The Effect of Weight Loss on Clinical Outcomes in Patients Implanted With a Cardiac Resynchronization Therapy Device—A MADIT-CRT Substudy

BackgroundThere are no data regarding the effect of weight loss on clinical outcomes in patients undergoing cardiac resynchronization therapy. This study was designed to evaluate the effect of weight loss on clinical outcomes in patients implanted with a cardiac resynchronization therapy with defibrillator (CRT-D).Methods and ResultsThe risk of heart failure (HF) or death, and of death alone, was compared between patients with and without weight loss of ≥2 kg or more at 1 year in the CRT-D arm of the Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT). Weight loss was observed in 170 of 994 patients (17%) implanted with a CRT-D. Multivariate analysis showed a significant increase in the risk of HF or death among patients with weight loss compared with those without weight loss (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.26–2.63; P = .001). Weight loss was associated with a 79% increase in the risk of all-cause mortality (HR 1.79, 95% CI 1.16–3.34; P = .01). When analyzed in a continuous fashion, each kg of weight loss was associated with a 4% increase in the risk of HF or death (P = .03). In left bundle branch block (LBBB) patients with a CRT-D, weight loss was associated with an especially high risk of HF or death (HR 2.23, 95% CI 1.36–3.65; P = .002) and of death alone (HR 2.33, 95% CI 1.07–5.06; P = .03; interaction P = .26).ConclusionsIn patients with mild symptoms of HF receiving CRT-D, weight loss observed at 1 year is associated with adverse clinical outcomes, especially in those with a LBBB electrocardiographic pattern.     

In situ proteomic analysis by MALDI imaging identifies ubiquitin and thymosin-β4 as markers of malignant intraductal pancreatic mucinous neoplasms

PurposeIntraductal pancreatic mucinous neoplasms (IPMN) are precancerous cystic lesions. The aim was to investigate the in situ IPMN proteome using MALDI (Matrix-Assisted Laser Desorption/Ionisation) imaging and to characterize biomarkers associated with the grade of dysplasia.Experimental designFrozen human Branch duct -IPMN sections were selected according to dysplasia and proteomic analyses were performed by MALDI imaging to obtain mass spectra distribution. The most discriminating peaks were identified using tissue extraction and nanoLC-ESI-MS/MS. Identified peaks were validated in independent series of IPMN by immunochemistry on surgical specimens (tissue-microarrays (TMA), n = 45) and endoscopic ultrasound fine-needle aspiration (EUS FNA) samples (n = 25).ResultsBD-IPMN samples with low (n = 10) and high (n = 10) grades of dysplasia were analyzed. Differential spectra of proteins were found in the two groups with significantly different intensities (n = 15). The two peaks (intense in high grade IPMN) (m/z 8565 and 4747) were characterized as the monomeric ubiquitin (Mascot score = 319.22) and an acetylated fragment of thymosin-β4 (2–42) (Omssa score = 1.37 E−9). Validation on TMA and EUS FNA samples confirmed that ubiquitin was overexpressed in high grade dysplasia (p = 0.04 and p = 0.0004). Thymosin-β4 expression was confirmed on TMA by immunohistochemistry on high grade IPMN (p = 0.011).ConclusionUbiquitin and thymosin-β4 are overexpressed in IPMN with high grade dysplasia. Positive immunochemical staining on EUS-FNA material is a major argument in support of preventive resection.     

左束支起搏心电图的特点观察

目的通过比较自身心律、左束支起搏、右室心尖部或右室流出道起搏时心电图的形态和QRS波群时限等,找寻左束支起搏心电图的特征表现。方法选取拟行左束支起搏42例患者,记录标准12导联体表心电图,通过测量,分别比较自身心律、左束支起搏及右室心尖部/右室流出道起搏时QRS波群时限、电轴、形态及ST段的差异。结果自身心律与左束支起搏相比,QRS波群时限无统计学差异(P=0. 49),但与右室心尖部/右室流出道起搏相比,具有显著差异(P <0. 000)。左束支起搏组,V1导联呈特征性"M"或"r SR"的比例为76. 19%;a VR导联亦可呈特征性"M"或"r SR"表现,比例为78. 57%。对于自身心律为右束支阻滞者,左束支区域起搏仅V1导联呈"M"或"r SR",a VR导联呈QS型,而无特征性"M"或"r SR"表现。与经典的右束支阻滞心电图比较:左束支起搏ST段和T波改变无规律性。结论左束支起搏心电图QRS波群时限和电轴与自身心律相比无显著差别,V1及a VR导联均可见特征性"M"或"r SR"表现,右束支阻滞患者仅V1导联呈特征性表现,但依靠心电图的特征性"M"或"r SR"改变判断起搏位点有局限性。     

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目的 探讨应用面神经分支转位吻合修复面神经分支缺损的疗效.方法 选择2005年10月至2010年9月濮阳市油田总医院口腔科收治的外伤性面神经损伤患者27例(损伤神经32支).应用携带肌筋膜的上颊支吻合颧支远心断端,颈支吻合下颌缘支远心断端.结果 术后1个月受损神经功能恢复达到2级以上10支,占31％;术后6个月达到2级及以上30支,占96.8％.结论 携带肌筋膜的面神经转位吻合修复面神经颧支、下颌缘支缺损神经,是一种有效的面神经功能重建的手术方法.