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1.
抗心律失常药物作用的新靶点   总被引:4,自引:1,他引:3  
目的 寻找抗心律失常药物作用的新靶点。方法 应用全细胞膜片钳技术记录乌头碱对大鼠心肌细胞动作电位时程的作用 ,分别给予奎尼丁、维拉帕米处理比较二者对动作电位时程的影响。结果 ①应用 1μmol·L- 1乌头碱使大鼠单个心肌细胞动作电位复极 5 0 %时程 (APD50 )从给药前 (5 7.2 5± 13.85 )ms增加到 (70 .5 1± 12 .4 4 )ms(n =8,P <0 .0 1) ,动作电位复极 90 %时程 (APD90 )从给药前 (86 .2 5± 2 4 .92 )ms增加到 (114 .12± 6 .81)ms(n =8,P <0 .0 5 )。② 10 μmol·L- 1 奎尼丁使乌头碱处理的大鼠心肌细胞APD50 进一步延长至 (111.6 3± 37.2 4 )ms(n =4 ,P <0 .0 5 ) ,使APD90 延长至 (2 0 1.75± 6 9.75 )ms(n =4 ,P <0 .0 1)。③ 10 μmol·L- 1 维拉帕米使乌头碱诱发的动作电位延长有所恢复 ,APD50 缩短至 (5 1.6 3± 15 .11)ms(n =4 ,P <0 .0 1) ,APD90 缩短至 (91.2 5± 11.0 6 )ms(n =4 ,P <0 .0 5 )。结论 使动作电位时程延长将诱发心律失常 ,使动作电位时程恢复近正常是抗心律失常药物作用的新靶点。  相似文献   

2.
甲醇对豚鼠单个心室肌细胞动作电位的影响   总被引:4,自引:2,他引:2  
目的 研究甲醇对正常豚鼠心室肌细胞跨膜动作电位影响 ,旨在探讨甲醇对心肌细胞的电生理作用。方法 酶解法分离豚鼠单个心室肌细胞 ,应用全细胞膜片钳技术记录甲醇对豚鼠单个心室肌细胞动作电位的影响。结果 应用 0 .2 %甲醇使豚鼠单个心室肌细胞动作电位复极 5 0 %时程 (APD50 )从给药前 (12 92 .6 8± 2 98.0 3)ms缩短到 (75 0 .2 5± 6 8.0 5 )ms (n =6 ,P <0 .0 5 ) ;动作电位复极 90 %时程 (APD90 )从给药前 (132 8.13± 2 89.91)ms缩短到(783.2 5± 6 3.4 4 )ms (n =6 ,P <0 .0 5 ) ;动作电位幅度 (APA)从给药前 (12 6 .35± 3.2 0 )mV减少到 (113.2 0± 6 .0 8)mV(n =6 ,P <0 .0 5 )。结论 甲醇降低动作电位幅度 ,缩短动作电位时程 ,影响心肌正常工作 ,可能与它对心肌细胞钾通道的作用有关。  相似文献   

3.
目的 研究自发性高血压大鼠 (SHR)左心室肌细胞的电生理特性。方法 以正常血压Wistar大鼠左心室肌细胞作为对照 ,采用玻璃微电极技术记录动作电位 ,应用膜片钳全细胞技术记录膜离子流 ,观察SHR左心室肌细胞动作电位及膜离子流的改变。结果 ①SHR和Wisar大鼠的心脏 /体重比分别为 5 .6 6± 0 .46mg/g(n =2 0 )和 3.7± 0 .2 9mg/g(n =2 8) (P <0 .0 0 1) ,平均细胞膜电容分别为 2 80 .6 8± 6 7.98pF(n =91)和 189.94± 5 6 .5 9pF(n =137) (P <0 .0 5 )。②SHR左心室肌细胞动作电位时程较Wistar大鼠明显延长 [APD50 :2 1.33± 1.5 6ms(n =6 ) ,vs 14.91± 2 .95ms(n =11) ,P <0 .0 0 1;APD90 :16 4.6 7± 4ms ,vs 93.2 7± 10 .5 9ms ,P <0 .0 0 1]。③内向电流 :SHR左心室肌细胞的ICa -L密度与Wistar大鼠间无差异 [6 .93± 1.71pA/pF(n =2 0 ) ,vs 6 .19± 2 .85pA/pF(n =37) ],但前者的慢失活时间常数显著延长 (5 6 .0 1± 13.36ms,vs 43.6 3± 17.89ms,P <0 .0 0 1)。SHR左心室肌细胞的INa密度与Wistar大鼠间无差异 [2 4.6 1± 6 .72 pA/pF(n =16 ) ,vs 2 4.95± 6 .99pA/pF(n =18) ]。④外向电流 :SHR左心室肌细胞IK1内向电流密度显著小于Wistar大鼠 [- 12 0mV时 ,11.3± 2 .2 6 pA/pF(n =17) ,v  相似文献   

