三维电解剖系统指导房性心律失常射频导管消融的价值

目的探讨电解剖系统指导在房性心律失常射频导管消融中的作用和优势。方法对25例心房颤动（阵发性15例、持续性10例）在电解剖系统指导下进行重建左心房后行线性消融，7例持续性房性心动过速（右心房性4例、左心房性3例）在电解剖系统指导下重建左／右心房标测激动顺序后行消融。结果25例心房颤动均完成预定的线性消融，其中14例阵发性者在窦性心律下电学隔离成功，10例持续性和1例阵发性者在心房颤动时电学隔离成功。7例持续性房性心动过速均在消融过程中转为窦性心律。电解剖系统指导下平均手术时间心房颤动为220min，房性心动过速为86min；平均X线透视时间心房颤动为48min，房性心动过速为20min。所有患者手术过程中均无并发症。结论在电解剖系统指引下，环肺静脉电隔离治疗心房颤动安全有效；有助于设计房性心动过速消融径线，缩短手术时间，提高成功率。     

Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomized double-blind study

To determine whether cytomegalovirus (CMV) antigenemiaguided ganciclovir treatment may be as effective, may require less treatment, and thus may cause less marrow toxicity than ganciclovir administered at engraftment, 226 marrow transplant recipients were randomized at engraftment to receive placebo (antigenemia-ganciclovir group) or ganciclovir (ganciclovir group) until day 100 in a double-blind study. In patients with antigenemia of 3 or more positive cells in 2 slides and/or viremia, study drug was discontinued and ganciclovir was started for at least 3 weeks or until negative CMV antigenemia and resumed only if antigenemia recurred. More patients in the antigenemia-ganciclovir group developed CMV disease before day 100 after transplantation compared with the ganciclovir group (14% v 2.7%, P = .002). Of the 16 patients with CMV disease before day 100 in the antigenemia-ganciclovir group, 10 (8.8%) had disease before or during the first episode of antigenemia and 6 (5.3%) developed disease after discontinuation of ganciclovir. Untreated low-grade antigenemia progressed to CMV disease in 19% of patients with grade 3-4 compared with 0% of patients with grade 0-2 acute graft-versus-host disease (P = .04). There was no significant difference in CMV disease by day 180 after transplantation and thereafter. CMV-related death, transplant survival, and neutropenia were not significantly different between the groups. In the ganciclovir group, more invasive fungal infections occurred (P = .03) and more ganciclovir was used (P < .0001). Thus, delaying the start of ganciclovir until highgrade antigenemia and discontinuing ganciclovir based on negative antigenemia results in more CMV disease by day 100 than ganciclovir administered at engraftment. However, ganciclovir at engraftment is associated with more early invasive fungal infections and more late CMV disease resulting in similar survival rates.     

克罗米芬联合促卵泡素治疗30例多囊卵巢综合征的疗效分析

目的探讨分析克罗米芬联合促卵泡素在多囊卵巢综合征（PCOS）治疗中的疗效。方法回顾性分析该院就诊并确诊为PCOS的患者共60例,随机数法分为两组,对照组治疗方案：克罗米芬＋人绒毛膜促性腺激素（HCG）,观察组治疗方案：克罗米芬＋促卵泡素＋人绝经期促性腺激素（HMG）＋HCG,排卵后黄体酮支持治疗两周,比较两组患者促排卵疗效。结果观察组患者排卵率和妊娠率均明显高于对照组（P〈0.05）;观察组患者治疗总有效率明显高于对照组（P〈0.05）。结论克罗米芬联合促卵泡素治疗PCOS促排卵疗效确切,能够有效提高排卵率和妊娠率,推荐临床推广应用。     

Prolonged Atrium Electromechanical Interval Is Associated with Stroke in Patients with Atrial Fibrillation After Catheter Ablation

Electromechanical Interval and Strokes After Ablations of AF . Introduction: Atrial fibrillation (AF) is associated with increased risk of embolic stroke. Catheter ablation of AF provides an effective therapy for patients with symptomatic and drug‐refractory AF. The aim of this study was to evaluate whether the atrial electromechanical interval is useful in identifying patients at risk of stroke after successful catheter ablation. Methods and Results: A total of 279 AF patients who received catheter ablation and showed no evidence of recurrences were enrolled. Electromechanical interval (PA–PDI) was determined as the time interval from the initiation of P wave deflection to the peak of mitral inflow A wave on pulse wave Doppler imaging. The PA–PDI interval was measured for each patient after the 3‐month blanking period of catheter ablation. The clinical endpoint was the occurrence of ischemic stroke. During the follow‐up of 46.5 ± 17.2 months, 6 patients suffered from ischemic strokes. Patients with strokes had higher CHA₂DS₂–VASc scores and longer PA–PDI intervals (138.7 ± 12.4 ms vs 161.2 ± 7.7 ms, P value < 0.001) compared to those without strokes. At a cutoff point of 150 ms identified by ROC curve, the positive and negative predictive values of the PA–PDI interval to predict stroke were 86.7% and 100%, respectively. The PA–PDI interval improved the predictive performance of the CHA₂DS₂–VASc score, and the area under the ROC curve increased from 0.75 to 0.85. Conclusions: Our results suggest that the PA–PDI interval is a useful tool to identify patients with high risk of stroke after successful catheter ablation of AF. (J Cardiovasc Electrophysiol, Vol. 24, pp. 375‐380, April 2013)     

