A novel individualized substrate modification approach for the treatment of long-standing persistent atrial fibrillation: Preliminary results

Background

The most effective approach for long-standing persistent atrial fibrillation (LPAF) ablation remained undetermined. Our goal was to explore the heterogeneous left atrial substrate in patients with LPAF and to evaluate the effectiveness of a novel individualized substrate modification (ISM) approach in LPAF ablation.

Methods

One hundred and twenty-four patients with LPAF were randomized to ISM group (n = 64) or stepwise ablation (SA) group (n = 60). After pulmonary vein isolation, ISM was performed in the ISM group and SA was applied in the SA group. The clinical effectiveness after a single and a repeated procedure was compared.

Results

The total procedural time was significantly shorter in ISM than that in SA. In the ISM group, mild left atrial substrate was observed in 17 (27.4%), moderate in 26 (41.9%) and severe in 19 (30.6%) patients after successful cardioversion of the 62 patients. The intention-to-treat analysis showed that sinus rhythm was maintained in 65.5% of patients in the ISM group and in 45.0% of patients in the SA group after a single procedure, P = 0.04. Atrial tachycardia (AT) recurred in 5 of 22 in the ISM group and in 20 of 33 in the SA group, P = 0.01. After a repeated procedure, 75% of patients in the ISM group and 63.3% of patients in the SA group were free of further recurrence, P = 0.16.

Conclusions

Left atrial substrate varied noticeably in patients with LPAF. The ISM approach was superior to SA approach in terms of procedural time, recurrence rate of AT and clinical effectiveness after a single procedure. However, they yielded comparable outcomes after a repeated procedure.     

3,4-亚甲二氧苯基甲酰吗啉与AMPA受体的结合作用研究

目的 研究3,4-亚甲二氧苯基甲酰吗啉（化合物1）与AMPA受体的结合作用。方法 采用放射性配体受体结合试验测定化合物1与AMPA受体结合的IC₅₀值;采用分子对接技术研究化合物1与AMPA受体的结合能力和结合模式。结果 化合物1与AMPA受体结合的IC₅₀值为1.74×10^-9 mol·L^-1,具有较强的结合能力;化合物1与AMPA受体的结合能为-5.46 kcal·mol^-1,同样表明结合能力较强。结合的驱动力主要是氢键、疏水作用和静电作用。化合物1结构中O原子可与AMPA受体的Ser108、Ser242氨基酸残基形成氢键,这可能是该化合物与AMPA受体结合的重要位点。结论 化合物1可与AMPA结合,且结合能力较强。     

Understanding the knowledge,attitudes and beliefs of community-dwelling older adults and their carers about the modification of oral medicines: A qualitative interview study to inform healthcare professional practice

BackgroundOral medicines are commonly modified (e.g. tablets split/crushed) to meet the dosing and swallowing requirements of older adults. However, there is limited research investigating the opinions of community-dwelling patients and carers about medicine modification.ObjectivesThe aim of this study was to investigate the views of community-dwelling older adults and their carers about oral medicine modification.MethodsSemi-structured, face-to-face interviews were conducted with community-dwelling older adults and carers of older adults who experienced difficulty swallowing medicines, or who required medicines to be modified. Participants were recruited from purposively selected community pharmacies using a combination of purposive, convenience and snowball sampling. Interviews were audio-recorded, transcribed verbatim and analysed thematically. The Francis method governed when data saturation had been reached.ResultsTwenty-six interviews (13 patients, 13 carers) were conducted (76.9% female, median length 11 min (IQR 8–16 min)). Four themes emerged from the data: variation in medical needs and preferences; balancing acceptance and resignation; healthcare professional engagement and; opportunities for optimising formulation suitability. The heterogeneity of medical conditions experienced by community-dwelling older adults resulted in a variety of modifications being required. Patients and carers are accepting of their medications and formulations. However, when challenges arise, they tend to feel resigned to coping within the constraints of the current medication regimen, resulting in a lack of focused communication with healthcare professionals. Thus, healthcare professionals were unaware of their difficulties and unable to offer advice or solutions.ConclusionHealthcare professionals must engage proactively with this group. Whilst a holistic approach to medication management is ideal, the disadvantage is that no single healthcare professional may identify this as their responsibility. Whilst the input and expertise of all healthcare professionals will be required, as medication experts, the pharmacy profession should take ownership and become the champion of, and for, the patient.     

分子生物学技术在利什曼病诊断中的应用

利什曼病是一种危害非常严重的寄生虫病。病原学检查被认为是利什曼病诊断方法的“金标准”。但是在实际防治中,病原学检查存在费时费力,需要专业的现场及实验室技术人员,在大规模流行病学调查中不易实施,同时敏感性受所检材料的影响且不能进行虫种鉴别等缺点。近年来,分子生物学技术的快速发展为利什曼病的诊断提供了新途径,以分子或DNA为基础的利什曼病诊断方法不断涌现。本文就利什曼病诊断的研究进展,特别是分子生物学技术在这一领域的应用进行综述。     

自制定位器引导模板辅助PET分子成像定向肺活检术

目的探讨自制定位器引导模板辅助技术在正电子发射断层扫描(PET)分子成像定向肺部结节穿刺活检中的应用价值,评估其准确性和安全性。方法收集2018年1月至2018年12月因疑诊为肺癌而需要接受PET分子成像定向肺部结节穿刺活检术的病例60例,采用随机数字表法将研究对象分为观察组(n=30,使用定位器引导模板辅助技术)和对照组(n=30,使用常规徒手操作),比较两组间穿刺针到达预定位置的一次性成功率、穿刺操作时间以及咯血和气胸等并发症的发生率等。结果观察组穿刺针一次性成功率明显高于对照组(86.7%比36.7%,χ^2=15.864,P<0.001);穿刺操作时间明显短于对照组[(21.44±5.75)min比(38.20±8.74)min,t=-8.289,P<0.001];患者并发症发生率明显低于对照组(6.7%比26.7%,χ^2=4.320,P=0.038)。结论自制定位器引导模板辅助技术可使CT实时引导下的PET分子成像定向肺活检术更加精确,缩短操作时间,有效降低并发症发生率,可在临床推广。