4.
一种筛选抗心律失常药物新模型的建立   总被引:1,自引:0,他引:1  
目的 建立一种细胞水平的心律失常模型 ,以用于抗心律失常药物的筛选和评价。方法 酶解法分离单个大鼠心室肌细胞 ,在细胞水平给予传统诱发心律失常药物乌头碱 ,应用膜片钳技术观察记录应用乌头碱后心肌动作电位时程 (APD)、钠电流(INa)、L 型钙电流 (ICa L)、内向整流钾电流 (IK1 )及瞬时外向钾电流 (Ito)的变化。结果 应用乌头碱 1μmol·L- 1 使大鼠单个心室肌细胞 90 %复极化动作电位时程 (APD90 )从给药前的 (15 0 .2 3± 7.0 2 )ms延长至 (2 36 .0 3± 2 3.2 2 )ms(n =8,P <0 .0 1)。应用奎尼丁 10 μmol·L- 1 后动作电位…  相似文献   

5.
鹌鹑心室肌细胞电生理特性的研究   总被引:2,自引:0,他引:2  
目的 建立鹌鹑单个心室肌细胞的分离方法 ,观察鹌鹑心室肌细胞的电生理特性 ,并探讨不同离子通道在鹌鹑心肌电活动中的作用。方法 采用酶解法分离单个心室肌细胞 ,应用全细胞膜片钳技术记录心室肌细胞动作电位和L型钙电流。结果 鹌鹑单个心室肌细胞的静息电位 (RP)为 ( 6 2 .2 8± 2 .6 4 )mV ,超射值 (OS)为 (5 9.38±3.81 )mV ,5 0 %复极时间 (APD50 )和 90 %复极时间 (APD90 )分别为 (80 .4 0± 1 9.1 0 )ms和 (1 2 1 .95± 38.72 )ms。在实验电压 +1 0mV时 ,L型钙电流的峰值为 ( 1 3.2 7± 3.70 )pA pF(n =4 )。结论 鹌鹑心室肌细胞上存在着L型钙电流 ,此电流为构成鹌鹑心室肌细胞动作电位的重要电流之一  相似文献   

6.
哇巴因诱发大鼠心律失常作用靶点的研究   总被引:9,自引:2,他引:7  
目的 观察哇巴因对大鼠心室肌细胞动作电位时程、钾通道的作用 ,探讨哇巴因诱发心律失常的作用机制 ,为寻找新的抗心律失常药物提供依据。方法 应用全细胞膜片钳技术记录哇巴因对大鼠心肌细胞动作电位时程 (APD)、内向整流钾电流 (Ik1 )、瞬时外向钾电流 (Ito)的作用。结果 ①哇巴因 5μmol/L使大鼠心室肌细胞动作电位时程从给药前的 86 .3ms± 2 5 .2ms(APD90 ) ,缩短至 58.9ms± 2 0 .8ms(n =5 ,P <0 .0 1 ,给药 1 0min) ;②哇巴因 5μmol/L可增加大鼠心室肌细胞内向整流钾电流 ,使Ik1 从 - 1 868pA± 1 88pA增加到 - 2 393pA± 367pA(刺激电压 - 1 2 0mV ,n=1 0 ,P <0 .0 1 ) ;③哇巴因 5μmol/L可增加大鼠心室肌细胞瞬时外向钾电流 ,使Ito从 1 2 73pA± 31 8pA增加到 1 70 7pA± 486pA(刺激电压 +60mV ,n =5 ,P <0 .0 1 )。结论 哇巴因诱发室性心律失常可能与它缩短心室肌细胞动作电位时程有关 ,而Ito的增加使二期平台期缩短 ,Ik1 的增加使三期复极加快 ,均参与了动作电位时程缩短的过程。同时增加Ik1 将影响静息膜电位 ,可能使膜反应性增强  相似文献   

