Quantification of red blood cell fragmentation by the automated hematology analyzer XE‐2100 in patients with living donor liver transplantation

The fragmented red cell (FRC) is a useful index for diagnosing and determining the severity of thrombotic thrombocytopenic purpura (TTP), thrombotic microangiopathy (TMA) and other similar conditions, as it is found in peripheral blood in patients with these diseases. The FRC expression rate has conventionally been determined by manual methods using smear samples. However, it is difficult to attain accurate quantification by such methods as they are time consuming and prone to a great margin of error. With cases of living donor liver transplantation, the current study examined the possibility of using a multi‐parameter automated hematology analyzer, the XE‐2100 (Sysmex Corporation) for FRC quantification. While there was a notable correlation between the manual and automated measurements, the manual measurement resulted in higher values. This suggested remarkable variations in judgment by individuals. The FRC values had a significant correlation with the reticulocyte count, red blood cell distribution width (RDW), fibrin/fibrinogen degradation products (P‐FDP) and lactate dehydrogenase (LDH) among the test parameters, and this finding was consistent with the clinical progression in patients. The automated method can offer precise measurements in a short time without inter‐observer differences, meeting the requirement for standardization. The determination of FRC count (%) by the XE‐2100 that enables early diagnoses and monitoring of TTP or TMA will be useful in the clinical field.     

fQRS as a marker of granulomatous disease in patients presenting with ventricular tachycardia and normal left ventricular ejection fraction

Background

Granulomatous myocarditis may present with sustained monomorphic ventricular tachycardia (SMVT) in the presence of normal left ventricular ejection fraction (LVEF), and could be mistaken for idiopathic ventricular tachycardia (IVT). The use of cardiac imaging for diagnosis can be limited by availability and high cost. ECG is readily available and inexpensive. Fragmented QRS (fQRS) on ECG has been found to be associated with myocardial scar. We hypothesized that fQRS could be useful in the diagnosis of granulomatous VT (GVT).

Methods

We compared the 12-lead ECG of 16 patients with GVT and 42 patients with IVT who presented with SMVT.

Results

The presence of fQRS was significantly higher in the GVT group compared to the IVT group (75% versus 19.1%, p < 0.001). The location of fQRS correlated with delayed enhancement cardiac magnetic resonance imaging (DE-CMR) in the same segment in 4/16 patients in the GVT group. It correlated with an affected segment on either DE-CMR or 18FDG positron emission computed tomography in 4/11 patients in the GVT group who had both imaging modality. Whenever fQRS was present in contiguous leads other than the inferior leads, it always corresponded to an affected segment on imaging.

Conclusions

In patients presenting with SMVT and no structural heart disease, the presence of fQRS is strongly associated with granulomatous myocarditis. fQRS on the surface ECG is a helpful tool the presence of which should prompt a CMR for a definitive diagnosis.     

碎裂QRS波群在心脏再同步化治疗中的研究进展

心力衰竭是21世纪最严重的心血管问题,是各种心脏病的严重表现和终末阶段,其发病率、病死率和再住院率均高。心脏再同步化治疗是目前治疗心脏失同步心力衰竭的重要方法,可改善心力衰竭患者的生活质量,降低病死率和减少心脏性猝死的发生,其治疗反应性的有无常与碎裂QRS波群的出现相关。碎裂QRS波群是心脏病患者心电图上出现的心室除极异常的一个指标,研究发现它与多种心脏疾病有关。现就碎裂QRS波群在心脏再同步化治疗患者中的研究认识发展及现状做一总结。     

The relationship between fragmented QRS complexes and syntax II scores in patients with ST-segment elevation myocardial infarction

Background

Even though the relationship between syntax score (SS) and fragmented QRS (fQRS) has been studied, the relation between syntax score II (SS II) and fQRS in patients with ST elevation myocardial infarction (STEMI) is undefined. We aimed to define the relationship between fQRS and SS II for the evaluation of extension and complexity of coronary artery disease.

