Current of injury predicts acute performance of catheter-delivered active fixation pacing leads

BACKGROUND: During pacemaker lead (PPML) implantation, the implanter must assess lead stability (fixation) and pacing threshold adequacy. Implanters rely principally on lead impedance (IMP) and pacing threshold measurements after fixation of the PPML to determine adequacy of pacing sites. Continuously monitoring lead parameters during fixation might better identify predictors of acute lead stability and performance. METHODS: At the time of PPML implantation with a catheter delivered, fixed screw, 4-Fr PPML (Medtronic 3830, Minneapolis, MN, USA) patients underwent measurements of R-wave amplitude, slew rate, and current of injury (COI) (maximum and at 80 ms) during each turn of the helix. Lead stability was tested with traction applied to the lead body. RESULTS: Eighteen patients (age 70 +/- 9 years, 9 males) were studied. Right ventricular lead positioning was attempted 43 times; 26 positions demonstrated good fixation and 18 had satisfactory threshold. Sites of good fixation consistently showed larger COI (maximum and at 80 ms) compared to poor fixation sites throughout each turn of the helix; R wave, slew rate, and IMP did not differ significantly. When all measures of COI were examined in a stepwise regression model only the final measure of COI at 80 ms proved significantly associated with acute stability (P = 0.032). CONCLUSIONS: Lead stability and threshold adequacy are predictable from assessment of the magnitude of injury current. Continuous monitoring of lead parameters during fixation does not appear to confer any benefit over assessment of the parameters after final rotation of the lead. A negative COI is associated with poor threshold and/or fixation.     

High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study)

A total of 685 clinical Streptococcus pneumoniae isolates from patients with pneumococcal diseases were collected from 14 centers in 11 Asian countries from January 2000 to June 2001. The in vitro susceptibilities of the isolates to 14 antimicrobial agents were determined by the broth microdilution test. Among the isolates tested, 483 (52.4%) were not susceptible to penicillin, 23% were intermediate, and 29.4% were penicillin resistant (MICs >/= 2 mg/liter). Isolates from Vietnam showed the highest prevalence of penicillin resistance (71.4%), followed by those from Korea (54.8%), Hong Kong (43.2%), and Taiwan (38.6%). The penicillin MICs at which 90% of isolates are inhibited (MIC(90)s) were 4 mg/liter among isolates from Vietnam, Hong Kong, Korea, and Taiwan. The prevalence of erythromycin resistance was also very high in Vietnam (92.1%), Taiwan (86%), Korea (80.6%), Hong Kong (76.8%), and China (73.9%). The MIC(90)s of erythromycin were >32 mg/liter among isolates from Korea, Vietnam, China, Taiwan, Singapore, Malaysia, and Hong Kong. Isolates from Hong Kong showed the highest rate of ciprofloxacin resistance (11.8%), followed by isolates from Sri Lanka (9.5%), the Philippines (9.1%), and Korea (6.5%). Multilocus sequence typing showed that the spread of the Taiwan(19F) clone and the Spain(23F) clone could be one of the major reasons for the rapid increases in antimicrobial resistance among S. pneumoniae isolates in Asia. Data from the multinational surveillance study clearly documented distinctive increases in the prevalence rates and the levels of antimicrobial resistance among S. pneumoniae isolates in many Asian countries, which are among the highest in the world published to date.     

体外原代培养纯化新生鼠嗅鞘细胞的实验方法：差速贴壁＋阿糖胞苷＋胰酶法

目的:通过细胞形态学观察及生物学特性鉴定,建立一种经济实用的体外原代培养纯化新生鼠嗅鞘细胞的实验方法。方法:实验于2006-06在武汉理工大学完成。①阿糖胞苷(Sigma,批号w10562);胎牛血清(杭州四季青产品);胰蛋白酶(Amresco);多聚赖氨酸(Sigma);胶质纤维酸性蛋白,神经生长因子受体蛋白抗体(博士德)。②选取出生3d内的Wistar大鼠5只,乙醇浸泡后断头处死,取嗅球的最外两层,通过1.25g/L胰蛋白酶消化分离嗅鞘细胞,体外原代培养。③采用Nash差速贴壁 阿糖胞苷 胰酶法纯化嗅鞘细胞。培养18h后将未贴壁的细胞悬液转种于另一未涂层的器皿中,再培养36h,重复上述步骤移入0.1g/L多聚赖氨酸包被的塑料培养瓶中进行培养,纯化后的细胞在24h内陆续贴壁,常规培养2d,加入终浓度为2mg/L的阿糖胞苷,作用48h后,换上新的培养基,继续培养1d,弃去培养基,用无钙镁的Hanks液清洗2次,然后用1.25g/L的胰酶消化10min,待细胞突起回缩、胞体变圆时,立刻加入纯血清终止,其血清终浓度为20%,制备单细胞悬液。④倒置显微镜下观察其形态变化,苏木精-伊红染色,同时行神经生长因子受体蛋白和胶质纤维酸性蛋白免疫组化染色鉴定嗅鞘细胞,并计算嗅鞘细胞阳性百分率。结果:①活细胞形态观察:分离培养的嗅鞘细胞具有双极或多极突起,且突起细长,相互交织。②嗅鞘细胞的苏木精-伊红染色鉴定:细胞呈三角形或梭形,有长的突起,胞浆被染成粉红色,胞核呈蓝紫色,胞核内深染的为核仁,有1～3个核仁。③嗅鞘细胞的胶质纤维酸性蛋白免疫组化染色鉴定:细胞呈现棕黄色,胞核淡染,阳性细胞成网状连接,胞体多为三角形,有细长突起,阳性率91.5%。④嗅鞘细胞的P75免疫组化染色鉴定:阳性细胞呈绿色,多数细胞染色阳性,阳性率89%。结论:实验所采用的Nash差速贴壁 阿糖胞苷 胰酶法分离纯化培养嗅鞘细胞切实可行,为神经诱导修复材料的研究提供种子细胞。     