7.
目的:探讨银杏叶提取物(Egb761)对家兔心室肌细胞瞬时外向钾电流(Ito)和动作电位的作用,揭示其抗心肌缺血及缺血引起的心律失常的离子机制。方法:酶解法分离家兔的心室肌细胞。全细胞膜片钳技术记录心肌细胞的Ito和动作电位及其被Egb761作用后的变化。结果:①在电压钳制方式下,60μg/L Egb761作用心室肌细胞5 min后,各个钳制电位下的Ito均明显增大,在钳制电位为+50 mV时,Egb761使Ito的电流密度由对照组的(7.59±0.19)pA/pF增加到(11.18±0.89)pA/pF(P<0.01,n=8),Egb761还使Ito的I-V曲线比对照组Ito的I-V明显抬高,但I-V曲线方向没有发生改变,表明Egb761引起了心肌细胞Ito的明显外流。②在电流钳制下,对照组心室肌细胞动作电位都具有从0期到4期的动作电位形态,60μg/L Egb761使心肌细胞动作电位形态呈三角形尖锥锋形,动作电位时程(APD)明显缩短,其复极化50%时程(APD50)和复极化90%时程(APD90)分别由(83.6±4.3)ms缩短为(51.3±3.2)ms和由(168.7±4.1)ms缩短为(93.8±4.4)ms(分别与对照组相比,P<0.01,n=8),尽管Egb761使动作电位幅度(APA)和静息电位(RP)降低,但与对照组相比,没有显著性差异(P>0.05)。结论:Egb761可使心室肌细胞Ito显著增加和APD明显缩短,从而减轻心肌缺血时细胞内阳离子超载对心肌造成的损伤和心肌缺血引起的心律失常的发生,以及增加心脏泵血功能。  相似文献   

8.
研究维拉帕米对豚鼠心肌动作电位3相的影响。将14只豚鼠按维拉帕米灌流和先尼可地尔灌流,然后同时加维拉帕米继续灌流两组,结果:维拉帕米灌流后豚鼠心肌细胞动作电位APD20由86±16ms缩短为对71±14ms(n=7,P<0.01),APD50由152±24ms缩短为140±26ms(n=7,P<0.01),APD90由182±28ms变为183±26ms(n=7,P>0.05);尼可地尔灌流后豚鼠心肌细胞动作电位APD50由154±33ms缩短为122±34ms(n=7,P<0.01),APD90由186±37ms缩短为154±36ms(n=7,P<0.01);在尼可地尔灌流后继续同时灌流维拉帕米,可见APD50由121±35ms进一步缩短为96±32ms(P<0.01),APD90由153±37ms缩短成115±34ms(P<0.01)。结论:结果提示维拉帕米能相对延长豚鼠心肌细胞动作电位3相时程,尼可地尔能抑制这种作用。  相似文献   

9.
目的 :研究腺苷 (Adenosine,Ado)对离体豚鼠心房肌细胞动作电位时程 (Actionpotentialduration ,APD)及收缩力的脱敏与反跳。方法 :采用标准玻璃微电极细胞内记录动作电位和肌力换能器记录心肌收缩力的方法 ,观察了Ado(1、10、10 0 μmol·L-1对离体豚鼠心房肌细胞动作电位 (Actionpotential,AP)的影响及对APD、收缩力的脱敏与反跳。结果 :(1) 1、10、10 0 μmol·L-1Ado缩短心房肌细胞APD的变化率分别为 9.5 8± 1.40 %、13.80± 2 .2 6 %、2 4.80±3.19% ,(2 ) 1μmol·L-1Ado对心房肌细胞APD无脱敏 (P >0 .0 5 ) ,10 μmol·L-1Ado与 10 0 μmol·L-1Ado对心房肌细胞APD均有脱敏 ,脱敏持续时间分别为 1min和 5min(P <0 .0 5 ) ;(3) 10 μmol·L-1Ado对心房肌收缩力有明显的脱敏现象 ,与对照值相比 ,收缩力的减小由 31.40± 16 .0 4% (2min)变为 5 0 .6 0± 15 .87% (4min) ;(4 )当洗脱Ado后 ,出现收缩力的反跳现象 ,与正常值相比 ,1、10、10 0 μmol·L-1Ado增加收缩力分别为 12 .38± 7.5 0 %、19.2 0± 8.44 %、2 7.6 0± 13.44 %。结论 :Ado可缩短心房肌细胞APD ;Ado对心房肌APD有脱敏现象 ,且呈浓度依赖性和时间依赖性 ;Ado对心房肌收缩力存在脱敏与反跳现象  相似文献   

