Recurrent Implantable Cardioverter‐Defibrillator Replacement Is Associated with an Increasing Risk of Pocket‐Related Complications

Background: Despite beneficial effects of implantable cardioverter‐defibrillator (ICD) therapy, limited service life results in replacement within the majority of patients. Data concerning the effect of replacement procedures on the occurrence of pocket‐related adverse events are scarce. In this study, the requirement for pocket‐related surgical re‐interventions following ICD treatment and the effect of device replacement were evaluated. Methods: From 1992 to 2008, 2,415 patients receiving an ICD at the Leiden University Medical Center were analyzed. Pocket‐related complications requiring surgical re‐intervention following ICD implantation or replacement were noted. Elective device replacement, lead failure, and device malfunction were not considered pocket‐related complications. Results: A total of 3,161 ICDs were included in the analysis. In total, 145 surgical re‐interventions were required in 122 (3.9%) ICDs implanted in 114 (4.7%) unique patients. Three‐year cumulative incidence for first surgical re‐intervention in all ICDs was 4.7% (95% confidence interval [CI] 3.9–5.5%). Replacement ICDs exhibited a doubled requirement for surgical re‐intervention (rate ratio 2.2, 95% CI 1.5–3.0). Compared to first implanted ICDs, the occurrence of surgical re‐intervention in replacements was 2.5 (95% CI 1.6–3.7) times higher for infectious and 1.7 (95% CI 0.9–3.0) for noninfectious causes. Subdivision by the number of ICD replacements showed an increase in the annual risk for surgical re‐intervention, ranging from 1.5% (95% CI 1.2–1.9%) for the first, to 8.1% (95% CI 1.7–18.3%) for the fourth implanted ICD. Conclusions: ICD replacement is associated with a doubled risk for pocket‐related surgical re‐interventions. Furthermore, the need for re‐intervention increases with every consecutive replacement. (PACE 2010; 1013–1019)     

Hepatitis B virus reactivation associated with anti‐neoplastic therapy

Reactivation of hepatitis B virus (HBV) infection is a known complication during and after anti‐cancer therapy. This condition can affect two patient populations: it is most commonly seen in patients who are seropositive for hepatitis B surface antigen (HBsAg), but it is also being increasingly reported among patients who are HBsAg‐negative but who have prior infection, as evident by seropositive status for antibody to hepatitis B core antigen (anti‐HBc), irrespective of their anti‐HBs (antibody to HBsAg) status. The clinical course can vary from asymptomatic hepatitis to fulminant hepatic failure that can be potentially fatal. With the increasing use of biological agents in addition to potent cytotoxic chemotherapy in the armamentarium of anti‐cancer treatments, reactivation of hepatitis B has become a common clinical situation that is faced by both oncologists and hepatologists especially in HBV endemic areas. In this review, we discuss the clinical course of reactivation in the two HBV‐infected sub‐populations, and the role of anti‐virals in the prevention and management of HBV reactivation in association with cytotoxic chemotherapy and biological therapies.     

一种新的阿片受点不可逆激动剂7α-二(β-氯乙基)胺甲基-6,14-乙烯撑基四氢奥利文的药理研究

α-CAM是一新的阿片受点不可逆激动剂,在离体组织(GPI,MVD,RVD和RbVD)及大鼠脑P_2膜制备上均表现不可逆作用。对小鼠镇痛(icv)ED_(50)为0.12 nmol/鼠,镇痛作用可持续2～3 d,是迄今所知镇痛时间最长的化合物。一次注射(icv)即可使小鼠成瘾,可作为研究成瘾机理的工具药。     

一种新的阿片受点不可逆激动剂7α-二(β-氯乙基)胺甲基-6,14-乙烯撑基四氢奥利文的药理研究

α-CAM是一新的阿片受点不可逆激动剂,在离体组织(GPI,MVD,RVD和RbVD)及大鼠脑P₂膜制备上均表现不可逆作用。对小鼠镇痛(icv)ED₅₀为0.12 nmol/鼠,镇痛作用可持续2～3 d,是迄今所知镇痛时间最长的化合物。一次注射(icv)即可使小鼠成瘾,可作为研究成瘾机理的工具药。     

Immunohistochemical evidence for a substance P-containing trigeminovascular pathway to pial arteries in cats

Immunoreactive substance P-containing fibers were examined in large pial arteries from 3 cats 21–28 days following unilateral trigeminal ganglionectomy. The number and density of fibers decreased dramatically in arterior, middle and posterior cerebral arteries ipsilateral to the lesion. By contrast, no changes were present in basilar and other arteries supplying posterior fossa. These observations support the existence of a trigeminovascular substance P-containing pathway to large pial arteries supplying forebrain structures.     

