• 【半自动化QRS评分可作为CRT治疗严格左束支传导阻滞患者生存的预测指标。】 复制标题 收藏 收藏
    DOI:10.1016/j.jelectrocard.2017.11.001 复制DOI
    作者列表:Reitan C,Chaudhry U,Atwater B,Jacobsson J,Couderc JP,Xia X,Carlson J,Platonov PG,Borgquist R
    BACKGROUND & AIMS: BACKGROUND:Cardiac Resynchronization Therapy (CRT) is widely used for treating selected heart failure patients, but patients with myocardial scar respond worse to treatment. The Selvester QRS scoring system estimates myocardial scar burden using 12-lead ECG. This study's objective was to investigate the scores correlation to mortality in a CRT population. METHODS AND RESULTS:Data on consecutive CRT patients was collected. 401 patients with LBBB and available ECG data were included in the study. QuAReSS software was used to perform Selvester scoring. Mean Selvester score was 6.4, corresponding to 19% scar burden. The endpoint was death or heart transplant; outcome was analyzed using Cox proportional hazards models. A Selvester score >8 was significantly associated with higher risk of the combined endpoint (HR 1.59, p=.014, CI 1.09-2.3). CONCLUSION:Higher Selvester scores correlate to mortality in CRT patients with strict LBBB and might be of value in prognosticating survival.
    背景与目标:
  • 【心脏再同步化治疗后根据基线QRS持续时间的绝对生存率: 一项多国10年经验: 来自多中心国际CRT研究的数据.】 复制标题 收藏 收藏
    DOI:10.1016/j.ahj.2013.10.017 复制DOI
    作者列表:Gasparini M,Leclercq C,Yu CM,Auricchio A,Steinberg JS,Lamp B,Klersy C,Leyva F
    BACKGROUND & AIMS: BACKGROUND:In the major trials of cardiac resynchronization therapy (CRT), the survival benefit of the therapy, relative to control subjects, increases with QRS duration. In the non-CRT heart failure population, however, a wide QRS duration is associated with a shorter survival. Relative survival benefit from a therapy, however, is not synonymous with a longer absolute survival. We sought to determine whether baseline QRS duration relates to the absolute survival after CRT. METHODS AND RESULTS:In this prospective, longitudinal, observational study, 3,319 consecutive patients undergoing CRT (QRS 120-149 ms 26%, QRS 150-199 ms 58%, and QRS ≥200 ms 16%) were assessed in relation to mortality over 10 years. Overall mortality rates (per 100 patient-years) were 9.2%, 9.3%, and 13.3% in the 3 groups, respectively (all P < .001). Cardiac mortality rates were 6.2, 6.0, and 9.9 per 100 patient-years, respectively (all P < .001). Compared with the QRS 120-149 ms group, cardiac mortality was highest in the QRS ≥200 ms group (hazard ratio [HR] 1.72 [95% CI 1.35-2.19], P < .001), independent of age, gender, New York Heart Association class, presence of atrial fibrillation, heart failure etiology, and left ventricular ejection fraction. Median survival after CRT was longest in patients with a width of QRS 120-149 ms and shortest in patients with a QRS ≥200 ms (P < .001). In multivariable analyses, a QRS ≥200 ms emerged as a powerful independent predictor of both overall (HR 1.44 [95% CI 1.07-1.94], P = .017) and cardiac mortality (HR 1.59 [95% CI 1.14-2.24], P = .007). CONCLUSIONS:At long-term follow-up, absolute overall and cardiac survival after CRT is similar in patients with a preimplant QRS duration of 120 to 149 ms and 150 to 199 ms but markedly shorter in patients with a QRS ≥200 ms.
    背景与目标:
  • 【用CRT将单室ICD升级为双室ICD时诊断出高压引线故障。】 复制标题 收藏 收藏
    DOI:10.1093/europace/eul094 复制DOI
    作者列表:Kaźmierczak J,Rzeuski R,Peregud-Pogorzelska M,Goracy J
    BACKGROUND & AIMS: :We describe a case of defibrillation lead damage which was detected only during an upgrade procedure from single-chamber ICD to dual-chamber ICD with biventricular pacing. The damage was not detected during routine checks in the ICD clinic.
