Objective:To evaluate the clinical feasibility of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation following transvenous lead extraction (TLE).Methods:This was a retrospective study. Consecutive patients who underwent S-ICD implantation at Peking University People′s Hospital between June 2015 and October 2023 were enrolled. Patients were divided into the TLE group and the newly implanted group based on whether they received TLE prior to S-ICD implantation. Baseline characteristics, S-ICD indication, defibrillation threshold test results, complications, and postoperative follow-up data were collected and compared between the two groups.Results:A total of 27 patients were included, aged (49.2±14.2) years, including 19 males. There were 12 patients in the TLE group and 15 in the newly implanted group. Compared with the TLE group, patients in the newly implanted group were younger ((43.3±13.7) years vs. (55.6±12.0) years, P=0.013). The main S-ICD indication in the TLE group was high infection risk (9/12), whereas in the newly implanted group it was younger age (11/15). All patients underwent successful S-ICD implantation, with 18 patients completing defibrillation threshold testing (all successful). Additionally, the TLE group had longer follow-up duration than the newly implanted group (42 (19, 60) months vs. 12 (3, 28) months, P=0.001). No complications or deaths occurred during follow-up, with normal device function in both groups. A total of 17 ventricular tachycardia or fibrillation events were recorded, of which 7 met defibrillation criteria and all received effective therapy. Conclusion:S-ICD demonstrates safety and efficacy as a therapeutic option for patients after TLE, with comparable device functionality and follow-up outcomes to patients with newly implanted S-ICD.

With the increasing numbers of implanted cardiovascular implantable electronic devices(CIED),the issue of lead management has become increasingly prominent.Currently,there is controversy on the management of redundant lead.In clinical practices such as CIED device upgrades,choosing to abandon redundant leads can avoid the risks associated with lead extraction.However,the strategy may increase the risks of future CIED infections,venous occlusions,and the risks of future lead extraction.On the other hand,choosing to remove redundant leads might expose patients to risks associated with lead extraction.Therefore,the management regarding redundant lead need to balance the risks of abandonment and extraction strategies.This article discusses the current strategies for redundant lead management and their potential risks.

With the increasing numbers of implanted cardiovascular implantable electronic devices(CIED),the issue of lead management has become increasingly prominent.Currently,there is controversy on the management of redundant lead.In clinical practices such as CIED device upgrades,choosing to abandon redundant leads can avoid the risks associated with lead extraction.However,the strategy may increase the risks of future CIED infections,venous occlusions,and the risks of future lead extraction.On the other hand,choosing to remove redundant leads might expose patients to risks associated with lead extraction.Therefore,the management regarding redundant lead need to balance the risks of abandonment and extraction strategies.This article discusses the current strategies for redundant lead management and their potential risks.

Objective:To evaluate the clinical feasibility of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation following transvenous lead extraction (TLE).Methods:This was a retrospective study. Consecutive patients who underwent S-ICD implantation at Peking University People′s Hospital between June 2015 and October 2023 were enrolled. Patients were divided into the TLE group and the newly implanted group based on whether they received TLE prior to S-ICD implantation. Baseline characteristics, S-ICD indication, defibrillation threshold test results, complications, and postoperative follow-up data were collected and compared between the two groups.Results:A total of 27 patients were included, aged (49.2±14.2) years, including 19 males. There were 12 patients in the TLE group and 15 in the newly implanted group. Compared with the TLE group, patients in the newly implanted group were younger ((43.3±13.7) years vs. (55.6±12.0) years, P=0.013). The main S-ICD indication in the TLE group was high infection risk (9/12), whereas in the newly implanted group it was younger age (11/15). All patients underwent successful S-ICD implantation, with 18 patients completing defibrillation threshold testing (all successful). Additionally, the TLE group had longer follow-up duration than the newly implanted group (42 (19, 60) months vs. 12 (3, 28) months, P=0.001). No complications or deaths occurred during follow-up, with normal device function in both groups. A total of 17 ventricular tachycardia or fibrillation events were recorded, of which 7 met defibrillation criteria and all received effective therapy. Conclusion:S-ICD demonstrates safety and efficacy as a therapeutic option for patients after TLE, with comparable device functionality and follow-up outcomes to patients with newly implanted S-ICD.

Objective To observe the changes in functional connectivity(FC)of raphe nucleus in patients with first-episode depression complicated with suicidal ideation(SI).Methods Ninety-eight first-episode depression patients were prospectively enrolled and assigned into SI group(n=56)or non SI group(n=42)based on complicated with SI or not,while 47 healthy volunteers were recruited as control group.Resting-state functional MRI was performed.FC between dorsal raphe nucleus(DRN),median raphe nucleus(MRN)and the whole brain were analyzed and compared among 3 groups and between each 2 groups,and the correlations of FC of different brain regions with clinical data of SI group were explored.Results Compared with control group,FC between DRN and left cerebellum and left putamen in SI group and non SI group decreased(all P＜0.05),between MRN and right inferior temporal gyrus increased but between MRN and left inferior frontal gyrus,right superior occipital gyrus,left inferior parietal lobule,left putamen decreased(all P＜0.05).FC between DRN and left putamen in SI group was higher than that in non SI group(P＜0.05).FC between MRN and right central posterior gyrus of SI group increased compared with that in the rest 2 groups(both P＜0.05).FC between MRN and left putamen in SI group was positively correlated with body mass score of Hamilton depression scale-24(HAMD-24)(rs=0.297,P=0.026).Conclusion Abnormal changes of FC between raphe nucleus and cortex,also between raphe nucleus and subcortical area occurred,and FC between MRN and left putamen positively correlated with body mass score of HAMD-24 in patients with first-episode depression complicated with SI.