认知矫正治疗对慢性精神分裂症患者临床症状和社会功能的影响

目的:观察认知矫正治疗对慢性精神分裂症患者临床症状和社会功能的改善作用。方法:选择2003-01/08在北京回龙观医院住院的慢性精神分裂症患者104例。均符合CCMD-Ⅲ及DSM-Ⅳ关于精神分裂症诊断标准;年龄25～55岁;病程≥2年;病情稳定,处于迁延、残留或部分缓解状态;药物治疗状况稳定,近期无换药打算;纳入对象或家属同意入组并签署知情同意书。应用随机数字表法将患者分认知矫正治疗组和对照组,每组52例。在相近药物治疗的基础上,认知矫正治疗组以Ann Delahunty和Rodney Morice等制定的神经认知矫正手册(汉化)为治疗工具,在治疗师的指导下进行认知作业练习,内容包括认知灵活性、工作记忆、计划执行功能3大功能模块。对照组予以相同时间的工娱治疗,主要包括有治疗师指导的操作性音乐治疗和舞蹈治疗。治疗前后两组患者分别进行PANSS、住院精神患者社会功能缺陷量表和护士观察量表的评定。结果:实验共纳入慢性精神分裂症患者104例,认知矫正治疗组44例,对照组46例进入结果分析,14例脱落。①治疗前后两组患者PANSS量表总分以及阴性症状量表、复合量表、一般精神病理量表、反应缺乏量表4个分量表的评分均有下降,组内比较差异有显著性意义(t=2.12～4.59,P<0.05);减分情况在两组间差异不明显(P>0.05)。②两组患者的社会功能缺陷量表总分在治疗后均有下降,与治疗前比较,差异有显著性意义(t=3.89,2.04,P<0.05);两组间比较,差异无显著性意义(P>0.05)。认知矫正治疗组治疗后护士观察量表的总病情以及总消极、迟滞2个分量表评分下降,与治疗前比较差异有显著性意义(t=1.49,1.19,2.81,P<0.05);其中迟滞项的减分在两组间比较,差异具有显著性意义(F=4.97,P<0.05)。③社会功能量表的改善与词语流畅性的改善呈正相关(R2=0.36,P<0.05),护士观察量表中总病情与积极两项评分的改善也与言语流畅性测验的改善正相关(R2=0.37,0.34,P<0.05)。结论:认知矫正治疗能在一定程度上改善精神分裂症患者的社会功能,并与部分认知功能的改善相关,但对临床症状无明显改善作用。     

Microsatellite markers within --SEA breakpoints for prenatal diagnosis of HbBarts hydrops fetalis

BACKGROUND: We sought to develop a rapid prenatal diagnostic test for simultaneous detection of HbBarts hydrops fetalis and exclusion of maternal contamination. METHODS: We developed a multiplex quantitative fluorescent PCR (QF-PCR) test that detects the presence/ absence of 2 microsatellite markers (16PTEL05/16PTEL06) located within breakpoints of the Southeast Asia ((-SEA)) deletion. HbBarts hydrops fetalis ((-SEA/-SEA)) is diagnosed by absence of both markers, and maternal contamination of fetal DNA is excluded by absence of noninherited maternal alleles. Fetal and parental DNA samples from 50 families were analyzed in a blinded clinical validation study, and QF-PCR results were compared with their respective molecular genotypes. RESULTS: The multiplex QF-PCR results included correct diagnoses of HbBarts hydrops fetalis in 11 of the fetuses tested, correct verification as unaffected in 20 fetuses, and correct identification as either carriers (alphaalpha/(-SEA)) or unaffected homozygotes in 18. Misidentification as unaffected occurred for 1 carrier. Sensitivity for diagnosis of HbBarts hydrops fetalis was 100% [lower 95% confidence interval, 76.2%], and specificity was 100% (lower 95% confidence interval, 92.6%). None of the samples tested showed any traces of noninherited maternal alleles; thus false-positives because of maternal contamination were eliminated. CONCLUSIONS: In this QF-PCR method, detection of maternally and paternally inherited fetal alleles allowed diagnosis of the double-deletion syndrome, and the ability to differentiate between these alleles allowed simultaneous exclusion of maternal contamination of the fetal genetic material. This novel strategy using cell-free fetal DNA in maternal plasma could form the basis for noninvasive testing for HbBarts hydrops fetalis.     

