软脉灵对大鼠非酒精性脂肪肝的预防作用

目的:观察软脉灵对非酒精性脂肪性肝病大鼠模型的预防作用.方法:采用高脂膳食喂养方式建立大鼠非酒精性脂肪性肝病模型.♂SD大鼠90只,随机分为模型组、药物组与空白对照组,每组30只.模型组应用高脂饲料喂养,药物组在高脂饲料喂养同时应用软脉灵灌胃,空白对照组应用基础饲料喂养.每组均于8,12及16 wk时各处死10只,观察肝脏指数,血清与肝组织生化指标及肝组织病理改变.结果:16 wk时与模型组相比较,药物组肝脏指数显著降低(F=51.626,P=0.000);血清胆固醇(CHOL)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-c),丙氨酸转氨酶(ALT)及谷草转氨酶(AST)水平明显降低(2.27±0.38 mmol/L VS 3.09±0.45 mmol/L;0.83±0.13 mmol/L vs 1.03±0.18 mmol/L;0.41±0.06 mmol/L vs 1.09±0.27 mmol/L;52.0±6.50 U/L vs 79.0±4.72 U/L;182.9±26.43 U/L vs 326.5±28.21 U/L;均P<0.01),但血清高密度脂蛋白胆固醇(HDL-c)水平提高(0.76±0.17 mmol/L vs 0.55±0.11 mmol/L,P<0.01);肝组织丙二醛(MDA)水平降低明显(167.2±14.00 mmol/g vs 263.6±26.84 mmol/g,P<0.01),超氧化物歧化酶(SOD)活力增加显著(9.95±0.33 U/g vs 4.36±0.46 U/g,P<0.01),肝组织脂肪变性程度(χ~2 =19.828-20.470,均P=0.000)和炎症活动度(F =10.170,P=0.000)明显减轻.结论:软脉灵具有预防大鼠非酒精性脂肪性肝病的作用.     

贞清方对2型糖尿病并发非酒精性脂肪肝大鼠LXRα表达的影响

目的:探讨贞清方对2型糖尿病非酒精性脂肪肝的治疗作用及可能机制.方法:高脂高糖饮食结合小剂量链脲佐菌素(STZ)腹腔注射建立2型糖尿病并发非酒精性脂肪肝大鼠模型.将成模大鼠随机分为模型组、贞清方治疗组和女贞子治疗组( n= 8),并设立正常对照组( n = 10),灌胃治疗8 wk.比较喂养4、8和16 wk时各组大鼠空腹血糖(FBG)、血清甘油三酯(TG)、总胆固醇(TC)、胰岛素(FINs)和胰岛素敏感指数(ISI)的变化.并于喂养16 wk时观察各组大鼠肝脏指数、TG含量和血清丙氨酸转氨酶(ALT)的水平以及病理变化.用PCR法观察大鼠肝X受体(LXRα)及其下游固醇调节元件结合蛋白-1c(SREBP-1c) mRNA的表达,免疫组织化学法观察肝脏LXRα蛋白的表达.结果:灌胃干预8 wk后,与正常组相比,模型组大鼠FBG、血清TG、肝脏指数及肝脏TG含量明显升高(均P<0.01),胰岛素敏感性明显降低( P<0.01),肝脏脂肪变明显加重,肝脏LXRα mRNA、SREBP-1c mRNA和LXRα蛋白的表达明显增多(均P<0.01).与模型组相比,贞清方治疗组大鼠FBG水平、血清TG水平、肝脏指数及肝脏TG含量明显降低(10.94±3.33 mmol/L vs 16.67±4.33 mmol/L; 0.79±0.27 mmol/L vs 1.33±0.33 mmol/L; 5.72±0.81vs 7.61±1.24; 0.041±0.0110 mmol/g vs 0.059±0.0160 mmol/g,均P<0.01),肝脏脂肪变明显改善,肝脏LXRα mRNA、SREBP-1c mRNA和LXRα蛋白的表达明显减少(0.75±0.11 vs1.23±0.17,0.68±0.16 vs 1.07±0.14,0.220±0.071 vs 0.334±0.037,均P<0.01).结论:贞清方对2型糖尿病性非酒精性脂肪肝具有一定的治疗作用,且其治疗作用可能与贞清方能下调非酒精性脂肪肝组织LXRα的表达有关.     