    背景与目标: : 我们描述了除颤铅损伤的情况,该情况仅在双心室起搏从单室ICD升级到双室ICD的过程中检测到。在ICD诊所进行常规检查时未发现损坏。
  • 【用CRT和TAT PTD修饰CEA在RNA脉冲DC疫苗接种中诱导有效的抗肿瘤免疫反应。】 复制标题 收藏 收藏
    DOI:10.1016/j.vaccine.2008.08.072 复制DOI
    作者列表:Kim SG,Park MY,Kim CH,Sohn HJ,Kim HS,Park JS,Kim HJ,Oh ST,Kim TG
    BACKGROUND & AIMS: :Carcinoembryonic antigen (CEA) is expressed on human colon carcinomas, is well characterized, and continues to be a promising target for cancer immunotherapy in humans. To enhance the immunogenecity of CEA, we developed a fusion gene (CRT-TAT-DeltaCEA) of the TAT protein transduction domain (PTD) and calreticulin (CRT) with human CEA devoid of its signal sequences (DeltaCEA) and evaluated anti-tumor immunity using RNA-pulsed dendritic cell (DC) vaccination. Mice vaccinated with DC by electroporation with mRNA encoding TAT-DeltaCEA (DC/TAT-DeltaCEA) and CRT-DeltaCEA (DC/CRT-DeltaCEA) had enhanced induction of tumor-specific cytotoxic T lymphocyte (CTL) and increased numbers of IFN-gamma-secreting T cells by ELISPOT, as compared to mice vaccinated with DC/DeltaCEA. DC/CRT-DeltaCEA and DC/TAT-DeltaCEA vaccines preferentially stimulated CD4+ and CD8+ T cells, respectively. The DC vaccine by electroporation with mRNA encoding CRT-TAT-DeltaCEA (DC/CRT-TAT-DeltaCEA) enhanced both CD4+ and CD8+ T cells. DC/CRT-TAT-DeltaCEA had the additional effects of CRT and TAT PTD and enhanced the anti-tumor effect against CEA-expressing tumors compared to DC/CRT-DeltaCEA or DC/TAT-DeltaCEA. These findings suggest that modification of CEA with both CRT and TAT PTD induces potent anti-tumor immune responses in RNA-pulsed DC vaccination and may be a useful approach for DC-based immunotherapy.
    背景与目标: : 癌胚抗原 (CEA) 在人结肠癌上表达,具有很好的特征,并且仍然是人类癌症免疫治疗的有希望的靶标。为了增强CEA的免疫原性,我们开发了TAT蛋白转导结构域 (PTD) 和钙网蛋白 (CRT) 的融合基因 (CRT-TAT-DeltaCEA) 与没有信号序列的人CEA (DeltaCEA),并使用RNA脉冲树突状细胞 (DC) 疫苗评估了抗肿瘤免疫。用编码TAT-DeltaCEA (DC/TAT-DeltaCEA) 和CRT-DeltaCEA (DC/CRT-DeltaCEA) 的mRNA电穿孔接种DC的小鼠增强了对肿瘤特异性细胞毒性T淋巴细胞 (CTL) 的诱导,并增加了IFN-γ 的数量ELISPOT分泌的T细胞,与接种DC/DeltaCEA疫苗的小鼠相比。DC/CRT-DeltaCEA和DC/TAT-DeltaCEA疫苗分别优先刺激CD4 + 和CD8 + T细胞。用编码CRT-TAT-DeltaCEA (DC/CRT-TAT-DeltaCEA) 的mRNA进行电穿孔的DC疫苗可增强CD4和CD8 T细胞。与DC/CRT-DeltaCEA或DC/TAT-DeltaCEA相比,DC/CRT-TAT-DeltaCEA具有CRT和TAT PTD的附加作用,并增强了对表达CEA的肿瘤的抗肿瘤作用。这些发现表明,用CRT和TAT PTD修饰CEA可在RNA脉冲DC疫苗接种中诱导有效的抗肿瘤免疫反应,并且可能是基于DC的免疫疗法的有用方法。
  • 【252的中子近距离放射治疗结合EBRT与3D-CRT治疗食管鳞状细胞癌的回顾性研究。】 复制标题 收藏 收藏
    DOI:10.1186/s13014-015-0520-7 复制DOI
    作者列表:Wang Q,Li T,Lang J,Wang J,Wang J,Liu H,Jia X,Liu B,Wang CK
