Randomised comparative trial of thermal balloon ablation and levonorgestrel intrauterine system in patients with idiopathic menorrhagia

AIMS: To compare the effectiveness of thermal balloon ablation (TBA) and levonorgestrel intrauterine system (LNG-IUS) in the management of idiopathic menorrhagia and changes in pictorial blood loss assessment chart (PBAC) scores in patients who had failed on oral medical treatment. METHODS: Phase III, single-centre, open randomised controlled trial. Following full screening and evaluation of 104 women, 33 were randomised to TBA and 33 to LNG-IUS. Primary outcomes were changes in PBAC scores from baseline to 12 months. Secondary outcomes were changes in haemoglobin and serum ferritin, at six months, continuation with treatment and hysterectomy rates at two years and changes in PBAC scores at three, six and nine months. RESULTS: All patients randomised had a PBAC score of > or = 120. At all assessment times, median PBAC scores were less than baseline, the greatest reductions being seen at 12 months for both treatments. When the median PBAC for the LNG-IUS (26 (0-68)) was significantly different to the median PBAC for the TBA cohort (62 (0-142)) P < 0.001. Irregular bleeding problems were the most common reason for discontinuation of the LNG-IUS and resulted in more women (39.8%) seeking other treatment by two years than the TBA (23.1%) (P < 0.05) and more undergoing a hysterectomy (20.7% vs 13.3%, respectively) (p > 0.05). Patient acceptability of the LNG-IUS and TBA was similar at 12 and 24 months in terms of their perceived satisfaction of effect on menorrhagia. CONCLUSIONS: Both TBA and LNG-IUS achieved significant decreases in PBAC scores, with those for the LNG-IUS being significantly greater at 12 months. However, prolonged days of bleeding resulted in fewer women continuing with the LNG-IUS at two years.     

超声引导经皮肝穿刺射频治疗肝癌

目的　探讨经皮肝穿刺射频治疗肝癌的有效性、安全性和肿瘤局部的控制情况。　方法　采用RF2 0 0 0射频治疗仪在超声引导下将射频电极放置于肝肿瘤内进行治疗。　结果　 (1) 30例肝癌患者 (肿瘤病灶直径 <5 cm及 >5 cm各 2 3个 )经过治疗 ,肿瘤完全缓解和部分缓解率占 5 4 .3% (2 5 /46 )。半年生存率为 93.3% ,1年生存率为 75 %。 (2 ) 2例出现肿瘤细胞针道种植转移 ,其他未见严重并发症。　结论　射频治疗肝癌是一种安全、有效的方法。对于肿瘤直径 <5 cm的肝癌治疗效果较佳 ;对于肿瘤直径 >5 cm者 ,应配合其他局部介入的综合治疗     

经导管射频消融治疗室性心律失常的疗效观察

目的 探讨经导管射频消融治疗特发性室性心动过速及频发室性期前收缩的疗效及安全性.方法 141例特发室性心动过速及频发室性期前收缩患者(男80例,女61例)采用激动顺序标测和(或)起搏标测方法行导管射频消融治疗.结果 消融成功128例,成功率为90.8%,起源于右室流出道的室性心动过速或室性期前收缩消融成功率为92.0%.20例患者行消融前后的Hoher检查,术前平均(21 824±12 769)次/24 h,术后平均(1 548±2 926)次/24 h,二者间差异有统计学意义(P<0.001).随访3～36个月,10例复发并全部再次消融成功.无并发症发生.结论 导管射频消融治疗症状严重且药物治疗无效的特发性室性心动过速或频发室性期前收缩是安全、有效、可行的方法.     

阵发性心房颤动的肺静脉电隔离治疗

目的 探索阵发性心房颤动的射频消融治疗方法及疗效。方法 对5例肺静脉起源的阵发性房颤患者，采用肺静脉内环状电极标测，温控导管对肺静脉电位进行射频消融，达到肺静脉完全电隔离。术后随访9～28个月，观察疗效。结果 5例患者电隔离治疗后，即刻成功率达100％；随访治愈2例，有效2例，无效1例，均无并发症发生。结论肺静脉电隔离治疗阵发性心房颤动是成功率较高，操作相对简单，比较安全的一种射频消融方法，有一定的发展前景。     

射频消融治疗家族性预激综合征

报告两例预激综合征患者系一家中两姐妹，均有严重发作性室上性心动过速，药物不能有效控制，行心腔内电生理检查诊断为右后间隔旁道，其姐姐仅有逆传，而其妹妹既有前传，又有逆传，但以逆传为主，在Ｘ线透视下，用射频消融（功率３０Ｗ，阻抗９６～１０５），１０ｓ内均成功阻断旁道的逆传及前传，经静脉点滴异丙肾上腺素及程序刺激不能诱发，随访３～６个月无心动过速发作。     