高脂血症和高脂血症性脂肪肝大鼠肾上腺髓质素2的变化

目的:研究高脂血症、高脂血症性脂肪肝大鼠血浆及肝组织ADM2/IMD的变化,探讨ADM2/IMD在高脂血症、高脂血症性脂肪肝病理过程中的意义.方法:雄性SD大鼠16只,随机均分为对照组与高脂组.大鼠被高脂喂食造模4 wk后,观察大鼠肝脏病理学变化,测定血脂(TG,TC,HDL-C,LDL-C)及肝功能(ALT,AKP);放免法测定血浆及肝组织匀浆ADM2/IMD含量.结果:高脂组体质量、肝质量及肝指数(肝质量/体质量)均显著高于对照组(P<0.01)肝组织呈轻中度脂肪变.高脂组TG、TC、LDL-C、ALT及AKP均显著高于对照组(0.29±0.05 mmol/L vs 0.18±0.09 mmol/L.2.49±0.35 mmol/L vs 1.25±0.16 mmol/L.1.69±0.18 mmol/L vs 0.49±0.06 mmol/L.25.46±5.14 kU/ L vs 13.15±2.83 kU/L,416.1±42.7 U/L vs 281.2±47.3 U/L;P<0.01).HDL-C则低于对照(0.65±0.11 mmol/L vs 0.75±0.10 mmol/L,P<0.01).血浆ADM2/IMD水平两组间差异无统计学意义(P>0.05);但高脂组肝组织匀浆ADM2/IMD水平较对照组高115%(26.21±11.2 pg/mg·pro vs 12.18±2.9 pg/mg·pro,P<0.01).结论:ADM2/IMD可能与大鼠饮食性高脂血症和高脂血症性脂肪肝病理进程有关.     

大鼠非酒精性脂肪肝造模方法的改进

目的:快速建立一种非酒精性脂肪肝大鼠模型.方法:24只♂SD大鼠随机平均分为正常组、常规组和改良组,分别喂普通基础饲料、常规用高脂饲料及常规高脂饲料 蔗糖 丙基硫氧嘧啶 胆酸钠.5 wk内动态观察三组大鼠的一般情况、体质量变化,均5 wk处死,观察大鼠肝脏病理形态变化,苏丹Ⅳ染色和电镜检测了解大鼠肝细胞胞质内脂滴存在情况,并比较三组大鼠血清甘油三酯(TG)、胆固醇(TC)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平、丙二醛(MDA)含量和超氧化物歧化酶(SOD)活力及肝组织甘油三酯(TG)、胆固醇(TC)含量的变化.结果:第4周开始正常组和改良组两组大鼠与常规组体质量之间有显著性差异(249.63±34.25,241.88±20.75 vs 275.38±6.59,P<0.05),改良组与正常组之间体质量无显著性差异(P>0.05).第5周在光镜下见改良组大鼠肝细胞内弥漫大量的脂肪空泡,电镜和苏丹Ⅳ染色证实肝细胞内有大量脂滴.肝脂肪变性程度为 ～ (H=13.36,P=0.0003),正常组和常规组大鼠肝细胞内未见明显脂肪变性.改良组大鼠血清TG,TC,ALT水平和MDA含量均高于正常组和常规组(TG:1.28±0.61 mmol/L vs 0.72±0.12,0.76±0.04 mmol/L;TC:12.78±1.47 mmol/L vs 1.71±0.03,2.31±0.49 mmol/ L;ALT:1518.64±186.04 nkat/L vs 1181.57±37.84,1262.92±159.20 nkat/L;MDA:13.40±4.24μmol/L vs 5.89±1.05,7.23±1.15μmol/L;均P<0.05),常规组与正常组比无显著差异(P>0.05);而改良组血清SOD活力显著低于正常组和常规组(5.21±0.81 nkat/mL vs 11.91±2.69,11.19±0.78 nkat/mL,P<0.05).肝组织TG,TC含量常规组和模型组均比正常组有增高(TG:2.14±0.26,5.83±1.42 mmol/L vs 1.20±0.16 mmol/L,P<0.05;TC:3.19±0.23,9.63±1.12 mmol/L vs 2.13±0.16 mmol/L,P<0.05),常规组与改良组也有显著差异(P<0.05).结论:通过与利用常规高脂饲料建模的方法比较,该改良方法5 wk成功地构建了非酒精性脂肪肝大鼠模型,缩短了建模时间,降低了实验成本且模型基本符合人类发病的自然状态,是一种理想的建模方式.     

