Have the Results of Randomized Clinical Trials of Pacing Altered the Practice of Cardiac Pacing?

Randomized clinical trials are the gold standard for the evaluation of new therapies. However, in the early years of pacing, the observational benefits were so great and the lifesaving benefits to patients so readily obvious that randomized trials were not necessary to prove benefit. As the technology has matured, advances have become more evolutionary than revolutionary, and observational analyses are unable to provide convincing evidence of small-to-moderate benefits. Thus, randomized trials of sufficient sample size are necessary to reliably assess the small-to-moderate effects of advances such as dual-chamber pacing, rate modulation, and mode switching. It is only during the last decade, however, that the evidence base for pacing with regard to randomized trials has begun to emerge. It is unclear whether the emerging results of these clinical trials have affected the clinical practice of pacing. (J Cardiovasc Electrophysiol, Vol. 14, pp. S15-S19, September 2003, Suppl.)     

Comparative Immunosuppression of Various Glycol Ethers Orally Administered to Fischer 344 Rats

Oral dosing of adult male F344 rats with the glycol ether 2-methoxyethanol(ME) or its principal metabolite 2-methoxyacetic acid (MAA)results in the suppression of the primary plaque-forming cell(PFC) response to trinitrophenyl-lipopolysaccharide (TNP-LPS).In the present study, the PFC response to TNP-LPS was used toevaluate the immunotoxic potential of ethylene glycol (EG) aswell as the glycol ethers 2-methoxyethyl acetate (MEA), 2-(2-methoxyethoxy)ethanol, bis(2-meth- oxyethyl) ether, 2-ethoxyethanol and itsprincipal metabolite 2-ethoxyacetic acid, 2-ethoxyethyl acetate,and 2-butoxyethanol relative to ME and MAA. Rats were immunizedwith TNP-LPS and then exposed 4 and 28 hr later to 50, 100,200, or 400 mg/kg of glycol ether or EG. Three days followingimmunization, the PFC response to TNP-LPS was determined. Inaddition to ME and MAA, only MEA, which was as effective asME, suppressed the PFC response to TNP-LPS. Concomitant administrationof the alcohol dehydrogenase inhibitor 4-methylpyrazole withME or MEA prevented suppression of the PFC response by theseglycol ethers. These results indicate that of the chemicalstested only ME, MEA, and MAA are immunosup pressive, and thatoxidative metabolism via alcohol dehydrogenase is necessaryfor ME- and MEA-suppression of the response to TNP-LPS.     

Mortality during intensive care after orthotopic liver transplantation

The postoperative course of 335 adult patients who underwent orthotopic liver transplantation from 1968-1987 was reviewed retrospectively to identify patients who died in the intensive care unit and the causes of death. Forty-four percent of all deaths occurred in the intensive care unit. The mortality rate in the intensive care unit peaked in 1984 (48%), but decreased to 11% in 1987. The main causes for death in the intensive care unit were infection (55%) and haemorrhage (19%). The patients who died spent more time in the intensive care unit, had a longer period of tracheal intubation and received a larger intra-operative blood transfusion than patients who died in other locations.     

新型输送型球囊扩张导管在颅内动脉狭窄治疗中的临床应用研究

目的：探讨新型输送型球囊扩张导管(Fastunnel)在颅内动脉粥样硬化狭窄介入治疗中的应用效果。方法：2021年11月至2022年2月,我们使用新型输送型球囊扩张导管对10例颅内动脉粥样硬化狭窄的患者进行了球囊扩张+支架成形术。收集并分析了患者的基线情况、影像学特点、治疗情况及围手术期情况。结果：男6例,女性4例,平均年龄(62.7±6.7)岁。10例患者均成功接受手术治疗,手术时长为16~65(37.3±18.2)min,治疗过程所受辐射剂量为1381~4901(2643.7±1131.7)mGy,剂量面积乘积(DAP)值为5707~38112(17526.8±10809.5)μGym₂^。围手术期无出血及缺血相关并发症。结论：输送型球囊扩张导管具有较好的安全性,能有效地简化手术步骤、缩短手术时间,对减少患者及医生所受射线剂量。