Clinical Experience with an Activity Sensing Pacemaker

During clinical evaluation of the Medtronic * Activitrax pacemaker in a worldwide multicenter study, implant and follow-up data were provided by 61 investigators on 222 patients. Pacing indications included two- and three-degree AV block in 149 and atrial arrhythmias in 174 patients; 16 patients received atrial pacing. Average and longest documented follow-up periods were 7.5 and 16 months respectively. Paired treadmill tests, one in Activity mode and one in VVI/AAI mode, were performed by 120 patients. At peak exercise, average heart rate was 95 bpm in VVI/AAI mode and 118 bpm in Activity mode (p < 0.0001). Average exercise time was 9.4 minutes in VVI/AAI mode and 10.8 minutes in Activity mode (p < 0.0001). In 54 patients who exclusively had paced rhythm during both treadmill tests, average heart rates and exercise times were 70 ppm and 8.1 minutes in VVI/AAI mode and 111 ppm and 10.3 minutes in Activity mode respectively (p < 0.0001). 24-hour Holter recordings typically demonstrated pacing at or near basic rate during periods of rest and appropriate increase in pacing rate during daily activities. Patients had significantly fewer problems with physical effort in daily life during a week of Activity mode pacing than during a week of VVI/AAI mode pacing (p < 0.05) as assessed from the symptom scores recorded by 62 patients in special diaries.     

多层螺旋CT三期增强扫描对肝腺瘤的定量分析

目的分析肝腺瘤的多排螺旋CT影像特征。方法对11例行三期增强扫描的肝腺瘤患者进行分析。结果11例中共发现19个病灶,其CT值在平扫、动脉期、延迟期存在统计学差异,门脉期无统计学差异。动脉期直径≤5cm病灶CT值高于5cm病灶,而其余各期无统计学差异。结论多层螺旋CT三期增强扫描结合定量分析有助于肝腺瘤的诊断及鉴别诊断。     

肾透明细胞癌的CT表现

目的分析肾透明细胞癌的CT影像特点。方法回顾性分析经病理证实的肾透明细胞癌16例,从病灶数目、大小、形态、强化方式及与邻近结构关系等方面总结其CT影像特点。结果本组16例均为单发病灶,多位于肾皮质,形态多为圆形或类圆形,多凸出肾轮廓之外,平均4.7cm(2.2~10cm不等),伴或不伴邻近结构受累;增强扫描大多数(12例)动脉期明显不均质强化,静脉期及分泌期强化程度降低,低于周围肾实质,即典型的"快进快出"式强化,1例动脉期中等度强化,2例仅轻度强化,1例肿瘤内形成动静脉瘘。本组病例其中1例为囊性肾透明细胞癌,内可见多发点状及条状钙化,增强后呈中等强化,囊内容物不强化。结论 CT扫描是肾透明细胞癌的重要检查手段,其较特征性的动脉期强化方式是与其它类型肾癌相鉴别的重要参考依据。     

艰难梭菌毒素B受体结合区CDB3融合蛋白诱导表达条件优化及其纯化

目的：优化艰难梭菌毒素B受体结合区CDB3融合蛋白诱导表达条件，在获得高表达融合蛋白后对其进行纯化，为艰难梭菌毒素B受体结合区CDB3单克隆抗体的制备奠定基础。方法以诱导前菌液600 nm处的光密度值（OD600）、诱导温度、诱导剂异丙基-β-D巯基半乳糖苷（IPTG）浓度和诱导时间为单变量，分别诱导融合蛋白的表达，在此基础上采用正交试验对融合蛋白的诱导表达条件进行优化，通过十二烷基磺酸钠-聚丙烯酰胺凝胶电泳半定量分析融合蛋白的表达量及表达形式，以Western blot对融合蛋白进行鉴定，以GST 亲和层析柱对融合蛋白进行纯化。结果融合蛋白诱导表达的最佳条件为诱导前菌液OD6000．8、IPTG浓度0．6 mmol/L、诱导时间12 h、诱导温度30℃，融合蛋白以可溶性蛋白表达形式为主，经纯化后，融合蛋白纯度超过90％。结论本研究成功优化了艰难梭菌毒素B受体结合区CDB3融合蛋白的诱导表达条件，获得大量表达，并成功对其进行了纯化，为后续单克隆抗体的制备奠定了基础。     

The Process of Transforming Mental Health Services in Australia

Australia commenced a nationally coordinated transformation of its public and private mental health services in 1993. This paper presents an overview of the changes in mental health service delivery using data from the 2004 Australian National Mental Health Report. In the 10 years from 1993 to 2002, government spending on mental health increased 65 percent in real terms, with a 145 percent growth in expenditure for community-based services. Government subsidies to the private psychiatrist sector have declined. Consumer and carer participation in service planning and delivery increased, measures to improve quality introduced and patient level outcome measures are being adopted widely. However, some consumers with specific needs have been neglected and the transformation has not been implemented uniformly across the country.     