    BACKGROUND & AIMS: BACKGROUND:We conducted a retrospective analysis on 884 patients who were diagnosed with esophageal squamous cell carcinoma (ESCC) and treated with either the neutron brachytherapy in combination with external beam radiotherapy (NBT + EBRT) or 3-dimensional conformal radiation therapy (3D-CRT) to determine the differences in efficacy and morbidity between the two treatment groups. METHODS:The 884 ESCC patients treated with either NBT + EBRT or 3D-CRT between 2002 and 2012 were retrospectively reviewed and analyzed. Multivariable Cox regression was used to compare oncologic outcomes of the two groups of patients in the context of other clinically relevant variables. The acute and chronic toxicities associated with the two groups were compared using Fisher exact and log-rank tests, respectively. RESULTS:Among the 884 patients, 545 received NBT + EBRT and 339 received 3D-CRT (i.e. EBRT-only). The age range is 39-95 years (median 66). The follow-up time range is 3-145 months (median 32). The analysis shows that the NBT + EBRT group has higher overall survival rate and local control rate than that of the 3D-CRT group. The acute toxicity effects were acceptable for both groups of patients with the NBT + EBRT group showing higher rates of leukopenia and thrombocytopenia and the 3D-CRT group showing higher rates on fistula and massive bleeding. CONCLUSIONS:The patients treated with NBT + EBRT showed better oncologic outcomes than those treated with 3D-CRT. The toxicity effects were acceptable for both groups with the NBT + EBRT group showing higher rates on the acute effects and the 3D-CRT group showing higher rates on the late effects.
    背景与目标:
  • 【纤维素增强淀粉 (CRT) 薄膜的生产和表征。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijbiomac.2015.11.037 复制DOI
    作者列表:Sudharsan K,Chandra Mohan C,Azhagu Saravana Babu P,Archana G,Sabina K,Sivarajan M,Sukumar M
    BACKGROUND & AIMS: :Starch from Tamarind seed is considered to be a nonedible and inexpensive component, with many industrial applications. Extraction and characterization of tamarind seed starch was carried out for the synthesis of biopolymer. Tamarind seeds were collected, cleaned and further roasted, decorticated, and pulverized to get starch powder. Total starch content present in each tamarind seed is estimated to be around 65-70%. About 84.68% purified starch can be recovered from the tamarind seed. Defatted Tamarind seed starch has an amylose content of 27.55 wt.% and 72.45 wt.% of amylopectin. Morphological (SEM) and X-ray diffraction were used to evaluate crystallinity. Likewise, TGA and DSC of starch have also been analyzed. Thermal properties of starch obtained from tamarind seeds showed good thermal stability when compared to other starch sources such as Mesquite seed and Mango kernel. This study proved that the tamarind seed starch can be used as a potential biopolymer material. Thermo-stable biofilms were produced through initial optimization studies. Predictive response surface quadratic models were constructed for prediction and optimization of biofilm mechanical properties. Correlation coefficient values were calculated to me more than 0.90 for mechanical responses which implies the fitness of constructed model with experimental data.