10.
丹参对缺血心肌细胞L-型钙电流的影响   总被引:19,自引:0,他引:19  
目的 :观察丹参对缺血心肌细胞L 型钙电流 (ICa L)的影响。方法 :应用膜片钳全细胞记录技术。结果 :5 0 ,10 0 ,2 0 0mg/L丹参分别将缺血心肌细胞ICa L 的峰值从 (6 5 9.7± 14 8.5 ) pA降至 (5 31.9± 113.2 ) pA、(492 .4± 4 9.3) pA、(341.8± 72 .6 )pA(n =8,P <0 .0 5或P <0 .0 1)。结论 :丹参能有效地减少缺血心室肌细胞的ICa L ,这种作用可能是其抗心肌缺血以及缺血性心律失常的机制之一  相似文献   

11.
Objective To investigate therapeutic action of verapamil on QT prolongation induced by arsenic trioxide (As2O3) in guinea pig and to further explore its possible mechanism. Methods Different doses of As2O3 was infused intravenously to observe the changes of QT interval on the electrocardiogram (ECG) at different times in guinea pig. Patchclamp technique and laser scanning confocal microscopy were utilized to study the action of As2O3 on action potential duration (APD),  相似文献   

12.
敲除Annexin A7基因的小鼠早期胚胎心肌细胞钙稳态正常   总被引:2,自引:0,他引:2  
范云  徐传骧  范家俊 《医学争鸣》2003,24(3):193-195
目的:研究Annexin A7在早期胚胎发育过程中对钙平衡调节的作用. 方法: 利用钙成像技术和膜片钳技术检测敲除Annexin A7小鼠的早期胚胎心肌细胞的钙平衡以及相应的离子通道的特性. 结果: 在胚胎心肌细胞发育的早期,敲除Annexin A7小鼠胚胎心肌细胞的静息钙(340/380荧光比例 0.78±0.02)、钙峰值(340/380荧光比例1.28±0.05)和正常细胞的值相似;动作电位(APD90 242.7±43.7 ms、最大去极化电位56.8±1.7 mV)以及L-型钙电流密度(14.1±2.5 pA/pF)和正常细胞的相似,并且钙电流能被碳酰胆碱减小(51.7±8)%,也和正常细胞相似. 结论: 敲除Annexin A7基因的小鼠早期胚胎心肌细胞具有正常的钙稳态以及正常的离子通道.  相似文献   

13.
OBJECTIVE: To investigate the characteristics of Na+/Ca2+ exchanger current (INa+ /Ca2+) and K+ current remodeling in midmyocardial cells of hypertrophic left ventricle for understanding the ionic basis of arrhythmia of the hypertrophic heart. METHODS: Twenty New Zealand rabbits were divided equally into normal control group and operation group, and in the latter, left ventricular hypertrophy was induced in the rabbits by partial ligation of the abdominal aorta. Action potentials, INa+/Ca2+, slowly activating delayed rectifier K+ current (IKs) and rapidly activating delayed rectifier K+ current (IKr) were recorded in the two groups by using whole-cell patch-clamp technique. RESULTS: At the basic cycle length of 2 s, 90% action potential duration (APD90) in control and operation groups was 522.0+/-19.5 ms (n=6) and 664.7+/-32.7 ms (n=7) respectively; at the testing potential of +40 mV, outward INa+/Ca2+ density in the two groups was 0.94+/-0.11 pA/pF (n=9) and 1.30+/-0.11 pA/pF (n=8) respectively; the testing potential of -100 mV elicited inward INa+/Ca2+ density of 0.40+/-0.05 pA/pF (n=9) and 0.56+/-0.02 pA/pF (n=8) respectively. The testing potential of +50 mV induced IKs tail current density of 0.26+/-0.03 pA/pF (n=8) and 0.17+/-0.01 pA/pF (n=9), and IKr tail current density of 0.34+/-0.02 pA/pF (n=8) and 0.23+/-0.02 pA/pF (n=9) respectively. Statistically significant differences were identified between the control and operation groups in all the above indices measured. CONCLUSION: The characteristics of electrical remodeling changes in midmyocardial cells of hypertrophic left ventricle, exhibited by prolonged action potential, up-regulated INa+/Ca2+ and down-regulated IKs and IKr.  相似文献   