PCI-32765和Bortezomib对B细胞肿瘤细胞系细胞增殖、凋亡的影响及其机制的研究

本研究旨在探讨Btk抑制剂PCI-32765和蛋白酶体抑制剂bortezomib对Raji、Ramos细胞的增殖、凋亡的影响及其作用机制.PCI-32765和bortezomib单药及联合用药处理Raji和Ramos细胞后,分别运用CCK-8法及流式细胞术检测细胞的增殖与凋亡,Western blot法检测Btk、NFκB、c-IAP1、Bcl-xL、caspase-3等蛋白的表达.结果表明：①PCI-32765（0.5、1.0、2.0、3.0、4.0、5.0、6.0μmol/L）和bortezomib（10、20、30、40、50、60、80 nmol/L）处理Raji和Ramos细胞48 h,均可抑制细胞增殖,抑制率呈剂量依赖性,且两药具有协同作用;②PCI-32765（2.0μmol/L）、bortezomib（20 nmol/L）单药及联合用药处理Raji和Ramos细胞不同时间（8、12、24、36、48、72 h）,均可抑制细胞存活率,抑制率呈时间依赖性,且两药具有协同作用;③PCI-32765（2μmol/L）和bortezomib（20 nmol/L）单药及联合用药处理Raji和Ramos细胞48 h,可明显促进Raji及Ramos细胞的凋亡.Raji细胞实验结果,空白对照组、PCI-32765和bonezomib单药组、联合用药组的细胞凋亡率分别为10.34±0.53％、24.26±0.91％、43.66±1.08％与74.06±0.72％,各组间有统计学差异（P＜0.05）;Ramos细胞实验结果,空白对照组、PCI-32765和bortezomib单药组、联合用药组的细胞凋亡率分别为15.16±1.49％、71.36±0.82％、75.32±2.36％与84.30±0.91％,各组间有统计学差异（P＜0.05）;④PCI-32765和bonezomib单药处理Raji、Ramos细胞后,细胞内Btk、NFκB、Bcl-xl及c-.IAP1的表达水平较对照组降低,Caspase-3的表达水平升高,两药联用后,作用增强.结论：PCI-32765和bonezomib可以协同抑制Raji与Ramos细胞的增殖,促进其凋亡,其机制可能与抑制Btk、NFκB的活性,下调Bcl-xl及c-IAP1等抗凋亡蛋白,同时上调Caspase-3等凋亡蛋白的表达而发挥作用.     

New England Medical Center Posterior Circulation Stroke Registry: I. Methods, Data Base, Distribution of Brain Lesions, Stroke Mechanisms, and Outcomes

Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs before strokes, and 16% had only posterior circulation TIAs. Embolism was the commonest stroke mechanism accounting for 40% of cases (24% cardiac origin, 14% arterial origin, 2% had potential cardiac and arterial sources). In 32%, large artery occlusive lesions caused hemodynamic brain infarction. Stroke mechanisms in the posterior and anterior circulation are very similar. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes), while the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Infarcts that included the distal territory were twice as common as those that included the proximal or middle territories. Most distal territory infarcts were attributable to embolism. Thirty day mortality was low (3.6%). Embolic stroke mechanism, distal territory location, and basilar artery occlusive disease conveyed the worst prognosis.     

LATE TENSION PNEUMOCEPHALUS FOLLOWING FRONTAL CRANIOTOMY

Tension pneumocephalus is an uncommon but life-threatening complication of craniotomy which requires urgent diagnosis and treatment. It most often occurs perioperatively following subsequent anaesthesia using nitrous oxide. All previously reported postoperative cases followed posterior fossa or upper spinal cord surgery. Only two cases associated with frontal craniotomy have been reported since 1972, both occurring intraoperatively.     

17-β雌二醇对不同月龄大鼠成骨细胞雌激素受体β表达的影响

目的探讨17-β雌二醇对不同月龄大鼠成骨细胞雌激素受体β（ERβ）表达的影响。方法雌性大鼠颅盖骨经多次酶消化、反复贴壁法分离纯化培养得到大量纯净成骨细胞并进行形态学检查和碱性磷酸酶（ALP）染色;免疫组化法（SABC）进行雌激素受体染色;用10-8mol/L17-β雌二醇处理培养的成骨细胞,SDS-PAGE电泳和western blot法检测雌激素受体。结果成骨细胞碱性磷酸酶染色阳性率为90%以上。形态学检查符合成骨细胞的特征。免疫组化染色显示大鼠的成骨细胞存在雌激素受体β,且位于胞核内。Western blot结果表明,与对照组相比,处理组的各月龄大鼠雌激素受体β表达均有上调。结论17-β雌二醇能提高各月龄组大鼠成骨细胞雌激素受体β表达水平,不同月龄间上调水平不同,以4、8月龄组最为显著。