    背景与目标: : 罗望子种子中的淀粉被认为是不可食用且廉价的成分,具有许多工业应用。罗望子种子淀粉的提取和表征用于生物聚合物的合成。收集罗望子种子,清洗并进一步烘烤,去皮,粉碎以获得淀粉粉。每个罗望子种子中存在的总淀粉含量估计约为65-70%。约84.68% 纯化的淀粉可从罗望子种子中回收。脱脂罗望子种子淀粉的直链淀粉含量为27.55重量 % 和72.45重量 % 支链淀粉。形貌 (SEM) 和x射线衍射用于评估结晶度。同样,也分析了淀粉的TGA和DSC。与其他淀粉来源 (例如豆科灌木种子和芒果仁) 相比,从罗望子种子获得的淀粉的热性能显示出良好的热稳定性。这项研究证明了罗望子种子淀粉可以用作潜在的生物聚合物材料。通过初始优化研究产生了热稳定的生物膜。建立了预测响应面二次模型,用于预测和优化生物膜的机械性能。对于机械响应,我计算的相关系数值超过0.90,这意味着构建的模型与实验数据的适用性。
  • 【认知修复疗法 (CRT) 对初始记忆能力低的精神分裂症患者受益更大。】 复制标题 收藏 收藏
    DOI:10.3109/09638288.2014.946153 复制DOI
    作者列表:Pillet B,Morvan Y,Todd A,Franck N,Duboc C,Grosz A,Launay C,Demily C,Gaillard R,Krebs MO,Amado I
    BACKGROUND & AIMS: PURPOSE:Cognitive deficits in schizophrenia mainly affect memory, attention and executive functions. Cognitive remediation is a technique derived from neuropsychology, which aims to improve or compensate for these deficits. Working memory, verbal learning, and executive functions are crucial factors for functional outcome. Our purpose was to assess the impact of the cognitive remediation therapy (CRT) program on cognitive difficulties in patients with schizophrenia, especially on working memory, verbal memory, and cognitive flexibility. METHODS:We collected data from clinical and neuropsychological assessments in 24 patients suffering from schizophrenia (Diagnostic and Statistical Manual of mental Disorders-Fourth Edition, DSM-IV) who followed a 3-month (CRT) program. Verbal and visuo-spatial working memory, verbal memory, and cognitive flexibility were assessed before and after CRT. RESULTS:The Wilcoxon test showed significant improvements on the backward digit span, on the visual working memory span, on verbal memory and on flexibility. Cognitive improvement was substantial when baseline performance was low, independently from clinical benefit. CONCLUSIONS:CRT is effective on crucial cognitive domains and provides a huge benefit for patients having low baseline performance. Such cognitive amelioration appears highly promising for improving the outcome in cognitively impaired patients.
    背景与目标:
  • 【使用异源DNA标准对MDR1转录本进行绝对定量-竞争性rt-pcr (crt-pcr) 方法的验证。】 复制标题 收藏 收藏
    DOI:10.2144/99266st03 复制DOI
    作者列表:el-Osta A,Kantharidis P,Zalcberg J
    BACKGROUND & AIMS: The multidrug resistance (MDR1) gene product, P-glycoprotein (Pgp), is a 170-kDa ATP-dependent pump that expels a variety of anticancer drugs out of malignant cells, reducing drug accumulation and thus antitumor activity. In recent years, considerable data has been presented that indicates the need to standardize detection methods for Pgp and MDR1. Reverse transcription (RT)-PCR is one of the most sensitive and specific techniques used to detect MDR1. Nevertheless, there is the need to address working criteria for quantitation by RT-PCR. In this study, we describe a flexible assay used to quantify MDR1 gene expression using heterologous (nonhomologous) standards for use in competitive RT-PCR (CRT-PCR). Our guidelines were to use a RT-PCR quantitation method that was independent of exponential phase kinetics, sensitive (detect low levels of gene measurement in clinical samples) and did not require radiolabel. Furthermore, the method would need to be flexible enough for the user to express quantitation as either the number of cells or amount of cDNA used in CRT-PCR. Using low-stringency amplification, heterologous DNA competitors were constructed for MDR1 and as an internal reference, the ubiquitously expressed human histone variant 3.3 (H3.3). The benefits of this approach are threefold(i) amplification kinetics of target and competitor molecules are identical, (ii) low-stringency PCR is a simple way of constructing heterologous DNA competitors that do not require special storage conditions and (iii) heterologous competitors avoid the formation of heteroduplex molecules. We conclude that CRT-PCR is an extremely flexible and sensitive assay that can quantify MDR1 based on competitive amplification of a heterologous competitor. This might complement future efforts to standardize MDR1 detection methods using RT-PCR.