14.
Methods Membraneionicchannelswerestudiedinenzymaticallydispersedspontaneouslyhypertensiverats (SHRs)leftventricularmyocytesusingthewhole cellconfigurationofpatch clamptechnique ,withnormalWistarratsventricularmyocytesascontrols Weobserveddepolarizingcurr…  相似文献   

15.
川芎嗪对单个心室肌细胞电生理的影响   总被引:6,自引:0,他引:6  
采用全细胞膜片钳(Wholecellpatch clamp) 技术研究川芎嗪( 四甲基吡嗪,trtramethylpyrazine,TMP) 对豚鼠心室肌细胞L型钙通道电流(L ICa)的浓度依赖性影响。当维持电位为- 40 m V,刺激频率为0-5 Hz,钳制时间为400 ms,步进电压为10 m V,去极到60 mV,发现3 μmol/LTMP对L ICa无影响(P> 0-05) ;10 ,30 和100 μmol/LTMP对L ICa的抑制为36-34 % ,58-94 % 和74-24% (P均< 0-01) ,且浓度愈大,其抑制作用愈强,但都不使I V曲线的峰值发生偏移。提示TMP具有阻断L ICa的作用,且呈浓度依赖性阻滞效应。  相似文献   

16.
目的:探讨二十二碳六烯酸(DHA)对大鼠心室肌细胞动作电位(AP)及钠通道电流(INa)的影响。阐述DHA抗心律失常的机制。方法:采用酶消化法获得大鼠心室肌细胞,用膜片钳技术分别记录0、20、40、60、80、100和120μmol/L DHA对大鼠心室肌细胞AP复极25%、50%和90%时程(APD25、APD50和APD90),对AP最大上升速率(Vmax)、幅值(APA)、超射值(OS)及INa的影响。结果:①不同浓度DHA对APD25、APD50和APD90呈浓度依赖性延长(P<0.05,n=20),对Vmax、APA和OS的影响无显著性差异(P>0.05,n=20)。②不同浓度DHA对INa呈浓度依赖性阻滞、I-V曲线上移、稳态失活曲线左移、失活后恢复时间延长,对稳态激活曲线无影响。在指令电压-30 mV时,上述浓度DHA对INa阻滞分别为(1.51±1.32)%、(21.13±4.62)%、(51.61±5.73)%、(67.62±6.52)%、(73.49±7.59)%和(79.95±7.62)%(P<0.05,n=20),DHA对INa的半效作用浓度(EC50)为(47.91±1.57)mol/L。结论:DHA对APD的延长及对钠通道的抑制作用可能是其抗心律失常机制之一。  相似文献   

