Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of a temperature-controlled radiofrequency catheter ablation system. METHODS AND RESULTS: The patient population included 1050 patients who had undergone ablation of atrioventricular nodal reentrant tachycardia (AVNRT), an accessory pathway (AP), or the atrioventricular junction (AVJ). Ablation was successful in 996 patients. The probability of success was highest among patients who had undergone ablation of the AVJ, lowest in patients who had undergone ablation of an AP, and in between for patients who had undergone ablation of AVNRT. A major complication occurred in 32 patients. Four variables predicted ablation success (AVJ, AVNRT, or left free wall AP ablation and an experienced center). Four factors predicted arrhythmia recurrence (right free wall, posteroseptal, septal, and multiple APs). Two variables predicted development of a complication (structural heart disease and the presence of multiple targets), and 3 variables predicted an increased risk of death (heart disease, lower ejection fraction, and AVJ ablation). CONCLUSIONS: These findings may serve as a guide to clinicians considering therapeutic options in patients who are candidates for ablation.     

Evaluating knowledge about human papillomavirus infection among Brazilian health professionals

Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases worldwide. Although two safe and clinically effective vaccines against HPV have been developed, they are not available to the public health network in Brazil. This study was performed to assess knowledge about HPV among seventy-nine professionals who completed a questionnaire about diagnosis, transmission, symptoms, prevention and general information. General knowledge about HPV was high, as most of them recognized that HPV is transmitted sexually (98.7%), the disease can be asymptomatic (82.3%) or warts can be present on the genitals (84.8 ) and the Pap smear is the screening method to identify cellular changes on the cervix (88.6%). However, many professionals did not know that there are now vaccines available for many HPV variants (38.0%) and that not all of them are oncogenic (44.3%). These data show that further educational programs, especially about HPV prevention, are needed in Brazil.     

骨髓间充质干细胞移植后脑梗死大鼠脑电图的变化

目的:对比观察骨髓间充质干细胞移植前后脑梗死大鼠脑电图的变化。方法:实验于2002-09/12在解放军第三军医大学中心实验室及西南医院神经内科肌电图室完成。①实验分组:选取清洁级健康成年Wistar大鼠15只,随机数字表法分为干细胞移植组、模型对照组、假手术组,5只/组。②实验方法:另取2只健康幼年Wistar大鼠用于骨髓间充质干细胞的提取,联合采用密度梯度离心及贴壁法分离培养大鼠骨髓间充质干细胞,选取生长良好的1～3代细胞用于移植实验。干细胞移植组、模型对照组大鼠建立大脑中动脉栓塞模型。假手术组仅分离颈总动脉、颈外动脉和颈内动脉,不予结扎和放置线栓。造模后1周,干细胞移植组、假手术组大鼠行细胞移植,在立体定向仪定位下于脑梗死区(壳核)直接注射骨髓间充质干细胞悬液5μL,细胞浓度1×104μL-1,移植坐标为前囟前1.0mm,右旁开3.0mm,硬膜下5.0mm。模型对照组大鼠于相同部位注射等量不含细胞的磷酸盐缓冲液。③实验评估:采用脑电图机分别于造模前、造模后1周(移植前)、细胞移植后4周对各组大鼠进行脑电图检测。结果:15只大鼠均进入结果分析。①造模前基本节律为8～11Hz、15～30μV的α波,间或少量θ波,双侧对称。②造模后1周,假手术组异常率为0;模型对照组20%(1/5)轻度异常,80%(4/5)中度异常;干细胞移植组20%(1/5)轻度异常,60%(3/5)中度异常,20%(1/5)重度异常。③细胞移植后4周,假手术组脑电图恢复正常;模型对照组随术后时间的延长慢波有所减少,但仍可见到δ波、棘波、棘慢波的发放,至细胞移植后4周60%(3/5)轻度异常,40%(2/5)中度异常;干细胞移植组术后局限性慢波逐渐减少,基本节律全部恢复为α波,不对称的情况明显好转,至细胞移植后4周60%(3/5)轻度异常,以病灶侧局限性θ波较多为主,另外40%(2/5)基本正常。结论:动物实验显示骨髓间充质干细胞移植对脑梗死大鼠的脑电图背景节律有改善作用,一定程度上促进了神经系统功能的恢复。     

脊髓损伤后真皮多能干细胞移植时机的选择

目的:观察脊髓损伤后不同时间移植真皮多能干细胞对大鼠运动功能修复的影响。方法:实验于2006-06/2007-03在第三军医大学生理学教研室完成。①实验材料:实验动物2～4月龄SPF级SD大鼠,体质量(210±40)g,雌雄不限,由第三军医大学实验动物中心提供。真皮多能干细胞为第三军医大学防原医学系从SD大鼠真皮中提取和分离。②实验方法:将42只SD大鼠在L4水平制成脊髓全横断损伤模型。将动物随机分为对照组(n=6)、真皮多能干细胞移植组(n=36)。真皮多能干细胞移植组又分为6个时间点:损伤后1,4,7,10,14,21d移植组,每组6只。各移植组于伤处移植大鼠真皮多能干细胞,而对照组于损伤后7d注射等量磷酸盐缓冲液。③实验评估:分别于移植后1d、1周、4周、8周、12周对各组大鼠进行动物行为学和脊髓诱发电位检测。结果:42只实验大鼠均进入结果分析,无脱落。①动物行为学评分:4周以后各组动物行为学评分比较差异有显著性意义(P<0.05),移植组明显高于对照组(P<0.05),各移植组间比较,以损伤后7,10d移植组动物行为学评分改善最显著。②各组大鼠脊髓诱发电位检查:体感诱发电位和运动诱发电位潜伏期和波幅值于移植后8,12周后明显高于对照组(P<0.05),各移植组间比较,以损伤后7,10d移植组体感诱发电位和运动诱发电位潜伏期和波幅值改善最显著。结论:脊髓损伤后7～14d进行真皮多能干细胞移植可明显改善大鼠后肢的运动功能。     

