Halo电极在心房扑动消融中的作用

目的评价Halo电极在心房扑动(房扑)标测和射频消融中的临床作用及点状消频方法在房扑消融中的效果。方法选择11例房扑患者,年龄(45±10)岁,男8例,女4例,应用Halo电极标测心房扑动的折返激动顺序和关键峡部,并利用其指导峡部的线性和点状消融。消融后分别于峡部两侧起搏判断峡部阻滞情况。结果9例患者诱导出房扑,11例房扑均为峡部依赖型,7例为逆钟向传导,4例为顺钟向传导,12例消融均成功,房扑不再诱发,峡部呈完全双向传导阻滞;手术时间(250±60)min,X线暴光时间(50±20)min,放电次数(25±12)次。无手术并发症。随访2～12个月,1例复发。结论在房扑标测和消融中应用Halo电极导管标测是安全有效的,不仅能确定折返头颈环路的顺序和关键峡部,而且能准确判断消融结果,同时减少X线暴光时间。     

三维标测系统Carto指导下标测、消融典型心房扑动

目的评价Carto三维标测系统标测、消融典型心房扑动的临床疗效。方法 14例典型心房扑动患者,采用Carto指导下右心房电解剖重建和激动顺序标测,冷盐水灌注导管消融三尖瓣峡部终止心房扑动,并通过起搏刺激验证消融线双向阻滞。观察消融即刻成功率、手术时间、消融时间和X线曝光时间以及并发症情况。通过随访,评价导管消融后远期疗效。结果 Carto指导下右房激动顺序标测证实10例为I型房扑、4例为Ⅱ型房扑。所有患者均在消融中终止心房扑动,平均手术时间（2.5±0.5）h,X线曝光时间（15±5.5）min。所有患者术中即刻均实现消融线两侧双向传导阻滞,S-A间期平均（120±15）ms。平均随访6个月,无心房扑动复发。结论 Carto指导下标测、消融典型心房扑动疗效肯定,同时可显著减少X线暴露及消融手术时间。     

EnSite-NavX指导下导管消融治疗快速性房性心律失常

目的 观察EnSite-NavX三维接触式标测系统指导下消融治疗快速性房性心律失常(AA)的可行性和临床疗效.方法 经电生理检查确诊房性心动过速(AT)4例,阵发性心房颤动(AF)6例,术中首先建立靶心腔的三维几何构型;AT者行激动顺序标测,分析心动过速的起源点或关键峡部,制定相应的消融策略,在系统导航下行消融治疗;阵发性AF行环肺静脉口外左房内线性消融,至双侧肺静脉电位消失.结果 4例AT中2例为局灶性AT,分别佗于右下肺静脉前庭和上腔静脉几部,行局灶性消融成功;1例房间隔缺损修补术后围绕右房游离壁切品瘢痕和三尖瓣环的"8"字折返性AT,于瘢痕至下腔静脉间、三尖瓣峡部线件消融终止AT;另1例三尖瓣峡部依赖的逆钟向房扑,在三尖瓣峡部线性消融至双向阻滞.6例阵发性AF,5例达消融终点,消融总成功率90%;1例因术中心包填塞而终止消融.随访9～14个月.1例AT复发并再次消融成功.结论 EnSite-NavX三维标测系统对AA电生理机制的阐明和指导消融具有较好的临床应用价值.     

不同X线投照体位下消融改良慢径治疗房室结折返性心动过速

目的 探讨不同X线投照体位下消融改良慢径治疗房室结折返性心动过速(AVN-RT)的疗效.方法 AVNRT患者126例,按X线投照体位分后前位组40例、右前斜(30度)位组44例和左前斜(45度)位组42例;均经导管标测消融改良慢径.结果 三组均100%成功消融改良慢径.希氏束(His)至冠状窦(CS)口距离、首获有效靶点时间、消融点数、累积放电时间和总X线时间三组间差异均无统计学意义(P>0.05).三组术中发生一过性房窒传导阻滞(AVB)各1例.随访3～6个月无一例复发.结论 经导管消融改良慢径,三种X线投照体位标测均可行、有效.     

导管射频消融治疗老年房性心动过速23例

目的观察老年房性心动过速(房速)的射频消融疗效及安全性。方法23例60岁以上房速患者行射频消融治疗,病程(5.5±3.3)月;合并房间隔缺损1例,冠心病5例,肥厚型心肌病1例,房间隔缺损经胸外修补术后2例,无器质性心脏病证据14例。所有均采用房速发作时激动顺序标测法确定心房最早激动点。结果房速消融成功率91.3%(21/23),术中和术后无并发症,术后随访(2.5±2.1)年,2例复发。结论老年房性心动过速患者导管射频消融是安全的,成功率较高。     

经导管线性消融治疗长程持续性房颤

目的探讨长程持续性房颤导管消融的可行性和疗效。方法 35例长程持续性房颤采用经导管射频消融治疗,术中完成环肺静脉前庭消融、左房顶部线、二尖瓣峡部消融和三尖瓣峡部消融,如未恢复窦性心律,采用直流同步电复律转复窦性心律,然后验证并实现双侧肺静脉电隔离及消融线阻滞。观察即刻消融效果及随访期间房颤复发情况。结果 2例患者消融中转复窦性心律,其余患者电复律恢复窦性心律;所有患者均实现双侧肺静脉电隔离,起搏下验证左房顶部线、二尖瓣峡部线和三尖瓣峡部线取得阻滞的比例分别为100%、88.6%和91.4%。随访期间6(17.1%)例复发。结论采用环肺静脉消融辅以线性消融治疗长程持续性房颤能够较有效地预防房颤复发,减少消融时间。     

