Subclavian artery stenting: Immediate and mid term clinical follow-up results

BACKGROUND: Intravascular stents are increasingly being used to treat subclavian artery obstructive disease. This study aimed to assess the immediate and midterm clinical outcome of subclavian artery stenting. METHODS AND RESULTS: Total occlusion of the subclavian artery was seen in 7 (28%) out of the 25 consecutive patients treated for subclavican artery stenosis. Mean lesion length was 14 &#45 4.3 mm. The mean preprocedure diameter stenosis was reduced from 83.2 &#45 14.9% to 9.6 &#45 5.4% postprocedure. success was achieved in all patients. Clinical follow-up was obtained in all patients. The initial success was maintained at follow-up (mean = 12 &#45 4 months) in 24 (96%) patients. Recurrence of symptoms occurred in 1 (4%) patient who had an angiographically documented restenosis four months after the procedure. It was successfully redilated. CONCLUSION: Stenting for subclavian artery obstructive disease is safe, technically feasible and has favorable clinical outcomes. It may be considered as the therapy of choice for subclavian artery Procedural obstructive disease. (Int J Cardiovasc Intervent 2000; 3: 231-235)     

Cryothermal Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in a Pediatric Patient after Atrioventricular Canal Repair

Anatomic displacement of the atrioventricular node and associated conduction tissue in atrioventricular septal defects has been previously described. In spite of the increasing use of cryothermal catheter ablation in the pediatric population, there remains very little literature regarding its use in congenital heart disease. We describe successful cryothermal modification of the slow atrioventricular nodal pathway in a 12-year-old patient with a previously repaired partial atrioventricular septal defect and inducible atrioventricular nodal reentrant tachycardia. The use of a steerable catheter to locate the displaced His signal combined with the use of cryothermal energy allowed for the safe and effective treatment of this patient's tachycardia.     

Cost‐of‐illness of chronic leg ulcers in Germany

Chronic wounds are important because of their frequency, their chronicity and high costs of treatment. However, there are few primary data on the cost‐of‐illness in Germany. The aim was to determine the cost‐of‐illness of venous leg ulcers (VLU) in Germany. Prospective cost‐of‐illness study was performed in 23 specialised wound centres throughout Germany. Direct, medical, non medical and indirect costs to the patient, statutory health insurers and society were documented. Thereover, health‐related quality of life (QoL) was recorded as intangible costs using the Freiburg quality of life assessment for wounds (FLQA‐w, Augustin). A total of 218 patients (62.1% female) were recruited consecutively. Mean age was 69.8 ± 12.0 years. The mean total cost of the ulcer per year and patient was € 9569, [ € 8658.10 (92%) direct and € 911.20 (8%) indirect costs]. Of the direct costs, € 7630.70 was accounted for by the statutory health insurance and € 1027.40 by the patient. Major cost factors were inpatient costs, outpatient care and non drug treatments. QoL was strikingly reduced in most patients. In Germany, VLU are associated with high direct and indirect costs. As a consequence, there is a need for early and qualified disease management. Deeper‐going cost‐of‐illness‐studies and cost‐benefit analyses are necessary if management of chronic wounds is to be improved.     

Microdeletions and Microduplications in Patients with Congenital Heart Disease and Multiple Congenital Anomalies

Objective. Multiple genetic syndromes are caused by recurrent chromosomal microdeletions or microduplications. The increasing use of high‐resolution microarrays in clinical analysis has allowed the identification of previously undetectable submicroscopic copy number variants (CNVs) associated with genetic disorders. We hypothesized that patients with congenital heart disease and additional dysmorphic features or other anomalies would be likely to harbor previously undetected CNVs, which might identify new disease loci or disease‐related genes for various cardiac defects. Design. Copy number analysis with single nucleotide polymorphism‐based, oligonucleotide microarrays was performed on 58 patients with congenital heart disease and other dysmorphic features and/or other anomalies. The observed CNVs were validated using independent techniques and validated CNVs were further analyzed using computational algorithms and comparison with available control CNV datasets in order to assess their pathogenic potential. Results. Potentially pathogenic CNVs were detected in twelve of 58 patients (20.7%), ranging in size from 240 Kb to 9.6 Mb. These CNVs contained between 1 and 55 genes, including NRP1, NTRK3, MESP1, ADAM19, and HAND1, all of which are known to participate in cardiac development. Conclusions. Genome‐wide analysis in patients with congenital heart disease and additional phenotypes has identified potentially pathogenic CNVs affecting genes involved in cardiac development. The identified variant loci and the genes within them warrant further evaluation in similarly syndromic and nonsyndromic cardiac cohorts.     

A Novel Approach to Gathering and Acting on Relevant Clinical Information: SCAMPs

The current tools to adequately inform the process of improving health-care delivery consist primarily of retrospective studies, prospective trials, and clinical practice guidelines. We propose a novel and systematic approach that bridges the gap of our current tools to affect change, provides an infrastructure to improve health-care delivery, and identifies unnecessary resource utilization. The objective of this special article is to introduce the rationale and methods for this endeavor entitled “Standardized Clinical Assessment and Management Plans” (SCAMPs). SCAMPs take a relatively heterogeneous patient population and through a process of iterative analysis and modification of standardized assessment and management algorithms, SCAMPs allow the intrinsic biologic variability in a patient population to emerge and be understood. SCAMPs can be used to complement our currently available tools in order to result in incremental and sustained improvement in health-care delivery.     

