for cathetsr-related infections need to be further investigated in multicenter studies。

Abstract：Background Femoral artery thrombosis is one of the most common complications of catheterizations in infants and young children. This study was conducted to investigate the feasibility and effectiveness of thrombolytic therapy for femoral artery thrombosis after left cardiac catheterization in children.Methods Thrombolytic therapy with urokinase was carried out in children with femoral artery thrombosis after left cardiac catheterization. Each patient was given a bolus injection of heparin (100 U/kg). A bolus of urokinase (30 000-100 000 U) was injected intravenously, and then a continuous infusion of 10 000-50 000 U/h was administered. Transcatheter thrombolysis was performed once previous procedures failed.Results Eight patients (aged (3.1±2.3) years (8 months to 7 years), body weight (13.1±4.2) kg (7 to 20 kg)) presented lower limbs ischemia alter left cardiac catheterizations was performed. Seven patients accepted thrombolytic therapy with urokinase. In 5 patients, peripheral intravenous thrombolysis was successful with restoration of a normal pulse. In the other 3 cases, peripheral intravenous thrombolysis failed, followed by successful transcatheter thrombolysis. The average duration of therapy was (7.25±5.31) hours (1-17 hours). The average doses of heparin and urokinase were (1600±723) U (800-3000 U) and (268 571±177 240) U (50 000-500 000 U), respectively. There were no statistically significant differences in partial thromboplastin time before and during urokinase therapy ((40.6±22.3) to (49.9±39.2) seconds). However, the prothrombin time was significantly longer ((12.7±9.58) to (48.1±18.6) seconds, P<0.05). Patency of the target vessel was evaluated in all the patients for 2 weeks and no occlusion recurred.Conclusion Thrombolytic therapy with urokinase is a safe and useful modality in children with femoral artery thrombosis after left cardiac catheterization。

Abstract：Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion (TCI) induction in eldedy patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in eldedy patients.Methods Ninety patients (60-80 years) with an American Society of Anesthesiologists (ASA) physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 (30 patients in each group). The patients in Group S1 received propofol with a target plasma concentration of 4.0 μg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 μg/ml that was raised to 4.0 μg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 μg/ml that was increased stepwised by 1 μg/ml until a target plasma concentration of 4.0 μg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer's Assessment of Alertness/Sedation (OAA/S) score of 1 was achieved, remifentanil (effect-site concentration (Ce) of 4.0 ng/ml) and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure (BP), heart rate (HR), and bispectral index (BIS) were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were (1.7±0.4) μg/ml, (1.9±0.3) μg/ml, (1.9±0.4) μg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was (2.8±0.2) μg/ml, (2.8±0.3) μg/ml, (2.7±0.3) μg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found (r=-0.580, P<0.01). Systolic blood pressure (SBP) before intubation was significantly lower in Group S1 than in Groups S2 and S3. SBP and HR after intubation in the three groups were significantly increased when compared with pre-intubation values, but they did not exceed baseline valuesConclusions During the TCI induction, Ce of propofol with (1.9±0.3) μg/ml may make the elderly patients unconscious. When remifentanil with a Ce of 4.0 ng/ml is added a Ce of propofol with (2.8±0.3) μg/ml is suitable for intubation. The Ce of propofol has a close correlation with the BIS values. Also, a two-step TCI technique seems to be a more suitable method of anesthesia induction in elderly patients compared with the no-stepwise TCI technique and three-step TCI technique。