导管射频消融治疗右室流出道室性心律失常

目的评价导管标测及射频消融治疗右室流出道室性心律失常的临床疗效。方法选择48例临床症状显著,抗心律失常药物治疗无效,无器质性心脏病的右室流出道室性心律失常患者,射频消融术前动态心电图记录室性早搏(16900.6±7094.9)次/24h。分为两组:常规消融组18例按射频消融常规术式行置管、标测与消融,单导管消融组30例采用单导管射频消融术。所有患者均采用起搏标测,以起搏与自然发作室早或室性心动过速12导联心电图QRS波形至少有11个导联相同作为消融靶点。结果消融术后动态心电图记录早搏(857.9±2605.6)次/24h,常规消融组与单导管消融组消融后室早分别为(824.6±2485.1)次/24h和(877.8±2716.9)次/24h,与术前比较差异均有统计学意义(P<0.001)。两组消融成功率分别为88.8%和90%,相比无统计学意义(P>0.05)。结论导管射频消融右室流出道室性心律失常安全有效,采用单导管消融术式同样安全有效,且操作更为简捷。     

射频消融房室结折近性心动过速55例临床分析

目的:房室结折返性心动过速(AVNRT)拟行射频消融(RFCA)治疗的患者,在术中密切注意各种操作细节,可降低Ⅲ度房室传导阻滞(AVB)的发生率,提高RFCA成功率.方法:选择自2000年6月至2006年1月共55例AVNRT拟行RFCA的患者,常规放置CS电极、HRA电极、HIS电极、RV电极,行心内电生理检查(EPS),确诊为AVNRT.消融导管经股静脉送至右房,采用影像与心内电图相结合确定靶点,在希氏束和冠状静脉窦口之间进行仔细标测,寻找小A大V,确定靶点图的标准为A/V为小于0.5,无H波,于窦性心律下行射频消融,功率为20 W-30 W,在放电过程中,严密监测,如有AV间期延长、快速交界心律(＞150 bpm)、消融电极向上移位等立即停止放电,重新标测;成功标志为:放电15秒内出现交界性心律,在该部位继续放电,直至交界性心律消失.消融的终点为:静滴异丙肾上腺素不能诱发原有的心动过速,无AH跳跃,无心房回波,消融成功.结果:55例AVNRTK患者均为慢径消融,成功率100%,无1例复发,其中2例在术中出现一过性I度AVB,立即停止放电,观察1-3 min均恢复正常房室传导,而另1例在术中出现Ⅲ度AVB,立即停止放电,但始终未恢复正常房室传导,成为永久性ⅢAVB.结论:在AVNRT的RFCA中,应严密监测,可降低Ⅲ度AVB发生率,提高RFCA成功率.     

冷冻消融慢径治疗房室结折返性心动过速临床研究

<正>房室结折返性心动过速(AVNRT)首选慢径消融毋庸置疑,但消融靶点与正常房室结传导系统非常之近,射频消融严重的并发症之一房室传导阻滞不可逆,冷冻消融通过冷冻改变电传导特性[1]与冷冻黏附、不出现结性心律等优势[2,3],为此类患者带来新的福音。本文观察了2014年1月至2014年8月山西省心血管病医院18例利用8 mm冷冻导管消融AVNRT患者的术中及术后,初步体会了冷冻消融治疗AVN-     

Ensite Array球囊标测系统下拖带刺激在器质性心脏病室性心动过速消融中的应用

目的探讨Ensite Array球囊标测系统联合拖带刺激在器质性心脏病室性心动过速中标测并指导射频消融的有效性和安全性。方法入选器质性心脏病室性心动过速患者20例,其中3例为法四术后,6例合并右室心肌病,4例合并瓣膜病,7例合并冠心病。经外周血管送Ensite Array球囊导管至心室并在三维标测指导下建心腔模型同时行激动标测,结合拖带标测技术,确定心动过速折返环的关键峡部或起源点,并进行消融。结果消融即时成功率85%（17/20）,随访（6±3）个月,1例冠心病并左室心尖部来源室速复发,发作时室速形态与消融前相同,再次于距初次消融约2mm处消融成功。结论 EnsiteArray球囊标测系统结合拖带刺激在器质性心脏病室性心动过速消融治疗是有效而安全的。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Nachweis einiger Heilmittel in der Kniegelenksynovialflüssigkeit

Zusammenfassung Mittels Gaschromatographie und Dünschichtchromatographie wiesen die Autoren 11 Substanzen nach, welche durch Injektion oder nach Verabreichung per os in die Kniegelenksynovialflüssigkeit eindrangen. In ihrer Aufstellung konnten sie eine direkte Beziehung zwischen Struktur sowie chemischphysikalischen Eigenschaften der Substanz und ihrer Fähigkeit, aus dem Blut in die Kniegelenksynovialflüssigkeit einzudringen, nicht nachweisen, außer der Tatsache, daß Substanzen mit starker Affinität zu Eiweißstoffen erst in höheren Dosen nachweisbar waren.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.