食管超声引导下经胸外科封堵治疗先天性心脏病的疗效

目的 探讨食管超声引导下经胸外科封堵术治疗先天性心脏病的疗效和预后.方法 选取2016年1月至2018年12月在我院行食管超声引导下经胸外科封堵治疗的先天性心脏病患者52例为研究组,同期行体外循环下修补治疗患者53例为对照组,记录并比较两组患者手术时间、术中出血量、输血量、呼吸机辅助时间、ICU停留时间、血管活性药物使用情况及术后住院时间、并发症发生率等指标,术前及出院前均采用经胸超声心动图对患者心脏结构功能进行评价,术后随访12个月观察预后情况.结果 两组患者全部手术成功,均无死亡和危及生命的严重并发症.研究组手术时间(72.69±6.14)min、术中出血量(29.96±5.99)ml、输血比例(1.92%)、呼吸机辅助时间(132.70±13.21)min、ICU停留时间(11.85±1.43)h、住院时间(6.83±0.49)d均明显少于对照组的(130.50±3.53)min、(112.80±11.93)ml、(28.30%)、(217.20±19.02)min、(20.60±0.71)h、(8.34±0.39)d(P<0.01).血管活性药物使用比例(32.69%)也明显低于对照组(90.57%),两组总并发症发生的差异也有统计学意义.术后3、6、12个月随访超声心动图检查示,52例患者封堵器均位置良好,未见残余分流及血栓形成,心电图也未见严重心律失常.结论 食管超声引导下经胸外科封堵治疗先天性心脏病是一种安全有效的方法,具有创伤小、易操作、恢复快等优点.     

食道超声引导下婴儿膜周部室间隔缺损经胸微创封堵治疗及中长期随访

目的 评价食道超声引导下经胸微创封堵术在婴儿室间隔缺损(VSD)治疗效果及中长期随访结果。方法：回顾性分析2014年8月至2019年10月期间,我科1岁以下26例先天性心脏病室间隔缺损婴儿行食道超声引导下小切口VSD经胸封堵手术的临床资料。结果 26例患儿中,25例患者封堵成功,一例术中置入封堵器后出现主动脉瓣轻度返流而转外科修补手术,封堵成功率为96.15%,全组患者手术顺利,术后痊愈出院,无死亡,与同期行体外循环下直视VSD修补手术的1岁以下39例患儿对比,手术时间（81.50±13.53 vs 129.62±29.23min）、术后呼吸机辅助时间（294.55±102.94 vs 655.41±370.37min）、术后引流量（59.12±20.10 vs 93.54±27.22ml）、术后住院时间（9.68±2.81 vs 11.03±1.99d）,经胸封堵组无输血,差异具有统计学意义（Ｐ<0.05）。随访2-66个月,平均随访34.76±24.55个月,生长发育良好,如正常同龄儿童。2例术后早期出现不完全性右束支传导阻滞在半年随访已恢复,无新发主动脉瓣或三尖瓣返流,无房室传导阻滞等并发症发生。结论 食道超声引导下经胸微创封堵术治疗婴儿室间隔缺损,与同期常规体外循环心内直视VSD修补术比较,创伤小,出血少,恢复快,术后中长期随访效果好,是可行的、安全有效的微创治疗方法。     

继发孔房间隔缺损经胸实时三维超声心动图引导封堵术可行性研究

【摘要】 目的 探讨经胸实时三维超声心动图（real-time three-dimensional transthoracic echocardiography ,RT-3D-TTE）引导封堵房间隔缺损的有效性和安全性。方法 回顾性分析2017年6月至2018年5月在临沧市人民医院及武汉协和医院接受介入封堵的房间隔缺损患者196例,其中行导管介入封堵治疗104例（A组）,行经胸实时三维超声心动图（RT-3D-TTE）引导封堵治疗92例（B组）。结果 A组手术成功率98.07％,手术时间（31.45±13.57）min,术后住院时间（5.06±2.01）d,并发症发生率5.8％,住院费用（2.94±0.42）万元。B组手术成功率100％,手术时间（25.28±10.56）min,术后住院时间（3.41±0.70）d,并发症发生率4.3％,住院费用（2.51±0.32）万元。随访3~12个月,无患者死亡。结论 两种方法都可有效治疗单纯继发孔房间隔缺损,且成功率高、住院时间短、创伤小、并发症少,经胸实时三维超声心动图（RT-3D-TTE）引导封堵,具有无X线辐射有良好的临床应用前景。     