Disrupting insulin-like growth factor signaling as a potential cancer therapy

The type I insulin-like growth factor receptor (IGF-IR) plays multiple roles in several cancers and increased circulating levels of insulin-like growth factor-I (IGF-I) are associated with increased risk of breast, colon, and prostate cancers. Because IGF-II and insulin signal via the insulin receptor (IR) to stimulate the growth of cancer cells, inhibition of IR might be necessary to totally disrupt the action of IGFs and their receptors. This review describes the well-recognized roles of IGF-IR in driving the malignant phenotype, examines the evidence that perhaps IR should also be targeted to inhibit the effects of the IGF ligands and insulin in cancer, describes the strategies to disrupt IGF signaling in cancer, and highlights some key issues that need to be considered as clinical trials targeting IGF-IR proceed.     

Type I IFN signaling in CD8– DCs impairs Th1-dependent malaria immunity

Many pathogens, including viruses, bacteria, and protozoan parasites, suppress cellular immune responses through activation of type I IFN signaling. Recent evidence suggests that immune suppression and susceptibility to the malaria parasite, Plasmodium, is mediated by type I IFN; however, it is unclear how type I IFN suppresses immunity to blood-stage Plasmodium parasites. During experimental severe malaria, CD4⁺ Th cell responses are suppressed, and conventional DC (cDC) function is curtailed through unknown mechanisms. Here, we tested the hypothesis that type I IFN signaling directly impairs cDC function during Plasmodium infection in mice. Using cDC-specific IFNAR1-deficient mice, and mixed BM chimeras, we found that type I IFN signaling directly affects cDC function, limiting the ability of cDCs to prime IFN-γ–producing Th1 cells. Although type I IFN signaling modulated all subsets of splenic cDCs, CD8^– cDCs were especially susceptible, exhibiting reduced phagocytic and Th1-promoting properties in response to type I IFNs. Additionally, rapid and systemic IFN-α production in response to Plasmodium infection required type I IFN signaling in cDCs themselves, revealing their contribution to a feed-forward cytokine-signaling loop. Together, these data suggest abrogation of type I IFN signaling in CD8^– splenic cDCs as an approach for enhancing Th1 responses against Plasmodium and other type I IFN–inducing pathogens.     

A review of factors affecting patient fertility preservation discussions & decision‐making from the perspectives of patients and providers

Women undergoing cancer treatments and their healthcare providers encounter challenges in fertility preservation (FP) discussions and decision‐making. A systematic review of qualitative research was conducted to gain in‐depth understanding of factors influencing FP discussions and decision‐making. Major bibliographic databases and grey literature in English from 1994 to 2016 were searched for qualitative research exploring patient/provider perspectives on barriers and facilitators to FP decision‐making. Two researchers screened article titles, abstracts and full‐texts. Verbatim data on research questions, study methodology, participants, findings and discussions of findings were extracted. Quality assessment and thematic analysis were conducted. The search yielded 74 studies dating from 2007 onwards; 29 met the inclusion criteria. Analysis revealed three types of barriers: (a) FP knowledge, skills and information deficits contributed to discomfort for providers and discontent for patients; (b) psychosocial factors and clinical issues influenced providers’ practices around FP discussions and patients’ decision‐making; and (c) material, social and structural factors (e.g., lack of resources and accessibility) posed challenges to FP discussions. Potential facilitators to FP discussions and decision‐making were also identified. A discussion of ways to improve physician's knowledge and facilitate women's decision‐making and access to FP is presented, along with areas for policy development and further research.     

Consensus and contentious statements on the use of probiotics in clinical practice: A south east Asian gastro‐neuro motility association working team report

The concept of consuming microorganisms in the treatment of a medical condition and in health maintenance has gained much attraction, giving rise to an abundance of medical claims and of health supplements. This study identified relevant clinical questions on the therapeutic use of probiotics and reviewed the literature in irritable bowel syndrome, inflammatory bowel disease, impaired intestinal immunity, liver disease, intestinal infections, and common childhood digestive disorders. Statements were developed to address these clinical questions. A panel of experienced clinicians was tasked to critically evaluate and debate the available data. Both consensus and contentious statements are presented to provide to clinicians a perspective on the potential of probiotics and importantly their limitations.