Abstract：Background Type 1 diabetes (T1D) is a multifactodal disease. This article aims to evaluate the relationship between allele polymorphism of HLA-DQ, DR and T1D in the Chinese population.Methods The odds ratios (ORs) of HLA-DQ, DR allele distributions in patients with T1D were analyzed against healthy controls. All the relevant studies in Pubmed and CNKI were identified, and poor qualified studies were excluded. The meta-analysis software REVMAN 4.2 was applied for investigating heterogeneity among individual studies and for summarizing all the studies. The publication bias were also evaluated.Results DQA10301, DQA1*0501, DQB1*0201, DQB1*0302 were the susceptible alleles (all P<0.05) in the Chinese population, their merger ORs 2.40, 3.15, 3.66, and 2.67 respectively. DQA1*0103, DQAI*0201, DQA1*0401, DQB1*0301, DQB1*0402, DQB1*0501, DQB1*0503, DQB1*0601 and DQB1*0602 were the protective alleles (P<0.05), their merger ORs were 0.11, 0.45, 0.30, 0.38, 0.23, 0.37, 0.25, 0.48, and 0.30 respectively. In serum level, DR3, DR4, DR9 alleles were the susceptible alleles (all P<0.05) and their merger ORs were 5.58, 1.53, 1.66, 29.78, and 6.65 respectively. HLA-DR2, DR5, and DR7 alleles were the protective alleles (all P<0.05) and their merger ORs were 0.39, 0.51, and 0.50. In genetic type level, DRB1*04, DRB1*0301, DRB1*0901 were the susceptible alleles (all P<0.05) and their merger ORs were 2.19, 6.43, 1.31,3.83, and 8.08. DRB1*07, DRB1*08, DRB1*12, DRB1*13, DRB1*14, DRB1*16, DRB1*0406 alleles were the protective alleles (all P<0.05) and their merger ORswere 0.44, 0.27, 0.45, 0.13, 0.19, 0.40, and 0.27 respectively.Conclusions in the Chinese population, some HLA-DQ, DR alleles are relevant to TID which are not totally the same as non-Chinese populations。

Percutaneous kyphon balloon kyphoplasty has achieved encouraging results in the treatment of osteoporotic compression fractures, both for correcting spinal deformities and relieving pain.1 Although kyphoplasty is a small invasion, the surgery itself has some defects such as more X-ray fluoroscopy time during the operation and accumulation of radiation dose causing harm to patients and operators, and the puncture is hard to achieve in a highly precise location.2 But those problems can be solved effectively with navigator guided puncture and kyphoplasty. The following is the summary of 38 cases treated successfully with the new puncture method in our hospital。

Castleman disease is a rare disorder of the lymphoid system characterized by noncancerous growths that may develop in lymph node tissues throughout the body. Most often this occurs in the neck, mediastinum, and abdomen where lymph nodes aggregate. Here we describe a case of asymptomatic intrapulmonary Castleman disease adjacent to the left pulmonary hilum that mimicked central pulmonary malignancy in a 27-year-old man who underwent curative surgical removal of the mass。

Hangman's fracture means bilateral pedicle fractures of the axis accompanying displacement and angulations between the body of C2 and C3. The injury is often caused as a result of falling down or being involved in a vehicular accident. In 1985, based on the classification of Effendi et al,1Levine and Edwards2 proposed a new classification of Hangman's fracture according to the mechanism, morphology and stability. The Hangman's fracture was classified as type Ⅰ, Ⅱ, IIA and Ⅲ, with type Ⅱ being the most common of the four types.…… Biography：Dr. LU Guo-hua,Correspondence to,Department of Spine Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China (Emai: bingwang20021972 @yahoo.com.cn)

Pneumocystis pneumonia (PCP) is one of the most critical and life-threatening infections in immunocompromised patients with AIDS (especially CD4+ T cell less than 0.2×109/L), hematological malignancies, organ transplantation or connective tissue diseases.1It is caused by a fungus called Pneumocystis firoveci (P. jiroveci, formerly called P. carinii).2Despite treatment with trimethoprim-sulfamethoxazole (TMP/SMZ) and corticosteroids, the morbidity of this disease is often high because of late treatment or contraindications of sulfanilamide. New therapeutic approaches are therefore warranted. Caspofungin, a beta-1, 3-glucan synthesis inhibitor, has shown activity against P. jiroveci in experimental animals,3but clinical trials about this are rare.4-8We here report our clinical experience with caspofungin in salvage treatment of severe PCP in a patient with chronic myelomonocytic leukemia (CMML) and uremia。

To the Editor: I read with interest the case report of Takotsubo cardiomyopathy in a Chinese woman.1 Unfortunately, the authors mistakenly attributed the original description of this syndrome to Tsuchihashi et al in 2001.2Actually Dote et al3 first described this syndrome in 1991, ten years before Tsuchihashi et al did.2 Incidentally, the authors did make a reference in their case report to the article by Dote et al3 which was cited as reference 1。