肩、肘关节外科新进展

肩关节（Shoulder） 旋转袖（Rotator Cuff） 基础研究（Basic Science） Zuckerman讨论了软骨诱导形态发生蛋白-2（cartilagederived morphogenetic protein-2，CDMP-2）的早期工作。在鼠肌腱修复中，4周时CDMP-2治疗组的修复强度高于未治疗组。Dines讨论了关于血小板衍生生长因子（platelet—derived growth factor，PDGF）和胰岛素样生长因子-1（insulin-like growth factor-1，IGF-1）最初的研究观察。     

Calcium pyrophosphate dihydrate deposition disease: morphological and microanalytical features

The light microscopic and polarization appearances of calcium pyrophosphate dihydrate crystal deposits in tissues are reviewed. In routine sections haematoxylinophilic crystalline deposits with a feathery or brush-like pattern are typical of calcium pyrophosphate dihydrate. Short rhomboidal crystals showing positive birefringence are seen on polarization; X-ray microanalytical and infrared spectroscopic data support the specificity of these appearances. The appearances of the crystal deposits in decalcified specimens are also described. We include six cases of calcium pyrophosphate dihydrate deposition within periarticular bone; to the best of our knowledge this has not previously been described.     

Modified Magnet Test for a Reversed Automatic Implantable Cardioverter Defibrillator

We present the case of a 55-year-old man with atrial septal defect and cardiomyopathy who underwent implantation of an automatic cardioverter defibrillator (AICD) for ventricular tachycardia resulting in collapse. This case demonstrates multiple unusual complications related to AICD, including rotation of the pulse generator unit about its long axis requiring a "left-handed" magnet test to determine the appropriate counts.     

THE EFFICACY OF LOCAL STEROID INJECTIONS IN IDIOPATHIC CARPAL TUNNEL SYNDROME: A DOUBLE-BLIND STUDY

In order to investigate the superiority of local steroid injectionover the intramuscular route, 37 patients with idiopathic carpaltunnel syndrome were treated with local or systemic steroidinjections in a double-blind study. The first group receivedsteroid injections into the carpal tunnel of the more severelyaffected hand and placebo into the deltoid muscle of the sameside. The second group received steroid injections intramuscularly,and placebo into the carpal tunnel. The only significant improvementobserved at the end of one month was in the steroid-injectedhands of the first group. At 10–12 months follow-up onlyfour (22%) of the 18 patients from this Group were symptom free. KEY WORDS: Carpal tunnel syndrome, local steroid injection     

红花籽粕对小鼠的急性毒性及抗溃疡性结肠炎作用研究

目的 评价红花籽粕(红花Carthamus tinctorius的种子经过压榨提取红花籽油后的副产品)对小鼠的急性毒性及抗溃疡性结肠炎(ulcerative colitis,UC)作用。方法 C57BL/6小鼠ig不同剂量的红花籽粕,7 d后计算脏器指数,采用苏木素-伊红(HE)染色观察肝、脾、肾组织病理变化,测定血清中肝功能、肾功能及血脂水平,以评价红花籽粕的急性毒性。建立葡聚糖硫酸钠(dextran sulphate sodium,DSS)诱导的UC小鼠模型,每天记录小鼠体质量,测定疾病活动指数(disease activity index,DAI)评分、结肠长度以及脏器指数,采用HE染色和阿利新蓝-过碘酸雪夫(AB-PAS)染色评价结肠组织病理学变化,采用qRT-PCR和Western blotting检测结肠组织中炎症和黏膜屏障相关因子表达。结果 急性毒性实验中,与对照组比较,红花籽粕组小鼠脏器指数、血液生化指标没有显著差异,脏器病理切片也未见异常。红花籽粕对DSS诱导的UC小鼠具有较好的保护作用,可以显著改善体质量减轻、DAI评分升高、结肠长度缩短等临床症状(P<0.01),减轻结肠组织病理损伤,抑制肠道炎症细胞的浸润,保护杯状细胞,提高紧密连接蛋白和黏蛋白的表达(P<0.05、0.01、0.001),改善肠道屏障完整性。结论 红花籽粕具有较高的安全性,且对DSS诱导的UC小鼠具有显著的治疗作用。     

Indirect computed tomography sign of renal artery injury: Retrograde filling of the renal vein

Computed tomography is a very useful diagnostic tool in children's trauma. In the present case report, retrograde filling of the renal vein during computerized tomographic examination of a patient with renal trauma is presented. This is an indirect sign of traumatic renal artery injury. This finding might assist in the early diagnosis of severe renovascular trauma.     

