EBUS-TBNA超声内镜对纵隔肿大淋巴结良恶性的鉴别诊断价值

目的:分析超声内镜引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration，EBUS-TBNA)术中肿大纵隔淋巴结的超声图像特点，探讨EBUS-TBNA超声内镜对纵隔淋巴结良恶性的鉴别诊断价值，以期提高EBUS-TBNA对纵隔淋巴结恶性病变的活检率。方法:回顾性分析2014年10月至2018年11月行EBUS-TBNA患者的超声内镜图像。我们使用以下EBUS超声内镜特征来预测淋巴结的良恶:回声，长轴长度，短轴长度，纵横比，形态，边界，淋巴门有无，淋巴结内血流信号分级。将超声检查结果与最终病理结果或临床随访结果进行比较。采用SPSS 20.0软件进行统计学分析，采用logistic回归分析评价肿大淋巴结EBUS-TBNA超声内镜下的特征与良恶性的相关性，以 P<0.05 为标准判定差异有统计学意义。结果:对130例纵隔淋巴结肿大患者的227个淋巴结进行回顾性分析，67.4%的肿大淋巴结被证实为恶性转移。Logistic回归分析显示回声、长轴及短轴的长度、正常淋巴门结构的消失是诊断恶性淋巴结的独立预测因素。结论:纵隔恶性淋巴结具有一定的超声特征，可以通过这些超声特征提高EBUS-TBNA对纵隔恶性淋巴结的检出率。     

Renal Denervation for Treatment of Cardiac Arrhythmias: State of the Art and Future Directions

Renal Denervation for Treatment of Cardiac Arrhythmias . It has now been more than a quarter of a century since modulation of the sympathetic nervous system was proposed for the treatment of cardiac arrhythmias of different origins. But it has also been some time since some of the early surgical attempts have been abandoned. With the development of ablation techniques, however, new approaches and targets have been recently introduced that have revolutionized our way of thinking about sympathetic modulation. Renal nerve ablation technology is now being successfully used for the treatment of resistant hypertension, but the indication spectrum might broaden and new therapeutic options might arise in the near future. This review focuses on the possible impact of renal sympathetic system modulation on cardiac arrhythmias, the current evidence supporting this approach, and the ongoing trials of this method in electrophysiological laboratories. We will discuss the potential roles that sympathetic modulation may play in the future.     

Clinical Evaluation of Automatic Tachycardia Diagnosis by an Implanted Device

Reliable discrimination between sinus tachycardia (ST) and pathologic tachycardia has been a major problem for automatic implantable antitachycardia devices. In patients whose sinus response to activity is as rapid or faster than their pathologic tachycardia (rate crossover), these unsophisticated devices deliver the programmed tachycardia response to either the pathologic or sinus tachycardia. Over a one-year period, 50 Intermedics Intertach Model 262–12 antitachycardia pulse generators were implanted to evaluate the specificity of a new group of tachycardia recognition algorithms. Patients were subjected to exercise testing and noninvasive programmed stimulation to demonstrate the efficacy of this new approach. The five recognition algorithms tested were various combinations of the following criteria: high rate HR), sudden onset (SO), rate stability (RS), and sustained high rate (SHR). False positive rates (tachycardia response inappropriately triggered by ST) were as follows: HR (93%); HR + SO (3%); HR + RS (63%); HR + (RS or SHR) (87%); HR + HS + SO (8%). Pair-wise significance testing between HR only and HR + SO (p < 0.001), HR + RS (p = 0.01) and HR + SO + RS (p < 0.001), demonstrated a significant reduction in the rate of false positives through the use of the sudden onset and rate stability criteria in concert with the standard high rate criterion.     

针刺夹脊穴治疗痉挛型脑瘫的临床研究

目的:观察针刺夹脊穴治疗痉挛型脑瘫的临床疗效。方法:将62例痉挛型脑瘫患者随机分成两组,治疗组采用针刺夹脊穴,对照组采用假针刺,每日针刺1次,10次为1个疗程,共治疗6个疗程,所有病例均配合常规的康复治疗。同时以修订的Ashworth量表(MAS)、粗大运动功能量表(GMFM)、儿童功能独立检查(WeeFIM)作观察指标,观察评定两组的治疗结果。结果:治疗后两组MAS评分均明显降低(P<0.01),且治疗组MAS评分明显低于对照组(P<0.05);治疗后两组患者的GMFM评分、WeeFIM评分均明显提高(P<0.01),且治疗组GMFM评分、WeeFIM评分明显高于对照组(P<0.01,P<0.05)。治疗组总有效率为84.4%,对照组总有效率为63.3%,两组比较差异具有显著性意义(P<0.05)。结论:针刺夹脊穴治疗痉挛型脑瘫患者的临床疗效确切。     

Identification of differentially expressed proteins in human stage I lung adenocarcinoma and tumor-adjacent tissues with two-dimension gel electrophoresis profiling

Objective： The aim of this study was to establish reproducible two-dimensional electrophoretic assay used for profiling and identification of differentially expressed proteins in human stage I lung adenocarcinoma and paired normal tumor-adjacent tissue. Methods： The proteins from 12 human stage I lung adenocarcinoma tissues and normal tumor-adjacent tissues were separated using isoelectric focusing electrophoresis （the first dimension） and the subsequent homogeneous SDS-polyacrylamide gel electrophoresis （SDS-PAGE） （the second dimension）. The differentially expressed proteins were determined with PDQuest image analysis software, and identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry （MALDI-TOF-MS） and database searching. Results： The well-reproducible 2-DE gel patterns of human stage I lung adenocarcinoma and normal tumor-adjacent tissues were profiled and 26 differentially expressed proteins uncovered. Nine of these 26 protein spots were cut out from the preparation gels and determined with MALDI-TOF-MS. Searching against the protein database, four candidate proteins were identified. They were 60S acidic ribosomal protein P2, Cathepsin B1, Apolipoprotein A-I precursor, and La 4.1 protein. Conclusion： In this study, high reproducible 2-DE gel protein images of human stage I lung adenocarcinoma and paired normal tumor-adjacent tissues were achieved successfully, and 4 differentially expressed proteins were revealed. These data will be helpful for screen of early biomarker and study of molecular mechanisms of human lung adenocarcinoma.