超声心动图引导经皮室间隔缺损封堵治疗术

目的探讨超声心动图引导经皮室间隔缺损(VSD)封堵术的可行性。方法于2014-2至2014-10在我院检查并治疗的单纯VSD患者28例,平均年龄(9.5±3.1)岁,VSD大小(4.6+0.9)mm,单纯采用超声心动图引导经皮室间隔缺损封堵术。超声实时监测封堵全过程,评估封堵效果。术后1个月、3个月、半年及一年超声随访,观察患者封堵效果。结果 21例患者在经胸超声心动图引导下成功完成经皮VSD封堵术,5例经食管超声引导下成功完成经皮VSD封堵术,1例患者因导管未能沿导丝通过VSD,改经食管超声心动图引导下经胸小切口封堵成功,1例患者因封堵后残余分流大于2衄,改常规外科手术治疗成功。患者的平均手术时间为(63.3±11.7)min;术后1个月及3个月随访,未发现瓣膜损伤、心包积液、封堵器脱落、残余分流、主动脉瓣反流及外周血管损伤等介入并发症。结论超声心动图可以独立安全引导经皮室间隔缺损介入封堵术,无需使用大型造影设备,减少了病人及医护人员射线损伤及手术成本。     

经胸超声心动图在先天性心脏病介入封堵术中的应用

目的观察经胸超声心动图（TTE）在先天性心脏病（先心病）介入封堵术中的应用。方法采用TTE观察97例房间隔缺损（ASD）、84例室间隔缺损（VSD）及75例动脉导管未闭（PDA）经介入封堵治疗的先心病患者，在介入封堵术前选择病例、术中引导和监测封堵器释放全过程及术后随访。结果256例先心病患者除5例ASD外其余均封堵成功，术后1周～6月超声随访无一例出现并发症。结论TTE在先心病介入封堵术中具有重要价值。     

经食管超声心动图引导房间隔缺损封堵治疗的研究

目的探讨经食管超声心动图引导房间隔缺损封堵术的方法。方法122例房间隔缺损患者,年龄10～65岁,男性36例,女性86例,在超声和X线共同监测引导下,用CardioSEAL和Amplatzer封堵器进行房间隔缺损封堵治疗。122例均经食管超声监测引导。结果经胸超声测定的房间隔缺损直径范围7.5～27mm,平均(16.5±4.3)mm,经食管超声测定的直径6～33mm,包括7例大于30mm,所有患者均有不同程度的右心房和右心室扩大。114例封堵治疗成功,无并发症发生。结论采用Amplatzer或CadrioSEAL封堵器,在经食管或经胸超声和X线共同监测引导下,可以安全有效地封堵治疗房间隔缺损。     

单纯经食管超声心动图引导经皮封堵左心耳的可行性研究

目的:传统左心耳封堵术需使用放射线及造影剂,但部分心房颤动(房颤)患者因合并肾功能不全等疾病需避免使用放射线及造影剂,本研究旨在探讨单纯经食管超声心动图引导下经皮封堵左心耳治疗房颤的可行性。方法:于2017-09至2017-12,入选合并慢性肾脏病Ⅳ期房颤患者5例。5例患者平均年龄(68.40±7.31)岁,平均体重(71.81±12.33)kg,平均左心耳开口直径(24.21±3.25)mm,术前平均肾小球滤过率(21.75±6.29)ml/(min·1.73 m~2)。患者均在经食管超声心动图引导下行经皮左心耳封堵术,术后1、2、3、6个月于门诊随访,行经胸超声心动图检查。结果:5例患者均在经食管超声心动图引导下完成经皮左心耳封堵术,平均手术时间为(33.93±10.37)min,封堵器直径32/36 mm 2例,30/36 mm 1例,26/32 mm 2例。患者平均住院时间(3.80±0.75)天,均顺利出院。平均随访2个月时,未发生封堵器脱落等手术并发症。结论:单纯经食管超声心动图引导经皮左心耳封堵术安全、有效。     

单纯超声心动图引导下经皮室间隔缺损封堵术的应用研究

目的:传统经皮室间隔缺损(VSD)封堵术存在放射线及造影剂损伤,本文探讨单纯超声心动图引导下进行经皮VSD封堵术的有效性和安全性。方法:于2014-02至2014-10期间入选先天性VSD患者28例,平均年龄(9.5±3.1)岁,平均体重(31.3±7.7)kg,平均VSD直径(4.6±0.9)mm。患者均在经胸超声心动图引导下行经皮VSD封堵术,封堵后以超声心动图检查评价治疗效果。术后1、3、6、12个月在门诊随访。结果:26例患者在经胸超声心动图引导下成功完成经皮VSD封堵术,1例患者因导管未能沿导丝通过VSD,改超声心动图引导下经胸小切口封堵成功,1例患者因残余分流大于2 mm,改常规外科手术治疗成功。患者的平均手术时间为(63.3±11.7)min,对称型VSD封堵器直径(6.6±1.0)mm;术后即刻微量残余分流2例;平均住院时间为(3.7±1.3)d。所有患者康复出院,无外周血管损伤及心包填塞等并发症。患者术后的平均随访时间为(6.2±3.4)个月,随访1个月时2例患者微量残余分流消失,所有患者未出现心包积液、封堵器脱落、房室传导阻滞和主动脉瓣反流等并发症。结论:单纯超声心动图引导下经皮VSD封堵术不仅安全有效,而且能避免使用放射线及造影剂。     