猕猴桃果仁油对小鼠非酒精性脂肪性肝病的作用

目的:观察猕猴桃果仁油对小鼠非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD) 的保护作用,并初步探讨其作用机制. 方法:健康,♂小鼠50 只,随机分为:对照组、模型组和果仁油低、中、高剂量组[90 、180 、270 mg/(kg·d)]5 组. 除对照组用普通饲料喂养外,其余各组均给予高脂饲料喂养. 实验6 wk 后处死全部小鼠,比较各组之间血清和肝脏生化以及肝脏组织病理学特征. 结果:与对照组相比,模型组小鼠血清TG 、TC 、ALT 、AST 和肝组织MDA 显著升高(均P<0.01),肝组织SOD 和GSH-Px 显著降低(均P<0.01);果仁油中、高剂量组小鼠血清TC 、TG 、ALT 、AST 及肝组织MDA 显著低于模型组(TC:3.05±0.32 mmol/L,2.55±0.43 mmol/L vs 4.55±0.23 mmol/L;TG:1.62± 0.68 mmol/L,1.56±0.57 mmol/L vs 1.90±0.55 mmol/L;ALT:76.91±16.32 U/L,64.54±11.32 U/L vs 170.34±9.32 U/L;AST:128.26±20.15 U/L,112.74±21.37 U/L vs 158.86±18.45 U/L;MDA:5.16±0.97 U/mg,5.01±1.14 U/mg vs 5.88±1.07 U/mg,P <0.05 或0.01),肝组织SOD 和GSH-Px 的显著高于对照组(均P<0.05);模型组小鼠肝脏脂肪变性严重,并伴有炎细胞浸润及坏死,而果仁油中、高剂量组小鼠肝脏脂肪变性程度轻,无明显炎细胞浸润及坏死. 结论:猕猴桃果仁油对高脂饲料诱导的小鼠非酒精性脂肪性肝病有明显的保护作用.     

应用磁共振氢谱技术评价中药肝脂消胶囊治疗非酒精性脂肪肝的疗效

目的:应用磁共振氢谱(~1H-MRS)技术定量评价复方中药肝脂消胶囊治疗非酒精性脂肪肝(NAFLD)的疗效.方法:依中华医学会NAFLD诊断标准入选NAFLD患者22例,并与20例健康人对照.两组均进行常规体检,包括体质量指数(BMI)、腰臀比(WHR)、血压(BP)、血清谷丙转氨酶(ALT)、空腹血糖(FBG)、胆固醇(TC)、三酰甘油(TG)、尿酸(UA)和肝脏~1H-MRS扫描,计算肝内脂质含量(IHCL).NAFLD组患者服用肝脂消胶囊8 wk,检测治疗前后血清生化指标和IHCL的变化.结果:NAFLD组BMI,WHR,DBP,ALT,FBG,TG,UA,IHCL分别较正常组(BMI:28.4±2.4 vs 21.7±2.2.WHR:0.91±0.04 vs 0.83±0.04,DBP:80±10 mmHg vs 72±8 mmHg,ALT:71.5±24.8 U/L vs 20.4±10.1 U/L.FBG:5.67±0.61 mmol/L vs 4.72±0.43 mmol/L.TG:2.48±1.46 mmol/L vs 1.05±0.40 mmol/L.UA:420.7±57.5μmol/L vs 372.1±50.6μmol/L,IHCL:27.49%±12.27%vs 1.34%±0.79%,P<0.05或P<0.01)明显升高,但IHCL和上述指标之间没有明显相关性.经治疗后ALT(54.6±19.9 U/L,P<0.01),TG(2.14±1.38 mmol/L,P<0.05),IHCL(19.7%±12.7%,P<0.01)均明显下降.结论:肝脏~1H-MRS扫描可对肝脏内脂质含量进行准确定量,肝脂消胶囊可有效治疗NAFLD.     