17.
Objective To investigate therapeutic action of verapamil on QT prolongation induced by arsenic trioxide (As2O3) in guinea pig and to further explore its possible mechanism. Methods Different doses of As2 O3 was infused intravenously to observe the changes of QT interval on the electrocardiogram (ECG) at different times in guinea pig. Patchclamp technique and laser scanning confocal microscopy were utilized to study the action of As2 O3 on action potential duration (APD),L-type calcium current (ICa-L ), rapid delayed rectifier potassium current (IKr) and intracellular calcium concentration ([Ca2+]i) of guinea pig myocytes. At the same time, verapamil was applied preliminarily to evaluate effects of verapamil on changes of the above index induced by As2O3. Results Intravenous administration of As2 O3 at the dose of 1.6mg/kg and 0.8mg/kg prolonged QT interval on ECG obviously in guinea pig hearts dose dependently and time dependently. QTc (corrected QT interval) was progressively prolonged in the 2-hour period of intravenous infusion of 1.6mg/kg As2O3 from (328.5 ± 30.9)ms of control to (388.4 ± 31.3)ms at 2h following As2O3 ( P < 0.01) .When verapamil was pretreated for 5min, then 1.6mg/kg As2 O3 was added, the results showed that QTe was shorter in verapamil-treatment group (357.3±21.4)ms than that in As2O3 group (388.4±31.3)ms (P<0.05) at 2h. Confocal experiments showed that in normal Tyrode solution, As2 O3 (1μmol/L and 10μmol/L) had no obvious effects on resting [Ca2+]i (P>0.05) in guinea pig cardiomyocytes, however, 10μmol/L As2 O3 could markedly enhance [Ca2+]i increase induced by KCl 60mmol/L and the peak value increased from 903.4±369.4 to 1674.6±563.2 ( P<0.05). The action of elevating [Ca2+]icould be blocked by 10μmol/L verapamil incompletely. The patch-clamp studies indicated that As2 O3 at concentration of 10μmol/L prolonged APD50 from (263.6 -±75.2)ms to (523.9±47.8)ms (P<0.01) and APD90 from (277.5 ± 77.5)ms to (536.3 ±49.6)ms (P <0.01) ,and increased ICa-L from (- 6.0±1.5)pA/pF to (-8.7±2.0)pA/pF (P<0.01) at 0mV and also reduced IKr from (6.7±1.8)pA/pF to (4.5±1.8)pA/pF (P<0.05). However, 10μmol/L verapamil could modulate prolonging APD50 from (523.9 ± 47.8) ms to (340.4±83.8) ms ( P<0.01) and APD90 from (536.3 ±49.6)ms to (348.9 ± 85.5)ms (P<0.01) and correct increasing Ica-L induced by 10μmol/L As2O3 from (-8.7±2.0)pA/pF to ( - 6.6±1.4)pA/pF (P<0.05) at 0mV. Conclusion As2O3 could induce prolongation of the QT interval on the ECG in guinea pig hearts and the ionic mechanism is associated with increasing Ica-L and inhibiting IKr/HERG. Verapamil may be useful in normalizing QT prolongation during As2 O3 therapy by decreasing Ica-L and [Ca2+]iof ventricular myocytes in guinea pig.  相似文献   

18.
Li N  Ma KJ  Wu XF  Sun Q  Zhang YH  Pu JL 《中华医学杂志(英文版)》2007,120(12):1068-1074
Background Shensong Yangxin (SSYX) is one of the compound recipe of Chinese materia medica. This study was conducted to investigate the effects of SSYX on sodium current (I(Na)), L-type calcium current (I(Ca,L)), transient outward potassium current (I(to)), delayed rectifier current (I(K)), and inward rectifier potassium currents (I(K1)) in isolated ventricular myocytes. Methods Whole cell patch-clamp technique was used to study ion channel currents in enzymatically isolated guinea pig or rat ventricular myocytes. Results SSYX decreased peak I(Na) by (44.84±7.65)% from 27.21±5.35 to 14.88±2.75 pA/pF (n=5, P&lt;0.05). The medicine significantly inhibited the I(Ca,L). At concentrations of 0.25, 0.50, and 1.00 g/100 ml, the peak I(Ca,L) was reduced by (19.22±1.10)%, (44.82±6.50)% and (50.69±5.64)%, respectively (n=5, all P&lt;0.05). SSYX lifted the I-V curve of both I(Na) and I(Ca,L) without changing the threshold, peak and reversal potentials. At the concentration of 0.5%, the drug blocked the transient component of I(to) by 50.60% at membrane voltage of 60 mV and negatively shifted the inactive curve and delayed the recovery from channel inactivation. The tail current density of I(K) was decreased by (30.77±1.11)% (n=5, P&lt;0.05) at membrane voltage of 50 mV after exposure to the medicine and the time-dependent activity of I(K) was also inhibited. Similar to the effect on I(K), the SSYX inhibited I(K1) by 33.10% at the test potential of –100 mV with little effect on reversal potential and the rectification property. Conclusions The experiments revealed that SSYX could block multiple ion channels such as I(Na) I(Ca,L), I(k), I(to) and I(K1), which may change the action potential duration and contribute to some of its antiarrhythmic effects.  相似文献   

19.
Epidemiologicalstudiesshowedthatpatientswithhealmyocardialinfarction (HMI)arethemainpopula tionofcardiacsuddendeath .CASTtrial[1 ] andSWORDtrial[2 ] hadaprofoundimpactonthepracticeofcardiolo gy,andthemortalitywassignificantlyhigherinpatientswithHMItreated…  相似文献   

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