Objective To evaluate the efficacy and safety of cryoballoon ablation（CBA） and traditional antiarrhythmic drugs（AADs） as initial treatment for paroxysmal atrial fibrillation（AF） by using Meta analysis. Methods After retrieval literature, inclusion and screening principles were determined, literatures were searched from PubMed（Medline）, Cochrane Library, China National Knowledge Network（CNKI）, Wanfang database within the time span from January 2010 to November 2021 about CBA and AADs for paroxysmal AF in the randomized controlled studies. The CBA group was treated with CBA, while the AADs group was treated with AADs. RevMan 5. 3 statistical software was used for Meta analysis.Results 4 retrieved documents were included, with a total of 969 subjects（528 in the CBA group and 441 in the AADs group）. The results showed that there was statistical significance in the recurrence rate of AF（P＜0. 05）, and CBA as the initial treatment for paroxysmal AF displayed a lower recurrence rate（RR=0. 59, 95%CI: 0. 49-0. 71; P＜0. 001）. There was no statistical significance in the 12-month success rate and the rate of serious adverse events, when comparisons were made between the 2 groups（P＞0. 05）.Conclusion The CBA was more superior with lower recurrence rate and lighter symptoms. However, observations or studies on the long-term effects were evidently inadequate in the 4included studies, and the average age of the included subjects was relatively young, with mild symptoms. Therefore, further analysis and evaluation are necessary in future studies.

Pregnancy predisposes to arrhythmias in females due to physiological changes in the cardiovascular system, enhanced activity of the sympathetic nervous system (SNS), and changes in the endocrine system, regardless of whether there exist cardiovascular diseases before the pregnancy. Tachyarrhythmias may present for the first time or worsen persistently during pregnancy, potentially leading to maternal heart failure and sudden death, as well as some adverse fetal outcomes such as growth restriction, distress, premature birth, and stillbirth. Radiofrequency ablation (RFA) is one of the most important therapeutic methods for tachyarrhythmias. According to the 2019 European Society of Cardiology (ESC) guidelines, RFA in pregnant women should preferably be performed without x-rays. Since the 2000s, 3D mapping technique has rapidly developed, laying the foundation for cardiac electrophysiology examination free from x-rays. Ventricular arrhythmia originating from the left coronary cusp (LCC) is not common in clinic. RFA is challenging in the treatment of this type of disease due to the anatomical feature that the opening of the left main coronary artery is localized in the LCC.

Brugada syndrome (BrS) is an inherited cardiac ion channelopathy, which can induce malignant arrhythmias and sudden cardiac death (SCD). The BrS ECG is characterized by an abnormal ST-segment elevation of at least 2 mm (0.2 mV) in leads V1-3, including three types. Type-1 manifests a coved pattern, which obtained the most diagnostic significance [1-3]. Brugada phenocopy (BrP) is referred to as a clinical situation that has an identical ECG pattern to congenital BrS but is induced by various other clinical factors. In this report, we describe the case of severe heart failure, in which the Type-1 Brugada pattern was recorded.

特发性室性期前收缩(IPVC)是临床上常见的心律失常,对于它的发病机制、诊断、治疗和管理仍存在诸多未知.本文全面回顾IPVC的基础研究、临床特征及治疗方式,尤其对近年来IPVC的电生理标测和导管消融技术的最新进展进行总结,分析每种IPVC消融技术的潜在优缺点,以期为临床工作提供帮助.

免疫球蛋白G4相关疾病(immunoglobulin G4-related disease，IgG4-RD)是一种免疫介导的全身性疾病[1]，常见于1型自身免疫性胰腺炎(autoimmune pancreatitis 1，AIP-1)，其他可能受影响的器官包括泪腺、唾液腺、肺、肾、肝、胆管、后腹膜、乳房、主动脉、垂体和前列腺等[2,3]。IgG4-RD典型的病理表现为淋巴组织中浆细胞浸润、闭塞性静脉炎和席纹状纤维化[4]。IgG4-RD的临床表现多样，可表现为器官或组织的非特异性肿大，具体表现取决于疾病累及的部位，而疾病早期往往由于病理学诊断不易获得，导致该疾病诊断困难。本文报道3例以乳房腋窝区肿块为主要表现的IgG4-RD，并对这类患者的临床特征及处理经验进行总结。

患者女，71岁，因“右侧乳房皮肤红色斑块15年，加重1年”入院。查体：右侧乳房内侧及胸正中的皮肤有红色湿疹样改变，中央有带缝线切口（图1），同侧腋窝未触及肿大淋巴结。病理活检提示：（乳房区皮肤）Paget病可能。免疫组化检查示：CK7（+），CK8（+），CK10/13（-），CEA（部分+），S100（-），ER（部分+），PR（-），CK20（-），AR（+），Her-2（+++），Ki67（30%~60%+）。超声检查提示：乳腺腺体内未见明显占位性回声。乳腺增强MR表现：未见明确异常强化占位灶。行右乳皮肤病损切除术+腹部大V形皮瓣转移术。冰冻病理检查示：（右侧乳房）皮肤Paget病，上、下、内、外切缘及基底切缘（-）。术后病理报告：带皮肤组织的右侧乳腺，灰黄、灰红色乳腺组织1块，大小9 cm×8 cm×3.2 cm，皮肤大小8 cm×8 cm，切面距上切缘3.2 cm、下切缘4 cm、内切缘3 cm、外切缘1.5 cm处见1个皮肤粗糙区，大小3.5 cm×1.3 cm，灰白色，实性，质硬，界不清。光镜检查：右侧乳腺组织见肿瘤位于表皮内，肿瘤细胞大、圆形，胞质丰富，核大，异型明显，呈小簇状、团巢状或散在分布于皮肤表皮内（图2）。未见浸润乳腺实质，未见导管内癌成分。上、下、内、外切缘及基底切缘均（-）。诊断为（右侧乳房）皮肤Paget病。随访2个月，局部未见复发，无远处转移，无并发症。