非缺血性扩张性心肌病中碎裂QRS波与恶性心律失常的相关性

目的研究碎裂QRS波(fQRS)与非缺血性扩张型心肌病(NDCM)患者恶性心律失常(MVA)发生的相关性。方法选取2009年2月~2011年8月山东省潍坊市潍坊医学院附属医院住院治疗的NDCM患者57例,通过分析心电图上是否出现fQRS波,分为有fQRS波组33例和无fQRS波组24例,随访(18.9±4.9)个月,比较两组患者的MVA发生率、全因病死率情况。结果两组患者的一般临床资料比较,差异无统计学意义。fQRS波组中发生MVA 15例(45.5%),无fQRS波组中发生MVA 4例(16.7%),fQRS波组中MVA的发生率明显高于无fQRS组,差异有统计学意义(P0.05);fQRS波组中病死6例(18.2%),无fQRS波组中病死3例(12.5%),fQRS波组病死率高于无fQRS波组,差异无统计学意义(P0.05)。结论fQRS对NDCM患者的MVA发生率有一定的预测价值,而与此类患者的全因病死率无明显关联。     

基于Spark计算模型的资源供给新范式

大数据背景下,图书馆各类信息系统、平台、数字资源总量的不断增多以及用户兴趣与关注焦点的不断变化,加速了碎片资源的产生。基于Spark计算框架,对不同分布式平台上的碎片资源进行重组、推荐。通过交互式查询和朴素贝叶斯分类算法设计的推介模型,提升了碎片资源供给时效,减轻了分别管理各种平台造成的负担,促进了图书馆碎片资源治理微生态的健康发展。     

冠状动脉完全闭塞病变患者碎裂QRS波与PCI术后心功能改善的关系

目的 观察冠状动脉完全闭塞病变患者接受经皮冠状动脉介入治疗（PCI）术后心功能的改善情况与合并QRS波碎裂的关系.方法 纳入2006年6月～2011年10月完全闭塞病变患者126例,根据入院时心电图的QRS波形态分为碎裂QRS波组（fQRS组,n=48）和无碎裂QRS波组（nfQRS组,n=78）,分析两组患者PCI术后6个月的心功能改善情况有无差异.结果 两组患者经PCI治疗后左室射血分数（LVEF）增加,左室舒张末容积指数（LVED VI）减少,同时6分钟步行试验距离也较前明显增加,但与nfQRS波组相比,fQRS波组患者LVEF [（54.04±3.11）% vs.（50.09±4.06）%,P＜0.05]增加更明显,LVEDVI[（76.58士6.19）ml/m2 vs.（79.00±8.19）ml/m2,P＜0.05]减少更明显,同时6分钟步行试验显示步行距离更长[（449.42±100.99）m vs.（439.60士84.46）m,P＜0.05].结论 介入治疗能够改善冠状动脉完全闭塞患者心功能,而且合并fQRS波的患者较不合并fQRS波的患者改善更加明显.     

碎裂QRS波与冠状动脉病变程度的关系

目的探讨碎裂QRS波(fQRS)与冠状动脉病变程度的关系。方法入选196例患者,经选择性冠状动脉造影检查分为冠状动脉粥样硬化组及冠心病组,分析fQRS与冠状动脉病变范围、狭窄程度的关系。结果冠心病组心电图均可见fQRS,冠状动脉粥样硬化组fQRS多出现于下壁导联(59.41%)。两组在fQRS出现的导联数、QRS波群时限、心电轴及心电图中是否出现J波方面比较,差异均有统计学意义(P<0.05)。结论 fQRS的出现可作为预测冠状动脉病变程度的指标。     

碎裂QRS与特发性扩张型心肌病预后关系研究

目的探讨碎裂ORS与特发性扩张型心肌病患者预后的关系。方法85例特发性扩张型心肌病患者根据常规心电图检查结果分为碎裂QRS组41例和非碎裂QRS组44例,随访2～33（16．5士9．4）个月,比较2组患者全因病死率和室性心律失常发生率。结果8例死亡,5例室性心律失常;碎裂QRS组全因病死率和室性心律失常发生率高于非碎裂QRS组（P〈0．05）;Kaplan-Meier生存分析碎裂QRS组生存率低于非碎裂QRS组（P〈0．05）;多变量C0z回归分析显示,碎裂QRS是特发性扩张型心肌病全因死亡和室性心律失常的预测因子（OR=1．182,95％CI：1．036～2．910,P=0．038）。结论碎裂QRS与特发性扩张型心肌病的不良预后有关,碎裂QRS对特发性扩张型心肌病患者全因死亡和室性心律失常有较高预测价值。