罗格列酮对高脂饮食诱导非酒精性脂肪肝大鼠胰岛素抵抗及脂联素的影响

目的:探讨罗格列酮对高脂饮食所致的非酒精性脂肪肝大鼠模型胰岛素抵抗及脂联素的影响.方法:30只大鼠随机分为3组,即模型组(高脂饮食 蒸馏水ig),空白对照组(正常饲料 蒸馏水ig)和罗格列酮组[高脂饮食 罗格列酮3 mg/(kg·d)ig].观察各组血脂、肝功、胰岛素抵抗指数(HOMA-IR)的变化和各组肝组织HE染色与脂肪特异性的苏丹Ⅲ染色的变化.采用实时荧光定量聚合酶链式反应(PCR)和免疫印迹(western blot)检测各组肝组织的脂联素水平.结果:模型组与空白对照组相比,甘油三酯(TG)(1.51±0.37 mmol/L vs 0.98±0.51 mmol/L,P<0.01),总胆固醇(TC)(2.74±0.65 mmol/L vs 1.71±0.37 mmol/L,P<0.05),ALT(450.20±244.12 U/L vs 264.56±48.44 U/L,P<0.011,AST(460.30±310.13 U/L vs 196.11±52.23 U/L,P<0.01)和HOMA-IR(3.46±1.16 vs 1.07±0.26,P<0.01)均显著升高.罗格列酮治疗可使TG(1.27±0.50 mmol/L),ALT(360.26±244.37 U/L,AST(300.20±233.13 U/L)以及HOMR- IR(1.44±0.37)得到明显改善(均P<0.05).从组织病理学亦可得到证实.肝组织实时荧光定量PCR及免疫印迹显示罗格列酮组的Adiponectin mRNA(552.40±268.13 vs 215.95±135.87,P<0.05)和蛋白表达均较模型组升高.结论:高脂饮食可诱导大鼠NAFLD和IR发生,并使肝功,血脂异常升高.罗格列酮可以改善高脂饮食大鼠的脂肪肝及IR情况,可能与Adiponectin缓解IR和NAFLD改善有关.     

非酒精性脂肪性肝病大鼠高脂饮食后改为普通饮食的实验观察

目的明确高脂饮食后改为普通饮食对大鼠非酒精性脂肪性肝病(NAFLD)的防治效果。方法 23只SD大鼠随机分为正常对照组(NC,n=8)、高脂模型组(HF,n=7)、高脂后改正常饲料组(HF+CD,n=8),16周后处死大鼠。检测大鼠体重、肝重、血生化、血脂肪细胞因子及肝脏TG水平;检测肝脏脂质合成及炎症因子mRNA及肝脏病理。结果与HF组比较,HF+CD组肝脏指数[(3.10±0.58)%vs(2.43±0.17)%]、ALT[(210.66±39.19)vs(175.00±18.94)U/L]、血清TGI-(0.71±0.08)vs(0.51±-0.14)mmol/L]、肝脏TG[(7.94-±-1.38)vs(6.09±1.62)μmol/L]及肝脏NF-κB mRNA[(2.28±0.24)vs(1.60±0.25)]均下降(P0.05或P0.01),其他指标及肝脏病理改变不明显。结论高脂饮食后改普通饮食对高脂NAFLD模型大鼠有治疗作用,但更积极的药物、限制热卡等治疗可能更有效。     

