Objective Various factors may affect the effects of cardiac resynchronization therapy or cardiac resynchronization and implantable cardioverter-defibrilator ( CRT/CRTD) in chronic heart failure patients ( CHF) .The aim of our study was to explore the correlation of age and gender with the effects of CRT/CRTD in chronic heart failure patients. Methods This study included 136 CHF patients, 92 males and 44 females, treated by CRT/CRTD from January 2005 to March 2015.We divided the patients into three age groups:≥70 yr (n=29), 50-70 yr (n=77), and <50 yr (n=30), and compared the baseline characteristics, CRT respon-ding rate and all-cause mortality among different groups.The CRT response was defined as the decrease of NYHA cardiac function≥1 grade and left ventricular ejection fraction ( LVEF) improvement ≥5%. Results In the 136 CHF patients, there were 72 CRT responders (53%), 52%in the≥70 yr group, 55%in the 50-70 yr group, and 50%in the <50 yr group, with no statistically sig-nificant differences among the three groups (P>0.05).However, the CRT responding rate was remarkably higher in the female than in the male patients (66%vs 47%, P=0.027).Cox multivariate and Kaplan-Meier analyses revealed no significant differences in all-cause mortality between different genders or age groups.Multivariate logistic regression analysis showed that the left ventricular diastolic diameter and base QRS duration were independent factors of the CRT response. Conclusion Age does not affect the CRT response in chronic heart failure patients, while female patients have a higher CRT respon-ding rate than male patients.

Objective To study the safety and feasibility of endobiliary intraductal radiofrequency ablation (RFA) to reopen occluded self-expandable metal stents in patients with malignant biliary obstruction.Methods 11 patients with malignant biliary obstruction and blocked metal stents were prospectively studied.During ERCP, after biliary cannulation, the blocked metal stents underwent RFA using a bipolar radiofrequency probe which was introduced into the stenotic bile duct via a guide wire.This was followed by a balloon to repeatedly remove debris and then endoscopic nasobiliary drainage.The patients were closely observed and followed up.Results RFA was successfully carried out in all the patients and patencies were achieved when compared with pre-RFA.The median post-RFA luminal diameter of the strictures showed significant improvement: 6 (4 ～ 10) mm versus 2 (0 ～ 5) mm, and the mean post-RFA total bilirubin level decreased sharply : (39.4 ± 8.7) μ mol/L versus (130.1 ± 38.2) μmol/L.Following this intervention, 3 patients developed fever, which were controlled with conservative therapy.There was no mortality, haemorrhage, bile duct perforation or bile leak.Of the 11 patients, 3 were dead and 6 were alive at a median follow-up of 187 (75 ～ 304) days.The median stent patency was 135 (75 ～ 203) days and the median survival was 278 (75 ～ 304) days.Four patients had their stents patent at the time of the last follow-up or death.Seven patients had their stents blocked on 113, 124, 154, 203, 96, 135 and 112 days post-procedure.Condusions Endobiliary intraductal RFA is technically feasible and safe to reopen occluded metal stents in malignant biliary obstruction.This efficacy needs to be confirmed by future randomized studies.

Objective:To explore the potential clinical value of 99Tc m-methoxyisobutylisonitrile(MIBI) SPECT/CT muscle imaging in the diagnosis of cervical dystonia (CD). Methods:From January 2021 to April 2022, 50 patients with CD (14 males, 36 females; age (45.8±12.5) years) who were treated in Second Affiliated Hospital of Soochow University were prospectively included. The 99Tc m-MIBI SPECT/CT muscle imaging results of 400 pieces of muscle (bilateral sternocleidomastoid, musculus scapulae, splenius capitis and musculus trapezius; each of 100 pieces) in 50 patients were analyzed and divided into the dystonic muscle group and normal muscle group according to the electromyography (EMG). Toronto western spasmodic torticollis rating scale (TWSTRS) score, SUV max and target-to-background ratio (TBR) of single superficial cervical muscle and total cervical muscle, and EMG diagnosis results were obtained before botulinum toxin injection. ROC curves of SUV max and TBR of dystonic muscles were constructed to determine AUCs and the difference was compared by Delong test. Differences of SUV max and TBR between 2 groups were analyzed by Mann-Whitney U test. Spearman rank correlation analysis was used to analyze the correlation of SUV max, TBR and TWSTRS scores of total cervical muscle. Results:There were 205 pieces of muscle in dystonic muscle group and 195 pieces of muscle in normal muscle group. The uptake of 99Tc m-MIBI in dystonic muscle was significantly increased in CD patients, and the non-whole uptake of 99Tc m-MIBI was increased in some dystonic muscles, which was manifested as uneven uptake of the whole muscle. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of visual analysis were 95.12%(195/205), 75.90%(148/195), 85.75%(343/400), 85.58%(195/242) and 93.67%(148/158), respectively. There were significant differences of SUV max (1.74(1.42, 2.12) vs 0.92(0.81, 0.99)) and TBR (2.55(1.92, 3.27) vs 1.44(1.22, 1.73)) between the dystonic muscle group and the normal muscle group ( z value: -15.29, -12.69, both P<0.001). The diagnostic efficiency of SUV max in dystonic muscle was better than TBR (AUC: 0.942 vs 0.867; z=5.03, P<0.001). SUV max, TBR and TWSTRS score in the neck muscles of patients with CD showed positive correlation ( rs values: 0.44, 0.45, both P<0.001). Conclusion:99Tc m -MIBI SPECT/CT muscle imaging is a good diagnostic method for dystonic muscle in patients with CD.

OBJECTIVE: To study the effects of cardiac resynchronization therapy (CRT) with different pacing rates and modes on MTWA.
 METHODS: From March, 2012 to October, 2014, 43 patients who received CRT or CRT-D implantation in the first affiliated hospital, Nanjing Medical University were studied. Time-domain MTWA test were assessed following CRT implantation. MTWA was measured at 90 min(-1) and 110 min(-1) by treadmill exercise test with GE CASE 8000 during CRT-on (BIV biventricular) and CRT-off (RA right atrial) pacing modes. The comparsion of MTWA values between different pacing mode and pacing rates were analyzed. According to the heart function classification the patients were divided into 3 groups. The correlation between MTWA and cardiac function was analyzed.
 RESULTS: MTWA-AAI was significantly increased compared to MTWA-BIV at the pacing rate of 90 min(-1) [(11.27±9.94) µV vs (7.09±7.16) µV, P=0.001]. The value of MTWA at pacing rate of 110 min(-1) was nonsignificantly higher than MTWA during AAI pacing [(16.91±12.51) µV vs (15.58± 10.97) µV, P=0.517]. The value of MTWA at pacing rate of 110 min(-1) was higher than MTWA at pacing rate of 90 min(-1) during AAI or BIV (P<0.05). MTWA-AAI and MTWA-BIV in group of NYHA IV were higher than those in group of NYHA II (P<0.05).
 CONCLUSION Biventricular pacing mode at lower pacing rates can significantly attenuate MTWA. The value of MTWA is associated with the severity of CHF.
Arrhythmias, Cardiac ; therapy ; Cardiac Resynchronization Therapy ; Exercise Test ; Heart Failure ; therapy ; Humans