Asymptomatic profound sinus bradycardia (heart rate ≤45) in non-small cell lung cancer patients treated with crizotinib

Crizotinib, a dual MET/ALK inhibitor, is now in advanced clinical development for the treatment of anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC). We have observed several patients who developed profound but asymptomatic sinus bradycardia (HR ≤45) during the course of crizotinib treatment. Herein, we describe the clinical characteristics of three separate patients enrolled in the A8081001 trial (NCT00585195) who developed asymptomatic profound sinus bradycardia with their accompanying electrocardiogram tracings.     

Mesenchymal stem cells and inorganic bovine bone mineral in sinus augmentation: comparison with augmentation by autologous bone in adult sheep

Our aim was to compare the osteogenic potential of mononuclear cells harvested from the iliac crest combined with bovine bone mineral (BBM) (experimental group) with that of autogenous cancellous bone alone (control group). We studied bilateral augmentations of the sinus floor in 6 adult sheep. BBM and mononuclear cells (MNC) were mixed and placed into one side and autogenous bone in the other side. Animals were killed after 8 and 16 weeks. Sites of augmentation were analysed radiographically and histologically. The mean (SD) augmentation volume was 3.0 (1.0) cm³ and 2.7 (0.3) cm³ after 8 and 16 weeks in the test group, and 2.8 (0.3) cm³ (8 weeks) and 2.8 (1.2) cm³ (16 weeks) in the control group, respectively. After 8 weeks, histomorphometric analysis showed 24 (3)% BBM, and 19 (11)% of newly formed bone in the test group. The control group had 20 (13%) of newly formed bone. Specimens after 16 weeks showed 29 (12%) of newly formed bone and 19 (3%) BBM in the test group. The amount of newly formed bone in the control group was 16 (6%). The results show that mononuclear cells, including mesenchymal stem cells, in combination with BBM as the biomaterial, have the potential to form bone.     

Nell-1基因修饰骨髓基质细胞复合β-磷酸三钙提升兔上颌窦底的实验研究

目的：评价Nel样I型分子（Nell-1）基因修饰骨髓基质细胞（bone marrow stromal cells,bMSCs）复合β-磷酸三钙提升兔上颌窦底的效果。方法：抽取兔骨髓进行bMSCs培养,体外采用腺病毒载体携带Nell-1基因（AdNell-1）及绿色荧光蛋白EGFP基因（AdEGFP）转染bMSCs,GFP表达检测转染效率、Nell-1免疫细胞化学检测目的基因的表达。碱性磷酸酶（ALP）染色、半定量检测及钙结节茜素红染色检测细胞成骨分化。将基因修饰bMSCs与β-磷酸三钙颗粒复合用于兔上颌窦底提升,分别在术后2周和8周取材,HE染色,测量成骨面积,并采用SPSS11.0软件包对2组间数据进行t检验。结果：AdEGFP基因修饰组GFP表达效率可达60%～80%,Nell-1细胞化学染色显示,AdNell-1基因修饰组呈阳性表达。AdNell-1基因修饰组ALP染色及钙结节茜素红染色均高于AdEGFP基因修饰组,ALP半定量检测具有统计学差异（P〈0.05）。体内实验研究中,AdNell-1基因修饰组新骨形成面积在8周时显著高于AdEGFP基因修饰组（P〈0.05）。结论：采用AdNell-1基因转染兔bMSCs可促进其成骨分化,体内可促进上颌窦底提升的效果。     

30例窦性心动过缓患者心率震荡分析

目的应用窦性心率震荡（heart rate turbulence,HRT）这一新的预测心脏性猝死方法,探讨窦性心动过缓患者的临床预后。方法30例窦性心动过缓患者接受动态心电图检查,窦性心率〈50次／分为入组条件。采集单发室性早搏的前2个窦性RR间期及后20个窦性RR间期,根据公式分别计算震荡初始（turbulence onset,TO）和震荡斜率（turbulence splope,TS）。结果30例窦性心动过缓患者的HRT均值TO：（1．03±0．97）％;TS：（3．87±1．93）ms／RR间期。提示本文30例窦性心动过缓患者室性早搏后初始窦性心率加速现象消失。结论窦性心率〈50次／分的心动过缓患者可能也是发生心脏性猝死的高危人群。     

Keeping it in the family: Use of the grandmother,mother, and child technique to navigate complex anatomy during Coronary sinus Reducer Implantation

The Coronary Sinus Reducer® (CSR) is an emerging therapy for refractory angina recommended once no further pharmacologic or coronary revascularization options are available. We present the case of a 72-year-old man who underwent CSR implantation. Complex coronary sinus anatomy necessitated an innovative “grandmother, mother, and child” catheter approach.     

Radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning: one-year results of a randomized controlled trial

The objective of this study was to perform a comparative evaluation of the radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning (BLSFE and LSFE, respectively) when applied concomitantly with implant placement. A randomized controlled clinical trial was conducted between February 1, 2016 and May 1, 2017 including 26 individuals with at least one missing tooth. Participants were randomized 1:1 to undergo BLSFE (10 participants, 16 implants) or LSFE (13 participants, 19 implants). Bovine-derived xenograft was used in both groups and the implants were inserted concomitantly. In the BLSFE group, the antrostomy was covered with a repositioned bone window and then with a concentrated growth factors (CGF) membrane. In the LSFE group, the antrostomy was covered with a CGF membrane. Panoramic radiographs were taken before surgery (T0), immediately postoperative (T1), and at 12 months postoperative (6 months after loading) (T2). Marginal bone loss (MBL), apical bone gain, augmented alveolar bone height, and intra-sinus bone augmentation were evaluated on panoramic radiographs at T2. A linear regression analysis with generalized estimating equation models was performed. The implant survival rate was 100% at 1 year after implant surgery. The residual alveolar bone height at T0 was comparable in the BLSFE and LSFE groups (3.58 ± 1.49 mm vs 4.12 ± 1.61, P = 0.32), as was the alveolar bone height at T1 (13.61 ± 1.82 mm vs 12.38 ± 1.82 mm, P = 0.06). At T2_, significantly higher alveolar bone height, intra-sinus bone augmentation, and apical bone gain, and lower distal MBL were observed in the BLSFE group when compared to the LSFE group, with adjusting for covariates (β = 2.44, 95% CI 1.42–3.46, P < 0.0001; β = 2.38, 95% CI 1.35–3.41, P < 0.0001; β = 2.33, 95% CI 1.23–3.42, P < 0.0001; and β = ?0.43, 95% CI ?0.83 to ?0.02, P = 0.038, respectively). No significant difference was observed for mesial MBL or apical bone resorption at T2. Lateral sinus floor elevation with bone window repositioning may result in higher bone augmentation after 1 year than the traditional approach. Further research is needed to elucidate the effect of lateral sinus floor elevation with bone window repositioning.     

Lateral augmentation of the sinus floor followed by regular implants versus short implants in the vertically deficient posterior maxilla: a systematic review and timewise meta-analysis of randomized studies

The aim of this study was to perform a timewise meta-analysis of randomized clinical trials (RCTs) comparing the outcomes of short implants (≤6 mm) versus lateral sinus floor augmentation followed by regular implants (≥10 mm) in the deficient posterior maxilla. Eleven RCTs with 1, 3, and 5 years of follow-up were reported in 21 articles. There was no significant difference in the implant loss rate at the patient level after 1 and 3 years between the two groups (risk ratio 0.50, P = 0.17; risk ratio 1.71, P = 0.51). After 5 years, the risk ratio was in favour of regular implants with augmentation and approached significance (3.28, P = 0.06). Excluding the results of two studies on ultrashort implants, the risk ratio for complications was in favour of short implants, but without significance (0.33, P = 0.08). Mean marginal bone loss was significantly lower at 1, 3, and 5 years for the short implants when compared to regular implants with augmentation. The residual osseointegration length of implants was between 3.4 mm and 5.9 mm in the short implants group and between 10.1 mm and 12.5 mm in the regular implants group after 5 years. In conclusion, short implants in the atrophic posterior maxilla demonstrate comparable outcomes to regular implants within the first 5 years. Patients who are fit for surgery should be informed about the risks and benefits of both options.     

功能性鼻窦内窥镜手术的护理配合

目的：探讨功能性鼻窦内窥镜手术在清除病变的基础上重建和恢复鼻腔鼻窦的通气和黏膜纤毛功能的效果。方法：对58例鼻窦炎、鼻息肉患者应用鼻窦内窥镜行功能性鼻窦镜手术,并积极配合术前、术中及术后护理。结果：手术均成功,患者鼻塞和脓涕消除,头痛缓解。结论：功能性鼻内窥镜手术具有损伤小、多视角、可直视等特点,不遗留面部瘢痕,不损伤鼻腔及鼻窦解剖结构并保持其生理功能。     

The Relationship Between Sinoatrial Conduction Time and Sinus Cycle Length Revisited

In 1974 we reported an inverse relationship between sinoatrial conduction time (SACT) and sinus cycle length (SCL) during sinus arrhythmia utilizing the indirect atrial premature stimulation technique for estimating SACT, However, this behavior seemed anomalous try analogy with the AV node. Subsequent to 1974, methodological considerations about and limitations of the indirect techniques for estimating SACT became apparent, making us question our former impression. When the capability to directly record sinus node electrograms was developed and established in the 1980s, we had the means to reevaluate the SACT/SCL relationship. This report presents our findings in 40 patients: the SACT/SCL relationship is direct, not inverse. Moreover, we also show that during the phasic fluctuations of sinus arrhythmia, the P-P alterations are initiated more frequently by changes in sinoatrial conduction time than by changes in sinus cycle length.