应用国产封堵器在治疗先天性心脏病的临床疗效分析

目的 总结国产封堵器经皮和经胸途径治疗先天性心脏病的临床疗效。方法 回顾性分析我院2013年1月至2017年12月在X线透视下或单纯超声心动图引导下采用经皮穿刺股静脉或股动静脉法，或者食管超声心动图监测下经胸小切口行先天性心脏病封堵1186例，其中经皮X线下封堵1081例、经皮单纯超声引导下封堵42例、经胸封堵63例；其中动脉导管未闭（ patent ductus arteriole，PDA）426例、房间隔缺损（atrial septal defect，ASD）363例、室间隔缺损（ventricular septal defect，VSD）348例、卵圆孔未闭11例、房间隔缺损合并室间隔缺损9例、房间隔缺损合并动脉导管未闭6例、房间隔缺损合并肺动脉瓣狭窄（pulmonary stenosis，PS）12例、动脉导管未闭合并肺动脉瓣狭窄8例、主肺动脉侧支封堵3例[经胸封堵66例改为63例，PDA443例改为426例]。结果 全组病例成功率98.2％（1165/1186），无死亡病例。随访1~36个月，术后第1、3、6、12个月及术后每年常规行超声心动图及心电图检查。术后第1、6、12个月的随访率分别为 92.9%（1102/1186）、84.1%（998/1186）、70.5%（836/1186）。超声心动图提示少量残余分流（<3 mm）18例；三尖瓣少量反流33例，中量反流5例；主动脉瓣轻度反流5例，中度反流1例；心律失常Ⅲ°房室传导阻滞（Avionics Bulletin，AVB[房室传导阻滞（Avionics Bulletin，AVB）]）1 例，Ⅱ°AVB 3例，完全性左束支3例，交界性心动过速3例，交界性逸搏2例。结论 国产封堵器在先天性心脏病封堵治疗中具有成功率高、创伤小、并发症低、操作容易、疗效确切、恢复快等特点，是治疗先天性心脏病的理想方法。     

经胸超声心动图引导房间隔缺损封堵术的可行性

目的 探讨经胸超声心动图(TTE)引导下行房间隔缺损封堵术的可行性.方法 入选2013年2至8月在阜外心血管病医院行超声心动图引导下封堵术的单纯房间隔缺损患者65例进行回顾性分析.根据引导方式的不同,将患者分为TTE组(30例)和经食管超声心动图(TEE)组(35例).TTE组患者在局部麻醉或基础麻醉下,仅在TTE引导下行房间隔缺损封堵术;TEE组患者在全身麻醉和气管插管下,仅在TEE引导下行房间隔缺损封堵术.术后1个月在门诊随访,复查超声心动图和心电图.结果 TTE组的28例患者成功置入封堵器;其余2例患者因TTE图像显示不清,改为在TEE引导下行房间隔缺损封堵术.两组患者的年龄、体质量、房间隔缺损直径、住院时间差异均无统计学意义(P均＞0.05).与TEE组比较,TTE组的手术时间较短[(52.77±9.00) min比(60.11±9.15)min,P＜0.05],呼吸机通气时间较短[(0.25 ±0.95)h比(3.17±0.69)h,P＜0.05],重症监护室住院时间较短[(1.50±1.96)h比(16.43±6.99)h,P＜0.05],丙泊酚使用量较少[(2.41±2.97) mg/kg比(9.43±3.70)mg/kg,P＜0.05].两组患者在住院期间均无残余分流、外周血管损伤和心脏穿孔等并发症.术后1个月随访,两组患者均无封堵器脱落、残余分流和心包积液等并发症.结论 在TTE引导下行房间隔缺损封堵术是可行的,具有广泛的应用前景.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.     

High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania

Objectives To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl. Methods We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 < 200 cells/μl or (ii) CD4 > 200 cells/μl (ART/CD4 < 200 and ART/CD4 > 200, respectively); ART‐naïve and (iii) CD4 < 200 cells/μl or iv)CD4 > 200 cells/μl (noART/CD4 < 200 and noART/CD4 > 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign. Results Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 < 200 group, 78 (17 men, median age 37 years, median CD4 345 cells/μl) in ART/CD4 > 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 < 200 and 86 (22 men, median age 33 years, median CD4 446 cells/μl) in noART/CD4 > 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 < 200 to 20.9% in noART/CD4 > 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2–3.3) and older participants (aOR 2.7, 95% CI 1.1–6.2 for age 40 + vs. <30 years). Conclusion Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV‐infected patients to an additional avoidable risk of DSP. Access to non‐neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.