Dual ultrastructural immunocytochemical labeling of μ and δ opioid receptors in the superficial layers of the rat cervical spinal cord

The δ opioid receptor (DOR) and μ opioid receptor (MOR) are abundantly distributed in the dorsal horn of the spinal cord. Simultaneous activation of each receptor by selective opiate agonists has been shown to result in synergistic analgesic effects. To determine the cellular basis for these functional associations, we examined the electron microscopic immunocytochemical localization of DOR and MOR in single sections through the superficial layers of the dorsal horn in the adult rat spinal cord (C2–C4). From a total of 270 DOR-labeled profiles, 49% were soma and dendrites, 46% were axon terminals and small unmyelinated axons, and 5% were glial processes. 6% of the DOR-labeled soma and dendrites, and <1% of the glial processes also showed MOR-like immunoreactivity (MOR-LI). Of 339 MOR-labeled profiles, 87% were axon terminals and small unmyelinated axons, 12% were soma and dendrites, and 2% were glial processes. 21% of the MOR-labeled soma and dendrites, but none of the axon terminals also contain DOR-LI. The subcellular distributions of MOR and DOR were distinct in axon terminals. In axon terminals, both DOR-LI and MOR-LI were detected along the plasmalemma, but only DOR-LI was associated with large dense core vesicles. DOR-labeled terminals formed synapses with dendrites containing MOR and conversely, MOR-labeled terminals formed synapses with DOR-labeled dendrites. These results suggest that the synergistic actions of selective MOR- and DOR-agonists may be attributed to dual modulation of the same or synaptically linked neurons in the superficial layers of the spinal cord.     

药用鼠尾草属植物中7种脂溶性成分的HPLC法分析

采用YWG-C₁₈H₃₇柱,以甲醇-水(77:23)为流动相,在254nm检测波长下用内标法测定了9种药用鼠尾草属植物中丹参酮Ⅱ-B、紫丹参甲素、二氢丹参酮Ⅰ、隐丹参酮、丹参酮Ⅰ、丹参酮Ⅱ-A及红根草邻醌的含量。     

Some cholecystokinin-8 immunoreactive fibers in large pial arteries originate from trigeminal ganglion

Cholecystokinin-8 immunoreactive (CCK8I) nerve fibers were demonstrated in whole mount preparations and cross-sections of pial blood vessels in the cat, guinea pig and rat using a specific antiserum and the avidin-biotin-peroxidase complex method. Positive fibers were present in nearly all pial arteries examined, and were located in the adventitial layer and at the junction of the adventitia and media. In general, CCK8I fibers were less abundant than substance P immunoreactive (SPI) fibers visualized in the same vessels. A marked depletion of CCK8I was noted in large cerebral arteries following treatment of adult guinea pigs with capsaicin, a drug shown previously to deplete CCK8 in some primary sensory neurons. The density of CCK8I-containing fibers was also decreased in the ipsilateral vessels of the cat circle of Willis following unilateral trigeminal ganglionectomies. These results indicate that CCK8I is contained in afferent fibers within large pial arteries of Willis' circle which project from neurons in the ipsilateral trigeminal ganglion. Whether CCK8 coexists with SP in these fibers remains to be determined.     

丹参中水溶性酚酸类成分的薄层扫描测定法

应用高效薄层扫描法对丹参根中的原儿茶醛、咖啡酸、迷迭香酸及其甲酯、丹酚酸A,B和C7种有效成分进行了含量测定。选择了最佳提取分离方法,即生药用热水提取并酸化后用乙酸乙酯萃取,萃取液浓缩后进行薄层色谱分离。展开剂A:氯仿乙酸乙酯——苯—甲酸(2.4:2:1:0.6)分离原儿茶醛,展开剂B:氯仿-乙酸乙酯-苯-甲酸甲醇(1.5:2:1;1:0.1)分离其余6种成分。并用所建立的分析方法分析比较了4种丹参根中7种有效成分的含量。