The impact of coagulation parameters on the outcomes of patients with severe community-acquired pneumonia requiring intensive care unit admission

Introduction

Coagulation abnormalities are frequent in patients with severe infections. However, the predictive value of d-dimer and of the presence of associated coagulation derangements in severe community-acquired pneumonia (CAP) remains to be thoroughly evaluated. The aim of this study was to investigate the predictive value of coagulation parameters in patients with severe CAP admitted to the intensive care unit.

Methods

d-Dimer, antithrombin, International Society of Thrombosis and Hemostasis score, clinical variables, Sequential Organ Failure Assessment (SOFA), The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the CURB-65 score were measured in the first 24 hours. Results are shown as median (25%-75% interquartile range). The main outcome measure was hospital mortality.

Results

Ninety patients with severe CAP admitted to the intensive care unit were evaluated. Overall hospital mortality was 15.5%. d-Dimer levels in nonsurvivors were higher than those in survivors. In the univariate analysis, d-dimer, SOFA, and APACHE II scores were predictors of death. The discriminative ability of d-dimer (area under receiver operating curve = 0.75 [95% confidence interval, 0.64-0.83]; best cutoff for d-dimer was 1798 ng/mL) for in-hospital mortality was comparable with APACHE II and SOFA and better than C-reactive protein. Moreover, the addition of d-dimer to APACHE II or SOFA score increased the discriminative ability of both scores (area under the receiver operating curve = 0.82 [0.72-0.89] and 0.84 [0.75-0.91], respectively).

Conclusions

d-Dimer levels are good predictors of outcome in severe CAP and may augment the predictive ability of scoring systems as APACHE II and SOFA.     

离子色谱法同时测定葡萄糖酸钙及其杂质(Cl-,SO42-)的含量

本文采用Waters ILC-1离子液相色谱仪,IC-PAK A50×4.6mm色谱柱,pH6.61×10^-3mol/L邻苯二甲酸溶液为流动相,430型电导检测器检测,由外标法和外标单点校正法同时测定了葡萄糖酸钙及其杂质(Cl^-,SO₄^2-)的含量。方法简便、快速,测定结果与中国药典法一致。外标法和外标单点校正法测定Cl^-,SO₄^2-的平均回收率为100.8%和100.2%,相关系数分别为0.9951(n=8)和0.9961(n=8)。     

Laparoscopic scar: A mimicker of Sister Mary Joseph’s nodule on positron emission tomography/CT

Positron emission tomography/CT is an established imaging method in the diagnosis and staging of cancers. ¹⁸F‐fluoro‐2‐deoxy‐d ‐glucose (FDG) is the most commonly used radiotracer in positron emission tomography/CT. It is a tumour viability agent and usually its uptake within a lesion reflects the presence of a viable tumour tissue. However, false‐positive FDG uptake is known to occur in benign processes of either inflammatory or infectious aetiology. We describe FDG uptake at the site of laparoscopic scar that mimicked Sister Mary Joseph’s nodule in a patient with gastric adenocarcinoma. Here, the knowledge of the patient’s history and subtle imaging findings helped in accurate staging of the patient. In this case report, we emphasize the value of the knowledge of the patient history and awareness of different pitfalls of FDG to achieve a correct diagnosis on positron emission tomography/CT.     

Nucleotide oligomerization domain 1 is a dominant pathway for NOS2 induction in vascular smooth muscle cells: comparison with Toll-like receptor 4 responses in macrophages

Background and purpose:

Gram-negative bacteria contain ligands for Toll-like receptor (TLR) 4 and nucleotide oligomerization domain (NOD) 1 receptors. Lipopolysaccharide (LPS) activates TLR4, while peptidoglycan products activate NOD1. Activation of NOD1 by the specific agonist FK565 results in a profound vascular dysfunction and experimental shock in vivo.

Experimental approach:

Here, we have analysed a number of pharmacological inhibitors to characterize the role of key signalling pathways in the induction of NOS2 following TLR4 or NOD1 activation.

Key results:

Vascular smooth muscle (VSM) cells expressed NOD1 mRNA and protein, and, after challenge with Escherichia coli or FK565, NOS2 protein and activity were induced. Macrophages had negligible levels of NOD1 and were unaffected by FK565, but responded to E. coli and LPS by releasing increased NO and expression of NOS2 protein. Classic pharmacological inhibitors for NF-κB (SC-514) and mitogen-activated protein kinase (SB203580, PD98059) signalling pathways inhibited responses in both cell types regardless of agonist. While TLR4-mediated responses in macrophages were specifically inhibited by the pan-caspase inhibitor z-VAD-fmk and the PKC inhibitor Gö6976, NOD1-mediated responses in VSM cells were inhibited by the Rip2 inhibitor PP2.

Conclusions and implications:

Our findings suggest a selective role for NOD1 in VSM cells, and highlight NOD1 as a potential novel therapeutic target for the treatment of vascular inflammation.