大鼠伏隔核多巴胺D2受体及转运体与吗啡条件性位置偏爱易感性的关系

Objective To explore the possible role of the expression of dopamine D2 receptor (D2R)and dopamine transporter(DAT)located in the nucleur accumben(Nac)in rats with difierent CPP susceptibility.Methods Altogether 160 male Sprague-Dawley rats were randomly assigned into experiment group(n=130)and control group(n=30).The experiment rats were re-classified into three groups according to the numerical value of the CPP(conditioned place preference),high preference group(HP group,n=26),moderate preference group(n=78)and low preference group(LP group,n=26).At the time of 3 hours,72 hours and 14 days after the final injection,rats in each group were scarified,and the mRNA levels of D2R and DAT in Nac were estimated with in situ hybridization.Results No significant difference of pretest scores staying at the non-preference chamber exist among the three groups(P=0.470),however.the time stayed at the conditioned preference chamber during the test period minus the time stayed at pretest natural preference was significantly higher in the HP group than the LP group(P＜0.01).In each time-point,the expression of D2R mRNA in HP group,were lower that in LP group[(131±3,122±5,119±5)and(125±4,117±8,114±5),P＜0.01].In each time-point,the expression of DAT mRNA in HP group,were significantly lower than that in LP group[(161±5,143±4,134±6)and(156±5,139±3,130±4),P＜0.01].Conclusions It can be inferred that D2R and DAT may be correlated closely and underlie the difierent susceptibility to morphine induced CPP.     

混合性结缔组织病患者血清免疫球蛋白含量和补体C3C4的相关性的研究

目的 探讨混合性结缔组织病患者血清免疫球蛋白含量和补体C3C4相关性的关系及其临床意义. 方法用免疫速率比浊法测定68例混合性结缔组织病患者血清免疫球蛋白和补体C3C4含量,并与70名健康体检者进行对比分析.结果 患者组免疫球蛋白I gA、I gG和补体C3C4的含量与对照组相比有明显差异,差异具有统计学意义(P<0.05).患者组补体C3C4的含量具有直线相关性,(P<0.05).结论 混合性结缔组织病患者血清免疫球蛋白I gA、I gG和补体C3C4的含量与病情有关,可用于病情判断和预后评价.     

MDM2基因多态性与食管鳞癌、贲门腺癌易感性的关系

目的：研究MDM2启动子区SNP309和Dell 518基因多态性与中国河北省高发区人群食管鳞状细胞癌（esophageal squamous cell carcinoma，ESCC）和贲门腺癌（gastric cardiac adenocarcinoma，GCA）易感性的关系。方法：应用引物引入限制性内切酶分析-聚合酶链反应（primer-introduced restriction analysis-polymerase chain reaction，PIRA-PCR）方法，分别检测了351例ESCC患者、212例GCA患者和642例健康对照组人群的MDM2启动子区SNP309和Dell518的基因型。应用EH和2LD软件分析两个多态性位点的相互关系。结果：MDM2基因型分布在总体ESCC患者组和健康对照组间无显著性差异（P〉0．05），而在总体GCA患者组与健康对照组间存在的差异有统计学意义（P〈0．05）。单体型分析显示，MDM2单体型分布在ESCC患者组与健康对照组间差异无统计学意义（P=0．198），而在GCA患者组与健康对照组间有显著性差异（P=0．000）。与SNP309G／Dell518＋单体型相比，检出SNP309T／Dell518-单体型组可显著降低GCA的发病风险（OR=0．51，95％CI=0．38～0．70）。结论：MDM2的SNP309和Dell518多态性与ESCC的发病风险可能无关；携带MDM2SNP309T等位基因的基因型（G／T与T／T）和携带Dell518-等位基因的基因型（＋／-与-／-）可分别降低GCA的发病风险：MDM2SNP309T／Dell518-单体型组可以降低GCA的发病风险。     

腹腔镜联合内镜治疗肝内外胆管结石

目的探讨肝内外胆管结石的腹腔镜联合内镜治疗的方法。方法选择自2002年10月至2007年12月收治的46例肝内、外胆管结石患者，先采用十二指肠镜治疗肝外胆管结石，再联合应用腹腔镜肝切除治疗肝内胆管结石，对围手术期相关指标进行观察分析。结果应用腹腔镜联合内镜方法治疗肝内外胆管结石患者46例，中转开腹2例，术后恢复顺利，无严重并发症。结论腹腔镜联合内镜治疗肝内外胆管结石是一种安全有效的方法，它能最大限度地减少对患者的创伤，充分体现了内镜、腹腔镜联合治疗的优越性。该方法对于内镜、腹腔镜技术较高的医疗单位是切实可行的。