抗中性粒细胞胞质抗体相关性血管炎（AAV）是一种免疫复合物坏死性血管炎，会累及全身多个脏器，活动期病情十分凶险，具有很高的病死率。本研究的目的是探讨利妥昔单抗（RTX）在AAV的诱导缓解和维持治疗中的作用。搜索从2000年1月至2021年6月间发表的有关AAV治疗方面的随机对照试验（RCT），病例对照研究，队列研究，描述性研究，以及ACR和EULAR摘要一起进行了分析，结果表明在AAV的诱导缓解治疗中，RTX不劣于环磷酰胺，并且在复发性AAV患者中优于环磷酰胺；而在维持缓解治疗方面，RTX优于硫唑嘌呤。

Objective:There is currently no consensus on the ideal plane for implant placement in breast reconstruction. This meta-analysis provides a comparison of prepectoral breast reconstruction (PBR) vs. subpectoral breast reconstruction (SBR), with primary outcomes of surgical efficacy and patient safety, to find out the best surgical approach.Methods:PubMed, Cochrane, Web of Science, and Embase databases were searched from January 1st, 2019, to April 1st, 2022, to retrieve studies that compared PBR with SBR after mastectomies. The main outcomes were surgical complications and satisfaction with breasts domain. The literature was screened according to the inclusion and exclusion criteria, the data was extracted and the methodological quality of the included studies was assessed by 2 reviewers independently. Meta-analysis was performed using RevMan 5.3.Results:A total of 14 comparative studies with 2 355 patients were included. The meta-analysis showed no statistical differences in seroma, implant removal, flap necrosis, capsular contracture, and wound dehiscence between PBR and SBR groups. PBR patients demonstrated lower hematoma, animation deformity rates, and higher BREAST-Q scores compared to SBR groups.Conclusions:Surgical efficacy and patient safety are similar between PBR and SBR groups. PBR patients have lower hematoma, animation deformity rates and are more satisfied with breasts domain. Further well-designed multi-center prospective studies are required to increase the robustness of the findings.

Objective:To evaluate the effectiveness and safety of rituximab (RTX) and cyclophosphamide/azathioprine (CYC/AZA) in the treatment of anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis (AAV).Methods:After setting up the search strategy, the inclusion and screening criteria of the literature were determined, the Pubmed, Cochrane Library, Embase, China Biomedical Literature Database, CNKI, Wanfang Database, Weipu Database were searched for RTX and CYC/AZA treatment for AAV. For randomized controlled studies, in which the experimental group was RTX for AAV, and the control group was CYC/AZA for AAV were included. The retrieval time span was from January 2000 to June 2021, and the data obtained were analyzed using Revman 5.3 software.Results:A total of 9 articles and 4 studies were included, with a total of 384 patients, including 203 cases in the experimental group and 181 cases in the control group. In the treatment of AAV, the difference in the remission rate of RTX and CYC/AZA treatment of AAV was statistically significant, and the remission rate of the RTX group was higher [ OR(95% CI)=1.58(1.03, 2.40), P=0.03]. For the remission rates of different types of AAV, RTX and CYC/AZA were benefit for the treatment of granulomatous vasculitis, microscopic polyangiitis, eosinophilic granulomatous vasculitis, there was no statistically significant difference in the remission rate of patients with protease 3-related vasculitis and myeloperoxidase-related vasculitis. The incidence of granulocytopenia in the RTX group was significantly lower than that in the CYC/AZA group, and RTX treatment could reduce the incidence of other serious adverse reactions. Conclusion:For the remission induction therapy, RTX is not inferior to CYC for all subtypes of AAV. In the maintenance treatment phase, RTX has a higher remission rate and a lower recurrence rate. During the entire treatment process, patients who were treated with RTX had a higher long-term remission rate than patients who were not treated with RTX. RTX can effectively reduce the occurrence of adverse reactions such as neutropenia.

间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)基因重排是发生非小细胞肺癌(non-small cell lung cancer, NSCLC)的重要致癌驱动因素之一,ALK阳性的NSCLC患者易发生脑转移,而ALK靶向抑制剂相对于一线化疗对脑转移有更好的疗效.但经第一代ALK抑制剂治疗后患者易耐药,进而出现颅内进展,第二代和第三代ALK抑制剂可增强其对中枢神经系统的渗透性、提高其到达靶点后的结合力,对脑转移癌有较好的治疗效果.本文回顾靶向治疗在ALK阳性NSCLC脑转移患者治疗方面取得的进展,并对目前存在的问题及未来发展方向进行探讨.