Picosecond Bessel Beam Fabricated Pure,Gold-Coated Silver Nanostructures for Trace-Level Sensing of Multiple Explosives and Hazardous Molecules

A zeroth-order, non-diffracting Bessel beam, generated by picosecond laser pulses (1064 nm, 10 Hz, 30 ps) through an axicon, was utilized to perform pulse energy-dependent (12 mJ, 16 mJ, 20 mJ, 24 mJ) laser ablation of silver (Ag) substrates in air. The fabrication resulted in finger-like Ag nanostructures (NSs) in the sub-200 nm domain and obtained structures were characterized using the FESEM and AFM techniques. Subsequently, we employed those Ag NSs in surface-enhanced Raman spectroscopy (SERS) studies achieving promising sensing results towards trace-level detection of six different hazardous materials (explosive molecules of picric acid (PA) and ammonium nitrate (AN), a pesticide thiram (TH) and the dye molecules of Methylene Blue (MB), Malachite Green (MG), and Nile Blue (NB)) along with a biomolecule (hen egg white lysozyme (HEWL)). The remarkably superior plasmonic behaviour exhibited by the AgNS corresponding to 16 mJ pulse ablation energy was further explored. To accomplish a real-time application-oriented understanding, time-dependent studies were performed utilizing the AgNS prepared with 16 mJ and TH molecule by collecting the SERS data periodically for up to 120 days. The coated AgNSs were prepared with optimized gold (Au) deposition, accomplishing a much lower trace detection in the case of thiram (~50 pM compared to ~50 nM achieved prior to the coating) as well as superior EF up to ~10⁸ (~10⁶ before Au coating). Additionally, these substrates have demonstrated superior stability compared to those obtained before Au coating.     

Atrial Fibrillation-triggered Ventricular Fibrillation in a Patient with Early Repolarization Syndrome

A 54-year-old man with early repolarization syndrome (ERS) implanted with an implantable cardioverter-defibrillator (ICD) developed persistent atrial fibrillation (AF) three years after the implantation. Similarly, the remote monitoring system begun frequently detecting ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PVT). Longer RR intervals were repeatedly observed just before the initiation of PVT/VF. Catheter ablation for AF successfully diminished both the PVT and VF events.     

New Insight into the Gas Phase Reaction Dynamics in Pulsed Laser Deposition of Multi-Elemental Oxides

The gas-phase reaction dynamics and kinetics in a laser induced plasma are very much dependent on the interactions of the evaporated target material and the background gas. For metal (M) and metal–oxygen (MO) species ablated in an Ar and O₂ background, the expansion dynamics in O₂ are similar to the expansion dynamics in Ar for M⁺ ions with an MO⁺ dissociation energy smaller than O₂. This is different for metal ions with an MO⁺ dissociation energy larger than for O₂. This study shows that the plume expansion in O₂ differentiates itself from the expansion in Ar due to the formation of MO⁺ species. It also shows that at a high oxygen background pressure, the preferred kinetic energy range to form MO species as a result of chemical reactions in an expanding plasma, is up to 5 eV.     

Cavotricuspid isthmus ablation guided by force‐time integral – A randomized study

BackgroundForce‐time integral (FTI) is an ablation marker of lesion quality and transmurality. A target FTI of 400 gram‐seconds (gs) has been shown to improve durability of pulmonary vein isolation, following atrial fibrillation ablation. However, relevant targets for cavotricuspid isthmus (CTI) ablation are lacking.HypothesisWe sought to investigate whether CTI ablation with 600 gs FTI lesions is associated with reduced rate of transisthmus conduction recovery compared to 400 gs lesions.MethodsFifty patients with CTI‐dependent flutter were randomized to ablation using 400 gs (FTI400 group, n = 26) or 600 gs FTI lesions (FTI600 group, n = 24). The study endpoint was spontaneous or adenosine‐mediated recovery of transisthmus conduction, after a 20‐min waiting period.ResultsThe study endpoint occurred in five patients (19.2%) in group FTI400 and in four patients (16.7%) in group FTI600, p = .81. First‐pass CTI block was similar in both groups (50% in FTI400 vs. 54.2% in FTI600, p = .77). There were no differences in the total number of lesions, total ablation time, procedure time and fluoroscopy duration between the two groups. There were no major complications in any group. In the total population, patients not achieving first‐pass CTI block had significantly higher rate of acute CTI conduction recovery, compared to those with first‐pass block (29.2% vs. 7.7% respectively, p = .048).ConclusionsCTI ablation using 600 gs FTI lesions is not associated with reduced spontaneous or adenosine‐mediated recurrence of transisthmus conduction, compared to 400 gs lesions.