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Objective To investigate the risk factors that may induce pneumothorax resulted from subclavian vein puncture during interventional therapy for arrhythmia.Methods The clinical data of 4 351 patients with heart disease,who were admitted to Wuhan Asia Heart Disease Hospital,China,during the period from January 2010 to January 2014 to receive subclavian vein puncture for the performance of radiofrequency catheter ablation or pacemaker implantation,were retrospectively analyzed.The gender,age,presence of chronic obstructive pulmonary disease (COPD) and the shape of clavicle of patients who developed pneumothorax were analyzed,and their relationships with the occurrence of pneumothorax were evaluated.Results Of the 4 351 patients,47 patients developed pneumothorax(1.08％),their age was 12-72 years old with a mean of (47.1±18.4) years old.Among the 47 patients,37 patients were females (78.7％).The angle between clavicle and sternum ＜60°(oblique clavicle) was seen in 27 patients,coexisting COPD was seen in 2 patients.The occurrence of pneumothorax was strikingly higher in females than that in males (OR=2.7,95％ CI=1.4-5.2).In patients with oblique clavicle the risk of pneumothorax was obviously increased (OR=3.5,95％ CI=1.6-7.9) and in patients with COPD the probability of pneumothorax was remarkably increased (OR=2.3,95％CI=1.2-4.7).No special treatment was employed in 5 pneumothorax patients,and the pneumothorax was absorbed by itself.In 19 patients,the pneumothorax was relieved through thoracic puncture and suction.Closed drainage of thoracic cavity was employed in 23 patients.All patients were discharged from hospital with complete rehabilitation.Conclusion Clinically,pneumothorax has been an important clinical problem in interventional therapy.In female patients and in patients who have oblique clavicle or coexisting COPD,pneumothorax is more likely to occur when they receive subclavian vein puncture.
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Objective To investigate the electrophysiological characteristics of atrial tachycardia (AT) originating from the side of the bundle of His, and to analyze the efficacy and safety of transcatheter radiofrequency ablation via the right side of the bundle of His and left noncoronary sinus of aorta for the treatment of AT. Methods A total of 12 patients with AT originating from the side the bundle of His, which was confirmed by conventional electrophysiological study and atrial activation patterns, were included in this study. The patient’s age ranged from 12 to 64 years old with a mean of (47.4±14.6) years. The mapping was carried out at the right side of the bundle of His and radiofrequency ablation was performed. When the ablation procedure failed, or the junction zone rhythm or atrioventricular block occurred, ablation via the left noncoronary sinus of aorta was employed. Results Atrial stimulation could repeatedly induce and terminate AT in all the 12 patients, the average cycle length was (327±76) ms. TA was terminated within 10 seconds after the start of ablation in 10 patients during their AT attacks. Ablation was unsuccessful in 2 patients. Ablation via the right side of His bundle was successfully accomplished in 2 patients, and the ablation via the left noncoronary sinus of aorta was successfully carried out in 8 patients. The average follow-up time was 1-6 years, and no recurrence of AT was observed. Conclusion Atrial tachycardia originating from the side of the bundle of His has certain electrophysiological characteristics, and transcatheter radiofrequency ablation is safe and effective for its treatment. Ablation via the left noncoronary sinus of aorta should be considered as a strategy of priority.
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<p><b>BACKGROUND</b>Diabetes-related pathogenic factors can cause retinal ganglion cell (RGC) apoptosis, but the specific mechanism is not very clear. The aim of this study is to investigate the correlation between glycogen synthase kinase-3 (GSK-3) activation and retinal neuron apoptosis.</p><p><b>METHODS</b>In an in vitro experiment, the number of apoptotic RGC-5 cells differentiated by staurosporine was evaluated via flow cytometry and nuclei staining using Hoechst 33258. GSK-3 phosphorylation and caspase-3 activation in RGC-5 cells after serum deprivation were determined using Western blotting. Mitochondrial membrane potential was detected using the dye 5, 5', 6, 6'tetrachloro-1, 1', 3, 3'-tetrethyl benzimidalyl carbocyanine iodide, and reactive oxygen species (ROS) levels were measured with dihydroethidium. In an in vivo experiment, the number of apoptotic retinal neurons was evaluated via terminal transferase dUTP nick-end labeling (TUNEL), and GSK-3 phosphorylation was determined using Western blotting, in the retinal nerve epithelial tissue of rats in which diabetes was induced by intravenous tail-vein injection of streptozotocin for 4 weeks.</p><p><b>RESULTS</b>The levels of phosphorylated Ser21/9 in GSK-3α/β and p-T308/S473-AKT were lower and the cleaved caspase-3 levels were higher in the serum-deprived model (P < 0.05). Lithium chloride treatment was associated with a slower rate of apoptosis, increased mitochondrial membrane potential, and decreased ROS levels in differentiated RGC-5 cells (P < 0.05). The level of blood glucose and the number of TUNEL-positive cells in the whole-mounted retinas were higher (P < 0.01), and the levels of phosphorylated Ser21/9 in GSK-3α/β and body weight were lower (P < 0.05). However, the thickness of the retinal nerve epithelial layer was not significantly less in diabetic rats compared with control group. Lithium chloride intravitreal injection increased the levels of phosphorylated Ser21/9 in GSK-3α/β and decreased TUNEL-positive cells in the whole-mounted retinas.</p><p><b>CONCLUSION</b>GSK-3 kinase is closely related to retinal neuron apoptosis, and the application of the GSK-3 inhibitor lithium chloride can reduce retinal neuron apoptosis in early diabetic retinopathy.</p>