    背景与目标: 多药耐药 (MDR1) 基因产物P-糖蛋白 (Pgp) 是一种170 kDa的ATP依赖性泵,可将多种抗癌药物从恶性细胞中排出,从而减少药物的积累,从而降低抗肿瘤活性。近年来,已经提供了大量数据,表明需要标准化Pgp和mdr1的检测方法。逆转录 (RT)-PCR是用于检测mdr1的最敏感和最特异的技术之一。然而,有必要解决rt-pcr定量的工作标准。在这项研究中,我们描述了一种灵活的测定法,用于使用异源 (非同源) 标准来定量MDR1基因表达,以用于竞争性rt-pcr (crt-pcr)。我们的指南是使用rt-pcr定量方法,该方法独立于指数期动力学,灵敏 (检测临床样品中的低水平基因测量) 并且不需要放射性标记。此外,该方法将需要足够灵活,以便用户将定量表达为crt-pcr中使用的细胞数量或cDNA量。使用低严格扩增,构建了MDR1的异源DNA竞争者,并作为内部参考,普遍表达的人组蛋白变体3.3 (H3.3)。这种方法的好处是三重 (i) 靶标和竞争者分子的扩增动力学是相同的; (ii) 低严格PCR是构建异源DNA竞争者的简单方法,不需要特殊的存储条件; (iii) 异源竞争者避免异源双链体分子的形成。我们得出的结论是,crt-pcr是一种非常灵活且灵敏的检测方法,可以基于异源竞争者的竞争性扩增来定量MDR1。这可能会补充未来使用rt-pcr标准化MDR1检测方法的努力。
  • 【与标准CRT方案相比,远端直肠癌新辅助放化疗 (CRT) 期间的巩固化疗导致肿瘤代谢持续下降。】 复制标题 收藏 收藏
    DOI:10.1186/s13014-016-0598-6 复制DOI
    作者列表:Habr-Gama A,Perez RO,São Julião GP,Proscurshim I,Fernandez LM,Figueiredo MN,Gama-Rodrigues J,Buchpiguel CA
    BACKGROUND & AIMS: BACKGROUND:Neoadjuvant CRT may lead to significant tumor regression in patients with rectal cancer. Different CRT regimens with consolidation chemotherapy may lead to increased rates of complete tumor regression. The purpose of this study was to understand tumor metabolic activity following two different neoadjuvant CRT regimens using sequential PET/CT imaging in two different intervals following RT. METHODS:Patients with cT2-4 N0-2 M0 rectal cancer treated by standard CRT (54Gy and 2 cycles of 5FU-based chemotherapy) or extended CRT (54Gy and 6 cycles of 5FU-based chemotherapy) underwent sequential PET/CT imaging at baseline, 6 weeks and 12 weeks from radiation completion. RESULTS:99 patients undergoing standard CRT were compared to 12 patients undergoing CRT with consolidation chemotherapy. Patients treated with consolidation CRT had increased rates of complete clinical or pathological response (66 % vs. 23 %; p < 0.001). SUVmax variation between baseline and 6 weeks (88 % vs. 63 %; p < 0.001) and between baseline and 12 weeks (90 % vs. 57 %; p < 0.001) were significantly more pronounced among patients undergoing extended CRT with consolidation chemotherapy. An increase in SUVmax between 6 and 12 weeks was observed in 51 % of patients undergoing standard and 18 % of patients undergoing consolidation CRT (p = 0.04). CONCLUSIONS:Most of the reduction in tumor metabolism after neoadjuvant CRT occurs within the first 6 weeks from RT completion. In patients undergoing CRT with consolidation chemotherapy, tumors are less likely to regain metabolic activity between 6 and 12 weeks. Therefore, assessment of tumor response may be safely postponed to 12 weeks in patients undergoing extended CRT with consolidation chemotherapy. TRIAL REGISTRATION:NCT00254683.