代谢综合征小鼠肝脏过氧化物增殖体受体γ共同作用因子-1的表达

目的:探讨代谢综合征小鼠肝脏过氧化物增殖体受体γ共同作用因子-1(PGC-1)表达.方法:进正常食C57BL/6J小鼠10只、进高脂高糖食8 wk小鼠5只及16 wkd小鼠10只.测定血脂、血清胰岛素(INS)及空腹血糖、肝功、肝脏重质量、腹部瘦肉及瘦肉含量,肝脏脂质含量及PGC-1蛋白表达采用Western blot免疫印迹,并做肝脏病理.结果:进高脂高糖食16 wk的小鼠腹部脂肪量、血清甘油三酯(TC)和空腹血糖(FBG)均明显高于正常小鼠(腹部脂肪量:3.63±0.62 vs 2.99±0.31.P<0.01:TC:2.31±0.16 mmol/L vs 2.04±0.15 mmol/L.P<0.01:FBG:6.90±1.84 mmol/L vs 5.11±1.86 mmol/L.P<0.05).高脂高糖食的动物血清TP、ALB及A/G低于正常动物,其中进食16 wk的动物ALB及A/G有显著差异(ALB:18.12±2.63 g/L vs 21.64±3.38 g/L,P<0.05;A/G:0.89±0.15 vs 1.06±0.18,P<0.05).血清ALT,ALP及AST高于正常动物,其中进食16wk的动物的ALP有显著差异(103.80±8.72 U/L vs 64.60±10.67 U/L,P<0.05).高脂高糖食小鼠肝脏有明显脂肪变性,16 wk重于8 wk的小鼠.16 wk进高脂高糖食的小鼠肝脏的TC和TG含量显著高于正常动物,达到正常的2倍以上(TC:0.0582±0.0251 mnlol/g干重vs 0.0275±0.0114 mmol/g干重,P<0.01;TG:0.1566±0.0166 mmol/g干重vs 0.063 1±0.0232 mmol/g干重,P<0.01).高脂高糖食小鼠肝脏PGC-1表达高于正常动物,16 wk强于8wk的小鼠.结论:高脂高糖食C57BL/6J小鼠可作为代谢综合征动物模型,其存在脂肪肝,肝脏的PGC-1蛋白表达量高于正常食小鼠,可能其参与脂肪肝的形成.     

高脂饮食诱导幼鼠脂肪肝模型的建立及其相关代谢研究

目的 通过高脂饮食诱导幼龄大鼠建立非酒精性脂肪性肝病(NAFLD)模型.方法 3周龄刚离乳SD大鼠30只,雌雄各半,随机分为正常(N)组、20%高脂饮食组(HFI组)、30%高脂饮食组(HF2组).无特定病原环境下饲养6周,第6周末处死大鼠,分别进行如下检测:(1)身长、体质量、肝脏质量测量,计算肝指数;(2)采血测空腹ALT、AST、甘油三酯(TG)、总胆固醇(TC)、胰岛素、血糖水平,计算HOMA胰岛素抵抗指数;(3)肝组织匀浆,检测肝脏TG水平;(4)肝组织切片苏木素-伊红染色观察肝组织病理形态,油红O染色显示脂质沉积;(5)免疫组织化学EnVision法染色,显示肝组织固醇调节元件结合蛋白-1、瘦素的表达.组间均数比较采用One-way ANOVA、两两比较采用LSD方法进行统计学分析.结果 病理结果显示模型组大鼠肝脏符合典型的NAFLD病理特征,HF2组内各标本脂肪变性程度较均匀,无动物死亡现象发生;与N组相比,HF2组血清TC显著升高[(2.50±0.39)mmol/L对比(1.82±0.43)mmol/L,P<0.01],肝脏TG含量显著升高[(25.38±13.29)mmol/L对比(12.09±9.59)mmol/L,P<0.01],血清ALT显著升高[(69.80±18.22)U/L对比(48.00±10.45)U/L,P<0.01];与N组相比,HF1组血清TG显著下降[(0.17±0.10)mmol/L对比(0.32±0.12)mmol/L,P<0.05];血糖水平显著升高[(12.33±3.48)mmol/L对比(8.13±2.53)mmol/L,P<0.05];各组血清AST、胰岛素、及HOMA胰岛素抵抗指数差异无统计学意义;模型组肝组织固醇调节元件结合蛋白-1、瘦素表达增加.结论 30%高脂饲料饲养6周,可以诱导幼龄大鼠建立NAFLD模型,高脂饮食导致幼鼠肝脏固醇调节元件结合蛋白-1表达增加,脂肪合成增加,瘦素表达增加.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.