Transvenous Single Lead Atrial Defibrillation: Efficacy and Risk of Ventricular Fibrillation in an Ischemic Canine Model

Transvenous atrial defibrillation with multiple atrial lead systems has been shown to be effective in models without the potential for ventricular arrhythmias. The specific aim of this study was to evaluate the efficacy and safety of transvenous single lead atrial defibrillation in a canine model of ischemia cardiomyopathy. Ten dogs had ischemia cardiomyopathy induced by repeated intracoronary micmsphere injections. The mean LV ejection fraction decreased from 71%± 9% to 38%± 14% (P = 0.003). Spontaneous atrial fibrillation (AF) developed in four dogs, and in six AF was induced electrically. Atrial defibrillation thresholds (ADFTs) were determined with synchronous low energy shocks using a transvenous tripolar lead with two defibrillation coils (right ventricle, superior vena cava) and an integrated sensing lead (RV coil vs electrode tip). The ADFTs derived by logistic regression were compared at 50% and 90% probability of success (ED₅₀, ED₉₀): ED₅₀ was 2.4 ±1.7 J and 2.9 ±2.1 J, respectively, for 5- and 10-ms monophasic shocks, and 1.8 ± 0.9 J and 2.1 ± 1.3 J, respectively, for 5- and 10-ms biphasic shocks. Immediately after 3 of 2,179 (0.1%) synchronized shocks, ventricular fibrillation (VF) developed. VF was induced in 3 of 1,062 (0.3%) shocks with integrated sensing (RV coil vs electrode tip) compared to 0 of 1,117 shocks when a separate bipolar RV sensing electrode was used for synchronization. In our canine model of ischemic cardiomyopathy, low energy atrial defibrillation via a transvenous single lead system was highly effective. However, there was a small but definite risk of VF induction, which seemed to be greater when an integrated as opposed to a true bipolar RV sensing was used.     

Optimized Measurement of Activation Rate at Left Atrial Sites with Complex Fractionated Electrograms During Atrial Fibrillation

Local Activation Rate in Atrial Fibrillation. Background: Complex fractionated atrial electrograms (CFAE) have become targets for catheter ablation of atrial fibrillation (AF). Frequency components of AF signals have also become important markers for identifying potential mechanisms of AF, yet inaccuracies exist, particularly in standard dominant frequency (SDF) calculations especially at CFAE sites. We developed new methodology to improve accuracy of AF rate determinations at such recording sites. Objective: To develop optimal methods for estimating activation rates in paroxysmal and persistent AF. Methods: Electrograms were obtained from one right atrial, coronary sinus, and 6 left atrial (LA) endocardial regions manifesting CFAEs in paroxysmal (N = 7) and persistent (N = 7) AF patients. SDF was measured from 8.4 s intervals and compared to (1) optimized DF (ODF) calculated by optimizing the filter coefficients which maximized dominant frequency power, (2) autocorrelation (AC), with the rate estimated as the inverse of the signal phase shift generating the largest autocorrelation coefficient, and (3) ensemble average (EA), with the rate estimated by summing successive signal segments and selecting segment length yielding maximum power. Rate measurements were compared between groups, at baseline and with additive interference, having similar frequency content to the electrograms, to test the robustness of the different methods. Results: From pooled data (N = 168 recording sites), a significantly higher LA dominant frequency was found in persistent versus paroxysmal patients using each method (P < 0.001), with a mean value for all methods of 6.23 ± 0.08 Hz versus 5.32 ± 0.10 Hz, respectively. At the highest additive interference level, the rate measurement error was significantly greater in SDF as compared with EA (P = 0.010) and ODF (P = 0.035), and at all interference levels SDF had the largest error of any method. Conclusions: SDF appears less robust to additive interference, compared to the ODF and EA methods of estimating the activation rate at CFAE sites in this small group of patients. Use of optimized filter coefficients for DF measurement, or use of correlative methods such as EA, that reinforce the signal rather than filtering the noise, may improve calculation of activation rates. (J Cardiovasc Electrophysiol, Vol. 21, pp. 133‐143, February 2010)