    背景与目标:
  • 【一项计算机规划研究,比较了胸腺肿瘤患者的3D-CRT,IMRT和质子束治疗的剂量和估计的毒性风险。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejmp.2019.03.028 复制DOI
    作者列表:Lideståhl A,Mondlane G,Gubanski M,Lind PA,Siegbahn A
    BACKGROUND & AIMS: PURPOSE:To compare the dose distributions produced in patients (pts) treated for thymic tumours with spot-scanning proton beam therapy (PBT) implemented with single-field uniform dose (SFUD), intensity-modulated radiation therapy (IMRT) and three-dimensional conformal photon-beam based radiotherapy (3D-CRT). METHODS:Twelve pts, treated with 3D-CRT, were included. Alternative IMRT and SFUD plans were constructed. The IMRT plans were created using a setup with beams incident from 5 to 6 different angles. For the SFUD plans, a field-specific planning target volume (PTV) was created for each patient and a clinical target volume (CTV)-based robust optimization was performed. A robustness evaluation was performed for the CTV for all SFUD plans. A dosimetric evaluation was conducted for the doses to the CTV and organs at risk (OARs) for all plans. The normal tissue complication probability (NTCP), for different endpoints, was calculated using the Lyman-Kutcher-Burman (LKB)-model and compared between plans. RESULTS:SFUD was associated with significantly lower mean doses to the oesophagus, the heart, the left anterior descending coronary artery (LAD), lungs and breasts compared to 3D-CRT and IMRT. The maximum dose given to the spinal cord was significantly lower with SFUD. The risks for pneumonitis, esophagitis and myelopathy were significantly reduced in the SFUD plans. CONCLUSIONS:The present study showed dosimetric advantages of using scanned-beam PBT for the treatment of thymic tumours, as compared to 3D-CRT and IMRT, especially in regard to lower doses to the oesophagus and lungs. The risk of toxicity was reduced with SFUD.
    背景与目标:
  • 【改变CRT刷新率对时间总和测量的影响。】 复制标题 收藏 收藏
    DOI:10.1111/opo.12227 复制DOI
    作者列表:Mulholland PJ,Zlatkova MB,Redmond T,Garway-Heath DF,Anderson RS
    BACKGROUND & AIMS: PURPOSE:To quantify the effect of cathode-tube-ray (CRT) monitor refresh rate on the measurement of the upper limit of complete temporal summation (critical duration) in the peripheral visual field of healthy observers. METHODS:Contrast thresholds were measured for seven achromatic spot stimuli (diameter 0.48°) of varying duration (nominal values: 10-200 ms) at an eccentricity of 8.8° along the 45°, 135°, 225° and 315° meridians of the visual field in three healthy, psychophysically experienced observers. Stimuli were presented on a CRT display with a refresh rate of 60 and 160 Hz. Contrast thresholds were expressed as contrast energy with stimulus durations being estimated using (1) the sum-of-frames (SOF) method and (2) Bridgeman's method incorporating measurements of phosphor persistence. Estimates of the critical duration were produced using iterative two-phase regression analysis. RESULTS:With stimulus duration expressed as SOF equivalent the critical duration was, on average, 10.6 ms longer with a refresh rate of 60 Hz (mean 45.7 ms, S.D. 10.1 ms) relative to 160 Hz (35.1 ms, S.D. 7.6 ms). When the Bridgeman method was used, minimal differences (1.8 ms) in critical duration values between the two refresh rates (60 Hz: 33.0 ms, S.D. 9.4 ms; 160 Hz: 31.2 ms, S.D. 7.0 ms) were observed. Identical trends were observed in all three subjects. CONCLUSIONS:Psychophysical measurements of temporal summation are independent of variations in CRT refresh rate when the Bridgeman method, incorporating measured values of phosphor persistence, is used to estimate stimulus duration. This has significant implications for the specification of stimulus duration in psychophysical studies of vision employing conventional display monitors.
    背景与目标:
  • 【ICD和CRT在女性缺血性心脏病中的应用。】 复制标题 收藏 收藏
    DOI:10.1007/s11883-015-0512-y 复制DOI
    作者列表:Mehta NK,Abraham WT,Maytin M
    BACKGROUND & AIMS: :Although the role of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) in improving outcomes in ischemic cardiomyopathy (ICM) has been described, the data regarding gender-based survival outcomes are limited. There is a higher preponderance of non-ischemic cardiomyopathy (NICM) in women, and most of the ICM literature is derived from sub-study analysis. This review summarizes the current body of literature on prognosis, pathophysiology, and the present clinical practice for device implantation in women with ICM.