Attention deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder that has been linked to the dopaminergic system. This study aimed to investigate the effects of regulation of the dopamine D4 receptor (DRD4) on functional brain activity during the resting state in ADHD children using the methods of regional homogeneity (ReHo) and functional connectivity (FC). Resting-state functional magnetic resonance imaging data were analyzed in 49 children with ADHD. All participants were classified as either carriers of the DRD4 4-repeat/4-repeat (4R/4R) allele (n = 30) or the DRD4 2-repeat (2R) allele (n = 19). The results showed that participants with the DRD4 2R allele had decreased ReHo bilaterally in the posterior lobes of the cerebellum, while ReHo was increased in the left angular gyrus. Compared with participants carrying the DRD4 4R/4R allele, those with the DRD4 2R allele showed decreased FC to the left angular gyrus in the left striatum, right inferior frontal gyrus, and bilateral lobes of the cerebellum. The increased FC regions included the left superior frontal gyrus, medial frontal gyrus, and rectus gyrus. These data suggest that the DRD4 polymorphisms are associated with localized brain activity and specific functional connections, including abnormality in the frontal-striatal-cerebellar loop. Our study not only enhances the understanding of the correlation between the cerebellar lobes and ADHD, but also provides an imaging basis for explaining the neural mechanisms underlying ADHD in children.
Attention Deficit Disorder with Hyperactivity ; diagnostic imaging ; genetics ; pathology ; Brain ; diagnostic imaging ; Cerebellum ; diagnostic imaging ; Child ; Corpus Striatum ; diagnostic imaging ; Female ; Frontal Lobe ; diagnostic imaging ; Genotype ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Minisatellite Repeats ; genetics ; Neural Pathways ; diagnostic imaging ; Oxygen ; blood ; Receptors, Dopamine D4 ; genetics ; metabolism ; Rest

A 74-year-old male patient with hypertension was admitted to hospital because of aphasia and movement disorder of his right limb for 3 hours. He was diagnosed as acute cerebral infarction. Thrombolytic therapy with alteplase (1 mg/ml ) was given 1 hour and 17 minutes after admission. Intravenous injection of alteplase 6.48 mg was given firstly (within 1-2 minutes of completing the injection) and then 58.32 mg was administered intravenously via an infusion pump. About 10 minutes after treatment with alteplase,the patient suddenly developed pallor,drenching sweats,cold limbs,and unconsciousness;his blood pressure dropped from 169/89 mmHg to 112/68 mmHg. Alteplase-induced anaphylaxis was considered. Alteplase was immediately stopped and oxygen inhalation and liquid supplements were given. At the same time,dopamine,diphenhydramine,dexamethasone,and other anti-anaphylactic and anti-shock agents were immediately given. The next morning,the patient developed anemia,RBC 2.12×1012/L,Hb 66 g/L. That night,hematoma appeared in his deep muscle from the right hip (at the injection site)to thigh. The peripheral hematoma was considered to be induced by alteplase. On the 3rd day of admission,the patient developed cerebral palsy and was discharged by his family′s request.

A 74-year-old male patient with hypertension was admitted to hospital because of aphasia and movement disorder of his right limb for 3 hours. He was diagnosed as acute cerebral infarction. Thrombolytic therapy with alteplase (1 mg/ml ) was given 1 hour and 17 minutes after admission. Intravenous injection of alteplase 6.48 mg was given firstly (within 1-2 minutes of completing the injection) and then 58.32 mg was administered intravenously via an infusion pump. About 10 minutes after treatment with alteplase,the patient suddenly developed pallor,drenching sweats,cold limbs,and unconsciousness;his blood pressure dropped from 169/89 mmHg to 112/68 mmHg. Alteplase-induced anaphylaxis was considered. Alteplase was immediately stopped and oxygen inhalation and liquid supplements were given. At the same time,dopamine,diphenhydramine,dexamethasone,and other anti-anaphylactic and anti-shock agents were immediately given. The next morning,the patient developed anemia,RBC 2.12×1012/L,Hb 66 g/L. That night,hematoma appeared in his deep muscle from the right hip (at the injection site)to thigh. The peripheral hematoma was considered to be induced by alteplase. On the 3rd day of admission,the patient developed cerebral palsy and was discharged by his family′s request.

Objective To explore neuroprotective effects of blonanserin on H2O2-induced injury in PC12 cells. Meth?ods PC12 cells were divided into four groups:control group (C group), H2O2-treated group (H group), blonanserin pretreat?ed group (B group) and positive control group (vitamin E- pretreated, E group). The effects of different concentrations of blonanserin (0, 5, 10, 20, 40, 80 and 160 μmol·L-1) on cell proliferation in PC 12 cells were observed. MTT assay was used to detect the cell activity of different groups. The apoptotic rates of different groups were measured by TUNEL assay. The mor?phological changes were observed using inverted microscope and Hoechst 33258 staining. The superoxide dismutase (SOD) vi?ability and malondialdehyde (MDA) levels were detecded by biochemical methods in four groups. Results The appropriate concentration of blonanserin (0-20 μmol·L-1) can promote the growth of PC12 cells. Comparing with the C group, the apoptot?ic rate and MDA level were increased in group H, while the cell viability and the SOD viability were decreased obviously ( P<0.05). Compared with H group, the cell viability, SOD viability were significantly increased, while the MDA level and apoptotic rate were decreased (P<0.05). Conclusion Blonanserin shows neuroprotective effect on H2O2-induced injury in PC12 cells.