Malfunction of Subpectorally Implanted Cardiac Resynchronization Therapy Defibrillators Due to Weakened Header Bond

Malfunction of Subpectorally Implanted Cardiac Resynchronization Therapy . Background: Implantable cardioverter defibrillator (ICD) implantation has increased significantly over the last 10 years. Concerns about the safety and reliability of ICD systems have been raised, with premature lead failure and battery malfunctions accounting for the majority of reported adverse events. We describe the unique mode of presentation, diagnosis, and management of cardiac resynchronization therapy defibrillators (CRT‐D) malfunctions that were caused by weakened bonding between the generator and header. Methods and Results: Between June 2008 and December 2009, 22 Teligen? ICDs and 24 Cognis? CRT‐Ds were implanted subpectorally at our institution, until a product advisory was issued. Of 24 Cognis? CRT‐D implants, 3 patients presented with CRT‐D malfunctions. All our cases presented with initially intermittent and then persisting increases in shock lead impedance, associated with nonphysiological noise in the shock electrogram channels. These issues were rectified by generator change. Postexplant laboratory analysis confirmed inadequate bonding between device header and titanium casing in all cases, resulting in loosening and rocking of the header followed by fatigue‐induced fracture of the shock circuitry. Conclusion: Weakened bonding between the header and generator casing of subpectorally implanted CRT‐Ds can result in fractures and malfunction of the HV circuit. Physicians monitoring patients with devices affected by the product advisory should remain vigilant in order to diagnose and manage similar device malfunction expediently. (J Cardiovasc Electrophysiol, Vol. 24, pp. 351‐355, March 2013)     

First 24 Hours of Acute Pancreatitis

Differences in metabolic Iiomeostasis in 12 patients with initial vs. eight patients with repeated attacks of acute pancreatitis have been compared during the acute phase of the disease. As a group, subjects vvitli a previous history of pancreatitis had significantly lower glucagon concfiitrations (P < 0.002) for the over all 24-hour study period. Conversely, the serum concentrations of blood sugar, insulin. growth hormone, gastrin, cortisol. nonesterified fatty acids, triglycerides and cholesterol failed to distinguish between the two patient groups. Likewise, immunoreactive plasma parathyroid hormone and calcitonin levels were comparable in both patient populations. Of the measurements considered. it would appear therefore that plasma immunoreactive glucagon is the best indicator of previous pancreatic inflanunation. Evaluation of parenchymal integrity during an episode of acute pancreatitis would he ol prognostic therapeutic value in this disease.     

Analysis of heat-shock protein expression in myeloid leukaemia cells by flow cytometry

Expression of heat-shock proteins (hsp) was analysed in the leukaemic cells of 12 patients with acute myeloid leukaemia (AML) and nine patients with chronic myeloid leukaemia (CML). Using monoclonal antibodies to hsp70, hsp90 and hsp60 (ML30, a mycobacterial antigen with homology to human hsp60), we measured hsp levels by flow cytometry of permeabilized cells. Mononuclear cells from 10 healthy volunteers were also examined. The results demonstrate that hsp expression is significantly increased (P<0'01) in the circulating cells of patients with AML compared with cells from CML patients, and compared with normal peripheral blood mononuclear cells. This increased pattern of expression was found for all three heat-shock protein families included in this study. Mononuclear cells from leukaemic patients showed a heterogenous pattern of hsp expression, between different patients, between cells from individual patients, and between the different hsp proteins examined. It is possible that hsp expression relates to the differentiation state or proliferative potential of these leukaemic cells.     

An analysis of the relationship between bile duct stones and periampullary duodenal diverticula

Previous studies have suggested a relationship between bile duct stones and periampullary duodenal diverticula. The aim of the present study was to examine this association in more detail, including step-wise logistic regression to identify independent predictors for the presence of diverticula. Clinical, endoscopic and radiological data were analysed from 794 consecutive subjects with bile duct stones; 44 with primary duct stones (without gall-bladder stones) and 750 with bile duct stones associated with current or previous gall-bladder stones. Frequencies of diverticula in subjects with bile duct stones were compared with those in age-matched controls who had undergone upper gastrointestinal endoscopy using a side-viewing endoscope (n = 100) or who had undergone endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic cancer (n = 100). The frequencies of diverticula in subjects with primary duct stones (70%) and bile duct stones with current or previous gall-bladder stones (25%) were significantly higher than in both control groups (7 and 8%, respectively). When subjects with bile duct stones were analysed by step-wise logistic regression, age and bile duct diameter were independent predictors of the presence of diverticula, but diverticula were unrelated to gender, mode of presentation, number of bile duct stones and outcome after endoscopic sphincterotomy. A significant association exists between duodenal diverticula and bile duct stones, perhaps because diverticula predispose to stone formation through the combined effects of bile stasis and bacterial contamination of bile.     

ARTHRITIS AND INTESTINAL DISEASES: A COMPARISON OF TWO FAMILY STUDIES

A comparison has been made between the results of two familystudies. Ninety-one patients with ulcerative colitis, 116 patientswith Crohn's disease and 449 of their relatives and spouseswere examined clinically and radiologically. A further 96 relativesand spouses were reviewed radiologically only. Intestinal synovitiswas found more frequently in patients with Crohn's disease thanin those with ulcerative colitis. This result was in accordwith published evidence and theoretical considerations. Sacro-iliitiswas found in similar proportions of probands, first-degree relatives,second-degree relatives, and spouses in each study. More ofthe subjects in the ulcerative colitis study were diagnosedas having ankylosing spondylitis, while a greater proportionof subjects with sacro-illtis in the Crohn's disease study werefemale. The possible interrelationship between these facts hasbeen discussed. ^*Formerly William Hewitt Research Fellow: Honorary Senior Registarin Rheumatology, Now Consultant Rheumatologist, South TeessideHospital Group Formerly Research Fellow Professor of Rheumatology