    背景与目标: : 尽管已经描述了植入式心律转复除颤器 (ICD) 和心脏再同步化治疗 (CRT) 在改善缺血性心肌病 (ICM) 结局中的作用,但有关基于性别的生存结局的数据有限。女性非缺血性心肌病 (NICM) 的优势较高,并且大多数ICM文献都来自子研究分析。这篇综述总结了有关ICM女性患者的预后,病理生理学和目前的临床实践的文献。
  • 【Beckman E4A,Beckman Synchron CX5,Nova CRT和Nova Stat Profile Ultra上的电解质和阴离子间隙的参考范围。】 复制标题 收藏 收藏
    DOI:10.1016/s0009-8981(01)00437-5 复制DOI
    作者列表:Lolekha PH,Vanavanan S,Teerakarnjana N,Chaichanajarernkul U
    BACKGROUND & AIMS: :The widespread use of ion-selective electrode causes the reference range of the anion gap (AG) to be lowered from 8-16 to 3-11 mmol/l. The use of the outdated reference range (8-16 mmol/l) leads to the misinterpretation of the value of the anion gap. To interpret the anion gap accurately, one must use an analyzer-specific reference range. This study established the reference ranges of the electrolyte and anion gap in four ion-selective electrode analyzers. We collected clotted and lithium-heparinized blood from 124 healthy volunteers. We determined the electrolyte in the Beckman E4A (serum), Beckman Synchron CX5 (serum), and Nova CRT (serum and plasma). The anion gap was calculated from the formula: [Na(+)-(Cl(-)+HCO3(-))]. Blood sodium, potassium and bicarbonate were determined using the Nova Stat Profile Ultra. We used the plasma chloride from the Nova CRT to calculate the value of the anion gap in the Nova Stat Profile Ultra. We established the reference ranges using the non-parametric percentile estimation method. Accuracy and precision of the electrolyte performances obtained from all analyzers were acceptable. Reference values of serum and plasma sodium, potassium, and chloride were similar in all analyzers. The value of blood sodium obtained from the Nova Stat Profile Ultra was slightly higher than the values for the serum and plasma sodium obtained from the other analyzers. The bicarbonate ranges obtained from the Nova analyzers were higher than the values obtained from the Beckman analyzers. For the anion gap, the reference ranges in this study were low but similar to other studies (3-11 mmol/l) using ion-selective electrode. However, our reference ranges were lower than the previous reference ranges obtained from the continuous-flow analyzer (8-16 or 9-18 mmol/l) incorporated with flame photometry and colorimetry techniques.
    背景与目标: : 离子选择电极的广泛使用导致阴离子间隙 (AG) 的参考范围从8-16降低到3-11 mmol/l。使用过时的参考范围 (8-16 mmol/l) 会导致对阴离子间隙值的误解。要准确解释阴离子间隙,必须使用特定于分析仪的参考范围。这项研究确定了四种离子选择电极分析仪中电解质和阴离子间隙的参考范围。我们从124名健康志愿者中收集了凝结的和锂肝素化的血液。我们确定了Beckman E4A (血清),Beckman Synchron CX5 (血清) 和Nova CRT (血清和血浆) 中的电解质。阴离子间隙由以下公式计算: [Na(+)-(Cl(-)+ HCO3(-))]。使用Nova Stat Profile Ultra测定血钠,钾和碳酸氢盐。我们使用来自Nova CRT的等离子氯化物来计算Nova Stat Profile Ultra中阴离子间隙的值。我们使用非参数百分位估计方法建立了参考范围。从所有分析仪获得的电解质性能的准确性和精密度都是可以接受的。在所有分析仪中,血清和血浆钠,钾和氯化物的参考值相似。从Nova Stat Profile Ultra获得的血钠值略高于从其他分析仪获得的血清和血浆钠值。从Nova分析仪获得的碳酸氢盐范围高于从Beckman分析仪获得的值。对于阴离子间隙,本研究中的参考范围较低,但与使用离子选择电极的其他研究 (3-11 mmol/l) 相似。但是,我们的参考范围低于先前从结合火焰光度法和比色法技术的连续流分析仪 (8-16或9-18 mmol/l) 获得的参考范围。
  • 【Crt-d植入患者的临床特征,死亡率,心脏住院和室性心律失常: ACTION-HF研究的结果。】 复制标题 收藏 收藏
    DOI:10.1111/jce.12023 复制DOI
    作者列表:Botto GL,Dicandia CD,Mantica M,La Rosa C,D'Onofrio A,Bongiorni MG,Molon G,Verlato R,Villani GQ,Scaccia A,Raciti G,Occhetta E
    BACKGROUND & AIMS: INTRODUCTION:The characteristics and outcomes of patients who undergo cardiac resynchronization therapy (CRT) device implantation in current clinical practice may differ from those of reference trial populations. Study objectives were to assess 2-year outcomes in a population implanted with a CRT plus defibrillator device in accordance with the standard of care and to evaluate any independent association between clinical variables and outcome. METHODS AND RESULTS:A total of 406 patients enrolled at 35 centers in Italy were followed up prospectively for 2 years. All patient management decisions were left to the treating physician's discretion, in accordance with clinical practice. ACTION-HF patients had a better baseline clinical status than patients enrolled in the COMPANION study: shorter HF history (1 vs 3.5 years, P < 0.01), less advanced NYHA functional class (III-IV: 73% vs 100%, P < 0.01), higher LVEF (26% vs 21%, P < 0.01), higher SBP (122 vs 112 mmHg, P < 0.01), and less diabetes (27% vs 41%, P < 0.01). This status was reflected in lower mortality (11.5% vs 26%) and a lower incidence of appropriate ICD shocks (12.1% vs 19.3%). AF history was an independent predictor of the combination of all-cause mortality and cardiac-cause hospitalization (HR: 3.31; P < 0.001). Recurrent or new atrial arrhythmias were independently associated with the development of ventricular arrhythmias (HR: 3.4; P < 0.001). CONCLUSIONS:This population appears clinically less compromised and had a lower incidence of adverse clinical outcomes than those of reference trials. However, we recorded a substantial burden of atrial arrhythmias, which was independently associated with a higher incidence of ventricular arrhythmias.
    背景与目标:
  • 【研究设计对报告的心脏再同步化治疗 (CRT) 对定量生理指标的影响: 窄QRS心力衰竭的分层荟萃分析及其对未来研究计划的意义。】 复制标题 收藏 收藏
    DOI:10.1161/JAHA.114.000896 复制DOI
    作者列表:Jabbour RJ,Shun-Shin MJ,Finegold JA,Afzal Sohaib SM,Cook C,Nijjer SS,Whinnett ZI,Manisty CH,Brugada J,Francis DP
    BACKGROUND & AIMS: BACKGROUND:Biventricular pacing (CRT) shows clear benefits in heart failure with wide QRS, but results in narrow QRS have appeared conflicting. We tested the hypothesis that study design might have influenced findings. METHOD AND RESULTS:We identified all reports of CRT-P/D therapy in subjects with narrow QRS reporting effects on continuous physiological variables. Twelve studies (2074 patients) met these criteria. Studies were stratified by presence of bias-resistance steps: the presence of a randomized control arm over a single arm, and blinded outcome measurement. Change in each endpoint was quantified using a standardized effect size (Cohen's d). We conducted separate meta-analyses for each variable in turn, stratified by trial quality. In non-randomized, non-blinded studies, the majority of variables (10 of 12, 83%) showed significant improvement, ranging from a standardized mean effect size of +1.57 (95%CI +0.43 to +2.7) for ejection fraction to +2.87 (+1.78 to +3.95) for NYHA class. In the randomized, non-blinded study, only 3 out of 6 variables (50%) showed improvement. For the randomized blinded studies, 0 out of 9 variables (0%) showed benefit, ranging from -0.04 (-0.31 to +0.22) for ejection fraction to -0.1 (-0.73 to +0.53) for 6-minute walk test. CONCLUSIONS:Differences in degrees of resistance to bias, rather than choice of endpoint, explain the variation between studies of CRT in narrow-QRS heart failure addressing physiological variables. When bias-resistance features are implemented, it becomes clear that these patients do not improve in any tested physiological variable. Guidance from studies without careful planning to resist bias may be far less useful than commonly perceived.
    背景与目标:

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